FLASH-Final Leap into A Safe Hand

FLASH -15
Final Leap into A Safe Hand

THE FINAL MBBS MANUAL

GENERAL MEDICINE
GENERAL SURGERY
ORTHOPAEDICS
PAEDIATRICS
GYNECOLOGY
OBSTETRICS

Dr.Anto Jose
MES MEDICAL COLLEGE , PERINTHALMANNA.

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 FLASH-Final Leap into A Safe Hand

Published by
7TH BATCH MBBS STUDENTS
MES MEDICAL COLLEGE, PERINTHALMANNA.
Contact number-8907734040,8547180517
Printed by
St. JOSEPH PRESS , PERINTHALMANNA

©Anto jose 2015

All rights reserved. No part of this publication should be reproduced,stored in a retrieval sys-
tem or transmitted in any form or by any means :electronic, mechani-
cal,photocopying,recording or otherwise, or without the prior written permission of the author
and the publisher.
First edition: 2014

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 FLASH-Final Leap into A Safe Hand

Preface

As the name ‘FLASH’-Final Leap Into A safe Hand .“flash

” is an exam oriented selection manual and helping the students to prepare for their

final MBBS examination. This manual is unique in its way of presentation and simplici-
ty. ‘Flash’ covering all the topics in the syllabus as directed by the Kerala University

of Health Sciences(KUHS).

This book emphasizes on all the practical aspects of GENERAL MEDICINE,

GENERAL SURGERY, ORTHOPAEDICS, PAEDIATRICS, GYNECOLOGY , OB-

STETRICS and includes

- Chapter wise question bank

- Standard exam oriented questions and answers

This book is prepared as such that students can memorise important topics in
short time and avoid mugging up. “flash” is preferred for last time revision and helps

the students to present them in the most appropriate way and score good marks in
the exam.

Anto Jose

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 FLASH-Final Leap into A Safe Hand

Acknowledgements

It is deep sense of gratitude and thanks to all persons, their thoughts, inspira-
tions incept the seed of the idea of the book ‘FLASH —The Final MBBS Man-
ual’.

First and foremost, I bow myhead before Gold Almighty, who is source of all
inspirations and actions of the universe. I thank him For his blessing conferred
on me to accomplish this work.

No words are sufficient to express my acknowledgements to my parents, my

brothers Seby Jose and Lijo Jose, For their endless Support.
I also express my gratitude to all my seniors, batchmates and Friends, espe-

cially Haseeb Ihsan,Soja raj, Jyothis Merry, Anumol Jai Joseph, Anagha EP,

Anju, Haffsath balil, Sanjana, Jerry john, Dhanuthra, Betsy, Anjaly for their

support given to me during the preparation of the book, without which the

book would have never been a reality.

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FLASH-Final Leap into A Safe Hand

GENERAL
MEDICINE

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 FLASH-Final Leap into A Safe Hand

According to KUHS,
Theory Paper I 60
Theory Paper II 60
Theory- Internal assessment 30
Viva voce ( 4 Stations) 20
Practicals 100
Practicals- Internal assessment 30
TOTAL 300

THEORY
ENVIRONMENTAL & NUTRITIONAL FACTORS IN DISEASE, NUTRITION,
ONCOLOGY, MOLECULAR AND GENETICS FACTORS IN DISEASE ,
CLINICAL BIOCHEMISTRY AND METABOLISM, KIDNEY AND URINARY
TRACT DISEASE, CARDIO VASCULAR DISEASE, ENDOCRINE DISEASE, DI-
Paper I
ABETES MELLITUS, ALIMENTARY TRACT AND PANCREATIC DISEASE,
LIVER AND BILIARY TRACT DISEASE
NEUROLOGICAL DISEASE
IMMUNOLOGICAL FACTORS IN DISEASE, AGEING AND DISEASE,
POISONING AND TOXICOLOGY, MEDICAL PSYCHIATRY,PAIN MAN-
Paper II AGEMENT AND CRITICAL CARE, INFECTIOUS DISEASES, HIV INFEC-
TION & AIDS, SEXUALLY TRANSMITTED INFECTIONS, BLOOD DIS-
EASE MUSCULOSKELETAL DISEASE, SKIN DISEASE

QUESTION PAPER MODEL

I Long Essay 2×10 20

II Short notes (20 nos) 20×2 40
TOTAL 60

PRACTICALS

Long case 50
Short case 2x25=50 100
X ray, ECG 5
VIVA VOCE Instruments 5
Charts 5 20
Drugs 5

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 FLASH-Final Leap into A Safe Hand

Important topics

Reference : dav- Davidson’s principles and

practice of medicine - 22th edition
 Sign vs. symptom
PAPER I sIgn: something I can detect even
if patient is unconscious. sYMp-
MOLECULAR AND GENETICS FACTORS tom is something only hYM knows
about.
IN DISEASE

 Oncogenes (dav-59)
 Atherosclerosis risk factors
 Human genome project
―SHIFT MAID‖
 Klinefilters syndrome ** (dav-766) S- Smoking
 rDNA technology (dav-681) H-Hypertension
I-IDDM
 FISH
F-Family hstory
 X – linked inheritance (dav-53) T-Triglycerides & fats
M-Male
 X linked recessive disorder * (dav-1051)
A-Age
 Genetic counseling** (dav-67) I-Inactivity
 Gene therapy * (dav-31) D-Diet

 Molecular mimicry (dav-87)

 Epigenetics and imprinting (dav-52,53)  MI- sequence of elevated en-

 Southern blotting (dav-) zymes after MI
―Time to CALL ‖
 Karyotyping (dav-57) From first to appear to last
Troponin
CK-MB
AST
LDH

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 FLASH-Final Leap into A Safe Hand

ENVIRONMENTAL & NUTRITIONAL

FACTORS IN DISEASE
 Causes of secondary hypertension
 Health hazards of smoking (dav-)
“CHAPS”
 Smoking cessation (dav-)
C- Cushing’s syndrome
 Radiation exposure (dav-)
H-Hyperaldosteronism
 Hypothermia (dav-104)
A-Aorta coarctation
 Frost bite (dav-105)
P-Pheochromocytoma
 Malignant hyperpyrexia (dav-106)
S- Stenosis of renal arteries
 Heat exhaustion (dav-106)

 Heat stroke** (dav-106)

 JONES crITERIA
 Hyperthermia (dav-106) Major- Joint (arthritis)
O-Obvious(cardiac)
 High altitude pulmonary edema (dav-
N-Nodule(rheumatic )
107) E-Erythema marginatum
S-subcutaneous nodules
 Drowning (dav-108)

NUTRITION

 BMI* (dav-114)

 Glycemic index (dav-112)

 Obesity** (dav-115)

 PEM (dav-120)

 Marasmus (dav-120)

 Total parenteral nutrition

 Beri beri (dav-128)

 C/F of hypoglycemia (dav-156)

 Dawn phenomenon (dav-)

 C/F of vit A deficiency (dav-126)

 Night blindness (dav-127)

 Hypervitaminosis (dav-)

 Vit B12 deficiency (dav-129)

 Vit D deficiency (dav-127)

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 FLASH-Final Leap into A Safe Hand

 Niacin deficiency (dav-128)

 Pellagra ** (dav-128)

 Korsakoff ‘s psychosis (dav-128)  Metabolic acidosis- causes

―USED CAR‖
U-Ureteroenterostomy
ONCOLOGY S-Saline hydration
 Tumour markers * (dav-269) E- Endocrinopathies
D-Diarrhoea / DKA/ Drugs
 Febrile neutropenia (dav-274) C-Carbonic anhydrase inhibi-
 Anti malignant drugs (dav-276) tors
A-Ammonium chloride
 Cyclophosphamide (dav-) R-Renal tubular acidosis
 Para neoplastic syndrome * (dav-271)
 Cause of metabolic alkalosis
―V HAD‖
CLINICAL BIOCHEMISTRY AND META- V-Vomiting decreases H+ & acids
H-Hyperaldosteronism
BOLISM A-Antacids
 Serum protein electrophoresis (dav-) D-Diuretic use

 SIADH** * (dav-438)  Normal gap acidosis

 Causes of polyuria (dav-472) ―HARDUP‖
H-hyperelimentation/ hyperventilation
 Causes of tetany (dav-760) A-acetazolamide
 Hypokalaemia* (dav-440) R-RTA
D-diarrhoea
 Hyperkalaemia-Rx, ECG changes *** U-ureteral diversion
P-pancreatic fistula
(dav-442)

 Anion gap * (dav-445)  Respiratory alkalosis

―Asthmatic sally poisoned
 Chronic fatigue syndrome (dav-246)
POPOE‘s HEN‖
 Metabolic acidosis (dav-445) Asthma
Salicylate poisoning
 Respiratory alkalosis * (dav-447)
PO-pulmonary edema
 Hyperlipidaemia (dav-455) PE-pulmonary embolism
HEN- hepatic encephalopathy
 Hypercholesterolaemia (dav-453)

 Porphyria (dav-458) 


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KIDNEY AND URINARY TRACT DISEASE

 Casts in urine (dav-)

 IVP (dav-)

 Renal biopsy***(ind, contraind) * (dav-

471)

 UTI ** (dav-511)

 Asymptomatic bacteriuria (dav-513)

 A/c pylonephritis * (dav-513)

 Renal manifestations in gout (dav-

1089)

 Erectile impotence (dav-474)

 Sildenafil *** (dav-474)

 Microscopic Haematuria*** (dav-474)  JVP: wave form

―ASK ME‖
 Proteinuria* (dav-476) Atrial contraction
Systole (ventricular contraction)
 Nephritic syndrome*- management* Klosure (closure) of tricusps, so atrial
filling
(dav-476)
Maximal atrial filling
 RPGN (dav-501) Emptying of atrium

 Acute tubular necrosis ***  Rheumatic fever : jones criteria

 Anaemia in CKD (dav-485) Major- ―CANCER‖ –
C-Carditis
 Renal osteodystrophy** (dav-1066) A-Arthritis
 Indications for dialysis (dav-489) N-Nodules
C-Chorea
 Haemodialysis * (dav-490) E-Erythema
 Peritoneal dialysis (dav-492)  Minor- ― CAFÉ PAL―
C-CRP elevated
 Renal transplant rejection (dav-492) A-Arthralgia
 Renal artey stenosis (dav-494) F-Fever
E- Elevated ESR
 Malignant hypertension * (dav-) P-Prolonged PR interval
L-leucocytosis
 Acute nephritis ** (dav-502)

 Post streptococcal glomerulonephritis* 

(dav-503)

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 FLASH-Final Leap into A Safe Hand

 Ig A nephropathy* (dav-500)

 Henoch-scholein purpura* (dav-501)  Aortic regurgitation: causes

―CREAM‖
 Goodpasteur’s syndrome (dav-500)
Congenital
 Alport’s syndrome* (dav-502) Rheumatic damage
Endocarditis
 Poly cystic kidney disease (dav-505) Aortic dissection/ Aortic root dilata-
tion
 Retroperitoneal fibrosis (dav-511) Marfan‘s
 Medical therapy of enlarged prostate *
 Aortic stenosis characteristics
(dav-514) ―SAD‖
Syncope
 Diabetic nephropathy *** (dav-830) Angina
Dyspnoea
 Lupus nephritis (dav-)
 Aorta vs. vena cava: right vs. left
(When looking at the patient from the
CARDIO VASCULAR DISEASE anterior side.)
Aorta and right each have 5 letters,
 Collapsing pulse *** so aorta is on the right.
Vena and cava and left each
 Pulses paradoxus* (dav-532)
have 4 letters, so vena cava is on the
 Angina (dav-539) left

 Cardiac tamponade ** (dav-545)  Apex beat: abnormalities found on

palpation, causes of impalpable
 Acute left ventricular failure (dav-548) ―HILT‖
 Congestive cardiac failure (dav-548) Heaving
Impalpable
 Pulmonary edema*-Rx* (dav-550) Laterally displaced
Thrusting/ Tapping
 Chest X ray findings in cardiac failure
 If it's impalpable, causes are COPD:
(dav-550) COPD
 Chest X ray features of pulmonary Obesity
Pleural, Pericardial effusion
edema (dav-550) Dextrocardia

 Acute pulmonary edema * (dav-)  Aortic to left Subclavian path

―ABC'S‖
 ACE inhibitors* (dav-551)
Aortic arch gives rise to:
 Vasodilators (dav-552) Brachiocephalic trunk
left Common Carotid
 Captopril left Subclavian

 Propanolol (dav-)

 Postural hypotension* (dav-556)

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 FLASH-Final Leap into A Safe Hand

 Cardiac arrest –mangmnt (dav-558)

 Defibrillation * (dav-)  Atrial Fibrillation causes

―Pirates‖
 Atrial flutter (dav-564) Pulmonary: PE, COPD
Iatrogenic
 Atrial fibrillation **** Mx ** (dav-565) Rheumatic heart: mirtral regurgita-
 Wolf Parkinson white syndrome* (dav- tion
Atherosclerotic: MI, CAD
568) Thyroid: hyperthyroid
Endocarditis
 Extra systole (dav-569) Sick sinus syndrome
 Complete heart block* (dav-572)
 Atrial fibrillation management
 Paroxysmal tachycardia* (dav-570) ―ABCD‖
Anti-coagulate
 Defibrillation (dav-577) Beta-block to control rate
Cardiovert
 Digoxin (dav-) Digoxin
 Digitalis toxicity *
 Beck's triad (cardiac tamponade)
 Digitalis ―3 D's‖
Distant heart sounds
 Cardiac Pacemker * (dav-578) Distended jugular veins
Darterial pressure
 Non modifiable risk factors for ishaemic

heart disease (dav-582)  Betablockers: cardioselective

betablockers
 Coronary artery disease(dav-583) Betablock-
ers Acting Exclusively At Myocardi
 Stable /unstable angina** (dav-583) um:
Betaxolol
 Treatment for angina * (dav-585) Acebutelol
 Myocardial infarction** (dav-596) Esmolol
Atenolol
 Diagnosis, investigations of MI (dav- Metoprolol

598)  CHF: causes of exacerbation

Failure
 Troponin (dav-593)
Forgot medication
 Thrombolytic therapy (dav-594) Arrhythmia/ Anaemia
Ischemia/ Infarction/ Infection
 Warfarin (dav-594) Lifestyle: taken too much salt
Upregulation of CO: pregnancy,
 Dresslers disease (dav-) hyperthyroidism
Renal failure
 Raynaud’s phenomenon (dav-602)
Embolism: pulmonary
 Hypertension(causes) * (dav-607) 

 Hypertensive retinopathy (dav-609)

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 FLASH-Final Leap into A Safe Hand

 Malignant hypertension * (dav-609)

 Anti hypertensive drugs (dav-611)  Complications of Myocardial In-

farction
 Hypertensive crisis * (dav-612) ―Darth Vader‖
Death
Arrythmia
RHEUMATIC FEVER** (dav-614) Rupture(free ventricular wall/ ven-
tricular septum/ papillary muscles)
 Achoff’s nodules (dav-614) Tamponade
Heart failure (acute or chronic)
 Jone’s Criteria (dav-614) Valve disease
 Subcutaneous nodules-types (dav-615) Aneurysm of Ventricles
Dressler's Syndrome
 Lab diagnosis (dav-615) thromboEmbolism (mural thrombus)
Recurrence/ mitral Regurgitation
 Prophylaxis (dav-615)

 Mitral regurgitation (dav-618)  MI: basic management

 Mitral valve prolapse (dav-) ―BOOMAR‖
Bed rest
 Aortic regurgitation (dav-623) Oxygen
Opiate
 Carey coomb’s murmer (dav-) Monitor
Anticoagulate
 Pulmonary stenosis (dav-625)
Reduce clot size[39]

 MI: signs and symptoms

INFECTIVE ENDOCARDITIS (dav-625) ―PULSE‖
Persistent chest pains
 Clinical features (dav-626) Upset stomach
Lightheadedness
 Bacterial endocarditis* (dav-627)
Shortness of breath
 Splinter haemorrhages (dav-) Excessive sweating

 Prophylaxis (dav-628)
 Pulmonary edema-Rx
 Trtmnt of SABE (dav-628) ―LMNOP‖
 Valve replacement (dav-629) L-lasix
M-morphine
N-nitrates (NTG)
O-oxygen
P-position (upright vs flat)

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CONGENITAL HEART DISEASE (dav-

629)  MI: therapeutic treatment

 Eisenmenger’s disease (dav-631) ―O BATMAN!‖
Oxygen
 ASD (dav-632) Beta blocker
ASA
 Chest Xray findings in left-right shunt
Thrombolytics (e.g. heparin)
(dav-633) Morphine
Ace prn
 Chest Xray findings in coarctation of Nitroglycerin[41]
aorta (dav-632)
 MI: treatment of acute MI
 VSD (dav-633) ―COAG‖
Cyclomorph
 Tetrology of fallot (dav-634)
Oxygen
 Radiological features of TOF* (dav- Aspirin
Glycerol trinitrate
635)

 Viral myocarditis (dav-636)  Acute LVF management

―LMNOP‖
 Restrictive cardiomyopathy (dav-638) Lasix (furosemide)
Morphine (diamorphine)
 Constrictive pericarditis (dav-641)
Nitrates
 Kussmaul’s sign (dav-545) Oxygen (sit patient up)
Pulmonary ventilation (if doing
 Left ventricular hypertrophy (dav-622) badly)
 Differential cyanosis (dav-)
 Heart valve auscultation sites
 Causes of raised JVP (dav-527) "All Patients Take Meds":
 HOCM ** (dav-637) Reading from top left:
Aortic
Pulmonary
Tricuspid
Mitral

 Pulmonary Edema: Treatment

―LMNOP‖
Lasix
Morphine
Nitro
Oxygen
Position/Positive pressure ventila-
tion

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 FLASH-Final Leap into A Safe Hand

ENDOCRINE DISEASE

 Water house friedrichson syndrome*  Cushing syndrome

 Thyroid function tests (dav-737)
 Hyperthyroidismcauses (dav-740)
 Thyroid storm * Mx * (dav-742)
 Hypothyroidism *-C/f, diagnosis (dav-
743)
 Myxoedemic coma ** (dav-745)
 Thyrotoxicosis –eye signs *Mx* (dav-
750)
 Carbimazole (dav-749)
 Radioiodine therapy (dav-749)
―CUSHING‖
Central obesity/ Cervical fat
pads/ Collagen fiber weak-
ness/ Comedones (acne)
Urinary free corisol and glucose increase
Striae/ Suppressed immunity
Hypercorti-
solism/ Hypertension/ Hyperglycemia/ Hir
sutism
Iatrogenic (Increased administration of
corticosteroids)
Noniatrogenic (Neoplasms)
Glucose intolerance/Growth retardation

 Thyroiditis (dav-751)  Pituitary endocrine functions often

affected by pituitary-associated
 Tetany * (dav-768) tumor
 Short stature (dav-760)
"Go Look For the Adenoma Please":
 PCOD (dav-764) Tropic hormones affected by growth
tumor are:
 Hypercalcaemia (dav-767) GnRH
LSH
 Cushing syndrome ** (dav-773) FSH
ACTH
 Adrenal crisis (dav-779)
Prolactin function
 Addison’s disease ** (dav-777)

 Adisonian crisis (dav-)  Symptoms of hyperthyroidism

―STING‖
 Pheochromocytoma-investigations
S- Sweating
(dav-781) T-Tremor/ tachycardia
I-Intolerance to heat , Irregular men-
 Steroid therapy- side effects **
truation & Irritability
 Whipples triad of hypoglycemia ** (dav- N-Nervousnes
G-Goiter& Gastrointestinal (loose
784)
stools/ diarrohea)
 Carcinoid syndrome (dav-785)

 Dwarfism (dav-786)

 Acromegaly * (dav-792)

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 FLASH-Final Leap into A Safe Hand

 Sheehan’s syndrome* (dav-787)

 Multiple endocrine neoplasia
 Multiple endocrine neoplasia ** (dav- MEN I --3P‘s
P-pituitary
795) P-parathyroid
P-pancrease
DIABETES MELLITUS

 Glycosylated Hb (dav-808)
 Diabetic ketoacidosis: I vs. II
 Diabetes-diagnostic criteria * (dav-809) ketONEbodies are seen in
 Diabetic keto acidosis*** (dav-811) type ONEdiabetes

 DKA- mngmnt ** (dav-813)  Hyperglycemia- causes

 Non-ketotic hyperosmolar diabetic co- ―GRIM FED‖
G-Granulomas
ma * (dav-814) R-renal failure
 Hypoglycemia (dav-815) I-immobility
M-malignancy
 Hypoglycemic coma (dav-815) F-familial
 Management & compl of diabetes ** E-endocrine
D-drugs(thiazide diuretics , lithium)
(dav-820) Endocrine causes of PATH :
 Oral hypoglycemic drugs *** (dav-821) P-Pheochromocytoma
A-Addison‘s disease
 Insulin analogue **** (dav-824) T-Thyrotoxicosis
 Human insulin* (dav-825) H-Hyperparathyroidism

 Insulin resistance (dav-825)  Cushing syndrome

 Diabetic nephropathy* (dav-830) ―CUSHING‖
C- Central obesity/ Cervical fat
 Diabetic neuropathy * (dav-833) pads/ Comedones (acne)
 Diabetic foot (dav-833) U-urinary free cortisol & glucose
increase
 Somogyi effect (dav-) S-striae/ suppressed immunity
H-hypercortisolism/ hypertension/
hyperglycemia/ hirsuitism
I-Iatrogenic (increased adm of cor-
ticosteroids)
N-non iatrogenic (neoplasm)
G-Glucose intolerance / Growth re-
tardation

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 FLASH-Final Leap into A Safe Hand

ALIMENTARY TRACT AND PANCREATIC

DISEASE

 Endoscopy (dav-846)  Most common symptoms of

PHEochromocytoma
 Barium swallow (dav-847)
P-palpitations
 Barium enema (dav-847) H-headache
E-episodic diaphoresis (sweating)
 ERCP * (dav-850)

 Hemoptysis/heamatemesis diff  Inflammatory Bowel Disease:

which has cobblestones
 Upper GI bleeding ** (dav-853) Crohn's has Cobblestones on en-
doscopy.
 Somatostatin (dav-841)

 GERD * (dav-865)  Pancreatitis: causes

―PANCREATITIS‖
 H.pylori *** (dav-872) Posterior
Alcohol
 Treatment for H.pylori *** (dav-872) Neoplasm
Cholelithiasis
 Carcinoid tumour * (dav-) Rx (lasix, AZT)
 Acute pancreatitis** (dav-889) ERCP
Abdominal surgery
 a/c pancreatitis-ransons criteria (dav- Trauma
Infection (mumps)
890) Triglycerides elevated
I'diopathic
 Inflammatory bowel disease (dav-897)
Scorpion sting
 Crohn’s disease* (dav-898)

 Ulcerative colitis* (dav-889)

 Extra intestinal manifestations of ulcera-  Pancreatitis: treat-

ment MACHINES:
tive colitis (dav-901) Monitor vital signs
Analgesia/ Antibiotics
 Pseudo membraneous enterocolitis Calcium gluconate (if deemed ne-
cessary)
(dav-) H2 receptor antagonist
 Irritable bowel syndrome (dav-907) IV access/ IV fluids
Nil by mouth
 Plummer Vinson syndrome (dav-870) Empty gastric contents
Surgery if required/ Senior review
 Topical sprue (dav-882)

 Whipples disease (dav-883)

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 FLASH-Final Leap into A Safe Hand

LIVER AND BILIARY TRACT DISEASE

 Serum alkaline phosphatase* (dav-  Hepatomegaly: 3 common causes,

3 rarer causes
928) Common are 3 C's:
Cirrhosis
 Ascitis- causes * (dav-939) Carcinoma
Cardiac failure
 Ascitis-diagnosis (dav-939)

 Ascetic fluid study (dav-939)  Rarer are 3 C's:

Cholestasis
 SAAG ** (dav-939) Cysts
Cellular infiltration
 Liver biopsy* (dav-931)

 Hepatic encephalopathy ** (dav-941)

