MEDICINE SEND UP

PRACTICAL
39 MBBS
TH
Batch A7 to A12

Compiled by
MUHAMMAD UMAIR SHAFIQUE
 COMPONENTS
■ 1 long case 60 Mks
■ 6 short cases as
1. One case of Derma Examination 20Mks
2. Short Viva on Psychiatry 20Mks
3. Pulmo examination
4. Cardio examination
30×4= 120Mks
5. Neuro examination
6. Gastro examination
In almost all short cases you may be asked to tell your findings and give DDs

■ 10 TOACs 5×10=50Mks
Total Marks:270
 INSTRUCTIONS
■ LONG CASE
– For long case almost 30 mins will be given and will be allotted
randomly

– Take 20 mins to take relevant history and examination

– Take at least 10 mins to prepare the case including whole

management plan by heart

– Keep management of all DDx in your mind

– While presenting, DON’T KEEP LOOKING AT THE PAPER

 INSTRUCTIONS
■ SHORT CASE
– 4 mins on each station

– Try to complete examination in 3 mins and spare last min for

questioning as it carries 50% of marks for each short case

– For unobserved, do ASAP as 4 mins are really short

Rest Station may or may not be there so be vigilant

 LONG CASES

Courtesy: Batch A7 to A12

 LONG CASES
■ NEUROLOGY ■ PULMONOLOGY
➢ Epilepsy ➢ Pulmonary TB
➢ Stroke ➢ Tuberculous
➢ CIDP Lymphadenitis
➢ GBS ➢ Pleural Effusion
➢ Transverse Myelitis / ➢ Bronchiactasis
Bechet’s Disease ➢ COPD Asthma overlap
➢ Pyogenic Meningitis
 LONG CASES
■ GASTRO
➢Acute Viral Hepatitis ➢Chronic Liver Disease
➢Upper GI Bleeding ➢Ulcerative Collitis

■ GENERAL MEDICINE and Misc.

➢Acromegaly ➢Undiagnosed Cases
➢Psoriatic Arthritis ➢Dengue
➢Hyperthyroidism
■ NEPHROLOGY
➢ CKD
➢ AKI- Post Rhabdomylysis
SHORT CASES
 NEUROLOGY
▪ Our Cases
1. Pt with Rt sided Ptosis, do Eye Exam:
➢ ALWAYS lift the drooped eye lid
2. Pt of Enlarged Thyroid : Look what’s wrong with the patient and
do relevant examination
▪ Other important examinations
1. Lower Limb Motor Exam
2. Cranial Nerves Exam
3. Upper Limb Motor Exam
4. Cerebellar Exam
5. Sensory System Examination
 PULMONOLOGY
▪ Our Case
➢ Front of Chest Examination: either whole or just Auscultation
➢ Our patient had Pleural effusion and Pleural Tap had been done
so important findings were
1. Dressing on Lt side of lower chest on INSPECTION
2. Absent breath sound with crepitations on Lt lower chest on
Auscultation
➢ Back of chest examination
▪ Prepare complete chest examination and commands may
be of any component on
➢ Front of Chest
➢ Back of Chest
 CARDIOLOGY
▪ Our Case
➢ Examine the Precordium: Pt had MS
➢ Pt of Mitral Regurg : Pan Systolic Murmur with Massive
Cardiomegaly

▪ Prepare complete CVS examination

▪ Commands usually given in exam
➢ Examine Precordium
➢ Examine the Relevant CVS
➢ Explain the Murmur if any
 GASTRO
▪ Our Cases
➢ Palpate the ABDOMEN. Patient had splenomegaly
➢ Examine the ABDOMEN. Patient had Hepatomegaly

▪ Prepare complete Abdominal examination

▪ Commands usually given in exam
➢ Examine Abdomen
➢ Do palpation only
➢ Palpate Spleen
TOACS
 Give Findings & Causes
■ Findings
1. CT scan film of Head- Coronal
Sections
2. Hyperechoic lesion in Lt Parieto
occipital areas filling the 3rd
ventricle – most likely ICB
1 3. Extension to the opposite
ventricle
4. Slight midline shift
So a case of Intra Cranial Bleeding
(ICB)
■ Cause
1. Hypertensive Hemorrhage
2. Trauma
 ■ Findings
1. Rate is irregular with Tachy
2. Rhythm is not sinus
3. P waves are non discernable
4. QRS complexes are narrower
and irregular

