porphyria cutanea tarda- increase urine uroporphyrinogens,associated with hep c,

and triggered by ethanol and estrogen.blisters,hypertrichosis,hyper pigmentatio

n.
alopecia areata can recur after successful treatment,its auto immune T cell infi
ltration around the hair follicles and associated with pernicious anemia,vitilig
o and thyroid diseases.

drugs exacerbate the psoriasis beta blockers,ace inhibitors,nsaids,anti malerial

s,lithium

A family member has >250 random cholestrol screen children at 2 years if <170 sc
reen again in 5 years,if family member has premature CAD order FLP directly.
Kava is herbal medicine used for anxiety cause liver toxicity.
PBC is associated with keratoconjuctivitis sicca,CREST syndrome,type 1 diabetes,
rheumatoid arthritis,anti thyroid antibodies.paradoxically despite hypercholestr
emia, atherosclerosis incidence is low.

Af management-one point for CHF,HTN,DM,>75 years two points for previous stroke
or TIA.If score is 0 treat with aspirin,if score >3 treat with warfarin.

tight glycemic control associated with less incidence of micro vascular complica
tions,relation with macro vascular complications are unclear.
In familial hypocalciuric hypercalcemia,24 hour urine ca is less than 100
pseudo hypo parathyroid:fahr's syndrome:bilateral cataracts and calcification of
basal ganglia.
type 1a(Albright heriditory osteo dystrophy) has feature of short stature,short
4th and 5th metacarpals,round facies,short neck.type1b has no such features
rash in mastocytosis is utricarial,and maculopapular,vesicular and pustular leis
ons also noted,particularly in children.generalised rash.rubbing the edge of the
rash produces wheals and erythema,called Darier's sign
stage1 RCC:with in the renal capsule-partial nephrectomy can be done.stage2:beyo
nd renal capsule but with in gerota's fascia-radical nephrectomy is indicated.

Hiv positive patients with siphilis - screen for neuro siphilis.If early siphili
s or latent siphilis less than one year durtion give one dose of benzathine penc
illin,otherwise for latent give 3 weeks.
tonsillar exudate,fever,absence of cough,tender ant.cervical nodes these are 4 c
entral crieteria for streptococal atleast 3 must be present.If two present do di
agnostic studies,if only one its viral.
bcg vaccination - ppd test if 10mm increase baseline less than 35 - new infectio
n .>35 years 15 mm increase is necessary
didanosine-pancreatits,abacavir-hypersensitivity,NRTIs-Lactic acidosis,NNRTIs-SJ
syndrome,nevirapine-liver failure
if the urinary infection is recurrant means more than 2 times in six months give
 prophylactic abs.if it is related to coitus one dose of ABs after the coitus.if
the inf reoccur with in 2 weeks same organism it is relapse,after 2 weeks recur
rent inf.different organism it is called recurrence.

7135286161 - 136
Tuberculous meningitis:isoniazid,rifampin,pyrizinamide for 2 months,isoniazid,ri
fampin for rest of 10 months.
contra indications for dtp- encephalopathy,anaphylaxis with in seven days.fever
of 104,seizures are no tcontraindications.give with caution next time.
RDA of calcium:calcium 9-18 years of age 1300 mg,19-50 years 1000 mg,.51 years
1200mg.
treatment for moderate to severe led poisoning 45 to 70 is iv EDTA or oral dmsa,
no oral edta.
AB prophylaxis for recurrent otitis media if >3 in 6 months,>4 in 12 months
turner syndrome investigations-Echo cardio,renal ultra sound,visual and hearing
tests,Tsh(primary hypothyroidism is common)
reiter syndrome treatment-antibiotics,exercise,disease modifying agents like sul
fasalazine then
methotraxate

mixed connective tissue diagnosis made when serology shows positive RNP antibodi
es,three clinical features of sle,poly myositis,systemic sclerosis are present s
imultaneously.These features include swollen hands,synovitis,myositis,acrosclero
sis and raynold phenomenon.

cion shaped crystals-calcium phosphate,bipyrmidal:calcium oxalate

allopurinol inhibs xanthine oxidase - dose of azathiprine should be reduced to 5
0-70%.treatment for acute attack of gout in renal transplant patients is intra a
rticular corticosteroids.
3 important crieteria for diagnosis of ankylosing spondylytis are presence of lo
w back pain for more than 3 months improves with activity,Limitation of range of
motion of the lumbar spine,limitation of the chest expansion to the normal valu
es.radiographs and esr are used to monitor the disease progression.other manifes
tations include uveitis,aortic regurgitation,apical pulmonary fibrosis,IgA nephr
opathy and restrictive lung disease.

losartan is a good choice for the hypertensive patients with hyperurecemia and g
out.Thiazide,loop diuretics,low dose aspirin should be avoided when possible.
Typical presentation of epididymitis is mild to moderate scrotal pain accompanie
d by swelling and tenderness.cremasteric reflex intact.Prehn's sign is usually p
ositive.most common cause is chlamydia trachomatis.

phynoxybenzamine (sympathetic block) is the most effective treatment in the firs

t three months of Reflex sympathetic dystrophy.
anti DS Dna and compliment levels are used to monitor the disease progression in
SLE patients.ANA and anti smith antibody titers are not used.

