BST

NOTES
 Discussion / Tutorial
1.
syrs old, productive cough
9/02/20)
for one
year, aggravated by cold
weather, intensify during early morning,
associated chestpain when
with
taking deep breath, breathless when couldn't
complete flightofstairs,
for past20 yrs
no fever, smoke

a) Further history? (6m)

-
work hazards: pollutants, asbestose (occupational hazards)
-

history asthma/atopy
of

inhalants and
taking did the breathlessness
improve
-

any with inhalants or not

previous infections;recur rentpneumonia

comorbids:HTW, DrC, hyperlipidemia COAD, asthma

still
smoking stopped
-

or

amount, colour, smell of sputum

-

any haemoptysis
-

any contactw ith TB patients

constitutional
symptoms:LOA, LOW,
-

malaise
-socioeconomi status

a
diet history
-

physical activity
mild

Alert, well
hydrated, no
pallor, no
jaundice, bilateral pedal oedema, no raised jup, no
cyanosis, nicotine
stain finger nails, BP:160190;145190, pR:9lbpm, RR: 20, tamp: 37.60,
on

SpO2:89-90% HRA,
beata t5th ICs mid-clavicular
apex line, s, and so heard, no thrills, no heaves, no murmurs,
trachea centrally located, normal air
entry, bibasal creputations and rhonchi as heard, normal vocal
resonance and vocal fremitus, normal abdominal examination

b) 5 most likely differentdiagnoses (sm)

Asthma:nocturnal cough
-
LOAD
COAD:
early morning cough
↳ for
by
smoking 20
yrs

↳ productive sputum for

lyr
↳ 35 yrs old
age
-Bronchial asthma

(CF/ cor
pulmonola
-

↳ bilateral
pedal oedema bibasal
with
reputation
↳
age 55 yrs old

↳ chestpain

* pulmonary embolism
↳ tall, younger patients
↳
prolonged immobilization
↳ sudden onset

Pulmonary TB (PTB)
-
Paeumonia Atypical pneumonia sometimes have no fever or
symptoms.
↳ mild fever 32,60
 For Ix
-

Lung ca
1) Provisional
diagnosis
2) TR0d/dx
2) 6
investigations and reasons
3) Complications (control assessment
-
FBC:TNC count (TRO infections
4) For screening
CxR: consolidation, cavitation,
cardiomegaly, hyperinflated lungs
-

(CAD), mass, canon ball lesion,

evidence of fluid overload

sputum (35: bacterial infection

-

mantoux test
(supportive test)
-

sputum AFB direct

s mear:TRO
-

pulmonary B

postbronchodilator spirometry:COAD, control COAD ifpresent

of

-
E(G

-cardiac enzyme

-Cardiac proBNP:TRO cardiac failure

no cavitation,
Cardiac enzyme and proBNP negative, (XR: no
consolidation, no hyperinflated lungs, fluid overload,
no fluid overload
no

spirometry (postbronchodilator):FEV, 70%, FEV,/FVC

0.65%, TBC:w 10.9, Hb13, platelet 17s, ECG:normal

Stelevation MI:a tleastin 2 leads should be

present

d) Provisional diagnosis
Moderate (OPD

Bilateral pedal oedema could be due to old or medications.

age
For cessation (SAs):
smoking
2) S
principles management
of
Ask
Assess
-

give O2 32/min through nasal prong

Advice
-
bronchodilator;SABA/SAMA
Assist
-
advice patientto quitsmoking
prophylactic antibiotics:
erythromycin, calithromycin
-

LABA/LAMA

-
chest physiotherapy like follow-up
-

recheck BP
again and give to come again (TCA)
-
consider other issues and consider for colorectal cancer
screening
vaccinations:annual
influenza,
-

pneumococcal and COVID-19

Dr. Suba

Chronic Hypertension ·
1100
120s
88
yrs old male

Chronic HTN

Diagnosed in HKL SHEB

broughtby passerby
Passed out on the road
OVAwith hemiparesis
Lower -> right
limb weakness for 2 weeks
CVA:- dysarthria (slur of speech)
Had paralysis and loss of
consciousness in lower limb weakness
2018
-

Has LAdilatation - IHD

-
dizziness
7, xpectleft axis deviation in ECG -13 and 20
Has
dyslipidemia yrs ago

Now Blood thinners is

on
simvastation, bisoprols, hydrochlorothiazide usually more benefiti n ACs.

