High Yield Points for PLAB by Clinchers

Causes of Haematuria:

Drug induced = recent drug Rx
Long distance runner = Rhabdomyolysis (Would … be RBC in blodd by myolocyter???)
Porphyria caused by ocp, barbiturates, and oral hypoglycemic drugs
Glomerulonephritis

Important Ix:

Asthma = peak expiratory flow
Pneumothorx = Cxr
Pneumonia = Cxr
PE = V/Q , spiral CT
DKA = glucose, ABG’s
RF = U/S
Ureteric stone = cystoscopy
MI = Cardiac enzyme
GERD = oesophagela-gastro-duodeno scopy
Acromegaly = (a) GTT with GH (b) S I GF screens???
Addisions = short synechtin test
Cushings = Dexa suppression test
Any mass initial Ix = US
DM screening test = FBS
Synmptomatic with 1 high FBS or 1 high RBS = Dx of DM
Asymptomatic with 2 high FBS or 2 high RBS or GTT
Gstric reflux Ix by gastroscopy
Cholecystits Ix by U/S
Stomach Ca. Ix by gastroscopy
Ca. Colon / Rectum Ix by sigmoidoscopy
Aortic aneurysm Ix by U/S, Best is CT scan

Ix:

SLE = autoantibody screen
Polycystic kidney = pelvic U/S
Multiple Myeloma = bence jones protein

Surgery:

Neck – midline mass = thyroglossal cyst, Ix: FNA
Neck – fluctuating mass beneath SCM = brachial cyst, Ix: FNA
Neck pulsatile mass beneath SCM = crotid body tumor, Ix: doppler u/s
Pharyngeal pouch = Ix: barium meal or contrast X-ray.
Lower oesohageal ring = sha…. Ring = Rx: oesophageal diverticulotomy
Bence jones protein for multiple myeloma
Pt. = diarrhoea / abd. Pain = necrotic ulcers on body = pyoderma gangrenosum
Pulstile swelling at the base of SCM = subclavian artery aneurysm
Swelling at lower part of inferior constrictor = pharyngeal pouch
Swelling attached to 7th cervical vertebra = cervical rib
Sweeling in midline between thyroid cartilage and tongue = thyroglossal cyst
Medial malleous ulcer = venous
All neck masses = initial Ix = U/S
Cystic mass = aspirate, solid mass = fine needle asiration (FNAC)
Known prostate cancer = back pain Ix = technitium 99 bone scan
Known cancer patien = confusion, abnormal ECG = Ix: hypercalcemia
Prostate cancer follow-up Ix = PSA
Renal failure Ix = U/S
Heavy smocker = ischemic lower limb = thrombo angitis obliterans
Post operative chest pain = (a) Lt. side = MI => Ix by ECG, (b) Breathless = PE => Ix by V/Q or Spiral CT
Post operative fever = (a) wound sepsis => Ix by wound swab …? (b) peritonitis=> Ix by Abd. U/S
Cancer patient with leg weakness, poor bowel/urine habits = cord compression due to bone metastasis
Post chemo = raised urea level in blood = tumor lysis synd
Antibiotics pre/post operative
3gm stat amoxil before procedure – dental on cardiac pt.
3/7 iv Abx pre op = heart valve replacement
NPO, Pa picpsulphate 1/7 pre op + i/v Abx pre op = sigmoid colectomy
Life long penicillin prophylaxis = post spleenectomy for 30yrs = Rheumatic fever
One dose metronidazole pre op = Emergency appendectomy
Nipple discharge Ix = ductogram
Pt. with the family history of breast Ca. = Genetic counselling & testing
Free mediastinal gass = ruptured oesophagus also surgical emphysema
Gas beneath diagphram = visceral abd. Part
Globular heart shadow = temponade = low voltage ECG, muffled heart sound
Widened mediastinum = ruptured aorta
Breast pain with menses = cyclical mastalgia
Neck lump biopsy showing giantcell + caseation = TB lymhadenitits
Ship worker with neck mass +/- interstitial chest fibrosis = mesothelioma
Ca. pt. having superior vena caval obstruction post radiation Rx = Dexameth
Bronchial Ca. pt. need to cough out spututm (bronchial secretion) = hyoscine injection
Renal stone ass. With …(malignancy???) arthritis = uric cid
Renal stone – if all the investigations re normal = check diet history
Doppler U/S best Ix for DVT
Bone mets causing pain Mx = Radio Rx
Young boys with inguinal hernia = Mx = Herniotomy
Adult male with inguinal hernia= Mx= mesh repair/herniography (herniorrhaphy)?????
Suspected abdominal aneurysm = laprotomy to Ix
Anaplastic carcinoma of thyroid grows very rapidly and causes hoarsness

Pre/post operative (surgery):

Surgery, long……, = SOB = PE
Post anesthesia = SOB = acute pneumonitis … to intubation +/- aspiration
Pt on warfarin required surgery stop warfaring 4/7 days pre op.
Pt on clopidogril (anti-PLT) b4 surgery = stop 1/52 preop
IDU pre op Ix = Hep screen

Gyne & Obs:

- Prolonged ruptured of membranes = complications = chorioamnionitis
- Juandice in pregnancy = (a) >40, abd pain, vomiting, ph = preeclampsia, hyoglycemia
  Acute fatty liver of pregnancy
  = (b) abd pain vomit, hemolysis, elevated liver enzyme, low platelet count (HELLP)
- Pregnancy = SPA pain right to thigh groin on walking = symphysis pubis dysfuntion
- Obese, acne, female, high insulin = polycystic ovarian synd
- Pelvic pain remenstrual, long standing, walks + post coital = pelvic congestion synd
- IUCD = increases risk of PID or long standing pessary in post menopause
- Female who exercise a lot having amenorrhoea= (1) adipose tissue repleced by muslce …. Testoteron (2) Constitutional
- Progesterone level confirs ovulation 7/7 post ovulation date
- Menorrhagia / Dysmenorrhia premenopausal …. To decreased progesterone
- Mx of painful menses = NSAIDS
- Remmoving fibroids while …. Uterus – myomectomy
- Pregnant female need anticoagulatn = S/C LMWH
- Ectopicc usually 6-8/40 after amenorrhoea = pregnancy test + U/S
- Preg. Induced dyspepsia Rx with antacid
- Pregnancy induced gastric reflux Mx = simple antacids