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The document summarizes causes of meningitis by age group, key findings in Fragile X syndrome, provides a mnemonic and description for Ewing's tumor, lists drugs that cause gingival hyperplasia and hypothyroidism, and discusses hypertension treatment based on comorbid conditions. Newborns are most commonly affected by GBS, E.coli, and listeria. Children under 6 years old are most commonly affected by strep pneumoniae, Neisseria, and H. Influenzae. Adults 6-60 years old are most commonly affected by Neisseria Meningitidis, enteroviruses, and strep pneumoniae. Adults over 60 years old are most commonly
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- 1. Causes of Meningitis with respect to Age: Newborns: 1- GBS 2- E.coli 3- listeria Children less than 6 years: 1- strep pneumoniae 2- Neisseria 3- H Influenzae 4- enteroviruses 6 years to 60 years: 1- Neisseria Meningitidis 2- enteroviruses 3- strep pneumoniae 4- HSV Over 60 years: 1- strep pneumoniae 2- listeria The story is different in HIV and immune-compromised patients where you have to think of listeria, fungi, JC virus, and toxoplasmosis. Important findings in Fragile X syndrome= "6M" 1) Mental Retardation 2) Mutation in FMR1 gene on X chromosome (X linked Dominant) 3) Macro jaw(large jaw) 4) Macro orchidism 5) Macrotia (large everted ears) 6) Mitral valve prolapse is associated with it. (Other points to remember for Fragile X=1)CGG Trinucleotide repeats in non-coding region of DNA 2)can cause Attention deficit disorder in females)
- 2. Ewings Tumor Picture Mnemonic! The above picture gives mnemonic for Ewing's tumor. First let us analyse the picture. Note the chick and swelling of Diaphysis of Tibia with the onion. Chick says VAC VACVAC VACA, VAC VACVAC AV / CV. The chick has fat and hence PAS stain positive. Note the moon and star at the top, Radio streaming music and chick fluttering it's wings up and down to the music as represented by 2 arrow marks at the left side. See the melted snow below the bone and a blood vessel from the side ( left corner ) Now, this is what the picture says: Ewings - the chick with wings; Arises from Diaphysis, most common bone is Tibia. Seen in children as represented by the chick. Onion represents the onion peel appearance in X-rays. The wings going up and down ( arrows ) represent that the size of tumor increases and decreases ( H/O Exacerbations and remissions ). The moon & star represents the clinical feature that pain is worse at night. Radio represents that the tumor is extremely radiosensitive - therefore melts like snow. Spread is by blood vessels and lymphatics. And what the chick says is the chemotherapy regimen - VAC ( Vincristine, Adriamycin, Cyclophosphamide ), VACA ( VAC + Actinomycin ), AV alternating with CV. Drugs causing Gingival Hyperplasia (Enlargement) Calcium channel blockers; specifically Nifedipine and Verapamil Anticonvulsants; sepcifically Phenytoin but also others Cyclosporine
- 3. Drugs causing Hypothyroidism mnemonic I SCALP...... Iodine overdose, Interferon, Imatinib Sulfonamide Carbamazepine Amiodarone, Aspirin, Antidepressants Lithium Phenytoin, Phenylbutazone Hypertension + Adrenal Mass If you face a case where the patient is presented with elevated blood pressure and a mass in the adrenal seen in CT scan or MRI then you have two options: 1. Pheochromocytoma 2. Primary hyperaldosteronism The differentiation is relatively easy: In Pheochromocytoma you have elevated catecholamines with its consequent increased urinary VMA and cortisol and the crises of tachycardia, sweating, irritability ...etc In Conn's syndrome you have the effects of high aldosterone such as hypokalemia and alkalosis. While surgical treatment is similar for both of them with resection of the tumor or adrenalectomy, medical treatment is certainly different. In pheo you give alpha and beta blockers while in conn you give aldosterone antagonists such as sprinolactone or amiloride. mnemonic 4 drugs causing flushing Mnemonic is NIACiN: Nitrates Isoproterenol Adenosine Clomiphene Calcium channel blockers NserottoNin Nitrates as niacin is famous for its side effect flushing so we can remember all flushing causing drugs by this.
