Plab bedside
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Transcript of Plab bedside
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Plab bedside
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HPI
1. When did it start
2. What was the first thing noticed
3. Progress since then
4. Ever had it before
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hands
5.Warm sweaty hands
Hyperthyroidism
6.Cold moist hands
Anxiety
7.Cold dry hands
hypothyroidism
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8.Pallor of palmer crease
Anemia
9.Palmer erythema
Cirrhosis pregnancy polycythemia
10.Pigmentation of creases
Normal in Asian/blacks Addison
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11.Fibrosis and contracture of palmer fasciaDupuytrens contracture
Liver disease trauma epilepsy aging
12.Swollen PIP joints with DIP joint sparingRA
13.Swollen DIP jointsOsteoarthritis gout psoriasis
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14.Distal and proximal nodesHeberden’s and Bouchard’s nodes
Osteoarthritis
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Nails
15.Spoon shape (koilonychias)
.Iron deficiency syphilis IHD
16.Destruction of nails (onycholysis)
Hyperthyroidism fungal infection psoriasis
17.Transverse furrows Beaus lines (temporary growth arrest due to severe illness)
Nail growth rate=0.1mm/day,measure stress date from cuticle
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18.Transverse bands white and parallel
Mees lines Hypoalbuminaemia
19.Pink/brown band on nail tip
Terry's lines-
cirrhosis CCF DM cancer aging
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20.Fine longitudinal streaks under nail
Splinter hemorrhages-Infective endocarditis
21.Pitting
Psoriasis Alopecia Areata
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22.Nail fold infarcts
Vasculitic disorders
13.Painful swollen nail with intermittent discharge
Chronic paronychia- chronic infection of nail fold
Rx. Dry erythro250mg/6hrPO Nystatin oint.
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clubbing
1.Thoracic causes1. 24.Bronchogenic CA(not small cell)2. 25.Chronic lung supporation
1. Empyma2. abscess3. Bronchiactesis4. Cystic fibrosis
3. 26.Fibrosing Alveolitis4. 27.mesothelioma
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2.GI causes
1. 28.Inflammatory bowl disease
2. 29.cirrohsis
3. 30.Malabsorption
4. 31.Lymphoma
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3.Cardiac causes
1. 32.Cyanotic congenital heart disease
2. 33.endocarditis
3. 34.Atrial myxoma
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4.Rare causes of clubbing;
35.Familial
36.Thyroid acropachy
5.Unilateral clubbing bc of
37.Axillary artery aneurysm
38.Brachial A-V malformation
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Abdominal distension
39.fat
40.faeces
41.fluid ( shifting dullness, fluid thrill)
42.fetus
43.flatus ( air is resonant on percussion)
44.food(malabsorption)
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AD due to Air
45.GI obstruction (inc. faeces) ||
46. Aerophagy (air swollowing )
V
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AD due to ascites
47. malignancy*
48. Hypoproteinaemia (nephrotic )
49. Right heart failure
50. Portal hypertension
qumber: any organ e.g liver, pancrease, kidney stomach colon*qumber: any organ e.g liver, pancrease, kidney stomach colon*
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AD due to solids
51.Malignancy*
52.Lymph nodes
53.Aorta aneurysm
54.Cysts • renal
• pancrease
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qumber: any organ e.g liver, pancrease, kidney stomach colon*qumber: any organ e.g liver, pancrease, kidney stomach colon*
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AD due to pelvic masses
55. Bladder• Full
• CA
56. Fibroid, fetus
57. Ovarian ( cyst, cancer)
58. Uterine cancer
qumber:u cant get below pelvic massesqumber:u cant get below pelvic masses
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Right illiac fossa mass
59.appendix ( mass, abscess)
60.kidney mass
61.Caecum CA
62.Crohns or TB mass
63.Intussusceptions
64.Amoebic mass
65.Any of pelvic mass mentioned above
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hepatomegaly
66.Right heart failure
67. Pulsatile hepatomegalyTricuspid incompetence
68.InfectionsGlandular feverHepatitisMalaria
s
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69. Malignancy
Metastatic or primary
Myeloma
Leukemia
Lymphoma
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70.misc
Sickle cell anaemia
Hemolytic anaemia
porphyria
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.Ascities and portal hypertension
71.Cirrhosis
72.Portal nodes
73.Budd-chiari syndrome
74.IVC or portal vein thrombosis
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DM
Lack of or diminished effectiveness of endogenous insulin and characterized by hypoglycemia
Two types
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defination
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defination
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Glucose normal
Normal glucose range3.5 to 5.5 mmol/lit
Ketone breathKetoacidosis
Secoondary DM developing After some disease,drugs or pancreatic surgery
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WHO criteria for labelling glucose
Fasting plasma venous glucose level
Equal to or >7mmol/lit
OGTT>? To label DM
11.1mmol?lit
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HBA1c specifity n sensitivity
99.6% n 99%
Urine glycoseuria specificity and sensitivity
33% n 90%
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Which diuretic u will use in renal impairment in DM
ACE inhibitors
What care to be taken in thyazolidine
LFTs monthly bc hepatotoxity
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Thiazolidines and biguanides MOA?
