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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. - PowerPoint PPT Presentation
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Plab bedside
Qumber
HPI
1. When did it start
2. What was the first thing noticed
3. Progress since then
4. Ever had it before
qumber:
Bed side
qumber:
Bed side
hands
5.Warm sweaty hands
Hyperthyroidism
6.Cold moist hands
Anxiety
7.Cold dry hands
hypothyroidism
qumber:
Bed side
qumber:
Bed side
8.Pallor of palmer crease
Anemia
9.Palmer erythema
Cirrhosis pregnancy polycythemia
10.Pigmentation of creases
Normal in Asian/blacks Addison
qumber:
Bed side
qumber:
Bed side
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
qumber:
Bed side
qumber:
Bed side
14.Distal and proximal nodesHeberden’s and Bouchard’s nodes
Osteoarthritis
qumber:
Bed side
qumber:
Bed side
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
qumber:
Bed side
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
qumber:
Bed side
qumber:
Bed side
20.Fine longitudinal streaks under nail
Splinter hemorrhages-Infective endocarditis
21.Pitting
Psoriasis Alopecia Areata
qumber:
Bed side
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.
qumber:
Bed side
qumber:
Bed side
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
qumber:
Bed side
qumber:
Bed side
2.GI causes
1. 28.Inflammatory bowl disease
2. 29.cirrohsis
3. 30.Malabsorption
4. 31.Lymphoma
qumber:
Bed side
qumber:
Bed side
3.Cardiac causes
1. 32.Cyanotic congenital heart disease
2. 33.endocarditis
3. 34.Atrial myxoma
qumber:
Bed side
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
qumber:
Bed side
qumber:
Bed side
Abdominal distension
39.fat
40.faeces
41.fluid ( shifting dullness, fluid thrill)
42.fetus
43.flatus ( air is resonant on percussion)
44.food(malabsorption)
AD due to Air
45.GI obstruction (inc. faeces) ||
46. Aerophagy (air swollowing )
V
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*
AD due to solids
51.Malignancy*
52.Lymph nodes
53.Aorta aneurysm
54.Cysts • renal
• pancrease
qumber:qumber:
qumber: any organ e.g liver, pancrease, kidney stomach colon*qumber: any organ e.g liver, pancrease, kidney stomach colon*
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
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
hepatomegaly
66.Right heart failure
67. Pulsatile hepatomegalyTricuspid incompetence
68.InfectionsGlandular feverHepatitisMalaria
s
69. Malignancy
Metastatic or primary
Myeloma
Leukemia
Lymphoma
70.misc
Sickle cell anaemia
Hemolytic anaemia
porphyria
.Ascities and portal hypertension
71.Cirrhosis
72.Portal nodes
73.Budd-chiari syndrome
74.IVC or portal vein thrombosis
DM
Lack of or diminished effectiveness of endogenous insulin and characterized by hypoglycemia
Two types
qumber:
defination
qumber:
defination
Glucose normal
Normal glucose range3.5 to 5.5 mmol/lit
Ketone breathKetoacidosis
Secoondary DM developing After some disease,drugs or pancreatic surgery
WHO criteria for labelling glucose
Fasting plasma venous glucose level
Equal to or >7mmol/lit
OGTT>? To label DM
11.1mmol?lit
HBA1c specifity n sensitivity
99.6% n 99%
Urine glycoseuria specificity and sensitivity
33% n 90%
Which diuretic u will use in renal impairment in DM
ACE inhibitors
What care to be taken in thyazolidine
LFTs monthly bc hepatotoxity
Thiazolidines and biguanides MOA?
Increase recetpor sensitivity
Alpha glycosidase inhibitors MOA
Stop starch conversion into glucose
Stop hepatic gluconeogenesis
Side effects of Alpha glucosidase inhibitors
Flatus abdominal distension
Cause of hypoglycemia in diabetics
Insulin and oral hyperglycemic
CAUSES
Cause of hypoglycemia in non diabeticEXPLAINExogenous drugs• Insulin• Oral hypoglycemics• Alcohol• Others quinine
sulphate,pentamidine,quinolones
( EXPLAIN )
Pitu insufficiency
Liver failure’
Addison’s disease
Islet cell tumor /insulinoma
Immune hypoglycemia
Nonpancreatic neoplasia
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
Confirm test for insulinomas
Suppresive test = insulin iv inf and measure c – peptide
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
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
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
qumber:
pediatrics
qumber:
pediatrics
Motor abnormalitis and drug
5.spastic diplegia
Cerebral palsy
6.Ataxia
Postvaricella infection
Mefloquine side effects
neuropsychiatric
qumber:
pediatrics
qumber:
pediatrics
Biopsy 5.werdnig-Hoffman disease or spinal muscular atrophyMuscle biopsy
6.secondary sclerosing panencephalitisBrain bipsy
Celiac diseaseVillus atrophy on jejunal biopsy
Hirschsprungs diseaseRectal biopsy
qumber:
pediatrics
qumber:
pediatrics
stridor5.usually well but worse during nightALTB
Prevention of recurrent moderate asthmaPulmicort inhaler
Treatment of mild asthmaBricanyl inhaler
qumber:
pediatrics
qumber:
pediatrics
asthma
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
qumber:
pediatrics
qumber:
pediatrics
epilepsy .10 yr+twitching corner of his mouth,arm leg consious
Benighn rolandic epilepsy
Sixmonth+shortlived flexion neck&limbs
Infantile spasms
qumber:
pediatrics
qumber:
pediatrics
8.Pallor of palmer crease
Anemia
9.Palmer erythema
Cirrhosis pregnancy polycythemia
10.Pigmentation of creases
Normal in Asian/blacks Addison
qumber:
pediatrics
qumber:
pediatrics
Viral infections of childhoodRash+cervical lymphadenopathy+arthritisrubella
Rash Lymphadenopathy organomegalyEBV
Hand foot mouth diseaseCoxsackie A
Diarrhea URTI conjunctivitisAdenovirus
Roseola infantumHHV
qumber:
pediatrics
qumber:
pediatrics
Marking= wrong ones
9/24/04 30/38 =78%
qumber:
Bed side
qumber:
Bed side
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