PM – General Revision

Parasomnias, which involve abnormal movements, behaviors, emotions, perceptions, or dreams occurring while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Insomnia involves difficulty falling or staying asleep. Narcolepsy involves daytime sleep attacks. Sleep apnea involves breathing interruptions during sleep.

A rapid onset of confusion and changes in cognitive function, distinguishing it from dementia, which has a gradual onset. Disorganized thinking is a symptom but not the primary characteristic. Memory loss can occur in delirium but is more characteristic of dementia. Hallucinations may occur in delirium but are not a defining feature.

Identifying and describing emotions, often seen in psychiatric conditions but not a disorder itself. Experiencing pleasure is anhedonia. Recognizing faces is prosopagnosia. Understanding language is aphasia.

Schizophrenia, representing a negative symptom where the individual speaks very little and may appear unresponsive in conversation. Major depressive disorder can include decreased speech but is not specifically characterized by alogia. Bipolar disorder may involve decreased speech during depressive episodes but not specifically alogia. Generalized anxiety disorder involves excessive worry, not alogia.

Thiamine (Vitamin B1) deficiency leads to beriberi, affecting the nervous system and heart. Niacin (Vitamin B3) deficiency causes pellagra. Vitamin C deficiency results in scurvy. Iron deficiency leads to anemia.

Necrobiosis lipoidica is a rare, chronic, and idiopathic disease characterized by collagen degeneration that causes skin lesions, typically on the anterior shin surface. This disease is classically associated with diabetes mellitus, typically type 1, and carries a risk of ulceration. Skin changes include thickening of the blood vessel walls, collagen deterioration, granuloma formation, and fat deposition.

Chronic arsenic intoxication can produce confusion and memory loss associated with nausea,
weight loss, peripheral neuropathy, pigmentation and scaling of the skin, and Mee’s lines – transverse
white lines of fingernails.

1-mL doses of purified inactivated rabies vaccine are given on 0, 3, 7, 14, and 28 days

Omega-3 fatty acids are known to reduce inflammation and are associated with a lower risk of heart disease. Saturated fats can increase LDL cholesterol. Trans fats are associated with an increased risk of heart disease. Monounsaturated fats are healthy fats that can improve cholesterol levels.

Neonatal hypothyroidism is due to thyroid gland dysgenesis in 80 – 85%, to inborn errors of thyroid
hormone synthesis in 10 – 15% & is TSH-R antibody-mediated in 5% of affected newborns.

Postpartum thyroiditis occurs 3 – 6 months after pregnancy

Vitamin C enhances the absorption of iron, particularly non-heme iron from plant sources. Calcium absorption is enhanced by vitamin D. Magnesium and zinc absorption can be affected by various factors but are not directly enhanced by vitamin C.

Felty’s syndrome consists of chronic RA, splenomegaly, neutropenia, anemia & thrombocytopenia.

Wilson‘s disease; Kayser-Fleischer rings are copper deposits in the cornea indicative of Wilson‘s disease. Hemochromatosis involves iron overload. Alkaptonuria leads to homogentisic acid accumulation, affecting connective tissue. Cystinosis involves cystine crystals in tissues.

Infective endocarditis; Osler‘s nodes are tender subcutaneous nodules on fingers or toes associated with infective endocarditis. Rheumatic fever can cause erythema marginatum. Gout involves uric acid crystal deposition in joints. RA (Rheumatoid Arthritis) leads to joint inflammation.

Leptospires traverse the interstitial spaces of kidney, penetrate basement membrane of proximal
renal tubules, cross through proximal renal tubule epithelial cells, and become adherent to proximal
renal tubular brush border, from where they are excreted in the urine.

Carpal tunnel syndrome; Phalen‘s test, involving flexing the wrists, indicates carpal tunnel syndrome if it elicits symptoms. Rheumatoid arthritis involves joint inflammation. Dupuytren‘s contracture affects fingers‘ flexion. De Quervain‘s tenosynovitis involves the thumb‘s tendons.

Upper motor neuron lesion; a positive Babinski sign, where the big toe extends upward, indicates an upper motor neuron lesion. Peripheral neuropathy involves damage to peripheral nerves. Lower motor neuron lesion results in flaccid paralysis. Cerebellar ataxia affects coordination and balance.

Interstitial lung disease; honeycombing is a late finding in interstitial lung disease, indicating fibrosis. COPD primarily affects airways, not typically causing honeycombing. Pulmonary embolism affects blood vessels. Acute respiratory distress syndrome (ARDS) involves diffuse alveolar damage.

Paget‘s disease of bone or osteoblastic metastasis; increased bone density giving a white appearance on X-ray. Osteoporosis involves decreased bone density. Ankylosing spondylitis can cause vertebral fusion. Vertebral compression fracture results in decreased vertebral height.

