Medicine Revision DR Ashish

NEXT LEARNING CENTER nlcofficialmain@gmail.
com
MEDICINE
Endocrinology
♦ Diabetes Mellitus
• Insulin - By β-cell - glut-2 in pancreas
- Shift glucose from blood to cell
- Wt gain
→ ↓ Blood glucose & is ketones, ↓ K+
• DM Types
C/F → Sweet Urine DM-1 - Insulin dependent
→ Insulin Related DM-2 Insulin independent
→ Poly Uria (↑ Urine) MODY
→ Polydipsia (↑Thirst) LADA
→ Wt loss because ↓ glucose to cells
• DI
→ Taste less urine Neurogenic
→ ADH defect Nephrogenic
Dx FBS GTT HbA1C [Best]
Normal < 100 < 140 < 5.6
DM > 126 > 200 > 6.5
Impaired 100-125 140-199 5.7-6.4.
1
NEXT LEARNING CENTER nlcofficialmain@gmail.com
♦ Dm Type-1 Dm Type-2
→ Auto Ab - Gad. ICA, IAA → Receptor defect
HLA DR 34, DQI
→ Young → Old, Obese, Insulin resistance
→ Insulin level ↓ → Insulin level ↑
→ Family Hx -nt → +nt
♦ LADA - Latent Autoimmune Diabetes in Adult
→ Dm - I of old people
→ GAD Ab positive
♦ MODY -Maturity onset diabetes of young
→ Dm - II in young people [ < 25 yrs]
→ HNF α - Gene mutation - A.D
Rx – DM-I = Insulin longest acting
DM-2 [Refrctory] = Insulin - De Glu Dec
DM-2 - Life Style Modification
Doc - Metformin S.E → Lactic Acidosis
- Sulphonyl Urea - ↑ Insulin by closing K+ channel
↳ Tolbutamide
↳ Glibenclamide
- TZD - ↓ Resistance to Insulin
↳ ROSI Glitazone
↳ PIO Glitazone
- AGI - (α Glucosidase Negative) - ↓ Starch Abs.
↳ Acarbose
- DDP - IV Inhibitor
↳ Sita, Saxa, Rita, Vilda-Gliptins

2
- SGLT - II Negative - ↓ Glucose Reabsrp. in Kidney
↳ CANA - Gliflozin
↳ DAPA - Gliflozin
• Rx Dm 1 & 2
- Acarbose, Pramzintide (These Dx can be used in both)
3
♦ DKA - Diabetic Ketoacidosis
→ Metabolic Acidosis τ ↑ Anion gap
→ pH < 7.3 & HCO3- < 24
→ ↑ Blood SUGAR - >250mg %
→ ↑ Ketone in blood & urine
→ ↑ Respiration - Kussmaul breathing + Sweet smelling breath
→ ↑ HR, BP ↓
Rx - IV – N.S (normal saline) - 1ˢᵗ Rx
Doc - Insulin
HCO3- for acidosis
Adrenal Gland
Cortex Medulla
↓ ↓
Steroid's Chromaffin Cell
↓
Catecholamine
E, NE, Dopamine
♦ Pheochromocytoma
→ Ab normal ↑ in catecholamine mainly [N.E]
→ Classical ∆ Palpitations
↑Sweating Headache
→ Postural Hypotention
Dx - Screening - 24hrs Fractional urine metanephrin
IxOC - Plasma free metanephrine [Best]
Metastasis - Pet-scan
4
Rx – IxOC - Surgical Resection
Doc - Phenoxybenzamine (oral) - Pre-Op
C.I = β-Blocker - Phentolamine (I.V) - Intr-Op
Labetolol – Post-Op
♦ Cushing Syndrome
• ↑ Cortisol From Adrenal Gland
• ↓ ACTH - Pigment -nt Exogenous Steroids
C/F - Loss of Diurnal Rhythm (Earliest)
- Thin limb's
→ Obese trunk & moon face
→ Red cheeks
→ Striae - Red stretch mark
Ix – 24 hrs urinary cortisol level (3 times ↑)
IxOC - Dexamethasone suppression test
Cushing Disease Cushing Syndrome
Mx - High ACTH Low ACTH

