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Imp Plab Points PDF
Imp Plab Points PDF
Patient well controlled on oral morphine but can't tolerate oral route - shift to
transdermal patch (fentanyl)
Patient not well controlled on oral morphine and not tolerating oral route - shift
to s/c or IV morphine with dose adjustment (half dose)
Patient not able to tolerate the side effects of morphine - change to
oxycodone
Post Coital Bleeding for the first time: Cervical smear first and depending on
result colposcopy. ( sometimes with punch biposy or core biopsy)
If PCB is persistent i.e 3 months duration etc, direct colposcopy.
pneumonia+headache+confusion=legionella
SOB + such high fever+ Localized pleural rub - seems Lobar pneumonia
Pleural rub present in pneumonia, PE and pleurisy.
This woman has lower abdominal pain and a positive pregnancy test
with signs of haemodynamic instability: an ectopic pregnancy (C) should
therefore be excluded urgently. Ovarian torsion (E) and ruptured ovarian
cysts (A) classically present with a sudden onset abdominal pain, and
are not commonly associated with a significant tachycardic hypotension.
Differentiating between them can be difficult. However, the natural
history of the pain is often helpful. Both may present with sudden onset
pain, but usually the pain of ovarian torsion will be out of keeping with
the clinical findings and will not improve with simple analgesia. Indeed
it does not normally decrease significantly at all. By contrast, the pain
of cyst rupture, while being of sudden onset, is often reduced by simple
analgesia and may decrease gradually as the peritoneal lining (having
been irritated by leaking fluid or blood from the cyst, causing pain)
absorbs intraperitoneal free fluid. A woman with a perforated appendicitis
(D) would often show signs of sepsis, including fever and peritonitis,
and pain is normally localized initially to the central abdomen or right
iliac fossa. At this level of beta hCG, an intrauterine pregnancy would
normally be visible on transvaginal ultrasonography. Of the two ectopic
pregnancy options available, cervical ectopics (B) would normally be
demonstrable on transvaginal ultrasound. Ruptured ectopic pregnancy
is a surgical emergency requiring prompt assessment, resuscitation and
urgent surgery. The urgency of the situation is even more pronounced if
there are signs of haemodynamic instability, such as in this case where
there is evidence of hypovolaemic shock
Important point
• Increased thirst
• Increased urination
• High fever
• Weakness
• Drowsiness
• Altered mental state
•
Headache
• Restlessness
• Inability to speak
• Visual
problems
• Hallucinations
• Paralysis
• Warm skin that doest not
prespire
(signs of hyperglycaemic shock....)
HAEMOCHROMATOSIS
…….joints, (arthralgia, osteoporosis, pancrease(bronze dm
heart,(dilated cardiomyopathies pituitary,(hypogonadisim and
hypoaldosteronisism liver(cirrhosis).
• Is autosomal recessive
• Is associated with more ferritin and decrease iron binding
capacity.
• >50% patients are diabetic
• Predispose to hepatoma
• Is caused by absorption of iron
Perl’s stain on liver biopsy for
iron loading.
The rooting reflex is present at birth and disappears around four months of
age, as it gradually comes under voluntary control.A newborn infant will turn
his head toward anything that strokes their cheek or mouth, searching for the
object by moving their head in steadily decreasing arcs until the object is
found.
The palmar grasp reflex appears at birth and persists until five or
six months of age. When an object is placed in the infant's hand
and strokes their palm, the fingers will close and they will grasp it
with a palmar grasp.
And if she unfortunately develops chicken pox, then give her acyclovir within a
day of appearance of rash (no immunoglobulins will help her once she
develops the disease so avoid)
If fetus develops chicken pox (soon after birth) give both immunoglobulin and
acyclovir A-- pale optic disc becoz artery is occluded
Features result from excessive copper deposition in the tissues, especially the
brain, liver and cornea:
1:2:1
Since they're asking for the most appropriate (not the initial most)
investigation, I'll go for endometrial sampling.
Painless syphlis
Painful single ulcer -- hem ducreyi
Hsv -- multiple
For babies who had no requirement for special care (or <48 hours in special
care).
