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Clinical > Mnemonics/DDs > Flashcards

Mnemonics/DDs Flashcards

1
Q

`Palpitation/Nervousness DDs

A

2 (MACE)
-Menopause
-Medication induced

-Anemia
-Anxiety/Panic/Stress

-CNS- trauma, epilepsy, stroke/TIA, infection
-CVS- arrhythmia, valvular heart disease, HTN, MI, IHD

-Endocrine: hyperthyroidism, hypoglycemia, Pheochromocytoma,
-Excess tea/coffee/recreational drug

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2
Q

Red lump on eye lid DDs

A

3Eyelid+2Eye+3Local=8

1.Stye
2.Chalazion
3.Dacrocystitis

4.Conjunctivitis
5.Cellulitis:
a.Orbital
b.Periorbital

6.FB (Foreign body)
7.Insect bite
8.Allergic reaction

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3
Q

Macrocephaly DDs

A

3B2IG HO2T (BIG HOT)

1.Bleeding/ Hemorrhage
2.Benign Familial Macrocephaly
3.BESSI- Benign Enlargement of Subarachnoid Space in Infancy

4.IIH (Increased Intracranial Hypertension)
5.Infection- Meningitis, Encephalitis, Abscess

6.Genetic disorder- (FAN GG): fragile X syndrome, achondroplasia, neurofibromatosis type 1, Gorlin syndrome, Greig cephalo-poly-dactyly syndrome

7.Hydrocephalus- fluid in ventricles
8.Over-growth of skull bones- cranial hyper-ostosis

9.Trauma- Hematomas
10.Tumor

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4
Q

Mobile head at term DDs

A

1.Normal
2. Abnormal presentation /Occipito posterior (OP) position with deflexed head

3.Polyhydramnious

4.Placenta praevia
5.Fibroids occupying lower pole of uterus

CPD:
6.Baby: (2)
a)Big
b)Birth defects
7.Pelvic bone deformities(2) due Vit D deficiency:
a)osteomalacia
b)rickets
8.Uterine abnormalities: Bicornuate, Septate

9.Unknown

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5
Q

Dizziness/Vertigo (remember which case)
DDs

A

Dx: Cerebellar metastasis secondary to lung carcinoma and R/o Acoustic neuroma

1.Drug induced- hypotensive drugs

Ear:(5) (with Vs no HL)
2.Acute labyrinthitis- persistent vertigo with hearing loss
3.Vestibular neuronitis- persistent vertigo without hearing loss
4.BPPV- intermittent vertigo without hearing loss
5.Meniere’s disease- intermittent vertigo with tinnitus and hearing loss
6.Wax in the ear

CNS: (4)
7.Cerebrovascular- PICA
8.Multiple Sclerosis
9.Trauma
10.Epilepsy

Other (3):ICE
11.Infections
12.CVS rel.
13.Electrolyte imbalance

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6
Q

Subfertility DDs

A

3HPO3U
2Endo
(Male+Couple)
+2 Med1Surg+FHx + SAD(Marijuana)M(SAC)

(Don’t mix with recurrent miscarriages w/h is 2AEIU-C)

5.Eating disorders
6.Exercise induced
7.Stress
8.Hyperprolactenemia

1.PCOS
2.PID
3.Fibroid
4.Endometriosis

Endo:
9.DM
10.Thyroid

Med:
11.SLE
12.Renal disorders
Surg:
13.Asherman’s syndrome

Couple factors
17.Infrequent intercourse

Male
18.Sperm abnormalities

14.SAD (Marijuana)
15.Medications-(SAC) Spironolactone, AntiPsychotics, Chemotherapeutic agents
16.Family history
(FRAPES: Fibroids, Renal d, Adhesions, PID, Endometriosis, SADMA)

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7
Q

Paediatrics Vomiting DDs

A

GP-DISH-VIT-CO (say other Ddx first if infant 1 D)
1.GOR/GORD
2.Pyloric stenosis
3.Duodenal atresia
4.Intususseption
5.Strangulated and incarcerated hernia
6.Hirschsprung :birth defect in which some nerve cells are missing in the large intestine, so a child’s intestine can’t move stool and becomes blocked. The main symptom is a newborn’s failure to have a bowel movement within 48 hours after birth. Other symptoms include a swollen stomach and vomiting.
Surgery is required to bypass the affected part of the colon or remove it entirely.
7.Volvulus
8.Intestinal obstruction
9.Testicular torsion

10.Congenital Adrenal Hyperplasia
Other: Fever:-
11.Meningitis (Septicaemia)
12.OM
13.Pneumonia
14.AGE
15.UTI

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8
Q

Travel fever DDs (adult and paeds)

A

(2H+6T+7R)=15

1.Hepatitis (A, B, C, D, E)
(Ques- ABP FIT NO SEX)
2.HIV

3.Malaria
4.Dengue
5.Typhoid
6.Paratyphoid

QLD:(2)
7.Ross river
8.Hemochromatosis (Fe binding protein deposition that causes liver damage, Diabetes, bronze skin)

RESPIRATORY:(3+2+2)
9.TB
10.Atypical pneumonia
11.Legionella

Vaccine:
12.Influenza
13.COVID pneumonitis

14.Viral URTI/LRTI
15.Bacterial sepsis

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9
Q

Short term memory loss DDs

A

A3C2E DEV (Alcohol, 3CNS, 2Endo, Dementia,Electrolyte, Vit B12)=9

1.Alcohol induced brain injury

CNS:(3)
2.Trauma/ head injury
3.Infection- Meningitis
4.Brain tumour

ENDOCRINE: (2)
5.Diabetes neuropathy
6.Thyroid dysfunction

7.Early DEMENTIA
8.ELECTROLYTE imbalance
9.Vit B12 deficiency

DELERIUM OR HI2D4EMAP C
Drug
Dementia
Endocrine
Electrolyte
Eye
Ear
Metabolic: liver or kidney failure
Alcohol
Psychosis/Depression
CNS: all

For Hx: ICCEE(EE)MM
INFECTION
CNS, CVS
Electrolyte
Endocrine
Ear , eye
Mood
medication

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10
Q

Uncomfortable feeling (3rd trimester)
DDs

A

(Think tummy pain)
1.Normal labour
2.Mal presentation

3.Trauma
4.APH- Abruptio (could be Concealed)

5.Fibroid(vary wt preg)
5.UTI/ pyelonephritis
7.Renal colic
8.Constipation

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11
Q

Transverse Lie:
Causes
Complications
Tx

A

2+2+3=7

This pregnancy:-
1.Polyhydramnious
2.Placenta previa

Previous pregnancy:-
3.Previous C-section
4.Multiparity

Uterus:-
5.Lax uterus
6.Small pelvis
7.Uterine malformation

Complications:
Obstructed labor
Cord Prolapse

Tx: Elective C section OR External Cephalic Version (ECV)
if ECV done successfully: Induction of labor for NVD trial
May need Emergency C section after this, so ECV done keeping all facilities ready.

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12
Q

Primary / Secondary PPH DDs

A

1.Uterine atony (Tone)
2. RPOC (Tissue)
3.Laceration- Episiotomy, instrument used, obstructed labor? vaginal and cervical (Trauma)
4. Bleeding disorder & blood thinning meds (Thrombin)

Secondary (extra)
5.Endometritis

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13
Q

Post partum fever DDs

A

Wind, water, wound, walking, wonder drugs)
3Bs

1.Breast: Mastitis/ Breast abscess
2.Birth canal: endometritis
3.Bladder: UTI
4. Wound infection (episiotomy/CS wound)
5.URTI/ Pneumonia
6.DVT

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14
Q

Dementia DDs

A

4D4C-2ED-VAM=14

1.Alzheimer’s
2.Frontal lobe
3.Lewy body
4.Vascular

5.Tumour
6.Trauma
7.Infection
8.Stroke

9.Diabetes
10.Thyroid

11.Depression

12.Vit B12 deficiency
13.Alcohol
14.Medication, ECT
15.Syphilis

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15
Q

Acquired brain injury causes

A

5CNS+3Dementia+1A+2:AlcDrug=11

.Hypoxia
CNS:(5)
1.Stroke, Aneurysm
2.Trauma
3.Brain surgery
4.Epilepsy
5.Tumor

Dementia:
6.Alzheimer’s
7.Parkinson’s
8.Huntington’s
9.MS (Multiple sclerosis)

10.AIDS
11.Thyroid
13.Depression

SADMA:
12.Alcohol
13.Drugs

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16
Q

Shoulder pain DDs,
Rotator cuff injury Mx
Shoulder Dislocation Mx

A

NI3PT 3FO3R B4CD
1.Nerve palsy- Suprascapular and Axillary
2.Infection
3.Pancost tumor
4.PMR
5.Polymositis/Dermatomyositis
6.Thyroid
7.Tumor

8.Frozen shoulder/ Adhesive capsulitis
9.Fibromyalgia
10.Fracture
11.Osteoarthritis
12.Rheumatoid arthritis
13.Rotator cuff injury
14.Raynaud’s phenomenon

15.Bicipital tendinitis
16.Cervical disc disease

17.Cervical spondylosis (wear &tear of spinal disc)
18.Cervical Sprain and Strain

19.Complex Regional pain syndromes
20.Dislocation- shoulder, AC

Mx of Rotator cuff injury:
IX:
 X-rays: usually normal or may show a small bone spur.
 MRI or ultrasound: more sensitive for soft tissues like the
rotator cuff tendons.
Shows:
1.Tear’s:
a.Location
b.Size
c.”old” or “new”
2.Rotator cuff muscles:
a.Quality

TREATMENT:

NONSURGICAL Treatment: (7)
1.Rest.
2.Sling (to help protect your shoulder and keep it still.)
3.Activity modification or Avoidance
4.NSAIDs: ibuprofen and naproxen reduce pain and swelling.
5.Strengthening exercises:
a.Restore movement
b.Strengthen shoulder
c.Relieve pain
d.Prevent further injury.