BP 158/28 mm
Hg-last appointment
Chronic cough for 2-3 yrs

Muscle
cramps every night disturbs
sleep
->

Undergone 2
surgeries for
cataract

↳ blind in
totally righteye
Parents"had diabetes

Non-smoker

No alcohol
drinking
Used to morka s rubber factory worker, after refinementworks as a
security guard
Has renal impairment
salt
to his dietevery time
Adds a
pinch of

PI

HR:80bpm
Height:175cm BM I =

= 24

BP:150/28 (140 -

150/90 mm Hg) Weight: 20

kg
RR 16
=

'targetcontrol in
very old patients)
Not dehydrated 780 yrs
old and above CKD-EPI:to
stage <KD
No stigmata of IEand [LD
/
Pulse hand depends
very difficultto be
on was on
palpated age, gender and
creatinine level
No raised sup
↳ can use
Corneal
ax calculator
arcus seen

Oral dentures in use

5, and so heard with

pansystolic murmur grade 3-radiates to the axilla-IAD
Bullness and crackles in lower zones

Motor functions normal in both legs

sensations loss in lag onSs and L

Proprioception loss in big toe

 Results
Ix

Urea:8

Sodium:134

Potassium:4.4

chloride:99

Creatinine:129
Erythropoietic production will be
↑BP 4.5 mmol/L
:

reduced
from (RD
stage 3b. starting
Ex i FBS & VA
stroke with
hemiparesis/chronic
-

HiN
-

lipid profile
venal
profile
-

ECG:LVH, LAB
-

UFEME

Further Ixi
echocardiogram:to
-

see overall heartfunction,

mitral wall
prolapse, mitral
-ultrasound KUB:evidence regugitation
parenchyma disease,
of
acute
obstructive
-
FBC;anaemia of CKD uropathy
in
CxR:crackles the
lungs
-

proper midstream urine collection

MX

↳ Non-pharmacological: -
lifestyle modification
-

reduce saltintake (DASH diet)

have active
lifestyle
-

and
always move around
(mobile)
↳
Pharmacological: -

simvastation
convert to atorvastation
-
ARB:to prevent
s troke

Perindopril plus /Hoza combination

screen for fall
prevention and geriatric depression
-

I
must have railings, no metfalls, hold on a
supportand stand up
in the
early morning
Dr. Suba
·
Hyperemesis Gravidarum 1100
120s
30
yrs old, gravidal para
second semester

Second visit

Nausea, excessive vomiting blackout

(during
->

Dx 2022 visit
↳ medications were
given Early booking less than
at 12 weeks.

Firstvisit(D9 < 2022)

should
gain around 12.5 kg throughout
↳ did US G
the 40

Had PCOs for 2

yrs
and treated
weeks of
pregnancy
Had migrains since childhood

Menarchs 14 old 12.5kg

at
yrs
1 month duration
Regular cycle with 40u

On Obimin
20n 20 W

Heightloss of 1.3kg during the v isit

cur rent

10k9 2.549
+
Dr. Suba
·
1100
Chronic Dra 120s

62 yos old, male, Indian, came

for regular follow-up

DR9

Dyslipidaemia
Hi N
3 diagnosed 23
yrs ago
1.

2.
(vs
symptoms

Hypoglycaemia
chestpain
for past23 yrs recall
On OAD ago 3.24 hour
dietary
Nowo n insulin 4.
Drug compliance
Gained around 3kg 3. Erectile dysfunction / Female sexual
dysfunction
/
Insulin pen not working properly have to the
screen
eye, heart, kidneys
FBS:9.S (latest)

HbA1c:12.4%three months ago

chronic osteoarthritis in the leftknee

knee pain-probably having

↳ relieved by sitting

No exercise

Mother had DR and HTN

Factory worker-cutting wood

Occasional drinker

Ex-smoker 3 stopped 2
yrs ago

No
poor wound healing

PE

BP:129/23 (under target) Height:159cm

PR:82 Height:13.7 kg
RR:17 BraI:29.2 (obesity grade 1)

