Professional Documents
Culture Documents
Imp Plab Points
Imp Plab Points
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.
endomysial antibodies for celiac disease. Weight loss. Abdominal bloating. Bulky
stools etc.
Sweat test if for cystic fibrosis. There will be associated recurrent chest infections
along with abdominal symptoms.
Tft. Hypothyroidism in children. They will have prolonged jaundice not increasing
jaundice.
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:
Fibrinolytic drugs
For patients who cannot be offered PCI within 90 minutes of diagnosis, a
thrombolytic drug should be administered along with either unfractionated heparin
(for maximum two days), a low molecular weight heparin (eg, enoxaparin) or
fondaparinux. Thrombolytic drugs break down the thrombus so that the blood flow to
the heart muscle can be restored to prevent further damage and assist healing.
In patients presenting within 12 hours after the onset of symptoms but reperfusion
therapy is not given, or in patients presenting after 12 hours, aspirin, clopidogrel and
an antithrombin agent (heparin, enoxaparin or fondaparinux) should be given as soon
as possible
1:2:1
Since they're asking for the most appropriate (not the initial most) investigation, I'll go
for endometrial sampling.
bilateral parotid and lacrimal gland enlargement was characterized by the term
Mikulicz's disease if the enlargement appeared apart from other diseases. If it was
secondary to another disease, such as tuberculosis, sarcoidosis, lymphoma, and
Sjögren's syndrome, the term used was Mikulicz's syndrome.
the best choice for lowering potassium is 10ml calcium gluconate 10% . the next
option is insulin plus dextrose infusion (the insulin helps potassium go into cells and
the dextrose protects against hypoglycemia).
calcium resonium takes time to act
Painless syphlis
Painful single ulcer -- hem ducreyi
Hsv -- multiple
MRI may be contra-indicated in up to a fifth of patients because they are too ill,
confused, dysphasic, have an intraocular or intracerebral metallic foreign body or
have a pacemaker.
Pancoast tumour is a type of lung cancer defined primarily by its location situated at
the top end of either the right or left lung
Pancoast tumour can include a complete Horner's syndrome in severe cases: miosis
(constriction of the pupils), anhidrosis (lack of sweating), ptosis (drooping of the
eyelid) and enophthalmos (sunken eyeball). In progressive cases, the brachial plexus
is also affected, causing pain and weakness in the muscles of the arm and hand
(thoracic outlet syndrome). The tumour can also compress the recurrent laryngeal
nerve and from this a hoarse voice and bovine cough may occur.
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..
Stockholm syndrome can be seen as a form of traumatic bonding, which does not
necessarily require a hostage scenario, but which describes "strong emotional ties that
develop between two persons where one person intermittently harasses, beats,
threatens, abuses, or intimidates the other.
Echopraxia (also known as echokinesis[1]) is the involuntary repetition or imitation
of another person's actions.[1] Similar to echolalia, the involuntary repetition of sounds
and language, it is one of the echophenomena ("automatic imitative actions without
explicit awareness").[1] It has long been recognized as a core feature of Tourette
syndrome,
Apraxia (from Greek praxis, an act, work, or deed[1]) is the inability to execute
learned purposeful movements,[2] despite having the desire and the physical capacity
to perform the movements
Folie à deux (/fɒˈli ə ˈduː/; French pronunciation: [fɔli a dø]; French for "a madness
shared by two"), or shared psychosis, is a psychiatric syndrome in which symptoms
of a delusional belief are transmitted from one individual to another
The Cotard delusion (also Cotard's Syndrome and Walking Corpse Syndrome) is
a rare mental illness, in which the afflicted person holds the delusion that he or she is
dead
The delusion of negation is the central symptom in Cotard's syndrome. The patient
afflicted with this mental illness usually denies their existence, or the existence of a
certain body part, or the existence of a portion of their body.
Asperger's syndrome (AS) lies within the autistic spectrum. Previously it was called
high-functioning autism. The main difference from classic autism is a lack of delayed
or retarded cognition and language. Those with AS are also more likely to seek social
interaction and share activities and friendships.
The term restless legs syndrome (RLS) was to describe a disorder characterised by
sensory symptoms and motor disturbances of the limbs, mainly occurring during rest.
A patient with Serum Na of 122 mmol\L, the following are likely causes:
DKA.
Hypoadrenalism.
Prolonged Infusion of 5% Dextrose.
Syndrome of Inappropriate ADH secretion.
