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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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