No IE CLD
stigmata of or

No mur murs

No
pitting oedema

patientappears to have abdominal obesity -> measure waist

circumference

↳
may be
could also be due
a
single biomarker for m to
lipodystrophy-because wrong of
insulin
muscle power is 3/5 in the left
leg injection sites

IX
results

FBS:9.5

Hb A, c;12.4 %

screening: - colorectal cancer

20pD
-

erectile dysfunction
Dr. Suba

oxoo
Acute on Chronic
Pyelonephritis
rars. RK, 43
yrs old, sikh, female
CC:came for
follow-up
HOPI:

-Had leftloin
pain since lastDecember
-

sudden onset

-
Pain was on and off

↳ have for 30 mins and

pain pain free for 3-4 has before the next
cycle
-

Poking in nature

-
No radiation
-

P57/10

Aggravates
-

when patientbend
Relieves
-

partially by applying bubble belly oilmentboughtfrom a friend

Had burning
-

sensation
during mictuition
Had 2 episodes
-

haematuria
of
in December 2022
↳ painful
Any painkillers?
↳ urine was
orange in colour
-

Blood investigations was ordered and she was referred for ultrasound
RUB in HRPB
RK Buntong in Dec 2022
during the firstvisitto

↳ she was prescribed with antibiotics (pander form) -ural

sachet/potassium strate/lamon mater
Had dysuria
·

a weeks ago
↳ relieved
by drinking barley seed water
No fever,
-

vomiting,
no
no
passing sandy
of
particles
during misterition, no
frothy foul
Systemic Review:
or
smelling urine

cardiovascular system
Urogenital system
-
No chest pain amuria
No
Urinary: - no

palpitation
-

-
no
diguria
-
Had dizziness
-
no
urinary retention

Alimentary system and Abdomen -no

urinary frequency
Have loss of
-
no
hesitancy, no
urgency
appetite-since December
-

2022
no
suprapublic pain
-

No loss
weight
~
of

Genitali abnormal discharge

no
-

-
Had abdominal
distension
↳
~
No nausea need to ask because can cause
drug resistantinfection due to continuous
No
dyspepsia
-

treatment of UTI
Respiratory System
-
No altered bowel habit systemic reviewo fother
No
jaundice No
dyspaoea systems
-

unremarkable.
-

were

No
cough
-

No
wheezing
-
Pastmedical Hx:

nO
HTN, n0DM, dyslipidemia
-

no

-
has asthma

↳ since 15
years old

↳ takes blue and chocolate gases

↳ takes
supplementation from ARNAs
(bioC, garlic with licorice, as more)
↳ last asthous attack 1
at
years old
has
migrains
-

↳ diagnosed in KK
Buntong 3
yrs ago
-> precipitated
by lack of
sleep
or overstress
↳ on medications

Past Surgical Hx:

appendectomy done 5yrs ago due to

appendicitis
~
Caesarian section done 2 times
underment
surgery to remove reproductive organ (yrsago and
cut tie the
Fallopian
tube]
Obstetrics and
Gynaecology Hx:
need further
Obstetrics: has 2 children (one girl and
boy)
-

one
questioning
↳ born term
at

↳ via c-section -
because patienthas small birth canal

↳ maternal
no or fetal complications
-
nO PIH, GDM
has anaemia
during pregnancy
-

for both the took

pregnancies -
medications and did blood
transfusion
Gynaecology: -
menarch a t10
yrs old
regular cycla
-

before
-

marriage, bleeding for

days;after marriage, bleeding for 5
-
uses 4-5
pads per days
day
-
has dysmenorrhea
done
pap smear
regularly
-

↳ last done in
pap smear
June 2022

↳ resulthas
suggestive bacterial vaginosis
of

-
no
menses for the 2
past months since December 2022 2mp?
Menopause is between 45-50 yrs old.
↳ lasti n November
2022
Allergy Axi -

no known allergies to drugs and environment (exactdate)

has
allergy to
squid
-

↳ develop has to take

rashes -
injection in the clinic

Hx:- mentioned above

Drug as

no
usage traditional medications
-

of

Family Hx: -
father had
tongue cancer and
passed away
mother has
cholesterol,
-

HTN, unsure whether has bra not-still alive and is

or
on medications
-
has 3
siblings sh
↳
patienti s the eldestchild
 ↳ siblings are all well and alive

