Clinchers: Rheumatology

A Gift to Dr. Swami and All the Students attending the course.
Clinchers
Rheumatology
Hot, painful, swollen joint +/- fever= septic arthritis= Ix: aspirtion = Rx: FLUCLOXACILIN
Young man, lower back pain = ankylosing apondylitis = Ix: x-ray sacroiliac joint
Polyarteritis nodusa necrotising vasculitis cause aneurysm / thrombitis of medium sized
arteries leads to infarct, Rx: Systemic Steroids, M>f, ass. With Hep-B
Arterial occlusion + HTN, Female = Takayasu arteritis (big vessel vasculitis),
Child = Kawasaki
A joint pain with ear pinna plaque = gout (raised uric acid level)
Pt. with progressive relapsing remitting arthritis = RA
Intermittent severe arthritis with symptoms free interval = Gout
Arthritis with pitted finger nail = psoriatic arthritis
Young man with lower back pain = ankylosing spondylitis
Lower back pain with paravertebral shadow = TB of vertebra
Elderly mand with lumbar back pain + enlarged vertebra = pagets
Septic arthritis Ix : joint aspiration ???
RA Ix : Rh factor
Reiters syndrome Ix : chlamydial IgA
Thiazide diuretics raises uric acid level = Gout
Arthritis following travelling history(india, spain, Thailand) usually Reiters synd
Schirmer test +ve in sjogren synd
Best Ix to Dx nerve compression = MRI
AS does not need any Ix as its Dx is clinical
Thanks to the anonymous Doctor who created it.
Thanks to Dr. Farhan, who provided us this gift.
Thanks to Dr. Sabri who helped typing it.
This document is liable to mistakes and modifications.
Thanks and Best of Luck.
Dr. Khurram Rasool
Page 1
Talengedtasia / Raynauds = Crest = Ix: Anti-centromial Ab

Female / pruiritis / raised Gamma GT = PBC = Ix: Anti-mitochondrail Ab
Rash on cheeks, photophobia = SLE = Ix: Anti-double Strand DNA Ab.
Pt. with thyroid with hashimoto = Anti-paroxy/thyroglobulin Ab
GCA Mx = Steroids
Diabetic retino pathy Mx = laser
HAEMATOLOGY
ITP initial Mx = Steroids
Very low ph with purura = ITP, Mx with predinsone, Ix: anti PLT antibody
Anemia with blood film showing target cells = thalassemia
Celiac disease will cause decreased folate anemia due to malabsorption
Rx with cyclophosphamide will cause aplastic anemia
Blood film showing immature cells = leukemia = confirm Dx by Bone Marrow Biopsy
Inherited anemia = pernicious (decreased vit-B12) + Haemophilia (coagulation defects)
HSP (Henoch Schonlein purpura) : abd pain, purpura on buttocks/thigh is allergic inflammation
of blood vessel wall.
DIC due to sepsis
Phenytoin / Methotrexate reduces Serum folate level
Thalassemia/sickle cell Ix = electrophoresis
Anemai with sore tongue = decreased Vit-B12
Anemia + bruising + infection = aplastic anemia (leukemias well)
Easy bleeds, all tests are normal with family history = osler weber rendu synd
Easy bleeds, prolonged clotting time with family history = von willi brands
Male, pale, anemic with paresthesia = pernicious anemia = Ix: Ab against intrinsic factor
Dr. Khurram Rasool
Page 2
Post. Cricoids web with decreased Fe anemia = plummer Vinson synd
Infectious
Children usually have viral meningitis, Ix: CSF MCS => PCR
TB = wt. loss, african, night sweat
Brucellosis = Hx of Farm work, visit to MECCA
Lyme = Hx of forest walk, insect/tic bite
Malaria by plasmodium falciparum severe intermittent fever, can cause cerebral malaria, Dx:
LP-CSF
I/V Acyclovir for varicella zoster = elderly, decreased immune, opthalmic
Orla acyclovir for varicella zoster = mild surgery + in pregnancy
For typical chicken pox = no management
Varicella Ig for high risk exosure on moderate compromise e.g pregnancy
Cellulitis caused by strep.pyogenes
Mucoid urethral discharge = chlamydia
Purulent urethral discharge = GC
Thick blood film confirms malaria
Hep-B Ag confirms active disease
Dye industry workers have increased risk of renal cell Ca.
MRSA found in ward = test all medical staff
MRSA +ve staff should be Rx with Mupurocin nasal spray
Staphylococcus is coagulase +ve cocci
Pneumococcus is gram +ve diplococcic
TB meningitis Ix = ????????
Meningitis after URTI = Strep
Dr. Khurram Rasool
Page 3
Syncope with sweating = hypoglycemia