Raloxefine cause deep vein thrombosis therefore should be discontinued 72 hours

before surgery.
memantine is disease modifying drug in alziemers.its a NMDA receptor antagonist.
used in moderate to advanced disease.
binswnger syndrome is a type of vascular demntia that involves white matter infa
rcts.Patients with this disease usually present with apathy,agitation and bilate
ral corticospinal and bulbars signs.
glatiramer and interferon are teratogenic.contraception is necessary.If become p
regnent stop all medication and follow up with obstretrician.therapeutic abortio
n is not indicated.

ginco used for memory cause bleeding,kava cause hepatits,licorice cause hyperte
nsion,
black cohosh used for premenstrual syndrome cause hypotension,Horse chestnut use
d for venous insuffeciency cause bleeding
Autoimmune metaplastic atropic gasrtitis consists of glandular atropy,intestinal
metaplasia and inflammation.

phrenic nerve infiltration and spinal cord involvement are deadly complications
pf pancoast tumour,patients need immediate treatment.look for asymetry of the ch
est movements and asymmetric lower limb reflexes.
hyper reflexia some times found in hypocalcemia,not in hypercalcemia.
amylase levels elevate in pancreatits,parotitis,intestinal disease,cholecystitis
,fallopian tube diseases,renal failure.
causes of fever of unknown origin are connective tissue disorders>infections>mal
ignancy.
Sudden hyperglycemia in the patients recieving the total parentral nutrition sho
uld lead to a suspecion of sepsis.
Hypophosphatemia cause respiratory weakness,hemolysis and impaired oxygen delive
ry to tissues because of decreased 2,3 BPG
INR goal should be 2.5(range 2-3) for aortic with bileaflet aortic valve.3 for M
itral valve (2.5-3.5) or aortic valve plus AF.If patient experience embolism sti
ll add aspirin.
Respiratory rate and tidal volume are used to control PCO2.Fio2 and PEEP are use
to control PO2.
Contraindication to use Mac sulfate is Myasthenia grevis.
Asymptomatic ITP (platelet count btw 30,000-50,000)need not be treated.
plasmaperisis is the tretment of choice in HUS.
the usual caloric requirement for the average person is 30 Cal/kg/day n pro is 1
gr/kg/day.In critically ill patients its 35-40 Cal/kg/day n pro is 1 gr/kg/day
As a rule one unit of platelets should rise platelet count by 5000.
HIV induced thrombocytopenia therapy is zidovudine 600mg,if no response give 100
0 mg.Second line is interferon alfa(platelets decrease again after stopping the
treatment with the interferon),corticosteroids only used for brief episodes,daps
one is sometimes used as adjuvant to zidovudine.spleenectomy may be recommended
for those patients with persistant or dependance on recurrent IVIg.
after starting HAART therapy check viral load 4,8,12 weeks after measure every 6
-8 weeks until viral load is undetectable(0-50).at this level evaluate viral loa
d every 3 months.
Contraindiacations to MMR vaccine:Moderate and severe illness,anaphylaxis to neo
mycin or gelatin,Severe Immunodefeciency,Thrombocytopenia after first dose,recen
t administration of immunoglobulins,pregnancy.
carotid dissection - unilateral headache,horner syndrome
In DKA give insulin drip till anoin gap get corrected(<12)
Hepatic encephalopathy aggrevates when there is gastrointestinal bleeding,hypoka
lemia,hypovolemia,hypoglycemia,hypoxia,sedatives,metabolic alkalosis,infection.
nitropruside should not be given more than 10mg/kg per more than 10 mins
Heart failure:cad(60-75%),Hypertension(13%),valvular disease(10-12%)
Corticosteroids are indicated in PCP when A-a gradient >35 Pao2 <70

Severe pain with little physical findings,mild acidosis is acute mesenteric isha
emia unless proven otherwise.Haematocrit and WBC count raises because of hemocon
centration.

In the patients admitted to the hospital after cirrhosis and varicial bleeding,t
he common complications are Infections,hepatic encephalopathy,renal failure.Prop
hylactic antibiotics are indicated with flouroquinolones.
Alcoholic ketoacidosis glucose may be normal,high or low.ppl have anoin gap and
respond to iv dextrose and thiamine.
Pheocromocytoma patients should be placed on alpha blockers for 10-14 days befor
e starting the surgery.
phenoxy benzamine is nonselective irreversible alpha blocker.

TTP more nerological symptoms,HUS more renal failure,neurological symptoms are l

ess
primary cns lymphoma associated with EBV
one of the causes for paralytic ileus is hypokalemia.abdominal distension and de
creased bowel sounds.