Must Know Topics

CVS/GIT
Acute rheumatic fever

Jones criteria
Prophylaxis
Fish mouth mitral valve
Erythema
marginatum
SC nodules
Valvular heart diseases
Mitral Stenosis-
Cause- RHD
h/o
sore throat
fleeting joint pain
abnormal movements
Symptoms-
Hemoptysis
Hoarseness-Ortner syndrome
Signs- mid diastolic murmur at apex
Investigations-
ECG- Left atrial enlargement
Treatment-
Percutaneous Balloon valvotomy-
Inoue Technique
Mitral Regurgitation-
Causes-
RHD
MVP
MI
Signs-
Pansystolic murmur at apex
Investigations-
ECG-LVH
Treatment
MV repair
Aortic Stenosis-
Cause- Age related, Bicuspid valve
Symptoms
Angina
Syncope
Dyspnea
Sign-
Ejection systolic murmur radiating to carotids

Remember
Gallavardin phenomena
Investigation
ECG-LVH
Treatment-
Aortic valve replacement
Aortic Regurgitation
Causes- age related, Marfans, CTD
Symptoms
Nocturnal angina
Signs-
Early diastolic murmur radiating to apex

Remember
Austin Flint Murmur
Investigations
ECG-LVH
Treatment
Aortic valve replacement
Infective endocarditis
Causes
Overall in native valve,Hospital acquired,IV drug
abuse,Max complications risk-
Staphylococcus aureus
Community acquired,Prosthetic valve >1 years-
Streptococcus viridans
Prosthetic valve overall/<1 year-
CoNS
Dukes criteria-
2 major-
5 minor-
Prophylaxis
Cardiomyopathy
Features DCMP HOCM RCMP
Pathology Systolic failure Diastolic failure Diastolic failure
Features DCMP HOCM RCMP
Pathology Systolic failure Diastolic failure Diastolic failure
Symptom Fatigue, swelling Angina, syncope Swelling
Features DCMP HOCM RCMP
Pathology Systolic failure Diastolic failure Diastolic failure
Symptom Fatigue, swelling Angina, syncope Swelling
Pulse Pulsus alternans Bifid Normal
apex diffuse double Localised
Features DCMP HOCM RCMP
Pathology Systolic failure Diastolic failure Diastolic failure
Symptom Fatigue, swelling Angina, syncope Swelling
Pulse Pulsus alternans Bifid Normal
apex diffuse double Localised
Heart sound S3 S4 S4
murmur Pansystolic Ejection systolic pansystolic
Features DCMP HOCM RCMP
Pathology Systolic failure Diastolic failure Diastolic failure
Symptom Fatigue, swelling Angina, syncope Swelling
Pulse Pulsus alternans Bifid Normal
apex diffuse double Localised
Heart sound S3 S4 S4
murmur Pansystolic Ejection systolic pansystolic
ECG VPC Giant inverted T AV blocks
waves
Features DCMP HOCM RCMP
Pathology Systolic failure Diastolic failure Diastolic failure
Symptom Fatigue, swelling Angina, syncope Swelling
Pulse Pulsus alternans Bifid Normal
apex diffuse double Localised
Heart sound S3 S4 S4
murmur Pansystolic Ejection systolic pansystolic
ECG VPC Giant inverted T AV blocks
waves
ECHO All 4 chamber Banana shaped LV Owl eye biatrial
dilatation cavity enlargement
Features DCMP HOCM RCMP
Pathology Systolic failure Diastolic failure Diastolic failure
Symptom Fatigue, swelling Angina, syncope Swelling
Pulse Pulsus alternans Bifid Normal
apex diffuse double Localised
Heart sound S3 S4 S4
murmur Pansystolic Ejection systolic pansystolic
ECG VPC Giant inverted T AV blocks
waves
ECHO All 4 chamber Banana shaped LV Owl eye biatrial
dilatation cavity enlargement
Treatment Diuretic,ACEI Betablocker Diuretics
Features DCMP HOCM RCMP
Pathology Systolic failure Diastolic failure Diastolic failure
Symptom Fatigue, swelling Angina, syncope Swelling
Pulse Pulsus alternans Bifid Normal
apex diffuse double Localised
Heart sound S3 S4 S4
murmur Pansystolic Ejection systolic pansystolic
ECG VPC Giant inverted T AV blocks
waves
ECHO All 4 chamber Banana shaped LV Owl eye biatrial
dilatation cavity enlargement
Treatment Diuretic,ACEI Betablocker Diuretics
Causes Idiopathic BMHC Amyloidosis
Alcohol.
Tako Tsubo CMP
Heart failure
Symptoms-PND, orthopnea, Cheyne stoke breathing
Signs-Pulsus alternans, Kussmaul sign, AJR
Investigations-BNP, Chest X ray
Treatment-O2+Furosemide+morphine
norepinephrine, Dobutamine, NNN
Not to be given-Digoxin,
Pericardial diseases
Acute pericarditis
Cause- Idiopathic, Viral
Symptom-pericardial chest pain
Sign-Pericardial rub
ECG-PR depression, ST elevation
Constrictive pericarditis
Symptom- Swelling
Sign- Pulsus paradoxus, deep x and rapid y descent
- Pericardial knock
ECG- ST depression, T wave inversion
Treatment- pericardiectomy
Cardiac tamponade
Symptom-Dyspnea
Sign- Pulsus paradoxus, deep x, absent y
-Beck’s triad
ECG- electric alternans
Chest x ray- increased cardiac shadow
Treatment- pericardiectomy
Systemic hypertension
Acute coronary syndrome
 ECG