Meningitis with rash Tx = Blood culture
Meningitis with raised ICP no LP
Infections in HIV patiens

HIV with diarrhoea = cryptosporidium
HIV with photophobia/meningitis = crytococcal
HIV with mouth ulcers = candidiasis
HIV with neuro symp, change in behaviour = toxoplasma Gondii
Hiv with Pneumonia = pneumocystits jerovici.
Respiratory
Pneumonia = Ix: CXR
Pulmonary embolism = Ix: (A )V/Q , Spiral CT, (B) plain angiogram
Pneumonia = erythmatous rash = target lesion = mycoplasma
CXR = pneumonia, pneumothorax (tension pneumothorax), Dx: clinical, Dont waste time on Ix go for
Mx.
V/Q = PE = spiral CT or best pumonary angiogram.
Spiral CT = PE = safe in preg.
PE = Raised PR, raised JVP, ECG: T decreased V1-3
Absent vascular markings on CXR = pneumothorax
Tall thin man with SOB = spontaneous pneumothorax
Travelers pneumonia is caused by legionella
Childhood asthmatic with family history will persist in adulthood
Childhood asthmatic without family history prognosis unknown
Dr. Khurram Rasool
Page 4
Infant SOB with failure to thrive = wt. below desired centile for height
FRS left in bronchus / lungs will develop into abscess
Pneumonia in COPD / CF = pseudomonas or H.influenza
Pneumonia in <1yr is bronchiolitis cause is viral
Mycoplasma Rx = erythromycin
Legionella Rx = erythromycin
Farmers + SOB = Extrinsic allergic alveolitis
OCCUPATIONAL HEALTH in respiratory system context

Coal miners = restrictive/obstructive lung disease, progressive fibrosis.
Allergic Rhinitis = Asthma, Churg straws synd
Farmer with chest condition = Extrinsic allergic alveolitis
CVS
ECG = chest pain, tacchyarrythmia = STEMI => SK , NSTEMI => B-Blocker
Echo = valve / septal . / murmur
Exercise ECG = Angina
Troponin I/ T = cardiac enzyme = MI
Heart failure= >55 yrs = give ACEI (also good in DM, C/I in RAS) = enalapril, verapamil.
<55yrs = B-Blocker
Black with any age = Ca+ channel blockers are best to use.
CCF with AF Mx is digoxin, without AF = amaiodarone
Post MI Mx = ACEI + B-Blocker + Statin + Asp?
IHD with CCF = Amiodarone
LVF following MI Rx with ACEI
Dr. Khurram Rasool
Page 5
Diabetic pt with HTN = Mx : ACEI

Tachycardiac pt not responding to meds = Mx: Dc
CCF pt. not getting better on furosemide = add thiazide
HOCM = Mx: B-Blocker
>55 or black 1st choice to Mx HTN = Ca++ channle Blocker (nifedipine) or thiazide
<55 = 1st choice to Mx HTN = ACEI (enalapril)
Give ARBs if pt. is intolerant to ACEI (e.g LOSARTAN)
If on C or D and still uncontrolled = add ACEI
If on A and not controlled = add C or D
Side Effects and C/I
ACEI : cough, Raised K+, RF C/I: renal or aortic stenosis