↓ ↓
MRI - Pit. Adenoma MRI-Adrenal Adenoma
↓ ↓
Trans Sphenoidal Resection Resection
↳ If using steroid then gradually taper dose
♦ Addison Disease [ Reverse of cushing]
→ Adrenal insufficiency
→ ↓ Cortisol ↓ Aldosterone
↓ ↓
• ↓ Bp, Metabolic Acidosis • ↓ Na+ → Salt Craving.
• ↑ K+ - Arrythmia, Hypogylcemia
5
Ix - ↓ S.Na+ - < 125 meq/L / Best test → ACTH stimulation test
↑ S.K+ - > 5.5 meq/L
Rx - Hydrocortisone & Fluid
Rx Addison Crisis - IV Hydrocortisone
♦ Conn’s Syndrome
→ ↑ Aldosterone – Due to Adrenal Adenoma/ Hyperplasia
→ ↑ Na+ & ↓ K+
→ Metabolic Alkalosis
Ix - Screening - ALD./ Renin ratio ↑ - > 750
Confirm - Saline Infusion Test
Rx - Spironolactone/ Eplerenone
♦ Hyperparathyroidism - ↑ S.Ca2+ & ↑PTH
→ Stone Formation
→ ↑ Bone Resorption [Osteoclastic Activity]
↳ Bone - Brown Tumor [Osteoclastic Lesion]
↳ Skull - Salt & pepper skull
↳ Spine - Rugger jersy spine (Zebra Spine)
Rx - Loop Diuretics - ↓ S.Ca2+
Cinacelet - ↓ PTH
♦ Hypo Para Thyrodism - ↓ S.Ca2+
↓
Hypo Calcemic Tetany
↳ Trousseau Sign [Carpo-Pedal Spasm]
↳ Chvostek Sign [Fascial Muscle Contraction]
Rx - 10% Calcium Gluconate I.V
6
♦ Thyroid Thyro Peroxidose - -ve by Carbimazole
Methimazole
TPO
→ I- + I- I2
TPO
→ I2 + Tyrosine MIT + DIT
TPO
→ MIT + DIT T3
TPO
→ DIT + DIT T4
S’Deiodinase
T4 = Less active T3 = Most active
Rx - Hyperthyroidism - PTU [Negative S' Deiodinase]
↳ Preg. 1st Trimester
T4 TSH Example
• 1° Hyperthyroidism ↑ ↓ Graves disease
• 2° Hyperthyroidism ↑ ↓ Pit. Adenoma
• RAIU- Radio Active Iodine Uptake
↳ To check activity of follicles
I123 - For test/ diagnosis
I131 - For ablation
Tc99 - Diagnosis
♦ Graves disease (Type V HSN. Rx)
→ 1° Hyperthyroidism – T4↑ & TSH ↓
→ Auto immune condition
↳ LATS
↳ HLA DR-3, B-8
C/F Lid Lag Sign
Dermatopathy
Ophthalmopathy
Goitre
7
Rx Young - Anti Thyroid Drug - Carbimazole
Old - • Sub Total Thyroidectomy
• Radio Iodine Ablation – I131
♦ Thyroid Storm - ↑ ↑ Sympathetic Activity
Rx - PTU + β-Blocker + I.V. Hydro Cortisone