 Signs of Chronic Liver Disease
 HE-(ppt factors & trtmnt) (dav-942) ―abcdefghij‖

 Asterixis * (dav-923) Asterixis, Ascites, Ankle oe-

dema, Atrophy of testicles
 Liver cirrhosis *** (dav-942) Bruising
 Cirrhosis-compl & trtmnt * (dav-944) Clubbing/ Colour change of nails
(leuconychia)
 Portal hypertension* (dav-945) Dupuytren‘s contracture
Encephalopathy / palmar Erythema
 Portal HTN-Mx (dav-945) Foetor hepaticus
Gynaecomastia
 Hypersplenism (dav-)
Hepatomegaly
 Acute variceal hematemesis* (dav-946) Increase size of parotids
Jaundice
 Porto systemic shunts (dav-948)

 Viral hepatitis ** (dav-948)  GI bleeding: causes ABCDEFGHI:

Angiodysplasia
 Hepatitis A immunization (dav-949) Bowel cancer
Colitis
 Hepatitis B-Rx & prevention* (dav-952) Diverticulitis/ Duodenal ulcer
Epitaxis/ Esophageal (cancer, eso-
 HbS Ag (dav-950)
phagitis, varices)
 Hepatitis B vaccine** (dav-954) Fistula (anal, aortaenteric)
Gastric (cancer, ulcer, gastritis)
 Alcoholic hepatitis (dav-957) Hemorrhoids
Infectious diarrhoea/ IBD/ Ischemic
 Non alcoholic steato hepatitis* (dav- bowel
959) 

 Interferons (dav-953)

 Hydatid disease(dav-956)

 Wilsons disease * (dav-973)

18
 FLASH-Final Leap into A Safe Hand

 KF ring* (dav-974)

 Desferrioxamine (dav-)  Stroke risk factors

 Budd chiari syndrome * (dav-976) ―HEADS‖
Hypertension/ Hyperlipidemia
 Amoebic liver abscess** (dav-957) Elderly
Atrial fib
 Gall stones (dav-981) Diabetes mellitus/ Drugs (cocaine)
Smoking/Sex (male)

NEUROLOGICAL DISEASE
 Horner Syndrome
 Lumbar puncture* (dav-1153) ―Horny PAMELA‖
Ptosis
 CSF findings in meningitis *** (dav-) Anhydrosis
Miosis
 Migraine ** (dav-1176)
Enophtalmos
 Cluster headache (dav-1177) Loss of ciliary-spinal reflex
Anisocoria
 Focal epilepsy (dav-1179)
 Miosis-causes of pin point pupil
 Simple partial seizures (dav-1180)
― CPR ON SLIME‖
 Complex partial seizures. (dav-1180)
Clonidine
 Generalized tonic clonic seizures (dav- Phenothiazines
1180) Resting (deep sleep)
Opiates
 Aura (dav-1158) Narcotics
 Sturge weber syndrome (dav-) Stroke (pontine hemorrhage )
Lomotil (diphenoxylate)
 Antiepileptic drugs (newer) ** (dav- Insecticides
1184) Mushroom / muscurinic
Eye drops
 Surgery for epilepsy (dav-1184)

 Status epilepticus *** (dav-1185)  Meningococcal meningitis - com-

plications
 Todd’s paralysis * (dav-) ―SAD REP‖
 Narcolepsy (dav-1187)
Sepsis/ Shock / Subdural effusion
 Cerebellar ataxia* (dav-272)
Ataxia/ Abscess (brain)
 Intention tremor* (dav-)
DIC/ Deafness
 Asterixis-causes *
Retardation
 Hemi ballismus
Epilepsy
 Clonus
Paralysis

Serotonin 19
Histamine
Muscurinic
 FLASH-Final Leap into A Safe Hand

 Dissociated sensory loss

 Acute confusional state (dav-238)  Cerebellar signs

―PINARDS‖
 Dementia (dav-250)
Past pointing
 Pre senile dementia * (dav-) Intention tremor
Nystagmus
 Wernick’s aphasia (dav-1169)
Ataxia
 Motor aphasia (dav-1168) Rebound
Dysdiadokokinesia
 Broca’s aphasia (dav-1169)
Slurred speech
 Sensory aphasia (dav-)
 Peripheral neuropathies –differentials
 Lateral medullary syndrome
“DANG THERAPIST”
 Pseudo bulbar palsy (dav-1174) D-Diabetes
 Papillary reflex (dav-) A-Amyloid
N-Nutritional
 Papilloedema (dav-1173) G-Guillen barre
 Neurogenic bladder (dav-) T-Toxic (amiodarone)
H-Hereditary
 Stroke ****
E-Endocrine
 Stroke-investigation & Rx (dav-1235) R-Recurring
A-Alcohol
 Babinski’s sign (dav-)
P-Pb (lead)
 Transient ischaemic attack *** (dav- I-Idiopathic
1237) S-Sarcoid
T-Thyroid
 Lacunar infarct* (dav-)

 Cerebral thrombosis-Rx

 Sub arachnoid haemorrhage (dav-

1246)

 Berry aneurysm (dav-506)

 Subdural hematoma (dav-)

 Methyl prednisolone

 Alzhemer’s disease (dav-251)

 Parkinsonism –Mx *** (dav-1194)

 Stereo tacic surgery for parkinsonism *

(dav-1197)

20
 FLASH-Final Leap into A Safe Hand

 Meningitis –Rx ** (dav-1204)  Eaton lambert syndrome (dav-1227)

 CSF findings in meningitis * (dav-1203)  Motor neuron disease (dav-1162)

 Tb meningitis * (dav-1204)
 Meningococcal meningitis - com-
 Viral encephalitis (dav-1205)
plications
 Dog bite-Mx * (dav-1205) ―SAD REP‖

 Rabies vaccination (dav-1205) Sepsis/ Shock / Subdural effusion

 Pulse polio immunization (dav-1207) Ataxia/ Abscess (brain)
 Polio vaccine (dav-1207) DIC/ Deafness
 Tetanus –Rx ** (dav-1209)
Retardation
 Neuro syphilis (dav-1209)
Epilepsy
 Raised intra cranial tension (dav-1212)
Paralysis
 False localizing signs in CNS disease*
 Whipple‘s Disease-features
 Neurofibromatosis (dav-1216) ―A WHIPPLES DOOM‖
 Normal pressure hydrocephalus(dav-)
Arthralgia
 Sub acute combined degeneration ofsp
Whipplei ( organism)
cord
Hypothalamic involvement
 Dissociated sensory loss
Intestinal involvement
 Entrapment neuropathy (dav-1224)
PAS positive macrophages
 Trigeminal neuralgia (dav-1178)
PCR positivity
 Metabolic causes of peripheral neuro-
Lymphadenopathy
pathy (dav-1223)

 Bell’s palsy * (dav-1163) Extrapyramidal involvement

 Horner’s syndrome (dav-1172) Septran treat with

 Myasthenia * (dav-1226) Dementia

 Myopathy (dav-130) Ocular abnormalities ( vertical gaze palsy)

 Duchene muscular dystrophy (dav- Oculomasticatory myorhthymia
1228) Myoclonus
 Ramsay hunt syndrome (dav-319)

 Guillian barre syndrome * (dav-1224)

21
 FLASH-Final Leap into A Safe Hand
PAPER II
IMMUNOLOGICAL FACTORS IN DIS-
EASE
 Complements * (dav-74)
 Mast cells (dav-75)
 Natural killer cells (dav-75)
 Cell mediated immunity * (dav-78)
 Antigen presenting cells (dav-78)
 CD4 count (dav-78)
 Warning signs of immune deficiency
(dav-)
 Radioimmuno assay (dav-)
 Type I Anaphylactic reaction (dav-)
 Immune complex mediated reaction *
 Delayed hypersensitivity
 Rheumatoid factor **
 Antinuclear antibodies*
 ANCA * (dav-1068)
 Anaphylaxis * (dav-91)
 Management of anaphylaxis (dav-92)
 Angioedema (dav-93)
 Organ transplantation (dav-94)
AGEING AND DISEASE
 Geriatric giants (dav-168)
 Common problems of elderly people
(dav-171)
 Postural hypotension (dav-7)
 Marfan syndrome features
Marfan
Mitral valve prolapes
Aortic aneurysm
Retinal detachment
Fibriillin
Archnodactly
Negative nitropurside test
Subluxative lens
 Down syndrome features: complete
My CHILD HAS PROBLEM!:
Congenital heart disease/ Cataracts
Hypotonia / Hypothyroidism
Incure 5th finger/ Increased gap be-
tween 1st and 2nd toe
Leukemia risk x2/ Lung problem
Duodenal atresia / Delayed devel-
opment
Hirshsprung's disease / Hearing loss
Alzheimer's disease / Alantoaxial in-
stability
Squint/ Short neck
Protruding tongue/ Palm crease
Round face/ Rolling eye (nystag-
mus)
Occiput flat/ Oblique eye fissure
Brushfield spot/ Brachycephaly
Low nasal bridge/ Language prob-
lem
Epicanthic fold/ Ear folded
Mentally retardation myoclonu
 Down syndrome pathology
DOWN:
Decreased alpha-fetoprotein and un-
conjugated estriol (maternal)
One extra chromosome twenty-one
Women of advanced age
Nondisjunction during maternal meio-
sis
22
 FLASH-Final Leap into A Safe Hand

POISONING AND TOXICOLOGY

 Paracetamol poisoning * * (dav-212)  Aspirin overdose – early symp-

 Salicylate poisoning * (dav-) toms
 Barbiturate poisoning “DAFT HID”
 Intravenous drug abuse D Deafness

 CO poisoning (dav-219) A Appear flushed

 Dapsone poisoning F Fever

 OP poisoning * * * (dav-220)
T Tinnitus
H Hyperventilation
 Intermediate syndrome (dav-222)
I Increased sweating
 Complications of OP poisoning (dav-
D Dizziness
222)

 Snake bite * (dav-229)

 Snake bite-comp & trtmnt * * (dav-229)

 Paracetamol
 Anti snake venom (dav-)
Paracetamol overdose – (the most
 Scorpion bite
common intentional drug overdose
 Forced alkaline dieresis
in the UK).
 Kerosene poisoning *

 Gastric lavage * (dav-210)

Risk factors
“ COMAH”
C Chronic alcohol abusers
O On drugs that increase cyto-
chrome P450 activity, anti-TB
drugs
M Malnourished individuals
A Anorexic patients
H HIV patients

23
 FLASH-Final Leap into A Safe Hand

MEDICAL PSYCHIATRY

 Delusion* (dav-236)  Depression: major episode char-

acteristics
 Hallucination * (dav-236)
―SPACE DIGS‖
 Electro convulsive therapy * * (dav-
Sleep disruption
241) Psychomotor retardation
Appetite chang
 Anxiety disorder * * (dav-242) Concentration loss
Energy loss
 Mood disorders (dav-243) Depressed mood
 Obscessive compulsive neurosis* (dav- Interest wanes
Guilt
243) Suicidal tendencies

 Newer Anti depressant drugs * (dav-  Narcolepsy: symptoms, epidemi-

ology
244)

 Lithium (dav-245) ―CHAP‖

Cataplexy
 Schrizophrenia * * * (dav-247) Hallucinations
Attacks of sleep
 Neuroleptic malignant syndrome ** Paralysis on waking
(dav-249)
 Sleep stages: features
 Alcohol dependence (dav-252) DElta waves during DEepest sleep
(stages 3 & 4, slow-wave).
 Alcoholism- complications * (dav-253)
dREaM during REM sleep.
 Delirium tremens * (dav-250)

 Alcohol withdrawal syndrome* (dav-  Mental state examination: stages

253)
 Drug addiction (dav-)
 Anorexia nervosa * (dav-255)
 Hysteria *** (dav-)
 Dissociative disorder * (dav-)
 Conversion disorders (dav-246)
 Lucid interval (dav-)
 Disulfuram (dav-254)
 Post traumatic stress disorder (dav-
in order
"As-
sessed Mental State To Be Positively
Clinically Unremarkable":
Appearance and behaviour [observe
state, clothing...]
Mood [recent spirit]
Speech [rate, form, content]
Thinking [thoughts, perceptions]
Behavioural abnormalities
Perception abnormalities
Cognition [time, place, age...]
Understanding of condition [ideas,
expectations, concerns]

242) 

24
 FLASH-Final Leap into A Safe Hand

 Behavior therapy (dav-241)

 Bulimia nervosa (dav-256)  Depression: symptoms and signs (DSM-

IV criteria)
―AWESOME‖
Affect flat
PAIN MANAGEMENT AND CRITICAL Weight change (loss or gain)
Energy, loss of
CARE
Sad feelings/ Suicide thoughts or plans or
 WHO analgesic ladder * (dav-287) attempts/ Sexual inhibition/ Sleep change
(loss or excess)/ Social withdrawal
 ARDS ** (dav-) Others (guilt, loss of pleasure, hopeless)
Memory loss
 Oxygen therapy (dav-) Emotional blunting
 Mechanical ventilation (dav-)
 Depression
 Positive pressure ventilation * (dav-) ―UNHAPPINESS‖
Understandable (such as bereavement,
 Advanced life support (dav-) major stresses)
 MODS (dav-) Neurotic (high anxiety personalities, nega-
tive parental upbringingHypochondriasis
Agitation (usually organic causes such as
dementia)
INFECTIOUS DISEASES Pseudodementia
Pain
 Adult immunisation schedule Importuniing (whingeing, complaining)
Nihilistic
 Polymerase chain reaction(dav-) Endogenous
Secondary (i.e. cancer at the head of the
 Interferon (dav-)
pancreas, bronchogenic cancer)
 Pyrexia of unknown origin ** (dav-298) Syndromal

 Liver biopsy  Psychiatric review of symptoms-

"Dpressed Patients Seem Anxious, So Claim
 Larva migrans * * (dav-375) Psychiatrists":

 Mycetoma (dav-382) Depression and other mood disorders (major

depression, bipolar disorder, dysthymia)
 Malignant otitis externa * (dav-) Personality disorders (primarily borderline
personality disorder)
Substance abuse disorders
Anxiety disorders (panic disorder with agora-
VIRAL INFECTIONS
phobia, obsessive-compulsive disorder)
 Mumps (dav-319) Somatization disorder, eating disorders
(these two disorders are combined because
 Herpes zoster * (dav-318) both involve disorders of bodily perception)
Cognitive disorders (dementia, delirium)
 Dengue haemorrhagic fever* (dav-322) Psychotic disorders (schizophrenia, delu-
sional disorder and psychosis accompanying
 Japanese encephalitis( transmission & depression, substance abuse or dementia)

prevention)* (dav-328)

25
 FLASH-Final Leap into A Safe Hand

 C/F & complications of IMN (dav-320)

 Paul bunnell test * (dav-321)

 Rashes-Time of appearance after
 Management of rabid dog bite (dav- fever onset
―Really Sick Children Must Take No
1206) Exercise‖
 Prevention of rabies (dav-1206) Rash will appear after

 Erisypeals (dav-1277) Day 1-Rubella

Day 2- Small pox/ scarlet fever
Day 3- Chickenpox
Day 4- Measles(koplik spots one day
BACTERIAL INFECTIONS prior to rash)
 Food poisoning (dav-341) Day 5-Typhus & Rickettsia
Day 6-Nothing
 Toxic shock syndrome* (dav-331) Day 7-Enteric fever Tetanus: treat-
ment for infection SAD RAT:
 Super antigens (dav-) Sedation
 Gas gangrene (dav-) Antitoxin
Debridement
 Septic shock Relaxant
Antibiotic
 Brucellosis treatment (dav-334) Tracheostomy
 Relapsing fever (dav-336)
 Pneumonia: causes: gram negative
 Leptospirosis *** (dav-336)
vs. gram positive Gram Negatives
 Weils disease (eg coliforms) are responsible mainly
for Nosocomial pneumonia.
 Plague (dav-338) Gram positives (eg strep pneumonia,
staph) are thus more responsible for
 Typhoid *** (dav-339) community acquired pneumonia.
 Widal test ** (dav-340)
 Influenza infection: clinical manifes-
 Vaccines for typhoid (dav-340) tations "Having
Flu Symptoms Can Make Moaning Chi
 Dysentery * (dav-345) ldren
A Nightmare":
 Diphtheria-serum sickness (dav-345) Headache
 Malignant pustule * (dav-) Fever
Sore throat
 Botulism * (dav-) Chills
Myalgias
 Tetanus * (dav-) Malaise
Cough
 Leprosy ** (dav-347) Anorexia
 Lepra reaction*** (dav-348) Nasal congestion

 Lepromin test (dav-349)



26
 FLASH-Final Leap into A Safe Hand

 National leprosy control programme

(dav-349)
 UTI-causing microorgan-
 Leonic facies (dav-348) isms KEEPS:
Klebsiella
 Weil felix reaction *** (dav-) Enterococcus faecalis/ Enterobacter
cloacae
 Biological warfare * (dav-346) E. coli
 Congenital syphilis (dav-419) Pseudomonas aeroginosa/ Proteus
mirabilis
 Shigellosis (dav-345) Staphylococcus saprophytic-
cus/ Serratia marcescens
 MRSA * (dav-330)
 Psedomonas aeruginosa: fea-
 Loffler’s syndrome (dav-)
tures AERUGINOSA:
 Brucellosis (dav-333) Aerobic
Exotoxin A
Rod/ Resistance
UTIs, burns, injuries
PROTOZOAL INFECTIONS Green-blue dressings
Iron-containing lesions
 Malaria –fever (dav-353)
Negative gram
 Quantitative buffy coat (dav-355) Odor of grapes
Slime capsule sometimes (in CF pt)
 Cerebral malaria *** (dav-356) Adherin pili
 Toxoplasma gondii: manifestations
 Treatment of malaria (includes chemo- "My Cat Eats Mice":
prophylaxix ) **** (dav-356) Mononucleosis-like illness
Chorioretinits/ Congenital infection
 Complications of malaria (dav-357) Encephalitis
Myocarditis
 Hepatic amoebiasis trtmnt * (dav-368)
 Endocarditis: indications for sur-
 Strongyloidosis (dav-370)
gery PUS RIVER:
 Ivermectin (dav-) Prosthetic valve endocarditis (most
cases)
 Neurocysticercosis * (dav-380) Uncontrolled infection
Supporative local complications with
 Hydatid disease hydatid cyst ** (dav- conduction abnormalities
Resection of mycotic aneurysm
380)
Ineffective antimicrobial therapy (eg
FUNGAL INFECTIONS Vs fungi)
Valvular damage (significant)
 Oral candidiasis (dav-383) Embolization (repeated systemic)
Refractory congestive heart failure


27
 FLASH-Final Leap into A Safe Hand

HIV INFECTION & AIDS

 Opportunistic infections (dav-394)

 AIDS pathogens (T-cell suppres-
 CD4 counts in HIV (dav-393) sion) worth knowing
"The ma-
 AIDS dementia complex (dav-) jor Pathogens Concerning Complete T
-Cell Collapse":
 Cutaneous manifestations of HIV (dav- Toxoplasma gondii
397) M. avium intracellulare
Pneumocystis carinii
 Oral manifestations of HIV (dav-398) Candida albicans
Cryptococcus neoformans
 Oral candidiasis* (dav-398) Tuberculosis
CMVCryptosporidium parvum
 Oesophageal candidiasis (dav-399)

 Pneumocystic carinii* (dav-400)

 HIV infection: high-risk groups HIV:
 PML (dav-402) Homosexuals/ Hemophiliacs
IVdrug abusers
 Kaposi sarcoma * (dav-397)

 Diarhoea in HIV patients (dav-)

 Endotoxin features ENDOTOXIN:
 Diagnosis of HIV (dav-399) Endothelial cells/ Edema
Negative (gram- bacteria)
 Anti retroviral drugs * (dav-407) DIC/ Death
Outer membrane
 HAART * * * (dav-408) TNF
 Adverse effects of quinolones (dav- O-antigen
X-tremely heat stable
409) IL-1
Nitric oxide/ Neutrophil chemotaxis

SEXUALLY TRANSMITTED INFECTIONS

 Klebsiella
 Non gonococcal urethritis (dav-) : "Get UPS you fat alcoholic":
UTI
Pneumonia
Sepsis
Fat capsule
Get up=nonmotile since no flagella.
Alcoholic=commonly seen
in alcoholicand nosocomial patients.

28
 FLASH-Final Leap into A Safe Hand

RESPIRATORY DISEASE

 ARDS * criteria * (dav-192)

 Chest X-ray analysis
 Clubbing ―ABCDEF‖
Airways (hilar adenopathy or
 Respiratory failure (dav-663) enlargement)
PLEURAL EFFUSION*** (dav-661) Breast shadows/ Bones (rib frac-
tures, lytic bone lesions)
 Light’s criteria* (dav-662) Cardiac silhoutte (cardiac
enlargement)/ Costophrenic angles
 Pleural tap (dav-) (pleural effusions)
Diaphragm (evidence of free
 Obstructive sleep apnoea air)/ Digestive tract
 Sleep apnoea syndrome * Edges (apices for fibrosis, pneu-
mothorax, pleural thickening or
 Positive pressure ventilation plaques)/ Extrathoracic tissues
Fields (evidence of alveolar fill-
 Mechanical ventilation ing)/ Failure (alveolar air space
disease with prominent vascularity
ASTHMA (dav-666) with or without pleural effusions)
 Life threatening features of a/c severe
 Asthma treatment
asthma (dav-667) ―ASTHMA‖
Adrenergic agonists
 Management ** (dav-669) Steroids
Theophylline
 Leukotriene antagonist * (dav-670)
Hydration
 Status asthmaticus** (dav-) Masked oxygen
Anticholinergics
 Aminophylline (dav-669)
 Croup: symptoms
COPD* Rx * 3 S's:
 Alpha 1 antitrypsin defici ency* (dav- Stridor
Subglottic swelling
673) Seal-bark cough

 Xray findings (dav-675) 

BRONCHIECTASIS * (dav-678)

 Bronchictasis sicca (dav-679)

PNEUMONIA * (dav-682)

 Community acquired pneumonia (dav-

682)

 Pathogenesis (dav-682)

 Nosocomial infection (dav-685)

29
 FLASH-Final Leap into A Safe Hand

 Pathological stages (dav-687)

 Atypical pneumonia (dav-687)

 Lung cancer: main sites for distant
 Lung abscess * (dav-687)
metastases
TUBERCULOSIS* (dav-688)
“BLAB”
 Miliary tuberculosis (dav-689)
Bone
 X-ray findings in pulm Tb (dav-693)
Liver
 Lab diagnosis (dav-696) Adrenals
 BCG vaccination (dav-696) Brain
 Tuberculin testing(dav-695)

 Mantoux test **(dav-695)  Clubbing- respiratory causes

 Chemoprophylaxis (dav-693) “ABCDEF”
 Drug resistance (dav-696) A-Abscess (ling)
 MDRTB ** (dav-696)
B-Bronchiectasis
CA LUNG* (dav-699)
C-Cancer (lung)
 Paraneoplastic syndrome (dav-)
D- Decreaed oxygen (hypoxia )
 Atelectasis
E-Empyema
 X ray findings in Ca (dav-703)
F-Fibrosing alveolitis


 Coal workers pneumonia (dav-720)

 Caplan’s syndrome (dav-712) 

 Pneumoconiosis (dav-716)

 Silicosis (dav-719)

 Sarcoidosis ** (dav-709)

 Pulmonary eosinophilia* (dav-)

 Pulmonary thrombo embolism (dav-

722)

 DVT-prevention ** (dav-723)

 Empyema (dav-662)

 Pyothorax (dav-662)

30
 FLASH-Final Leap into A Safe Hand

 Pneumothorax**(types,Mx) * (dav-729)

 Cheyne stokes breathing (dav-544)  Anemia (normocytic): causes

―ABCD‖
Acute blood loss
BLOOD DISEASE Bone marrow failure
Chronic disease
 APTT* (dav-999) Destruction (hemolysis)
 Splenomegaly- causes *** (dav-1006)  Anemia causes (simplified)
 Massive splenomegaly * (dav-) ―ANEMIA‖
Anemia of chronic disease
 Thrombocytopenia (dav-1007) No folate or B12
Ethanol
 Pancytopenia (dav-1008) Marrow failure & hemaglobi-
nopathies
 Platelet transfusion(dav-1012) Iron deficient
 Blood transfusion (dav-1011) Acute & chronic blood loss

 Components in blood (dav-1012)  Pentad of TTP---“FAT RN”

 Iron deficiency anaemia (dav-1021) Fever

 Parenteral iron therapy (dav-1023) Anemia

Thrombocytopenia
 Pernicious anaemia (dav-1025)
Renal
 Megaloblastic anaemia-Rx * (dav-1026)
Neuro changes
 Anaemia due to chronic renal failure

