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Remember to categorize everything:Gram+, Gram-, Anaerobes, TB, Parasites.

Know the guidelines for Staph - what to use with MSSA, MRSA.

Know what to use for TB - both for treatment (rifampin, isoniazid, pyrazinamide or ethambutol),
and prevention in close contacts. Know about isoniazid and pyridoxine deficiency.

Know the uses of metronidazole-Anaerobes, GET on the metro:


Giardia
Entamoeba
Trichomonas

Erythromycin (or other macrolide) for Mycoplasma pneumo.

3rd-gen ceph for gonorrhea. Also tx Chlamydia in such a patient with doxy or azithromycin.
(Remember not to use doxy or tetracycline on a child or potentially pregnant female).

Doxy/Tetracycline for Lyme or RMSF unless child or preg, then use Macrolide.

Macrolide for Legionella

Trimethoprim/sulfamethoxazole for UTI (usual agent E.coli). If resistant use FQ(but not if child or
pregnancy)
In pregnant female, use Ampicillin for UTI. If UTI recurs, use TMP/SMX

CI in Pregnancy and children:


• Tetracyclines
• Fluoroquinolones
• Aminoglycosides
• Sulfonamides.
GASTROENTEROLOGY: Cholera
HISTORY AND EXAMINATION ‘D’yphoid
E Coli (eg. traveller's diarrhoea)
Causes of a massive spleen = MMM Food poisoning
Myelofibrosis Giardia
Myeloid leukaemia (chronic)
Malaria Inflammatory bowel disease
Pain Blood
Causes of abdominal distension = FFFFF U. Colitis X P
Fat Crohns P X
Fluid Ischaemic P P
Faeces Colitis
Foetus
Flatus Treatment of ulcerative colitis = SSSS
Supportive (eg. fluids etc.)
Causes of weigh loss with a normal appetite Steroids (local initially)
Thin Can Still Die Salazopyrine
TH = thyrotoxicosis Surgery
IN = Infections e.g. parasitic
CAN = cancer Small bowel obstruction with no scars =
STILL = steatorrhoea CLAN
DIE = diabetes mellitus Crohn's disease
Lymphoma
MALABSORPTION Acid fast bacilli
Neoplasia
Bacterial reasons for malabsorption = BB
B12 is consumed "Medical" causes of abdominal pain (to be
Bile salts are deconjugated considered after the "surgical" causes have
been excluded).
What is absorbed in the terminal ileum? = Angie's Addicted Family Cat Let Her Poor
BB Sick Hen Die on the Kitchen Table.
B12 Angioedema (familial)
Bile Salts Addison's disease
Familial Mediterranean fever
Bruising in flanks = AA Calcium disturbances (e.g.
Acute pancreatitis hyperparathyroidism)
Aortic aneurysmal rupture (retroperitoneally) Lead poisoning
Herpes zoster (pre-rash)
Whipples disease = malabsorption plus a Porphyria
PLAN Sickle cell crisis
Pigmentation Henoch-Schonlein purpura
Lymphadenopathy Diabetes mellitus (e.g. hypoglycaemic
Arthritis episodes)
Neurological changes Kidney failure (uraemia)
Tabes (tabetic crisis)
DIARRHOEA HEPATOBILIARY DISEASE
Infectious diarrhoeas to consider in a patient Causes of gallstones = SSSS
who has been overseas = ABCDEFG Solute
Amoebic dysentery Stasis
Bacilliary dysentery Seeding
Hypersplenism
Causes of hepatitis = ABC (hep virus) Hepatic fetor and hand flap (portosystemic
then DIAL for help encephalopathy)
Drugs (alcohol, toxins, drugs)
Infection (I mononucleosis, amebic) NEUROLOGICAL
Autoimmune
Leptospirosis (has also meningoencephalitis, Causes of coma - cerebral or extracerebral
renal dysfunction)
CEREBRAL = FETCH
Incubation periods Fit (convulsion)
Hepatitis A = 2-6 weeks Encephalitis
Hepatitis B = 2-6 months Trauma
Cancer
Worsening ascities = TTT Haemorrhage or other cerebrovascular
Tumour (eg. hepatoma) accident
Thrombosis of portal vein
Tuberculosis EXTRACEREBRAL = SUGARS
Septicaemia
Primary biliary cirrhosis associations = Uraemia or other major organ failure
MMM Glucose low
Middle aged female Risky drugs
antiMitochrondrial antibody Sodium low or other metabolic change
M antibody (IgM)
Alternative = AEIOU
Chronic pancreatitis – associations = Accident (trauma, cerebrovascular)
ABCD Epilepsy
Abdominal pain Infection (intra and extracranial)
Booze Overdose (self-induced)
Calcification on x-ray Uraemia and other metabolic causes (diabetes,
Diabetes mellitus Addison's disease, hypothyroidism, hypoxia,
and other organ failures)
Post-operative jaundice = ABCD
Anaesthetic (halothane) Fainting on neck turning = CC
Bile duct tied off / obstructed Carotid sinus hypersensitivity
Calculus left behind Cervical spondylosis
Drugs
Global brain disease = PUPS
Perseveration
Relapsing jaundice = RAID Upward gaze failure
Relapsing hepatitis Palmo-mental reflex
Alcoholic Synkinesia
Intermittent
Drugs CRANIAL NERVES

