Pm†þ¡UP˜xÔè¾@< @†"Data.app!@‰.17?GAGH : usually v or ^ from stressIGF-1 : ~ mean GH level / 24 hoursGTT: failure to v GH = diagnostic, (25% -> ^ glucose on GTT) (false +ve with steroids)insulin/arginine -> ^^ GHprolactin : ^ in 30%pituitary function : often vlateral SXR : macro-adenoma -> ^ fossaCT/MR : to visualise tumour'@õ€@ Disclaimer Please Read]Ü@ @[¿ @¼Øÿÿÿ_JAA = aplastic anaemiaAb = antibodyABG = arterial blood gasABPI = ankle : brachial pressure indexAC = adenylate cyclaseAC = amino-caproic (acid)ACC = American College of CardiologyACD = anaemia of chronic diseaseACE = angiotensin converting enzymeACE-I = ACE inhibitorACTH = adreno-cortical trophic hormoneAd = adrenalineAD = autosomal dominantADH = anti-diuretic hormoneADP = adenosine diphosphateADR = adverse drug reactionAF = atrial fibrillationAFP = alpha-feto proteinAg = antigenAG = anion gapAHA = American Heart AssociationAIDP = acute inflammatory demyelinating polyneuropathyAIDS = aquired immuno-deficiency synd.AIHA = auto-immune haemolytic anaemiaAIP = acute intermittent porphyriaAITP = auto-immune thrombocytopaenic purpuraa.k.a = also known asALD = adreno-leuko-dystrophyALD = alcoholic liver diseaseALG = anti-lymphocyte globulinALL = acute lymphoblastic leukaemiaALP = alkaline phosphataseALT = alanine transferaseAMA = anti-mitochondrial antibodyAMI = acute MIAML = acute myeloblastic leukaemiaAMVL = anterior mitral valve leafletANA = anti-nuclear antibodyANCA = anti-neutrophil cytoplasmic AbANP = atrial natriuretic peptideAPC = activated protein CAPL = anti-phospholipidAPLS = anti-phospholipid syndromeAPML = acute promyelocytic leukaemiaAPSAC = anisoylated plasminogen streptokinase activator complexAPTT = activated partial thromboplastin timeAPUD = amine precursor uptake + decarboxylationAR = aortic regurgitationAR = autosomal recessiveARDS = adult respiratory distress synd.ARF = acute renal failureAS = aortic stenosisASD = atrial septal defectASOT = anti-streptolysin A titreassoc. = associatedAST = aspartate transferaseAT-II = angiotensin IIAT-II-RA = angiotensin II receptor antagonistsAT-III = anti-thrombin IIIATN = acute tubular necrosisATP = adenosine triphosphateAV = arterio-venousAV = atrio-ventricularAVB = atrio-ventricular blockAVH = acute viral hepatitisAVM = arterio-venous malformationAVN = atrio-ventricular nodeAVNRT = AVN re-entry tachycardiaAVRT = AV re-entry tachycardiaAXR = abdominal radiographAZA = azathioprineBAV = bicuspid aortic valveBCC = basal cell carcinomaBCG = Bacille Calmette-GuerinBCS = Budd-Chiari syndromeBCT = backwardly conducted tachycardiaBD = x2 / dayBFB = bi-fasicular blockBHL = bilateral hilar lymphadenopathyBHS = British Hypertension SocietyBIH = benign intracranial hypertensionBJP = Bence-Jones proteinBM = bone marrowBMI = body mass indexBMJ = British Medical JournalBMT = bone marrow transplantBP = blood pressureBRC = benign renal cystBT = bleeding timeBVF = biventricular failure prednisolone -> v with remission ->20% = complete resolution30% = partial sustained response30% = partial unsustained response20% = no responseif unsuccessful -> splenectomy ->90% success rate (30% relapse)if unsuccessful -> immunosuppression(if acute / pre-op -> plts + immunoglob.)A FSH LH PL OESTv GT v v n v^ PL v / n v / n ^ vPOF ^ ^ n vROS ^ ^ n nPCOS n ^ n / ^ ^¯AHLA-B27 in 95% of cases(found in 5% of population)HLA-B27 -> 20% risk of ank. spond.lumbago + stiffness (inflammatory)^ kyphosis + v chest expansionv lordosis + v spine flexioniritis (30%)apical fibrosisARperipheral polyarthritis (LL's)plantar fasciitisX-Rays : square vertebrae syndesmophytes interspinous ossificationRx : exercise NSAID's SSZ (MTX if polyarthritis)6BBacillus anthracisG +ve bacillus? aerobicspore-forminginfection <- animals / wool / hides / meatincubation = 1-5 dayscutaneous : maculopapular lesion -> vesicle -> ulcer + black baserespiratory : Woolsorter's lung fever / dry cough / pain cyanosis / pleural effusiongastrointestinal : gastroenteritis bloody diarrhoea haematemesisIx : specimens -> m+c+s serologyRx : penicillin (erythromycin) vaccination husbandryÂADOPAMINE ANTAGONISTS : * phenothiazines eg. prochlorperazine (central action only + vestibular) * metoclopramide (central + peripheral actions) * domperidone (v central action -> v Parkinsonism)ANTI-HISTAMINES : * cyclizine etc. (less effective but useful addition)SEROTONIN (5HT3) ANTAGONISTS : * ondansetron etc. (newest / most expensive / ? best)CANNABINOIDS : * nabilone (hallucinogenic - use if others fail)éBAntiplatelet Triallists CollaborationBMJ (1994) 308:81PREVIOUS CVA / TIA :untreated -> 22% CVA/MI/deathanti-platelet Rx -> 18% CVA/MI/deathrelative risk reduction = 18%PREVIOUSMI :untreated -> 17% CVA/MI/deathanti-platelet Rx -> 13% CVA/MI/deathrelative risk reduction = 24%ACUTE MI :untreated -> 14% CVA/MI/deathanti-platelet Rx -> 10% CVA/MI/deathrelative risk reduction = 29%UNSTABLE ANGINA :untreated -> 14% CVA/MI/deathanti-platelet Rx -> 9% CVA/MI/deathrelative risk reduction = 36%overall RRR of CVA = 1/3overall RRR of MI = 1/3overall RRR of death = 1/6average RRR for all conditions = 1/4regardless of age / gender / ^BP / DMno difference in aspirin vs. other Rx'sno difference in aspirin 75-1500 mg ODwApenicillinscephalosporinscarbapenems -> cell wall synthesismacrolidesaminoglycosidestetracyclineschloramphenicolfusidic acid -> ribosomes/protein synth.trimethoprimsulphonamidescotrimoxazole -> folate synthesisquinolones -> DNA synthesis (gyrase)rifampicin -> DNA synthesisnitroimidazoles -> DNA breaksglycopeptides -> cell wall synthesis4ARx of ^BP / HF :ANP = large -> requires parenteral Rxso ^ endogenous level by v breakdownwith a neutral endopepetidase inhibitorhowever NEI's also -> ^ AT-IIso must include ACE-I / AT-II-RA in Rxbut should help prevent "ACE-I escape"NEI's = anti-proliferative-> v atherosclerosis / v hypertrophy$AQuincke's sign (nail beds)Corrigan's sign (carotids)DeMusset's sign (head-nodding)Mueller's sign (uvula)Austin-Flint murmur (AMVL)Hill's sign (leg BP > arm BP)Traube's (femoral "pistol-shot" murmur)Duroziez's (femoral "to + fro" murmur) (if pressure applied distally)_Aradial = normal rate/rhythm + "collapsing"BP = ^ systolic + ^ pulse pressurecarotid = visible + ^ volume + ^ rise+fallJVP = not raised + normal waveformapex = displaced + "thrusting"no heaves / thrillsHS = (soft S1 + soft A2)HM = EDM at LSE + aortic area ^ by leaning forward + expirationHF = ? signs of LVFPVD = (not relevant)gAradial = normal rate / rhythmBP = v systolic + v pulse pressurecarotid = low volume + "slow-rising"JVP = not raised + normal waveformapex = undisplaced + heavingsystolic thrill at apex / aortic / carotidHS = soft A2 + S4 presentHM = ESM at aortic area -> carotid ^ by leaning forward + expirationHF = ? signs of LVFPVD = (not relevant)}Aindicated by : slow-rising pulse sustained apex beat loudness (unreliable) soft / absent A2 LVH on ECGdefine as : "mild" = <25 mmHg gradient "moderate" = 25-50 mmHg "severe" = >50 mmHg gradient-> surgery if > 50 mmHg + symptoms > 75 mmHg + no symptoms@#ÿÿUMÞdR¼¥4ÂD‘L±5AMLFAB Classification (8)¸M0 - undifferentiatedM1 - undifferentiated myeloblasticM2 - granulocyticM3 - promyelocytic (APML)M4 - myelomonocyticM5 - monoblasticM6 - erythroleukaemicM7 - megakaryoblastic5AnaemiaIxÆcheck PV : v if acute bleed / dry ^ if dilutionalcheck reticulocytes : v if deficiency ^ if haemolysis-> check for deficiency or haemolysis5Anaemia - ? deficiency Ix (4+3+2+1)IironTIBCferritinZPPB12folatered cell folatevitamin CzincTFT5Anaemia - ? haemolysisIx (8+2)åFBC = vreticulocytes = ^film = RBC fragÝÅments / spherocytes etc.DCT = +ve (if AIHA)haptoglobin = ^LDH = ^unconjugated bilirubin = ^urinary urobilinogen = ^urinary haemosiderin (Perl's)plasma met-haemalbumin (Schumm's)5Angioid Streaks Causes (4)Paget'sSCDPXEEDS5 Anion Gap Calculationn{ [Na] + [K] } - { [Cl] + [HCO3] }-> normal range = 10-18 mmol/l(1 g/l v albumin -> 0.25 mmmol/l v AG)Ankylosing SpondylitisFeatures¯5Anorexia NervosaFeaturesBcold sensitivityhypothermiav HRv BPconstipationrestlessness5Anorexia NervosaIx (8)leukopenia (lymphocytosis)v T3v FSH / LH^ GH^ cortisol^ cholesterollong flat glucose tolerance curveloss of cortisol diurnal variation5Anorexia NervosaPoor Prognosis (6)poor childhood adjustmentpoor parental relationshipsolder onsetsevere weightlossbulimic patternanxiety on eating in publicAnthraxFeatures 65Anti-Cholinergics Examples (5)@TCA'sphenothiazineschlorpheniraminepropanthilineamantidine Anti-Emetics Classes (4)!Â5Anti-Platelet DrugsMechanisms (4)ÿaspirin-> inhibits COX-1-> v TX-A2dipyridamole-> inhibits phosphodiesterase -> ^ cAMP-> ^ PG-I2clopidogrel-> blocks platelet surface ADP receptor-> v activity of (COX-1) + GP-IIb/IIIa-Racbiximab= mAb-> blocks glycoprotein IIb/IIIa receptorAnti-Platelet Rx ATC Results"é5Antibiotic Choice Factors (4+4)Šefficacybactericidal / bacteriostaticsensitivitymechanism of resistanceroute of administrationpenetrationdose / durationtoxicity…A^ supra-orbital ridge, jaw, nose, earsdental spreading + prognathismmacroglossiadeep voicespade-like/doughy handsthick/greasy skinbitemporal hemianopiacarpal tunnel syndromeDMsleep apnoeahypertensioncardiomyopathyhypercalciuria -> renal stoneschondrocalcinosis -> pseudogoutproximal myopathyperipheral neuropathy^ risk of colonic carcinomaoverall x2 mortality untreatedíACONGENITAL ANOMALIES : * variousGONADAL DYSGENESIS : * Turner's (XO) * XY dysgenesis (risk of malignancy)HYPOGONADOTROPISM : * 1° = Kallman's * hypothalamic disorder * BMI < 19 / body fat < 17% * excess exerciseHYPERPROLACTINAEMIA : * prolactinoma (60%) * tumour compression effects * hypothyroidism (^ TRH -> ^ PL) * dopamine antagonists + other drugsOVARIAN FAILURE : * primary ovarian failure (POF) * resistant ovary syndrome (ROS) * polycystic ovary syndrome (PCOS)ùB pH pCO2 HCO3resp. acidosis v / n ^^ ^resp. alkalosis ^ / n vv (v)met. acidosis v / n v vvmet. alkalosis ^ / n (^) ^^pH < 7.35 = acidosispH > 7.45 = alkalosisacidosis + pCO2 > 6.0 = respiratory (HCO3 > 22)acidosis + pCO2 < 6.0 = metabolic (HCO3 < 22)alkalosis + pCO2 < 4.5 = respiratory (HCO3 < 28)alkalosis + pCO2 > 4.5 = metabolic (HCO3 > 28)resp. acid. + HCO3 > 28 = compensatedmet. acid. + pCO2 < 4.5 = compensatedresp. alk. + HCO3 < 22 = compensatedmet. alk. + pCO2 > 6.0 = compensatedIATRANSUDATE (protein < 30 g/l) * portal hypertension (eg. cirrhosis) * RVF (eg. constrictive pericarditis) * hypoalbuminaemia (eg. nephrotic) * Meig's syndrome (ovarian fibroma)EXUDATE (protein > 30 g/l) * infection * malignancy * Budd-Chiari / IVC thrombosis * lympatic obstruction * pancreatitis * hypothyroidismAostium secundum (60%) : * small -> presents @ 20-40y * RBBB + RAD + RVH * assoc. AF + WPW + SAN diseaseostium primum (30%) : * large -> presents @ 0-20y * RBBB + LAD * assoc. MR + TRsinus venosus (10%) : * small in upper septum near SVC * assoc. pulmonary venous anomaliesØGÿÿÍT6}XubAò=ì5Nù5AchondroplasiaFeatures™AD - chromosome 4 - FGFR3 geneassoc. with ^ paternal agetrunk = normal lengthlimbs = short + broadskull = enlargedface = smallnose = flat bridge AcromegalyExamination (4x2+5x2)… AcromegalyIx (8)G5Acute Phase Proteins Examples (10)zC-reactive proteina1-antitrypsincaeruloplasminferritinfibrinogenhaptoglobinALPGGTcomplement (C9)serum amyloid PAcute Tubular Necrosis Causes (10)5 ACE : ^ LevelCauses (1+4+1+2)|sarcoidosis (> 2 SD's in 75%)tuberculosislymphomaasbestosissilicosisother granulomatous diseasesleprosyGaucher's5Adenoma SebaceumSee ... "Tuberous Sclerosis"5Afferent Pupillary Defect Causes (6)€central retinal artery occlusionischaemic optic neuropathyoptic neuritisoptic nerve compressionglaucomaretinal detachment5AIHA Causes (3+3)¼"warm" : * autoimmune disease * LPD * drugs (methyldopa)"cold" : * infection (mycoplasma,EBV,CMV) * LPD * paroxysmal cold haemoglobinuria5AIHA Features (3)eintra + extra-vascular haemolysis"warm" = IgG -> strongly +ve DCT"cold" = IgM -> weakly +ve DCT5AIHARx (2+2)"warm" -> steroids (80% recover)? immunosuppression / splenectomy"cold" -> underlying causeother Rx's usually ineffective5AITPAssociations (5+2)\AIHA (Evans's syndrome)viruses (inc. HIV)CLLSLEdrugs(thyroid disease)(solid tumours)5 AITP (Acute)Features (2+2)omostly childrenusually post-viralmostly resolves spontaneouslyif symptomatic -> steroids / immunoglobulin5AITP (Chronic)Features (1+2+6)Ÿmostly adult women-> autoantibodies in 60-70%= vs. platelet membrane glycoproteinsbruising + purpuraepistaxis + menorrhagia(haemorrhage + splenomegaly)AITP (Chronic)Rx (2+4+2+1+1)J5Alcoholic Liver DiseaseFeatures - Uncommon (6)Œpyrexiahaemolysis + ^ lipids (Zieve's)myoglobinaemia (myopathy)^ beta + gamma globulins^ liver iron deposits (Kupffer cells)HCC (10%)^±²³´µ¶·¸¹º»¼½¾`ë Myotonia Cp‹ Noonan's S€)Osteoporos˜Pelvic Inf 'PneumatosiЖPseudo-BulàQ Feverð´Rhabdomyol“Sheehan's SVAS áThyroid Ey00Ulceration@dVagal TonePáThyroid Ey00Ulceration@dVagal ToneP´Rhabdomyol“Sheehan's SVAS áThyroid Ey00Ulceration@dVagal TonePÜASeems like everything needs a disclaimer these days ... here's mine :This data is for information only and is in no way meant to be a substitute for professional medical care or formal medical training. Whilst all reasonable care has been taken in compiling this data, the author makes no guarantee as to its completeness, accuracy or suitability for use. Access and use of this data is undertaken entirely at the user's own risk.Mark physik Baileyphysik@physik.co.ukÑ@Y€%1 Dedication¼ Timothy Bailey 1975-1999 I will always miss you + life will never quite be the same - cya later kid ... www.timothybailey.com>BPhysik's Lists is not meant to compete with any of the reputable medical text books that have been converted to the handheld / palmtop computer formats.It is not intended to be a comprehesive text itself, but is a compilation of the aide-memoirs that I have found particularly useful in clinical practice (general internal medicine) and exam preparation (MRCP - UK & Ireland). I hope it will be equally useful for USMLE.Physik's Lists should complement a more comprehensive text and I hope that you find it as useful as I have.Mark physik Baileyphysik@physik.co.uk$@;@:Preface version 1.0÷>@-ÿÿá©%þÙ¹ZØ=)¡<5 Apex BeatPathology (4+4)ÇLV hypertrophy = pressure overload-> normal position + "heaving"eg. athletes, ^BP, AS, HOCMLV dilatation = volume overload-> inf./lat. displacement + "thrusting"eg. MR, AR, MI, cardiomyopathy5Aplastic AnaemiaCauses (3+2+3)–Fanconi's (AR)idiopathic (50%)pregnancyinfections (hepatitis,measles,PVV,HIV,TB)haemolysis (PNH,HS = esp. + infection)drugschemicalsradiation5Aplastic AnaemiaRx (3+3)Îanti-lymphocyte globulin -> 55% recoverALG + cyclosporin -> 80% recoverMRD BMT -> 90% 3YSno benefit from haemopoietic factors(occasionally if chronic / refractory)(but levels usually n / ^ already)5 Apoprotein A1 Details (4)ha-apolipoproteinpart of HDL moleculesinverse relationship to IHD^ in nephrotic syndrome (as is HDL)5APC resistanceFeatures (2+2+2+1)¡AD - ch.1APC resistance = factor V Leiden5% of population20% of venous thrombosesx3 risk of venous thrombosisx3 risk of recurrent PEx35 risk with COCP5APLS Features (8)µarterial/venous