(dav-1023)  Haemolytic anaemia –types

 Coomb’s test (dav-1030)
 Vaccination for post splenectomy pa-
tients (dav-1028)
 Sickle cell disease* (dav-1032)
 Sickle cell crisis (dav-1032)
 Exchange transfusion (dav-1033)
 Thalassemia ***(dav-1034)
 Acute leukemia- Rx *(dav-1036)
 Bone marrow transplantation(dav-1017)
 Graft versus host reaction (dav-1018)
 CML –Rx *** (dav-1039)
“PIT SHEET”
P-paroxysmal nocturnal hemoglobinuria
I-Immune hemolytics (warm Ab, cold Ag)
T-trauma to RBCs
S-sickle cell
H-hereditory spherocytosis
E-enzyme deficiencies (G6PD, pyruvate
kinase )
E-erythroblastosis fetalis
T-thalassemia (alpha, beta)


31
 FLASH-Final Leap into A Safe Hand

 Reed Sternberg cells(dav-1042)

 Tear drop cells (dav-1048)

 Thalassemia
 Interferon * (dav-1039)
“THAL “
 Myelodisplastic syndrome * (dav-1041)
T-Target cells
 Hodgkins lymphoma (dav-1042)
H-Howell jolly bodies
 Burkitt’s lymphoma(dav-1043)

 Paraproteinemias (dav-1045)
A-Anisocytosis

 Multiple myeloma ** (dav-1046) L-Low MCV (hypochromic mi-

 MM-diagnosis * (dav-1047) crocytic anaemia)

 Bence jones protein (dav-477)

 Aplastic anaemia –Rx * (dav-1048)  Disseminated intravascular co-

agulation—causes
 Treatment of polycythemia vera (dav-
― DIC TEAR ―
1049) D-related to Delivery
 ITP –Mx * (dav-1050) I-Infections/ Immunological
C- Cancer
 Splenectomy (dav-1050) T-Toxemia of pregnancy
 Haemophilia* (dav-1051) E-Emboli (amniotic)
A-Abruptio placenta
 Basophilic stippling (dav-999)
R-Retained fetal parts
 Heinz bodies1031

 Bone marrow aspiration (dav-1048)  TTP –clinical features

 Von willebrand disease (dav-1053) “PARTNER “
 DIC * (dav-1055) P-Platelet count low
 Anti phospholipid syndrome (dav-1055) A-Anemia (microangiopathic hemo-
 DVT ** (dav-1009)
lytic
 Warfarin (dav-1020)
R-Renal failure
 LMW heparin (dav-1018)
T-Temperature rise
N-neurologic deficit
ER-Emergency admission




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 FLASH-Final Leap into A Safe Hand

MUSCULOSKELETAL DISEASE

 Rheumatoid factor*** (dav-1067)

 Thrombotic thrombocytopenic pur-
 Antinuclear antibodies** (dav-1067)
pura- signs--―FAT RN‖
 Alkaline phosphatase* (dav-1066) F-Fever
A-Anaemia
 Electromyography * (dav-1068)
T-Thrombocytopenia
 Cyclooxygenase isoenzymes(dav-1078) R- Renal problems
 Selective cox2 inhibitors (dav-1078)
 Splenomegaly causes
 DMARD (dav-1102) ‖CHIMP‖
C-cysts
 Sulfasalazine (dav-1102)
H-haematological
 TNF alpha antagonist * (dav-1102) (eg:CML,myelofibrosis)
I-Infective (viral, bacterial)
 Steroid therapy- side effects * (dav-
Metabolic/ misc (amyloid, gaucher‘s)
1079) Portal hypertension
 LE cell (dav-)
 Accessory muscles of respiration
 RHEUMATOID ARTHRITIS (dav-1096) ―PASS SALT‖
P-Pectoralis major
 Criteria(dav-1097)
A-Alae nasi
 Hand deformities in RA (dav-1098) S-Sternocleido mastoid
S- Scalene
 Extra articular manifestations of RA
S-Serratus anterior
(dav-1099) A-Abdominal muscles
L-Lattissimus dorsi
 Neurological manifestations of RA
T-Trapezius
(dav-1099)

 Ocular lesions in RA (dav-1099)

 Osteoarthritis: x-ray signs
 Management (dav-1101) ―LOSS‖
Loss of joint space
 DMARD in RA (dav-1102) Osteopyhtes
Subcondral sclerosis
 Felty’s syndrome* (dav-1100) Subchondral cysts
 

 Sero negative spondyloarthropathy

(dav-1104)

 Ankylosing spondylitis (dav-1105)

 Reiter’s syndrome * (dav-1107)

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 FLASH-Final Leap into A Safe Hand

 Psoriatic arthritis** (dav-1108)

GOUT**  Nodes in arthritis

 Hyperuricemia (dav-1087)  ―HD‖-High Definition
H-Heberden
 Gouty tophi (dav-)1088
D-DIP (dital interphalangeal joint)
 Acute gouty attack (dav-1088)  ―BP‖
B-Bouchard
 Colchicine (dav-1089)
P-proximal interphalangeal joint )
 Renal manifeastations of gout (dav-
 Gout vs. pseudogout: crystal lab
1088) findings
 Pseudo gout* (dav-1088) Pseduogout crystals are:
Positive birefringent
 Septic arthritis (dav-1094) Polygon shaped
 Gout therefore is the negative needle
 Radiological features in osteoporo- shaped crystals. Also, gout classically
strikes great Toe, and its hallmark
sis(dav-1120) is Tophi.
 Osteoporosis- diagnosis(dav-1122)
 SLE –sign and symptoms
 Bone mineral density (dav-1065) ―MD SOAP BRAIN‖
M-malar rash
 Steroids in medicine (dav-)
D-discoid rash
 Osteomalacia (dav-1125) S-serositis(pleuritis, pericarditis)
O-oral ulcers
 SLE
A-arthritis
 Diagnostic tests (dav-1111) P-photosensitivity
B-blood (anaemia, leuko-
 Hematological manifestations (dav-
penia,thrombocytopenia)
1110) R-renal
A-ANA
 CREST syndrome* (dav-1112)
I-immunologic (DS DNA)
 Respiratory compli if systemic sclero- N-neurologic (psych, seizures)
sis(dav-1112)
 Epidermis layers
 X ray changes in scleroderma (dav- ―CoLGate Super Brush‖
From superficial to deep
1113)
C-Corneum
 Polymyositis (dav-1114) L-Lucidium
G-Granulosum
 Sjogren syndrome (dav-1114)
S-Spinosum
 ANCA (dav-1118) B-Basale

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 FLASH-Final Leap into A Safe Hand
 Henoch scholein purpura ** (dav-
1119)
 Charcot’s joint *** (dav-1133)
 Stills disease* (dav-1104)
 Juvenile rheumatoid arthritis (dav-1103)
 Anti phospholipid antibody syndrome
(dav-)

SKIN DISEASE
 Tinea versicolar (dav-1280)
 Urticaria* * (dav-1290)
 Psoriasis *** (dav-1286)
 Scabies **(RX)* (dav-1280)
 Exfoliative dermatitis* (dav-)
 Xanthoma (dav-1302)
 Beau’s line (dav-1298)
 Pemphigus (nikolski’s sign) ** (dav-
1294)
 Erythema nodosum (dav-1303)
 Acanthosis nigricans (dav-1303)
 Erythema marginatum (dav-615)
 Toxic epidermal necrolysis(TEN) (dav-
1292) *
 SSSS (dav-1276)
 Patch test (dav-1285)
 Leonine facies
DRUGS
 Adverse effects of quinolones (dav-157)
 Side effects of dapsone (dav-158)
 Chloramphenicol * (dav-151)
 Adv effects of sulphonamide (dav-130)
 Atropine
 Causes acute renal failure (ARF)
Mnemonic: ACUte
A ATN/Acute GN
C Circulatory dysfunction (i.e.
shock – hypovolaemia, sepsis, car-
diogenic)
U Urinary outflow obstruction
 Clinical presentation of chronic ren-
al failure
Mnemonic: RESIN & 8 Pʼs
R Retinopathy
E Excoriations (scratch marks)
S Skin is yellow
I Increased blood pressure
N Nails are brown
P Pallor
P Purpura and bruises
P Pericarditis and cardiomega-
ly
P Pleural effusions
P Pulmonary oedema
P Peripheral oedema
P Proximal myopathy
P Peripheral neuropathy
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 FLASH-Final Leap into A Safe Hand

ESSAY questions

1) A 18 yr old female is admitted with h/o

has pallor, clubbing and mild
swelling of limbs, puffiness of face and
splenomegaly.
decreased urine output with normal
 Your prov diagnosis?
blood pressure.
 What are the signs you look for
 What is the provisional diag-
?
nosis?
 How will you investigate this pa-
 What is the immunological in-
tient ?
jury ?
 What treatment will you start
 Investigations?
empirically?
 Management ?
INFECTIVE ENDOCARDITIS
GLOMERULONEPHRITIS

4) A 34yr old lady presents with 4 month

2) A 30yr old man admitted with head-
history of weight loss increased sweat-
ache, giddiness , vomiting of 2days du-
ing and amenorrhoea. On examina-
ration. His BP was 180/100mm of Hg.
tion, she has neck swelling, tremor and
 Provisional diagnosis?
tachycardia.
 What are the common causes
 Your provisional diagnosis?
of secondary hypertension ?
 Eye manifestations ?
 Investigations ?
 Complications that you suspect
 Management ?
?
SEVERE HYPERTENSION
 Name the blood investigations ?

 How will you manage the crisis

3) A 40yr old male patient with rheumatic
?
vavular heart disease was admitted
THYROTOXICOSIS
with one month fever. On examination

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 FLASH-Final Leap into A Safe Hand

5) A 15yr old patient on insulin for diabe- 8) A 14yr old boy is admitted with fe-

tes mellitus was brought with vomiting, ver,headache and vomting for 3

abdominal pain and altered sensorium. days.physical examination showed

 Diagnosis? neck rigidity and kronig’s sign

 d/d?  What is the most likely diagnosis ?

 what are the precipitating factors  What is the most important inves-

? tigation to confirm the diagnosis?

 management ?  List three causes of meningism ?

DIABETES MELLITUS MENINGITIS

6) a 55yr old male chronic alcoholic is 9) A 20 yr old boy is admitted with al-

admitted with h/o jaundice and disten- leged poisoning. Physical examination

sion of abdomen . O/E white nails, spi- shows pulse rate of 30/min only

der naevi and ascites  What is your diagnosis?

 what is your likely diagnosis?  Antidote?

 what investigations are useful?  Management ?

 How will you manage the case ? OP POSINING

 Anticipated complications?

LIVER CIRRHOSIS 10) A 40yr old farmer presents with 5days

fever, jaundice , oliguria and hemopty-

7) A 24yr old female is admitted with sis. On examination he has icterus,

chest pain, palpitation, breathlessness subconjunctival hemorrhage and bilat-

followed by weakness of left half of eral rales

body  What is the most likely diagno-

 What is the provisional diagnosis? sis?

 Common causes of young stroke ?  d/d?

 Management ?  treatment ?

STROKE LEPTOSPIROSIS

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 FLASH-Final Leap into A Safe Hand

11) `A 40yr old manual labourer is admit-  d/d?

ted with trismus  Investigations ?

 List 2 d/d?  Management ?

 Treatment ? BRONCHIAL CARCINOMA

 Management ?

TETANUS 15) A 32YR OLD lady presents with bilat-

12) A 52YR OLD diabetic presents with eral hand and wrist joint pain of 1 yr

fever, pleuritic chest pain and rusty duration associated with morning stiff-

coloured sputum. ness. On examination she has de-

 Your diagnosis? formities of hand joints.

 Common etiological agents ?  Your provisional diagnosis?

 What are the clinical features ?  Systemic manifestation s?

PNEUMONIA RHEUMATOID ARTHRITIS

13) A 25yr old malnourished adult pre- 16) A 50 yr old, alcoholic male has come

sented with evening rise of tempera- to the hospital with haematemesis.

ture, chest pain , breathless ness and a ) Diagnosis b) Investigation c)

cough of 2 weeks duration Complication d) Management

 What is the prov diagnosis? PORTAL HYPERTENSION WITH AL-

 Enumerate the investigations ? COHOLIC LIVER DISEASE

 Complication s?

TUBERCULOSIS 17) A 20 yr old female with H/o migratory

polyarthritis, palpitation and dyspnoea,

14) A 45 yr old male presented with h/o had loud S1,with mid-diastolic murmur

loss of weight, chest pain and hemop- at apex

tysis for 4 month. O/E he I having de- a) Diagnosis b) Investigation c) Man-

creased respiratory movements on age d) Anticipatcd complications e)

right side with tony dullness Prophylaxis

 Your provisional diagnosis? RHEUMATIC HEART DISEASE

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 FLASH-Final Leap into A Safe Hand

21) A 40 yr old female with loss of weight

18) A 45 year old male alcoholic for 20 yrs with good appetite, palpitation tremor,

is admitted with Haematemesis and sweating, diagnosis other clinical fea-

ascites a) Diagnosis b) c/f c) tures, investigations, treatment

Causes of haematemesis in an alco- THYROTOXICOSIS

holic cases? d) Manage-

ment e) Complications 22) A 55yr old female, diabetic for 15yr

PORTAL HYPERTENSION WITH AL- came with acute onset of right hemi-

COHOLIC LIVER DISEASE paresis which progressed over few

hours to a complete hemiplegia

19) A 55 yr old male old alcoholic is admit- a) what furher investigations is required in

ted with H/o jaundice and distention of her history b)aetiological factors c) in-

abdomen. O/e white nails spider naevi vestigations d) Rx

and ascites a) Diagnosis b) Etiology

c) Manage d) Complications e) Con-

23) A 12 year old boy gives history of re-
trairrdications of liver biopsy
current haemarthrosis from childhood
CHRONIC LIVER DISEASE
a) diagnosis, b) mode of inheritance

c) investigations d) Rx
20) A 22 yr old pt with H/o rheumatic multi
HAEMOPHILIA
valvular lesion with irregular pulse pre-

sents with sudden loss of concious-

24) A 50yr old female patient presented
ness, deviation of angle of mouth to
with bilateral small joint pain and swell-
left and weakness of right half of the
ing of hands and feet with morning
body a ) Diagnosis b) etiology c)
stiffness, has splinted deformity of fin-
clinical signs d) Investigation e)
gers and ulnar deviation of fingers
Management
a) Diagnosis b) investigations c)
RHEUMATIC HEART DISEASE WITH AF
Rx d) deformities of hand
CAUSING EMBOLIC STROKE.
RHEUMATOID ARTHRITIS

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 FLASH-Final Leap into A Safe Hand

a) Diagnosis b) which coronary ves-

25) A 30year old man was brought to the sel is likely to be involved c) inves-

casuality in a comatose state. On ex- tigations d) management

amination both pupils are small, respi- ACUTE CORONARY SYNDROME

ration was decreased. His breath and

gastric lavage were odourless 28) A 25 year old male with DOE, exer-

a) diagnosis b) D/D c) management tional palpitation and frequent chest in-

d) how will you monitor the case fections now presents with fever since

3 weeks, loss of appetite and loss of

weight; arthralgia. O/E pallor +, club-

bing +, a PSM at the apex,

26) A 25year old man was brought to the splenomegaly +

casuality with sweating and froth com- a) diagnoisis b) clinical findings, c)

ing from the mouth. Wheezing present, aetiological agents d) management

pupils are pin point. Muscle fascicula-

tion. a) Diagnosis, b) how can you con-

firm the diagnosis c) management 29) A 55 yr old chronic smoker presents

OP POISONING with history of low grade fever, mal-

aise, fatigue and cough with haemop-

27) A 50 year old male, a known diabetic tysis of 3 weeks duration and loss of

and hypertensive, presents with sud- weight. O/E: pallor +, post tussive

den onset of epigastric pain, nausea & rales in Rt supraclavicular, infraclavi-

vomiting. He gives history of retroster- cular and axillary area.

nal discomfort with pain in the throat a) What is the most likely diagnosis?

and left shoulder on exertion and sex- b) What other possibilities will you

ual intercourse O/E HR- 50/min keep in mind?

,irregular ; BP-120/80 mm of Hg c ) What are the clinical features of the

disease? (signs & symptoms)

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 FLASH-Final Leap into A Safe Hand

d) What are complications you can ex- half of the body including the face.

pect? She gives H/o exertional dyspnoea, fa-

e) What are the main investigations tigue and palpitation for the past l0

you will you like to ask for? What are years. O/E: pulse : l20/min, irregular

the likely findings ? with varying volume; BP- I l0/70 rnm of

f) What are the main pathological va- mg

rieties of the disease? a) Diagnosis?

g) Outline the main modalities of Rx. b) Predisposing factors ?

CA LUNG c) Management ?

d) Complications associated with the

30) A 45 year old male smoker with history disease ?

of high grade fever, malaise, headache CVA WITH ATRIAL FIBRILLATION

and dry cough is presenting with in-

crease in dyspnoea, vomiting and 32) A 50 year old lady under treatment for

streaky blood stained sputum. severe asthma for a long time pre-

a) What are the likely diagnosis? sented with back pain ,which was se-

b) Mention the predisposing factors for vere. Her face was puffy and she had

the condition. protuberant abdomen.

c) What are the other possibilities to be a) What is the Iikely diagnosis?

kept in mind? b) What may be the cause of back

d) What investigations are to be asked pain

for? c) What metabolic abnormality do you

e) how will you treat the patient? expect ?

f) Comment on the C/f and Rx of se- d) what investigations will you like to

vere pneumonia perform ?

PNEUMONIA

31) A 38 year old female presents with 33) A 62 yr old patient presented with

sudden onset of weakness of the left dyspnoea& altered sensorium . he is a

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 FLASH-Final Leap into A Safe Hand

chronic smoker. Cough with expecto-

ration for past 10years. Cyanosis and

flapping tremor + diagnosis, investi-

gations, treatment, complications ?

RESPIRATORY FAILURE

34) A 30 years old female presented to the

hospital with H/o fever 3 days duration.

o/e, jaundice, hepatosplenomegaly,

generalised bodyache, subconjunctival

bleeding and oliguria

(a) What is your diagnosis ?

(b) Organisrn responsible for this dis-

ease?

(c) Mention the full C/f

(d) Mention the treatment

LEPTOSPIROSIS

35) DKA

36) STATUS EPILEPTICUS

37) FE DEFANAEMIA

38) A 15yr old boy pc of swelling around eyes decreased

urine op and hdache of 1wk drn.1.diag 2.dd 3
confirmn 4. Rx
NEPHRITIC SYNDROME

20yr old lady c o fevr myalgia oliguria of one

wk.she is jaundiced and congested
conjunctiva
Dx dd inv rx
LEPTOSPIROSIS
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 FLASH-Final Leap into A Safe Hand

CASE FORMAT
Identification : name, age, sex , occupation

Chief complaints: cough/expectoration/hemoptysis/breathlessness,chest pain,fever

History of presting illness :

Past history: DM,HTN, PTB, Asthma, jaundice,

Family history: Diet,Bowel & bladder habits. Loss of appetite, loss of weight, sleep distur-

bances.

Occupational history:

Treatment history:

Menstrual history:

GENERAL EXAMINATION

Conscious, cooperative, oriented to time, place, person.

Pallor(P), icterus(I), clubbing(C), cyanosis(C), lymphadenopathy(L), edema (E)

Lymphadenopathy?

VITALS

Pulse- Rate, rhythem, volume, character, blood vessel thickening, radiofemoral delay. Peri-

pheral pulses.

Blood pressure: mm of Hg @ right arm supine position

Respiratory rate: __resp/min, Abdomino-Thoracic in Males (ATM)

Temperature: afebile or record the temp

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 FLASH-Final Leap into A Safe Hand

RESPIRATORY SYSTEM EXAMINATION

UPPER RESPIRATORY TRACT

Flaring of nasal alae

Nasal septum deviation

Sinus tenderness

LOWER RESPIRATORY TRACT

I)Inspection:

Shape of chest : Normally it is bilaterally symmetrical.

Position of trachea: Usually central in position. A slight shift towards right is normal.

Movements of chest wall: Normally chest moves equally on both sides.

Apex beat: lt is defined as the lowermost and outermost point on precordium where definite

cardiac impulse can be seen or felt. In adult normally it is seen or felt in 5th left intercostal

space 1cm medial to midclavicular line.

Acessory muscles of respiration:

Drooping of shoulder:

Supraclavicular hollowing:

Infraclavicular flattening :

Intercostals indrawing:

Spine: central, no kyphosis, scoliosis,

II) Palpation

Position of trachea: Place the middle finger of the right hand over the laryngeal prominence

and the index and ring finger on the sternoclavicular joints on either side. Trace the trachea

downwards

Position of the apex beat : Palpate the apex beat

Movement of chest wall: Placing the finger tips of both hands on either side, so that the tips

of the thumbs just meet in the midline in front of the chest. The distance of movement of the

thumb from the midline indicate the extent of expansion.

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 FLASH-Final Leap into A Safe Hand

Measurements: chest circumference, hemithorax circumference,Anteroposterior diameter,

transverse diameter.

Expansion of chest: Using a measuring tape at the level of nipple measure during inspira-

tion and expiration.

Tactile vocal fremitus : It is the vibration transmitted from the trachea and bronchus to the

chest wall which is appreciated with the ulnar border of hand. Here, ask the patient to say

"one", or '99' repeatedly while placing the ulnar border of the paim over the chest wall on

corresponding areas on either side of chest.

Intercostals tenderness:

III)Percussion:

@ supraclavicular, clavicular, infraclavucular,mammary, axillary, infraaxillary, scapular, in-

frascapular, interscapular.

Chest area- normal lung resonance in either side with equal intensity

Liver dullness- upper border of liver dullness is on the right 5th intercostals space in the

mid-clavicular line

Liver span:

Cardiac dullness- Left border corresponds to apex beat. Right border corresponds to right

margin of sternum. Normally, right 2nd intercostals space is resonant (in pulmonary hyper-

tension –dullness)

IV) Auscultation

Character of breath sounds

a) Over chest : Normal vesicular breath sound

b) Over trachea : Normal bronchial breath sound

Adventitious sounds: crepitations/ rhochi/ rub

Vocal resonance : Ask the subject to say 'one, one' repeatedly and auscultate different

areas in corresponding areas of both sides

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 FLASH-Final Leap into A Safe Hand

CARDIO VASCULAR SYSTEM EXAMINATION

I)Inspection:

Shape of chest :

Shape of precordium : any precordial bulge?

Site of apex beat :

Pulsations:Visible left parasternal pulsations, visible epigastric pulsations, viible left 2nd ICS

pulsations

Any scars, dilated vein, sinus :

Spine abnormalities: :

II) Palpation

Position of apex beat :

Character of apex beat : whether tapping,forceful or heaving.

Palpable Left parasternal heave : Medial aspect of palm is kept over the to feel for an

impulse termed as left parasternal heave

Palpable epigastric pulsations, palpable left 2nd ICS pulsations:

Palpability of heart sounds : eg: 2nd heart sound is palpable in pulmonary area in pulmo-

nary hypertension.

Thrills : A thrill is a palpable murmur.

f)other pulsations :

III) Percussion :

Left border : It corresponds with apex beat

Right border : Pleximeter finger is placed on the right side of the chest in the 2nd ICS

, 4 -5 cms away from sternum and note the resonance.

Upper border: Resonant note is obtained over clavicle. Normally left 2nd ICS shows reson-

ance.

Lower border : It is in relation with diaphragm and left lobe of liver below it, Hence it cannot

be defined by percussion,

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 FLASH-Final Leap into A Safe Hand

IV) Auscultation :

Mitral area : S1 & S2 sounds are heard – normal intensity (S1 louder).

No additional sounds and no murmer/click/pericardial rub

Tricuspid area : S1 & S2 sounds are heard – normal intensity (S1 louder).

No additional sounds and no murmer

Pulmonary area : S1 & S2 sounds are heard – normal intensity (S2 louder).

No additional sounds and no murmer

Aortic area : S1 & S2 sounds are heard – normal intensity (S2 louder).