Ca++ Blocker: flushes, gum hyerlesia, fatigue, ankle oedema
Thiazide: decreased Na+,K+ level, postural hyotneiosn, impotence, C/I: Gout
B-Blocker: bronchospasm, CCF, cold periphries, lethargy, impotence C/I: Asthma
Mx of ventricular tachycardia = amiodarone
Mx of paroxysmal A.fib = flecanide or sotalol
Mx of HTN in pregnancy = methyldopa
Comlete heart block site = bundle of hiss
Open foramen ovale = interatrial septum
Cardiac aneurysm site = Lt. ventricle
Endocarditis in IDU site = tricuspid valve
Heart skipping beat = most probably ventricular ectopic
Young erson with tachycardia = most probably SVT
Dr. Khurram Rasool
Page 6
Old person with tachycardia = most probably VT

Severe brady cardia following MI = heart block
Athletes with slow PR = sinus brady cardia
Ix of choice for murmur = Echo
Pt. on long term aspirin (following CVA/.) will suffer from anemia
T-waves inversion on ECG with chest pain(wihtout chest pain=SOB) = NSTEMI
NSTEMI donot need SK just give B-blocker
ST elevation after MI = Give SK
MI after >4hrs of Strep = cant repeat SK for untill 5yrs = Give Recombinant tissue plasminogen activator
(r-tpa)
ST depression may indicate angina or PE
SVT Mx: carotid massage => adenosine / verapamil

Bradycardia after MI = Mx with cardiac pacer
Cholestrole level following MI should be <4 (normal = 5.5)
CPR: 30 breath / 2 chest compression (adult)
15 breath / 2 chest compression (child)
HTN with kidney disease best drug = ACEI (CCF, CCF with DM, CCF with IHD)
TIA Ix = Doppler of carotid arteries
Syncope while frming = postural hypotension
Syncope while stress / anxiety = vasovagal
Syncope with amnesia = transient dysarrhythmia
CNS
CT of brain = SOL (space occupying lesion) / Embolus / Haemorrhage
Petechial hemorrhage in tempo-inferio frontal lobe = herpes simplex encephalitis
Dr. Khurram Rasool
Page 7
Parkinsons Mx = benhexol?
Symptoms of raise ICP = HTN = no SOL = benign intracranial HTN
Mx of benign intracranial HTN is acetazolamide (diuretic)
Pancoast tumor will cause horner synd
Caf au lait lesion at birth with multiple nodule = NF
Motor neuron disease = multiple motor dysfunction
Undue fatigue end of day with afternoon blindness = Myasthenia Gravis
Myasthenia gravis : autoimmune Ab against acetylcholine receptor
Myasthenia gravis Ix : Auto-Ab + Tnsilon test
Myasthenia gravis Mx: Anticholinestrase / steroids
GIT
RUQ pain, fever, H/o = cholecystitis
Rigors/fever = pyelonephritis / pneumonia / malaria / sclerosing cholangitis
Rectal bleed = diverticulitis(painless) / colorectal Ca.(fresh blood) / piles / crohns / UC
PAS (periodic acid schiff on jejunal biopsy) positve granules = whipples disease
Whipples disease = GI mal absorption, middle age male, arthalgia (colonic migratory), wt loss,
diarrhoea, colicky. Ix: jejunal biopsy = PAS granules/ st villi, Rx: Ceftriaxone
Travellers diarrhoea = E.coli / compylobacter
HbsAg = first to appear post exposure
HbeAg = signify acute phase
Abdominal pain (african), bladder calcification = schistosoma haematobium
Infective bowel disease with juandice, RUQ pain = PSC
Juandice getting worse after infection = Gilbert synd
Fever, juandice with epigastric pain = charcots triad(ascending cholangitis)
Dr. Khurram Rasool
Page 8
GI perforation = Ix: erect CXR => gass under diagphram (abd X-ray?)
Excess alcohol damages liver which affects Vit-k = Bruising
Endocrinology
Obese, weight gain, tired + constiated = aqquired hypothyroidism
Female sex harmone => hypothalamus => pituitary => ovary
PPH = sheehans synd = (a) ant. Pituitary ischemia (most harmone RF )
(b) post pituuitary = ADH
No menses, hirsutism, acne, balding = ovarian reason
17,B-Estradiol = ovaries produce this.
Estrone = adipose tissue produce this + androstenedione
Gulucose inhibits GH is acromegaly GTT + GH confirms Dx
Oral pigmentation / hypotension = addision, Ix: short synechtin test
Confirm addisons disease = short synechtin test
pt. with Ca++ renal stones =check PTH
Type-1 DM = absolute deficiency of insulin => DKA
Typ-2 DM relative deficiency of insulin => HONK
Cushing = raised glucocorticoids = raised cortisol
Drug induced thyrotoxicosis by amiodarone / lithium / digoxin
Heat intolerance = hyperthyroidism ,
cold intolerance = hypothyroidism
Hyperparathyroidism will cause increased serum calcium level