Persistent hepatitis antigen = CCCC Unilateral Ptosis


Carrier Pupil dilated = third nerve
Congenital Disease Pupil constricted = Horner's syndrome
Chronic active hepatitis Brain stem diagram
Cirrhosis Courses of the second, third and seventh
cranial nerves
Results of portal hypertension = HHH
Haemorrhage Features of bulbar disease = DD
Dysarthria Esoteric
Dysphagia
Failure to control diabetes = III
MOTOR CHANGES Infection
Insulin resistance
Side effects of Levodopa = LEVODOPA Incidental disease (A to E as above)
Liver dysfunction
Extra – blood (positive Coombes) gout, Treatment of hypersosmolar non-ketotic
flushes diabetic state
Vomiting, nausea, diarrhoea - half strength saline
Ocular – glaucoma - half strength insulin
Dyskinesia
On – off phenomenon Symptoms of Addison's disease = “The 4
Personality changes Ps”
Arrhythmias and hypertension Pooped
Pewking
Causes of peripheral neuropathy = Pigmented
ABCDE Posturally hypotensive
Alcohol and other drugs
B1, B12 deficiency Features that precipitate Addison's
Cancer disease - SSS
Diabetes Stress
Exotic (lead, dyphtheria, leprosy) Septicaemia (eg. menginococcal)
Surgery of the adrenal gland
Raised intracranial pressure triad =
Headache Multiple endrocrine adenomatosis
Vomiting syndrome = PPPPP
Papilloedema Parathyroid
Pituitary
Pancreatic islets (ZE)
ENDOCRINE Pheochromotocytoma
Phyroid (medullary carcinoma)
Causes of galactororrea = PPP
Physiological Hand features in hyperthyroidism =
Pituitary (tumours or stalk rupture) CATS
Pharmacological (alpha methyldopa, Clubbing
maxolon/stemetil, phenothiazines,oestrogens) Acropachy
Tremor
Sweaty and hot
DIABETES MELLITUS
Features of hypothyroidism = CCC
Symptoms of hypoglycaemia = SCAR Clinical
Sweating Cholesterol increased
Confused CPK
Abdominal pain
Respiratory rate increases Features of hypercalcaemia = Stones,
Bones, Moans, Groans, Thrones and
Unusual causes of diabetes = ABCDE Psychological Overtones
Acromegaly Stones = renal or biliary
Bronze diabetes (haemochromatosis) Bones = bone pain due to osteodystrophy
Cushings disease Moans = peripheral pain (eg. muscle pain,
Drugs (steroids, thiazides) pseudogout)
Groans = abdominal pains to due Septic
pancreatitis, peptic ulcer,
pancreatic adenoma (…..etc) Difference between Still's disease and adult
Thrones = polyuria [using the 'throne' ie. rheumatoid arthritis = SMARTS
toilet] Systemic features
Mono-oligarticular
Causes of short stature = Anterior uveitis
(achondroplasia, Down's syndrome, vitamin Rheumatoid factor negative
D-resistant Ricketts) Two years old (median age)
Salmon pink rash
Non-drug causes of SIADH = TTT
Tumours (intrathoracic) Features of Reiter's syndrome = DACS
Trauma to brain (trauma, stroke, infection) Discharge or diarrhoea
Tuberculosis Arthritis
Conjunctivitis
Abnormal hirsutism = ABCD Skin disease
Acromegaly
Birth tendency Temporal arteritis
Cushing's disease Muscle aches
Dilantin and other drugs Eye changes
Jaw claudication
Virulism = congenital, ovarian, adrenal, ESR
drugs
Associations with dermatomyositis =
CCC
Carcinoma
MUSCULOSKELETAL Cardiac disease
Connective tissue disease features eg.
Causes of acute arthritis = pus, blood, Raynaud's
crystals, crud
Pus = septic arthritis
Blood = haemarthrosis HAEMATOLOGY
Crystals = gout or pseudogout
Crud = all the connective tissue diseases General Values
Normal MCV = 75-100
Connective tissue diseases = seropositive Normal Blood differential = 60/30/6/3/1
(rheumatoid arthritis or seronegative 60% neutrophils
(RAPE) 30% lymphocytes
Reiters-reactive 6% monocytes
Ankylosing spondylitis 3% eosinophils
Psoriasis 1% basophils
Enteropathic (Crohn's ulcerative colitis)
Causes of an ESR over 100 = MM, CA,
Ie. ask about bowels, back, skin, clap TB,TA
MM = Multiple myeloma
Causes of a false positive rheumatoid CA = Carcinoma
factor = SSSSSS TA = Tuberculosis
Sarcoidosis TA = Temporal arteritis
Still's disease
SLE Blood groups to know
Scleroderma Individuals have antibodies against the groups
SBE that they do not have themselves
Universal donor = O negative Platelet count falls
Universal recipient = AB Pulmonary fibrosis

