Medicine Rapid Revision (RR 2.0)

Spirometry & Patterns

• FEV1/FVC Ratio:
  • < 0.7: Obstructive Lung Disease (COPD, Asthma, Bronchiectasis).
  • > 0.7 (Normal/Increased): Restrictive Lung Disease (ILD, Kyphoscoliosis) or Normal.
• Reversibility Test: Give Salbutamol. Improvement in FEV1 > 12% AND > 200ml = Asthma. No improvement = COPD.

Flow Volume Loops

• Obstructive: Shift to Left + Concavity in expiratory limb.
• Restrictive: Shift to Right + Narrow shape ("Witch's Hat" / Beanie cap).
• Fixed Upper Airway Obstruction (Tracheal Stenosis): Box pattern (Flattening of both inspiratory and expiratory loops).
• Variable Extrathoracic (Croup/Vocal Cord Palsy): Flattening of Inspiratory loop only.
• Variable Intrathoracic: Flattening of Expiratory loop only.

DLCO (Diffusion Capacity)

Increased DLCO Mnemonic: "Abhishek Sharma Plays Cricket"

• Alveolar Hemorrhage (Goodpasture's)
• Shunts (L -> R) / Supine position
• Polycythemia
• Congestive Heart Failure (Early)
• Note: Asthma usually Normal/High (High in acute attack).

Decreased DLCO Mnemonic: "VIP LATE"

• Valsalva
• ILD / IPF
• Pulmonary Hypertension
• Lung resection
• Anemia / Amiodarone toxicity
• Thromboembolism (PE)
• Emphysema

Diseases & Management

• Asthma (GINA 2024/25):
  Step 1 & 2: As needed Low dose ICS-Formoterol (MART therapy). No SABA alone.
  Samter's Triad: Asthma + Nasal Polyps + Aspirin Sensitivity.
• COPD (GOLD): Based on Symptoms (CAT score) & Exacerbations.
  Group A: Bronchodilator. Group B: LABA+LAMA. Group E: LABA+LAMA (+ICS if eos > 300).
• ABPA: Asthma/CF patient + Brown Sputum + High IgE (>1000).
  Sign: Central Bronchiectasis (Finger in glove). Rx: Steroids + Itraconazole.
• Pneumonia (CURB-65):
  Confusion, Urea >7, RR ≥30, BP <90/60, 65 Age.
  Score 0-1: Home. 2: Ward. 3-5: ICU.
• Pulmonary Embolism:
  ECG: S1Q3T3 (Rare but specific), Sinus Tachycardia (MC).
  CXR: Hampton's Hump, Westermark Sign, Palla's Sign.
  Echo: McConnell's Sign. IOC: CTPA.

Esophagus

• Zenker's Diverticulum: Halitosis, Regurgitation. Killian's Dehiscence (Posterior). False diverticulum.
• Achalasia Cardia: Dysphagia to Liquids > Solids. Bird Beak appearance. Rx: Heller's Myotomy / POEM.
• Diffuse Esophageal Spasm (DES): Corkscrew Esophagus. Chest pain mimicking angina.
• Schatzki Ring: Steakhouse syndrome. Dysphagia to solids.
• Plummer Vinson: Web, Iron deficiency anemia, Glossitis. Risk of SCC.

Inflammatory Bowel Disease (IBD)

Hepatology Scores

• MELD Score (CBI): Creatinine, Bilirubin, INR. (MELD 3.0 adds Na + Albumin).
• PELD (Pediatric): "Big Apple" - Bilirubin, INR, Growth failure, Albumin, Age.
• Child-Pugh Score ("Pour Another Beer At Eleven"):
  PT/INR, Ascites, Bilirubin, Albumin, Encephalopathy.
• Wilson's Disease: Nazer Score / New Wilson Index (Dhawan's Index).
• SAAG (Serum Ascites Albumin Gradient):
  > 1.1 (High): Portal HTN (Cirrhosis, CHF, Budd-Chiari).
  < 1.1 (Low): TB, Cancer, Pancreatitis, Nephrotic.

SLE (Systemic Lupus Erythematosus)

• Screening: ANA (Best screening).
• Specific: Anti-Smith, Anti-dsDNA (Correlates with disease activity/Nephritis).
• Drug Induced Lupus: Anti-Histone ("SHIP" drugs: Sulfonamides, Hydralazine, Isoniazid, Procainamide).
• Treatment: Hydroxychloroquine (All patients), Steroids (Flares), Mycophenolate/Cyclophosphamide (Lupus Nephritis). Belimumab (Monoclonal).

Vasculitis

• Large Vessel:
  • Takayasu: Pulseless disease, young female, Subclavian artery.
  • Giant Cell (Temporal): Elderly, Jaw claudication, Blindness risk. Rx: Steroids.
• ANCA Associated:
  GPA (Wegener's): c-ANCA (PR3). Upper resp + Lower resp + Renal (Triad). Saddle nose.
  MPA: p-ANCA (MPO). No granuloma. No Upper resp involvement.
  EGPA (Churg-Strauss): p-ANCA. Asthma + Eosinophilia.
• Behcet's: Oral ulcers + Genital ulcers + Uveitis. Pathergy test positive.