Intimal flap; an intimal flap on CT angiography indicates aortic dissection. Mediastinal widening may suggest aortic aneurysm or other mediastinal pathology. Calcification of the aortic knob is seen with age or atherosclerosis. Pericardial effusion appears as an enlarged cardiac silhouette.

Silicosis; eggshell calcification of lymph nodes is characteristic of silicosis, a pneumoconiosis. Sarcoidosis can also show lymph node calcification but not typically eggshell. Tuberculosis can cause calcified granulomas. Lymphoma may cause lymph node enlargement but not eggshell calcification.

Earliest sign of congenital syphilis (2 – 6 weeks after birth) is usually rhinitis, or “snuffles” which is soon
followed by other mucocutaneous lesions which include bullae (syphilitic pemphigus), vesicles,
superficial desquamation, petechiae, and papulosquamous lesions, mucous patches & condylomata
lata.

Aspergilloma; The crescent sign suggests a fungus ball within a pre-existing lung cavity, typical of aspergilloma. Tuberculosis can cause cavitation. Bronchogenic carcinoma may present as a solitary nodule or mass. Pulmonary edema shows diffuse alveolar and interstitial infiltrates.

Constrictive pericarditis; A pericardial knock is an early diastolic sound, indicative of constrictive pericarditis, due to rapid cessation of ventricular filling. Aortic regurgitation presents with a diastolic murmur. Mitral valve prolapse may show a midsystolic click. Tricuspid regurgitation presents with a systolic murmur.

Cerebral aneurysm; The rupture of a cerebral aneurysm is a common cause of SAH, leading to bleeding into the subarachnoid space. Hypertension is a risk factor for intracerebral hemorrhage. Atherosclerosis increases the risk of ischemic stroke. Migraines are associated with headaches but not directly with SAH.

Reperfusion of the affected brain area; The main goal in treating acute ischemic stroke is to restore blood flow to the brain tissue as quickly as possible, typically with thrombolytics or mechanical thrombectomy. Blood pressure control is important but secondary. Reducing intracranial pressure is more relevant to hemorrhagic stroke. Preventing seizures may be a consideration but is not the primary treatment goal.

Wernicke‘s Encephalopathy; This condition is due to thiamine (vitamin B1) deficiency, typically seen in alcoholism. Korsakoff‘s syndrome involves memory loss and confabulation following Wernicke‘s. Beriberi involves thiamine deficiency but affects the cardiovascular system and peripheral nerves. Benedikt‘s syndrome involves midbrain lesions affecting ocular movements and coordination.

Bitemporal hemianopsia; Compression of the optic chiasm by a pituitary adenoma can lead to loss of the outer (temporal) halves of the visual field in both eyes. Homonymous hemianopsia results from post-chiasmal lesions. Central scotoma is a loss in the central field of vision. Tunnel vision involves peripheral vision loss.

Rapidly progressive dementia with myoclonus; CJD is a prion disease characterized by quick progression of dementia and muscle jerks. Parkinsonian features suggest Parkinson‘s disease. Focal seizures are associated with localized brain disturbances. Sensory loss is typical of peripheral neuropathies.

Most common types of tertiary disease are gumma (benign granulomatous lesion), cardiovascular
syphilis (ascending aorta aneurysm) & symptomatic neurosyphilis (tabes dorsalis and paresis)

Gait disturbance, urinary incontinence, and dementia; This triad suggests NPH, a condition involving CSF accumulation without increased pressure. Confusion, fever, and headache suggest meningitis. Weakness, numbness, and tingling could indicate peripheral neuropathy. Photophobia, phonophobia, and nausea are associated with migraines.

Biconvex (lentiform) hyperdense area not crossing suture lines; An epidural hematoma appears as a lens-shaped bleed that is typically arterial in origin and does not cross cranial suture lines. Subdural hematoma presents as a crescent-shaped hyperdensity crossing suture lines. Subarachnoid hemorrhage shows blood in the subarachnoid spaces. Cerebral contusion appears as an irregular area of brain tissue damage.

Enhancement of GABA-A receptor activity; Benzodiazepines increase the efficiency of GABA, the primary inhibitory neurotransmitter, reducing neuronal excitability. NMDA receptor antagonism is a mechanism of certain anesthetics. Dopamine reuptake inhibition increases dopamine levels, used in ADHD and narcolepsy. Monoamine oxidase inhibition increases levels of neurotransmitters like serotonin and norepinephrine.

