PLAB 1 Notes and Checklist

These are some short notes on the common and repeat questions i encountered INTERNAL MEDICINE Notes: Causes of hematemesis: •Esophageal varices, peptic ulcer, Mallory-Weiss syndrome, cancer esophagus , cancer stomach and general causes •Peutz-Jegher Syndrome: mucocutaneous dark freckles on the lips, oral mucosa, palms and soles ± GI polyps causing bleeding or obstructions "usually hamartomas" •Angiodysplasia: submucosal arteriovenous malformations that typically presents as fresh PR bleeding in the elderly Abnormal ECG: •Hypokalemia: is usually associated with diuretics like frusemide, there's U waves can be noted in leads V3 and V4 •Hypocalcemia: is a usual complication of thyroidectomy •Myxedema: there's sinus bradycardia and low voltage "amplitude" ECG Urinary tract obstruction: •Pressure flow studies are done in a case of diabetic neurogenic bladder •Dynamic scintigraphy is used to assess renal blood flow and in such a case it's used to establish the extent of renal perfusion posttransplantation Diagnosis of renal failure •Wegener's granulomatosis : generalized vasculitis that involved upper resp tract "rhinitis" , lungs and kidneys •Hemolytic uremic syndrome: multi-disorder of thrombosis of microvasculature with acute G.N. , it's the most common cause of acute renal failure in childhood •Amyloidosis: is disorder of protein metabolism. Patients present s with heart failure , nephrotic syndrome or bleeding. "Congo red" stains the

amyloid into pink. Biopsies are taken from gums or rectum •Acute interstitial nephritis: usually occurs as hypersensitivity to some drugs as Allopurinol, penicillamine and NSAIDS "analgesic nephopathy Chronic joint pain •The most common cause of post operative arthritis is gout •Pyrophosphate arthropathy: aspiration of synovial fluid reveals positively birefringent crystals •Systemic sclerosis is associated with increase of anti-nuclear antibodies •Anti-centomere antibodies :CREST syndrome (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) , a variant from systemic sclerosis •Anti-Ro antibodies : Sjogrens's and systemic lupus •Anti-Jo-1 : Polymyositis and dermatomyositis •ANCA : Wegener's granulomatosis and Henoch Schonline purpura •Anti-mitochondreal : primary biliary cirrosis •ANA and anti -smooth muscle antibodies (ASM): type I autoimmune hepatitis •Anti- microsomal liver kidney antibodies: type II autoimmune hepatitis Facial nerve palsy •Longitudinal temporal bone fracture is not commonly associated with facial nerve injury and is presented by blood in the external auditory meatus, while transverse temporal bone fracture is associated with haemotymapnum and facial nerve palsy Diagnosis of liver diseases •Gamma glutamyl peptidase is specific for alcoholic hepatitis •Chlorpromazine is associated with obstructive jaundice Pneumonia •Pseudomonas auregnosa is treated with tobramycin or ciprofluoxacin •Farmer's lung or extrinsic allergic alvelitis is caused by inhalation of spores of Micropolyspora faetni, found in mouldy hay and treated with

predinsolone Sexually transmitted diseases •Lymphogranuloma venereum is caused by Chlamydia trachomatis, the groove sign which is a depression between the inguinal and the femoral lesions is characteristic •Granuloma inguinale is caused by Calymmatobacterium granulamtis, it's associated with Donovan bodies in the edges scarping with Giemsa staining •Chancroid is caused by Haemphilus ducreyi, painful ulcers Post operative complications •Halothane gas inhalation and succunyl choline may result in malignant hyperthermia , ttt with intravenous dantrolene sodium "muscle relaxant" •Hyperkalemia is treated with insulin in dextrose •Gentamycin can enhance the action of neuromusclar blocking agent by impairing the neurotransmission leading to breath stop, ttt with calcium gluconate •Anticonvulsants side effects: a)phenytoin "a pt with gum hypertrophy " b)sodium valproate "someone with liver failure " c)carbamazepine "a pt with electrolyte distrubences " d)vigabatrin "a pt with visual field defect " not sure e)phenobarbitone "a pt with rash" not sure

INTERNAL MEDICINE Checklist: •Cardiovascular Chest pain ( ACS and angina) and its management Palpitations Peripheral arterial diseases Oedema

Breathlessness Diagnosis of hypertension •Respiratory Pneumonia Bronchiolitis COPD Asthma Sleep apnea Cough Hemoptysis Wheeze/ stridor •Blood and lymphatic Abnormal blood film (anemia) Bleeding, bruises, purpura Blood loss Enlarged L.N. Pallor •Renal Abnormalities of urine Groin/scrotal pain and/or swelling Renal failure Urethral discharge including STI Urinary symptoms Urinary tract obstruction (including prostate and calculas) UTI •Digestive Abdominal pain Abdominal mass (generalized and localized) Altered bowel habit (incl. constipation) Anorexia and weight loss