Uses the AOAE test. Babies not passing this test are given the AABR test.
Uses both AOAE and AABR tests. The latter can detect auditory neuropathy,
which is more common in special care babies.
Muscle pain due to inflammation in the body's soft tissues. Myofascial pain is
a chronic condition that affects the fascia (connective tissue that covers the
muscles). Myofascial pain syndrome may involve either a single muscle or a
muscle group. In some cases, the area where a person experiences the pain
may not be where the myofascial pain generator is located. Experts believe
that the actual site of the injury or the strain prompts the development of a
trigger point that, in turn, causes pain in other areas. This situation is known
as referred pain.
Myofascial pain symptoms usually involve muscle pain with specific "trigger"
or "tender" points. The pain can be made worse with activity or stress. In
addition to the local or regional pain associated with myofascial pain
syndrome, people with the disorder also can suffer from depression, fatigue
and behavioral disturbances.
Diagnosis
Trigger points can be identified by pain that results when pressure is applied
to an area of a person's body. In the diagnosis of myofascial pain syndrome,
four types of trigger points can be distinguished:
The National Institute for Health and Clinical Excellence (NICE) advises that
women should be offered screening for anaemia at booking and at 28 weeks
of gestation.[2] Anaemia is defined as an Hb level <11.0 g/dL at booking;
haemodilution will result in further drops during pregnancy and subsequent
reduction in oxygen-carrying capacity. In the second and third trimesters the
diagnostic level for anaemia is an Hb level of <10.5 g/dL. Postpartum the
diagnostic level is 10.0 g/dL.
Parkinson type effects plus urinary symptoms are shy drager syndrome
shy dagger syndrom..wet wobbly wacky..
Pancoast's
Syndrome Classically caused by an apical
(superior pulmonary sulcus) malignant neoplasm of the lung. The
neoplasm is usually bronchogenic in origin (most commonly
squamous cell carcinoma, sometimes adenocarcinoma and large-
cell carcinoma).
Presentation
This syndrome results from the invasion of a number of structures
and tissues around the thoracic inlet and may be characterised by:
• An ipsilateral invasion of the cervical sympathetic plexus leading
to Horner's syndrome (miosis, enophthalmos, ptosis; in 14-
50% of patients).[1]
• Ipsilateral reflex sympathetic dystrophy may occur.
• Shoulder and arm pain (brachial plexus invasion C8-T2) leading
to wasting of the intrinsic hand muscles and paraesthesiae in
the medial side of the arm.
• Less commonly, unilateral recurrent laryngeal nerve palsy
producing unilateral vocal cord paralysis (hoarse voice ±
bovine cough), and/or phrenic nerve involvement.
• There may be arm oedema secondary to the compression of
blood vessels.
Superior vena cava syndrome may also occur.
Features
These are:[2]
• Short stature.
• Retinitis pigmentosa, nystagmus, choroidal atrophy, cataract and
squint.
• Micropenis with hypoplastic scrotum.
• Type 2 diabetes mellitus.
• General learning disability.
• Speech delay and deficit.
• Ataxia with spastic paraplegia.
Renal anomalies, eg clubbing, diverticula or calyceal cysts.
Goodpasture syndrome (GPS; also known as Goodpasture’s
disease, anti-glomerular basement antibody disease, or anti-
GBM disease) is a rare autoimmune disease in which antibodies
attack the lungs and kidneys, leading to bleeding from the lungs
and to kidney failure
0-14yrs- ALL
15-59yrs- AML
40-60yrs- CML
60+ CLL
Status epilepticus
Administer intravenous lorazepam as first-line treatment. Administer
intravenous diazepam if intravenous lorazepam is unavailable, or buccal
midazolam if unable to secure immediate intravenous access. Administer a
maximum of two doses of the first-line treatment (including pre-hospital
treatment)
Phenytoin is 2nd line.