[Propranolol]
♦ Hashimoto Thyroiditis [ Hypothyroidism]
→ Autoimmune HLA DR3/DRS
→ Type II HSN.
→ Anti TPO Ab
Histopath - Hurthle cell seen
C.P – 1st Hyperthyroidism Later Hypothyroidism
↓ ↓
Rx- β-Blocker + PTU Levothyroxine
♦ Sub-acute/ De Qvervain Viral Inf.
1st Hyper → Later Hypo → Normal
♦ Reidel's disease = Fibrosis of thyroid
C/F - Hypothyroid, Dysphagia, Hoarseness
8
Neurology
♦ Headache
1. Tension Headache [Mc 1° headache]
→ B/L Condition F > M
→ Compression like feeling
→ Rx - NSAID'S
2. Cluster Headache
→ U/L, M > F
→ Multiple attacks
→ S/s - Red Eye, Retro Orbital Pain, Rhinorrhoea Epiphora (Excessive Tear's) +
Claustrophobia
→ Rx - 100% High flow O2
Doc Triptans – MOA - V.C & relief hypoxia
3. Migraine (2nd Mc)
→ U/L Mc F > M
→ C/F P → Pulsatile + Photophobia
O → One Day (Duration τ in 24 hrs)
U → U/L
N → Nausea, vomiting
D → Disability
Rx - Mild to Moderate - NSAID'S
Mod. to Severe - Triptan's → Act on SHT 1B/ 1D (V.C)
Prophylaxis - Doc – Proprenolol
9
♦ Prions Disease –
→ Due to abnormal & infectious protein
→ β-sheets are seen
→ Can cause 1 - Mad cow disease In Animals
2 - Bovine Spongiform Encephalopathy
3 - KURU - In cannibal's eg. Snake eat snake
4 – CJD - Creutz Feldt Jacob Disease
↳ Sporadic - By meat
↳ Genetic - Mutation
→ EEG - Sharp wave discharge
→ MRI - Hockey stick sign + Cortical ribboning
Rx - No Rx (person dies in 6-12 month)
♦ Alzeimer's Disease
→ Temporo - Partial lobe is damaged
→ Cause - Genetic – APO E4 - Causative Factor
APO E2 - Protective
→ H/P - Hirano bodies in Hippocampus
→ Pathology - A-β- Amyloid → Make senile plaque
Tau Protein → Make tangles
→ C/F - ↓ Memory, ↓ Speech, ↓ Knowledge, ↓ Motor Fnc.
- Myoclonic jerk
→ MRI –
→ Enlarged ventricles
→ Diffuse cortical atrophy
→ Doc - Donepazil - MOA - ↑ Ach
10
♦ Seizure Disorder
→ ↑ Electrical Discharge Cortical Neurons
→ If >2 Seizure → Epilepsy
1 → Mc Seizure in neonate - Subtle seizure
2 → Mc Seizure in children - Febrile seizure
τ Fever
Doc - Diazepam/ Lorazepam
Prophylaxis - Clobazam
3 → School going children - Absence seizure
↳ No LOC
↳ No Motor Features
↳ Blank Staring Episode → Teacher complains not paying attention
↳ IxOC – EEG - 3 wave/ sec + Spike pattern
↳ Doc - Typical → Ethosuximide
Atypical → Valproate
4 → GTCS - Gen. Tonic Clonic Seizure
→ Loss Of consciousness + Muscle contraction & relaxation
→ Episode - 1-5min
→ If > 5min - Status epilepticus
→ If > 60min - Refractory
→ Doc - GTCS - Valproate
→ Doc - Status Epilepticus - I.V Lorazepam or
I.M Midazolam
I.V Phenobarbitone
11
♦ Basal Ganglia Disorder
1. Huntington Disease
→ Loss of GABA gic neuron → ↑ Dopamine activity
→ Triple neucleotide repeat → CAG
→ MRI - Box Car Ventricle
C.P - Huntington chorea
Anormal eye movement (Dancing)
Psychosis
Doc - Tetrabenazine
2. Parkinson’s Disease - Mask like face seen
→ ↓ Dopamine & ↑ Ach
→ ↓ Movement → Bradykinesia - Slow movement
→ Hypo Kinesia - Small movement
→ ↑ Tone → Rigidity [ Lead pipe & Cogwheel rigidity]
→ Resting Tremor's (4-6 hertz)
→ GAIT - Festinating/ Shuffling Gait
Pathophysio → Lewy body is seen
