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

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