2 ■ Dx
– ATRIAL FIBRILLATION
■ Drugs
– Beta blockers
– Ca Channel Blockers
– Digoxin
 ■ Findings
1. Rate approx 100bpm
2. Rhythm is sinus
3. ST elevations in Chest leads(V1 to V4) and
Lateral leads (I, avL and V5 & 6)
4. Reciprocal ST depression in inferior leads
■ Dx: Anterolateral MI- Acute Coronary Syndrome
■ Rx
3 1. Admit patient
2. Prop up and give Oxygen @100%
3. Give IV Morphine and anti-emetics
4. Start ACS protocol i.e
■ Oral Asprin. Nitrate, Statin, Clopidogrel
5. Prepare for reperfusion therapy
■ Definitive Treatment
1. Primary Percutaneous Coronary Intervention with stent placement
2. For triple vessel disease: CABAG
 ■ Identify: Swan Neck
Deformity
■ Dx: Rheumatoid Arthritis
■ Other Deformities

4
 ■ Findings
1. CXR frontal projection with adequate
exposure and central airway
2. Blunted Lt CP angle
3. Lt sided meniscus sign- likely effusion
4. Chest tube in place on Lt side
5. Lt Clavicle fracture
5 ■ Dx
Pleural effusion most likely
Tuberculous Effusion
 ■ Adrenaline ampule 1mg/ml 1:1000
■ Indications
1. Anaphylaxsis 0.2 to 0.5 ml
2. Cardiac Arrest as in CPR 1ml every 3-5 min
3. Acute Asthma
■ Side effects
6 1. anxiety
2. nervousness
3. headache
4. fear
5. palpitations
6. SOB
7. Tremors
 ■ Identify
– Double Lumen Rubber Foleys Catheter –
17French
■ Indications
1. Urine drainage in Pts with
2. Obstructive Uropathies like BPH & Spinal Injury
3. Intraoperatively
7 4. For urine output monitoring
5. For delivery of BCG vaccine to bladder in
pts of Urothelial Ca
■ Complications
1. Injury to Urethra leading to Stricture formations
2. Urethral Rupture
3. Bladder Injury
4. UTIs
 ■ Abnormalities
1. Deviation of Facial Muscles to the
Lt side
2. Absent Rt Nasolabial Fold
3. Wide open Rt eye
■ Diagnosis
– Rt Sided Facial Nerve Palsy likely
8 Bell’s Palsy
■ Management
1. Corticosteroids- oral prednisolone
2. Anti-viral Therapy-
3. Eye drops & and patch to protect
the cornea from Dry Eye Syndrome
 ■ Identify
– 20 Gauge Intra Venous Cannula
■ Uses
1. Theraputic
■ Administration of IV fluids & Drugs
■ Transfusion of Blood and blood product
9 2. Diagnostic
■ Pleural Tap
■ Peritoneal Tap

■ Complications
1. These are operative dependent
2. Infections like cellulitis and Phlebitis
3. Injury to internal Organs
4. Injury to NV bundle
 ■ Identify
– Hydrocortisone Sodium Succinate SOLU-CORTEF 100mg/2ml

■ Indications
– Replacement Therapy in Adrenal Disorders
■ Acute Adrenal Insufficiency
■ Addison’s Disease
■ Congenital Adrenal Hypoplasia
– Non-Adrenal Disorders
10 ■ Status Asthamaticus
■ Cerebral Edema
■ Gram Negative Septicemia
■ Nephrotic Syndrome : MCD

■ Side Effects
– Headache
– Stomach upset due to increased acid secretion
– Perspiration increased
– Iatrogenic Cushing’s Syndrome
GOOD LUCK
Stuff for preparation for the TOCAs is
available on Google Drive