to correct Hyperkalemia
1st n qickest is calcium gluconate
Then insulin n dextrose
Then calcium resonium
Afib is the most common arrythmia in alcoholics. Also known as holiday heart
syndrome
in holiday heart syndrome AF occurs due to binge drinking and theres no
underlying heart patho
swelling in ankles in an elderly female indicates heart failure. alcoholic so AF
hence reathlessness and palpitations
CRAO, cherry red sopt is clincher. applying pressure might increase the blood
flow
TIA. Doppler usg. Majority of TIA develop due to emboli which are picked up
on carotid doppler.
for dehydration and dka its NS and for burns its hartmans solution
if on the electrolyte picture it shows hypernatremia only then go for 0.45% NS.
otherwise give 0.9% NS if normonatremia or hyponatremia.
and potassium is always added to the fluid regimen after confirming the lab
values and a good urine output
before surgery for diabetics iv insulin n glucose n k
Chicken has blisters of different ages .. Some healing ( crusted in this case ) ,
others ( the new ones ) still erupting ( weeping in this case )
In Shingles , all come at same time and with preceding pain in dermatomal
area and heal by crusting at the same time
for shingles , there should be some history , a minor clincher towards
immunocompromised state . It doesnt usually erupt just like that in healthy
young individuals whereas chicken pox can !!
Also though chicken pox starts from trunk , it surely is there on face and
around eyes.
Aspirin should b given from the 1st day of +ve pregnancy test n heparin
should b given as soon as fetal heart is seen on us….Anti phospholipids
syndrome
Beningn essential tremors ease off and become less noticeable on use of
affected limb or movement
Whereas in cerebellar disease there are tremors specifically on desired
movement ( intention tremors )
The Valgus stress test is a test for ligament damage. It involves placing the
leg into extension, with one hand placed as a pivot on the knee. With the
other hand placed upon the foot applying an abducting force, an attempt is
then made to force the leg at the knee into valgus. If the knee is seen to open
up on the medial side, this is indicative of medial collateral ligament damage
and may also indicate capsular or cruciate ligament laxity.
similarly varus stress test for lateral collateral
Patient allergy to contrast media or renal failure do V/Q scan. If they give
chest Xray is normal or if no significant cardiopulmonary history in the patient
then again V/Q scan preferred.
CTPA in all other cases
Otitis media with effusion aka secretory otitis media aka glue ear. Common in
young children, 40db hearing loss, increase volume of tv. Dull greyish blue
tympanic membrane with air fluid levels are all the clinchers
Right dominant circulation= 85%= Post desc artery arises from Right coronary
artery
Left dominant circulation= 8%= PD arises from Left coronary artery
so basically dominancy depends on this Post desc artery.. from where it
arises
Rathke cleft cysts (RCCs) are benign lesions that typically arise within the
sella between the anterior and posterior lobes of the pituitary.Most often they
are asymptomatic. These lesions, however, can cause mass effect on
surrounding structures such as the pituitary gland and optic chiasm, leading to
headache, pituitary dysfunction, or visual disturbance.Rathke cleft cysts are
remnants of the Rathke pouch, a structure of ectodermal origin formed during
the fourth week of gestation
No gas bubble means oesophageal atresia. Double bubble sign for duodenal
atresia
Smoking is the most important risk factor for bladder cancer. Smokers are at
least 3 times as likely to get bladder cancer as nonsmokers. Smoking causes
about half of the bladder cancers in both men and women.
Ovarian torsion
'sudden onset vomiting and pain abdomen' + mobile swelling in RIF is the
clincher.
PRADER WILLI: After birth there is hypotonia, failure to thrive and sleepiness.
The child usually has blue eyes and blond hair. They tend to lag behind other
children in the transition to solid food.
The second stage becomes apparent at the age of 12-18 months, when an
exceptional interest in food becomes apparent.[7] Hyperphagia, obesity,
hypogonadism, short stature and sleep apnoea and cor pulmonale occur.[12]
They have markedly elevated levels of ghrelin, a hormone associated with
hunger.
Nappy rash is a skin inflammation. Most cases are due to a reaction of the
skin to urine and poo (faeces, stools, or motions). In addition, a germ called
candida commonly thrives on the inflamed skin. (This is the germ that causes
thrush.) Candida can cause a more inflamed rash which may include darker
red spots spreading around the nappy area ('nappy thrush')