-grandfather had asthma

-
no other history of
malignancy
Social Hx: -
works as a
factory worker in
computer chip making factory (working hours?
lives in Harmoni
flats with her children and sister
-

-
no
smoking
no
drinking alcohol
-

-
no
taking of illicit
drugs
-dist:-
usually rege for 3
days in a week
-

eats mostly home cooked food

PE

Patientw as alertand
cooperative during the examination. She is
Vital signs: BP:122/73
Hg
-

mm

PR:72bpm

RR:18
breaths per minute
-

General examination:

No
conjunctival pallor
-

No scleral
jaundice
~

-
No central cyanosis

-Oral hygiene has good

-

Carotid pulse was feltand equal on both sides

-
No raised Jup
No
scalling in the neck, enlarged lymph
-

no
nodes
-

No peripheral cyanosis
-No
finger clubbing, no
laukodychia, no
koilonychia
No
palmar erythema
-

No
pallor the
palms
-
on

-Radial pulse has felto n both hands with

regular and equal volume, radio- radial
-
No
collapsing pulse
and no
delay
No
pitting oedema in the legs
-

Abdominal Examination

Inspection:- abdomen was not

grossly distended
abdomen with
moves
respiration
-

umbilicus inverted and centrally located

-

was

there was healed surgical scar in the RIF

and Pfanenstiel scar

Palpation: -
superficial -
tenderness in suprapubic region
-

deep-pain in LL, LIF and suprapublic region;n o mass felt

no
hepatomegaly
-

ballotable
no
kidney
-

positive renal
angle tenderness the leftside
on

Percussion: -

splenomegaly could not be identified

-

shifting dullness negative

Anscultation: bowel sound was heard

↳ I clicks per minute

no renal bruit
heard
-

CVS Examination

apex beato n left th

-
ICs
mid-clavicular line
-
no murmurs heard

Respi Examination

-air
entry was
equal on both sides
no dullness percussion the apices, upper, middle and lower
bilaterally
-

on on zones

-
no added sounds heard

>

:
plax:acute nolithiasis
-
acu +e PID

acute
pyelonephritis
-

Anti-epileptic can as
analgesic.
ac t
-

fibroids

ectopic pregnancy Opiods:

-

-
morphing
-
ovarian cyst -

tramado I

Δ acute U T I
E.coli-trimethoprim
↳ acute chronic Double
pyelonephritis
on

antibiotics
↳
always given in hospital/IsU
EX: -
urine FEMA
↳ settings
given
not

-
USG KUB orally

cystoscopy
~

Candida
-
(T A
further investigations ->
pessary
-

Urine (BS

maxi-
analgesics (paracetamol)
-
antibiotics
-
drink more water

↳ can hydrate by drinking boiled rice water

to
-not restrict
f rom
passing urine
educate on
personal hygiene (to preventascending infection
-

proper

screen for Don-because patientis

~

>40 yrs old

do
vulvo-vaginal examination
-

screen for
vaginal infections
~
Dr. Suba

Well controlled asthma 8

102/
2023
10
yrs 8 months old, boy
Firstepisode:- a
at
yrs old
-

diagnosed with bronchial asthma in

hospital
~given nebuliser in hospital
-given blue and chocolate
pumps
- also given aerochamber
had sOB, cough, rapid breathing for
-

3 days
Has night t ime
symptoms: - one to three times in 3 months
No
previous hospitalization

Allergy to peanuts: -

rapid breathing after

eating peanuts
subsided
spontaneously
-

Took 2 doses of
COVID-19 vaccination

Father and older brother has sinusitis

Older brother is 13
yrs old, younger brother is 7yrs old, younger sister is 6
yrs old.
School absentrism?

[↳
No restriction of
Exercise induced asthma? activity

Howin the school?