Diarrhea Dyspepsia Dysphagia Facial pain and swelling GI bleeding "lower and upper" Nutrition Jaundice Nausea and vomiting Abdominal trauma Diagnosis of acquired liver diseases malabsorption •Homeostasis Abnormal blood sugar Complications of diabetes Acid base imbalance Electrolyte disturbances Shocked patient Thyroid abnormalities Hypercalcemia treatment and causes •Infectious diseases Fever and PUO Serious infections as (meningitis, HIV, Hep B and TB) Travel medicine Tropical infections as (malaria) HIV risk prevention •Neurology Coma Blackouts Headache Faints and falls Cranial nerve problems

Peripheral nerve problems Seizures and complications of anti-epileptics Movement disorders including (tremors and gait disorders) Immediate treatment of meningitis and head injury Management of stroke and TIA •Rheumatology Rheumatoid arthritis SLE Gout and pseudogout Osteoathrosis Dermatomyosistis, scleroderma, ankylosing, Reiter's, Sjogren's, Behcet's • Seriously ill patients Anaphylaxis Multiple trauma Septicemia Serious infection Burns •Others Antibiotic prophylaxis Causes of immobility Decision making in terminal care Management of pain in a terminal care Poisoning Pain relief Prescribing drugs in renal failure Prevention and treatment of DVT PSYCHIATRY Notes: Key words: • Depression

• Anxiety • Blunting of affect • Labile mood • Inconsistent mood • Pressure of speech • Poverty of speech • Thought block • Flight of ideas • Preservation • Loosening of association • Thought broadcast • Thought insertion • Thought withdrawal • Thought content ( obsessional rumination and compulsion) • Insight • Delusions • Ideas of reference • Illusion • Hallucination • Pseudo-hallucination • Depersonalization • Derealization • Déjà vu • Jamais vu •Tourette syndrome tics is controlled by Haloperidol •Huntington chorea "familial".. Is usually controlled by Tertabenazine Cluster A (odd or eccentric disorders) •Paranoid personality disorder: characterized by irrational suspicions and mistrust of others •Schizoid personality disorder: lack of interest in social relationships, seeing no point in sharing time with others •Schizotypal personality disorder: also avoids social relationships,

though out of a fear of people Cluster B (dramatic, emotional, or erratic disorders) •Antisocial personality disorder: "pervasive disregard for the law and the rights of others." •Borderline personality disorder: extreme "black and white" thinking, instability in relationships, self-image, identity and behavior •Histrionic personality disorder: "pervasive attention-seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions" •Narcissistic personality disorder: "a pervasive pattern of grandiosity, need for admiration, and a lack of empathy" Cluster C (anxious or fearful disorders) •Avoidant personality disorder: social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction •Dependent personality disorder: pervasive psychological dependence on other people. •Obsessive-compulsive personality disorder (not the same as obsessivecompulsive disorder): characterized by rigid conformity to rules, moral codes, and excessive orderliness Pasted from

•Dythymia : It's considered a form of chronic depression but less severe than major depressive disorders, the depression lasts for at least 2 years. •Somatoform disorders : • Somatization disorder "Briquet's syndrome": Somatization disorder is characterized by many somatic symptoms that cannot be explained adequately based on physical and laboratory examinations. Specific

characteristics of somatization disorder include the following: o Onset of unexplained medical symptoms in persons younger than 30 years o Multiple and chronic complaints of unexplained physical symptoms o Multiple pain symptoms involving multiple sites, such as the head, neck, back, stomach, and limbs o At least 2 or more unexplained gastrointestinal symptoms, such as nausea and indigestion o At least 1 sexual complaint and/or menstrual complaint o At least 1 pseudoneurological symptom, such as blindness or inability to walk, speak, or move • Pain disorder: Pain disorder is a somatoform disorder characterized by a focussed pain complaint that cannot be entirely attributed to a specific medical disorder. Specific symptoms of pain disorder include the following: o Pain in 1 or more anatomical site producing a predominant clinical focus o Psychological factors (felt to play an important role in the onset, severity, or course of pain) o Pain symptom that is not feigned or intentionally produced • Hypochondriasis: Hypochondriasis is a somatoform disorder characterized by unexplained physical symptoms related to fear of a specific medical condition, ie, a complaint of breast pain perceived as being due to breast cancer when no breast cancer is present. Specific characteristics of hypochondriasis include the following: o Preoccupation with fear of having a serious medical illness o Bodily symptoms reported consistent with patient's conception of specific illness o Preoccupation persists despite medical evaluation and reassurance o Fear persists for at least 6 months • Conversion disorder: Conversion disorders are a somatoform disorder