Rx - A-Men → Amantidine - ↑ Dopamine
Love → L-Dopa
Benz → Benztropine Doc for drugs induced P.D
→ Benzhexol ↓ Ach
Car → Carbidopa
Roling → Ropinirole Doc For Parkinson Disease
Gliding → Geline
Not Parked → Entecapone
12
Doc For pt > 50yrs – L-Dopa + Carbidopa
↓
S.E → On/ Off phenomena
Doc - Safinamide
Sx - Pallidotomy, Deep Brain Stimulation
3. Atypical Parkinsonism
I. Progressive Supra Nuclear Gaze Palsy
[Damage to medial longitudinal fasciculus]
→ Not able to look down
→ Fall down while climbing down
→ Spill Food, drinks
EOG - Sq. wave pattern
MRI - Hummingbird sign
II. Multisystem Atrophy
↳ Brain stem
↳ Cerebellum – Ataxia
13
♦ Cerebellum Disorder
I. Cerebellum Lesion
→ Loss of co-ordination - Ataxia
Test
1. Gait → Drunken Gait
2. Finger Nose Test
3. Slurred Speech
4. Nystagmus
II. Friedreich Ataxia [UMNL & LMNL]
→ Frataxin Gene on Chr. - 9
→ GAA repeat
→ Sensory Ataxia
Test – Romberg’s test +ve
↳ Pt. Fall down on closing eye’s
III. Stroke [UMN involved]
Non convulsive focal neurological deficit
>24 hrs – Stroke
<24 hrs – TIA – Transient Ischemic Attack
Stroke Types
Ischemic (75%) Haemorrhagic (25%)
Mcc- Thromboembolism HTN/ SDH/ EDH etc.
Mc-site of MTN bleed - Putamen
Mc Vessel involved in stroke - Middle Cerebral Artery
14
C/F - Clasp Knife Spasticity
Spastic/ Circumduction Gait
Contra Lateral Spastic Paralysis
Sign - Babinski Sign +ve for Putamen Bleed
↳ Dorsiflexion of great toe + Fanning of other finger
Ixoc - NCCT head
Best - MRI
Gold Standard - Cerebral Angiography
Rx - Control BP -Nimodipine
Ischemic Hemorrhagic
→Thrombolysis → Main aim control BP
→ TPA - Reteplase, Streptokinase → I.V labetalol/ Nicardipine
→ Aspirin, Clopidogrel
→ LMWH
15
♦ Meningitis
→ 0-2 month - E. Coli (Gm -ve) Mc in India
→ 2m – 2yrs - H. Influenzae Type B
→ > 2 yrs - Mewing ococcus
→ Adult - Pneumococcus
→ In HIV +ve pt. Mcc Meningitis - Cryptococcal Neoformans
C/F - Fever, Headache, Neck Rigidity, Projectile Vomiting
Sign - Kernig & BrudzinskisSign
→ Neck Rigidity → Knee Flexion
- ↑ ICP → Fundoscopy - Papilioedema
→ ↑ BP but ↓ HR - Cushing reflex
Ixoc - Lumbur Puncture
↳ Low glucose in CSF → Bacterial cause
↳ Normal glucose in CSF → Virus cause
↳ Cogweb pattern + ↑ Lympocytes - TB Meningitis
Rx - Pneumo or Meningococcal – Penicillin-G
Pseudomonas - Ceftazidime
Cryptococcal - Amphotericin B + Flucytosine
Gram -ve - Ceftriaxone
IV Steroids - Dexamethasone in TB Meningitis τ ATT
16
♦ Motor Neuron Disease
I. ALS - Amyotrophic Lateral Sclerosis
→ Normal IQ, normal sensory function, normal bladder & bowel cont.
Features
A - Asymmetrical B/L distal muscle affected
↳ Can't walk/ stand
B- Bulbar Palsy - CN – VII, IX, X, XI, XII
↳ Ipsilateral tongue deviation so difficulty in swallowing, chewing, speech
C - Spastic Paralysis
↳ Muscle wasting, Babinski +ve, ↑ DTR
Pathophysio → SOD - Gene mutation
↑ Free radical will damage neurons
Rx - Riluzole - ↓ Glutamate Excitotoxicity
Edavarone - Free Radical Scavenger
II. Myasthenia Gravis
→ LMN Lesion
→ Autoimmune Condition, Type II Hypersensitivity Rx
Pathophysio - Ab against Ach receptor
Also musk Ab. & LRP-4 Ab.