Asthma control testi s 2012) -

well controlled
is partof
Asthma action plan
Mother has bronchial asthma

PE

Has small
body built

Height:130 cm (below9th centile)

weight:25kg (beloveth centile)

Any chronic disease
during childhood can cause growth disturbances.
Temp:36.50 Orange -
Flutica some

RR:22
breaths per minute Blue-Salbutamol
SpO2: 98% RA
Chocolate -
Budesonide
presence Harrison
sulci-only presentin
of
chronic
↳ could be lung diseases
pactus excavatum
Rhonchiheard both
on
lungs
step2
* well controlled asthma
Is + bronchodilator
nx: -
stepwise (step down)
↳ salbutanes) PRN

educate on
triggers
asthma action
plan
-

-
ABC
Cairndy, breathing, circulation) -
in acute exacerbation
Dr. Suba
Long COVID
syndrome 07/02/
2023
yrs old, female, Malay
27

Fatigue - 3
months, after getting CONID-19
·
second episode
↳ November 2022

↳
istepisode in April 2821 -
how long took the
it symptoms
to reduce before and episode
chestpain; -2 months after
getting COVID-19
-

sometimes mild pain,

sometimes in nature
poking
-
P54 -
5/10

no
relieving factors
-

Has dizziness

Took 3 doses of COVID-19 vaccination

symptoms usually during exacerbation ten

Has
difficulty in
sleeping, shortness of breath, difficulty in concentration
LMp?

old Housewife
year and
child is one 5 months
Has diploma in tourism
Need by the age
to
complete family 35 yrs old.
of

PR:46
bpm (bradycardial
BP:103/63 mm
Hg
No tenderness

Lungs were clear

& Long COVID

syndrome

D1dx: -

hypothyroidism
-long at syndrome:need to be on some
medication(s)
previously
generalized anxiety disorder
-

(GAD)
-
anaemia

MX: social
-
Welfare

counseling
~

screen for smear

~
heatthermal pap
therapy
infrared
therapy
-

analgesics
short term
anxiolytics
-

do
thyroid function test
-

do GAD
questionnaire
-

-
assessmental health status -
DASs, Wooly's
FBC:to
anaemia
-

see

occupational therapy
-

physiotherapy
-

breathing technique
-

give (follow
TCA -

up)
Dr. Suba

Poorly controlled DM, uncontrolled HTN, cardiomyopathy and

peripheral neuropathy 09/02
goes
60
yrs old, male, Indian

Rightleg spelling-pricking in
nature, exacerbates in the night
Admitted days in GAfor excision
2
carbuncle in the
of
leg
known Dr:
-diagnosed IS yrs ago
12 units 4 times a
day injectable insulatand;metformin 500
mg
twice a day
RBS 11.3 mmol/L in the afternoon
was one week prior in KK
to follow-up

Has HIV and

hypercholesterolaemia; Has erectile
dysfunction
stayed 2 months in hospital for COVID-19
social drink gr
Did cholecystectomy
Had BPH;Has IHD (chest pain and SOB on exertion)
Father had MI

PE

Obese

BMI:35.5

Has to the
SOB and chest tightness when walking from the waiting area

No walking aid;No abnormal gait

Echo done in 2019: -

EF64%
PR:76 bpne
regional wall
myocardial
~

BP:145/70 mm
Hg
abnormality (RIMA)
RR:32 breaths/min grade I diastolic
dysfunction
-

Has pedal oedema up

to the mid shin

Reduced breath sound

Abdomen distended grossly

Liver and spleen couldn'tbe palpated due to the
grossly distended abdomen

Fluid thrill positive

Poker3/5
HTN, DM, dyslipidaemia
Loss s ensation
of the lower limb
of complications ↑

~
& poorly controlled DM, uncontrolled HTN, cardiomyopathy and
peripheral neuropathy (metabolic syndrome)

Ex: -

fasting blood sugar/STATblood glucose (RBS)

-liver profile
Not available in KK: -

~
renal profile
Echo
-

E(G
stress ECG
-

~
chestX-ray

Troponic testing
~

Mx: -dief control

ABG
-

-
exercise thatsuits the patient
VBG
-

-weightreduction
-
teach insulin injection
technique
-screed
for falls

educate patiento n care

foot
proper
-

change the insulated to long acting

-
 09/02
Dr. Suba

PostTerm
Pregnancy 4023
27 old, Chinese
yrs

came for anternal check-up

LMP: 25/04/2022

EDD;04/02/2023

Primigravida
40 weeks 6 days currently (postdata)
and pregnancy confirmed by UpT
missed her period for 5
days was

USG done in 12th week of

gestation

is Bt
Blood group coming for check-up
every day since 39 weeks
↳ reduced
Worry of
fetal movement
and
Quickening 20
at weeks intrauterine death
MoGTT
done 1
at weeks and resultwere normal

