Remember

In constrictive pericarditis and tamponade, catheterisation shows the same diastolic pressure in all 4 chambers!

Remember

Pronator drift is a sign of upper motor neurone lesion

Patient is asked to hold out both arms at shoulder level, fully extended with forearms supine, and hold the position.

If the patient is unable to hold the position and the forearm pronates, then pronator drift is positive and the patient most likely has a contralateral pyramidal tract (UMN) lesion.

Closing the eyes accentuates it.

Remember

If u see migratory thrombophlebitis, look for visceral malignancies.

Remember

FeNa> 2% = intrinsic renal disease i.e acute tubular necrosis or acute interstititial nephritis

In prerenal azotemia e.g due to dehydration, FeNa is <1%, urine sodium is <20mEq/L, urine osmolality> 500mEq/L
Kidney reabsorbs Na and water to compensate for the hypovolaemia or hypotension.

Remember

Neonate turns blue when feeding, turns pink when crying = choanal atresia

may be part of the CHARGE Syndrome

Coloboma
Heart defects
Atresia of the choanae
Retardation (mental)
Genitourinary anomalies
Ear anomalies

suspect if you can't pass an intranasal catheter, confirm with  contrast CT.

Remember

Physiologic steatorrhoea can occur in neonates especially preterm neonates due to low amounts of bile acids.
Treatment is to replace long chain triglycerides in formular with medium chain trig (which do not require bile acids for digestion).

Do not confuse with CF which will show other features like meconium ileus, family history etc.

Remember

Patient with sudden onset cardiac decompensation with acute pulmonary edema should have an ECG done first before any medications, to rule out arrhythmia e.g atrial fibrillation which may require immediate synchronised cardioversion.

If no arrhythmia, then reduce preload with diuretics, nitrates and morphine.

Remember

For all left heart stenotic murmurs, reducing preload (e.g diuretics) prolongs devt of pulmonary congestion

For all left heart regurgitant murmurs, drug treatment is aimed at reducing afterload (vasodilators)

For mitral valve prolapse, drug treatment (if symptomatic), is aimed at increasing preload (propanolol)

For hypertrophic cardiomyopathy, increasing preload reduces the murmur( squatting increases VR, beta blockers and calcium channel blockers allow more ventricular filling)

note: Valsava manoeuvre increases afterload, reduces preload. It therefore increases intensity of murmur in aortic stenosis but reduces the intensity in HCM.

Remember

Elderly woman with new onset ascites, no Liver involvement: investigate for ovarian CA

Remember

Bloody diarrhoea + leucocytosis post abdominal aortic aneurysm repair, think of ischemic colitis (desc and sigmoid)

Confirm with colonoscopy or flexible sigmoidoscopy

Do colonic resection + colostomy

Remember

Fixed splitting of S2 = ASD

Remember

Most senstive test for subarachnoid haemorrhage, SAH, is Lumbar puncture: shows xanthochromia

Remember

Check TSH and T4 in every patient with new atrial fibrillation  
 (? HYPERTHYROIDISM)

Check TSH and T4 in every patient with hyperprolactinemia    
(? HYPOTHYROIDISM)

Check TSH and T4 in elderly patient with sudden dementia + new hypercholesterolaemia +decreased deep tendon reflexes , constipation, weight gain etc
(? HYPOTHYROIDISM)