- 4. Drugs Causing Acute Interstitial Nephritis FEVER + RASH + JOINT PAIN = AIN Drugs are SCARP SCARP S= SULFA DRUG C= CEPHALOSPORIN A= ALLOPURINOL , ASPIRIN ( NSAIDs ) R= RIFAMPIN P= PENICILLIN , PPI SLE DIAGNOSTIC CRITERIA DOPAMINE RASH Discoid rash Oral ulcer Photosensitivity Arthiritis Malar rash Immunologic criterias Neurological symptoms-(lupus ceribrites) Elevated ESR Renal disease ANA+ve Serosites Heamatological abnormality Hypertension Drug of Choice in various coexisting conditions *Best initial therapy= Thiazide *Excellent treatment of systolic HTN= CCB *HTN + Recurrent stroke= ACEI, Thiazide *HTN + Migraine = BB or CCB *HTN + Raynaud's phenomena= CCB *HTN + Essential tremor= BB *HTN + Glaucoma= BB *HTN + Hyperthyroidism= BB *HTN + Depression= avoid BB *HTN + Asthma= avoid BB *HTN + CHF + AF from ischemia= BB *HTN + LVH= BB, CCB *HTN + CAD= BB, ACEI, ARB
- 5. *HTN + Heart failure= ACEI, ARB, BB, Spironolactone *HTN + Osteoporosis= Thiazide *HTN + ADPKD= ACEI *HTN + Pregnancy= M.dopa , nifedipine HTN + Multiple cardiovascular risk factors + Undergo non-cardiac surgery= BB *HTN + BPH=ALPHA Blockers *HTN + Bilateral renal artery stenosis= Avoid ACEI*HTN + MI + low EF<40 %= ACEI or ARBs HTN secondary to Pheochromocytoma Phentolamine or Phenoxybenzamine OR Labetalol/Carvelidol as they have BOTH beta and alpha blocking activity CML Mnemonic Imp features of CML is an exam of UK ..PLAB P = PHILADELPHIA CHROMOSOME L = LEUKOCYTOSIS A = ALKP low B = Basophilia IHD Patient discharge Mnemonic Here's the mnemonic ABCDE Aspirin and Anti-Anginals Beta blocker, Blood pressure control Cholesterol lowering and stopping Cigarettes Diet and Diabetes control Education and Exercise Hypokalemia Mnemonic hypokalemia caused by 4 D: 1-diarrhea 2-diabetes mellitus ...( insulin therapy ) 3-digitalis 4-diuretics
- 6. Types of Vaginal Discharges Here is quick list of Vaginal Discharges and their common presentation with diagnosis White-curd like = Candida Albicans Vaginitis Purulent = N.Gonorrhoeae&C.Trachomatis Yellow-Green, foamy, foul smelling = Trichomonas Gray, fishy odor = G.VaginalisVaginosis Drug of choice for Tineacapitis is Oral Griseofulvin or itraconazole. According to JM its Griseofulvin while according to Kaplan its itraconazole orally. Drug of choice for alopecia Areata in children is topical steroids ( children below 2 years) while for elderly or grown up people its Intralesional steroids. Difference between Histrionic and Borderline personalities. Borderline personality------they have intense but shallow emotions; -pros and cons view. -multiple partners(promisquity) -they have unclear self image -impulsive,low frustration tolerance -easily addicted to substance use and suicidal attempts. -they feel sense of emptiness associated wit psychotic episodes Histrionic---------they seek attention..wanted to be center of attraction -they have superficial relationships, low tolerance to frustration( like borderline) -seducing,egocentric,manipulative behavior --extreme sensitive to criticism -exhibitionism,dramatic,hurt others
- 7. Differentiating Alpha from Beta Thalassemias BETA THALASSEMIA SYNDROMES: "blacks, Greeks and Italians" 1.-Major beta thalassemia - Skeletal changes : "chipmunk facies", delayed skeletal maturation and "hair-on-end" radiographic appearance of the skull. - Hepatomegaly is prominent early in the disease + massive splenomegaly - Endocrine and metabolic abnormalities*(quite common) attributable, at least in part, to chronic iron overload. Hypogonadism 40 percent, Growth failure 33 percent, Diabetes 13 percent & Hypothyroidism 10 percent. - Cardiac malfunction, including heart failure and fatal arrhythmias, are frequent causes of death, and cardiac dilatation secondary to anemia is nearly universal. basic lab: profound hypochromic, microcytic anemia (MCV < 65 fL) & target cell 2.- Beta thalassemia minor (or beta thalassemia trait / silent carrier of beta thalassemia = heterozygotes who carry one normal beta globin allele and one beta globin thalassemic allele.) The vast majority of these patients are entirely asymptomatic. Typically, the blood count and peripheral blood film exhibit features similar to those seen in iron deficiency anemia (eg, hypochromia and microcytosis), but this patients almost always have a hematocrit >30 percent, and a mean corpuscular volume of the red cells (MCV) <75 fL. We also can see target and tear drop shaped red cells. ALPHA THALASSEMIA SYNDROMES: "blacks and Southeast Asians" 1.-Alpha thalassemia-2 trait (aka alpha thalassemia minima aa/a-): Patients are asymptomatic. The complete blood count, hemoglobin electrophoresis, and peripheral smear are usually normal. 2.-Alpha thalassemia-1 trait (aka alpha thalassemia minor) resembles mild beta thalassemia trait. 3.-Hemoglobin H disease: This patients suffer from hemolytic anemia throughout much of gestation and are symptomatic at birth, often presenting with neonatal jaundice and anemia, and occasionally with hydropsfetalis. This occurs because alpha globin synthesis is required in utero for the production of the major hemoglobin found during late gestation: hemoglobin F (alpha2/gamma2). Patients with beta thalassemia, on the other hand, do not have these difficulties until a few months after birth, when hemoglobin F production decreases markedly and there is a need for increased production of beta chains for hemoglobin A (alpha2/beta2). 4.-Hydropsfetalis and hemoglobin Barts is usually fatal in utero.