thrombosismiscarriagesthrombocytopeniaanti-cardiolipin antibodiesatherosclerosisvalvular heart diseaseepilepsy, chorea, migrainelivedo, vasculitis, necrosis5APLSIxu^ APTT-> no correction with normal plasma= indicates presence of inhibitor(excludes clotting factor deficiency)5APLSRx>primary prevention = aspirinsecondary prevention = warfarin5APMLFeatures¦AML type M3 = t(15,17) translocation-> DICRx = usual DIC Rx all-trans-retinoic acid (ATRA) consolidation chemotherapyPx = good after acute stage5APTT ^ Causes (6)š-> mMÃeasures intrinsic pathwayheparinAPL syndromehaemophilia Ahaemophilia Bfactor XI deficiency (mild bleeding)factor XII deficiency (no bleeding)Arterial Blood GasesInterpretation*ù5ARDS Causes (5)Zsepticaemianear-drowninggastric aspirationmultiple transfusionsprolonged hypotension5AsbestosTypes¾a mixture of minerals arranged in fibreswhite = chrysolite least fibrogenic restricted useblue = crocidolite most fibrogenic now banned from use5Asbestos-Related Disease Types (3+3)cpleural thickeningpleural plaquespleural effusionsmesotheliomabronchial carcinomaasbestosis5 AsbestosisFeatures’pulmonary +/- pleural fibrosis-> dyspnoea finger-clubbing basal late inspiratory cracklesCXR = possibly normalHRCT = more sensitiveAscites Causes (4+6),IµJÿÿ5‰ñ±ñ9AP HCCcompensated + abstinence -> 90% 5YS + still drinks -> 60% 5YSafter decompensation -> 50% 1YS 35% 5YS5 Aldosterone Actions (5)ˆsodium + water retentionpotassium + magnesium losssympathetic activationparasympathetic inhibitionmyocardial / vascular fibrosis5AlopeciaCauses (2+2+2+4)àSLE (scarring)lichen planus (scarring)androgenetic (myotonic dystrophy)telogen effluvium (post-partum)alopecia areatadrugs (cytotoxics,anticoagulants)hypopituitarismhypoparathyroidismhypothyroidismhyperthyroidism5Alopecia areataAssociations (6x2)‡alopecia areatavitiligoSjögren'sMGHashimoto'sGrave'sautoimmune v PTHselective IgA deficiencyIDDMAddison'sPAcoeliac disease5Alport's SyndromeFeatures (1+3+2)~AD or X-linked inheritenceGNhaematuriaprogressive renal failurehigh-frequency nerve deafnessocular abnormalities (15%)5Alzheimer's DiseaseFeatures (3+3)—insidiousno atherosclerosisno focal signs (until late in disease)global cognitive deficitglobal personality impairmentv insight -> v depression5Alzheimer's DiseaseRxucholinesterase inhibitors :if mild-moderate (MMTS = 10-26 / 30)20% -> global improvementbut ? long term benefit5ALL Prognosis€with Rx : 5YS = 60% in children 5YS = 30% in adultsv with : ^ age ^^ WCC B cell type AmenorrhoeaCauses (1+2+4+4+3)í AmenorrhoeaIx (5x4)5Aminophylline (IV)Dosingþ-> 5 mg/kg over 30 minutes(unless already taking aminophylline)(but do give if [aminophylline] is low)-> 0.5 mg/kg/hour infusion(v 50% in heart/liver failure)(^ 50% in adult who smoke)(make up 500 mg in 500 ml)(-> {1/2 body weight} in ml/hour)5Amyloid NephropathyFeatures (3+4)®proteinurianephrotic syndromerenal failureeosinophilic infiltrationpolarising light -> green birefringenceCongo red -> pink stainingimmuno-stains -> AL vs. AA amyloid5Amyloidosis (1°) (AL)Features (2+10+2)÷= a plasma cell dyscrasiaassociated with other LPD'spurpuramacroglossia (20%)cardiomyopathyconstrictive pericarditishepatomegaly(splenomegaly)nephropathyarthropathyneuropathycarpal tunnelparaproteinaemiaurinary Bence-Jones protein5Amyloidosis (2°) (AA)Associations (10)ˆRAank. spond.UCCrohn'sTBleprosyHL/NHLcarcinomaparaplegiachronic sepsis : osteomyelitis bronchiectasis5Amyloidosis (2°) (AA) Features (6)(thyroidheartliverspleengutkidneys5Amyloidosis (Familial)Features (1+3+1)several types described ->neuropathy (autonomic)nephropathy (esp. FMF)cardiac conduction disordersfamilial CJD is relatedG)ÿÿY@™eÑü.