No additional sounds and no murmer

CENTRAL NERVOUS SYSTEM EXAMINATION

1.HIGHER FUNCTION-COMISH

Right/left handed person

Level of Consciousness : conscious

Orientation of time,place,&person : oriented

Memory short term - : normal

Long term - : normal

Intelligence : normal

Speech : normal

Delusion and Hallucinations : no delusions and hallucinations

2.EXAMINATION OF CRANIAL NERVES

Cranial nerve Cranial nerve testing Right L
Olfactory nerve I Test for sense of smell ef
Visual acuity t
Optic nerve II Distant vision
Near vision
Field of vision
Colour vision (ishihara chart)
Presence of squint, nystagmus, & ptosis
Occulomotor III
Size Normal
Trochlear IV
Pupil Shape Round

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 FLASH-Final Leap into A Safe Hand

Abducent VI position Central

Extraocular movements in all directions
Direct
Light reflex Indirect
Accomodation reflex
Test for sensory functions (over the face)
Sensation over face
Test for reflex
Corneal reflex
Trigeminal V
Conjunctival reflex
Jaw jerk
Test for motor functions
Ask the patient to clench his teeth (masseter,temporalis)
Ask the patient to open his mouth-(med & lat pterygoid)
Test for sensory function
Taste sensation over ant 2/3rd
Test for motor functions
Look for wrinkling over forehead
Ask the subject to close his eyes tightly &then tell him to open
Facial nerve VII
it against resistance
Look for nasolabial folds
Ask the subject to smile
Ask the subject to inflate both cheeks
Ask the subject to whistle
Look for any deviation of angle of mouth Not deviated
Hyperacusis
Watch test
Vestibule-cochlear rinnes
Rinne’s test
nerve VIII Weber’s test
Schwabach’s test
Test for sensory functions
Glossopharyngeal Taste sensation over post 1/3rd
nerve IX Sensation of mucous membrane of soft palate & palate
Test for motor functions
Pharyngeal reflex (gag reflex)
Nasal regurgitation
Vagus nerve X Nasal tone to voice
Position of uvula
Dysphagia
Palatal reflex
Ask the subject to shrug his shoulders against resistance
Spinal-accessory XI Ask the subject to turn his head against resistance with a hand
nerve on sideforofany
Look facefasciculations,wasting & tremors of tongue
Hypoglossal nerve Movement of tongue
XII Look for any deviation on protrusion of tongue
Look for protrusion of cheek on pushing with cheek

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3.EXAMINATION OF SENSORY SYSTEM

Superficial sensation

Pain

Touch

Temperature

Deep sensations

Joint sense, fine touch

Vibration sense, position sense

Cortical sensation

Tactile localization

Point discrimination

Streognosis : It is the ability to recognize common objects like pen, pencil, key etc.,

with eyes closed.

Graphasethesia

4.EXAMINATION OF MOTOR SYSTEM

R L

A.Attitude Upperlimb
Lower limb
Upper Arm
B.Bulk: Circumference of different parts of the
limb Forearm
limb is measured
Lower Thigh
limb Calf
C.Tone : :resistance against opassive stretch Upper limb
Lower limb
Elbow Flexion
D.Power Extension
UL Abduction
Adduction
Shoulder Supination
Pronation
Hip Flexion
Extension
Knee Flexion
Extension
LL Ankle Dorsi flexion
Plantar flexion
Supination
Eversion

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E.COORDINATION OF MOVEMENTS

Upper Limbs
Finger nose test : normal on both sides
Dysdiadochokinesia : normal
Lower limbs
Heel knee test : normal on both sides
Romberg' s sign : normal (negative)

F.INVOLUNTARY MOVEMENTS : not present (fasciculations, tremor, chorea, atheto-

sis, hemiballismus,

G.GAIT :

H.EXAMINATION OF REFLEXES :

Reflexes are classifieds in to 3 types

Superficial , deep and visceral/sphincteric reflexes

Superficial reflex

a) Conjunctival reflex : Blinking of eyes on both sides

b) Corneal reflex : Blinking of eyes on both sides

c) Pupillary reflex

Direct light reflex :

Indirect light reflex :

Accommodation reflex :

d) Superficial abdominal reflexes: Contraction of underlying abdominal muscles

e) Plantar reflex : Flexor plantar reflex on both sides

f) Anal reflex : not tested

g) Cremasteric reflex : not tested

h) Bulbo-cavernosus reflex : not tested

Deep reflex

a) Knee jerk : Brief extension of knee, caused by contraction of quadriceps

b) Ankle jerk : Contraction of calf muscles

50
 FLASH-Final Leap into A Safe Hand

c) Triceps jerk : Contracts causing etension

d) Biceps jerk : Contracts causing flexion of elbow and supination of forearm

e) Supinator jerk : Sudden flexion and supination of forearm

f) Jaw jerk : Absent Brudzunski’s sign

Sphincteric reflexes :

Deglutition reflex : normal

Micturition reflex : normal GASTRO INTESTINAL SYSTEM

Defaecation reflex : normal ORAL CAVITY

Clonus a) Hygiene b) teeth-caries, den-

Patellar clonus : not present ture,c) gum-blleding ? d) tongue-n

Ankle clonus : not present size, surface, colour e) palate

f)tonsil g) halitosis
5.CEREBELLAR SIGNS
INSPECTION
Head
Shape :
Nystagmus
Abdominal distension :
Scanning of speech
Movement – all quadrants moves equally
Titubation
with respiration
Upper limb
Umbilicus- central, inverted/everted
Intention tremor
Visible masses:
Dysdiadokokinesia
Visible gastric peristalsis:
Rebound phenomenon
Visible pulsations/dilated veins:
Lower limb

Knee heel incordination Hernia orifices: normal

Pendular knee jerk

PALPATION
Tandem walking
Local rise of temperature
6.SKULLL & SPINE
Tenderness:

7.MENINGEAL SIGNS Rigidity:

Neck stiffness Guarding :

Kernig’s sign Rebound tenderness:

51
 FLASH-Final Leap into A Safe Hand

Tender spot : AUSCULTATION

Palpate for liver : position, direction, Bowel sounds: 2-3/min

edge, consistency, Venous hum/ bruit:

Palpate for spleen : position, direction,

edge, consistency

PERCUSSION

Liver dullness:
DIFFERENTIAL DIAGNOSIS::
Liver span :

Fluid thrill/ shifting dullness:

52
FLASH-Final Leap into A Safe Hand

GENERAL
SURGERY

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 FLASH-Final Leap into A Safe Hand

According to KUHS,
Theory Paper I 30 +30(ortho)
Theory Paper II 60
Theory- Internal assessment 30
Practicals 100
Practicals- Internal assessment 30
Viva voce ( 4 Stations) 20
TOTAL 300

THEORY
Surgery- GIT
Paper I Orthopaedics
Paper II General Surgery (except GIT), Anaesthesia,
Radiotherapy, Dental

MODEL QUESTION PAPER

SURGERY I
I Long Essay 1×5 5
II Short essays 2×6 12
III Clinical situation 1x3 3
IV Short notes (5 nos) 5×2 10
TOTAL 30
ORTHOPAEDICS
I Long Essay 1x6 6
II Short essays 4x3 12
III Short notes 6x2 12
TOTAL 30
60

SURGERY II
I 1.Essay 1×15 15
2.essay 1x5 5
II Short essays 2×4 8
III Short notes (4 nos) 4x3 12
IV Answer briefly 10×2 20
TOTAL 60

PRACTICALS

Long case 50
Short case(surgery1,ortho-1) 2x20=40 100
OSCE (Surg-1, Ortho-1) 2x5=10
X ray 5
VIVA VOCE Instruments(surg+ortho) 5
Operative procedures 5 20
Specimen 5

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 FLASH-Final Leap into A Safe Hand

Important topics

SRB-SRB‘s manual of surgery- 4th edi-

tion by SRIRAM BHAT

M-Manipal manual of surgery -4th edi-

tion by SHENOY  Central abdominal pain
If it’s acute here are some possible
PAPER I causes:
PERITONEUM “Your Terrible Ties Make Gas in Ura-
 Mesenteric cyst * (srb-611,m-658) nus”

 Sub diaphragmatic abscess (srb- Your -Yersinia

Terrible -Tuberculosis
609,m-648)
Ties -Typhoid
 Pneumo peritoneum(m-655)
Make- Meckel’s
 Laproscopy * (srb-603,m-643)
Gas -Gastroenteritis
IN- INflammatory bowel disease
ABDOMINAL TUBERCULOSIS
(IBD)
 Tuberculous lesions of intestine(srb-
Uranus- URinary tract infection
615,m-673)

 Management of ileo cecal tuberculo- And if it’s chronic the causes may in-
sis(srb-618,m-673) clude:

 Tuberculous peritonitis** (srb-621,m- Sticking Radios in Cranes Can End

the Burglaries
671)
Sticking- Adhesions
LIVER
Radios- Radiation
 Segmental anatomy of liver(srb-628,m-
In -Ischaemia of bowel
526) Cranes- Crohn’s
 Amoebic liver abscess(srb-631,m-519) Can -Cancer
 Portal hypertension** (srb-651,m-537) End -Endometriosis

 Porto systemic anastomosis*(srb- The -Burglaries TB

652,m-538)

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 FLASH-Final Leap into A Safe Hand

 Modified child’s criteria (m-540)

 Liver abscess *(srb-631,m-517)

 Gallstones
 Surgical cause of abdominal disten- Another anonymous aide memoire for
the risk factors for gallstones.
sion * The 5 Fs
Fair
 Budd chiari syndrome**(srb-664,m- Fat
Female
546)
Forty
 TIPSS (m-542) Fertile

GALL BLADDER  Jaundice

When taking a history from somebody
 ERCP *** (srb-671,m-570) with jaundice you may find the
mnemonic CATHODES helpful.
 Choledochal cyst (srb-675,m-580)
CATHODES
 Gall stones ** (types, comp,Rx) (srb- C Contacts
A Anaemia
679,m-552) T Travel
H Had it before
 Saint’s traid (srb-680,m-553) O Operations
D Drugs (including recreational intra-
 Cholecystitis ** (srb-684,m-556)
venous use)
 Mucocele of GB* (srb-688,m-557) E Extra-hepatic causes (e.g. gall-
stones, sickle cell)
 Murphy’s sign (srb-689,m-557) S Sexual preference

 Mirizzi’s syndrome (srb-683,m-562)  Meckel‘s diverticulum

 Biliary stones(srb-690,m-554)
 Charcot’s triad *** (srb-691)
 Calot’s triangle * (srb-970,m-551)
 T tube (srb-692)
 CBD stones *** (srb-690,m-556)
 CBD exploration (srb-693)
 Courvoisier’s law *** (srb-694,m-567)
 Obstructive jaundice ** (srb-695,m-
565)
 Surgical causes of obstructive jaundice
This is part of the vitello-intestinal duct
which completely disappears in
98% of the population. It causes compli-
cations such as perforation, and
haemorrhage from peptic ulceration, ob-
struction (as it contains cells
similar to those from stomach or pan-
creas).
A Meckel‘s diverticulum follows this rule
of 2s.
Rule of 2s
2% of the population affected
2 to 1 male to female ratio
2 inches long
2 feet from the iliocaecal valve (on the
antimesenteric border of the small in-
testine)

(srb-695,m-566)

 Surgical jaundice *** (srb-695,m-575)

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 FLASH-Final Leap into A Safe Hand

 Biliary stricture* (srb-697,m-577)

 Carcinoma gall bladder (srb-699,m-

 Pancreatitis – acute causes
562) ―GET SMASHED‖
G- gall stones
 Cholecystectomy (srb-705,m-559)
E-ethanol (most imp cause)
 Laproscopic cholecystectomy (srb- T-trauma
S-steroids
706,m-562)
M-mumps
A-autoimmune
SPLEEN S-scorpion stings
H-hyperlipidemia/ hypercalcemia
 Splenic rupture ** (srb-712,m-619) E-ERCP
 Kehr’s sign (srb-713,m-620) D-drugs

 Splenectomy (indi & compli) ** (srb-

 CHILD –PUGH CLASSIFICATION
720,m-622)
"Pour Another Beer At Eleven":
 Emergency splenectomy (srb-721,m-
PT
622)
Albumin
 OPSI (srb-722,m-632)
Bilirubin
 Hypersplenism (srb-723,m-628)
Ascites

PANCREAS Encephalopathy

Scoring (each is either 1, 2 or 3 points):

 Acute pancreatitis *** (srb-727,m-597)
 Cullen sign ** (srb-728,m-601)
 a/c pancreatitis-Complications * (srb-
732,m-605)
 Ranson’s criteria* (srb-733,m-602)
 Pseudocyst of pancreas** (srb-735,m-
607)
 Juraz operation **
PANCREATIC CARCINOMA
 Investigations(srb-750,m-591)
PT (greater than 12 sec.): 1-3 or 4-6 or
>6.
Albumin: >3.5 or 2.8-3.5 or less than 2.8
Bilirubin: less than 2 or 2-3 or >3.
Ascities: none or slight or moderate
Encephalopathy: none or 1-2 (subjective)
or 3-4 (subjective)
· Interpretation:
Class A: 5-6 points (candidate for surgi-
cal liver resection).
Class B: 7-9 points (consider chemoem-
bolization or RFA).
Class C: 10-15 points (consider options
in B or no therapy).

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 FLASH-Final Leap into A Safe Hand

 Treatment of CA head of pancreas

(srb-752,m-593)  Femoral triangle

Contents (medial to lateral)
 Carcinoma –ampulla of vater (srb-
―VAN‖
748) V-Vein,
A-Artery,
 Whipples operation* (srb-753,m-593)
N-Nerve
 Billroth I & II operation. (srb-754)
 Hernias of Abdominal Wall Think of
 Roux-en Y anastomosis (srb-754)
the abdomen as a bucket,
 Whipple’s triad* (srb-756,m-596) or PAIL that contains the viscera.
These are the four groups of hernias:
 Annular pancreas* (srb-759,m-610)
Pelvic hernias: obturator, perineal,
 Zollinger Ellison syndrome (srb- sciatic
Anterior hernias: epigastric, inci-
758,m-596)
sional, Spigelian, supravesical,
umbilical
Inguinal hernias: indirect, direct,
ABDOMINAL WALL & UMBILICUS femoral
 Meckel’s diverticulum**** (srb-786, m- Lumbar hernias: inferior lumbar trian-
gle (Petit), superior lumbar
742 ) triangle (Grynfelt)
 Desmoid tumour (srb-791)
 Inguinal mass: differen-
tial "Hernias Very Much
HERNIA
Like To Swell":
Hernias (inguinal, femoral)
 Anatomical types of inguinal hernia Vascular (femoral aneurysm,
sapheno varyx)
(srb-800, m-844) Muscle (psoas abscess)
 Inguinal canal * (srb-804,m-842) Lymph nodes
Testicle (ectopic, undescended)
 Internal ring occlusion test (srb-804,m- Spermatic cord (lipoma, hydrocoele)

848)  Haematocele: etiology 3T's and

2 H's:
 Inguino scrotal swelling (srb-805) Tumor
 Herniotomy (srb-807,m-851) Torsion
Trauma
 Herniorraphy (srb-808,m-851) Hydrocele as a complication
Haemophilia (blood diseases)
 Inguinal hernia-compli * (srb-816,m- 
854)

 TAPP (srb-815)

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 FLASH-Final Leap into A Safe Hand

 TEP (srb-815)

 Strangulated hernia ** Mx* (srb-  Oesophageal cancer risk fac-

817,m-855)
tors PC BASTARDS:
Plummer-Vinson syndrome
 Ritcher’s hernia (srb-818,m-858) Coeliac disease
Barrett's
 Maydle’s hernia (srb-818,m-858) Alcohol
 Sliding hernia *** (srb-820,m-858) Smoking
Tylosis
 Hernia englisade (srb-820) Achalasia
Russia (geographical distribution)
 Femoral hernia*** (srb-822,m-860)
Diet
 Incisional hernia*** (srb-825,m-866) Stricture
 Umbilical & paraumbilical hernia (srb-
 Inguinal mass: differen-
829,m-863)
tial "Hernias Very Much
 Mayo’s operation * (srb-173,m-866) Like To Swell":
Hernias (inguinal, femoral)
Vascular (femoral aneurysm, sa-
OESOPHAGUS
pheno varyx)
Muscle (psoas abscess)
 Haematemesis-causes (srb-893) Lymph nodes
 Bleeding oesophageal varices (srb- Testicle (ectopic, undescended)
Spermatic cord (lipoma, hydro-
893) coele)
 GERD/GORD ** (srb-842,m-432)

 Hiatus hernia * (srb-847,m-435)  Haematemesis

GUM BLEEDING
 Reflux oesophagitis (srb-848,m-438) Gastritis,
 Barret’s oesophagitis*** (srb-849,m- Ulcer,
Mallory-Weiss
437) Biliary (Haemobilia),
 Achlasia cardia **** (srb-850,m-441)
Large varices,
Esophagitis,
 Tracheo oesophageal fistula* (srb- Entero-aortic fistula,
Duodenitis,
857,m-447) IBD,
 Mallory weis syndrome * (srb-856,m- Neovascularisation,
Gastric carcinoma
484)

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 FLASH-Final Leap into A Safe Hand

STOMACH

 Stomach- blood supply (srb-870,m-  GI bleeding: caus-

461)
es ABCDEFGHI:
Angiodysplasia
 H.pylori* (srb-875,m-464) Bowel cancer
Colitis
 Virchow’s node(m-462) Diverticulitis/ Duodenal ulcer
 Visible gastric peristalsis (srb-885) Epitaxis/ Esophageal (cancer,
esophagitis, varices)
 Ramsted’s operation (srb-886) Fistula (anal, aortaenteric)
Gastric (cancer, ulcer, gastritis)
 Treatment of chronic duodenal ulcer*
Hemorrhoids
(srb-886,m-471) Infectious diarr-
hoea/ IBD/ Ischemic bowel
 Peptic ulcer-compl (srb-878,m-467)

 Mayo’s operation (srb-173)  Pyloric stenosis (congential):

presentation Pyloric
 Surgical procedure for peptic ulcer(m-
stenosis is 3 P's:
479) Palpable mass
Paristalsis visible
 Perforation of duodenal ulcer-Mx * Projectile vomiting (2-4 weeks af-
(srb-887,m-477) ter birth)

 Bleeding duodenal ulcer-MX (srb-  Pertoneum Facts

891,m-478)
 Haematemesis ** (srb-893)
 Trichobezoars (srb-898,m-509)
 Upper GI bleeding –causes ** (srb-
1061,m-480)
CA STOMACH (m-488)
 Pre malignant lesions (srb-903,m-488)
 Modes of spread (srb-906,m-490)
 Krukenberg tumour (srb-907)
 Linitis plastica (srb-908,m-491)
 D2 dissection (srb-912,m-498)
 Management**(srb-911,m-495)

The idea is to relate key letters of
related parts...
stOMach and OMentum (which
lays over the stomach)
The bacterium e. coLI is found in
the Large Intestine
The OMentum covers the stOM-
ach
The Lesser OMentum holds the
Liver and stOMach
The Mesentery holds the sMall in-
testine
The mesoCOLON attaches the
large intestine (COLON) to the
posterior abdominal wall.
The periTONEa, which prevents
the intestines from kinking,
TONES the GI tract.

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 FLASH-Final Leap into A Safe Hand

 Pyloroplasty (srb-918)

 Gastrostomy* (srb-918,m-505)

 Gastrojejunostomy (srb-920,m-503)  Vomiting: extra GI differential

VOMITING:
 Vagotomy (srb-920,m-503) Vestibular disturbance/ Vagal (re-
flex pain)
Opiates
Migrane/ Metabolic (DKA, gas-
SMALL INTESTINE troparesis, hypercalcemia)
Infections
Toxicity (cytotoxic, digitalis toxicity)
 Meckel’s diverticulum *** (srb-922,m- Increased ICP, Ingested alcohol
744) Neurogenic, psychogenic
Gestation
 Meckel’s diverticulectomy* (srb-

924,m-743)  Ulcerative colitis: definition of a

 Crohn’s disease (srb-925,m-683) severe attack A STATE:
Anemia less than 10g/dl
 Typhoid perforation-compl (srb-929) Stool frequency greater than 6
stools/day with blood
 Intestinal perforatation -causes* -Mx * Temperature greater than 37.5
(srb-929) Albumin less than 30g/L
Tachycardia greater than 90bpm
 Carcinoid tumour * (srb-939,m-692) ESR greater than 30mm/hr

LARGE INTESTINE
 Ulcerative colitis –complications
―PAST COLITIS‖
 Hirschprung’s disease (srb-949,m-758)
P-Pyoderma gangrenosum
 Ramsted’s operation (srb-954,m-506) A-ankylosing spondylitis
S-sclerossing pericholangitis
 Ulcerative colitis-compli, Mx (srb-
T-Toxic megacolon
957,m-677) C-colon carcinoma
 Rectal polyp * (srb-961) 

 Adenomatous polyp (srb-963,m-704)

 Familial adenomatous polyposis * (srb-

963,m-705)

61
 FLASH-Final Leap into A Safe Hand

CA COLON ** (srb-964)

 Predisposing factors (srb-964,m-708)  Intestinal obstruction-symptoms

Vomit PAD
 Aetiological factors (srb-965,m-709) Vomit Vomiting
P Pain
 Duke’s staging (srb-967,m-712) A Absolute constipation
 Mx*** (srb-973,m-716) D Distended

 CA left side of colon (srb-972,m-711)  Abdominal distension (causes)

The 6 Fs
 Left hemicolectomy (srb-972,m-716) A Flatulent Fat Fetus Floats in Fluid
 Colostomy****(types, compli)* (srb- Faeces

975,m-716)
 Dukes cancer staging
INTESTINAL OBSTRUCTION Dukes staging for colon cancer (modi-
fied) goes like this:
 Intestinal obstruction ** (srb-983,m- DUKESA A-OK (best prognosis) – in
bowel wall only
729) DUKESB Breached Bowel wall
DUKESC Colonic regional nodes
 Closed loop obstruction (srb-986,m- DUKESD Distant metastases
734)

 Radiological findings in intestinal ob-

 GI obstruction
struction (srb-987,m-735) PV D&C
Pain,
 Intussusception** (srb-994,m-749)
Vomiting,
 Volvulus (srb-997,m-740) Distension,
Constipation
 Sigmoid volvulus** (srb-997,m-765)

 Paralytic ileus** (srb-1000)

 Small bowel obstruction
 Pseudo intestinal obstruction(m-765)
SHAVIT
 Meconium ileus (srb-792,m-761) Stone,
Hernia,
Adhesions,
Volvulus,
Intussusception,
Tumour


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 FLASH-Final Leap into A Safe Hand

VERMIFORM APPENDIX
 Appendicitis: Alvarado's scoring
 Acute appendicitis*** (Mx) * (srb- system for diagnosis
MANTRELS:
1006,m-826)
Migratory pain (1)
 Alvarado scoring (srb-1011) (MAN- Anorexia (1)
Nausea (1)
TRELS) Tenderness (2)
Rebound tenderness (1)
 Appendicular mass **** (srb-1014,m- Elevated temperature (1)
Leucocytosis (2)
832)
Shift to left (1)
 Interval appendicectomy(srb-1013) · Score 3-4 = no appendicitis. Score
5-6 = doubtful. Score 7 or more =
 Appendicular abscess** (srb-1015,m- appendicitis is confirmed.
834)
 Appendicectomy: complica-
 Oschner-sherren regimen*** (srb- tions WRAP IF HOT:
1015,m-833) Wound infection
Respiratory (atelectasis, pneumonia)
 Pseudo myxoma peritonei* (srb- Abscess (pelvic)
Portal pyemia
1016) Ileus (paralytic)
Fecal fistula
Hernia (r. inguinal)
Obstruction (intestinal due to adhe-
sions)
RECTUM AND ANAL CANAL Thrombus (DVT)
 Pouch of douglas –clinical significance
 Bleeding PR
(srb-1020,m-773) Haemorrhoidal DRAIN
 CA RECTUM** (srb-1023,m-774) Haemorrhoids,
Diverticulitis,
 Duke’s staging (srb-1024,m-778) Radiation enteritis,
AV malformation,
 Anterior resection (srb-1028) Ischaemia,
 APR (srb-1027,m-779) Neoplasm

 Hartmann’s operation(srb-1028,m-784)  Fistulas: conditions preventing

closure FETID:
 Rectal prolapse ** (srb-1030,m-787) Foreign body
Epithelialization
 Solitary rectal ulcer (srb-1029,m-778)
Tumor
 Anal stenosis (srb-1031) Infection
Distal obstruction
 Pilonidal sinus *** (srb-1036,m-804) 