↓
↓ Muscle Contraction → Flaccid Paralysis
→ Mc in females
C.P → → B/L Ptosis & Diplopia
→ Snarling face
→ Resp. Muscle Paralysis In Crisis
→ Normal sensory, Normal DTR (deep Tendon Reflex), Normal nerve

conduction
17
Ix – Ixoc - Anti -ACH -Ab - Most specific test
- Ice Pack test - Apply to end → ↓ Ptosis
- Tension Test – I.V Endorphonium
↳ ↑ Ach → ↓ Paralysis
Rx - Doc –
↳ ACH Esterase Inhibitor - Pyrido & Neostigmine
↳ Steroids
Myestnenia Crisis
↳ Remove Abs By Plasmapheresis
↳ Iv - Immunoglobin [Against Ach - Receptor]
III. - GBS - Guillian Barre Syndrome
→ Autoimmune disorder -Type II H.S.
→ Post infection antibodies → Destroy gangliocytes & destroy myelin
Mcc – GIT → Campylobacter Jejuni
Respiratory → Viral - CMV, EBV
Non Viral - Mycoplasma, H. Influenza
C/F - Flaccid ascending paralysis
- Pain & Paraesthesia
- Loss of touch, Vibration etc
- M.C normal Involve - Facial nerve
Ix - CSF = Albumin - Cyto dissociation
↳ ↑↑ protein but normal cell count
NCV = Nerve Conduction Test = ↓ velocity
Rx - Plasmapheresis, IV Immunoglobin
18
♦ Spinal Cord Syndrome
Touch Pain
Brown Sequard -nt Same Side -nt Opp. Site
Tabes Dorsalis -nt Both Side + Both Side
[Lower Limbs]
Syringomyelia +nt Both Side -nt Both Side
Upper Limbs, Chest
19
Respiratory System
♦ Hypoxia
1. Hypoxic Hypoxia → ↓paO2, ↓SPO2, Central cyanosis +nt
↳ Cause → Any pulmonary disease
2. Anemic Hypoxia – Normal paO2, Normal SpO2, ↓Hb
↳ Cause → Less Hb
3. Stagnant Hypoxia - normal paO2, normal SpO2, Peripheral Cyanosis +nt
↳ Cause → heart disease
4. Histotoxic Hypoxia - Normal PaO2, Normal SpO2, Cyanosis -nt
↳ Cause → Cyanide & CO Poisoning
Mechanism → Tissue fails to use oxygen
Respiratory Failure
Type-I Type-II
→ Only Hypoxia - ↓paO2 → Hypoxia - ↓pO2, Hypercapnia –

→ Due To Hyperventilation ↑ PaCO2 > 45 mmHg
↳ Resp. Alkalosis → Due To Hypoventilation
↳ Resp. Acidosis
Rx - 100% O2 High Flow Rx -Low Flow O2
Example - Emphysema, Asthma, COPD – eg. - Chronic Bronchitis, Chest

ARDS, ILD Wall injury
20
Obstruction
Fixed Variable
→ Both inspiration & expiration poor
If Exp. Poor If Insp. Poor
Wheezing Stridor
Ex - COPD, Asthma Ex -Tracheomalacia
Vito → Variable Veto - Variabl
Intrathoracic Obs. Extratoracic Obs.
♦ Flow volume curve
21
Lung Disease
RLD (Restrictive) OLD (Obstructive)
→ Poor compliance → Narrow airway
→ ↓ Size of Lung → Air trapped inside →
→ All volumes ↓↓ ↑ Size of lung, ↑ RV
→ Normal FEV1 % → FEV1 % < 80%
♦ OLD → Obstructive Lung Disease

↓
Give Salbutamol
↓
Bronchodilation
→ Good response →If poor response
→ Reversible Obs . → Irreversible Obs.
Eg - Asthma Eg - Chronic Bronchitis, Emphysema, COPD
♦ Asthma
→ Type-I Hypersensitivity Rxn.
Etiology - Allergen (Pollen grain/ dust etc)