øiìd^ÆTT5Antibiotic Resistance Aetiology (4)ppoint mutationtransformation (naked DNA)transduction (bacteriophage)conjugation (R factor plasmid transfer) Antibiotics Mechanisms$w5ANAAssociations (6+4)nSLE (95%)SS (80%)Sjögren's (60%)RA (30%)PM/DM (30%)Still's (30%)CAHPBCinfections (IE)elderly5ANCA'sAssociations (1+11)ÉcANCA with Wegner's :sensitivity = 50-100%(marker of disease activity)specificity = 90%(also in other vasculitides)pANCA with :PANCSSHSPUCGNRASLECAHPSCSjögren'sdrugs (hydralazine)5ANP Actions (8)‡natriuresisvasodilation^ GFRv BPv renin secretionv aldosterone secretionv angiotensin II activityv Na retention by aldosterone5ANPSecretion (3+3)žtype A = atrialtype B = ventriculartype C = endothelial^ secretion in : SVT cardiac failure renal failure5ANP Uses (Ix)nmild heart failurepost-MI screeningLVH (in ^BP / HOCM)optimising diuretic useexercise-induced ischaemiaANP Uses (Rx)@45Aortic DissectionAssociations (2+2+4+2)QhypertensionpregnancyCoABAVMarfan'sTurner'sNoonan'sEhlers-DanlosSLEGCA5Aortic DissectionClassification·De Bakey : I = ascending + descending II = ascending only III = descending onlyShumway : A = any ascending B = descending only5Aortic RegurgitationAssociations (3+3)LIERhFsyphilisaortic dissectionMarfan's syndromeankylosing spondylitisAortic RegurgitationEponymous Signs (8)%$Aortic RegurgitationExamination (10)&_5Aortic Stenosis Causes (4)FBAV (found in 1% of general population)RhFcalcificationcongenitalAortic StenosisExamination (10)'gAortic StenosisSeverity (5+3+2)(}ÂEQÿ=ð^öAr5 AspergillusIx¾ prick test precipitins ABPA + +aspergilloma - +++aspergillosis - +/-5Atrial FibrillationCauses (4+4+1)SAMIIHDMVDCHFalcoholinfection (LRTI)hyperthyroidismhyperkalaemiaidiopathic5 Atrial MyxomaFeatures (2+4)¨75% LA (rarely bilateral + ASD)benign - but friable + may metastasise-> embolism mitral regurgitation pulmonary hypertension autoimmunity / vasculitisAtrial Septal DefectFeatures (4+4+3).5Austin-Flint MurmurFeatures\= MDM at apex occurring in severe ARfrom regurgitant jet -> AMVL or because LVDP > LADP5Auto-AntibodiesAssociations (4+2+2+1+1)üdsDNA = SLE (50% sensitive, ^ specific)ENA = SLE + MCTDAC = SLE + APL syndromeSm = SLE (5-30%)Ro = SLE + Sjögren's (-> fetal CHB)La = (SLE) + Sjögren'sScl-70 = SS (25%)nucleolus = SScentromere = CRESTJo-1 = PM (35%) DM (5%)5Auto-Immune DisordersRespiratory (3)hWegner's : cANCA +ve / monocytosisPAN : pANCA +ve / neutrophiliaCSS : pANCA + ve / eosinophilia5Autonomic Neuropathy See ... "Neuropathy - Autonomic"5Avascular NecrosisCauses (4x4+1)âpregnancyalcoholsteroids + other immunosuppressantsNSAID'sPerthe'sCaisson's (divers)Gaucher'sfracturesfat embolushyperlipidaemiapancreatitisdiabetes mellitusSCD (in10%)PRVhaemophiliavasculitis (RA,SLE)DXT­HS = significant (statistically)sAg = surface antigenSAH = sub-arachnoid haemorrhageSAN = sino-atrial nodeSBM = spino-cerebellar muscularSBP = systolic blood pressureSC = sclerosing cholangitisSC = subcutaneousSCC = squamous cell carcinomaSCD = sickle cell diseaseSD = sclerodermaSD = standard deviationSERM = selective estrogen receptor modulatorSFX = side-effectsSHBG = sex hormone binding globulinSI = small intestineSIADH = syndrome of inappropriate ADHSj's = Sjögren's syndromeSJS = Stevens-Johnson syndromeSLE = systemic lupus erythematosisSMA = spinal muscle atrophySmMA = smooth muscle antibodySNA = sero-negative arthritisSR = slow releaseSRV = small round virusSS = systemic sclerosisSSPE = subacute sclerosing pan-encephalitisSSS = sick sinus syndromeSSSS = staphylococcal scalded skin syndromeSSZ = sulphasalazineStaph. = StaphylococcusSTD = sexually transmitted diseaseStMA = striated muscle antibodyStrep. = StreptococcusSTS = somatostatinSVAS = supra-valvular aortic stenosisSVC = superior vena cavaSVCO = SVC obstructionSVT = supra-ventricular tachycardiaSXR = skull radiographt1/2 = half-lifeT3 = thyroxine T3T4 = thyroxine T4TB = tuberculosisTBG = thyroxine binding globulinTCA = tri-cyclic anti-depressantTdP = Torsades de Pointes = polymorphic VTTDS = x3/dayTEN = toxic epidermal necrolysisTFB = tri-fasicular blockTFT = thyroid function testsTG = triglycerideTGF = transforming growth factorTIA = transient ischaemic attackTIBC = total iron binding capacityTIPS = transjugular intrahepatic portosystemic shuntTLC = total lung capacityTLCO = pulmonary transfer factorTMJ = temporo-mandibular jointTNF = tumour necrosis factorTOE = trans-oesophageal echocardiographyTOP = termination of pregnancyTPA = tissue plasminogen activatorTPM = temporary pacemakerTPN = total parental nutritionTPR = total peripheral resistanceTR = tricuspid regurgitationTRH = thyrotropin releasing hormoneTS = tricuspid stenosisTSH = thyroid stimulating hormoneTSSU = terminal stream specimen of urineTT = thrombin timeTTE = trans-thoracic echocardiographyTTP = thrombotic thrombocytopaenic purpuraTV = tricuspid valvetx = tranexamicTX = thromboxane]Fo+c+p = ova + cysts + parasitesO2 = oxygenOA = osteoarthritisOCP = oral contraceptive pillOD = once dailyOGTT = oral glucose tolerance testOM = osteomalaciaONP = oro-naso-pharyngealOP = osteoporosisOPV = oral polio vaccineOWR = Osler-Weber-Rendu syndromep.a. = per annumPA = pernicious anaemiaPAN = polyarteritis nodosumPBC = primary biliary cirrhosisPCOS = polycystic ovary syndromePCP = Pneumocystis carinii pneumoniaPCR = polymerase chain reactionPCV = packed cell volumePD = Parkinson's diseasePDA = patent ductus arteriosusPE = pulmonary embolusPEFR = peak expiratory flow ratePEO = progressive external opthalmoplegiaPF = pulmonary fibrosisPFO = patent foramen ovalePFT = pulmonary function testsPG = prostaglandinPI = protease inhibitorPIP = proximal interphalangealPK = phosphokinasePKD = polycystic kidney diseasePL = prolactinplts = plateletsPM = polymyositisPMF = progressive massive fibrosisPMR = polymyalgia rheumaticaPNH = paroxysmal nocturnal haemoglobinuriaPO4 = phosphatePO = per oram = by mouthPOF = primary ovarian failureposs. = possiblePP = pulse pressurePPM = permanent pacemakerPRCA = pure red cell aplasiaPRV = polycythaemia rubra veraPs. = PseudomonasPS = pulmonary stenosisPSC = primary sclerosing cholangitisPSM = pan-systolic murmurPT = prothrombin timePTH = parathyroid hormonePTH-RP = PTH-related peptidePUD = peptic ulcer diseasePUO = pyrexia of unknown originPV = plasma viscosityPVD = peripheral vascular diseasePVR = pulmonary vascular resistancePVV = parvovirusPW = Prader-Willi syndromePx = prognosisPXE = pseudoxanthoma elasticum®Hca. = carcinomaCa = calciumcAg = core antigenCAH = chronic active hepatitisCAH = congenital adrenal hyperplasiaCAPD = continuous ambulatory peritoneal dialysisCCB = Ca channel blockerCCK = cholecystokininCD = Crohn's diseasecf. = because ofCF = cystic fibrosisCFA = cyptogenic fibrosing alveolitisch. = chromosomeCH = cholesterolCH = chronic hepatitisCHB = complete heart blockCHF = chronic heart failurechr. = chromosomeCI = confidence intervalCIDP = chronic inflammatory demyelinating polyneuropathyCIN = cervical intra-epithelial neoplasiaCJD = Creutzfelt-Jakob diseaseCl = chlorideCL = cutaneous leishmaniasisCLL = chronic lymphocytic leukaemiaCM = chylomicronCML = chronic myeloid leukaemiaCMT = Charcot-Marie-Tooth diseaseCMV = cytomegalovirusCN = cranial nerveCNS = central nervous systemCoA = coarctation of the aortaCO = carbon monoxideCO2 = carbon dioxideCOAD = chronic obstructive airways disease = COPDCOCP = combined oral contraceptive pillCOPD = chronic obstructive pulmonary disease = COADCOX = cyclo-oxygenaseCPH = chronic persistant hepatitisCPP = cyclophosphamidecr = creatinineCREST = calcinosis + Raynaud's + esophageal dysmotility + scleroderma + telangiectasiaCRF = chronic renal failureCRF = corticotropin releasing factorCRP = C-reactive proteinc+s = culture + sensitivityCSF = cerebro-spinal fluidCSS = Churg-Strauss syndromeCSV = Coxsackie virusC.t. = Chlamydia trachomatisCT = computerised tomographyCTD = connective tissue disorderCVA = cerebro-vascular accidentCVS = cardio-vascular systemCXR = chest radiographd = daysDBP = diastolic blood pressureDC = direct currentDCT = direct Coomb's testD-d = D-dimersDDAVP = desmopressinDI = diabetes insipidusDIC = disseminated intravascular coagulationDIP = distal interphalangealdis. = diseaseDKA = diabetic keto-acidosisDM = dermatomyositisDM = diabetes mellitusDMD = Duchenne muscular dystrophyDMI = depo-medrone injectionDNA = deoxyribonucleic aciddsDNA = double-stranded DNADoB = date of birthDPG = diphosphoglycerateDRPL = dentato-rubral-pallido-lyusianDU = duodenal ulcerD+V = diarrhoea + vomitingDVT = deep vein thrombosisDXT = radiotherapyDZT = di-zygotic twinsÑIm2 = metre squaredmAb = monoclonal antibodyMAC = mycobacterium avium complexMAI = mycobacterium avium intracellulareMALT = mucosa associated lymphoid tissuemcg = microgrammesm+c+s = microscopy + culture + sensitivityMCH = mean cell haemoglobinMCHC = mean cell haemoglobin concentrationMCL = muco-cutaneous leishmaniasismcmol = micromolsMCN = minimal change nephropathyMCTD = mixed connective tissue disorderMCU = micturating cysto-urethroscopyMCV = mean cell volumeMD = myotonic dystrophyMDS = myelodysplastic syndromeMDM = mid-diastolic murmurMDMA = methylene-dioxy-metamphetamineMELAS = mitochondrial encephalopathy + lactic acidosis + stroke-like episodesMEN = multiple endocrine neoplasiaMERRF = myoclonic epilepsy with ragged red (muscle) fibresMESNA = uromitexanm : f = male : femaleMF = myelofibrosismg = milligrammesMg = magnesiumMG = myaesthenia gravisMHA = Mental Health Act (UK)MHR = maximum heart rateMI = myocardial infarctionMIBG = meta-iodo-benzyl-guanidineMID = multi-infarct dementiaml = millilitremm3 = cubic millimetreMM = multiple myelomaMMR = measles-mumps-rubellaMND = motor neurone diseaseMNG = multi-nodular goitreMOF = multi-organ failureMPD = myeloproliferative disorderMPGN = membrano-proliferative GNMPS = mononuclear phagocyte systemMR = magnetic resonanceMR = mitral regurgitationMRCP = Membership of the Royal College of PhysiciansMRD = matched related donorMS = mitral stenosisMS = multiple sclerosisMTB = Mycobacterium tuberculosisMTX = methotrexateMVD = mitral valve diseaseMVP = mitral valve prolapseMZT = mono-zygotic twinsn = normalN2 = nitrogenNa = sodiumNAd = nor-adrenalineNAP = neutrophil alkaline phosphotaseNARTI = nucleoside analogue reverse transcriptase inhibitorNCS = nerve conduction studiesNCT = normally conducted tachycardianDI = nephrogenic DINEI = neutral endopeptidase inhibitorNF = neurofibromatosisN.g. = Neisseria gonorrhoeaeNGU = non-gonoccal urethritisNHL = Non-Hodgkin's lymphomaNIDDM = non-insulin dependant DMNL = necrobiosis lipoidicaNM = neuro-muscularnmol = nanomolsNNRTI = non-nucleoside reverse transcriptase inhibitorNNTT = number needed to treatNO = nitric oxideNOF = neck of femurNPH = normal pressure hydrocephalusNP-Y = neuropeptide YNS = nervous systemNS = non-significant (statistically)NSAID = non-steroidal anti-inflammatory drugNSU = non-specific urethritisnvCJD = new variant CJDN+V+D = nausea + vomiting + diarrhoeaNYHA = New York Heart Association‹@Table1*Main Title ÿ œÿÿÿd&Sub-Title ÿ œÿÿÿdNoteÿÿÿÿœÿÿÿd¦@OOOÿÿÿOOOÿÿÿJ@iTable1 ColA1 ÿColB1ColA2 ÿColB2ColA3ColB3 !Aoccurs in 3%typically within 5-15 daysusually multiorgan - rarely just rashfever 70-80%rash 60-80%N+V+D 50%malaise 50%mucosal lesions = not SJSv lymphocytesv platelets^ LFT's^ CKwithdrawl of Rx -> rapid resolutionusually within 24h or 72h for rash! 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