Causes of eosinophilia = APPLES RENAL / ELECTROLYTES ETC


Allergies (eczema, allergic rhinitis, asthma)
Parasites Low sodium = observe potassium
Pulmonary disease (eg. eosinophilic If low or normal = SIADH
pneumonia) If high = Addison's disease
Lymphoma
Eosinophilic leukaemia and other leukaemias Chronic renal failure is a syndrome of
Secondary carcinoma uraemia, anaemia and hypertension.

Causes of non-megaloblastic macrocytosis Skin changes in uraemia = PPPP


= HHHHH Pruritis
Hepatic disease Pallor
Hypothyroidism Petechiae
Hodgkin's disease Pigmentation
Haemolytic anaemia
Hydantoin Causes of polyuria = DDDD
Diabetes Mellitus
Causes of anaemia = reduced production Diabetes insipidus (including psychogenic
or increased loss polydipsia)
Dialysis list (chronic renal failure)
Reduced production = D - vitamins (hypercalcaemia)
A) THE FACTORS (iron, B12, folate,
vitamin C, protein) Causes of jaundice with acute renal failure
B) THE FACTORY (Marrow -leukaemia, (excluding haemolysis ) = HIT
lymphoma, myelofibrosis, carcinoma, Hepato-renal syndrome (especially cirrhosis)
myeloma) Infections (eg leptospirosis)
Increased loss Toxins (eg. CCL4, paracetemol)
A) OUTSIDE THE BODY (haemorrhage)
B) INSIDE THE BODY (HHH) Treatment of chronic renal failure prior to
Haemorrhage,Haemolysis, Hypersplenism dialysis
Antihypertensives
Causes of target cells = SLIT Antacids
Splenectomy Allopurinol
Liver disease Antibiotics
Iron Deficiency Appropriate organ therapy (eg. joints,
Thalassemia parathyroids, blood etc.)