6.Stretches to improve flexibility and ROM.
7.Steroid injection.

Indications for SURGERY: (3)
1.Symptoms have lasted 6 to 12 months
2.Large tear (more than 3 cm) and the quality of the
surrounding tissue is good.
3.Significant weakness and loss of function in your shoulder

Mx of Shoulder Dislocation:
X-Ray to R/O Fx if suspected
Reduction after anesthesia (Lignocaine, Nitrous Oxide/ Fentanyl)
if req. by (Kocher’s technique: there will be no sudden movements or pulling. Relax arm while i move it and put it into place)
P-PRICE(SS):
Painkiller, Physio, Restriction of certain movements
RICE,Sling (few days),Shoulder strappling during active sports
Course:2 wk(most activities),12 weeks(heavy lifting sports)
Complication: Axillary nerve damage, Shoulder Arthritis (1/3), Recurrence

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17
Q

One-Sided Weakness DDs
Chronic Bilateral weakness + numbness DD

A

One-Sided Weakness DDs:
1.Subdural hematoma
2.Epidural hematoma
3.Subarachnoid haemorrhage

4.TIA
5.Stroke
6.Tumour/SOL
7.Meningitis
8.Encephalitis
9.Trauma
10.Epilepsy

11.Hemiplegic migraine: (migraine with motor aura can cause temporary paralysis on one side of the body.)
12.Psychogenic (Somatic Symptom D)

Bilateral weakness + numbness= PAD2S BVM
Peripheral Neuropathy
Alcohol
DM
Stroke
Spinal Cord Compression

Brain tumor
Vit B12 Deficiency
MS

(C&C Opthalmoplegic Migraine: Binocular Diplopia
Migraine: Vision loss)

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18
Q

Adult chronic Diarrhoea DDs

A

4I 3C HAT DP

1.IBD
2.IBS
3.Infections- Hepatitis A, Giardiasis, HIV?
4.Intolerance (lactose) (dont mix with intestinal parasite)

5.Celiac
6.Cystic fibrosis
7.Cancer

8.Hyperthyroidism/Thyrotoxicosis, HIV?
9.Antibiotic induced (Pseudomembrane Colitis)
10.Travel related

11.Diverticular disorder
12.Psychiatric

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19
Q

Murmur in pregnancy DDs

A

PRAIS-P
1.Pulmonary embolism (S1Q3T3: presence of an S wave in lead I with Q wave and T inversion in lead III.)
2.Respiratory causes (Asthma, URTI, LRTI)
3.Anemia
4.Infective endocarditis
5.Structural heart defects like MS
6.Physiological murmur

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20
Q

Dysphagia DDs (slide number 48- GIT)

A

Esophageal (3SPAM) & Oropharngeal (S2PR3M)
2[CGP]

Esophageal cause (3SPAM):
(Peptic) Stricture
(Esophageal) Spasm
Scleroderma
Pharyngeal pouch(oropharyngeal)
Achalasia cardia
(Esophageal) Mass

Oropharngeal cause (S2PR3M)
Stroke
Parkinson
Polymyositis
Radiation (head & neck)
MG (Myasthenia Gravis): Tired at end of day?
MS
Medication

2C:
CA(Esophageal, Oral)
Candidiasis

2G:GERD, Globus

2P:Peritonsillar Abscess, Plummer Vinson syn
(Read in detail in Mx)

Also ask: HOT-GCG: (Hiatal Hernia,Oral CA,Thyroid,GERD,Candida, Globus)

Candida & HIV
GERD
Thyroid
Hiatal Hernia???
Voice: for stroke, Esophageal CA, R/O issues with near-by structures
Globus
Smoking (for Oral CA)

PEFE:
Anemia Qs: (for nutritional deficiency and Plummer Vinson)
Esophageal ring/web
Peritonsillar Abscess
Thyroid

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21
Q

Enlarged LN DDx
Mx of Acute Adenitis

A

P6V 3BA4IT 2M
Post-viral
Viral+:(6)
EBV,CMV, HIV,
Kawasaki (not viral)
Toxo, Cat scratch,

Bacterial:(3)
TB
Acute Bacterial Adenitis (NOT B. TRACHITIS of SOB)
Dental infection

Allergy: Atopic Eczema

Inflammation:(4)
Tonsillitis, Quinsy,
JRA(juvenile rheumatoid arthritis), SLE

Thyroid

Malignancy:(2)
Lymphoma, Leukemia

Ix:6+4
1.FBC

2.Serology: (5)
a.EBV
b.CMV
c.HIV
d.Toxo
e.Cat scratch
(Swab for Tonsillitis)

3.Mantoux
4.C-XRay

5.CT
6.Biopsy

Management of acute Adenitis/Fluctuant Node (3)
1.Incision and Drainage (CI in suspected TB: possible Sinus formation)
2.Oral Antibiotics: Flucloxacillin for 10 days, with review in 48 hours.
(Hypersensitivity to penicillin: Cefalexin)
3.IV antibiotics: (Neonates, unwell or failed oral Rx)

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22
Q

Atrial fibrillation Causes + Complications

A

PIRATES
Pulmonary: lung dx (coughing)
Ischemia: Hx of heart attack
Rheumatic fever
Atrial myxoma: structural prob+Fhx of heart prob, MI, abnormal heart valves, congenital heart defects, previous heart surgery
Thyroid-hyper
Emboli: bleed &clotting disorder
Sepsis: F/N/vomit
+
SADMA+S: smoking, alcohol, caffeine, stress

Complications (5): stroke, PE, HF, mesenteric ischemia, PVD

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23
Q

Thyroid lump DDs

A

2G H 3C 3L
1.Grave’s disease
2.Goitre (Multi nodular)

3.Hashimotos’ thyroiditis

Cysts
4.Thyroglossal
5.Sebaceous

6.Cancer-thyroid

7.LN
8.Lipoma
9.Lymphoma

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24
Q

Med of ulcerative colitis

A

IP3ASSS(3):
Immune modulator
Painkiller
Anti-Diarrheal, Anti-biotic, Aminosalicylate
Steroid
Supplement(3): iron, vit D, Calcium
Surgery- talk about stoma bag

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25
Q

Complications of ulcerative colitis

A

F-5O-P- BTCON

Fulminant colitis: severe inflammation of gut with high fever and tummy pain

5 Organs:(BELS-J): the same inflammation that triggers flares in your intestines can have an impact on other parts of the body — including your skin

Bile duct (primary sclerosing cholangitis): The bile ducts are a series of thin tubes that go from the liver to the small intestine.
In primary sclerosing cholangitis, inflammation causes scars within the bile ducts. These scars make the ducts hard and narrow and gradually cause serious liver damage.

Eye (episcleritis, uveitis):
Can colitis cause vision loss?
Approximately 10% of people with inflammatory bowel disease (IBD) experience eye problems. However, most of these are treatable and do not pose any significant threat to loss of vision.

Liver
Skin (erythema nodosum, pyoderma gangrenosum)
Joint

Perforation: hole in gut
Bleeding

Toxic megacolon: occurs when swelling and inflammation spread into the deeper layers of your colon. As a result, the colon stops working and widens. In severe cases, the colon may rupture.

CA
Osteoporosis (because of steroids)
Nutritional deficiency

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26
Q

Elevated aminotranferases DDs

A

MCAAT
1.Muscle disease
2.Celiac disease
3. Addison d. (Adrenal insufficiency: can be rel to abrupt steroid withdrawal: low BP), [OPP: Conn (Hyperaldosteronism): increased BP)]
4.Anorexia nervosa
5:Thyroid disease

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27
Q

Rectal Bleeding DDs

A

M3IC HAD 2B 2P

Mesenteric ischemia
Ischemic colitis
IBD
Infection
CA

Hemorrhoids
Anal fissure
Diverticular disease

Bleeding disorder
Blood thinner

Polyp
Peptic Ulcer

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28
Q

Tiredness DDx.