↓
Bind IgE Ab
↓
Mast cell release [ Histamine, LTC4, LTD4, LTE4]
↓
Broncho Constriction [Wheezing Sound]
→ On Sputum Examination → 3C Creola Bodies
Charcot Lyden Crystal
Curschman Spirals
22
→ Prophylaxis → Prevent Exposure
→ -ve IgE Ab - Omalizumab
→ -ve Mast cell release - Nedocromil
- Cromoglycate
→ Leukotriene Antagonist - Monotelukast
- Zefirlukast
→ Bronchodilator -SABA, LABA
→ Steroids - Inhalational Cortico steroid
↳ Budesonide
↳ Fluticasone
Diagnosis - Wright Peak Flow Meter [PEFR]
↳ < 250 - Poor flow
- FEV1 % By spirometer
Rx - Intermittent Asthma (<2 days/ week)
↳ SABA + Inhalational Cortico steroid [ICS]
[Reliever] [ Controller]
- Persistant Asthma
↳ ICS + LABA + Prophylaxis
- Severe asthma attack
↳ Oral Steroid
23
♦ COPD –
I. Chronic Bronchitis II. Emphysema
Etiology – Smoking/ Pollution

↓
Inflammatory Response
Damage to ciliated epithelium Sq. Metaplasia ↑ Mucus production due to

↓ ↓ hyperplasia of gland's
Reduced mucociliary clearance Cause cancer Cough τ Copious Sputum
↓
Cause - Stasis if mucus +nt
→ Inflammation → Irreversible airway obstruction
Dx - Reid Index - >= 05 But 0.4 Or Less = Normal
C/F – H/O of smoking
Blue Bloater - Cyanosis Rt Side Heart Failure
Cough τ Sputum → Corpulmonale
Clubbing
Ix - Spirometer - ↓ FEV1 %
Rx - Stop Smoking - Doc - Varenicline
Antibiotic, Mucolytics
Steroids + Brochodilator
II Emphysema → Damage to elastin protein by elastase
Mcc - Smoking → Centriacinar Type
α1 - Antitrypsin Deficiency → Panacinar Type
24
Etiology - ↓ Elastase → Poor Recoil → Air trapped inside → Barrel shape chest
- ↑ Pulmonary Resistance → Pul. HTN → RV hypertrophy & heart failure
[Cor Pulmonale] → Heart failure due to lung disease
- Hypoxia - ↑ RBC Production - Polycythemia
- Hyperventilation - Pink Puffer
Rx - Stop Smoking Sx - Lung Transplant
Antibiotic ↳ Criteria - Bode Index
Steroids [7-10 score]
Bronchodilator
♦ Bronchiectasis
→ Irreversible airway damage
→ Dilation of airway
→ Mc Site - LLL [Left Lower Lobe]
→ Pathophysio – Mc-Infection in India – TB > Kartagener Syndrome
Kartagener Syndrome
B → Bronchiectasis
S → Sinusitis
D → Dextrocardia
C/F - Cyanosis, Clubbing, Cough τ Muco-Purulent Sputum
On CT-Scan – → Signet Ring appearance
Rx – Antibiotic, Mucolytic
O2 therapy
Lung Exercise
25
CVS
→ Pacemaker of heart → SA Node (Max. Freq)
→ Slowest conduction → AV Node (Max. Block)
→ Fastest → Purkinjie Fibre
♦ Atrial Depolarization - P Wave
♦ Ventricle Depolarization - ORS complex
♦ Ventricle Repolarization - T Wave
♦ Heart
→ Supply to left ventricle
→ Supply to ant. wall & left ventricle
→ Mc Artery involve in coronary artery disease LADA
26
♦ Coronary Artery Disease
↓
Ischemia
↓
Chest Pain [Angina] + ↑ HR + Sweating ↑
→ Classical Sign → Levine Sign [Clenched fist over chest]
♦ Angina Pectoris
Classical Variant/ Prinz Metal
→ Pain on exertion → Pain at rest due to vasospasm