HTN with low K+ = conns syndrome (decreased ADH)
Hyperthyroid Ix = raised T4 (thyroxine) level
DM : long standing nephropathy will cause raised insulin levels if it is not checked/regulated
regularly causing hypoglycemia
Dr. Khurram Rasool
Page 9
Autonomic neuropathy will causd diarrhea, postural hypotension, impotence

Hypothyroid on thyroxine follow up Ix = TSH
Nephrology
IgA nephropathy = glomerulonephritis sec. to URTI infection in children (1-3/7 post URTI)
Henoch schonlein purpura = buttocks rash in children + abd pain
Minimal changed nehropathy = fusion of podocytes on electron microscope
Access of RF = renal U/S = see size of kidney
ca+ renal stones ass.with thiazide diuretics, also urate = Gout
Renal stone or abdominal mass = U/S
Mx of BPH = a-Blocker (terazosin)
Mx of anemia in RF pt. = Erythropoietin inj
Acute renal failure with PE = Mx by Dialysis
Causes of Haematuria
Drug induced = recent drug Rx
Long distance runner = Rhabdomyolysis (Would be RBC in blodd by myolocyter???)
Porphyria caused by ocp, barbiturates, and oral hypoglycemic drugs
Glomerulonephritis
Important Ix:
Asthma = peak expiratory flow
Pneumothorx = Cxr
Pneumonia = Cxr
PE = V/Q , spiral CT
DKA = glucose, ABGs
Dr. Khurram Rasool
Page 10
RF = U/S
Ureteric stone = cystoscopy
MI = Cardiac enzyme
GERD = oesophagela-gastro-duodeno scopy
Acromegaly = (a) GTT with GH (b) S I GF screens???
Addisions = short synechtin test
Cushings = Dexa suppression test
Any mass initial Ix = US
DM screening test = FBS
Synmptomatic with 1 high FBS or 1 high RBS = Dx of DM
Asymptomatic with 2 high FBS or 2 high RBS or GTT
Gstric reflux Ix by gastroscopy
Cholecystits Ix by U/S
Stomach Ca. Ix by gastroscopy
Ca. Colon / Rectum Ix by sigmoidoscopy
Aortic aneurysm Ix by U/S, Best is CT scan
Ix:
SLE = autoantibody screen
Polycystic kidney = pelvic U/S
Multiple Myeloma = bence jones protein
Surgery
Neck midline mass = thyroglossal cyst, Ix: FNA
Neck fluctuating mass beneath SCM = brachial cyst, Ix: FNA
Dr. Khurram Rasool
Page 11
Neck pulsatile mass beneath SCM = crotid body tumor, Ix: doppler u/s
Pharyngeal pouch = Ix: barium meal or contrast X-ray.
Lower oesohageal ring = sha. Ring = Rx: oesophageal diverticulotomy
Bence jones protein for multiple myeloma
Pt. = diarrhoea / abd. Pain = necrotic ulcers on body = pyoderma gangrenosum
Pulstile swelling at the base of SCM = subclavian artery aneurysm
Swelling at lower part of inferior constrictor = pharyngeal pouch
Swelling attached to 7th cervical vertebra = cervical rib
Sweeling in midline between thyroid cartilage and tongue = thyroglossal cyst
Medial malleous ulcer = venous
All neck masses = initial Ix = U/S
Cystic mass = aspirate, solid mass = fine needle asiration (FNAC)
Known prostate cancer = back pain Ix = technitium 99 bone scan
Known cancer patien = confusion, abnormal ECG = Ix: hypercalcemia
Prostate cancer follow-up Ix = PSA
Renal failure Ix = U/S
Heavy smocker = ischemic lower limb = thrombo angitis obliterans
Post operative chest pain = (a) Lt. side = MI => Ix by ECG, (b) Breathless = PE => Ix by V/Q or Spiral CT
Post operative fever = (a) wound sepsis => Ix by wound swab ? (b) peritonitis=> Ix by Abd. U/S
Cancer patient with leg weakness, poor bowel/urine habits = cord compression due to bone metastasis
Post chemo = raised urea level in blood = tumor lysis synd
Antibiotics pre/post operative
3gm stat amoxil before procedure dental on cardiac pt.
Dr. Khurram Rasool
Page 12
3/7 iv Abx pre op = heart valve replacement

