High Yield Points for PLAB by Clinchers

Paeds:

Child with enuresis <5yrs => incontinent pents, >5yrs => desmopressin
UTI can cause Fecal / Urine incontinence in child / elderly
Commonest cause of UTI’s are: (a) E.coli, (b) proteus
Child / man with unknown cause of UTI do U/s
Female with recurrent UTI do U/s

Paed’s (congenital Disorders):

Female with coarctation of aorta = turner’s (45XO)
Small chin, low ears, rocker bottom feet = Edward’s synd 47XY (Chr.no.18)
Tall boy with female features = kleinfilters synd (47Xxy)
Dysmorpphic, floppy body = Down’s 47XY (21)
Large head with large testes = fragile X-syndrome
Cyanosed body = boot shaped heart = tetrology of fallot
Failure to thrive, pansystolic murmur t lower sternal edge, prasternal thrill= VSD
Cool extremities, no femoral pulse = transosition of great vessels?????
Machinary murmur = PDA

Psychiatry:

Mild depression = CBT
Severe depression = SSRI, cant sleep-amitryptalin (khurram bhai I think Here ECT is required)
Atypical deression = MAOI-phenelzine
PA eating, not resopnding to Rx, post natal = ECT

DERMA:

Skin cancer long standing bleeds on touch = squamous cell Ca.
Treatment of acne = doxy, erythro, topical benzyl, topical retinoids, oral retinoids
White itchy plaque on vulva / …. = lichen sclerosis
Pearly lesion with raised edges on labial folds = Basal cell Ca.
Subcutaneous non-tender slowly growing nodule = lipoma
Raidly growing raised lesion with rolled out edges with horny plug = kerato-acanthoma
Redish brown scaly plaque, sun exposed area, very slow groing = sq.cell Ca, in situ (Bowens disease)
Colour / size changing lesion = melanoma
Weeping + crusting eczema = staph. Infected
Sebhorric eczema is cused by yeast

ENT:

Diabetics with ear furuncle = staph
Any ear perforation = immediate refer
Mass in fron of ear drum = wax/ ???
Mass behind of ear drum = cholestema
Family history of hearing loss = otosclerosis
Hearing loss with facial numbness = acoustic neuroma
Old age degenerative hearing defect = presbycusis
Unilateral sensory hearing loss = acoustic neroma (will have facial pain)
Bilateral sensory hearing loss = noise induced ( heals spontaneously)
Bilateral progressive sensory hearing loss = presbycusis
Bilateral conductive hearing loss = otosclerosis, wax
Mx of otitis externa = Genta (topical), Cipro (oral)
Vertigo following URTI = vestibular neuritis (labyrinthitis)
Deafness + vertigo + tinnitus = Menier’s
Basal skull fracture (temporal) = ear discharge (petrus)
Basal skull fracture (ethmoidal) = nasal discharge
Pink ear drum = viral OM, Mx: pc?
Red ear drum = bacterial OM, Mx: ABx
Best ABx for OM = amoxil UTI = trimetn/cefuroxime
A nasal septal defect = suspected cocaine abuse
Hoarsness / loss of voice following physiological or prolonged intubation = functional
dysphonia

Opthalmology:

Acute glaucoma Rx = topical pilocarpine + topical steroids
Hx of IHD = symp of decreased vision = central retinal artery occlusion
Tunnel vision = glaucoma, Seeing haloes = glaucoma
Curtain coming down = retinal detachment
Curtain coming down vision = retinal detachment
Smokers = optic atrophy => will have pale fundus

Anatomy & Fractures:

Over weight, leg length dis…., externally rotated, age >10 = slipped upper femoral epiphysis
Leg lenth dis…., groin pain increased on exersion, age <10 = perthes
Hip pain / Inflammation after URTI = transient synovitis or irrit… hip synd
Walking roblem from birth, limp while walk = developmental dyslasia of hip
Mid point of suprasternal notch and symphisis pubis = transpyloric plane
Tip of 9th costal cartilage = fundus of galbladder
T10 = oesophagus enters diagphram
Just above mid inguinal point = femoral artery pulse
Best Ix to diagnose spinal fracture is plain X-ray

Fractures:

- Punch hard surface = metacarpal #
- Shoulder dislocation after fit = posterior
- No radial pulse = supracondylar # of humerus
- Old lady falling on outstretched arm = distal radius# = colle’s #
- Patient complain of pain/swelling after POP = check pulse = remove POP
- If # causing arterial occlusion = immediate reduction
- Rx of osteoprosis = Bisphosphonate
- Prevention of osteoprosis = Ca++ supplements
- On Field # Mx = 1st : pain relief, 2nd : immobilize, 3rd : X-ray
- Fractured wrist distal to radius = schahoid # => initial X-ray will be normal
- Wrist drop after # = Radial nerve (is for dorsiflexion) damage as in spiral # of humerus
- No radial pulse after # is supracondylar # of humerus
- Babies carying when hard lifted usually after traumatic delivery = # clavicle
- Pt. with perilunate dislocation = refer to ortho
- Snuff box = scaphoid # = x-ray wrist (lateral???) view, Mx: POV cast, R/V in 2/S2
- Back seat passenger in MVA = whiplash injury, Mx: physio
- Foot drop is result to compression on common peroneal nerve
- Linear transverse bruising from lap belt abobe umblicus in MVA = Mesenteric vascular injury
- In emergency if iv access cant be made = (a) >12 yrs => CVP, (b) <12yrs => intraosseous
- #shoulder = decreased sensation on lateral aspect of deltoid = axillary nerve
- #fibula = loss of dorsiflexion/sensation on lateral side of leg = common peroneal nerve
- #medial epicondyle = decreased sensation 4th/5th finger = Ulnar nerve
- #humerus = wrist drop = radial nerve
- #hip with weakness of hamstring = sciatic nerve