A

2H3EM3I FA2DOC

Hemochromatosis, Hepatitis
Endocrine: DM, Thyroid, Addisons
Malignancy
Infection, infective endocarditis, Atypical pneumonia

Fibromyalgia
Anemia
Depression, Drug (Steroid Withdrawal)
Obstructive sleep apnea
Celiac Dx

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29
Q

GDM Complications

A

Mother: 5P+1
Polyhydramnios
Pre-Eclampsia
(Before time)
Preterm labor
PROM
Placental abruption
&
Induction/ C section

Baby: 3+3+3 (Baby size(3), Defects(3), After delivery(3))

Before birth:
Macrosomia
IUGR
FDIU/IUD: Fetal death-in-utero

Defects:
NTD (Neural tube defect)
Vertebral
Heart

After birth:
RDS
Hypoglycemia
Jaundice

(C&C Congenital Rubella syn.=Vision, Hearing, Limbs, Mental, Heart)

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30
Q

Pancytopenia causes/ DDs

A

Causes:-(M3I2C H2AD)
1.Medications (reduced prod, inc destruction)
2.Infection (post-viral: red prod, virus: inc destruction, Hep/HIV/ParvoV)
3.Cancer (Leukemia, Myelofibrosis)

4.Hypersplenism
5.Anaemia (Fanconi, Aplastic)
6.Diet

[Fanconi: reduced absorption of substances in kidney so they leave body
Aplastic: Bone marrow doesn’t makes adequate RBC
Leukemia: Blood CA with increased WBC production
Myelofibrosis: Bone marrow CA with scarring]

1.Decreased production:
Hereditary (Fanconi anaemia)
Post viral (Parvovirus B19, HIV, Hepatitis)
Drugs
Leukaemia
Aplastic anaemia

2.Increased destruction:
Hypersplenism
Myelofibrosis (Bone marrow CA)
Infections

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31
Q

Pain in lower back DDs

A

2(SO) A 2(P DIM F) -C
Sciatica
Spinal Stenosis

Osteoporosis
OA

Ankylosing Spondylitis

Paget
PMR (C&C Shoulder)

Discopathy
Disc Prolapse

Infection: EPIDURAL ABSCESS, SA/ OM

Malignancy (Multiple Myeloma, Prostate CA)
Mechanical back pain

Fracture
Fibromyalgia

Cauda Equina Syndrome

MCS+4Image+2P+3CA

MCS:
1.Mechanical back pain
2.Cauda equina
3.Sciatica (L5-S1 Radiculopathy)

[Imaging findings:(4)
5.Fracture of vertebral body
6.Spinal canal stenosis
7.Ankylosing spondylitis
8.Abscess

8.PMR
9.Paget‘s disease

10.Multiple myeloma
11.Prostate cancer
12.Malignancy]

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32
Q

Weight gain DDs

A

G L 3E AMPS
1.Genetic cause
2.Life style (junk food, sedentary)

Endocrine:
3.Diabetes (Both T1 & 2 are associated with health complications that can lead to weight gain.)
4.Thyroid-Hypothyroidism
5.Cushing‘s syndrome

6.Alcohol

7.Medication (3)- Quetiapine(antipsy),
Lithium,
Steroid

  1. PCOS (in female)

9.Smoking CESSATION

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33
Q

Miscarriage causes

A

CII SEE U
Chromosomal abnormalities
Immune and blood clotting problems(3):
APAS, SLE, Thrombophilia
Infections(3): TORCH, STI, Hepatitis B&C

SAD
Endocrine: thyroid & DM
Epidemiological: advanced age, prev H

Uterine abnormalities

AE2IU-C
Advanced age
Endocrine: DM, Thy

Infec:(3):
TORCH
STI
Hepatitis B&C

Inflammation:3
SLE
APAS
Thrombophilia

Uterine & CERVICAL abnormalities
Chromosomal abnormalities

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34
Q

Causes of Vit B12 deficiency

A

Intake/Nutritional deficiency:
1.Poor intake of meats and dairy products in the elderly
population (aged 65 and above)
2.Strict vegan diets
3. Alcoholism

Increased requirement:
4.Pregnancy and lactation

Absorption:
5.Autoantibodies against the intrinsic factor (pernicious
anemia) deficiency
6.Impaired absorption
7.Atrophic gastritis
8.Gastrectomy

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35
Q

Slow school performance DDs

A

HI 3T GO 4A P
1.Hearing and vision
2. Infections
3. Trauma
4.Temper tantrum
5.Tourette

6.Gender dysphoria
7.ODD

8.Absence seizures
9. Anemia
10.Autism Spectrum Disorder
11.ADHD

12.Psychological/Stress

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36
Q

Hoarseness DDs

A

VIA- TC- 2S
1. Vocal abuse- Occupation
2. Infection
3. Asthma

4.Thyroid
5.Cancer
6.Stroke
7. Surgery

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37
Q

Scrotal swelling DDs

A

3H 2E LV CT
Hydrocele
Hernia
Hematocele

Epididimo orchitis
Epididymal cyst

Lipoma
Varicocele

CA
Trauma

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38
Q

Foot pain DDs

A

BY SITE:
Plantar:(5)
1. Plantar fascitis
2. Heel spur
3.Heel pad syndrome
4. Nerve entrapment
5.Calcaneal stress fracture

Posterior:
1.Achilles tendinopathy

Midfoot (medial)(4)
1.Posterior tibialis tendinopathy
2.Flexor digitorum longus tendinopathy
3.Flexor hallucis longus tendinopathy
4.Tarsal tunnel syndrome

Midfoot (lateral)(2)
1.Peroneal tendinopathy
2.Sinus tarsi syndrome

3PANTS 2F2HC=12
Plantar Fascitis
Posterior tibialis tendinopathy
Peroneal tendinopathy

Achilles tendinopathy
Nerve entrapment
Tarsal tunnel syndrome
Sinus tarsi syndrome

Flexor digitorum longus tendinopathy
Flexor hallucis longus tendinopathy

Heel spur
Heel pad syndrome

Calcaneal stress fracture

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39
Q

Encephalitis DDx

A

VBT HAD HT
—Meningitis:
Viral
Bacterial
TB

Hemorrhage
Abscess
Drug overdose

Hypoglycemia
Tumor (coz Trauma same as hemorrhage)

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40
Q

Fever, Rash, Splenomegaly Ddx
&
Investigations

A

2HES CT MMRV ID

–Caused by sexual contact:(2HES):
HIV, Hep, EBV, Syphilis(congenital),

–Splenomegaly+Rash:(CT)
CMV, TOXO

–Rash Ddx:(MMRV ID)
MMRV
Dengue
ITP

Inv:-
1.FBE, UEC, ESR/CRP, LFTs,
2.Urine MCS,
3.HIV serology.
-CD4 count as a baseline,
-ELISA antibody testing.
Take consent after Pre-test counselling for HIV.
4.Hepatitis A,B&C,
5.Monospot test for EBV (Epstein-Barr serology)
6.Syphilis If indicated
7.Urethral and anal swab for culture.

8.TORCH serology
(nothing for MMRV, ID)

Review: For HIV:-If negative -repeat in 6w -3m

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41
Q

hiatal hernia:
Hx, Dx
Barrettes Sx

A

Heartburn Qs:
how long? Did you taste sour or bitter taste in your mouth?
(Any water brash?), did you try anything? How often did it happen? Are you having your meals regularly? Relates to any food or drinks?
Anything make it better or worse?

Associated symptoms
-Pain – epigastrium, Vomiting? Any blood in
vomiting? Any blood color stool? Any weight changes? Loss of appetite?
Any problem with swallowing of food?