NPO, Pa picpsulphate 1/7 pre op + i/v Abx pre op = sigmoid colectomy
Life long penicillin prophylaxis = post spleenectomy for 30yrs = Rheumatic fever
One dose metronidazole pre op = Emergency appendectomy
Nipple discharge Ix = ductogram
Pt. with the family history of breast Ca. = Genetic counselling & testing
Free mediastinal gass = ruptured oesophagus also surgical emphysema
Gas beneath diagphram = visceral abd. Part
Globular heart shadow = temponade = low voltage ECG, muffled heart sound
Widened mediastinum = ruptured aorta
Breast pain with menses = cyclical mastalgia
Neck lump biopsy showing giantcell + caseation = TB lymhadenitits
Ship worker with neck mass +/- interstitial chest fibrosis = mesothelioma
Ca. pt. having superior vena caval obstruction post radiation Rx = Dexameth
Bronchial Ca. pt. need to cough out spututm (bronchial secretion) = hyoscine injection
Renal stone ass. With (malignancy???) arthritis = uric cid
Renal stone if all the investigations re normal = check diet history
Doppler U/S best Ix for DVT
Bone mets causing pain Mx = Radio Rx
Young boys with inguinal hernia = Mx = Herniotomy
Adult male with inguinal hernia= Mx= mesh repair/herniography (herniorrhaphy)?????
Suspected abdominal aneurysm = laprotomy to Ix
Anaplastic carcinoma of thyroid grows very rapidly and causes hoarsness
Dr. Khurram Rasool
Page 13
Old pt. with lower back pain = MM

Never do uretheral catheterization in in suspected urethral injury esp following pelvic # , to
relieve do suprapubic Tap.
Cystoscopy to Dx bladder Ca.
Crush injuries usually causes Rhabdomyolysis
Barrets esophagitis needs surveillance endoscopy to pic a Ca.
Mx of oesophageal stricture = dilatation
Mx of oesophageal tumor (localized) = excision
Mx of oesophageal tumor with metastasis = Celestin tube
Hyaline fibrous tissue in submucosa of GIT = scleroderma
Hirshprug nerve ganglion missing in GIT hence decreased Peristalsis
Severe vomiting cause Met.alkalosis (due to increased loss of H+ ion)
Severe diarrhea causes hyokalmeia
Constipation with overflow diarrhea = fecal impction
Young pt. with changing bowel habits = IBS
Barrets esophagitis Mx regularly endoscopic surveillance
Pre/post operative (surgery)