Nephrotic Syndrome

Proteinuria > 3.5g/day, Edema, Hypoalbuminemia, Hyperlipidemia.

• Minimal Change Disease: MC in children. Effacement of foot processes (EM). Excellent steroid response.
• Membranous Nephropathy: MC in adults. Anti-PLA2R antibody. Spike and Dome pattern. Associated with Hep B, SLE, Drugs.
• FSGS: Associated with HIV, Heroin. Poor prognosis.

Nephritic Syndrome

Hematuria (RBC casts), HTN, Oliguria.

• PSGN: 1-3 weeks after throat/skin infection. Low C3. Lumpy Bumpy deposits (Subepithelial humps).
• IgA Nephropathy: 1-2 days after infection (Synpharyngitic). Normal C3. Mesangial deposits.
• RPGN: Crescentic GN.
  Type 1: Goodpasture (Anti-GBM, Linear deposit).
  Type 2: Immune Complex (SLE, PSGN).
  Type 3: Pauci-immune (ANCA vasculitis).

Tubular Defects

• Bartter Syndrome: Like Loop Diuretics (Thick Ascending Loop). Hypokalemia, Alkalosis, hypercalciuria.
• Gitelman Syndrome: Like Thiazides (DCT). Hypokalemia, Alkalosis, Hypocalciuria, Hypomagnesemia.
• Liddle Syndrome: Gain of function ENaC. HTN + Hypokalemia + Alkalosis. Low Renin/Aldo. Rx: Amiloride.

Rheumatic Fever

• Jones Criteria (Revised):
  Major: Carditis, Arthritis (Poly in low risk, Mono/Poly in high risk), Chorea, Erythema Marginatum, Subcutaneous Nodules.
  Minor: Fever, Arthralgia, High ESR/CRP, Prolonged PR interval.
• Mitral Stenosis: Opening Snap, Mid-diastolic murmur (Presystolic accentuation). Loud S1. Malar flush.
  Severity: Inversely proportional to A2-OS gap.

ECG Diagnosis

• Hyperkalemia: Tall Tented T waves -> Wide QRS -> Sine wave. Rx: Calcium Gluconate (Stabilize membrane), Insulin+Dextrose.
• Hypokalemia: U waves, ST depression.
• MI Localization:
  II, III, aVF: Inferior Wall (RCA).
  V1-V4: Anterior Wall (LAD).
  I, aVL, V5, V6: Lateral Wall (LCX).
• Pericarditis: Diffuse ST elevation (Concave upwards) + PR depression.

Pericardial Diseases

Stroke Management

• Ischemic Stroke: Thrombolysis (Alteplase) within 4.5 hours.
  Mechanical Thrombectomy up to 24 hours (large vessel).
• Hemorrhagic Stroke: BP control. No antiplatelets.

Headache

• Migraine: Unilateral, Pulsating, Nausea/Photophobia. Rx: Triptans. Prophylaxis: Beta blockers, Topiramate.
• Cluster Headache: Unilateral, Retro-orbital, Lacrimation/Rhinorrhea. Restless patient.
  Rx: 100% Oxygen (DOC), Sumatriptan. Prophylaxis: Verapamil.
• Tension Headache: Band-like, Bilateral. Rx: NSAIDs.

Parkinson's Disease

TRAP (Tremor - Resting, Rigidity - Cogwheel, Akinesia/Bradykinesia, Postural instability).

• Drug of Choice: Levodopa + Carbidopa.
• Young onset (<60y): Dopamine Agonists (Pramipexole, Ropinirole).

Adrenal Disorders

• Cushing's Syndrome:
  Screening: Overnight Dexamethasone Suppression Test.
  Confirm: High Dose DST. (Suppression = Pituitary/Cushing Disease. No suppression = Ectopic/Adrenal).
• Addison's Disease: Hyperpigmentation, Hyperkalemia, Hyponatremia, Hypotension.
  Diagnosis: ACTH Stimulation test.
• Pheochromocytoma: Palpitations, Perspiration, Pressure (HTN), Pain (Headache).
  Rule of 10s: 10% Bilateral, 10% Extra-adrenal, 10% Malignant.
  Pre-op: Alpha blockade FIRST (Phenoxybenzamine), then Beta blockade.

Pituitary

• Acromegaly: High GH, High IGF-1.
  Screening: IGF-1 levels. Confirmatory: Oral Glucose Suppression Test (GH fails to suppress).
  Rx: Surgery (Trans-sphenoidal). Somatostatin analogues (Octreotide).
• Prolactinoma: Galactorrhea, Amenorrhea.
  Rx: Dopamine Agonists (Cabergoline - DOC). Surgery only if resistant/visual field defects.