→ ↑ O2 demand
↳ Ischemia & Hypoxia
→ Pain relief at rest
Rx → Nitrates, Aspirin, CCB, β- Rx - Nitrates (S/L) CCB but never β-
blocker blocker
♦ Stable Angina –
→ Pain relieved within 10-15 min at rest
→ Screening. Test - Stress Test [Done in stable angina]
Exercise Drug
→Treadmill test → Dobutamine
→ If HR ↑ on stress test
↓
Dx - If CAD Ischemia occur
Ix - ECG - St Depression - >1mm for > 80m/ sec
Angiography - Narrowing is seen
27
Rx Angioplasty → PCI [Percutaneous Intervention]

↓
Dilate vessel τ balloon & place stent or CABG
[Coronary Artery Bypass Grafting]
♦ Unstable Angina
→ Pain for > 15min not relieved on rest
Dx - ACS - Acute Coronary Syndrome

↓
Necrosis in heart
↓
Release K+ & biomarker in blood
↓
Arrythemia & ECG changes
→ 1st change - τ in min → Tall τ wave
→ 2nd change - 3-4 Hrs → St Evevation
→ 3rd change - 12 Hrs → T Wave inversion
→ 4th change – 24hrs → Pathological Q wave
↳ Sign of Hx of MI
Ix → Biomarker
• 1st Rise → HFABP
• Most Specific → 3-8hrs Troponin T & I
• Later 3-10 hrs → LDH1 >>> LDH2 ↳ Best
28
If biomarker +ve
↓
ECG - Check stevenation
Stemi Non - Stemi
Rx S - Streptokinase Rx M - Morphine
M - Morphine O - O2
O - O2 N - Nitrates
N - Nitrates A - Aspirin
A - Aspirin +
→ Anti platelets drug –
TOC - PCI Clopidogrel
→ Door to balloon time
90min (upto 120min) → Low mol wt. heparin –
Enoxaparin
→ β-Blocker, CCB etc.
→ Door to needle time
30min (upto 60min)
Delayed PCI – Angioplasty
Rx → Inferior Wall M.I → IV Fluid + Ionotropics + MONA
Hypertension
• BP - >= 130/85 [Latest]
Primary HTN (95%) Secondary HTN

Mcc - Idiopathic Mcc - Renal Artery Stenosis, Glomerulo
Nephritis Cushing, CONN, SLE
S/S - Few/ No
Silent Killer
Management → Wt. loss
→ ↓ Salt in diet
→ -ve alcohol & smoking
29
Drug used - HTN > 140/90
If < 60 yrs If >60 yrs
↓ ↓
ACE -ve CCB + Diuretics
↓ If not cont. ↓ If not cont.
CCB +ACE -ve ACE -ve + CCB
If not cont. If not cont.

ACE -ve + CCB + Diuretics
↳ If still not controlled it is known as refractory MTN
Doc-Spironolactone
Drug used - HTN > 180/120

↓
HTN Emergency
1. If Preeclampsia – Doc - I.V Labetalol
2. If stroke - Nicardipine, Clevidipine
3. Pulmonary Oedema
↳ Systolic Dysfunction - Nicardipine +NTG + Loop DIU.
↳ Diastolic Dysfunction – Esmolol + NTG + Loop Diuretic
4. Dissecting of Aorta or MI - Doc β- Blocker + CCB
↳ Esmolol
5. Reinal disease – Fenoldopam
30
♦ Heart Failure
↓ Stroke volume
→ Cardiogenic shock & congestion ↓ Cardiac output
↓ BP but ↑ HR
Systolic HF Diastolic HF
→ Poor pumping → Less filling
→ ↓ SV & EF ↑ → ↓ EDV, Normal EF
→ ↑ Blood in heart → Cardiomegaly → Cardiac Temponade
→ ↑ S3 sound → S4 sound
RHF LHF - MCC – Pul. Odema
X-Ray -Bat wing app.
→ Pulmonary Ischemia → Cardiogenic Shock
→ Poor Exchange ↓ Urine, cold skin, fatigue
→ Systemic Congestion → Paroxysmal Nocturnal Dyspnoea
↓ [Breathlessness on lying down]

