High Yield Points for PLAB by Clinchers

Infections in HIV patients:

HIV with diarrhoea = cryptosporidium
HIV with photophobia/meningitis = crytococcal
HIV with mouth ulcers = candidiasis
HIV with neuro symp, change in behaviour = toxoplasma Gondii
Hiv with Pneumonia = pneumocystits jerovici.
Respiratory Pneumonia = Ix: CXR
Pulmonary embolism = Ix: (A )V/Q , Spiral CT, (B) plain angiogram
Pneumonia = erythmatous rash = target lesion = mycoplasma
CXR = pneumonia, pneumothorax (tension pneumothorax), Dx: clinical, Don’t waste time on Ix go for Mx.
V/Q = PE = spiral CT or best pumonary angiogram.
Spiral CT = PE = safe in preg.
PE = Raised PR, raised JVP, ECG: T decreased V1-3
Absent vascular markings on CXR = pneumothorax
Tall thin man with SOB = spontaneous pneumothorax
Travelers pneumonia is caused by legionella
Childhood asthmatic with family history will persist in adulthood
Childhood asthmatic without family history prognosis unknown
Infant SOB with failure to thrive = wt. below desired centile for height
FRS left in bronchus / lungs will develop into abscess
Pneumonia in COPD / CF = pseudomonas or H.influenza
Pneumonia in <1yr is bronchiolitis cause is viral
Mycoplasma Rx = erythromycin
Legionella Rx = erythromycin
Farmers + SOB = Extrinsic allergic alveolitis

Respiratory:

Pneumonia = Ix: CXR
Pulmonary embolism = Ix: (A )V/Q , Spiral CT, (B) plain angiogram
Pneumonia = erythmatous rash = target lesion = mycoplasma
CXR = pneumonia, pneumothorax (tension pneumothorax), Dx: clinical, Don’t waste time on Ix go for Mx.
V/Q = PE = spiral CT or best pumonary angiogram.
Spiral CT = PE = safe in preg.
PE = Raised PR, raised JVP, ECG: T decreased V1-3
Absent vascular markings on CXR = pneumothorax
Tall thin man with SOB = spontaneous pneumothorax
Travelers pneumonia is caused by legionella
Childhood asthmatic with family history will persist in adulthood
Childhood asthmatic without family history prognosis unknown
Infant SOB with failure to thrive = wt. below desired centile for height
FRS left in bronchus / lungs will develop into abscess
Pneumonia in COPD / CF = pseudomonas or H.influenza
Pneumonia in <1yr is bronchiolitis cause is viral
Mycoplasma Rx = erythromycin
Legionella Rx = erythromycin
Farmers + SOB = Extrinsic allergic alveolitis

OCCUPATIONAL HEALTH in respiratory system context:

Coal miners = restrictive/obstructive lung disease, progressive fibrosis.
Allergic Rhinitis = Asthma, Churg straws synd
Farmer with chest condition = Extrinsic allergic alveolitis

CVS:

- ECG = chest pain, tacchyarrythmia = STEMI => SK , NSTEMI => B-Blocker
- Echo = valve / septal …. / murmur
- Exercise ECG = Angina
- Troponin I/ T = cardiac enzyme = MI
- Heart failure= >55 yrs = give ACEI (also good in DM, C/I in RAS) = enalapril, verapamil.
  <55yrs = B-Blocker
  Black with any age = Ca+ channel blockers are best to use.
- CCF with AF Mx is digoxin, without AF = amaiodarone
- Post MI Mx = ACEI + B-Blocker + Statin + Asp?
- IHD with CCF = Amiodarone
- LVF following MI Rx with ACEI
- Diabetic pt with HTN = Mx : ACEI
- Tachycardiac pt not responding to meds = Mx: Dc
- CCF pt. not getting better on furosemide = add thiazide
- HOCM = Mx: B-Blocker
- >55 or black 1st choice to Mx HTN = Ca++ channle Blocker (nifedipine) or thiazide
- <55 = 1st choice to Mx HTN = ACEI (enalapril)
- Give ARB’s if pt. is intolerant to ACEI (e.g LOSARTAN)
- If on C or D and still uncontrolled = add ACEI
- If on A and not controlled = add C or D
- Side Effects and C/I
- ACEI : cough, Raised K+, RF C/I: renal or aortic stenosis
- Ca++ Blocker: flushes, gum hyerlesia, fatigue, ankle oedema
- Thiazide: decreased Na+,K+ level, postural hyotneiosn, impotence, C/I: Gout
- B-Blocker: bronchospasm, CCF, cold periphries, lethargy, impotence C/I: Asthma
- Mx of ventricular tachycardia = amiodarone
- Mx of paroxysmal A.fib = flecanide or sotalol
- Mx of HTN in pregnancy = methyldopa
- Comlete heart block site = bundle of hiss
- Open foramen ovale = interatrial septum
- Cardiac aneurysm site = Lt. ventricle
- Endocarditis in IDU site = tricuspid valve
- Heart skipping beat = most probably ventricular ectopic
- Young erson with tachycardia = most probably SVT
- Old person with tachycardia = most probably VT
- Severe brady cardia following MI = heart block
- Athletes with slow PR = sinus brady cardia
- Ix of choice for murmur = Echo
- Pt. on long term aspirin (following CVA/….) will suffer from anemia
- T-waves inversion on ECG with chest pain(wihtout chest pain=SOB) = NSTEMI
- NSTEMI donot need SK just give B-blocker
- ST elevation after MI = Give SK
- MI after >4hrs of Strep = cant repeat SK for untill 5yrs = Give Recombinant tissue plasminogen activator (r-tpa)
- ST depression may indicate angina or PE
- SVT Mx: carotid massage => adenosine / verapamil
- Bradycardia after MI = Mx with cardiac pacer
- Cholestrole level following MI should be <4 (normal = 5.5)
- CPR: 30 breath / 2 chest compression (adult)
  15 breath / 2 chest compression (child)
- HTN with kidney disease best drug = ACEI (CCF, CCF with DM, CCF with IHD)
- TIA Ix = Doppler of carotid arteries
- Syncope while frming = postural hypotension
- Syncope while stress / anxiety = vasovagal
- Syncope with amnesia = transient dysarrhythmia