Surgery, long, = SOB = PE
Post anesthesia = SOB = acute pneumonitis to intubation +/- aspiration
Pt on warfarin required surgery stop warfaring 4/7 days pre op.
Pt on clopidogril (anti-PLT) b4 surgery = stop 1/52 preop
IDU pre op Ix = Hep screen
Gyne & Obs

Dr. Khurram Rasool
Page 14
Prolonged ruptured of membranes = complications = chorioamnionitis

Juandice in pregnancy = (a) >40, abd pain, vomiting, ph = preeclampsia, hyoglycemia
Acute fatty liver of pregnancy
= (b) abd pain vomit, hemolysis, elevated liver enzyme, low platelet count (HELLP)
Pregnancy = SPA pain right to thigh groin on walking = symphysis pubis dysfuntion
Obese, acne, female, high insulin = polycystic ovarian synd
Pelvic pain remenstrual, long standing, walks + post coital = pelvic congestion synd
IUCD = increases risk of PID or long standing pessary in post menopause
Female who exercise a lot having amenorrhoea= (1) adipose tissue repleced by muslce . Testoteron (2)
Constitutional
Progesterone level confirs ovulation 7/7 post ovulation date
Menorrhagia / Dysmenorrhia premenopausal . To decreased progesterone
Mx of painful menses = NSAIDS
Remmoving fibroids while . Uterus myomectomy
Pregnant female need anticoagulatn = S/C LMWH
Ectopicc usually 6-8/40 after amenorrhoea = pregnancy test + U/S
Preg. Induced dyspepsia Rx with antacid
Pregnancy induced gastric reflux Mx = simple antacids
Peds
Child with enuresis <5yrs => incontinent pents,
>5yrs => desmopressin
UTI can cause Fecal / Urine incontinence in child / elderly

Commonest cause of UTIs are: (a) E.coli, (b) proteus
Child / man with unknown cause of UTI do U/s
Female with recurrent UTI do U/s
Dr. Khurram Rasool
Page 15
Peds (congenital Disorders)

Female with coarctation of aorta = turners (45XO)
Small chin, low ears, rocker bottom feet = Edwards synd 47XY (Chr.no.18)
Tall boy with female features = kleinfilters synd (47Xxy)
Dysmorpphic, floppy body = Downs 47XY (21)
Large head with large testes = fragile X-syndrome
Cyanosed body = boot shaped heart = tetrology of fallot
Failure to thrive, pansystolic murmur t lower sternal edge, prasternal thrill= VSD
Cool extremities, no femoral pulse = transosition of great vessels?????
Machinary murmur = PDA
Psychiatry
Mild depression = CBT
Severe depression = SSRI, cant sleep-amitryptalin (khurram bhai I think Here ECT is required)
Atypical deression = MAOI-phenelzine
PA eating, not resopnding to Rx, post natal = ECT
DERMA
Skin cancer long standing bleeds on touch = squamous cell Ca.
Treatment of acne = doxy, erythro, topical benzyl, topical retinoids, oral retinoids
White itchy plaque on vulva / . = lichen sclerosis
Pearly lesion with raised edges on labial folds = Basal cell Ca.
Subcutaneous non-tender slowly growing nodule = lipoma
Raidly growing raised lesion with rolled out edges with horny plug = kerato-acanthoma

