PassMedicine Top 100 Concepts
CARDIOLOGY
Nicorandil
Nicorandil may cause ulceration anywhere in the gastrointestinal tract
Complete heart block
Complete heart block causes a variable intensity of S1
Peri-arrest rhythms: tachycardia
In the context of a tachyarrhythmia, a systolic BP DC cardioversion
Hypertension: management
Blood pressure target (
Pulses
Bisferiens pulse - mixed aortic valve disease
Long QT syndrome
Hypokalaemia can lead to long QT syndrome
CLINICAL SCIENCES
Vitamin B1 (thiamine)
Dry beriberi is caused by thiamine deficiency and causes peripheral neuropathy
IL-1
Sepsis triggers the release of IL-1 causing vasodilation --> hypotension
Membrane receptors
Insulin binds to a receptor tyrosine kinase in the cell membrane
Oncogenes
RET - multiple endocrine neoplasia (types II and III)
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Significance tests
Power = 1 - the probability of a type II error
Renal stones
Renal stones are most commonly composed of calcium oxalate
ENDOCRINOLOGY
Fibrates
Fibrates may increase the risk of venous thromboembolism
Hyponatraemia: treatment
Osmotic demyelination syndrome develops secondary to astrocyte apoptosis
Graves' disease: features
TSH antibodies are found in 90% of patients with Graves' disease and can help distinguish from other forms of
hyperthyroidism
Congenital adrenal hyperplasia
Congenital adrenal hyperplasia is most commonly due to 21-hydroxylase deficiency
Pituitary adenoma
Non-functioning adenomas are generally diagnosed due to their compressive symptoms (e.g. visual problems) or
hormone deficiencies - transsphenoidal surgery is therefore the first-line treatment
Hypophosphataemia
Refeeding syndrome causes hypophosphataemia
Corticosteroids: side-effects
Glucocorticoid treatment can induce neutrophilia
Thyroid storm
Thyrotoxic storm is treated with beta blockers, propylthiouracil and hydrocortisone
Thyroid cancer
Hashimoto's thyroiditis is associated with thyroid lymphoma
Primary hyperaldosteronism
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Bilateral idiopathic adrenal hyperplasia is the most common cause of primary hyperaldosteronism
Corticosteroids
Corticosteroids can induce neutrophilia
Primary hyperparathyroidism
The definitive management of primary hyperparathyroidism is total parathyroidectomy
Klinefelter's syndrome
Klinefelter's syndrome - elevated gonadotrophin levels
Diabetes mellitus: management of type 2
T2DM initial therapy: if metformin is contraindicated + patient has a risk of CVD, established CVD or chronic heart
failure --> SGLT-2 monotherapy
Prolactin and galactorrhoea
Causes of raised prolactin - the p's - pregnancy - prolactinoma - physiological - polycystic ovarian syndrome -
primary hypothyroidism - phenothiazines, metoclopramide, domperidone
Pregnancy: thyroid problems
Women with hypothyroidism may need to increase their thyroid hormone replacement dose by up to 50% as early as
4-6 weeks of pregnancy
Kallmann's syndrome
Kallman's syndrome - LH & FSH low-normal and testosterone is low
Subacute (De Quervain's) thyroiditis
Thyrotoxicosis with tender goitre = subacute (De Quervain's) thyroiditis
Diabetes mellitus: Ramadan
During Ramadan, one-third of the normal metformin dose should be taken before sunrise and two-thirds should be
taken after sunset
Acromegaly: investigations
Serum IGF-1 levels are now the first-line test for acromegaly
Glycaemic index
A high glycaemic index food has a greater ability to raise blood glucose compared with glucose in normal glucose-
tolerant individuals
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Thiazolidinediones
Pioglitazone may cause fluid retention
Hypokalaemia and hypertension
11-beta hydroxylase deficiency associated with hypertension
Diabetes mellitus: GLP-1 drugs
Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1
Urinary incontinence
Duloxetine may be used in patients with stress incontinence who don't respond to pelvic floor muscle exercises and
decline surgical intervention
Diabetes mellitus: management of type 2
TD2M: if a triple combination of drugs has failed to reduce HbA1c then switching one of the drugs for a GLP-1
mimetic is recommended, particularly if the BMI > 35
Hypothyroidism: levothyroxine therapy
Iron / calcium carbonate tablets can reduce the absorption of levothyroxine - should be given 4 hours apart
Primary hyperparathyroidism
The PTH level in primary hyperparathyroidism may be normal
Pregnancy: thyroid problems
Raised total T3 and T4 but normal fT3 and fT4 suggest high concentrations of thyroid binding globulin, which can be
seen during pregnancy
Cushing's syndrome: causes
Small cell lung cancer accounts 50-75% of case of ectopic ACTH
Hypocalcaemia: causes and management
Intravenous calcium gluconate is used for the acute management of hypocalcaemia
Syndrome of inappropriate ADH secretion
SIADH is treated with fluid restriction
Thyroid eye disease
Exposure keratopathy is the most common complication of thyroid eye disease
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Primary hyperparathyroidism
Cinacalcet is a calcimimetic - a drug that 'mimics' the action of calcium on tissue by allosteric activation of the
calcium-sensing receptor
Addison's disease: investigations
9 am cortisol between 100-500nmol/l is inconclusive and requires further investigation with a short synacthen test
Hypocalcaemia: features
The most common ECG change in hypocalcaemia is prolongation of the QTc interval
Polycystic ovarian syndrome: management
Infertility in PCOS - clomifene is typically used first-line
Urinary incontinence
Mirabegron is a beta-3 agonist
Hashimoto's thyroiditis
Hashimoto's thyroiditis is associated with the development of MALT lymphoma
Addison's disease: investigations
A normal short synacthen test does not exclude adrenocortical insufficiency due to pituitary failure
Subacute (De Quervain's) thyroiditis
Subacute thyroiditis causes hyper- then hypothyroidism
Hypercalcaemia: causes
In hypercalcaemia secondary to malignancy, PTH is low, although PTHrP may be raised
Corticosteroids: side-effects
Systemic glucocorticoids can cause drug-induced acne. This is characterised as monomorphic papular rash without
comedones or cysts. This does not respond to acne treatment but improves on drug discontinuation
Thiazolidinediones
Pioglitazone - contraindicated by: heart failure
Carbimazole
Carbimazole blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin -->
reducing thyroid hormone production
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Gitelman's syndrome
Gitelman's syndrome is due to a reabsorptive defect of the NaCl symporter in the DCT
Diabetes mellitus: GLP-1 drugs
Exenatide = Glucagon-like peptide-1 (GLP-1) mimetic
Thiazolidinediones
Glitazones are agonists of PPAR-gamma receptors, reducing peripheral insulin resistance
DVLA: diabetes mellitus
Patients on insulin may now hold a HGV licence if they meet strict DVLA criteria
GASTROENTEROLOGY
Proton pump inhibitors
Omeprazole can increase your risk of severe diarrhoea (Clostridium difficile infections)
Ulcerative colitis: management
If a mild-moderate flare of ulcerative colitis does not respond to topical or oral aminosalicylates then oral
corticosteroids are added
Variceal haemorrhage: management
Terlipressin - method of action = constriction of the splanchnic vessels
RESPIRATORY MEDICINE
Chest drain
The triangle of safety for chest drain insertion involves the base of the axilla, lateral edge pectoralis major, 5th
intercostal space and the anterior border of latissimus dorsi
Sarcoidosis: investigation
Sarcoidosis CXR - 1 = BHL - 2 = BHL + infiltrates - 3 = infiltrates - 4 = fibrosis
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