Cause Qs:
1.Chronic cough
2.Constipation
3.Heavy weight lifting, exercise

4.BMI
5.Diet- coffee, spicy food
6-Smoking
7.Aspirin

8.Advance age

9.Prev surgeries/injury
10.Congenital

Cond:
– draw a picture,
it is when part of your stomach bulges up into your chest through an opening in your diaphragm, the muscle that separates the two areas.
The opening is called the hiatus.
But we don’t see any ulcerations, no Barret’s oesophagus which is the cell changes in lower part of the gullet due to reflux and
no H.pylori infection which is a bug causing ulcers in food bag. So this is good thing.
Normally, that hiatus is just a small opening just wide enough for your food pipe to pass through. Causes>becomes wide

Sx of Barretts (not Hiatal Hernia):
Frequent heartburn
Difficulty swallowing food
Chest pain (less common

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42
Q

Anxiety Ddx

A

GOLD 4PTAS
GAD
OCD
Lifestyle stress
Depression

Pheochromocytoma
Panic attack/disorder
PTSD: Acute, chronic, delayed.
Phobias

Thyroid
Adjustment syn?
Social anxiety

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43
Q

Urinary retention in female & male DDs

A

FORMAT:
4B&B
2P (Polyp, Prolapse),
MF (M, F causes)
STI,
CA & Trauma
PM/SHx,
Meds

GENERAL DDx:
1.Polyp
2.STI eg.HSV
3.Pelvic organ prolapse- Cystocele, rectocele

Bladder Outlet obstruction:
4.UTI(severe)
5.Stone: (KUB) Kidney, Ureter, Bladder
6.Stricture/scar tissue at bladder neck,
7.Malignancy of genitourinary tract

8.Constipation, Faecal impaction

10.Medications (anticholinergics, antipsychotics)
11.Medical conditions:- stroke/MS.
12.Pelvic surgery eg Hernia
13.Trauma

14.Tight pelvic floor muscle

MALE causes:(3):Prostate
1.BPH
2.Prostatitis
3.Prostate cancer

FEMALE(3)
1.Pregnancy
2.Fibroid
3.Ovarian CA

44
Q

Leg pain and swelling Ddx

A

LAT-VANS(NI2CE)
Lymph
Arthritis
Trauma

Vein: DVT
Artery: PVD
Nerves: neuropathic pain/lumbar radiculopathy

Skin:NI2CE:

Necrotizing Fascitis
Insect bite
Contact Dermatitis
Cellulitis
Erythema Multiforme (infec, Bull’s Eye)

45
Q

Jerky movement Ddx
OR
Epilepsy-like Conversion disorder DDs

A

(2E+2S+M+2T)+2(Electrolyte&Alc)+5CNS+2(Liv,Thy)+4F(CVS,HypoT,VV,Preg)+2Psy=22

1.Another episode of epilepsy attack
2.Side effects of anti-epileptics as extra pyramidal SE

3.Simple focal seizure
4.Myoclonic seizures

5.Conversion disorder (different from factitious: sympathy)
6.Malingering

7.Benign essential tremors
8.Intentional tremors

9.Electrolyte imbalance
10.Alcohol withdrawal (Delirium Tremens)

CNS:(5)
11.Infections
12.ICSOL
13.Stroke
14.Tumour
15.Trauma

16.Thyroid problems
17.Liver problems

Fainting Ddx?(4)
18.CVS-(MI, Arrhythmia, AS, HOCM)
19.Postural hypotension
20.Vasovagal syncope
21.Pregnancy (coz: weakness?)

22.Panic attack
23.Any anxiety disorder

46
Q

Puffy face child DDs

A

Local:
1.Allergy- NSAIDs
2.Insect Bite
3.Cellulitis

4.Trauma
5.Child abuse
6.Malnutrition

Systemic:
7.Kidney problem
8.Heart problem
9.Liver failure

10.Hypothyroidism
Cushing?

47
Q

Erectile dysfunction Causes & Mx

A

PTI -H 3E 2C- 5M 4(D) 2S:

1.Psychogenic- stress
2.Trauma
3.Infections- Mumps

4.Heart- BP
5.PVD

Endocrine (3)
6.DM
7.Thyroid
8.Prolactinoma

CNS (2)
9.Stroke
10.MS

11&12.PM/SHx:-
-previous surgery/Prostatectomy
-Radiation/ EBR (External Beam Radiation)

-previous history of :
Kidney disease
Heart disease, HF,
Uncontrolled Bp/ BSL,
Lipid/cholesterol level
Stroke
Spinal cord lesion

13.(9=5+4): Medications + SADMA

Meds:(5)
Beta-blocker
Thiazide
H2 Antagonist
antiDepressant,
antiPsychotic

SAD:(4)
Smoking
Alcohol
Cocaine
Marijuana

Ix:
1)FBC, UEC, LFT
2)Lipid profile
3)HBA1c/FBS

4)TFT
5)Prolactin level

6)FSH, LH
7)Testosterone

8)ECG (imp b4 Sildenafil?)
9)Penile Tumescence Test (3-5 spontaneous is N)

Mx:(9)
1)Psychologist
2)Family therapy
3)Relaxation techniques

4)Address and Modify RFx
a.LSM
b.DM
c.BP- Stop BB, Cardiologist

5)Meds: Sildenafil
SE-Side effects: (6)(F3H-NP)
a.flushed skin
b.hypotension
c.headache
d.heartburn
e.nasal congestion
f.priapism
*CI (3): Angina, IHD, Nitroglycerin

6)Penile injection: Papaverine, Phentolamine, Prostaglandin E1: Alprostadil
7)Pump A vacuum
8)ITestosterone, taking this hormone will help if LOW
9)Surgery: Penis Implant /Prosthesis (last resort)

48
Q

CF with Decline in school performance & growth chart Ddx

A

TRAM HAD 2I3C:
1Thyroid
2.Reduced intake/increased exercise
3.Anorexia
4.Malnutrition

5.Hypopituiatrism
6.Anemia
7.Depression

8.Infection
9.IBD
10.Celiac
11.Cystic Fibrosis
12.CA

49
Q

Men Breast enlargement bilaterally DDs

A

13=
1.Normal change in puberty and obesity
2.True & Pseudo-gynecomastia

3.Chronic Liver insufficiency

Endo(3)
4.Thyroid
5.Cushing’s
6.Prolactinoma

7.Medications:(3) Steroids, Spirinolactone(Diuretic), Ramipril(ACEI)

8.Breast cyst
9.Cancer:(3) Breast, Testicular, Adrenal

50
Q

PROM causes & complications

A

2+1+1+2=6
Anything that over distends the uterus:(2)
1.Polyhydramnios
2.Multiple pregnancy

3.Cervical incompetence

4.Maternal infections

Maternal conditions :(2)
5.GDM
6.Pre-Eclampsia.

Complication-(2) CC
1.Infection (Chorioamnionitis)
2.Cord prolapse

51
Q

Diarrhoea/ Sewage DDs

A

HE2G 2C2T LESS
1.Hepatitis A/E
2.Escherichia coli Diarrhea
3.Gastroenteritis
4.Giardiasis

5.Campylobacteriosis
6.Cryptosporidiosis
7.Typhoid Fever/ Paratyphoid

8.Leptospirosis
9.Encephalitis
10.Salmonellosis
11.Shigellosis

52
Q

Dyspareunia DDs

A

4V 3C 5U- 1O 1B
[VCU-OB]

Superficial penetration(4)
1)Vulv-itis
2)Atrophic vaginitis
3)Vaginal infection
4)Vagin-ismus: (psychosocial problem, vagina spasms. Can’t ask in hx. On exam on touching vagina will spasm.)

Deep penetration-
CERVIX:
1)Cervic-itis
2)Cervical Ectropion: (Sx: excessive mucosal discharge)
3)Cervical CA

UTERUS:(5)
Endometriosis
PID
Fibroid
Endometrial CA
Displaced IUCD

Ovarian Cyst

BLADDER: Cystitis

VAGINISMUS:
DDx:
Dyspareunia
Psychological (e.g. performance anxiety)

Mx:
Diagnosis confirmed if vaginal muscles contract involuntarily with pelvic exam

Gradual vaginal dilators
Physical therapy to relax the tight muscles
Counseling

53
Q

fever + rash peds cluster
Blanchable cluster
Non-blanchable cluster

A

(MMRV DR HIKE-2S
HIMAL V)

MMRV DR HIKES:
MENINGOCOCCAL MENINGITIS
Measles
Rubella
Varicella

Drug reaction
Roseola infantum

*HFM (Hand Foot Mouth)
Infectious Mononucleosis
Kawasaki
ERYTHEMA INFECTIOSUM
Scarlet fever
Septicemia

non-Blanchable: HIMAL-V (HER)
*HSP
ITP
Meningococcemia
Allergic rash
Leukemia
Viral:(HER) Hemophilus influenza, EBV, Rubella

SKERV(MMV)-A: Blanchable
Scarlet
Kawasaki
Erythema Infectiousum
Roseola Infantum

3)Virus: (MMV:) Measles, Mumps, Varicella
Allergic Rash

54
Q

Peds jaundice:
Hx
Ddx: conjugated vs unconjugated

A

Hx structure:

1)BEFORE: AR+TORCH
: ABO, RH, maternal fever: immunization & meds

2)DURING:
Trauma: cephalohematoma

3)AFTER: P+2H+2B+3L+2F+S
a)Physiological
b)Heel-prick: Galactosemia(cataract), Hypothyroidism

c)Feeding: Breastfeed & Breastmilk (after 14 D)

d)Liver(obstructive jaundice): (3)
Neonatal Hepatitis
Biliary atresia
Choledochal cyst

e)FHx: G6PD def, Hereditary Spherocytosis, blood dyscrasia

f)Sepsis

UNCONJUGATED: (8)
1.Physio
2.ABO,
3.Rh

4.TORCH
5.Breast milk
6.Breast feeding

7.Herediary Spherocytosis
8.G6PD def.

