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Plab bedside

Plab bedside. Qumber. qumber: Bed side. HPI. When did it start What was the first thing noticed Progress since then Ever had it before. qumber: Bed side. hands. 5.Warm sweaty hands Hyperthyroidism 6.Cold moist hands Anxiety 7.Cold dry hands hypothyroidism. qumber: Bed side.

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Plab bedside

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  1. Plab bedside Qumber

  2. qumber: Bed side HPI • When did it start • What was the first thing noticed • Progress since then • Ever had it before

  3. qumber: Bed side hands • 5.Warm sweaty hands • Hyperthyroidism • 6.Cold moist hands • Anxiety • 7.Cold dry hands • hypothyroidism

  4. qumber: Bed side • 8.Pallor of palmer crease • Anemia • 9.Palmer erythema • Cirrhosis pregnancy polycythemia • 10.Pigmentation of creases • Normal in Asian/blacks Addison

  5. qumber: Bed side • 11.Fibrosis and contracture of palmer fascia • Dupuytrens contracture • Liver disease trauma epilepsy aging • 12.Swollen PIP joints with DIP joint sparing • RA • 13.Swollen DIP joints • Osteoarthritis gout psoriasis

  6. qumber: Bed side • 14.Distal and proximal nodes • Heberden’s and Bouchard’s nodes • Osteoarthritis

  7. 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 qumber: Bed side Nails

  8. qumber: Bed side • 18.Transverse bands white and parallel • Mees lines Hypoalbuminaemia • 19.Pink/brown band on nail tip • Terry's lines- • cirrhosis CCF DM cancer aging

  9. qumber: Bed side • 20.Fine longitudinal streaks under nail • Splinter hemorrhages-Infective endocarditis • 21.Pitting • Psoriasis Alopecia Areata

  10. qumber: Bed side • 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.

  11. qumber: Bed side clubbing 1.Thoracic causes • 24.Bronchogenic CA(not small cell) • 25.Chronic lung supporation • Empyma • abscess • Bronchiactesis • Cystic fibrosis • 26.Fibrosing Alveolitis • 27.mesothelioma

  12. qumber: Bed side 2.GI causes • 28.Inflammatory bowl disease • 29.cirrohsis • 30.Malabsorption • 31.Lymphoma

  13. qumber: Bed side 3.Cardiac causes • 32.Cyanotic congenital heart disease • 33.endocarditis • 34.Atrial myxoma

  14. qumber: Bed side 4.Rare causes of clubbing; • 35.Familial • 36.Thyroid acropachy 5.Unilateral clubbing bc of • 37.Axillary artery aneurysm • 38.Brachial A-V malformation

  15. Abdominal distension • 39.fat • 40.faeces • 41.fluid ( shifting dullness, fluid thrill) • 42.fetus • 43.flatus ( air is resonant on percussion) • 44.food(malabsorption)

  16. AD due to Air • 45.GI obstruction (inc. faeces) || • 46. Aerophagy (air swollowing ) V

  17. 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*

  18. qumber: AD due to solids • 51.Malignancy* • 52.Lymph nodes • 53.Aorta aneurysm • 54.Cysts • renal • pancrease qumber: any organ e.g liver, pancrease, kidney stomach colon*

  19. 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 masses

  20. 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

  21. hepatomegaly • 66.Right heart failure • 67. Pulsatile hepatomegaly • Tricuspid incompetence • 68.Infections • Glandular fever • Hepatitis • Malaria s

  22. 69. Malignancy • Metastatic or primary • Myeloma • Leukemia • Lymphoma

  23. 70.misc • Sickle cell anaemia • Hemolytic anaemia • porphyria

  24. .Ascities and portal hypertension • 71.Cirrhosis • 72.Portal nodes • 73.Budd-chiari syndrome • 74.IVC or portal vein thrombosis

  25. qumber: defination DM • Lack of or diminished effectiveness of endogenous insulin and characterized by hypoglycemia • Two types

  26. Glucose normal • Normal glucose range • 3.5 to 5.5 mmol/lit • Ketone breath • Ketoacidosis • Secoondary DM • developing After some disease,drugs or pancreatic surgery

  27. WHO criteria for labelling glucose • Fasting plasma venous glucose level • Equal to or >7mmol/lit • OGTT>? To label DM • 11.1mmol?lit

  28. HBA1c specifity n sensitivity • 99.6% n 99% • Urine glycoseuria specificity and sensitivity • 33% n 90%

  29. Which diuretic u will use in renal impairment in DM • ACE inhibitors • What care to be taken in thyazolidine • LFTs monthly bc hepatotoxity

  30. Thiazolidines and biguanides MOA? • Increase recetpor sensitivity • Alpha glycosidase inhibitors MOA • Stop starch conversion into glucose • Stop hepatic gluconeogenesis

  31. Side effects of Alpha glucosidase inhibitors • Flatus abdominal distension

  32. Cause of hypoglycemia in diabetics • Insulin and oral hyperglycemic

  33. CAUSES • Cause of hypoglycemia in non diabetic • EXPLAIN • Exogenous drugs • Insulin • Oral hypoglycemics • Alcohol • Others quinine sulphate,pentamidine,quinolones

  34. ( EXPLAIN ) • Pitu insufficiency • Liver failure’ • Addison’s disease • Islet cell tumor /insulinoma • Immune hypoglycemia • Nonpancreatic neoplasia

  35. 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

  36. Confirm test for insulinomas • Suppresive test = insulin iv inf and measure c – peptide

  37. 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

  38. 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

  39. qumber: pediatrics limp • 5.painful arthritis+macular rash+fever+lymphadenopathy • Juvenile ideopathic arthritis • 6.6yr+painless Ar+flattened epiphyseal ends • Perthes disease • 7.3 yr+painless limp+skin crease • Congenital dislocation of hip

  40. qumber: pediatrics Motor abnormalitis and drug • 5.spastic diplegia • Cerebral palsy • 6.Ataxia • Postvaricella infection • Mefloquine side effects • neuropsychiatric

  41. qumber: pediatrics Biopsy • 5.werdnig-Hoffman disease or spinal muscular atrophy • Muscle biopsy • 6.secondary sclerosing panencephalitis • Brain bipsy • Celiac disease • Villus atrophy on jejunal biopsy • Hirschsprungs disease • Rectal biopsy

  42. qumber: pediatrics stridor • 5.usually well but worse during night • ALTB • Prevention of recurrent moderate asthma • Pulmicort inhaler • Treatment of mild asthma • Bricanyl inhaler asthma

  43. qumber: pediatrics • 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

  44. qumber: pediatrics epilepsy • .10 yr+twitching corner of his mouth,arm leg consious • Benighn rolandic epilepsy • Sixmonth+shortlived flexion neck&limbs • Infantile spasms

  45. qumber: pediatrics • 8.Pallor of palmer crease • Anemia • 9.Palmer erythema • Cirrhosis pregnancy polycythemia • 10.Pigmentation of creases • Normal in Asian/blacks Addison

  46. qumber: pediatrics Viral infections of childhood • Rash+cervical lymphadenopathy+arthritis • rubella • Rash Lymphadenopathy organomegaly • EBV • Hand foot mouth disease • Coxsackie A • Diarrhea URTI conjunctivitis • Adenovirus • Roseola infantum • HHV

  47. qumber: Bed side Marking= wrong ones • 9/24/04 30/38 =78%

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