characterized by a sudden loss of neurological function, usually in the context of a severe stressor. Specific characteristics of conversion disorder include the following: o One or more symptoms of loss of voluntary motor or sensory function, eg, inability to walk, sudden blindness o Psychological factors felt important in initiation or exacerbation of loss of function o No evidence that the symptom is feigned or intentionally produced o Loss of function that is not due to medical illness or culturally expected behavioral response o Common conversion symptoms (eg, pseudoseizure, paralysis, becoming mute) • Body dysmorphic disorder: Body dysmorphic disorder is a somatoform disorder characterized by a focus on a physical defect that is not evident to others. Specific characteristics of body dysmorphic disorder include the following: o Preoccupation with an imagined defect in appearance o May be associated with multiple, frantic, and unsuccessful attempts to correct imagined defect by cosmetic surgery Pasted from • Malingering: is a medical and psychological term that refers to an individual fabricating or exaggerating the symptoms of mental or physical disorders for a variety of motives, including getting financial compensation (often tied to fraud), avoiding work, obtaining drugs, getting lighter criminal sentences, trying to get out of going to school, or simply to attract attention or sympathy. Because malingerers are usually seeking some sort of primary or secondary gain, this disorder remains separate from somatization disorders and factitious disorders in which the gain is not obvious. Legally, malingering is often referred to as fabricated mental illness or feigned mental illness

• Münchausen syndrome is a psychiatric disorder in which those affected fake disease, illness, or psychological trauma in order to draw attention or sympathy to themselves. It is in a class of disorders known as factitious disorders which involve "illnesses" whose symptoms are either self-induced or falsified by the patient. It is also sometimes known as hospital addiction syndrome

PSYCHIATRY checklist: Psychiatric introduction Acute confusional state Differential diagnosis of confusion Causes and management of dementia Diagnosis of depression Management of schizophrenia Risk of suicide Treatment of alcohol and drug abuse Treatment of psychosis SURGERY Notes:

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Causes of varicose veins: DVT : pain and swelling in the calves, it increases with forced planter flexion Klippel Trenaunay syndrome: a triad of varicose veins, limb hypertrophy and port wine stain Other causes: Pregnancy, ovarian cyst, intra-abdominal malignancy, ascitis, abdominal lympadynopathy and AV fistula SURGERY Checklist: Antibiotic prophylaxis in surgical patients Complications of cholecystectomy

Investigations of acute abodmen Investigations of breast lump Investigations of chronic abdominal pain Management of burns Varicose veins and DVT Management of ischemic limb Malignancy: Brian: astrocytoma, neuroblastoma, medulloblastoma and brain stem glioma Kidney: hypernephroma and Wilm's tumor Bone tumors Blood: Leukemia and lymphoma Muscle: rhabdomysaroma and liemyosarcoma Upper limb fractures and dislocations Lower limb fractures and dislocations Bone infections Urine retetion Obstructive uropathy

PAEDIATRICS Notes:

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Childhood extremity pain: Juvenile rheumatoid arthritis: arthritis of knee and ankles, iridocyclitis, ANA is +ve and RF is -ve Osgood Schlatter disease: tibial tuberosity apophysitis and quadriceps tendonitis affects children 10-14 years old. The tuberosity is tender. Other causes include: growing pain, SLE, non-accidental injury, slipped femoral epiphysis, sickle cell and reactive arthritis. PAEDIATRICS Checklist: Developmental delay and failure to thrive Non accidental injury and sexual abuse

Abdominal pain Acute vomiting in children and causes of vomiting Difficulty in walking Jaundice Treatment of acute and chronic asthma Treatment of UTI

OBS & GYN Notes:

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Amenorrhea Stein Leventhal syndrome : is a severe form of polycystic ovarian disease, with hirstism and severe acne Kallman's sydnrome : primary amenorrhea, anosmia and colour blindness OBS & GYN Checklist: Antenatal screening Normal pregnancy and care Bleeding in pregnancy Pre-eclampsia Hyper emesis Contraception Irregular periods and investigations of amenorrhea Abnormal vaginal bleeding Pelvic mass Vaginal discharge Causes of incontinence

ENT and OPTHALMOLOGY Notes: Causes of visual disturbances:

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Argyll Robertson's pupil : small irregular pupil which is fixed to light but constricts on convergence, this occurs with neurosyphilis Multiple sclerosis: bilateral internuclear opthalmoplegia is almost pathognomonic for multiple sclerosis ENT and OPTHALMOLOGY Checklist:

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ENT Diagnosis and treatment of earache Hearing problems Hoarseness Rhinorrhea and epistaxis Vertigo Speech disorders

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Ophthalmology Sudden loss of vision Red eye Orbital swelling Visual impairment

DERMATOLOGY Notes:

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Treatment of skin conditions: Topical tar is ttt of choice of psoriasis Topical steriods r ttt of choice of eczema Oral nystatin is ttt of choice of oral candidiasis Oral corticosteroids are ttt of choice of pemphigus vulgaris " ppt by penicillamine" Contact dermatitis can be treated by topical steroids Scabies is treated with malathion liquid Lichen planus is treated with topical steroids + oral antihistaminics

DERMATOLOGY Checklist: Skin infection Moles and pigmented lesions e.g. malignant melanoma Pruritis Rashes Ulcers