CONJUGATED:(6):ie 2Heel-prick + 3Liver + SEPSIS
1.Galactosemia
2.Hypothyroidism

3.Neonatal Hepatitis
4.Choledochal Cyst
5.Biliary Atresia

6.Sepsis

55
Q

Peds: Sore throat Ddx

A

6+5(-itis)=11
VC-ESKA-TQPLA:
1.Viral URTI
2.Covid 19

3.EBV
4.Scarlet fever
5.Kawasaki disease

6.Allergy

-ITIS(5):
1.Tonsillitis
2.Quinsy
3.Pharyngitis
4.Laryngitis
5.Allergic rhinitis

56
Q

Peds Developmental:
PEx
Ddx

A

4Birth, 4 CNS,
+ 3: Child Abuse, Metabolic, GDD, Familial delay =12

Genetic or hereditary:(4)
1)Downs syndrome
2)Cerebral palsy (Hyertonia(spastic), Athetoid(hypotonic)Dx after 2Yrs
3)Spina bifida

4)Congenital hypothyroidism
Sx: 4 (Lethargy, Hoarse cry, Feeding problems, Constipation)
PEx:6 (GA(2): dry skin, prolonged Jaundice,
V=Hypothermia,
Macroglossia,
Umbilical hernia,
Hypotonia)

 CNS:(4)
Trauma
Tumor
Infections
Epilepsy

Child abuse
 Metabolic disease
 GDD: (Global Developmental Delay)
Familial Delay

57
Q

Peds:
Lack of Weight Gain/
concern about wt & nutrition Ddx

A

2Q D2A6IG: GLEAMBIC
GLEAM (med cond) B(breast infec) I(infec:BB) C(Cleft l&p)
(Intake, Quality, Quantity, Deformity, Absorption, Increased Usage, Genetic)

INTAKE:
QUALITY: junk, no solid food

QUANTITY: Inadequate(malnutrition/neglect), Breast feed (supply, infec)

DEFORMITY: Cleft lip or Palate

ABSORPTION: Celiac, Cystic fibrosis

INCREASED USAGE: (6 in 3 Categ)
Infection:(B&B) diarrhea, UTI
Endo: DM, hyperthyroidism
Chronic illness: (CVS &Resp) Chronic respiratory, CHD (congenital heart disease)

Genetic

58
Q

Peds: Acute Abdominal Pain

A

GUTS ATE M-2H:
GE
UTI
Testicular Torsion
Strangulated Hernia

Appendicitis
Trauma
Encopresis

Mesenteric Adenitis (swollen LN in tummy, better wt/out Tx, common<16Yrs)
HSP (Henoch Schonlein Purpura
HUS (Hemolytic Uremic Syndrome)

[Deserves acute tummy pain after eating my house)

59
Q

Peds Groin Pain Ddx

A

T-testicular torsion
R-renal stone
U-UTI
S-strangulated hernia
T-trauma
A-Appendicitis
E-Epididymo-orchitis
I-Intestinal obstruction

60
Q

Peds: D/D of chronic abdominal pain:

A

4C3IL
4C: digestion rel & Psy:
Cows milk
Celiac
Constipation
Childhood Migraine, Non-Specific pain

3 I: IBS, IBD, Intestinal(parasites)

L: Lactose intolerance

61
Q

Peds Acute Diarrhea DDs

A

HIIFAT:
HUS
Infections: Meningitis, OM, Pneumonia, UTI, AGE,
Intussusception
Food allergy
Travel

(C&C vomit and acute Diarrhea: all infec)

62
Q

Peds Chronic Diarrhea Ddx, Ix
Not gaining weight + Anemia

A

3C-3IL GF2T (Girl Friend: Giardiasis, Food Allergy):
1.Cow Milk Protein Allergy
2.Cystic Fibrosis
3.Celiac

4.IBD
5.IBS
6.Intestinal Parasite

7.Lactose Intolerance

8.Giardiasis
9.Food Allergy

10.Toddlers Diarrhea
11.Travel

Investigations: (6)
FBE, ESR/CRP,UEC
Stool microscopy and culture + for Reducing Sugar (lactose intolerance)
Celiac disease serology if all other Ix normal

(C&C Galactosemia: Reducing substance)

63
Q

Peds limping:
Ddx,
5: Mx

A

HOST LMNOP C
H-3O-2S-2T
HSP
OM, OA, JRA
SA, SCFE
Trauma, TTN

Ligament inj,
Malignancy
Neonatal: DDH
Os-good Schlatter
Perthes

Child abuse

PERTHES:
PEx: +Roll test: rotation invokes Guarding or Spasm, esp. with Internal Rotation.
Mx:
Inv: Xray, CT/MRI/Bone scan
Perthes: Orthopedic support for 2Yrs,
Physio: strengthen Thigh muscles
Complications: (2)
1.OA
2.shortening of leg/permanent deformity and disfigurement

Irritable hip: Aspiration for infection.
Ix: FBE/ ESR/ X-ray or USG: Hip joint.
 Once infection is R/O: Mx.-Painkillers, Rest, Crutches
Repeat X ray in 4-6 weeks: To R/O Perthe’s

OM/Septic arthritis:
Ix: FBC, ESR/CRP, Blood Culture
Aspiration of joint
IV Antibx until improvement fol/by Oral 3-6 Weeks
May need Plaster, traction or Splint (immobilization)
Joint wash out to drain infection (if req)

HSP:
Ix: FBC, ESR/CRP, Urine Analysis
Monitor urine for Output & proteins (:May req Steroids).
F/U for 6 Months to monitor Kidney involvement

SCFE:
Inv:
some x rays (AP and frog lateral
Pelvis X Rays of both hips )
Mx:
-shouldn’t bear weight and be on strict bed rest.
-urgent referral to the
Orthopedic specialist to review his
condition.
-Crutches if needed.
-The specialist might consider surgery to prevent further slipping and can do Pinning to Stabilize the bone and almost all cases require Surgery
-Advise him to lose Weight in the future. This may help in Preventing recurrence.

The outcome is usually good with treatment.
I will be in contact with
the specialist and follow him up in the future.

Complications:(3)
1.OA
2.Recurrence
3.Avascular necrosis
(C&C Hip pain Ddx: Avascular necrosis)

64
Q

Peds Chronic Cough Ddx +Triggers+ FHx

A

PAPPA-GCC-FISH:

POST VIRAL COUGH
ASTHMA
PERTUSSIS
PSYCHOGENIC COUGH
ALLERGIC RHINITIS

GERD
CONGENITAL HEART DISEASE
CYSTIC FIBROSIS

Foreign body
Irritant-induced: like parental smoking
Sinusitis
Habit cough/Tics

FHx: (HEAA-HC)
Hay fever, eczema, asthma, allergy
Heart disease, Cystic fibrosis

Asthma triggers: 2C2PDS+EU:
carpet, cold air
pet, pollen
dust
smoke
exercise
URTI

65
Q

Peds Ddx of Acute SOB:

A

3A2B3C2D EFU 3P:

Asthma, Anaphylaxis/Angioedema

BRONCHIOLITIS
Bacterial Tracheitis(toxic child wt high fever, bacterial, steeple)

CROUP
CHF (Congestive heart failure)
Covid-19

Developmental abn: a)laryngomalacia: Birth defect of larynx causing inspiratory stridor
b)vascular ring

EPIGLOTTITIS
Foreign body
URTI

PNEUMONIA
PERITONSILLAR ABSCESS/Quinsy
Panic attack

66
Q

Chronic Nasal Discharge DDs & PEx

A

RARE-FNC:

1.Recurrent viral infection/URTI
2.Allergic Rhinitis
3.Rhino Sinusitis
4.Enlarged Adenoid

5.FB
6.Nasal Polyp
7.CF

PEx:
GA : active /irritable/ drowsy?
Any Adenoid Facies? Any Mouth-breathing?
PICKLED

Vitals and GC !

ENT:
-EAR :
any Discharge from the ear? Any Tympanic membrane changes?

-Nose:
Any nasal crease? Is the nasal Mucosa pale and Congested? Boggy in appearance?

Any Polyp, FB or Ulcers?
Any Hypertrophy of Nasal Turbinate?

-Throat:
Any bad ODOR from the Mouth?
Any throat Congestion or exudate?
Any Tonsillar or Adenoid Hypertrophy?
Mallampati score 1-4

Finish off wt: Respiratory & CVS.

