By Kinesh Patel

In the face of knowledge overload whilst revising on your ultimate assessments, what you will want is a revision e-book that offers the entire key evidence you must recognize and none that you just do not. Complete Revision Notes for clinical and Surgical Finals does simply that, proposing info in a stimulating means, which in flip permits effortless recall.

Structured via clinical and surgical specialties, the contents are organised in a weighted type to mirror assurance in undergraduate curricula. With pharmacology and pathology built-in all through, this moment version covers all of the key issues in:

Medicine * surgical procedure * Paediatrics * Obstetrics & Gynaecology * Psychiatry * Orthopaedics * ENT * Urology * Ophthalmology * Oncology * Public Health.

Effective use is made up of student-friendly codes and bullet issues for simple details retrieval, and renowned positive factors together with textboxes, precis tables and transparent and reproducible line diagrams were retained and more advantageous. totally revised and up-to-date with the most recent scientific info, and together with new illustrations, Complete Revision Notes for clinical and Surgical Finals keeps to supply and obtainable and stimulating path to examination good fortune. for those who recognize what's during this booklet then you definately will be aware of adequate to move your finals.

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8 (a) Pericarditis. v. benzylpenicillin + gentamicin); add flucloxacillin in IVDUs Septic emboli, mycotic aneurysms, meningitis, intracranial haemorrhage, emboli, glomerulonephritis Ca r d i o l o g y MISCELLANEOUS HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY (HOCM) P ● A ● Sy ● Si ● Ix ● Rx ● Cx ● Left ventricular hypertrophy, especially involving the septum; varying degrees of myocardial fibrosis ~50 per cent patients have a +ve family history; multiple mutations have been identified; associated with Friedrich’s ataxia Many are asymptomatic; dyspnoea, fatigue, palpitations, angina, syncope, sudden death a wave in the JVP, double apical impulse, ejection systolic murmur at lower left sternal border, pansystolic murmur at the apex, 4th heart sound ECG (LV hypertrophy, Q waves, arrhythmias), CXR (increased cardiothoracic ratio [CTR]), echo (asymmetric septal hypertrophy, systolic anterior motion of the mitral valve, small LV cavity with posterior wall motion, MR) b-blockers/verapamil to improve LV function, amiodarone as anti-arrhythmic, surgery (myotomy/myectomy), ethanol injections into the septum (causes partial infarction of the septum), cardiac pacing; avoidance of any drugs that significantly lower the preload Arrhythmias, ischaemia, sudden death ATRIAL MYXOMA P ● A ● Sy ● Si ● Ix ● Rx ● Cx ● Benign tumour; gelatinous polypoid structure attached to the atrial septum; usually left atrium & > (; 3rd–6th decades; most are sporadic; occasionally familial (autosomal dominant) Fever, dyspnoea, weight loss, arthralgia, syncope; can mimic mitral valve disease (stenosis from the tumour prolapsing into the valve, or regurgitation from related valve trauma) Loud 1st heart sound, tumour ‘plop’ (a loud 3rd heart sound), clubbing Echo, FBC (anaemia or polycythaemia), ≠ ESR Surgical resection Peripheral or pulmonary emboli 13 M e di c i ne RESPIRATORY RESPIRATORY INVESTIGATIONS Chest radiography (CXR): be careful to look at the apices, behind the heart and costophrenic angles ● Computed tomography (CT): better at distinguishing between tissue densities and assessing lesions; high-resolution CT shows subtle parenchymal changes useful in the diagnosis of interstitial lung diseases; CT pulmonary angiography (CTPA) can diagnose pulmonary emboli in the segmental and larger pulmonary arteries ● Ventilation–perfusion scans: albumin labelled with technetium 99m FVC is administered intravenously to FEV1 demonstrate blood flow, and radiolabelled xenon gas is inhaled to demonstrate ventilation.

2 in an infected effusion Glucose: low in empyema, rheumatoid, lupus, TB, malignancy Amylase: raised in acute pancreatitis, oesophageal rupture, malignancy Cytology: positive in ~60 per cent malignancy Aimed at the underlying cause If there is any respiratory compromise a pleurocentesis should be performed. 15 (a) Right pneumothorax: absence of lung markings beyond the lung edge; (b) left-sided tension pneumothorax. 16 CT scan showing extensive interstitial thickening with small cystic spaces in a patient with idiopathic pulmonary fibrosis EXTRINSIC ALLERGIC ALVEOLITIS (EAA) P ● A ● S ● Ix ● Rx ● Hypersensitivity reaction to various antigens Less likely to be smokers than the general population Farmer’s lung (Thermoactinomyces in mouldy hay) and bird fancier’s lung (avian protein on feathers) are most common; other antigens include isocyanates (chemical workers), Aspergillus spp.

Thorax 1999;54:1–28. g. recent travel, recent bowel resection, dairy product intolerance, chronic pancreatitis, etc. Diarrhoea, steatorrhoea, weight loss Anaemia, oedema, hypovitaminosis FBC, U&E, LFT, albumin, calcium, folate, iron, B12, vitamin D, coagulation, coeliac serology, thyroid function1 Further investigations depend on history and results of blood tests indicating possible region of bowel involved: – Imaging: OGD + small bowel biopsy, barium follow-through (BaFT), sigmoidoscopy/colonoscopy, barium enema, SeHCAT scan – Functional testing: 24-h faecal fat, faecal elastase, urinary d-xylose test, 24-h urinary protein (if albumin low), gut hormones aimed at underlying cause: – Whipple’s disease/bacterial overgrowth/tropical sprue: antibiotics – coeliac disease: gluten-free diet – lactose intolerance: avoidance of dairy products – short bowel syndrome: anti-diarrhoeals, low-fat, high-fibre diet; nutritional replacement – chronic pancreatitis: enzyme supplements Gastroenterology COELIAC DISEASE P ● A ● Sy ● Si ● Ix ● Rx ● Cx ● Gluten sensitivity leading to small intestinal enteropathy Affects all ages; peak in 3rd decade Lethargy, weakness, diarrhoea, reduced fertility, weight loss Anaemia Diagnostic tests: OGD + intestinal biopsy showing subtotal villous atrophy, coeliac antibodies (including antibodies to gliadin, endomysium and tissue transglutaminase [tTG]).

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