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 FLASH-Final Leap into A Safe Hand

 Fissure in ano *** (srb-1046,m-802)

 Sentinel pile* (srb-1048)

 Pancreatitis
 Perianal abscess (srb-1049,m-798)
GET SMASHED
 Ischiorectal abscess *** (srb-1050,m- Gallstones / Gravid,
798) Ethanol,
Trauma (incl. surgery)
 Fistula in ano *** (srb-1051,m-799) Steroids,
 Goodsall’s rule *** (srb-1053,m-800) Mumps,
Autoimune (PAN),
 Carcinoma anal canal* (srb-1057,m-
Scorpion bites,
806) Hyper-lipid / calcium / hypo-
thermia,
 Bleeding per rectum- causes* , inves-
ERCP,
tigation ** (srb-1063) Drugs (azothioprine, thiazide
 diuretics)

Ronson’s criteria for

above:
ACUTELY
What A GAL
↑WCC
↑Age
↑Glu
↑AST
↑LDH

> 48 hours
FUCH BO
↑Fluid sequestered (>6L)
↑Urea (>10mmol)
↓Ca2+ (<2mmol)
↓Haematocrit (>10%)
↑Base XS (>-4)
↓O2 (<8kPa)

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 FLASH-Final Leap into A Safe Hand

PAPER II

GENERAL SURGERY  TPN indications "MISIPPI Burn-

ing":
Major visceral injury
WOUNDS IBD
Sepsis
 Wound healing* (srb-5,m-4) Ileus
Post-op
 Wound healing by secondary intention Paralysis
Intestinal fistula
(srb-6,m-4) Burns
 Factors influencing wound healing*  Compartment syndrome: signs
and symptoms · 5 P's:
(srb-7,m-6) Pain
Palor
 Wound dehiscence (srb-13) P ulseless
 Delayed primary closure of wounds Paresethesia
Pressure (increased)
(srb-14,m-6)

 Crush syndrome* (srb-10)

 Prophylactic antibiotics
 Hypertrophic scar * (srb-12,m-8)
APPLE
 Keloid *** (srb-11,m-8) Amputations,
Prosthesis,
 Difference b/w hypertrophic scar & ke- Penetrating wounds,
Large bowel surg,
loid (srb-12,m-8) Endocarditis
 Compartment syndrome (srb-8,m-8)

ULCERS  Leg Ulcers
VAIN PAIN
 Edges of ulcer (srb-14,m-16) Venous,
Arterial,
 Non healing ulcer* (srb-15) Infection (e.g. syphilis),
Neuropathic
 Management of ulcer (srb-19,m-63) Pressure sores,
Arthritis (e.g. RA, PAN),
 Trophic ulcer (srb-21,m-64)
Injury / IDB,
Neoplastic
INFECTIOUS DISEASES

 Carbuncle*** (srb-47,m-23)

 Tetanus *** (srb-49,m-33)

 Paronychia (srb-50,m-41)

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 FLASH-Final Leap into A Safe Hand

 Gas gangrene ** (srb-53,m-36)

 Actinomycosis * (srb-56,m-51)  Oedema causes: genera-

 Hutchinson triad (srb-56,m-54)
 Madura foot *** (srb-57)
 Nosocomial infections * (srb-61,m-26)
 Universal precaustions against HIV
transmission (srb-65,m-56)
SWELLINGS
 Lipoma *** (srb-71,m-214)
 Dermoid cyst* (srb-75,m-234)
 Epidermal cyst (srb-79,m-236)
 Wen (srb-79,m-236)
 Desmoids tumour * (srb-82,m-882)
 Oedema causes: localised ALIVE:
ELECTROLYTE AND NUTRITION
 Fluids and electrolytes (srb-96,m-200)
 Hypokalaemia** (srb-97,m-204)
lised "HILARI IS SAVE" (Hilary):
Heart failure
Iatrogenic
Liver causes
Aldosterone increased/ ADH in-
creased
Renal cause
Inadequate protein in blood (hypoal-
buminaemia)
· Causes for the inadequate protein in
blood are:
Intake Inadequate (Kwashiorkor)
Secretion fro pancreas decreased
(pancreatitis)
Synthesis decreased (liver failure)
Absorption decreased (Crohn's dis-
ease)
Vomit (pyloric stenosis)
Excretion increased (nephrotic)
Allergic (angio-oedema)
Lymphatic (elephantiasis)
Inflammatory (infection, injury)
VEnous (DVT, chronic venous insuf-
ficiency)

 Crystalloids and colloids in surgery

 TPN indications "MISIPPI Burning":
(srb-124,m-206) Major visceral injury
IBD
 Fresh frozen plasma (srb-124,m-178) Sepsis
Ileus
 BMI (srb-106) Post-op
 Parenteral nutrition * (srb-105,m-209) Paralysis
Intestinal fistula
 TPN *** (srb-104,m-209) Burns


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SHOCK

 SIRS ** (srb-117)  Diabetic ketoacidosis: precipitating

 Vasovagal shock (srb-113,m-175) factors · 5 I's:
 Septic shock (srb-114,m-172) Infection

 MODS* (srb-117) Ischaemia (cardiac, mesenteric)

Infarction
HAEMORRHAGE AND BLOOD TRANS- Ignorance (poor control)
FUSION Intoxication (alcohol)

 Secondary haemorrhage (srb-121,m- Whipple's disease: clinical mani-
festations SHELDA:
171) Serositis
 Blood components *** (srb-124,m-178) Hyperpigmentation of skin
Eating less (weight loss)
 Blood transfusion-complication (srb- Lymphadenopathy
Diarrhea
125,m-170) Arthritis
 Blood transfusion reactions*** (srb-
 Liver failure (chronic): signs found on
126,m-180)
the arms CLAPS:
BURNS Clubbing
Leukonychia
 Wallace’s rule of nine * (srb-130,m-
Asterixis
187) Palmar erythema
 Curling’s ulcer ** (srb-134,m-187) Scratch marks
 Pathology of burn (srb-132,m-185)

 Complications ? (srb-134,m-188)  Splenomegaly: causes CHIMP:

Cysts
 Management (srb-135,m-187)
Haematological ( eg CML, myelofi-
TRAUMA brosis)
Infective (eg viral (IM), bacterial)
 Triage * (srb-143)
Metabolic/ Misc (eg amyloid, Gauch-
 Glasgow coma scale (srb-1175) ers)
 ATLS * (srb-145) Portal hypertension


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HAND AND FOOT

 Paronychia** (srb-160,m-41)  Arterial thrombus

The P signs
 Terminal pulp space infection * (srb- Pale/pallor
161,m-43) Painful
Pulseless
 Deep palmar space infection (srb- Paralyzed
Paraesthesia
162,m-45) Perishing with cold!
 A/c tenosynovitis (srb-164,m-45)  Ulcers: edge types F PURE:
 Kanavel sign (srb-164,m-46) Flat (eg venous)
Punched-out (eg trophic, arterial)
 Ingrowing toe nail (srb-172,m-46) Undetermined (eg pressure, TB)
Rolled (eg BCC)
Everted (eg SCC)
ARTERIAL DISEASES
 4P's of stopping bleeding
 Scalene triangle (srb-174,m-100)
PRESSURE
 Thoracic outlet syndrome * (srb- PACKING
PRESSOR
174,m-100)
PRAY
 Boyd’s grading (srb-176,m-77)

 Rest pain (srb-176,m-77)

 Critical limb ischaemia (srb-177,m-89)

 Pre gangrene (srb-177,m-105)

 Gangrene –types * (srb-177,m-107)

 Dry gangrene * (srb-177,m-76)

 Line of demarcation ** (srb-178)

 Harvey’s sign (srb-178)

 Lerich’s syndrome ** (srb-178)

 Investigations in arterial occlusive dis-

eases * (srb-179,m-92)

 ABPI* (srb-180)

 TAO *** (srb-184,m-82)

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 Raynaud’s phenomenon *** (srb-
188,m-98)
 Horner’s syndrome *** (srb-)
 Lumbar sympathectomy * (srb-194,m-
87)
 Brown’s vasomotor index * (srb-)
 Embolism (srb-197)
 Fat embolism * (srb-201,m-94)
 Aneurysm ** (srb-202)
 Diabetic foot-gangrene* (srb-213)
HAMARTOMA AND VASCULAR LESION
 Hemangioma ***** (srb-221)
 Cavernous hemangioma (srb-223)
VENOUS DISEASES
DEEP VEIN THROMBOSIS ****
 Risk factors (srb-231,m-140)
 Treatment (srb-233,m-141)
 Prophylaxis (srb-235,m-142)
VARICOSE VEIN(srb-235)
 Saphena varix (srb-238)
 Tests for varicose veins (srb-238,m-
131)
 Investigations (srb-240,m-133)
 Treatment ** (srb-242,m-133)
 Raynaud‘s phenomenon
Raynaud‘s disease is most common in
young women (60–90% of reported
cases) and is idiopathic, hence:
Raynaud‘s Disease we Don‘t know
Phenomenon has a Pathological
cause
Some of the causes are listed here,
made more memorable by this naughty
mnemonic.
My Servant‘s Vibrator‘s So Cold, Ergo
Dames
Thighs Are Nervous
My Malnutrition
Servant‘s Cervical rib
Vibrator Vibrating tools
So Subclavian aneurysm and Steno-
sis (cause
emboli)
Cold Cold exposure and Collagen dis-
eases
Ergo Ergot
DaMes Diabetes Mellitus
Thighs Thyroid deficiency
Are Atherosclerosis/Buerger‘s dis-
ease
Nervous Neurological causes (e.g.
spinal cord
disease)
 Varicose veins: symp-
toms AEIOU:
Aching
Eczema
Itching
Oedema
Ulceration/ Ugly (LDS,
haemosiderin, varicosities)
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 Tredelenberg operation (srb-244,m-

136)  Swollen leg: unilateral swelling

causes TV BAIL:
 Complications *** (srb-240,m-137) Trauma
Venous (varicose veins, DVT,
 Venous ulcer –management * (srb-
venous insufficiency)
250,m-138) Baker's cyst
Allergy
 Bisgard’s regime* (srb-250,m-139) Inflammation (cellulitis)
Lymphoedema
 Varicose ulcer-compl (srb-,m-138)

 Migrating thrombophlebitis (srb-251)  Oedema causes: general-

ised "HILARI IS SAVE" (Hilary):
LYMPHATICS Heart failure
Iatrogenic
Liver causes
 Lymphoedema ** (srb-257,m-110) Aldosterone increased/ ADH in-
 Aetiological classification of lymphoe- creased
Renal cause
dema (primary, secondary) (srb- Inadequate protein in blood (hy-
poalbuminaemia)
257,m-111) · Causes for the inadequate pro-
tein in blood are:
LYMPHOMAS (srb-264,m-111) Intake Inadequate (Kwashiorkor)
 Classification (srb-265,m-111) Secretion fro pancreas decreased
(pancreatitis)
 Clinical staging of hodgkin’s lympho- Synthesis decreased (liver failure)
Absorption decreased (Crohn's
ma** (srb-266,m-120) disease)
Vomit (pyloric stenosis)
 Ann arbor staging * (srb-267,m-120) Excretion increased (nephrotic)
 Investigations (srb-267,m-119)

 Management *** (srb-268,m-120)

 Oedema causes: local-
 Chyluria (srb-271,m-124) ised ALIVE:
Allergic (angio-oedema)
PERIPHERAL NERVES Lymphatic (elephantiasis)
Inflammatory (infection, injury)
 Tinel’s sign (srb-275) VEnous (DVT, chronic venous in-
sufficiency)
 Carpel tunnel syndrome(srb-276)

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NEOPLASM  Immune suppressive therapy (srb-355)

 FNAC * (srb-289)

 Melanoma
SKIN TUMOURS
―A-B-C-D–BITCHES‖
A Asymmetry (irregular)
 Premalignant lesions of skin *** (srb- B Border (notched, indistinct or ul
cerated)
298,m-145)
C Colour (increasingly variegated,
 Marjolin’s ulcer (srb-302,m-145) especially black/grey)
D Depth (of invasion)
 Basal cell carcinoma/ Rodent ulcer ** B Bleeding
(srb-303,m-146) I Itching (persistent)
T Tethering
 MOHS ** (srb-306,m-149) C Colour
H Halo
 Naevus (srb-307,m-155)
E Eczema-like features
 Junctional naevus * (srb-307,m-156) S Size (rapidly increasing) and Sat
ellites (presence of)
 Malignant melanoma **** (srb-309,m-

156)  Melanoma sites "Mel SEA"

(Pronounced "Mel C" from the
 MM-types, Mx * (srb-310,m-159) Spice Girls)
· Melanoma sites, in order of
 Kaposi sarcoma (srb-328,m-165)
frequency:
Skin
AMPUTATION Eyes
Anus
 Below knee amputation (srb-334,m-
 Squamous cell carcinoma
1167) Clinical presentation
 Symes amputation (srb-332,m-1167) ― S, CELL, C‖
S Sun-exposed areas are usu-
ally affected: ears, dorsum of
RECONSTRUCTION
the hands, bald scalp
C Crusted, firm, irregular lesion
 Skin grafting-types * (srb-340) E Excision used as treatment
 Split thickness skin graft * (srb-340)
L Lower lip can be affected in
smokers
L Less likely to metastasise
TRANSPLANTATION C Associated with Chronic in-
flammation such as venous leg
 Graft versus host reaction* ulcers
 Allograft rejection * (srb-359,m-1109)

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FACIOMAXILLARY DISEASE

 Fracture of mandible (srb-378)  Endotracheal intubation: diagnosis

 Epulis (srb-382)
 Dentigerous cyst (srb-385)
ORAL CAVITY
 Rannula ** (srb-389)
 Plunging ranula (srb-389)
 Leukoplakia * (srb-392,m-273)
of poor bilateral breath sounds
after intubation DOPE:
Displaced (usually right mainstem,
pyreform fossa, etc.)
Obstruction (kinked or bitten tube,
mucuous plug, etc.)
Pneumothorax (collapsed lung)
Esophagus

 Erythroplakia (srb-393)

 Premalignant conditions of oral cavity

(srb-394,m-273)  Respiratory complications of

anaesthesia: patients at risk
CA TONGUE* (srb-417,m-283)
COUPLES:
SALIVARY GLANDS COPD
Obese
 Sialography* (srb-434,m-1050,m-
Upper abdominal surgery
306) Prolonged bed rest
 Salivary calculi * (srb-435,m-306) Long surgery
 Ranula ** (srb-389) Elderly

 Sialectasis * (srb-437,m-304) Smokers


 Parotid abscess ** (srb-438,m-304)

 Parotid gland neoplasms (srb-440,m-

307)

 Pleomorphic adenoma ** (srb-441,m-

307)

 Mixed parotid tumour *** (srb-446,m-

307)

 Ectopic salivary tumour (srb-450,m-

311)

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 FLASH-Final Leap into A Safe Hand

 Warthin’s tumour **** (srb-444,m-311)

 Frey’s syndrome * (srb-452,m-314)  Dry mouth: differential "DRI":

·2 of each:
NECK Drugs/ Dehydration
Renal failure/ Radiotherapy
 Waldeyer’s ring (srb-455,m-100) Immunological (Sjogren's)/ Intense
emotions
 Thoracic outlet syndrome** (srb-

456,m-100)

 Cervical rib **** (srb-457,m-101,103)  Branches of the facial nerve

 ―To Zanzibar By Motorcar‖
 Adson’s test (srb-458)

 Branchial cyst*** (srb-459,m-251) T Temporal nerve

Z Zygomatic nerve
 Branchial fistula *** (srb-460,m-253) B Buccal nerve
M Marginal mandibular nerve
 Cystic hygroma *** (srb-464)
C Cervical nerve
 Ludwig’s angina * (srb-465,m-245)

 Thyroglossal cyst* (srb-488,m-247)  Symptoms of hypothyroidism

 Carotid body tumour** (srb-,m-254) Hypothyroidism is 10 times more
common in females & occurs mainly
 Thymoma * (srb-1207) in middle life.
“ MOMʼS SO TIRED
 Sternocleido mastoid tumour (m-255)
M Memory loss
 Tuberculous lymphadenitis *** (srb- O Obesity
M Malar flush/Menorrhagia
470,m-672) S Slowness
 Tuberculous sinus (srb-) S Skin and hair become dry
O Onset is gradual
 Cold abscess **** (srb-474,m-253) T Tired
I Intolerance to cold
 Collar stud abscess *** (srb-475,m-
R Raised blood pressure
21) E Energy levels are low
D Depressed
THYROID

 Lingual thyroid *** (srb-486,m-357)

 Thyroglossal cyst ** (srb-488,m-247)

 Sistrunk operation (srb-488,m-249)

 Thyroglossal fistula ** (srb-488,m-248)

 Lateral aberrant thyroid (srb-489)

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 FLASH-Final Leap into A Safe Hand

 Thyroid function test ** (srb-489,m-  Recurrent laryngeal nerve paralysis

322) (srb-527,m-355)

 Colloid goiter (srb-491,m-326)

 Hyperthyroidism: Signs and Symp-
 Solitary nodule (srb-494,m-350)
toms (mnemonic)-―THYROIDISM‖
 Retrosternal goiter (srb-497,m-331)
T = Tremor
 Hyperthyroidism (srb-499)
H = Heart rate up
 Grave’s disease** (srb-499,m-332)

 Thyrotoxicosis *** (clin feat,Rx) * (srb- Y =Yawning [fatigability]

500,m-331) R = Restlessness

 Classify thyroid neoplasm * (srb- O = Oligomenorrhea & amenorr-

hea
509,m-326)

 Adenoma thyroid (srb-,m-338) I = Intolerance to heat,

 Carcinoma of thyroid ** (srb-509,m- D =Diarrhea

338) I = Irritability
 Treatment of carcinoma thyroid (srb-
S = Sweating
516,m-349)
M = Musle wasting & weight loss
 Medullay carcinoma thyroid (srb-
E = Exophthalmos
518,m-348)

 Papillary carcinoma (srb-518,m-338)

 Hashimoto’s thyroiditis* (srb-519,m-

354)

 Lymphocytic thyroiditis (srb-520,m-

354)

 Reidel’s thyroiditis (srb-520,m-355)

 Thyroidectomy**** (srb-521,m-1163)

 Thyrotoxic crisis/storm *** (srb-

522,m-356)

 Hypothyroidism (srb-526)

 Myxedema (srb-504)

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PARATHYROID & ADRENALS

 Parathyroid adenoma (srb-)

 Breast cancer
 Hyperparathyroidism ** (types)* (srb- D‗s nipple changes1
Deviation
532,m-363)
Depression
 Tetany ** (srb-537,m-362) Destruction
Displacement
 Hypocalcaemia(srb-537,m-364) Deviation
 Hyperadrenalism (srb-538,m-369) Discharge
Duplication
 Addison’s disease (srb-539)

 Conn’s syndrome* (srb-540,m-369)  Treatment options in Metas-

 Pheochromocytoma *(srb-542,m-372) tatic Breast Cancer
―HEROIC‖
 MEN *** (srb-536)

Hormone therapy
Endocrine Manipulation
BREAST Radiotherapy
Oestrogen blockers
 Lymphatic drainage of breast* (srb- Immunotherapy
546,m-378) Chemotherapy

 Mammography *** (srb-547,m-402)  Prognotic factors for cancer:

 ANDI ** (srb-548,m-384) general PROGNOSIS:
Presentation (time & course)
 Fibroadenoma *** (srb-548,m-388) Response to treatment
Old (bad prog.)
 Fibroadenosis ** (srb-551,m-385)
Good intervention (i.e. early)
 Cystosarcoma phylloides ** (srb- Non-compliance with treatment
Order of differentiation (>1 cell
552,m-382) type)
 Fibrocystic disease **** (srb-552,m- Stage of disease
Ill health
385) Spread (diffuse)

 Galactocele (srb-554,m-390)

 Breast abscess ** (srb-556,m-379)

 Antibioma (srb-558,m-381)

 Duct papiloma breast * (srb-562,m-

391)

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 FLASH-Final Leap into A Safe Hand

 Paget’s disese of nipple (srb-567,m-

396)

 CA breast****-staging (srb-573,m-401)
 Hemolytic-Uremic Syndrome
 Peau’d orange (srb-569,m-398)
(HUS): components "Remember
 Triple assessment **** (srb-579,m- to decrease the RATE of IV fluids
in these patients":
400)
Renal failure
 Neo adjuvant chemotherapy (srb- Anemia (microangiopathic, hemo-
586,m-412) lytic)
Thrombocytopenia
 Sentinel lymph node biopsy (srb-
Encephalopathy (TTP)
578,m-480)
 Acute Abdomen
 QUART (srb-582,m-407)
―MEDIC CURSES A MOP‖
 Ductal carcinoma insitu (srb-565,m- Mesenteric Adenitis,
397) Enteritis,
Diverticulitis,

Ischaemic Colitis
Cholycystitis,
KIDNEY
Ulcers,
Renal Colic,
 Microscopic hematuria (srb-1075,m-
Salphingitis,
934) E ctopic Pregnanc y ,
 IVU (srb-1067) Small bowel obstruction
Appendicitis
 Horse shoe kidney (srb-1076,m-935) Meckels Diverticulum,
 Poly cystic kidney disease **** Ovarian Cyst,
Pancreatitis
(srb-1077,m-933)

 Hydro nephrosis** (srb-1084,m-939)

 Renal stones (srb-1089,m-935)

 Stag horn calculus * (srb-1097,m-936)

 Ureteric stones (srb-1094,m-939)

 Wilm’s tumour * (srb-1099,m-946)

 Nephroblastoma (srb-1099,m-946)

 Hypernephroma * (srb-1100,m-947)

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 FLASH-Final Leap into A Safe Hand

URINARY BLADDER

 Urinary diversion (srb-1119,m-961)  Hematuria: differential HEMATU-

 Foley’s catheter * (srb-1120) RIA:
 Vesico-colic fistula (srb-1120) Hereditary (PCK and OWR) / He-

 Ectopic vesicae* (srb-1106,m-959) noch Schonlein purpura

Embolism (infective endocarditis)
 Nerve supply of urinary bladder (srb-
Malignant HTN
1105,m-955)
Acute and chronic glomeruloneph-
PROSTATE
ritis / IgA nephropathy
 Prostate specific antigen * (srb- Tumors / Trauma / Toxic drugs
1121,m-977) Urolithiasis
 BPH *** (srb-1122,m-973) Renal papillary necrosis

 TURP * (srb-1128,m-979) Infection (pyelonephritis, cystitis,

urethritis)
 Prostatitis (srb-1125,m-978)
Anti-coagulants
URETHRA

 Rupture of urethra ** (srb-1129,m-963)

 Management & complications * (srb-

1130,m-963)

 Stricture urethra ****(Mx) * (srb-

1131,m-964)

 Hypospadiasis **(srb-1132,m-967)

 Posterior urethral valve * (srb-1133,m-

968)

 Retention of urine ** (srb-1136,m-968)

PENIS

 Phimosis (srb-1138,m-981)

 Paraphimosis (srb-1139,m-982)

 Circumcision ** (srb-1140)

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 FLASH-Final Leap into A Safe Hand

CA penis (srb-1142,m-982)

 Premalignant conditions (srb-1145,m-  Scrotum: scrotum swelling dif-

982) ferential THE THEATRES:
Torsion
 Treatment (srb-1145,m-984)
Hernia
Epididymytis, orchitis
SCROTUM Trauma
Hydrocoele, varicocele, hema-
 Layer’s of scrotum (srb-1148) toma
 Fournier’s gangrene* (srb-1148,m- Edema
Appendix testes (torsion, hemor-
998)
rhage)
 Hydrocele **-types * (srb-1149,m- Tumour
988) Recurrent leukemia
Epididymal cyst
 Congenital hydrocele (srb-1151,m- Syphilis, TB
988)
 Scrotal layers
 Epididymal cyst **** (srb-1155,m-991)
From superficial to deep
 Epididymoorchitis * (srb-1155,m-991) ―Some Damn Englishman
 Spermatocele (srb-1156) Called It The Testis‖
S-Skin
 Varicocele ****** (srb-1157,m-993)
D-dartos
E-external spermatic fascia
TESTIS
C-cremaster
I-internal spermatic fascia
 Orchiopexy * (srb-1163)
T-tunica vaginalis
 Ectopic testes (srb-1163,m-993) T- testis
 Retractile testes (srb-1164)

 Tortion of testes* (srb-1164,m-994)  Epididmyitis: bacterial causes

 Testicular tumours ** (srb-1165,m- CENT:
Chlamydia trachomatis
994) E. coli
Nisseria gonorrhoeae
 Seminoma * (srb-1166,m-995)
Tuberculos bacteria

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NEUROSURGERY

 Cerebral concussion (srb-1172,m-  Testicular atrophy: differen-

tial TESTES SHRINK:
1036) Trauma
 Glasgow’s coma scale ** (srb-1175,m- Exhaustional atrophy
Sequelae
1037) Too little food
Elderly
 Extradural hematoma* (srb-1177,m-
Semen obstruction
1037) Sex hormone therapy
Hypopituitarism
 Lucid interval **** (srb-1177,m-1037) Radiation
 Subdural hemorrhage (srb-1178,m- Inflammatory orchitis
Not descended
1039) Kleinfelter's
 Battle sign (srb-)

THORAX

 Flail chest ** (srb-1196,m-1010)

 Stove in chest * (srb-1196,m-1011)

 Pneumothorax * (srb-1197,m-1011)

 Intercostal tube drainage (srb-,m-

1013)

 Pericardial tamponade * (srb-1210)

 Diaphragmatic hernia (srb-1211,m-

456)

 CDH (srb-1213)

ANAESTHESIA

 Regional anaesthesia (srb-1235,m-

1091)

 Spinal anaesthesia ****** (srb-

1235,m-1091)

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 FLASH-Final Leap into A Safe Hand

 Epidural anaesthesia ***** (srb-

1236,m-1093)
 Post-operative fever causes Six
 Differ b/w Spinal/ epidural (srb-
1235,m-1091)
 Bier’s block * (srb-1235)
 Complications of GA (srb-1234,m-
1076)
ADVANCED IMAGING TECHNIQUES
 Ultra sound scan (srb-1238,m-1052)
W's:
Wind: pulmonary system is primary
source of fever first 48 hours, may
have pneumonia
Wound: infection at surgical site
Water: check IV for phlebitis
Walk: deep venous thrombosis, due
to pelvic pooling or restricted
mobility related to pain and fatigue
Whiz: urinary tract infection if urinary
catheterization
Wonder drugs: drug-induced fever

 CT scan (srb-1240,m-1051)
 Post-operative complications (im-
 MRI scan ** (srb-1242,m-1052) mediate) "Post-op
PROBS":
Pain
OPERATIVE SURGERY Primary haemorrhage
Reactionary haemorrhage
 Sterilization of instruments** (srb- Oliguria
Basal atelectasis
1244) Shock/ Sepsis
 Suture materials (srb-1256,m-1140)  NG tube removal post op
 Diathermy (srb-1258) 4Ps
Peristalsis,
 Vasectomy (srb-1260,m-1160) Passage of flatus,
 Tracheostomy (srb-1263,m-1161) Paucity of aspirate,
Patient Peckish
 Cryosurgery (srb-1264,m-1180)

 Laproscopic surgery ** (srb-1167,m-

1174)

 (srb-)

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ESSAY QUESTIONS
PAPER 1  treatment ?