Has labor symptoms such as colicky abdominal pain and

watery vaginal discharge
Done 2 s mears
pap

↳ 1st in 2021

↳ 2nd in 2022
during pregnancy

She is on haematinics currently

Working as a
general clerk in Cameron

Currently living with mother and sister in Buntong

confirmation by doing
VDRL is not active;RVD?- by doing rapid test, then ELISA
test
↳retroviral disease

Post date

Normal, uncomplicated pregnancy:

40/s2+4daysare
GDM on diet control:40132 (102)

GDM on insulin:38/s2 (I02(

PE

Rightankle on dama

varicose veins

BP:184/54 mm Hg

Lungs were clear

Fundal heightis 39m

31st of fetal head was
palpable/2/sth is engaged
Ex:-serial FBC -
monitor Hb (anaemial
and albumin levels
~
urine FEME -glucose
and eclampsial
-urine protein-proteinuria (pre-eclampsia
U5G
-

↳ at booking
↳ a+ 24-26 weeks: annomalies, placenta
↳ at 3rd trimester:growth
correspondence the fetus,
of
position the
of
fetus, placenta, AFI

Mxi - to ensure patientcompliantto harmetinic

-
to ensure patientkeeps strictfatal kick chart

↳ 10 active kicks by 12 has

↳ ifdid
complete
not 10 kicks, need to do CTG (cardiotocography) in hospital
mobilise bestas
possible
-

as

-plan next
delivery
↳ admit
to
pre-pregnancy clinic -

priming for code 1family planning method

↳ continue haematinic for 3 months after delivery

↳ avoid
pregnancy
for 2 yrs after delivery
old
↳ plan to complete family by 35 yrs
-

encourage for exclusive breastfeeding

-
come back anytime to the clinic if fetal is
movement reduced

~
come for appointment everyday for daptons
~
IOL
Dr. Suba

GDM
09/03/200s
24
yrs old

Primigravida
34 2e9KS POG

LMP:16/06/2022 EDD:23/03/2023

Epigastric pain: -
958/10

burning in nature
-

-
no
exacerbating factors

-partially relieved by hot water

UPT done at 2 weeks of POA

Booking done ata weeks

Insulin given 4 times a day

↳ 18, 18, 18, 16 U

Quickening at26 weeks

USG:
singleton boy
menarchs at13 yrs old

Has dysmenorrhea

Currently has GDr and is on insulin

Mother had Gora and Dra

Patienti s a housemaker

Height gain of 10 kg

PE

Average body built

BP:102/74 mm
Hg
RR:19 breaths / min

Tenderness on
epigastric

D1dX: - acute gastritis

-
GERD

-
pre-eclampsia
-costochondriatis
-
false labor

Exi -
HbAIC

eye assessment
-

-serial FBC -monitor Hb

(anaemial
and albumin levels
~
urine FEME -glucose
and eclampsial
-urine protein-proteinuria (pre-eclampsia
U5G
-

↳ at booking
↳ a+ 24-26 weeks: annomalies, placenta
↳ at 3rd trimester:growth
correspondence the fetus,
of
position the fetus, placenta,
of
AFI
Mx: -
PPI for GERD

-continue insulatard

-
avoid certain food like spicy, oily or sour foods

to take meal close to time

-not
sleeping
on the lateral side
sleep or
prop up
-

- diet control (suky suku separuh)

~
check on insulin
injection technique
↳ avoid fetal areas

↳ injectatthe sides of the abdomen

-
to ensure patientkeeps strictfatal kick chart

-continue haematinic after

delivery /implants
notto getpregnantfor the next 2
years
intrauterine device
-

-
I02
by 37 weeks 6 days

BPD, AC, HC, FL is than 3

On USG, more weeks
discrepancy for
macrosomic
baby.
↳ only upto 2 weeks (14 days) allowed
discrepancy is
 Tutorial 2

1
10/02/2023
s5yos old gentleman, known case
HTN, dyslipidemia
of
and Dan came for
follow-up.
a) Describe the lesion.