Pedal Oedema
→ ↑ IVP
→ Ascitis
→ Hepato Splenomegaly
Dx - Fluid Thrill test → For Ascitis
On X-Ray → Cardiomegaly
31
♦ CHF - Congestive Heart Failure
→ RVF + LHF
Rx - Inotropes
↳ For systemic heart failure
ACEI/ ARB
↳ Best for & mortality
Loop Diuretics
↳ For Pulmonary Oedema
32
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NEXT LEARNING CENTER nlcofficialmain@gmail.

• Insulin - By β-cell - glut-2 in pancreas

- Shift glucose from blood to cell

→ ↓ Blood glucose & is ketones, ↓ K+

C/F → Sweet Urine DM-1 - Insulin dependent

→ Insulin Related DM-2 Insulin independent

→ Poly Uria (↑ Urine) MODY

→ Polydipsia (↑Thirst) LADA

→ Wt loss because ↓ glucose to cells

→ Taste less urine Neurogenic

→ ADH defect Nephrogenic

Dx FBS GTT HbA1C [Best]

Normal < 100 < 140 < 5.6

DM > 126 > 200 > 6.5

Impaired 100-125 140-199 5.7-6.4.

→ Auto Ab - Gad. ICA, IAA → Receptor defect

HLA DR 34, DQI

→ Young → Old, Obese, Insulin resistance

→ Insulin level ↓ → Insulin level ↑

→ Family Hx -nt → +nt

♦ LADA - Latent Autoimmune Diabetes in Adult

♦ MODY -Maturity onset diabetes of young

→ Dm - II in young people [ < 25 yrs]

→ HNF α - Gene mutation - A.D

Rx – DM-I = Insulin longest acting

DM-2 [Refrctory] = Insulin - De Glu Dec

DM-2 - Life Style Modification

Doc - Metformin S.E → Lactic Acidosis

- Sulphonyl Urea - ↑ Insulin by closing K+ channel

- TZD - ↓ Resistance to Insulin

- AGI - (α Glucosidase Negative) - ↓ Starch Abs.

↳ Sita, Saxa, Rita, Vilda-Gliptins

- SGLT - II Negative - ↓ Glucose Reabsrp. in Kidney

- Acarbose, Pramzintide (These Dx can be used in both)

♦ DKA - Diabetic Ketoacidosis

→ Metabolic Acidosis τ ↑ Anion gap

→ pH < 7.3 & HCO3- < 24

→ ↑ Blood SUGAR - >250mg %

→ ↑ Ketone in blood & urine

→ ↑ Respiration - Kussmaul breathing + Sweet smelling breath

Rx - IV – N.S (normal saline) - 1ˢᵗ Rx

HCO3- for acidosis

→ Ab normal ↑ in catecholamine mainly [N.E]

Dx - Screening - 24hrs Fractional urine metanephrin

IxOC - Plasma free metanephrine [Best]

Rx – IxOC - Surgical Resection

Doc - Phenoxybenzamine (oral) - Pre-Op

C.I = β-Blocker - Phentolamine (I.V) - Intr-Op

• ↑ Cortisol From Adrenal Gland

• ↓ ACTH - Pigment -nt Exogenous Steroids

C/F - Loss of Diurnal Rhythm (Earliest)

→ Obese trunk & moon face

→ Striae - Red stretch mark

Ix – 24 hrs urinary cortisol level (3 times ↑)

IxOC - Dexamethasone suppression test

Cushing Disease Cushing Syndrome

Mx - High ACTH Low ACTH

♦ Addison Disease [ Reverse of cushing]

Ix - ↓ S.Na+ - < 125 meq/L / Best test → ACTH stimulation test

↑ S.K+ - > 5.5 meq/L

Rx - Hydrocortisone & Fluid

Rx Addison Crisis - IV Hydrocortisone