1. A 30yr old man is brought to the ca- GALL STONES

suality with history of 7 bout of vomit-

ing of blood. He has history of alcohol- 3. A 40 yr old male attends the casuality

ism. O/E the patient is in shock. He with h/o acute abdominal pain , radiat-

has abdominal distension . aspiration ing to the back. He has history of alco-

yields clear fluid. What are the possi- holism. On examination he is in severe

ble conditions to be considered in the shock.

diagnosis?  Diagnosis?

 What is the emergency manage-  d/d?

ment ?  investigations ?

 Investigations ?  treatment?

 Treatment ? ACUTE PANCREATITIS

PORTAL HYPERTENSION

4. A 60yr old male presents with progres-

2. A 45 yr old female patient presented sive jaundice of 3 months duration.

with yellowish discolouration of sclera There was no fever or abdominal pain.

and urine for three weeks duration. He has severe itching all over the body

She had history of fever , itching and and passes clay coloured stools.

right upper abdominal pain. On exami-  Most probable diagnosis?

nation gall bladder is not palpable  Inmvestigations ?

 Ur diagnosis?  Treatment ?

 What is charcot’s triad ? PANCREATIC CARCINOMA

 d/d?

 investigations ? 5. A 50yr old male patient was brought to

the casuality with sudeden onset of dif-

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fuse abdominal pain. Patient was on ir- ing of 12 hrs duration. On examination

regular treatment for pain epigastrium there is Mcburney’s tenderness.

which relieved by taking food. The pa-  What is your diagnosis?

tient was alcoholic  Emergency treatment ?

 Most probable diagnosis?  Complications ?

 Investigations ?  What is oschner sherren regime ?

 Treatment ? ACUTE APPENDICITIS

DUODENAL ULCER

9. A 60yr old man with past history of rec-

6. A 70yr old man is brought to the ca- tal bleeding was admitted with abdo-

suality with h/o abdominal distension minal pain, vomiting, and constipation.

and constipation of 5 days duration. Is said he lost weight and anorexic.

(hb-6gm/dL) O/E his temperature was 99F , pulse-

 Ur diagnosis? 90/min, BP-150/90 mm of Hg, abdo-

 Investigations ? men was distended with no hepato-

 Discuss the physiology of abdo- megaly. PR was empty.

minal distension ?  Diagnosis?

CA COLON  Investigations ?

 Precancerous conditions of the co-

7. A 40yr old male with acute bowel ob- lon and rectum?

struction since 20 hrs. CA RECTUM.

 What is the purpose of passing

ryles tube ?

 Radiological findings ?

 Treatment ?

BOWEL OBSTRUCTION

8. A 30yr old female is brought to casuali-

ty with symptoms of pain, fever, vomit-

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PAPER II  Ur diagnosis?

 Investigations ?
10. A 50 yr old lady weighing 40kg is
 Treatment ?
brought to the casuality with history of
 Classify salivary gland neoplasms ?
attempted suicide by self immolation.
PLEOMORPHIC ADENOMA
 How do you asses the severity of

injury ?
13. A 30yr old female patient with history
 What is the management, if 60%
of thyroid swelling of 2 months dura-
of the body surface is burnt ?
tion. She had symptoms of palpitation,
 What investigations u prefer ?
excessive sweating, increased apetite,

loss of weight . Examination revealed

uniform thyroid enlargement .

11. A 32 yr old male patient complaints of
 Diagnosis?
pain in the right calf on walking for 2
 Investigations ?
months. He had been a chronic smok-
 Treatment ?
er for 10yrs. O/E he had reduction in
PRIMARY THYROTOXICOSIS
the peripheral pulses in the afceted

lower limb.
14. A 35 yr old male patient came to the
 d/d?
casuality with a pulsatile swelling on
 boyd’s grading ?
the skull with a solitary nodule thyroid
 investigation s?
since 6 months. Sweeling on the scalp
THROMBOANGITIS OBLITERANCE
since 1 month

 Ur diagnosis?
12. A 40yr old man presented with a pain-
 Investigations ?
less swelling below the left ear of 1 yr
 Surgery ?
duration. Examination revealed the
 What is the [ost ioperatrive man-
mass was firm, non tender and was
agement ?
raising the ear lobule . there was no
FOLLICULAR CARCINOMA THYROID
facial nerve paralysis.

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15. A 22yr old female patient presents with  Tumour markers ?

painless lump breast size of 6x6cm  Histological types ?

fixed to the pectoralis major and fixed SEMINOMA TESTES

axillary lymph node on same side. The

duration of illness is 2 months. 18. A 20 yr lady with multiple discrete firm

 Diagnosis? painless swelling over both sides of

 TNM staging ? the neck, 6 month duration anorexia

 Investigations ? and evening rise in temperature - Di-

 Treatment ? agnosis, Differential diagnosis?

CA BREAST

19. 35% burns - classification, skin grafting

16. A 40yr old man had a fall from a build- of burns-condition? Priorities in initial

ing site. He has not passed urine for Rx of burns,fluid resuscitation, Rx of

12hrs. catheterization produced severe burns.

bleeding.

 What are the possible causesof 20. A 30 yr old male, fever, convulsion,

retension of urine ? history of thorn prick,o/e rigidity of ab-

 Emergency treatment? dominal muscles and trismus Dx?

 Investigations u will prefer ? DCx?

 Complications ? TETANUS

Rupture urethera

21. A 25-yr old female- with painless no-

17. A 38yr old man presented with a pain- dule in right lobe of thyroid. non ma-

less swelling in his right testes. Ultra- lignant condition presenting like this,

sound scan of the rt testes showed ill Rx if it is malignant nodule, complica-

defined hypo echoic mass in the upper tion of surgery, Rx of post operative te-

pole. Left testes is normal. tany.?

 What is ur diagnosis?

 Classifications ?

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22. A 45 year old man presents with fever 24. Following an attempted infusion, in the

& rigor, swelling and pain of the lower cubital region, patient complains of se-

limb with redness and shiny skin. Fol- vere pain in hand and soon had severe

lowing a minor trauma to the foot with pallor and numbness of the hands.

a thorn, (a) What is the most likely possibility?

(a) What is the most probable diagno- (b) What are the urgent measures you

sis? do under these circumstances?

(b) What are the predisposing factors (c) What investigations will be helpful

for this condition? in conferencing your diagnosis?

(c) What trc the commenest causative (d) lf conservative measures fail, what

agents? is the ideal treatment?

(d) What is the ideal treatment of the

condition?

CELLULITIS 25. 15. A psychiatric patient on Rx with

lithium salts (not properly mortared)

23. A patient with primary haemorrhoides presents with anaemia and numbness

and Hb % of 4 admitted under your of hand. On examination, Sensory def-

care. As a measure to stop bleeding, icit noted in thumb and index finger

you decide to give sclerotherapy along with wasting thenar region.

with replacement of Hb deficit (a) What is your diagnosis?

(a) what are the necessary instru- (b) What is the underlying problem for

ments you require to do it? this condition?

(b) What are the common sclerosants (c) What is the single investigation that

used? clinches the diagnosis?

(c) What is Albright's solution? (d) how will you treat the patient medi-

(d) Where will you inject the sclero- cally?

sants?

(e) What are the possible complica-

tions of the procedure?

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CASE FORMAT
1. THYROID SWELLING
 Kocher’s test- to R/o obstructed
Local examination of neck
trachea.
Inspection
Percussion
 In c/o short neck-perform pizzilo’s
 Resonant over manubrium sterni
method
 Dull note in c/o retyrosternal exten-
 Describe about site, shape,size,
sion
extent
Auscultation
 Movement with deglutition
 Bruit – in c/o malignancy (increased
 Movement with protrusion of ton-
vascularity)
gue

 Plane of swelling

 Lower border –visible/not

2. BREAST EXAMINATION
 Skin over swelling
INSPECTION –Sitting
 Pemberton’s sign (+ in retrosternal
Breast
goiter)
 Position –displaced /not

 Size
Palpation (stands behind the patient)
 Shape
 Lahey’s method
 Puckering/ dimpling
 Crile’s method- Describe about
Skin over the breast
site, shape,size, extent, margin,
 Colour & texture
consistency
 Engorged veins
 Local rise of temperature
 Retraction/ puckering
 Mobility- horizontal/ vertical
 Peau’d orange appearance
 Plane of swelling
 Nodules
 Lower border –palpable / not
 Ulcerations/ fungations?

Nipple

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 Presence, symmetry, retraction 3. HERNIA

 Position INSPECTION
 Size & shape
 Swelling
 Accessory nipple
 Size
 Surface-cracked/fissure/eczema
 Shape
 Discharge
 Extends to scrotum (complete/ in-
Areola
complete)
 Colour
 Position
 Size
 Visible pulsations
 Surface & texture
 Skin over the swelling
Arm & thorax
 Skin wrinkled ? Wound ?
Axilla & supraclavicular fossa
 Impulse on coughing
PALPATION
 Position of penis
 Local rise of temperature
PALPATION
 Local tenderness
 Local rise of temperature
 Position (quadrant)
 Tenderness
 Size & shape
 Size
 Margin
 Shape
 Consistency
 Position & extend
 Fluctuation
 To get above the swelling
 Transillumination
 Consistency
 Fixity to the skin
 Expansile impulse on coughing
 Fixity to breast tissue
 Reducibility
 Fixity to underlying fascia & mus-
 Invagination test
cles
 Ring occlusion test
 Fixity to chest wall
PERCUSSION
EXAMINATION OF LYMPH NODES
 Dullness- omentocoele

 Tympanic note- enterocoele

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4.VARICOSE 5.PVD

INSPECTION INSPECTION

 Varicose vein –site  Change in colour

 Swelling (oedema)  Signs of ischemia(thining of skin, di-

 Skin- colour, texture, minished hair growth, shininess,loss

 Impulse on coughing @ saphenous of subcut fat)

opening  Buerger’s postural test

PALPATION  Capillary filling time

 Brodie trendelenburg test II  Venous refilling time

 Brodie trendelenburg test I PALPATION

 Modified perthe’s test  Local rise of temperature

 Schwarth’s test  Capillary refilling time

 Multiple Tourniquet test  Venous refilling time

 Fegan’s test  Crossed leg test

 Morrisey’s test  Cold & warm water test

 Perthe’s test  Elevated arm test

 Pratt’s test  Allen’s test

PERCUSSION  Branham’s sign

 Schwart’s test  Costoclavicular compressive manu-

AUSCULTATION vre

REGIONAL LYMPH NODES  Hyperabduction manuvre

ABDOMINAL EXAMINATION to r/o any Palpation of blood vessels

mass p/a

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6. ULCER

INSPECTION

 Size

 Shape

 Number

 Position

 Margin

 Edge

 Floor

 Discharge

 Surrounding area

PALPATION

 Local rise of temperature

 Tenderness

 Edge

 Margin

 Base

 Depth

 Bleed to touch

 Surrounding skin

Examination of regional lymph nodes

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ORTHOPAEDICS

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IMPORTANT TOPICS
Reference : Mah – Essential Orthopaedics
by J. MAHESHWARI -4th edition
ORTHOPAEDICS
ORTHOPAEDIC TRAUMA
 Open fracture (mah-2)
 Pathological fractures ****(mah-3)
 Ligament injuries (mah-5)
 Mallot’s finger fracture (mah-3) **
 Pott’s fracture (mah-3) *
ANATOMY OF BONE AND FRACTURE
HEALING
 Fracture healing (mah-10) ***
 Stage of callus (mah-11)
TREATMENT OF FRACTURES
 Plaster of paris (mah-17) -***
 External fixator (mah-19)
SPLINTS AND TRACTIONS
 Thomas splint (mah-24) ***
 Skeletal traction(mah-26)
 Nonunion of bones: differen-
tial You need a SPLINT:
Soft tissue interposition
Position of reduction (too much trac-
tion, immobilization, or movement)
Location (eg. lower third of tibia slow
to heal)
Infection
Nutritional (damaged vessels or dis-
eased bone)
Tumor (pathological fracture)
 Joints classification, by amount of
allowed movement at joint
SAD:
Synarthroses
Amphiarthroses
Diarthroses
 Fracture: describing (short ver-
sion) DOCTOR:
Displaced vs. non-displaced
Open vs. closed
Complete vs. incomplete
Transverse fracture vs. linear fracture
Open Reduction vs. closed reduction

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RECENT ADVANCES IN TREATMENT

 DCP (mah-29) *  Forearm: fractures "Break the fore-

arm of the MUGR
 Interlocking nails (mah-31) **
(mugger)":
 C arm (mah-
Monteggia=Ulna
 Ilizaro’s technique (mah-33) **
Galeazzi=Radius

COMPLICATIONS OF FRACTURE
 Sprain treatment
 A very common mnemonic in clinical
 Fat embolism (mah-42) ** practice used by many health
 Crush syndrome (mah-43) *  professionals.
 RICE
 Compartment syndrome (mah-46) ***  R Rest
 I Ice (cold pack, e.g. frozen peas,
 Delayed and non union (mah-47) or gel pack)
 Avascular necrosis (mah-49)  C Compression (tubular crepe
bandage)
 Sudeck’s osteodystrophy (mah-50)**  E Elevation (keep affected limb
elevated)
 Myositis ossificans (mah-51)**

FRACTURE IN CHILDREN  Fractures: principles of manage-

ment FRIAR:
 Salter and harris classification (mah-
First aid
56) **
Reduction
 Green stick fracture (mah-57) Immobilisation
Active Rehabilitation
PERIPHERAL NERVE INJURIES
 Mnemonic: Please Remember Be
 Seddon’s classification (mah-60) *** Brave Medically
From lateral to medial:
 Klumpkey’s palsy(mah-60)
P Posterior interosseus nerve
 Card test (mah-64)* R Radial nerve
 Wrist drop (mah-60)* B Biceps tendon
B Brachial artery
 Foot drop (mah-60)
M Median nerve
 Froment’s sign (mah-60) *

 Saturday night palsy (mah-60)**

 Ulnar paradox (mah-61)

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 Tinel’s sign (mah-66)*

 Erb’s palsy (mah-59)*

 Salter Harris fracture classifica-
TREATMENT OF ORTHOPAEDIC DIS-
ORDERS
 Osteotomy(mah-
 Bone grafting (mah-81)
INJURIES AROUND THE SHOULDER,
FRACTURE HUMERUS
 Bankart’s lesion (mah-87) **
tion Salter Harris,
modified to SALTR:
type 1: Slipped epiphysis
type 2: Above the eiphyseal plate
type 3: Lower than the eiphyseal
plate
type 4: Through both above and be-
low eiphyseal plate
type 5: Raised epiphysis, as in a

 Kocher’s manuevre (mah-88)** compression injury

· Salter Harris classification utilises
 Fracture clavicle (mah-85)
visualising long bone distal portion
 Shoulder dislocation (mah-84) **
with diaphysis superiorly placed and
compli
epiphysis inferiorly placed.

INJURIES AROUND ELBOW

 Painful neck – differentials
 Gunstock deformity(mah-98)** Mnemonic: Jock STRAP
 Volkmann’s ischaemic contrac- J Jerking back of the head and
ture(mah-98)** neck, ie whiplash

 Supracondylar fracture (mah-93)*** S Spondylosis/Spondylolisthesis

of cervical discs
 Supracondylar fracture- compli (mah-
T Torticollis (spas-
98)
modic/infantile)

INJURIES OF FOREARM & WRIST R Cervical Rib

A Abnormal posture
 Galeazzi fracture- dislocation (mah- P Prolapsed cervical disc
107)

 Monteggia fracture dislocation (mah-

106)

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 Colle’s fracture (mah- 107) ***

 Dinner fork deformity (mah-108) **

 Differential diagnosis of a limp
 Complications of colle’s fracture (mah-
Mnemonic: STARTSS HOT
110) S Septic joint
 Smith’s fracture (mah-110) T Tumour
A Avascular necrosis (Legg–
 Scaphoid fracture(mah-111)
Calve–Pertheʼs)
R Rheumatoid arthritis/juvenile
HAND INJURIES
rheumatoid arthritis
 Mallot finger(mah-114) T Tuberculosis
S Sickle cell disease
 Benett’s fracture (mah-113)*
S Slipped upper femoral epiph-
ysis (SUFE)
PELVIC FRACTURES
H HSP
O Osteomyelitis
 Types of injuries (mah-120)
T Trauma
INJURIES AROUND HIP  Features of Ankylosing spondylitis
Mnemonic: SPINAL
 Classifications, diagnosis, treatment &
S Sacroiliac and low back pain
complications of fracture neck of femur P Pleuritic chest pain
(mah-128) *** I Inherited gene marker: HLA-
B27 (>90% HLA-B27 +ve, general
 Vascular signs of narath
population
frequency – 8%)
FRACTURE SHAFT OF FEMUR
N Neck hyperextension – ques-
tion mark posture
 Interlock nailing (mah-137)
A Arthritic symptoms in peri-
 Intramedullary nail (mah-138) pheries (asymmetrical)
L Loss of spinal movement
INJURIES AROUND KNEE JOINT
which is progressive

 Fracture of patella (mah-142) 

 Meniscal tear (mah-145)***

 Arthroscopy (mah-147)

 Mc murray test (mah-356)*

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 Apley’s test (mah-356)*

INJURIES OF LEG, ANKLE & FOOT  Congenital talipes equinovarus

(CTEV, clubfoot): major physical
 Sprained ankle (mah-157)
findings CAVE:
 Calcaneal fracture (mah-158)
Cavus
 Jone’s fracture (mah-160) ***
Adduction
 March fracture (mah-160) Varus
Equinus
INFECTIONS OF BONES AND JOINT

 Sequestrum (mah-166)  Rheumatoid arthritis (RA)

 Involucrum (mah-166)
 Brodiess abscess (mah-169)
 Acute osteomyelitis (mah-162)
TB OF BONES AND JOINTS
 Pott’s disease (mah-179)**
 Carries sicca
 Spina ventosa(mah- *
 Cold abscess(mah-
 Triple displacement of knee (mah-195)
INFECTIONS OF THE HAND
 Paronychium (mah-199) *
 Apical subungal infections (mah-199) *
 Kanavel’s sign (mah-202) *
CONGENITAL TALIPES EQUINO VA-
RUS (CTEV) (mah-203) ***
Features
Mnemonic: RHEUMATISM
R - Rheumatoid factor (RF) +ve in
80%/Radial deviation of wrist
H - HLA-DR1 and DR-4
E - ESR/Extra-articular features (re-
strictive lung disease, subcutaneous
nodules)
U -Ulnar deviation of fingers
M -Morning stiffness/MCP+PIP
joint swelling
A - Ankylosis/Atlanto–axial joint sub-
luxation/Autoimmune/ANA +ve in
30%
T T-cells (CD4)/TNF
I - Inflammatory synovial tissue
(pannus)/IL-1
S -Swan-neck deformity, Bouton-
niere deformity, Z-deformity of
thumb
M- Muscle wastage of small mus-
cles of hand

 Club foot (mah-203)*

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 CTEV- treatment (mah-207)*

 Triple arthrodesis (mah- 209)

 Rheumatoid arthritis (RA)
CONGENITAL DISLOCATION OF HIP Management
(mah-212) DMARDs (Disease-Modifying Anti-
Rheumatic Drugs)
 Barlow’s test (mah-213) Mnemonic: Most Sufferers Can Get
Appropriate Pain Control
 Trendelenberg test (mah-214)
M Methotrexate
S Sulfasalazine
POLIOMYELITIS
C Ciclosporin
G Gold
 Triple deformity (mah-
A Azathioprine
BONE TUMOURS P Penicillamine
C HydroxyChloroquine
 Osteoid osteoma (mah-228) *
 Osteosarcoma: risk fac-
 Osteoclastoma (mah-230)-radiological
tors PRIMARY:
features ** Paget's
 Osteosarcoma (mah-232)** Radiation
 Ewing’s sarcoma (mah-236) **- radio- Infaction of bone

logical features Male

Alcohol, poor diet, sedentary life-
 Chondrosarcoma (mah-239)
style [adults only]
 Osteochondroma (mah-240)
Retinoblastoma, Li-Fraumeni syn-
 Bone cyst (mah-242)
drome
 Fibrous dysplasia (mah-243) Young [10-20 yrs]
· Osteosarcoma is the most com-
PROLAPSED INTERVERTEBRAL DISC
mon primary malignant tumor of
bone.

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SPINAL INJURIES

 Classification of spinal injuries (mah-  Charcot‘s joints

259)
ARTHRITIS
 Rheumatoid arthritis (mah-278) **
 Extra articular manifestations of
RA(mah-280)
 Ankylosing spondylitis (mah-283)**
 Charcot’s joint (mah-286)*
 Gout (mah-285)
 Pseudo gout (mah-285)
 Osteotomy (mah-289)
AFFECTIONS OF THE SOFT TISSUE
Causes of Charcot‘s joints to remember.
Charred lepers could syringe deaf
tabby
Charred Charcot‗s
Lepers Leprosy
Could Cauda equine lesion
Syringe Syringomyelia (cyst in spinal
cord)
Deaf Diabetes
Tabby Tabes dorsalis (degenerative
condition of neurons)
 Gout vs. pseudogout: crystal lab
findings
P seduogout crystals are:
P ositive birefringent
P olygon shaped
 Gout therefore is the negative needle
shaped crystals. Also, gout classically
strikes great Toe, and its hallmark
is Tophi.