Causes of pancytopoenia Causes of chronic renal failure =


Same as anaemia CHOPIN TWINS
Chronic gromerulonephritis
Abnormal findings in polycythaemia Hypertension
Ascites in hepatomegaly (cor pulmonale) Obstruction
Palpable kidney (renal carcinoma) Podagra
Splenomegaly (oplycythaemia rubra vera) Ischaemia
Others Nephritis
Chronic pyelonephritis
Complications of busulphan therapy = Hypercalcaemia
PPP Organ disease (eg. hepato-renal)
Pigmentation Phenacetin
Iatrogenic Simplex
Nephrotic syndrome Streptococcus
Sulphurs
Complications of peritoneal dialysis = Sedatives
PPP SLE
Peritonitis Leukaemia
Pneumonia (Diaphragmatic splinting)
Protein loss Nail changes in psoriasis = PSO
Pitting
Haemolytic-uraemic syndrome = PPP Subungal hyperkeratosis
Paediatrics Oil drop
Pregnancy
Pill (contraceptive) Causes of unnatural pigmentation =
Addison's disease
Causes of renal stones = SSS Haemochromatosus
Solute concentration Prophyria
Seeding
Stasis Black and white skin = vitiligo with
Addison's disease
Abnormalities in the eyes in a patient with
polyuria Photosensitivity = SAND
Diabetic fundus, cataracts SLE
Pituitary disease (visual fields, exophthalmos) Albinos
Calcium changes (band keratopathy) Niacin deficiency (pellagra)
Chronic renal failure (hypertension, anaemia) Drugs (eg. Tetracyclines, phenothiazines,
thiazides, sulphonamides
METABOLIC DISORDERS
Pemphigoid = older (legs larger_
Hyperlipidemia = 2ABC Pemphigus = usually younger (mouth,
2A = beta lipoprotein = cholesterol minisize)

MISCELLANEOUS Causes of leg ulcers = VINEGAR


Venus
SHOCK Ischaemia
Is either.... Neoplasis
a) hypovolemic Esoteric (eg. neuropathies)
(loss of blood outside the body, eg GI Gumma
bleed, or inside, eg intraabdominal bleed Anaemia
or big fracture, tor loss of fluids eg. Rare (eg. Pyoderma gangrenosum)
diarrnoea, burns)
b) normovolemic Eye examination = CAPER
A - anaphylactic Confrontaton
B - bacterial eg. septic shock Acuity
C - cardiogenic. Pupil and corneal reflexes
Extraocular movements
Causes of vascular instability leading to Retina
purpura = SSS
Senile Conjunctival sludging = Sick Ribs Die
Steroids Crying
Scurvy Sickle cell disease
Riboflavin deficiency
Causes of erythema multiformae Diabetes Mellitus
Cryoglobulinaemia

Causes of night blindness = retinitis


pigmentosa and vitamin A deficiency

Causes of scotomas
Bilateral = TT
Tobacco - alcohol
Toxic (methyl alcohol, other drugs)

Unilateral = VD
Vascular (haemorrhage, obstruction)
Demyelination

Steroid side effects


"I was hopping mad"
Infection
Wasting
Adrenal insufficiency
Sugar disturbances (diabetes)
Hypotension
Osteoporosis
Peptic ulcer and pancreatitis
Proximal myopathy
Incidental (fat face, hirsutism)
Necrosis of the femoral head
Glaucoma / cataracts
Mad (psychological changes)

Tricyclic antidepressant overdose =


CRASH
Coma
Respiratory depression
Arrhythmias
Seizures
Hyperpyrexia

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