House Move and MRCP Part 2

It's all about the house move at the moment - here's a photo taken a couple of weeks ago inside the new house. Still quite a lot of work needing done but things are moving along well. Most of my time at the moment seems be spent either working, packing or studying. First set of CMT nights about to come up this week (starting tomorrow) followed by a week of annual leave!

MRCP Part 2 is about 6 weeks away now so time to do lots of practice questions. Here are some interesting topics which I've been revising over the past few days:

Spironolactone in heart failure - The RALES study showed that adding spironolactone to existing therapy in patients with severe clinical heart failure and an ejection fraction of <35 ace="" added="" already="" an="" and="" benefit.="" diuretics="" inhibitor="" loop="" shows="" span="" survival="" taking="">

Post-MI Mitral Regurgitation – A 56 year-old man becomes acutely unwell on the cardiology ward 4 days after an MI with evidence of acute LVF. Cause? Acute mitral regurgitation due to ruptured chordae tendonae. If blood pressure allows, these patients benefit from volume reduction using diuretics and initiation of an ACE inhibitor.

Cholesterol Emboli - The clinical syndrome associated with cholesterol emboli is: low C3 level, eosinophilia, raised ESR and urine proteinuria. Cholesterol emboli occurs in patients with existing arterial disease who undergo arterial manipulation – the patient develops a purpuric rash over the feet with impaired blood supply to the lower limbs.

 

Dermatitis Herpetiformis – This is an immune mediated blistering skin disease associated with gluten-sensitive enteropathy. Characteristically it causes a very itchy rash with blistering lesions over the extensor surfaces. First line treatment is with Dapsone. Dapsone is usually given initially because it allows for a faster recovery compared to a gluten-free diet alone.

Drug-Induced Hepatitis asoc with Anti-TB Therapy – Pyrazinamide should not be used in patients with known chronic liver disease. Rifampicin should be avoided where there is decompensated liver disease. Ethambutol can accumulate in patients with chronic renal failure leading to optic neuropathy and therefore should be given at a lower dose.

Progressive Supranuclear Palsy – This is a rare, progressive disorder that causes adult-onset Parkinsonism with postural instability and multiple falls. Impaired DOWN-gaze is always pathological (impaired upgaze can be seen in normal elderly patients).

Coeliac Disease – This is a common condition, with a prevalence of approximately 1 in 100 people (up to 1 in 30 in parts of Ireland). Severe malabsorption can lead to Vitamin D deficiency with secondary hyperparathyroidism, low albumin, impaired clotting, iron deficiency anaemia and weight loss. Iron deficiency anaemia is the most common presentation of coeliac disease and stool is FOB positive in approximately 50% of cases. The presence of other autoimmune conditions makes the diagnosis much more likely.

Invasive aspergillosis - This condition usually manifests with fever, cough, dyspnoea and pleuritic chest pain in patients with prolonged neutropenia or immunosuppression.