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

Next Page