Generalized high amplitude rapid spikes; During a generalized tonic-clonic seizure, the EEG typically shows generalized high amplitude spikes indicating widespread brain involvement. Focal slowing indicates localized brain dysfunction. Alpha rhythm dominance is normal during wakeful relaxation. Sleep spindles are seen during stage 2 sleep.

Rose spots are a faint, salmon-colored, blanching, maculopapular rash primarily on trunk & chest,
in ~30% of patients at the end of 1st week & resolves after 2-5 days. Salmonella can be cultured
from punch biopsies of these lesions. Difficult to detect in dark skinned patients.

In dengue fever, skin rash occurs in 50% of cases. To start with its a diffuse flushing, midway
through illness, it is maculopapular rash, beginning on trunk & spreads centrifugally to extremities
and face, after defervescence, petechiae on extremities may occur. A second rash may appear
during recovery phase, ranging from mild maculopapular rash to severe, itchy lesion suggesting
leukocytoclastic vasculitis that resolves with desquamation over a period of 1 to 2 weeks.

The four species of Plasmodium that attack humans are P. falciparum (malignant tertian malaria),
P. vivax & P. ovale (benign tertian malaria), & P. malariae (benign quartan malaria).

Control of blood pressure and blood sugar; Early intervention with blood pressure and blood sugar control can slow the progression of CKD. High protein diet is generally discouraged in CKD due to the increased workload on the kidneys. NSAIDs can worsen kidney function. Corticosteroids are used in specific conditions like nephrotic syndrome, not routinely in CKD.

Low urine output due to decreased renal perfusion; Prerenal AKI results from conditions that decrease blood flow to the kidneys, leading to reduced urine output. High urine output may be seen in conditions like diabetes insipidus. Normal urine output with high creatinine suggests intrinsic renal damage. Anuria indicates very low or no urine output, seen in severe cases.

Urine dipstick test; The urine dipstick test is a quick and easy method to screen for proteinuria. 24-hour urine collection quantifies exact protein loss but is more cumbersome. Serum albumin assesses protein loss’s impact on the body but doesn’t measure urine protein directly. Urine microscopy can identify cells and casts but not quantify protein.

Tubular atrophy and interstitial fibrosis; Chronic interstitial damage is marked by these histological changes. Crescent formation suggests rapidly progressive glomerulonephritis. Mesangial expansion is seen in diabetic nephropathy. IgA deposition characterizes IgA nephropathy.

In order of frequency, the extrapulmonary sites most commonly involved in tuberculosis are the
lymph nodes, pleura, genitourinary tract, bones and joints, meninges, peritoneum & pericardium

Disorganized bone remodeling; Paget‘s disease involves excessive breakdown and formation of bone tissue, leading to bones that are large, weak, and deformed. Hypercalcemia can be a consequence but is not defining. Bone density increase occurs but does not accurately describe the pathology. Autoimmune bone destruction is more characteristic of conditions like RA.

Elevated C-reactive protein (CRP); CRP is an acute-phase reactant produced by the liver in response to inflammation, making it a good indicator of active inflammatory processes. Elevated erythrocyte sedimentation rate (ESR) also indicates inflammation but is less specific than CRP. Positive rheumatoid factor and ANA suggest autoimmune diseases but are not direct indicators of inflammation severity.

Tumor-suppressor NF1 gene on chromosome 17. Its mutation causes von Recklinghausen’s
disease. It encodes protein neurofibromin. NF2 gene is on chromosome 22q, & encodes
neurofibromin 2, schwannomin, or merlin.

Temporal artery biopsy; A biopsy showing inflammation with multinucleated giant cells confirms GCA. Elevated platelet count can be seen in GCA but is nonspecific. High-resolution ultrasound can suggest GCA but is not definitive without biopsy confirmation. Elevated liver enzymes are not directly related to GCA diagnosis.

Inflammation of the aorta and its major branches; Takayasu‘s arteritis primarily affects large vessels, leading to symptoms like arm claudication and reduced pulse. Granulomatosis with polyangiitis involves small to medium vessels. Eosinophilic granulomatosis with polyangiitis is characterized by asthma, sinusitis, and eosinophilia. Henoch-Schönlein purpura affects small vessels, often presenting with palpable purpura.

Skin thickening and hardening; Scleroderma (systemic sclerosis) uniquely presents with skin thickening, especially of the hands and face, due to excessive collagen deposition. Malar rash is associated with SLE. Erosive joint disease is typical of RA. Photosensitivity is seen in SLE and dermatomyositis but is not as distinguishing as skin thickening in scleroderma.

Type 1 (Distal) RTA presents as hypokalemia, hypocitraturia, hypercalciuria, nephrocalcinosis,
nephrolithiasis. Chronic untreated acidosis may lead to rickets or osteomalacia.