 Osteoarthritis: x-ray signs

 Common bursitis (mah-292) ―LOSS‖
 Tenosynovitis (mah-293) Loss of joint space
Osteopyhtes
 Tennis elbow (mah-293)** Subcondral sclerosis
Subchondral cysts
 Golfer’s elbow (mah-293)**  Nodes in arthritis
 deQuervein’s tenovaginitis (mah-  ―HD‖-High Definition
H-Heberden
294)** D-DIP (dital interphalangeal joint)
 Trigger finger (mah-294)**  ―BP‖
B-Bouchard
 Carpel tunnel syndrome (mah-294)***

 Frozen shoulder (mah-295)**  Monoarthritis differential GHOST:

 Painful arc syndrome (mah-296)* Gout
 Meralgia paresthetica (mah-. Haemarthrosis

 Bence jones protein Osteoarthritis

Sepsis
 M band
Trauma
 

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METABOLIC BONE DISEASES

 Rickets (mah-300)***  Pagets disease of bone: signs

 Radiological feature (mah-301) * and symptoms PANICS:

Pain
 Renal rickets (mah-302)
Arthralgia
 Osteomalacia (mah-302)*
Nerve compression / Neural deaf-

ness

MISCELLANEOUS AFFECTIONS OF Increased bone density

Cardiac failure
THE BONE
Skull / Sclerotic vertebrae
 Diaphysial aclasis (mah-307)

 Paget’s disease(mah-307)  Carpal tunnel syndrome:

 Osteochondritis (mah-307)* treatment WRIST:

Wear splints at night
 Perthe’s disease (mah-308)
Rest

Inject steroid
MISCELLANEOUS REGIONAL DISEAS- Surgical decompression

ES Take diuretics

 Torticollis (mah-311)

 Congenital torticollis (mah-311)

 Cervical rib (mah-312) *

 Coxa vara (mah-313)

 Genu varum (mah-315) **

 Popliteal cyst (mah-316)*

 Flat foot (mah-316) *

 Hallux valgus (mah-317)

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Essay questions

1. An elderly female presents in the ca-

(d) What are the group of muscles in-
suality with history of a fall. She Is un-
volved ?
able to move her keft lower limb. On
(e) What are the cause of claw hand ?
examination limb is found to be erxter-

nally rotated.
3. Young footballer following an injury
(a) What is the most probable diagno-
complaints of give away click and lock-
sis?
ing of his knee joint
(b) how will you classify this condition
(a) What are the structures liable to be
?
injured ?
(c) What is the mode of management
(b) What are the tests that you will do
?
for reaching a diagnosis ?
(d) What are the complications?
(c) What is the treatment for meniscal

injury ?
2. A head load worker presented in the

casuality with history of a heavy load

4. A new born is brought with bilateral
on his left shoulder. He also com-
club foot
plaints of weakness of his same upper
(a) What are the component deformi-
limb. o/e he has difficulty in abduction
ties of club foot ?
and external rotation of the same up-
(b) What is the line of treatment ?
per limb.
(c) What will you do for late presenta-
(a) What is the most probable diagno-
tion ?
sis?
(d) Give some corrective operative
(b) Draw and label the brachial plexus
surgeries ?
showing the site of injury

(c)

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5. In case of fall on out stretched hands

(a) What are the possible injuries you

can think of ?

(b) If there is pain at the wrist, what

could be the possible injury, inves-

tigations ? Rx ?

6.

7.

8.

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CASE taking form,at

INSPECTION MEASUREMENTS

 Attitude  Longitudinal

 Deformity  Circumferential

 Swelling  Carrying angle

 Wasting, shortening, irregularity  Midpoint of lines joining epicon-

 Undue prominence of bone dyles

 Effusion
Special tests
 Skin over & surroundings

 Trophic changes of fingers Neuro vascular defcit

PALPATION Lymph node

 Local rise of temperature Proximal joint

 Local tenderness Atrophic changes

 Thickening, irregularity,
Systemic examinations
 Crepitus, myositis ossificans

 Lymph nodes

MOVEMENTS

 Range of motion

 Associated with pain, spasm, crepi-

tus

 Deformity

 Abnormal mobility-both active &

passive

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OBSTETRICS

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SYLLABUS- obg

According to KUHS,
Theory Paper OBSTETRICS 40 80
GYNECOLOGY 40
Theory- Internal assessment 20
Practicals 50
Practicals- Internal assessment 20
Viva voce ( 4 Stations) 30
TOTAL 200

QUESTION PAPER –MARK DISTRIBUTION

OBSTETRICS & GYNECOLOGY (same pattern)

I Long Essay 1×10 10
II Short essays 3x4 12
III Short notes 2x3 6
IV Answer briefly 3×2 6
V One word answers 4x1 4
VI Draw & label 2x1 2
TOTAL 40

PRACTICALS

Obstetric case (1) 1x25=25 25

Gynaecology case (1) 1x25=25 25
Record 10 10
Specimen
Viva (theory) NST, CTG,partogram
Instruments 30
Drugs
50

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IMPORTANT TOPICS

dt - D C DUTTA‘s textbook of
gynecology (new edition)
 Diagonistic tests
sh - textbook of obstetrics by sheila
balakrishnan-2nd edition CAT

C=CHORIONI VILOOUS SAM-

ANATOMY AND PHYSIOLOGY
PLING=10-12wks. OF GEST. DONE
 Perineal body * (dt-4,sh-16)
A=AMINOCENTESIS=14-16wks.OF
 Graffian follicle (dt-, )
gest.
 Decidua (dt-24,)
T=Triple test(MSAFP)= -
 Trophoblast (dt-24,)
18wks.OF GA
 Chorionic villi (dt-)

FETUS
 Gestation period, oocytes, vaginal
 Foetal circulation *** (dt-43,sh-69)
pH, menstrual cycle: normal num-
PHYSIOLOGICAL CHANGES IN PREG- bers
NANCY

 Braxton-hicks contractions * (dt-47,sh- 4 is the normal pH of the vagina.

90)
 Breast changes in pregnancy (dt-
49,sh-95)
 Weight changes in pregnancy* (dt-
50,sh-70)
 Physiological anaemia of pregnancy
(dt-51, sh-284)
 Cardiovascular changes in
pregnancy***** (dt-52, sh-79)
 Iron metabolism in pregnancy (dt-54,
40 weeks is the normal gestation pe-
riod.
400 oocytes released between men-
arche and menopause.
400,000 oocytes present at puberty.
28 days in a normal menstrual cycle.
280 days (from last normal menstrual
period) in a normal gestation period


sh-77)

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ENDOCRINOLOGY IN RELATION TO

REPRODUCTION
 Abdominal pain: causes during preg-
HCG ***** (dt-58, sh-84) nancy LARA CROFT:
Labour
DIAGNOSIS OF PREGNANCY
Abruption of placenta
 Diagnosis at first ANC (dt-66,sh-94)
Rupture (eg. ectopic/ uterus)
 Regular ANC ** - routine investigations Abortion
in ANC (dt-98,sh-95) Cholestasis
 Signs of pregnancy (dt-64,sh-88) Rectus sheath haematoma

 Chadwick’s sign (dt-65,sh-88) Ovarian tumour

Fibroids
 Hegar’s sign* (dt-65,sh-89)
Torsion of uterus
 Pregnancy tests* (dt-66,sh-89)

 Pseudocyesis (dt-72,sh-92)
 Fetus: cardinal movements of fe-
 Pelvic grip * (dt-78,sh-41) tus "Don't Forget
I Enjoy Really Expensive Equipment
FETUS IN UTERO
Descent
 Parity (dt-95,sh-36) Flexion

 Gravid (dt-95,sh-36) Interal rotation

Extension
 Lie (dt-75,sh-29)
Restitution
 Engagement * (dt-81,sh-102)
External rotation
 Attitude of fetus (dt-81,sh-29)
Expulsion
 Nagele’s rule * (dt-96,sh-43)

FETAL SKULL AND MATERNAL

PELVIS

 Diameters of fetal skull (dt-84,sh-28)

 Biparietal diameter* (dt-85,sh-28)

 Caput succeddaneum *** (dt-86,sh-

33)

 Diagonal conjugate ** (dt-88,sh-22)

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ANTENATAL CARE

 Antenatal care * (dt-94,sh-93)

 CVS and amniocentesis: when per-
 Folic acid in pregnancy** (dt-99,sh-94)
formed "Chorionic" has 9
 Immunisation in pregnancy ** (dt- letters and Chorionic villus sampling
100,sh-94) performed at 9 weeks gestation.
ANTENATAL ASSESSMENT OF "AlphaFetoProtein" has 16 letters and

FETAL WELL BEING it's measured at 16 weeks

gestation.
 Antepartum fetal surveillance (dt-

108,sh-509)
 Labour: preterm labor causes
 Doppler velocimetry (dt-109,sh-511) DISEASE:
Dehydration
 Bio physical profile ** (dt-109,sh-510)
Infection
 Foetal movement count* (dt-108,sh- Sex
Exercise (strenuous)
509)
Activities
 Non stress test** (dt-108,sh-509) Stress
Environmental factor (job, etc)
 CTG ** (dt-109,sh-518)

 Chorionic villous sampling * (dt-106)

 Abdominal pain: causes during preg-
 Triple test (dt-106)
nancy

NORMAL LABOUR LARA CROFT:

Labour
 Bishop’s score ** (dt-523,sh-558)
Abruption of placenta
 Prelabour changes (dt-115,sh-107)
Rupture (eg. ectopic/ uterus)
 Stages of labour ** (dt-116,sh-107)
Abortion
 Lower uterine segment (dt-119,sh-
Cholestasis
110)
Rectus sheath haematoma
 Mechanism of labour (dt-123,sh-100)
Ovarian tumour
 Engagement* (dt-123,sh-102)
Fibroids
 Internal rotation (dt-124,sh-104)
Torsion of uterus
 Moulding * (dt-86,sh-31)

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 Second stage of labour * (dt-

113,135,sh-111)
 Multiple pregnancy complications
 Third stage of labour *** (dt-139,sh-

111)
HI, PAPA:
 Active Management of third stage of
Hydramnios (Poly)
labour ***** (dt-141,sh-119)
IUGR
 Management of newborn (dt-137)
Preterm labour
 Brandt Andrew method (dt-140,sh-
Antepartum haemorrhage
120)
Pre-eclampsia
 Fourth stage of labour (sh-120)
Abortion

NORMAL PUERPERIUM
 Labour: preterm labor causes

 Puerperium (dt-144,sh-422) DISEASE:

Dehydration
 Lochia* (dt-146,sh-422)
Infection
 Physiology of lactation (dt-148,sh-
Sex
427)
Exercise (strenuous)
 Suppression of lactation *** (dt- Activities
149,sh-432) Stress
 Involution of uterus ** (dt-144,sh- Environmental factor (job, etc)

422,424)
 Fetal Monitoring
VOMITING IN PREGNANCY
VEAL CHOP
Variable Early Decelera-
 Hyperemesis gravidarum*** (dt-
tion Acceleration Late Deceleration
154,sh-141)
Cord compression Head compres-
sion O2 Placental Insufficiency

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HAEMORRHAGE IN EARLY PREG-

NANCY
 Spontaneous abortion: defini-
 Abortion- definition (dt-158,sh-144) tion "Spontaneous abortion" has
 Threatened abortion** (dt-160,sh-145) less than 20 letters [it's exactly 19 let-

 Inevitable abortion** (dt-161,sh-145) ters].

Spontaneous abortion is defined as
 Missed abortion ***** (dt-163,sh-146)
delivery or loss of products of con-
 Septic abortion * (dt-164,sh-146)
ception at
 Causes of recurrent abortions (dt-
less than 20weeks gestation.
167,sh-144)

 Posterior colpocentesis  Miscarriage: recurrent miscarriage

 Cervical incompetence** (dt-168,sh- causes RIBCAGE:

Radiation
149)
Immune reaction
 Cervical encirclage * (dt-170,sh-150)
Bugs (infection)
 MTP act (dt-172,sh-148)
Cervical incompetence
 Method of first and second trimester Anatomical anomaly (uterine septum
MTP **** (dt-174) etc.)
 Ectopic preganancy ** (dt-177,sh-156) Genetic (aneuploidy, balanced trans-

 Medical management of ectopic location etc.)

Endocrinev
pregnancy* (dt-185,sh-162)

 Decidual cast ** (dt-181,sh-158)

 INVESTIGATIONS ,PRENATAL DI-
 Management of ectopic pregnancy *
AGNOSIS,TIMINGS
(dt-184,sh-161) Uk-CAT
 Vesicular mole *** (dt-190,sh-168) U............USG...............6-40WKS.
 Follow up of molar pregnancy ** (dt- C...........CVS................9-12

195, sh-171) A..........AMNIOCENTESIS..15-18

T............TRIPLE TEST.......16-18
 Persistent trophoblastic disease (dt-

199)

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MULTIPLE PREGNANCY

 Multiple pregnancy * (dt-200,sh-178)

 Preeclampsia: classic tri-
 Complications of MP * (dt-204,sh-180)
ad PREeclampsia:
 Determination of chorionicity (dt-200,
Proteinuria
sh-179) Rising blood pressure
 Discordant twins (dt-205,sh-179) Edema
 Polyhydramnios ** (dt-211,sh-213)

 Acute hydramnios (dt-215,sh-214)  Multiple pregnancy complica-

tions HI, PAPA:
 Oligohydramnios * (dt-215,sh-215)
Hydramnios (Poly)
 Succenturiate placenta (dt-216,sh-
IUGR
226)
Preterm labour
 Vasa praevia (dt-218,sh-138) Antepartum haemorrhage
Pre-eclampsia
HYPERTENSIVE DISORDERS IN Abortion

PREGNANCY

 Preeclampsia ** (dt-219,sh-253)

 Predisposing factors of PIH * (dt-  APGAR score components SHIRT:

220,sh-253) Skin color: blue or pink

 Investigations (dt-25,sh-259)
 Management** (dt-227,sh-262)
 HELLP syndrome*** (dt-222,sh-259)
 Roll over test (dt-227,sh-261)
 Eclampsia –investigations & Rx (dt-
230, sh-267)
Heart rate: below 100 or over 100
Irritability (response to stimulation):
none, grimace or cry
Respirations: irregular or good
Tone (muscle): some flexion or ac-
tive


 Use of magnesium sulphate in ec-

lampsia (dt-234,sh-268)

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ANTEPARTUM HAEMORRHAGE

 Types of placenta praevia** (dt-

 Antepartum hemorrhage (APH): ma-
241,sh-128)
jor differential APH:
 Management of PP (dt-248,sh-131)
Abruptio placentae
 Abruptio placenta** (dt-252,sh-133)
Placenta previa
 Couvelare uterus ** (dt-254,sh-135)
Hemorrhage from the GU tract
 Management of abruption placenta

(dt-256,sh-136)

MEDICAL AND SURGICAL ILLNESS  Parity abbreviations (ie: G 3, P 2,

COMPLICATING PREGNANCY L2)

“To Peace And Love”:

 Iron metabolism in pregnancy (dt-
T: of Term pregnancies
54,sh-77)
P: of Premature births
 Anaemia in pregnancy*** (dt-260,sh-
A: of Abortions (spontaneous or
284)
elective)
 Treatment of anaemia in pregnancy
L: of Live births
(dt-264,sh-287)
• Describes the outcomes of the to-
 Parenteral iron therapy* (dt-266,sh-
tal number of pregnancies (Gra-
287)
vida).
 Gestational diabetic mellitus *** (dt-

281,sh-240,1244)

 Glucose challenge test **** (dt-

282,sh-245)

 Managemnet of GDM* (dt-285,sh-

245)

 Complications of GDM***(fetal compl)

(dt-283,sh-241)

 Viral hepatitis in pregnancy (dt-

289,sh-282)

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 Pyelonephritis in pregnancy*** (dt-

298,sh-274)  IUD: side effects PAINS:

 Asymptomatic bacteriuria ** (dt- Period that is late
298,sh-273) Abdominal cramps

 VDRL test * Increase in body temperature

Noticeable vaginal discharge
 Management of labour in a CVS
Spotting
patient (dt-277,sh-232)

GYNAECOLOGICAL DISORDERS IN  Clinical conditions

Labour - onset
PREGNANCY
“ Ready Mom for Some Discomfort”
 Trichomonas vaginalis (dt-306,sh-
R Regular and painful uterine contrac-
300)
tions
 Ovarian tumours in pregnancy (dt- M Membranes ruptured
310,sh-222) S ʻShowʼ
PRETERM LABOUR, PROM & IUD D Dilatation and effacement of cervix

 Preterm labour* (dt-314,sh-192)

 Preterm rupture of membrane (dt-

 Post-partum haemorrhage (PPH)
317,sh-196)
causes
 Chorioamnionitis *
:”4 Tʼs “
 Diagnosis of IUD* (dt-323,sh-208)  T Tissue (retained placenta)
 T Tone (uterine atony)
SPECIAL CASES
 T Trauma (traumatic delivery, epi-
 VBAC * (dt-329,sh-339) siotomy)

 Impending signs of scar rupture (dt-  T Thrombin (coagulation disor-

ders, DIC)
328,sh-341)

 Prevention of Rh isoimmunisation*

(dt-334,sh-310)

 Indirect coomb’s test (dt-335,sh-310)

 Bad obstetric history (dt-342)

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CONTRACTED PELVIS

 Anthropoid pelvis (dt-346,sh-359)  Female pelvis: shapes GAP:

 Android pelvis *** (dt-346,sh-359) · In order from most to least com-

 Flat pelvis (dt-,sh-359) mon:

Gynecoid
 CPD ** (dt-352,sh-359)
Android /Anthropoid
 Trial labour* (dt-355,sh-363)
Platypelloid

ABNORMAL UTERINE ACTION

 Alpha-fetoprotein: some major
 Uterine hypertonicity (dt-359,sh-357)
causes for increased maternal se-
 Precipitate labour** (dt-361)
rum AFP
 Bandl’s ring / retraction ring ***** (dt-
during pregnancy TOLD:
362,sh-358)
Testicular tumours

MALPOSITION, MALPRESENTATION Obituary (fetal death)

AND CORD PROLAPSE Liver: hepatomas

Defects (neural tube defects)

 Mobile head at term

 Occipito-posterior *** (dt-365,sh-363)

 Face to pubis delivery ** (dt-368)

 Labour: factors which determine
 Deep transverse arrest*** (dt-372,sh-
rate and outcome of labour 3
369)
P's:
 Breech presentation *** (dt-374,sh-
Power: stength of uterine contrac-
374) tions
 Footling presentation (dt-375,sh-375) Passage: size of the pelvic inlet

 External cephalic version *** (dt- and outlet

Passenger: the fetus--is it big,
379,sh-)
small, have anomalies, alive or
 Brow presentation * (dt-392,sh-373)
dead
 Transverse lie (dt-393,sh-383)

 Cord prolapse **** (dt-398,sh-385)

 Lovset’s manoeuvre (dt-387,sh-380)

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 Nappy rash

 Hydrops foetalis (dt-497,sh-493)

 Components of congenital rubella syn-  Post-partum haemmorrage (PPH):

drome (dt-,sh-) risk factors PARTUM:

 Causes of DIC Polyhydroamnios/ Prolonged la-

bour/ Previous cesarian
 Asphyxia neonatorum (dt-468,sh-534)
APH/ ANTH
PROLONGED LABOUR, OBSTRUCTED
Recent bleeding history
LABOUR AND DYSTOCIA
Twins
 Causes of prolonged labour (dt-401) Uterine fibroids
 Shoulder dystocia (dt-406) Multiparity
 Hydrocephalus ** (dt-406,sh-392)

 Causes of post term pregnancy ** -  Post-partum haemorrhage (PPH):

(complications and management ) *
(dt-,318sh-218)
COMPLICATIONS OF THIRD STAGE OF
LABOUR
 Post partum haemorrhage (dt-410,sh-
causes 4 'T's:
Tissue (retained placenta)
Tone (uterine atony)
Trauma (traumatic delivery, episiot-
omy)
Thrombin (coagulation disorders,

395) DIC)

 Atonic and traumatic PPH * (dt-

 DYSTOCIA
410,sh-395)
CAUSES:Remeber 4 Ps.
 Management of PPH (dt-412,sh-397)
Passenger (large baby)
 Complications of masssive PPH (dt- Passage (Abnormal Pelvis)
411) Propulsion (uterine contraction)
 Placenta accrete, increta, percreta * Proprotion (disproportion Cephalo-

(dt-419,sh-404) pelvic)

 Retained placenta (dt-418)

 Acute inversion of uterus ** (dt-

420,sh-406)

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INJURIES TO BIRTH CANAL

 Complete perineal tear *** (dt-422,sh-

415)  Postpartum collapse: caus-

es HEPARINS:
 Cervical tear (dt-423,sh-417)
Hemorrhage
 Rupture of uterus (dt-429 )
Eclampsia
ABNORMALITIES OF PUERPERIUM Pulmonary embolism
Amniotic fluid embolism
 Puerperial pyrexia ** (dt-432,sh-433)
Regional anaethetic complications
 Post natal retension of urine * (dt-437) Infarction (MI)
Neurogenic shock
Septic shock
NEONATOLOGY
 Shoulder dystocia: manage-
 Advantages of breast feeding** (dt- ment HELPER:
449) Call for Help
 IUGR ** (define) (dt-461,sh-201) Episiotomy

 Aetiology of IUGR * (dt-462,sh-201) Legs up [McRoberts position]

 Role of corticosteroids in pregnancy
 APGAR score **** (dt-470,sh-534)
 RDS/ HMD *** (dt-474,sh-549)
 Foetal distress * (dt-473)
 Erythroblastosis foetalis**(dt-,sh-)
 Meconium aspiration syndrome*** (dt-
Pressure subrapubically [not on fun-
dus]
Enter vagina for shoulder rotation
Reach for posterior shoulder and de-
liver posterior shoulder/ Return
head into vagina [Zavanelli maneuv-
er] for C-section/ Rupture clavicle or

476,sh-550) pubic symphisis

 Neonatal jaundice (dt-476,sh-543)

 Physiological jaundice * (dt-476,sh-

543)

 Neonatal convulsions ** (dt-481,sh-

550)

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 Cephalhematoma*** (dt-483,sh-552)

 Erb’s palsy * (dt-486,sh-552)

 B-agonist tocolytic (C/I or warn-
 Necrotising enterocolitis (dt-490,sh-
ing) ABCDE:
551) Angina (Heart disease)
 Ophthalmia neonatorum** (dt-489) BP high
Chorioamnionitis
PHARMACOTHERAPEUTICS
Diabetes

 Oxytocin ** (dt-498,sh-561) Excessive bleeding

 Methyl ergometrine(dt-501,sh-567)
 IUGR: causes IUGR:
 Prostaglandins * (dt-503,sh-540,567)
Inherited: chromosomal and genetic

disorders
 Tocolytics ** (dt-507,sh-573) Uterus: placental insufficency
 Magnesium sulphate * (dt-509,sh-268) General: maternal malnutrition, smok-
 Anticoagulants in pregnancy (dt- ing

510,sh-571) Rubella and other congenital infecton

INDUCTION OF LABOUR  Forceps delivery

A few things to remember when for-
 Induction of labour (dt-522,sh-559)
ceps delivery is likely.
 Bishop’s score* (dt-523,sh-558)
FORCEPS
 F Fully dilated
 Artificial rupture of membrane * (dt- O Occiput presentation
525,sh-560) R Ruptured membranes

 Amniotomy (dt-525,sh-560) C Catheter to empty bladder

E Engaged
OPERATIVE OBSTETRICS
P Pain relief should be adequate
 Episiotomy **** (dt-568,sh-453)
S Space/Scissors (episiotomy)
 RMLE ** (dt-569,sh-)

 Forceps delivery ** (dt-572,sh-443)

 Outlet forceps operation (dt-576,sh-

444)

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 FLASH-Final Leap into A Safe Hand

 Kielland forceps ** (dt-578,sh-446)  Partogram *****(dt-531,sh-121)

 Failed forceps (dt-580,sh-446) 

 Vaccum extraction/ Ventous 

application *** (dt-580,sh-447) 

 Advantages of vaccum over forceps 

(dt-581,sh-449) 

 External cephalic version *** (dt- 

583,sh-451) 
 Delivery: instrumental delivery pre-
 Indication for cesarean section ** (dt- 
requisites AABBCCDDEE:
589,sh-458) 
Analgesia

Classical CS *** (dt-595,sh-462) Antisepsis
 Bowel empty
 Steps of LSCS ** (dt-592,sh-459)  Bladder empty
 Management of previous CS (sh-338)  Cephalic presentation
Consent
SPECIAL TOPICS 
Dilated cervix

 MMR (dt-602,sh-594) Disproportion (no CPD) Engaged

Episiotomy
 Maternal mortality * (dt-602,sh-594)

 Perinatal mortality *** (dt-605,sh-555)

 Late deccelaration ** (dt-,sh-521)

 Management of variable decceleration

(dt-612,sh-521)

 BFHI ** (dt-,sh-428)

IMAGING IN OBSTETRICS

 Ultrasound in obstetrics (dt-644,sh-

474)

 Singer’s test (dt-655,sh-131)

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ESSAY QUESTIONS
1. A `25yr old primigravida is admitted at
37 weeks of pregnancy with com-
plaints of convulsions
 What are the d/d?
 Management ?
 Maternal complications of eclamp-
sia?
 HELLP syndrome ?
ECLAMPSIA
2. A28yr old primigravida at 30 week of
gestation was brought to hospital with
h/o convulsions
 Mention the d/d?
 Investigations ?
 Complications?
 Management of care of eclamp-
sia at term
ECLAMPSIA
3. A 28 yr old woman with previous LSCS
admitted at term with labour pains
 Explain the term VBAC
 How will you find out that the
lady is fit for vaginal delivery
 Steps of LSCS
4. A 22yr old primi presenting with mo-
bile head at term
 Ur diagnosis?
 What specific clinical examination
will you do on this patient ?
 What is meant by trial labour ?