- 8. Borderline Personality Disorder Mnemonic PRAISE: Paranoid ideas Relationship instability Affective instability/ Abandonment fears/ Angry outbursts Impulsiveness/ Identity disturbance Suicidal behavior/ Self-harming behavior Emptiness Conduct Disorder Vz Antisocial Personality Disorder Conduct Disorder is seen in Children Antisocial Personality Disorder is seen in Adults Rheumatic Fever Jone's Criteria Mnemonic Jones 5 criteria: Rheumatic fever: SPACE S: Subcutaneous nodules P:Pancarditis A: Arthritis C: Chorea E: Erythema Marginatum Minor criteria Fever Arthralgia Raised ESR or CRP Leukocytosis 1st degree heart block Previous episode of rheumatic fever or inactive heart disease Sublimation - transfer of unacceptable impulse into acceptable 1 like one is frustrated and he goes home and paints to take out the bad feeling. Negetive emotions but positive outcome. Displacement is like you angry on A and you take it out on B, just the target changes but the primary emotion doesn't get altered. Out come Negative
- 9. Diagnostic algorithm for RA Target population (who should be tested?): patients who 1) have at least one joint with definite clinical synovitis (swelling)* 2) with the synovitis not better explained by another disease† Classification criteria for RA (score-based algorithm: add score of categories A–D a score of ≥6/10 is needed for classification of a patient as having definite RA) A. Joint involvement§ 1 large joint 0 2−10 large joints 1 1−3 small joints (with or without involvement of large joints) 2 4−10 small joints (with or without involvement of large joints) 3 >10 joints (at least one small joint) 5 B. Serology (at least 1 test result is needed for classification) Negative RF and negative ACPA 0 Low-positive RF or low-positive ACPA 2 High-positive RF or high-positive ACPA 3 C. Acute-phase reactants (at least one test result is needed for classification) Normal CRP and normal ESR 0 Abnormal CRP or normal ESR 1 D. Duration of symptoms <6 weeks 0 ≥6 weeks 1 RF is type 2 hypersensitivity RA is type 3 hypersensitivity RF:commonly involves large joints,small joints involvement is uncommon,asymmetrical joints involvement RA:involve both large and small joints,symmetrical joint involvement RF:acuteonset,lasts for shorter period RA:insidiousonset,lasts longer than RF RF:arthritis dramatically responds to aspirin RA:arthritis mainly responds to DMARDs RF:usually no deformity of joint occur RA:high rate of deformity of joint RF:H/o sore throat 2-4 weeks prior to onset of illness
- 10. RA:usually there is no h/o sore throat RF:it involves heart(carditis/valvular lesion) and brain(chorea) other than joint RA:uveitis,lymphadenopathy,hepatosplenomegaly occur other than arthritis polymyositis and dermatomyositis are inflammatory myopathies often confused with similar features here are some features similar features------both cause proximal muscle weakness,elevatedcreatine kinase, anti Jo-1 antibody(60%) here are some contrast features-----1) dermatomyositis------gottron'spapules,heliotrope rash, malar rash(like sle),antibody mediated damage,perifascicular atrophy(perimysial inflammation-----as @beka-cts told remember it as skin lie towards the surface) 2) polymyositis------no papules,no rash, T-cell mediated damage(CD8-MHC-1------>lymphocytic infiltrate),endomysial inflammation,@ with gastric carcinoma usually Causes of deficiency (Pellagra): Dietary deficiency mainly arise in geographic areas where consumption of corn is the main source of staple rather than wheat. Niacin in corn in nonabsorbable. This is specially seen in African countries. Hartnup disease, because Tryptophan being a large neutral amino acid will be deficient and thence Niacin will also be deficient. Isoniazid treatment as it inhibits vitamin B6 needed for endogenous synthesis as mentioned above. Alcoholics as the over active dehydrogenases will consume all the NAD available. HIV patients Multiple Myeloma Calcium elevation Renal disease Anemia Bone/back pain. Plasma cells and bence jones proteinuria.