Dr. Khurram Rasool
Page 16
Redish brown scaly plaque, sun exposed area, very slow groing = sq.cell Ca, in situ (Bowens
disease)
Colour / size changing lesion = melanoma
Weeping + crusting eczema = staph. Infected
Sebhorric eczema is cused by yeast
ENT:
Diabetics with ear furuncle = staph
Any ear perforation = immediate refer
Mass in fron of ear drum = wax/ ???
Mass behind of ear drum = cholestema
Family history of hearing loss = otosclerosis
Hearing loss with facial numbness = acoustic neuroma
Old age degenerative hearing defect = presbycusis
Unilateral sensory hearing loss = acoustic neroma (will have facial pain)
Bilateral sensory hearing loss = noise induced ( heals spontaneously)
Bilateral progressive sensory hearing loss = presbycusis
Bilateral conductive hearing loss = otosclerosis, wax
Mx of otitis externa = Genta (topical), Cipro (oral)
Vertigo following URTI = vestibular neuritis (labyrinthitis)
Deafness + vertigo + tinnitus = Meniers
Basal skull fracture (temporal) = ear discharge (petrus)
Basal skull fracture (ethmoidal) = nasal discharge
Pink ear drum = viral OM, Mx: pc?
Red ear drum = bacterial OM, Mx: ABx
Dr. Khurram Rasool
Page 17
Best ABx for OM = amoxil UTI = trimetn/cefuroxime

A nasal septal defect = suspected cocaine abuse
Hoarsness / loss of voice following physiological or prolonged intubation = functional dysphonia
Opthalmology
Acute glaucoma Rx = topical pilocarpine + topical steroids
Hx of IHD = symp of decreased vision = central retinal artery occlusion
Tunnel vision = glaucoma,
Seeing haloes = glaucoma
Curtain coming down = retinal detachment

Curtain coming down vision = retinal detachment
Smokers = optic atrophy => will have pale fundus
Anatomy & Fractures

Over weight, leg length dis., externally rotated, age >10 = slipped upper femoral epiphysis
Leg lenth dis., groin pain increased on exersion, age <10 = perthes
Hip pain / Inflammation after URTI = transient synovitis or irrit hip synd
Walking roblem from birth, limp while walk = developmental dyslasia of hip
Mid point of suprasternal notch and symphisis pubis = transpyloric plane
Tip of 9th costal cartilage = fundus of galbladder
T10 = oesophagus enters diagphram
Just above mid inguinal point = femoral artery pulse
Best Ix to diagnose spinal fracture is plain X-ray
Fractures:
Punch hard surface = metacarpal #
Shoulder dislocation after fit = posterior
Dr. Khurram Rasool
Page 18
No radial pulse = supracondylar # of humerus

Old lady falling on outstretched arm = distal radius# = colles #
Patient complain of pain/swelling after POP = check pulse = remove POP
If # causing arterial occlusion = immediate reduction
Rx of osteoprosis = Bisphosphonate
Prevention of osteoprosis = Ca++ supplements
On Field # Mx = 1st : pain relief, 2nd : immobilize, 3rd : X-ray
Fractured wrist distal to radius = schahoid # => initial X-ray will be normal
Wrist drop after # = Radial nerve (is for dorsiflexion) damage as in spiral # of humerus
No radial pulse after # is supracondylar # of humerus
Babies carying when hard lifted usually after traumatic delivery = # clavicle
Pt. with perilunate dislocation = refer to ortho
Snuff box = scaphoid # = x-ray wrist (lateral???) view, Mx: POV cast, R/V in 2/S2
Back seat passenger in MVA = whiplash injury, Mx: physio
Foot drop is result to compression on common peroneal nerve
Linear transverse bruising from lap belt abobe umblicus in MVA = Mesenteric vascular injury
In emergency if iv access cant be made = (a) >12 yrs => CVP, (b) <12yrs => intraosseous
#shoulder = decreased sensation on lateral aspect of deltoid = axillary nerve
#fibula = loss of dorsiflexion/sensation on lateral side of leg = common peroneal nerve
#medial epicondyle = decreased sensation 4th/5th finger = Ulnar nerve
#humerus = wrist drop = radial nerve
#hip with weakness of hamstring = sciatic nerve
Pharmacology
Dr. Khurram Rasool
Page 19
Yellow vision = digoxin

