Random MRCP Bullets

#MRCPbullets

Alcoholic hepatitis

– almost always presents with jaundice

– presence of hepatic bruit is suggestive

– high mcv

– ast > alt

– raised IgA

– low alb, high inr

* MDS > 32 s/o 50% 2 month mortality

Treatment-

1. Pabrinex (vit b1, b2, b3, b6 and c)

2. Nutritional support (>2000kcal / day , use ng if necessary)

3. Prednisolone (reduces 28 days mortality if mds >32 or HE present)

4. Pentoxyphylline (use only if HRS present)

#MRCPbullets

White-out Hemithorax

Always check the Trachea to narrow down the differential

1. Trachea pulled to the white out lungs:

– Pneumonectomy

– complete lung collapse

– pulmonary hypoplasia

2. Trachea central:

– consolidation

– pulmonary edema

– mesothelioma

3. Trachea pushed away from the white out lungs:

– massive pleural effusion

– large thoracic mass

– diaphragmatic hernia

#MRCPbullets

Ventricular Tachycardia (VT)

1. VT without pulse = asynchronized DC

2. VT with pulse + hemodynamically stable = 1st line: amiodarone, 2nd line: lidocaine, still fails: Synchronized cardioversion

3. VT with pulse + hemodynamically unstable = Synchronized cardioversion

4. VT due to digoxin toxicity = 1st line: Phenytoin, 2nd line: lidocaine, still fails: dc cardioversion

5.  Cardiac arrest due to VT >> 72 hours post arrest – check pupillary response to explain prognosis

6. VT on patient with severe LV impairement – avoid Lidocaine

7. Do not use verapamil in VT patients

8. Polymorphic VT (a subtype Torsade De pointes) = IV Mgso4 (give even when serum Mg level is normal)

#MRCPbullets

Asthma

1. Asthma + proximal bronchiectasis = Allergic bronchopulmonary aspergillosis

2. Asthma + sinus abnormality + microscopic hematuria = churg strauss syndrome

3. Asthma + nasal polyps + aspirin sensitivity = samter’s triad

4. Asthma + atrial fibrillation = Rate control by calcium channel blocker (e.g diltiazem)

5. Asthma + supraventricular tachycardia = give Verapamil / fleccainide

6. Asthma + H1N1 infection = avoid Zanamivir

7. Asthma + Essential tremor = use primidone (avoid propranolol)

8. Asthma + Glaucoma = use latanoprost (avoid timolol)

9. Asthma + Variceal bleeding = use isosorbide mononitrate for prophylaxis (avoid propranolol for prophylxis

10. Occupational Asthma = Isocyanates are associated

#MRCPbullets

Dysphagia

1. Solid > Liquid = Carcinoma

2. Liquid > solid + choking during meals = Neurogenic dysphagia

3. Liquid > solid + proximal muscle weakness + ptosis = Myasthenia Gravis

4. Solid & Liquid + chest pain + Aspiration pneumonia = Achalasia

5. Solid & Liquid + proximal muscle weakness + facial rash + ANA positive = Dermatomyositis / Polymyositis

6. Solid & Liquid + halitosis + regurgitation + nocturnal cough = Pharyngeal pouch

7. Solid & Liquid + dysarthria + diabetes + distal muscle weakness = Myotonic Dystrophy

#MRCPbullets

Avoid

1. Avoid Nitrates, ACE inhibitors and Inotropes in HOCM

2. Avoid Sotalol, Adenosine, Verapamil and Digoxin in WPW

3. Avoid Beta blockers in treating Cocaïne induced chest pain or Acute MI

4. Avoid Verapamil in SVT with RBBB

5. Avoid Mediastinoscopy, Bronchoscopy or Biopsy to diagnose Sarcoidosis if CT scan is diagnostic.

6. Avoid Vitamin C supplementation in hemochromatosis

7. Avoid Lactulose to treat constipation in IBS.

8. Avoid Intraarticular steroids in patients with Sickle cell anemia.

9. Avoid highly purified or recombinant preparation in VWD.

10. Avoid Statins in rhabdomyolysis.

11. Avoid Colchicine in gout if Crcl <10 ml/min.

12. Avoid Alpha-blocker for at-least 4 hour after sildenafil.

13. Avoid Tetracycline, Nitrofurantoin, NSAIDs, Lithium and Metformin in Renal failure.

14. Avoid Statin in patient with history of intracerebral hemorrhages.

15. Avoid Haloperidol in Delirium Tremens

16. Avoid contact sports for 8 weeks in Infectious Mononucleosis.

17. Avoid Haloperidol in Lewy body dementia.

18. Avoid Fluoxetine in postnatal depression

19. Avoid Amiodarone in TCA overdose.

20. Avoid antioxidant supplements in smokers

21. Avoid smoking and radio-iodine treatment in Thyroid Eye Disease

22. Avoid Diclofenac in AIP (Ibuprofen is safe)

#MRCPbullets

Pneumonia keywords

1. Community Acquired Pneumonia; Herpes Labialis; Cold sore = Streptococcus pneumoniae

2. After flu; Pneumatocele; IV drug abuser = Staphylococcus aureus

3. Flu-like symptoms; Dry cough; Derranged LFT; Lymphopenia; Hyponatremia; Holiday to Spain; AC; Water tank; Hotel; Shower; Diarrhoea = Legionella pneumonia

4. Flu-like symptoms; Dry cough; Derranged LFT; Hemolytic anemia; Erythema multiforme; Meningoencephalitis; GBS; Peri/Myocarditis; young; Hostel; Class-mate recently ill; Epidemic every 4 years = Mycoplasma

5. Foamy intraalveolar exudate; Exercise induced desaturation; Normal chest finding; Immunocompromised = PCP

6. Middle-aged; Alcoholic/Diabetic = Klebsiella

7. Structural Lung disease like Bronchiectasis, Cystic fibrosis = Pseudomonas aeruginosa

8. Veterinarian/Farmers = Coxiellan burnetti

#MRCPbullets

Think of SLE

If there is multisystem disorder and increased ESR but Normal CRP.

IF INCREASED CRP in such case:

Think instead of infection, serositis, or arthritis first.

#MRCPbullets

Increased PTH, decreased Calcium, increased Phosphate with:

Low Hb : Think of CKD

High Hb: Think of ADPKD

#MRCPbullets

1. Dementia + Chorea = Huntington's Chorea

2. Dementia + Parkinsonism + Syncopal attack (autonomic disturbance) = Multiple System Atrophy

3. Dementia (Fluctuating - with lucid interval) + Parkinsonism = Lewy body dementia

4. Dementia (Sparing visuospatial skills) + Personality change = Frontotemporal dementia

5. Dementia + Sensory ataxia + Polyneuropathy + UMN signs = B12 deficiency

6. Dementia + ataxia + Ophthalmoplegia = B1 deficiency (Wernicke's Syndrome)

7. Dementia + High cholesterol = Hypothyroidism

8. Dementia + Myoclonus = Creutzfeldt Jakob Disease

9. Dementia + Gait apraxia + Urinary incontinence = Normal Pressure Hydrocephalus

10. Dementia (Stepwise progression) + Pseudobulbar palsy = Vascular dementia

11. Dementia + Pseudobulbar palsy + Gaze abnormalities + Torticollis = Progressive Supranuclear Palsy

#MRCPbullets

Cerebral Vs Sensory ataxia

Cerebral ataxia are usually accompanied by Nystagmus and Dysarthria

Sensory ataxia has impaired vibration and joint position sense and all the signs are worse on removing visual input (for eg Positive Romberg's Test)