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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

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