Blue vision = vigra
ASA = take with meal
Rx for lyme = doxy = to be taken after meal = patient to be upright for 30 mints
Any fever = Rx with Abx
Folic acid dose = 5mg / tablet
Pneumonia that causes steven johnsons synd = mycoplasma = rash
Li BeH line + terminal spinal cord
To reduce serm Ca++ = Mx = Bisphosphonate
Poisoning
FeSo4 overdose will cause pyloric stricture
Panadol overdose will cause liver damage, Antidote = N-acetylcystine
TCA overdose causes tachyarrythmia, dry mouth, hallucination
Opiate overdose causes hypotension, hypoventilation, small pupil
Digoxin overdose will cause bradycardia, visual disturbance
Genetics
Obese child, floppy body, wanting to eat and eat (hunger baby synd) = prader willi synd
Short, fat, prolonged steriod use = cushings
Traumatology
Blunt abdominal injury best Ix = CT abdomen
Blunt abd. Injury with epigastric pain = pancreatic rupture
Blunt abd. Injury with RUQ pain = liver rupture
Blunt abd. Injury with LUQ pain = spleen
Dr. Khurram Rasool
Page 20
Blunt abd. With loin pain = kidney rupture / anuria

Blunt abd. With with umblical area = mesenteric vessel injury
Blunt abd. Injury with abd. Pain/SOB = diagphramatic rupture
Occupational Health
Furniture maker has high risk of Maxillary antral Ca.
Rubber or tyre workers has high risk of Bladder Ca.
Dye workers has high risk of Renal cell Ca.
Ship worker has high risk of Mesothelioma
Sheep farmer with nasal bleed = ORF

Dr. Khurram Rasool
Page 21

Dr. Khurram Rasool
Page 22

Clinchers: Rheumatology

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A Gift to Dr. Swami and All the Students attending the course.

Dr. Khurram Rasool

Talengedtasia / Raynauds = Crest = Ix: Anti-centromial Ab

Dr. Khurram Rasool

Post. Cricoids web with decreased Fe anemia = plummer Vinson synd

Dr. Khurram Rasool

Syncope with sweating = hypoglycemia

Infections in HIV patiens

Dr. Khurram Rasool

OCCUPATIONAL HEALTH in respiratory system context

Dr. Khurram Rasool

Diabetic pt with HTN = Mx : ACEI

ACEI : cough, Raised K+, RF C/I: renal or aortic stenosis

Dr. Khurram Rasool

Old person with tachycardia = most probably VT

SVT Mx: carotid massage => adenosine / verapamil

Dr. Khurram Rasool

Dr. Khurram Rasool

cold intolerance = hypothyroidism

Hyperparathyroidism will cause increased serum calcium level

Dr. Khurram Rasool

Autonomic neuropathy will causd diarrhea, postural hypotension, impotence

Dr. Khurram Rasool

Dr. Khurram Rasool

Dr. Khurram Rasool

3/7 iv Abx pre op = heart valve replacement

Dr. Khurram Rasool

Old pt. with lower back pain = MM

Pre/post operative (surgery)

Gyne & Obs

Dr. Khurram Rasool

Prolonged ruptured of membranes = complications = chorioamnionitis

>5yrs => desmopressin

UTI can cause Fecal / Urine incontinence in child / elderly

Dr. Khurram Rasool

Peds (congenital Disorders)

Thanks to the anonymous Doctor who created it.

Dr. Khurram Rasool

Dr. Khurram Rasool

Best ABx for OM = amoxil UTI = trimetn/cefuroxime

Seeing haloes = glaucoma

Curtain coming down = retinal detachment

Anatomy & Fractures

Dr. Khurram Rasool

No radial pulse = supracondylar # of humerus

Dr. Khurram Rasool

Yellow vision = digoxin

Dr. Khurram Rasool

Blunt abd. With loin pain = kidney rupture / anuria

Thanks to the anonymous Doctor who created it.

Dr. Khurram Rasool

Thanks to the anonymous Doctor who created it.

Dr. Khurram Rasool

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