Increase recetpor sensitivity
Alpha glycosidase inhibitors MOA
Stop starch conversion into glucose
Stop hepatic gluconeogenesis
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Side effects of Alpha glucosidase inhibitors
Flatus abdominal distension
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Cause of hypoglycemia in diabetics
Insulin and oral hyperglycemic
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CAUSES
Cause of hypoglycemia in non diabeticEXPLAINExogenous drugs• Insulin• Oral hypoglycemics• Alcohol• Others quinine
sulphate,pentamidine,quinolones
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( EXPLAIN )
Pitu insufficiency
Liver failure’
Addison’s disease
Islet cell tumor /insulinoma
Immune hypoglycemia
Nonpancreatic neoplasia
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PRESENTATIONS
HI or norm insulin + no ketones = insulinoma , sulphonylurea, insulin auto anti bodies
Low or undetectable insulin + no ketones= non pancreatic neoplasia and ins rec antibodies
Ins low or undetected + hi ketones=adrenal or pitutary failure
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Confirm test for insulinomas
Suppresive test = insulin iv inf and measure c – peptide
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Investigations
BSR by lab or glucometer
Exclude liver failure or malaria• LFT and Mp slide
OGTT for post prandial hypoglycemia
72 hr fast and BSR monitoring for fasting hypoglycemia
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TREATMENT
oral sugar 25-50g iv glucose stat as 25% D/W
Glucagon 0.5 – 1.5mg iv
Frequent CHO meals
Long acting starch for recurrence
Guar and pectin instead of CHO incase of recurrence after starch
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limp
5.painful arthritis+macular rash+fever+lymphadenopathyJuvenile ideopathic arthritis
6.6yr+painless Ar+flattened epiphyseal endsPerthes disease
7.3 yr+painless limp+skin creaseCongenital dislocation of hip
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pediatrics
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pediatrics
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Motor abnormalitis and drug
5.spastic diplegia
Cerebral palsy
6.Ataxia
Postvaricella infection
Mefloquine side effects
neuropsychiatric
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pediatrics
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pediatrics
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Biopsy 5.werdnig-Hoffman disease or spinal muscular atrophyMuscle biopsy
6.secondary sclerosing panencephalitisBrain bipsy
Celiac diseaseVillus atrophy on jejunal biopsy
Hirschsprungs diseaseRectal biopsy
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stridor5.usually well but worse during nightALTB
Prevention of recurrent moderate asthmaPulmicort inhaler
Treatment of mild asthmaBricanyl inhaler
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pediatrics
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pediatrics
asthma
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5.newborn+lymphedema of feet+low hairline+small chin
45XO, turner
6.15 gynocomestia +poorly developed testes
Klinefelter, 46XXXy
Small chin,mental retardation+abnormally shaped souls
Trisomy 18s
Cleft palatte aortic arch+Abnormal T function
Deletion of 22q11 Digeorge syndrome
Hypotonicnewborn brachycephaly and duodenal atresi
Trisomy, down syndromea
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pediatrics
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pediatrics
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epilepsy .10 yr+twitching corner of his mouth,arm leg consious
Benighn rolandic epilepsy
Sixmonth+shortlived flexion neck&limbs
Infantile spasms
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pediatrics
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8.Pallor of palmer crease
Anemia
9.Palmer erythema
Cirrhosis pregnancy polycythemia
10.Pigmentation of creases
Normal in Asian/blacks Addison
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pediatrics
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Viral infections of childhoodRash+cervical lymphadenopathy+arthritisrubella
Rash Lymphadenopathy organomegalyEBV
Hand foot mouth diseaseCoxsackie A
Diarrhea URTI conjunctivitisAdenovirus
Roseola infantumHHV
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Marking= wrong ones
9/24/04 30/38 =78%
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