67
Q

Differential Diagnoses of DUB, 3 Layers of womb

A

3PIES FAT B
PID
PCOS
POLYP

IUCD (Intra-Uterine Contraceptive Device)

Endometriosis
* Endometrial Hyperplasia (Cystic or Complex)

Submucous Myoma
* Fibroids/ Leiomyoma (Uterine Myomata)

  • Diffuse adenomyosis (is characterized by endometrial tissue scattered diffusely within the myometrium.)
  • Complex adenomatous hyperplasia

OTHER:
* Chronic PID
* Blood dyscrasia
* Hypothyroidism
* Neoplasia (imp)

(Three layers of uterus:
endometrium
myometrium
perimetrium: also k/n as serosa)

68
Q

Green stool DDs

A

DIIMS:
1.Diet: Green leafy diet like grape, grape juice and spinach

2.Infection: diarrhea like salmonella, E. Coli
3.immune: IBS diarrhea

4.Med: Antibiotic use
5.Surg: Removal of Gall bladder (recent)

69
Q

Ddx of Painful Swelling and discharge near tailbone

A

3PAR2T3S WH

1.Pilonidal abscess/cyst/sinus (one opening)
2.Perianal abscess
3.Perianal fistula (small tunnel)

4.Anal fissure
5.Rectal prolapse

6.Tumor (Sacrococcygeal Teratoma?)
7.Trauma

8.Sebaceous cyst
9.Skin tag
10.Syphilis Chancre

11.Warts (Genital)
12.HSV ulcer

70
Q

SOL DDs
incl mets in brain

A

1.PRIMARY Tumour
2.METASTASIS:
a.Head
b.Neck
c.Melanoma
d.Lung
e.Breast
f.Genitourinary

3.Glioma

4.ABSCESS:

a.OM
b.Sinusitis

c.HIV (C&C AIDS in ABI)
d.immune deficiency state
e.Toxo (ring enhancing lesion)

5.Haematoma
Subdural, Epidural
6.Intracranial Bleed

71
Q

Mania criteria

A

O-DIGFAST
Disinhibition/Distractibility
Increased Energy
Grandiosity

Flight of Ideas
Agitation
Sex/Sleep- deceased
Talkativeness

Over-Sexual
Over-Spending/ Gambling
Over-Speeding

??Mania: min. 7D, Delusions/ Hallucinations, Bipolar 1
Hypomania: min. 4D, no Delusions, no Hallucinations, Bipolar 2

72
Q

History of breast cancer
+
neck pain
+
unusual sensation in her hands

DDs and Inv

A

2C3AS2T LMN
1.Cervical Spondylosis
2.Cervical Disc prolapse
3.AS,RA,OA

4.Stroke
5.Trauma

6.Tumor: Pancoast
7.Metastasis

8.Lymphedema
9.Nerve damage because of
radiation

Inv:-
1.FBC, LFT, RFT
2.Tumor markers
3.Mammogram if breast
tissue present
4.Imaging X-ray and MRI of the spine
5.CXR
6.PET scan

73
Q

1)Pain and swelling of the right first metatarsophalangeal joint

2)Ankle pain + gardening Hx

A

JOINT PATHO: 4
1.Gout
2.Pseudogout
3.Septic arthritis, OA/RA

LOCAL CAUSES: 4
4.Trauma
5.Stress fracture

6.Cellulitis
7.Insect bite

DEFORMITIES: 2
8.Hallux valgus bunion
9.Ingrown toe nail

74
Q

Gout Risk factors

A

MEDs:
1.Atenolol
2.Thiazides
3.Aspirin (High dose)

DIET:
4.Purine containing foods like fish and meat

5-10: ABCDF
Frequently associated with: ABCDF
Alcohol
BP,BMI (high)
Cholesterol (high)
DM, Diet (purine)
FHx

75
Q

Groin Pain after Total Hip Replacement DDs, Complications

A

Ddx: L-H-2(INT)

Loosening of hip implant

Hernia- Inguinal

Infection- cellulitis, sepsis
Inflammation- OA,SA,Osteomyelitis

Nerve- low back nerve irritation
Necrosis- avascular necrosis

Tendons- iliopsoas tendinitis, adductor tendinitis
Trauma- pelvic fracture

Complications: HIS PM
-Hip Dislocations
-Increased incidence in Falls.
-Stroke

-Pseudotumor
-Metal toxicity due to wear particles

76
Q

Reflux,
Bloating and
increased Weight,
Constipation

DDs ,
Sx, PEFE, Mx

A

5(UGIT)+2(Uterine)+2(Cyst)+3(CA)+D

UGIT:(5)
1.Cholecystitis
2.Hepatitis
3.Cirrhosis (liver)

4.Gastritis
5.PUD

FEMALE CAUSES:(2)
Uterine:
-Fibroid
-Endometriosis

OVARIAN
Cysts:(2)
Ovarian cyst
Functional ovarian cyst
CA:(3)
-Benign ovarian tumor
-Primary ovarian cancer
-Metastasis

-Drug Induced

Signs and symptoms of ovarian cancer may include:(8)

Abdominal bloating or swelling.
Discomfort in the pelvic area.
Back pain.

Weight loss.
Early satiety.
Fatigue.

B&B:
Changes in Bowel habits, such as constipation.
A frequent need to urinate

PEFE:-
1.Shifting dullness

2.Adnexal mass on lower abdomen, non tender
3.orange shaped mass
pushing the uterus from behind

4.PR exam: Mass in pouch of Douglas

Inv:-
FBC, UEC, CRP
LFT, RFT

TFT
CA 125
TVS

CT Abd
PET scan
Genetic testing (BRCA1,2 & Lynch/HNPCC)

Mx:-
3.MDT
4.Surgery
5.Chemo/Radio

77
Q

Iron deficiency anaemia causes/dds

A

5: Intake, Absorption, Increased Req., GI/non-GI Blood loss

Decreased Iron Intake:
1.Low socioeconomic status, 2.Vegetarian or vegan diets,
3.Lack of balanced diet
4.Poor oral intake

Diminished Iron Absorption: (med, medical, surgical)
-Malabsorption
1.Medications that decrease gastric
acidity or bind iron

2.Coeliac disease
3.Chronic Gastritis
4.Chronic Renal failure
(Healthy kidneys produce a hormone called erythropoietin or EPO, which stimulates the bone marrow to make red blood cells needed to carry oxygen (O2) throughout the body)

5.Gastrectomy
6.Intestinal bypass

Increased Iron Requirement: (child, mum)
1.Growth (infants, children, adolescents),
2.Pregnancy, Lactation, Multiparity

Gastrointestinal blood loss:
1.Medication related (e.g. aspirin, NSAIDs)
2.Malignancy e.g. colon, PUD
3.Infection: Parasites

4.Angiodysplasia (: a small vascular malformation of the gut. It is a common cause of otherwise unexplained GIT bleeding and anemia.
Lesions are often multiple, and
Frequently involve the cecum or ascending colon, although they can occur at other places)

Non-Gastrointestinal blood loss:
1.Menorrhagia

2.Iatrogenic:
a-repeated Phlebotomy,
b-Post op patients with significant blood loss,

c-Haematuria,
d-intravascular Haemolysis
e-extreme physical Exercise

(C&C Absorption prob: Vit B12, CF, lack of Wt gain)

78
Q

GAD criteria

A

I CAN’T REST (TESTIN-C)

T- TIME 6 months
E- ENERGY decreased
S- SLEEP impaired
T- TENSION in muscles
I- irritability, A- anxiety, nervousness, worry R- restless
N- NO control over worry

C- CONCENTRATION impaired

79
Q

Tracheo-oesphageal fistula
Hx
Dx

A

Most common type C
VACTERL
vertebral defects(defects in backbone?)
anal atresia (passed meconium?),
cardiac defects,
tracheo esophageal fistula,
renal anomalies,
limb abnormalities (any limb anomalies?)

VACTERL should be 3 of them positive

COMPLICATIONS
Choking
Aspiration pneumonia

Post-Operative:
Reflux
Esophageal Stricture

Vomiting Hx Qs:
tell more about it,
when start,
CCVO

Forceful/not,
related to feed/food

DDx: VJDHE2MS
Obstruction due to hernia/lump or bump in tummy
Infection: fever, rash?
TE fistula:
cough? Turning blue while feeding? (aspiration)

Well-Baby:
general condition? Floppy? Appetite? Pee and poo?
BINDS
BEFORE: Any sickness/med/complication during pregnancy
DURING: AT TERM?
AFTER: PASS STOOL YET/DELAYED PASSAGE/RESUS REQUIRED/

80
Q

Febrile convulsion:
DDs
Dx and Mx

A

FAB 2H3C
Febrile convulsion
Absence seizure
Breath holding attack

Hypoxia
Hypo/Hyperglycemia

SOL/Tumour
Trauma
Epilepsy

Commonality:
1 in 25

Cause & Association:
high temp,
absence of disease in brain, immature brain

Course:
4-6 yrs

Complication:
(recurrence)

Cure:self-limiting

Ix
BSL, C X-Ray,urine

Tx:
Panadol
tepid sponging
remove Tight clothing, sharp objects

Do not:
Restrain
Put anything in mouth.

