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

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