~
below the righteye
~

yellowish in colour

~
about 1 cm

xanthelasma
->

irregular/modular surface

-
no skin changes I can also be found in
the tendon
~well defined border
exanthomal or
extensor part
of
the hands
-

plague
-
no
discharge

b) How to treati t?

surgical removal
~

2.
5yrs old boy, fever and sore throat for last 3
days.
9) Describe
both tonsils
enlarged and inflamed
-

are

-presence of
exudate/pus
-
uvula is deviated to the left

b) Differential
diagnosis.
acute bacterial tonsilitis
-

based on McIsaac Xartho criteria

-

acute viral tonsilitis

↳ age s
=> can give antibiotics it score is 400
-
peritonsillar abscess
↳ sough Lpenicillin/ erythromycin
·
infectious mononucleosis
↳ exuda e => ifscore is 1 2- viral
+

or
↳ caused by EBV
↳ fever => ifscore is 3- have to
temperature of
starttreatment
and
↳ kill also develop do
pt ↳ anterior cervical
lymph nodes investigations simultaneously
rashes, sometimes

splenomegaly

3. 40 yrs old
gentleman, rashes.

as Describe the lesion.

raised lesion (plague) Any

·

skin diseases
back of the hand and the elbow will
respond
at
to steroid.
-

scaly
-

well defined borders

=) psoriasis
-

irregular shape
skin
no
changes
-

b) D/dX

later in life
-

psoriasis -
t he
at extensors, happens on

flexors, have history

~eczema - at the
atopy/asthma, happens
of
at
younger age
4.
3 yrs
old, girl, very itchy

9) Describe.
·

between the webs the hand

space of

multiple small lesions

macules and
papules
-

b) D/dX
-

scabies
-

hand, foot and mouth disease

5.

-> can be found in

any folds the
of
body
including the
armpit

a) Describe.

-velvety appearance on the nape of the neck

b) Diagnosis.
acanthosis nigricans
1) Associated disease.

diabetes mellitus

6.35 yrs old

gentleman, leftknee
pain for last 3
days,
a) Describe.

erythematous

the left
smelling k nee
-
on

papules/petechian Gout
=>

unilateral
b) Further
history.
history
~

t rauma
of

any fever
-

Rheumatoid arthritis is
usually bilateral.
-

any other jointpain

-

any pain/pain score

aggravating/alleviating
-

factors

1) D/dx
~

septic arthritis

goat-classically begins in the

big toe butcan occur atany jointo fthe body
-
trauma
 -
heme arthrosis because trauma
of

a) Investigations.
-FBC:TRO infections (IBC), plateletlevel for
coagulopathy
knee
X-ray: TRO trauma
-

any
-

joint fluid aspiration:to see urea crystals

 Practice for ECG
(4/02/2022

TIPS:

ForECG:

ifa whole ECG is

given,
-

most
probably it's a rel or bundle branch block

One
Rhythm strip small box 0.04S
=

30
big boxes 6 =

sec One large box:0.25

↳ 30x0.82 6
=

Normal PR interval:3 - 5 small boxes (0.12-0.2s)

1.
Regularity
2. Ra + e

3. p wave

↳ absent/present?
↳ followed by GRS
complex?
4. PR interval

S. QRS ( <0.12s)
complex
-

->
Prolonged PR interval

Type I heartblock

->
Gradually increased of P have

-> rissed GRS

complex

=> Type I second degree heartblock

↑ &
35
5 &
65
 => Third
degree heartblock

Atrial fibrillation (AF)

Rate:
irregularly irregular
->

comm on in AF

Flutter wave
-> 'Save tooth' pattern
4 jaggard
spike
Atrial flutter
=>

Lrhythm need to be regular (irregularly regular)

Supraventricular tachycardia
-> nar row
QRS complex

rate
>150bpm
->

Ventricular tachycardia (vi)

-> wide QRS

complex
 need more than I leads
I
to
Inferior lateral
=>
MI diagnose
RI
Inferior lateral I
need to see us and US
also
stelevation
->

↳
higher l east
at
more than I small boxes of
the isoclectric line
*
Need at least leads to
2
diagnose MI

->
Reciprocal changes in all lead

ECG

1
L

sielevation ST
depression

V v

STEM I Cardiac biomarker

↳ increase
cardiac biomarker no
change
will be L ↓
increased
NSTEMI
Unstable
anging
 23/02/2022
Dr. Suba