Note the time.
Consult doc next day

Red flags :
Prolonged fits more than 5 mins

Focal neurological deficit after fits,
drowsy after fits, (Epilepsy)

high fever,
rash,
neck stiffness (Meningitis)

81
Q

Peds:
a.Headache
b.Causes of papilloedema

A

Common causes of Peds HA: SMA TEST
▪Sinusitis (most common in GP)
▪Migraine
▪Analgesic-induced headache

▪Toothache
▪Ear pain

▪Trauma
▪SOL

Causes of Papilledema: 3T3I 3BI(4)D
▪Brain Tumor
▪Spinal cord tumor

▪Trauma /head injury

▪Infection:
a.(Encephalitis, Meningitis)
b.Brain Abscess

▪Uncontrolled , life threatening high BP
▪Bleeding in brain
▪Blood clot or a problem within certain vein

▪IIH: Idiopathic intracranial hypertension
▪Drugs (Corticosteroid, isotretinoin, lithium, tetracycline)

82
Q

Ddx 1 day old infant vomit

A

VJ-DHE-2M-S
Volvulus: Volvulus occurs when a loop of intestine twists around itself and the mesentery that supplies it, causing a bowel obstruction.
Symptoms include abdominal distension, pain, vomiting, constipation, and bloody stools. The onset of symptoms may be insidious or sudden.
Jejunal obstruction (small bowel obstruction elsewhere

Duodenal Atresia (in Downs):Malrotation is a birth defect link that occurs when the intestines do not correctly or completely rotate into their normal final position during development. Treatment: nasogastric suction, surgery (duodenoduodenostomy)

Hirchsprung (in Downs): A condition of the large intestine (colon) that causes difficulty passing stool.
Hirschsprung’s disease involves missing nerve cells in the muscles of part or all of the large intestine (colon). Present at birth, it causes difficulty passing stool.
The main symptom is a newborn’s failure to have a bowel movement within 48 hours after birth. Other symptoms include a swollen stomach and vomiting.
Surgery is required to bypass the affected part of the colon or remove it entirely.

Esophageal Atresia/Tracho-esophageal fistula

Meconium ileus: Meconium ileus (pronounced meh-COE-nee-um ILL-ee-us) means that a baby’s first stool (feces), called meconium, is blocking the last part of the baby’s small intestine (ileum). This can happen when the meconium is thicker and stickier than normal.

Malrotation: Malrotation is a birth defect link that occurs when the intestines do not correctly or completely rotate into their normal final position during development.

Sepsis/Infection

-Malrotation: is an abnormality of the bowel, which happens while the baby is developing in the womb.
-Volvulus: is a complication of malrotation and occurs when the bowel twists so the blood supply to that part of the bowel is cut off.

83
Q

unprovoked fit Ddx and Mx

A

Differential diagnosis:

Unprovoked seizure
(Ddx: young: breath holding attacks, teen: Drug)

Provoked seizure causes are:
1.Trauma
2.Tumor
3.Infection

4.Electrolyte imbalance (Na, Ca)
5.Hypo or Hyperglycemia

6.Alcohol, Drugs, Medications, toxins

Cond:
most likely unprovoked seizure, which could be precipitated by many Factors like: (5)
sleep deprivation
hunger
stress

Infection
Bright flashing light.

Ix:
Blood tests (FBE, ESR, CRP) (UCE, LFT,
TFT,
BSL)
Urine MCS if UDT +
X-Ray chest
+/-CT decided by specialist
Drug screen with consent of parents.

Referred to Neurologist.
referred to 1st Seizure Clinic they might do EEG
General measures in case if happen again. Need to know what to do:
Do not allow him to Swim alone, no baths, no sea diving, Heights to prevent injury.
Stay away from fires.

84
Q

Bilateral leg swelling DDx, Mx

A

10=
CD AN2T F: HLK
FAILURES:
1.Heart
2.Liver
3.Kidney

Wt Loss Rel:
4.Thyroid problems (Pretibial myxedema)
5.Tumors in pelvis and tummy

6.Nutritional oedema,
7.Amlodipine induced edema,

8.DVT
9&10. Cellulitis and trauma unlikely

Most likely – heart failure – as the heart is not working properly, there is
increased fluid Congestion backwards in the vessels we call Veins,
Instead of moving forward, blood is congested in the Legs, and also other
Organs like lungs resulting in Swelling of the legs and Dyspnea.

85
Q

Peds: R forearm pain

A

(7 Trauma+3 Arthritis +Neuro)

FB- GP - SIN
1. Fracture
2. Buckle

3.Greenstick (leg?)
4. Pulled elbow

  1. Sprain (wrist)
  2. Infection
    a. SA
    b. OM
    c. Post Viral Arthritis

8.Neuro Lesion

4.Toddler fracture (leg?9M-3Y, walking boot)

86
Q

peds obesity Ddx, complications, Mx

A

GLEM (no A&S for Alcohol/smoking)
LSM: Diet & exercise & Screen time
Endo:
hypothyroidism
Cushing
Med: Steroid

COMPLICATIONS:

MEDICAL: 5
1.DM
2.Heart dx
3.Liver dx,
4.breathing problem
5.joint problems.

PSYCHOLOGICAL: 3
1.Low self-esteem
2.Bullying
3.Obesity in adulthood

Mx: Refer to Weight Mx Clinic
Healthy Diet
Use small Plates to make portion size looks bigger
Give home-made Lunch box.

Exercise:
* Increased physical activity (1-5 yrs – 3 hrs active play, > 5yrs – 1 hr)

  • Reduce screen time (<2 – 0, 2-5 years- 1 hr, 5-12 yrs – 2 hrs)
87
Q

Peds vaginal discharge + pain on passing urine

A

Differential Diagnosis : CUF TTV
*Child abuse
*UTI
*Foreign body
*Threadworms
*Trauma
*Vulvovaginitis

Risk factors: COSST DP
1. Cancer
2. obesity
3. soaps/bubble baths
4. swimming
5. tight clothing
6.DM
7.products-change in cosmetics- allergy

88
Q

Explanation of SBP
DDx for hepato-cellular damage

Alcoholic Hepatitis:
Hx,
PEFE,
Dx,
Mx

A

Spontaneous bacterial peritonitis:
can occur when bacteria that normally live in the intestine enter the abdominal cavity and the ascites becomes infected.
This happens in advanced liver disease
because the immune system response weakens and the bacterial environment in the gut changes

DDx:
1.Viral hepatitis (A,B,C,D,E)
2.Alcoholic hepatitis
3.Drug induced hepatitis (toxin, acetaminophen)

Other:- jaundice
4.Cirrhosis
5.Pancreatitis
6.Pancreatic cancer
7.Gall stones

8.Ischemic hepatitis
9.Autoimmune hepatitis
10.Budd-Chiari syndrome
11.HELLP ( hemolysis , elevated liver enzymes, low platelets) syndrome
12.Acute fatty liver of pregnancy
13.Wilson disease
14.Alpha -1 antitrypsin deficiency
15.Nonalcoholic fatty liver disease (steatohepatitis)

Hx:
fever? abdominal pain?
Jaundice questions (ABP FIT NO SEX)?
Swelling Qs: SOB? Leg swelling? Abdominal swelling?
R/O Hepatic encephalopathy: Confusion?
(Fever as?)Muscle or joint pain?

Tummy pain Qs: Bowel & bladder Qs
Wt changes? (LOW/LOA) (ascites, cachexia?)
TMAC
SADMA
Stress?

Physical Examination
General appearance: jaundice, dehydration, BMI
VS: stable
Skin: needle marks
ENT: sclera or under the tongue
Chest and Heart
Abdomen: mass, pulsations, liver span, tenderness, organomegaly
Leg edema?
Bruit over liver? (feature of severe alcoholic hepatitis)
decreased grip strength?

Investigations (AST>ALT alcoholic hepatitis rather than viral or
drug induced)

PEFE card: (+)Fever, (+)jaundice, (+) ascites (+) hepatomegaly
(+)parotid enlargement

Cx:-
Alcoholic hepatitis

Cause(2):
Heavy: binge drinking or long-term drinking

Commonality: 40-50yr

CFx:
RUQ pain+ jaundice+fever
hepatic encephalopathy
proximal muscle wasting

Mx:-
R/o other causes of fever if present:-
1.Spontaneous bacterial peritonitis
2.Pneumonia
3.UTI
4.Other hepatitis

Inv:-
1.Hepatitis serology
2.Septic screen
(C-Xray, UMCS, Blood culture)
3.LFTs (AST/ALT => 2 will be found)
4.Transabdominal USS with doppler
(Biliary obstruction or Budd Chiari syndrome)

High: serum bilirubin, serum GGT, neutrophils, INR

Low: albumin and pre albumin

Tx:-
Stop (OCP/ offending drug/)Alcohol
Paracentesis under USS guidance
(If fluid: antibiotics can be discontinued after 48 hours if ascitic fluid, Blood, and urine cultures demonstrate no bacterial growth and the ascitic fluid PMN count is <250/mm3(per cubic mm.)

89
Q

Oral Candidiasis Ddx, Mx

A

Ddx: CO-MAIL
 Celiac disease
 Oral thrush candida (NOTE wt O not C)

 Milk residue
 Antibiotics S/E
 Immune suppressive condition
 Lactose intolerance

Mx:

Investigation:
FBE, ESR CRP,
immunoglobulins IgA, IgG, IgM,
Swab of thrush MCS,
stool MCS,
celiac screening

Refer to pediatrician
Antifungal Miconazole gel for 10 days
Advice to wash nipples and sterilize objects in contact with thrush.