ST
ST elevation
depression

Troponin Troponin

Normal Elevated Normal Elevated

=USA =NSTEMI =Prinzmetal =STEMI
angina
Management
-USA/NSTEMI=
antiplatelets+antithrombotic+nitrate+beta blocker ,PCI
CI-thrombolytics
-Prinzmetal angina= Nitrate,CCB
CI-Aspirin,beta blocker
-STEMI = Antiplatelets,PCI>thrombolytics
CI- CCB
ECG
GIT-
Malabsorption

Tests
-D xylose, Schilling test
Etiologies
-celiac sprue, tropical sprue, Whipple disease, BOGS
IBD
Clinical features
Extraintestinal features
Investigations
Treatment
 ROME- IV
criteria

Irritable
Age< 45 Fever
Bowel
yrs
Syndrome Blood in
Mucus stools
in stools
Weight
Tenderness loss
Nocturnal
Vomiting diarrhea
Hepatitis
Clinical features
-Relapsing hepatitis=hepatitis A
-Serum sickness like=hepatitis B
-Insulin resistance=hepatitis C
-Cholestatic hepatitis=hepatitis E
Serology
-Hepatitis B
-Hepatitis C
 HBV-
DNA

>2000 <2000

Biopsy observation

N-Mild Mod-severe
inflammation inflammation

observation antiviral
Metabolic liver diseases
Wilson disease
Clinical-Liver +KF ring+ Neuropsychiatry
Treatment-
-Zinc
-LT
Hemochromatosis
Clinical –
-Liver disease
-Diabetes
-Skin pigmentation
-Arthropathy
Treatment
-Phlebotomy
score Parameters used value Used for

Child Pugh Encephalopathy ≥ 10 Severity of cirrhosis

Ascites
S. Bilirubin
PT/INR
S. Albumin
MELD S. Bilirubin >18-20 Indication for liver
INR transplant
S. Creatinine
Nazer score S. Bilirubin >9 Severity of Wilson
PT disease cirrhosis
SGOT
Maddrey’s ADF S. Bilirubin, PT >32 Severity of ALD
AST Platelet Ratio AST >1.5 Cirrhosis diagnosis
Index(APRI) Platelets
Complications of Liver Failure
Ascites-
Encephalopathy
Grades
EEG
Treatment
-Lactulose
-Rifaximin
-Zinc
-L ornithine L aspartate
-Mannitol
All the best