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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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