90
Q

Implications of Pertussis
Implications of Recurrent URTI

A

❑ Implication of Pertussis: CAPE DISH
▪ Cessation of respiration/ Apnoea
Atelectasis (collapse of lung or part of lung: lobe when tiny air sacs :alveoli lose air)
▪ Pneumonia
▪ Emphysema (permanent enlargement of lung air spaces)

▪ Dehydration
intracranial haem.
▪ Seizure, fits,
▪ Hypoxic encephalopathy

Implications of URTI: SOD SEL
Acute/Chronic Sinusitis
Otitis media
Dental prob Overbite) d/t mouth breathing

Sleep disturbance /Apnea
Excessive daytime fatigue/ poor school performance
Learning impairment.

91
Q

Facial Pain DDs

A

*Dental pathology
*Eye disorders
*EAR infection
*Nose: Rhinitis, sinusitis
*Mouth: Ulcer/ Cancer/ Tonsillitis
*TMJ dysfuction
*Erysipelas
*Herpes zoster
*Trigeminal neuralgia (tic douloureux
*Glossopharyngeal neuralgia
*Migrainous neuralgia (cluster
headache

Parotid gland: Infection
Temporal Arteritis
Chronic paroxysmal hemicrania
Cervical spinal dysfunction

92
Q

Depression Ddx

A

T2AME4D GL
Thyroid
Adjustment D
Anniversary Grief
Menopause
Empty Nest
Depression
Dysthymia
Dementia (early)
Drugs

Grief
Life stress: Sickness
Seasonal affective disorder

93
Q

Lymph nodes

A

CASE PI=LN
Cervical (includes submental, post auricular)
Axillary
Supraclavicular, Infraclavicular
Epitrochlear

Paraaortic
Inguinal

94
Q

Anal discharge ddx

A

Physical exam:
Scrotal exam then need to specifically ask for perineum and DRE:
a picture of a sinus at the
perineum will be given

Ddx: 3S2I3P HAC
Syphilic Chancre
STI (no skin tag)
Solitary rectal ulcer syn

Incontinence
Impaction

Perianal fistula
Pilinoidal cyst
Pilonidal sinus

HSV ulcer
Anal: Fistula (not fissure)
CA of margin

95
Q

Third trimester Abdominal Pain Ddx

A

Differential Diagnosis: 3P 2T M
 Preterm labor
False Labor/Braxton Hicks contractions
 Pre-Eclampsia
Placental Abruption

 Trauma

 TORSION of Ovarian Cyst

 MEDICATION causes:
UTI, Appendicitis, Cholecystitis, Pancreatitis

96
Q

shakiness of hand DDx Qs

A

BET
Parkinson
Drug induced: Risperidone

Thyroid
Liver
Lung: CO2 retention/COPD
Cerebellar disease

Post-stroke
Brain abscess
MS
Peripheral Neuropathy
(Q: RA)

Tea/coffee
Alcoholic withdrawal/ Delerium tremens

Anxiety disorders: GAD

97
Q

Ddx of Chest pain that’s:
Acute, 1st time, 1-2 H

A

Differential diagnosis for Chest pain:
-Cardiac MI
-Pulmonary embolism
-Aortic dissection
-Pericarditis
-Tension pneumothorax
-Esophageal rupture ( Boerhaave’s syndrome)

98
Q

Ankylosing Spondylitis extra intestinal features

A

AEOU:
Arthritis
Erythema Nodosum
Oral ulcers
Uveitis

99
Q

increased :Thirsty and urination Hx, Dx, Ddx

A

Causes of excessive thirst –
▪ Diabetes mellitus - Do you have those symptoms like tiredness? Extreme
hunger? Blurred vision? Slow healing wounds? Skin infections?
▪ Diabetes insipidus –Causes of diabetes insipidus - any head injury?
Previous surgery? Headache? Nausea? Vomiting? (brain tumor)
▪ Loss (dehydration) – any diarrhoea or excessive vomiting? Any profuse
sweating? Or strenuous exercises
▪ Loss of body fluids into tissue - Any history of recent infections with high
fever, heart, liver or kidney disease? Any recent injury or burn?
▪ Psychogenic – any mental illness before?
▪ Any medications you are taking? (lithium, diuretics and antipsychotics?)
Are you taking any supplements? (Vit D and calcium? )(key q)
▪ Do you eat a lot of spices or salty foods?
▪ Calcium or vit D intake + , symptoms of hypercalcemia – constipation?
Tummy pain? Headaches? Muscle cramps? Or weakness? Any disturbance in
thinking process?

Dx – There are many causes leading to this increased thirst but
most likely in your case is hypercalcemia which is the increased
calcium level in the blood as you have a history of excessive Vit
D/calcium intake. Too much calcium in the blood means that
kidneys have to work harder leading to increased urination and
excessive thirst.
▪ Other causes can be Diabetes mellitus which is increased blood
sugar, increased sweating, any heart, liver or kidney diseases,
Diabetes insipidus which is a abnormality levels of hormone called
ADH or spicy and salty foods but less likely according to your history.

DDx:
DM

Diabetes Insipidus: abnormality levels of hormone called ADH

Vit Ca/ D intake: Too much calcium in the blood means that
kidneys have to work harder leading to increased urination and excessive thirst.
(DM DI D(dehydration) injure&burn Mental Failure , medication, supplement, spicy alcohol

Spicy and salty foods but less likely according to your history.
Heart
Liver
Kidney

(

100
Q

Chest pain Ddx

A

16 IN 6 CATEGORIES =5+ 3+ [2X4]

CVS:
1.Angina
2.MI
3.Pericarditis
4.Aortic dissection
5.Aortic stenosis

LUNG:
1.Pneumonia
2.Pulmonary embolism
3.Pneumothorax

GIT:
1.GERD
2.PUD

MSK:
1.Costochondritis
2.Rib Fx

NEURO:
1.Prolapsed disc
2.Herpes Zoster

PSYCHOLOGICAL:
1.Anxiety rel.
2.Panic attack

ACUTE LIFE THREATENENING: 5
CVS:
Aortic Dissection
MI
Pericarditis

RESPIRATORY:
PneumoThorax
PE

NON-LIFE THREATENING: 8
CVS:
Heart Failure
Aortic stenosis

RESPIRATORY:
Pneumonia
Lung CA

MSK:
Shingles
Costochondritis

GI:
Biliary Colic
PUD

101
Q

Hx of SOB in child

A

HD
HOPC-SOB
Associated-FEVER(if +:neck stiffness, fits),RASH,VOMITING
COUGH(SOCRATES-onset,type,pattern,any relationship to feeding)
Does he turn blue/stops breathing for few secs?(Cyanosis/Apnea)
Wheeze (if +: at rest or with activity)
stridor(if +: while breathing in or out)
Any recent URTI?
Asthma: (Able to complete a sentence)
Epiglottitis-any drooling of saliva?Any particular posture that child prefers?
FB-Any choking episode? Anytime he is unsupervised?
WELL-B & B habit? Diarrhoea or reduction of wet nappies, LOW/LOA
TMAC(if + asthma Hx: 2CPDS-EU
BINDS-SMA=Social-any stress, Smoking
PMH/FHx of Allergies or Known heart or lung condition from birth?

102
Q

Hx of Hypercalcemia

A

Thyroid Qs:
Hypercalcemia Qs:
Abdominal groans: Hows bowel habit? Any abdominal pain?Any constipation or diarrhea? Any vomiting?
Stones: How is your waterworks? Any pain or difficulty passing urine? Any PMHx of stones?
Any bone pain?
How’s your mood? What about your sleep and appetite? Any tiredness?
Hypercalcemia cause Q: Do you feel thirsty? Drink enough water?
DDx:
Addisons:Dizziness? Discoloration?
Raynaud: Any bluish discoloration of hands on exposure to cold?
TMAC:
Any Hx of travel or contact with pets?
Malignancy: Any LOW/A? Any bone pain or muscle aches?
SADM(steroid, vit D)A
PMHx: Kidney stones? Amyloidosis, Histoplasmosis, Sarcoidosis
FHx of CA

103
Q

Contraindications of HRT

A

BC-CCL
Bleeding, Clotting
CA: BOU (breast, ovarian, uterine)
CVS: BMS: uncontrolled BP, MI, Stroke
Liver disease

104
Q

Asthma hospital severe asthma

A

SOAP IM
Salbutamol by MDI/inhaler
O2
Aminophylline
Prednisone oral/IV Methyprednisolone

Ipratropium

105
Q

Causes of not/ kicking in baby

A

PPO BCS-OIC MAT
Position of mom
Placental position
Obesity
Busy lifestyle
Coffee
Sleep

Oligohydramnios
IUGR
Congenital anomalies

Maternal infections
Anemia
Thyroid problems

Clinical (5 decks)

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