In young lady psychologically disturbed and drinks water excessively
Like
The American College of Rheumatology has identified six criteria for the diagnosis of
Churg-Strauss syndrome:[2]
• Asthma (wheezing, expiratory rhonchi).
• Eosinophilia of more than 10% in peripheral blood.
• Paranasal sinusitis.
• Pulmonary infiltrates (may be transient).
• Histological confirmation of vasculitis with extravascular eosinophils.
• Mononeuritis multiplex or polyneuropathy.
If the syrinx extends into the brainstem, syringobulbia results. This may affect one or
more cranial nerves, resulting in facial palsies. Sensory and motor nerve pathways
may be affected by interruption and/or compression of nerves.
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
Laparoscopy is the criterion standard for the diagnosis of PID. It is significantly more
specific and sensitive than are clinical criteria alone. The minimum criteria for
diagnosing PID laparoscopically include tubal wall edema, visible hyperemia of the
tubal surface, and the presence of exudate on the tubal surfaces and fimbriae.
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
A 40 year old man after an operation had a heavy bleeding. What abnormality will
you find? Low calcium
TIA. Doppler usg. Majority of TIA develop due to emboli which are picked up on
carotid doppler.
osteosarcoma is relatively painless whereas ewings presents with pain and redness
around the tumor area.
Remember
Knee or shoulder..painless..osteosarcoma
Thigh or pelvis..painful..ewings
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
in children UTI always present due to some underlying disease...it could be VUR or
something. So even on single episode of UTI we need to further investigate by doing
an USG
dexa scan for osteoporosis and nuclear bone scan to see metastasis
Normal is a T-score of -1.0 or higher
Osteopenia is defined as between -1.0 and -2.5
Osteoporosis is defined as -2.5 or lower, meaning a bone density that is two and a half
standard deviations below the mean of a thirty-year-old man/woman.
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
BCC usually presents as a pearly nodule with telangiectatic edge
Any lesion above the neck is BCC until proved otherwise
Actinic keratosis presents as yellowish scaly crusts not as a nodule
SIADH is a common complication of small cell lung ca, paancreas, prostate ca. 1st
line is fluid restriction
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
Isonatremic and hyponatremic volume depletion states may be treated with normal
saline or other isotonic solutions. The goal for correction rates for either hyponatremic
or hypernatremic patients should be no more than 1 mEq/L/h to prevent the
devastating CNS complications of overrapid correction (central pontine myelinolysis
and cerebral edema, respectively). Full correction of severe sodium abnormalities
usually should be staged over 24 hours or longer.
Although a potassium deficit is present in all cases of volume depletion, it is not
usually clinically significant; few patients with moderate dehydration require
supplemental potassium. However, failure to correct for hypokalemia during volume
repletion may result in clinically significant hypokalemia.
Add potassium to fluids when the patient has documented hypokalemia. For all other
patients, avoid adding
potassium to fluids until the patient has received several hours of resuscitation and the
patient has demonstrated adequate urine output.
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
In Symptomatic patient (test once only) : fasting glucose >=7 or Random blood
glucose>=11.0 confirms diabetes
In asymptomatic patient (do test on 2 occasions): fasting glucose > 7 or random blood
glucose> 11 confirms diabetes
Acamprosate works by reducing the desire or craving to drink alcohol. It is only given
to people who have successfully stopped drinking. Acamprosate calcium helps to
reduce the chances of you drinking again. People who are taking Acamprosate
calcium will usually have a programme of counselling as part of their treatment.
Treatment with Acamprosate calcium usually lasts one year.
Clang associations are ideas that are related only by similar or rhyming sounds rather
than actual meaning.[8] Example: "He ate the skate, inflated yesterdays gate toward
the cheese grater
in flight of ideas thy jump from topic to topic
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.
Drug of choice for a hypertensive who is above 55 years of age with no cough or
renal problems (no contraindications i mean) CCB
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')
Erotomania or Clerambault’s Syndrome, is a psychological condition in which the
affected person has delusions that the object of his or her affection feels the same
toward him or her. This condition is otherwise known as love obsession
Usually the object of their affection is inaccessible like a superstar, an actress, a rock
star
An acoustic neuroma is a rare type of brain tumour (growth). It is not cancerous and
so is called a benign tumour. The tumour grows along a nerve in the brain (a cranial
nerve) that is called the acoustic or vestibulocochlear nerve. This nerve controls your
sense of hearing and balance.