Mrcp pearls-Medicinelogy

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🍀 Easy steps to diagnose ge***al ulcer🍀

☘Other causes of ge***al ulcer:

1. - Usualy painless.

2. 's disease: Recurrent oral + recurrent ge***al ulceration.

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🔥Gout Vs pseudogout

🍀 Very important topic of

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🍀 Wilson's disease:

1. Wilson's disease increases the risk of liver cirrhosis, but it's not a risk factor of hepatocellular carcinoma.

2. In every liver disease serum ceruloplasmin will be increased except wilson's disease.

🍀 Examinations:

🍁 Slit lamp examination: Kayser-fleischer ring.

🍀 Investigation:

1. Reduced serum caeruloplasmin

2. Reduced total serum copper.

3. Free serum copper is increased

4. 24hr urinary copper excretion is .

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🍀 Aromatase inhibitors:

1. Anastrozole.

2. Letrozole.

🍀 Function of aromatase enzyme:

🍁 Converts androgens into estrogens.

🍁Note: Aromatisation accounts for the majority of peripheral oestrogen production in postmenopausal women.

🍀 Indication:

🍁 Oestrogen receptor positive breast cancer.

🍀 Precaution:

NICE recommends a scan when initiating a patient on aromatase inhibitors.

🍀 Adverse effects:
1. . ( )
2. Hot flushes.
3. Arthralgia.
4. Myalgia.
5. Insomnia.

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1. Give I/M glucagon- Hypoglycemic patient unable to drink oral glucose.

2. Give I/V glucagon- Bradycardia due to beta-blocker overdose not responding to atropine.

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🍀Complications of disease:

1. Megaoesophagus.( Presents like achalasia cardia)

2. Megacolon.

3. Dilated cardiomyopathy(DCM)

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🍀 Safe anti-diabetic drugs in CKD🍀

These drugs can be used safely in DM irrespective of eGFR.

1. Glipizide (Sulfonylurea)
2. Repaglinide (Meglitinide)
3. Linagliptin (DPP-4 inhibitors)

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🍀Management of osteoarthritis🍀

A. Initial treatment:
1. .
2. Local muscle strengthening exercises.
3. Aerobic fitness.

B. -line treatment:
1. . ( )
2. OA of the knee or hand: Topical NSAIDs.

C. Second-line treatment:
1. Oral NSAIDs/COX-2 inhibitors
2. Opioids.
3. Capsaicin cream.
4. Intra-articular corticosteroids.

Note: A proton pump inhibitor should be co-prescribed with NSAIDs and COX-2 inhibitors. These drugs should be avoided if the patient takes .

C. Non-pharmacological treatment:
• Supports and braces.
• TENS and
• Shock-absorbing insoles or shoes

• D. Surgery: if conservative methods fail then refer for consideration of joint replacement.

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🍀PR INTERVAL🍀

1. Short PR interval: WPW syndrome.

2. Prolonged PR interval: Heart block.

3. Depressed PR segment: Acute pericarditis- Most specific finding. ( )

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🍁 Sickle cell anaemia- Initially splenomegaly, later functional hyposplenism.

🍁 Thalassaemia major- Always splenomegaly.

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🔥Traveller’s diarrhoea- Enterotoxigenic E. coli.

🔥 Severe vomiting within 1-6hours of eating + Mild diarrhoa- Staphylococcus aureus.

🔥Diarrhoea in child- Viral (rota virus).

🔥Bloody diarrhoea + Pain in right iliac fossa- Campylobacter jejuni.

🔥Flaccid paralysis followed by diarrhoea- Guillain-Barre syndrome by campylobacter jejuni.

🔥Urthritis, arthritis, conjunctivitis followed by diarrhoea- Reactive arthritis by campylobacter jejuni.

🔥Diarrhoea + Renal impairment + Haemolysis- Hemolytic uremic syndrome by E. coli 0157:H7.

🔥Diarrhoea following long term use of second & third generation cephalosporins- Pseudomembranous colitis.

🔥 Diarrhoea after eating reheated rice- Bacillus cereus.

🔥 Diarrhoea among the members of old home/nursing home- Norovirus. ( )

🔥 Gradual onset of bloody diarrhoea + RUQ pain- Amoebiasis.

🔥 Steatorrhoea following history of travel- Giardiasis.

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🍀 Carbamazepine exacerbates two seizures.

1. Absence seizure.

2. Myoclonic seizure.

🍀 Drugs contraindicated in absence seizure:

1. Carbamazepine.

2. Phenytoin.

3. Vigabatrin.

4. Gabapentin.

🍀 Treatment of absence seizure:

1. Ethosuximide.

2. Sodium valproate.