5. A primigravida at 40weeks of gestation
is admitted with labour pain. The head
is mobile .
 What are the causes for mobile
head in a primi at term?
 Investigations, will you do ?
 How will you diagnose occipito
posterior position ?
 How will you manage deep trans-
verse arrest ?
6. A 20yr old primigravida presents with
breech presentation at term
 What are the types of breech
presentation ?
 Describe the mechanism of
breech delivery ?
 How will you conduct assisted
breech delivery ?
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7. A 3rd gravid just delivered having pro-  Cause of PPH

fuse Post partum haemorrhage.  First aid administered

 Describe predisposing factors  Management ?

for post partum haemorrhage ?

 Management ? 11. A 28 year old primigravida at 34 week-

sof pregnancy presents with sudden

8. A 26 yr old gravida2, para1, previous onset of painless bleeding. G/e re-

LSCS , is admitted at 34 weeks gesta- vealed nothing abnormal. On Obste-

tion with sudden episode of profuse trics exmn uterus was corresponding

bleeding . to 3weeks .Foetal heart was normal

 What are the conditions to sus-  Diagnosis?

pect? Give reasons ?  Reason for diagnosis?

 What are the difference be-  Management

tween scar rupture and scar

dehiscence ? 12. 24yr old P1L1 post fullterm normal va-

ginal delivery 45minutes back started

bleeding per vaginum. O/e BP-

9. A primi 38 wks comes with h/o one ep- 80/60mm Hg, plus rate-144/min.
isode of convulsions now another ge-  Most probable diagnosis?
neralized convulsion. Her BP-160/130;  Maternal complications?
cephalic presentation ; FHR-good;  Etiology?
urine albumin+  Management?
 Immediate management ?
PPH
 Investigations ?

13.

10. A 32 year old para 4. Patient after deli-

very of placenta –PPH. o/e uterus ap-

pears relaxed and there are no fea-

tures of any trauma

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CASE TAKING FORMAT

Name : age: address : occupation :

Name & occupation of husband:

Blood group:

Obstetric formula : gravida…. Para….. living…..abortion…….

Last menustral period (LMP): Cycles : reg/irreg

Expected date of confinement:

Last child birth ………..years ago

Date of admission :

Presenting complaints

Admitted for safe confinement (in this case don’t mention presting complaints)

Pain/bleeding/leaking

High BP(PIH) /edema/ convulsions/ hyperemesis

History of present illness (omit if for safe confinement)

Onset , progress, duration, associated symptoms

History of present pregnancy

1) First trimester (<12 weeks)

 Detected to be pregnant …..weeks after missing her periods by urine preg-

nancy test, since then she has regular antenatal check ups

 Pain  Drugs /radiation

 Excessive vomiting  Urinary tract infections

 Bleeding  TT

 Fever with rash  Folic acid tablet

2) Second trimester (13-28 weeks)

 Quickening felt at  Hypertension

………weeks  GDM

 USG taken at ……… month  UTI

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 Bleeding  Iron and folic acid tablets

 Edema

3) Third trimester(>28 weeks)

 Bleeding/leakage/ discharge  Hypertension

 Pain  GDM

 Edema  Varicocities

Past obstetric history

Age ,,,,Home/hospital,,,,,vaginal/CS,,,,birth weight ,,, by local dhais,,,,any antenatal

complications, prolonged labr,,,normal mile stones of development

Menstrual history

 Menarche (age)  Amount of flow

 Rhythem (regular/not)  Premenstrual symptoms

 Length of the cycle  Associated pain

 Duration of flow

Marital history

 Age at marriage  Dyspareunia

 Duration of marriage  Contraceptive methods adopted

 Frequency of coitus  Treatment for infertility

Past history  Congenital anomalies/repeated

 Any chronic illness(DM, thyroid, TB, abortions

HTN,jaundice, asthma,RHD)  Multiple pregnancies

 Any surgical intervention(D&C) Personal history

 Any drug intake or h/o blood transfu-  Diet (veg/non veg diet)

sion  Sleep pattern (normal/) and

 History of anti-D Ig in case of Rh(-) Apetite

mothers  Bowel and bladder movements

Family history  Any addictions

 h/o fibroid/ ovarian malignancies/ Treatment history –H/o allergy to drugs

breast carcinoma in the family

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GENERAL EXAMINATION Palpation

Patient conscious,cooperative,well ori-  Fundal height :………weeks of gesta-

ented tion

Height,weight, BMI:  SFH- ……cm

Pallor ,icterus, cyanosis, clubbing, lym-  Abdominal girth (>100cm is abnormal)

phadenopathy, edema (PICCLE)  Fundal grip: Cephalic-hard , round,

Skin,hair, nail thyroid and breast freely movable& ballotable mass

VITAL SIGNS Breech –broad, soft,

Pulse:…………..BP:……………rt arm sit- irregular,non ballotable mass

ting..Respiration :……………….. Tem-  Umbilical grip: Back-firm, uniform re-

perature:………… sistance

Limbs- multiple nod-

OTHER SYSTEMS ules

CVS- normal S1, S2 heard,no murmer  First pelvic grip: cephalic-

RESP: normal vesicular sounds are hard,round,,,,,,Breech-soft,

heard broad,,,,,head fixed / not

GIT:normal bowel sounds are heard  Second pelvic grip : covergent -- fin-

,,no hepatomegaly, no splenomegaly gers approximated—not engaged

divergent --

ABDOMINAL EXAMINATION (after fingers not approximated—engaged

evacuation of bladder)  confirm the findings in 1st pelvic

grip,,,,,,,,,whether engaged or not

Inspection

Shape: abd longitudinally dis- Auscultation :normal heart sounds heard (

tended///,,flanks full/empty fetal heart rate –120-160/min)

Stria gravidarum & linea nigra seen/not

Scars/ engorged vein /

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GYNAECOLOGY

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IMPORTANT TOPICS
dt - D C DUTTA‘s textbook of
gynecology (new edition)
sh - textbook of obstetrics by
sheila balakrishnan-2nd edition
ANATOMY OF THE FEMALE PELVIC
ORGANS
 Bartholins gland(dt-2,sh-3)
 Doderlein’s bacillus **(dt-7)
 Pelvic ureter * (dt-15,sh-12)
 Pelvic floor (dt-17,sh-12)
 Levator ani (dt-17)
 POD (dt-20)
 Lymphatic drainage of uterus, cervix &
vulva*** (dt-29,sh-4,8)
CONGENITAL MALFORMATIONS OF
THE FEMALE GENITAL ORGANS
 Imperforate hymen (dt-41,sh-87)
 Haemocolpos*** (dt-43,sh-71,87)
 Cryptomenorrhoea ** (dt-42,sh-71)
 Mullerian duct anomaly (dt-45,sh-81)
PUBERTY AND MENOPAUSE
 Precocious puberty (dt-51,sh-66)
 Puberty menorrhagia* (dt-54,sh-)
 HRT ** (dt-61,sh-155)
 Menopause - symptoms
Mnemonic: FSH > 20 IU/L
Remembering that this is the most
accurate blood test in confirmation of
the
menopause!
F hot Flushes/Female genitalia
(vaginal) dryness and burning
S Sweats at night
H Headaches
I Insomnia
U Urge incontinence
L Libido decreases

 Menopause – long-term effects
Mnemonic: CONU
C Cardiovascular disease: IHD,
stroke, arterial disease
O Osteoporosis: accelerated
bone loss leading to osteoporosis
and pathological
fractures
N Neurological: Alzheimerʼs dis-
ease
U Urogenital atrophy: loss of
pelvic floor muscle tone
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 Clinical features of menopause (dt-

57,sh-155)  Pelvic Inflammatory Disease (PID):

causes, effects
 Postmenopausal bleeding *** (dt-559)
"PID CAN be EPIC":
Causes:
NEUROENDOCRINOLOGY IN RELA-
Chlamydia trachomatis
TION TO REPRODUCTION Actinomycetes
Neisseria gonorrhoeae
 FSH (dt-70,243,sh-26)
Effects:
Ectopic
MENSTRUATION
Pregnancy
 Graffian follicle ** (dt-84,sh-30) Infertility
Chronic pain
 Corpus luteum (dt-87)

 Secretory phase of endometrium (dt-  RLQ pain: brief female differen-

91,sh-36) tial AEIOU:
Appendicitis/ Abscess
EXAMINATION OF A GYNAECOLOGI- Ectopic pregnancy/ Endometriosis
Inflammatory disease (pelvic)/ IBD
CAL PATIENT
Ovarian cyst (rupture, torsion)
 Pap smear *** (dt-110,sh-279) Uteric colic/ Urinary stones

 Ayer’s spatula * (dt-110,sh-42,280)

 Post coital test (PCT) * (dt-115,sh-  ABSOLUTE CONTRAINDICATION

125) TO HORMONE REPLACEMENT
THERAPY
 Colposcopy* (dt-115,sh-283)
ABCD
 Fern test *** (dt-115) A = Acute liver disease
 Culdocentesis ** (dt-120) B= undiagnosed vaginal (B)leeding
C=Cancer (breast/uterine)
 Diagnostic laproscopy (dt-121)
D= DVT (thromboembolic disease )

PELVIC INFECTION

 PID *** (dt-127,sh-214)

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SEXUALLY TRANSMITTED DISEASES

 Leucorrhoea* (dt-150)  Pelvic Inflammatory Disease

 Bacterial vaginosis *** (dt-152,sh-206) (PID): complications I FACE
PID:
 Clue cells (dt-152,sh-207)
Infertility
 Genital herpes* (dt-153,sh-207) Fitz-Hugh-Curitis syndrome
Abscesses
INFECTIONS OF THE INDIVIDUAL PEL- Chronic pelvic pain
VIC ORGANS Ectopic pregnancy
Peritonitis
 Bartholin’s cyst** (dt-162,sh-191,392) Intestinal obstruction
 Marsupialisation ** (dt-162,sh-392) Disseminated: sepsis, endocardi-
tis, arthritis, meninigitis
 Trichomonas vaginalis *** (dt-163,sh-

205)  Bacterial vaginosis

 Monilial vaginitis/ candidiasis *** (dt- Think: ―Take a Whiff and get
some Clue of Fishy odour!‖
164,sh-205)
 On Whiff test the vaginal dis-
 Senile vaginitis ** (dt-165,sh-192) charge gives a Fishy (amine)
 Pyometra** (dt-168,sh-232) odour
Clue cells are seen on microscopy
 Acute salpingitis (dt-169)

 Hydrosalpinx (dt-170)

 Salpingitis isthmica nodosa (dt-172,sh-

118)

 Colpotomy (dt-176)

 Tubo ovarian mass (dt-129,sh-216)

DYSMENORRHOEA &OTHER DISORD-

ERS OF MENSTRUAL CYCLE

 Dysmennorrhoea * (dt-178,sh-202,)

 Congestive dysmenorrhoea (dt-

181,sh-203)

 Ovulation pain (dt-181,sh-111)

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 Premenstrual symptoms (dt-182,sh-

200)
 Dysfunctional uterine bleeding
ABNORMAL MENSTRUAL BLEEDING
 Metrorrhagia** (dt-186,sh-49)
 Dysfunctional uterine bleeding *** (dt-
187,sh-49)
 Metropathia haemorrhagica / Cystic
(DUB): 3 major causes DUB:
Don't ovulate (anovulation: 90% of
cases)
Unusual corpus leuteum activity (pro-
longed or insufficient)
Birth control pills (since increases
progesterone-estrogen ratio)

glandular hyperplasia ** (dt-188,sh-50)

 Causes of premenarchal bleeding:
 Medical management of DUB * (dt- FEST
191,sh-54) F=Foreign body
E=Exogenous estrogen
 DUB-management(dt-191,sh-54)
S=sexual abuse
 Mirena (dt-192,sh-356)
T=Tumors(ovarian,adrenal,pitutary,sa
rcoma botryods.)
DISPLACEMENT OF THE UTERUS

 Fixed retroverted uterus (dt-198)  PROLAPSE ETIOLOGY

 Supports of uterus*** (dt-201,sh- ―all c ‗s‖
c-child birth trauma
18,310)
c- congenital weakness-suporting tissue
 Nulliparous prolapse (dt-201,sh-322) pelvic floor
 Pelvic organ prolapse** (dt-204,sh- c-chronic increase of abdominal pres-
310) sure
c-chronic cough/constipation
 Degrees of POP (dt-205,sh-311)
c-climatrix-decrease ostrogens
 Procidentia (dt-206,sh-311) 
 Decubitus ulcer (dt-206,sh-316) 

 Cystocele*- Diagnosis and treatment **

(dt-209,sh-314,318) 

 Rectocele * (dt-209,sh-315)

 Ring pessary* (dt-210,sh-317)

 Fothergill’s operation** (dt-216,sh-320)

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 POP-investigation & treatment* (dt-
210,sh-316)
 POP-differential diagnosis** (dt-
210,sh-316)
 Chronic inversion of uterus* (dt-223)
INFERTILITY
 Causes of male & female infertility (dt-
227,229,sh-110,130)
 ZIFT ** (dt-254,sh-140)
 Semen analysis** -- (normal) ** (dt-
232,sh-133)
 Tubal factors of infertility (dt-230,sh-
117)
 Tubal patency tests** (dt-238,sh-117)
 Cervical mucus study ** (dt-236,sh-
125)
 Induction of ovulation (dt-242)
 Ovulation inducing drugs (dt-243)
 GIFT * (dt-253,sh-140)
 FISH ** (dt-251)
BENIGN LESIONS OF THE CERVIX
 Cervical erosion/ Cervical ectopy**
(dt-267,sh-193)
 Transitional zone** (dt-321,sh-194)
 Nabothian cyst (dt-268,sh-194)
 Infertility – causes and risk factors
Mnemonic: INFERTILE (in females)
I Idiopathic
N No ovulation – PCOS, meno-
pause, pituitary disease, thyroid dis-
orders
F Fibroids – physical hindrance
E Endometriosis
R Regular bleeding pattern dis-
rupted – oligo/amenorrhoea
T Tubal disease leading to
blocked/damaged cilia
I Increasing age >35 years
L Large size – obesity
E Excessive weight loss – ano-
rexia nervosa
 Endometrial carcinoma: risk factors
• HONDA:
Hypertension
Obesity
Nulliparity
Diabetes
Age (increased)
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BENIGN LESIONS OF THE UTERUS

 Fibroid ******* (dt-272,sh-166)
 Fibroid-synptoms, signs, investi, Rx,
compli (dt-277,280,sh-166)
 Different types of fibroid (dt-272,sh-
168)
 Degenerative changes (dt-275,sh-
163)
 Myomectomy ** -compli (dt-604,sh-
 Meig syndrome
Meig syndrome is an ovarian tumour as-
sociated with ascites and pleural
effusion or hydrothorax. J. V. Meigs was
a Professor of Gynaecology at
Harvard. Now think of a HAT for its main
features.
HAT
H Hydrothorax
A Ascites
T Tumour of ovary
 Risk factors for cervical dysplasia

170) ―OSHA Ends Dirt, Garbage, and

Chemicals‖
 Fibroid polyp * (dt-285,sh-177) Oral contraceptives
Sex
BENIGN LESIONS OF THE OVARY HPV
Alcohol
 Functional cysts of the ovary (dt- Educaion—Poverty
DES (Diethylstilbestrol)
289,sh-179)
Genetics
 Follicular cyst (dt-289,sh-179) Cigarettes

 Classification of ovarian tumour ***

 Metastasis of cervical cancer
(dt-291,sh-252) RIB Eye Steak
Rectal
 Dermoid cyst **** (dt-293,sh-182)
Intra-abdominal
 Decubitus ulcer (dt-,sh-316) Bladder
Endometrial
 Meig’s syndrome *** (dt-296,sh-182)

 Pseudo myxoma peritonei (dt-300,sh-

187,254)

 Management of ovarian tumour (dt-

300,sh-259)

 Ovarian cystectomy (dt-300,sh-391)

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ENDOMETRIOSIS & ADENOMYOSIS

 Disordered proliferative endometrium  Endometriosis - symptoms

Mnemonic: Classic ʻquartetʼ of
(dt-305) DIPS
D Deep dyspareunia
 Chocolate cyst of the ovary****** (dt-
I Infertility
308,sh-146,180) P Pelvic pain (cyclical)
S Secondary dysmenor-
 Danazol ** (dt-311,sh-55,150,174)
rhoea
 Adenomyosis ** (dt-314,sh-175)
 Endometriosis: Symptoms
PREMALIGNANT LESIONS 5 ―D‖s
Dysmenorrhoea
 CIN *** (dt-320,sh-277) Disorders of menstruation
Dyspareunia
 Types of CIN* (dt-320,sh-277) Dyschezia
 CIN III* (dt-322,sh-277) Dull ache of abdomen

 Colposcopy (dt-324,sh-283)  Ovarian cancers: important types, by

WHO classification •
GENITAL MALIGNANCY • Surface:
"My Sister Began Experiencing Can-
 Carcinoma cervix *** (dt-339,sh-240) cer":
Mucinous
 Ca cervix-etiology, investigations, Rx, Serous
DD** (dt-340,sh-240) Brenner
Endometrioid
 Biopsy cervix (dt-245) Clear
• Germ cell:
 Cone biopsy (dt-589,sh-248,287)
"Doctor Examined The Ovaries":
 Schiller’s iodine test** (dt-325) Dysgerminoma
Endometrial sinus
 Brachytherapy * (dt-350,sh-304) Teratoma
 Endometrial carcinoma ** (dt-354,sh- Ovarian choriocarcinoma
• Sex cord:
228) "She Felt Grim":
 Staging of ca endometrium * (dt- Sertoli-Leydig
Fibroma
357,sh-235) Granulosa-theca
• Metastatic
 Fractional curettage ** (dt-357,sh-232)
"Killed":
 Invasive mole** (dt-361,sh-294) Krukenberg

 Choriocarcinoma * (dt-362,sh-294)

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 CA 125** (dt-370,sh-145,185,285)

 Dysgermonima ** (dt-381,sh-264)

 Endodermal sinus tumour (dt-383,sh-  Chronic Pelvic Pain

265) Think of LEAPING pain
Leiomyoma
 Granulosa cell tumour * (dt-384,sh- Endometriosis
262) Endometritis
Adhesions
 Fibroma ovary (dt-385,sh-182) Adenomyosis
 Krukenberg tumour (dt-387,sh-266) PID
Infections rather than PID
Neoplasia
URINARY PROBLEMS IN GYNAECOL-
Gastrointestinal
OGY
 Acute Pelvic Pain
 Retension of urine * (dt-397,sh-) A ROPE
Appendicitis
 Stress urinary incontinence (dt-397,sh-
Abscess
325) Abortion
Ruptured ovarian cyst
 Kelly’s placation (dt-402,sh-330) Ovarian torsion
 Asymptomatic bacteriuria *** (dt-411) PID (tubo-ovarian abscess)
Ectopic pregnancy
GENITAL FISTULA
 Reversible Causes of urinary in-
 Vesico genital fistula** (dt-417,sh-333) continence
DIAPPERS
Delirium
Infection
Atrophic Vaginitis
GENITAL TRACT INJURIES
Pharmacologic causes
Psychiatric causes
 Complete perineal tear* (dt-430)
Excessive Urine production
Restricted mobility
INTERSEX Stool impaction

 Turner’s syndrome** (dt-441,sh-63)

 Androgen insensitivity syndrome (dt-

443,sh-72,95)

 Down’s syndrome (dt-41)

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AMENORRHOEA

 Primary amenorrhoea** (dt-450,sh-70)  Polycystic Ovarian Syndrome

(PCOS): first line treatment
 Cryptomenorrhoea (dt-450,sh-71)
Treat PCOS with OCP's(oral contra-
 Hematocolpos***(dt-450,sh-71) ceptive pills).
 Mullerian agenesis (dt-454,sh-
 Oral contraceptive complications:
72,82,88)
warning signs ACHES:
 Secondary amenorrhoea** (dt-457,sh- Abdominal pain
74) Chest pain
Headache (severe)
 Asherman’s syndrome* (dt-459,sh-75)
Eye (blurred vision)
 Sheehann’s syndrome* (dt-465) Sharp leg pain
 Polycystic ovarian syndrome *** (dt-

459,sh-97)  Asherman syndrome fea-

 Hirsuitism (dt-571) tures ASHERMAN:
Acquired Anomaly
 Anorexia nervosa (dt-)
Secondary to Surgery
Hysterosalpingography confirms di-
CONTRACEPTION
agnosis

 Pearl index**(sh-342) Endometrial dam-

age/ Eugonadotropic
 Natural methods of family planning*
Repeated uterine trauma
(dt-478,sh-362) Missed Menses
 Femshield Adhesions
Normal estrogen and progesterone
 Cervical mucous method (dt-478)

 Conventional contraceptives ** (dt-  Secondary amenorrhea: causes

SOAP:
476)
Stress
 Condoms ** (dt-476,sh-366) OCP
Anorexia
 Female condom * (dt-476,sh-360) Pregnancy
 IUCD ** (dt-479,sh-355)

 Copper T (dt-479,sh-355)

 Multi load* (dt-480,sh-356)

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 Progestasert * (dt-480,sh-256)

 Hormone containing IUCD (dt-480,sh-

355)
 Alpha-fetoprotein: causes for in-
 Mirena/levonorgesterol IUS * (dt- creased maternal serum AFP dur-
480,sh-356) ing
pregnan-
 Hormonal contraception (dt-483,sh-
cy "Increased Maternal Serum Alpha
342) Feto Protein":
 MTP act(sh-374) Intestinal obstruction
Multiple gestation/ Miscalculation of
 1st & 2nd trimester MTP(sh-375)
gestational age/ Myeloschisis
 Menstrual regulation (dt-,sh-376) Spina bifida cystica
 OCP *** (dt-485,sh-343) Anencephaly/ Abdominal wall defect
Fetal death
 OCP-advantages, contraindications***
Placental abruption
(dt-487,sh-346)

 Non contraceptive benefits of OCP (dt-  Oral contraceptives: side ef-

fects CONTRACEPTIVES:
489,sh-346)
Cholestatic jaundice
 Triphasic pill (dt-490,sh-344) Oedema (corneal)
 Progesterone only pill (dt-491,sh-347) Nasal congestion
 Injectable contraceptives (dt-491,sh- Thyroid dysfunction
Raised BP
348)
Acne/ Alopecia/ Anaemia
 Norplant* (dt-492,sh-350) Cerebrovascular disease
 Post natal contraception method Elevated blood sugar
Porphyria/ Pigmentation/ Pancreatitis
 Emergency contraception **** (dt-
Thromboembolism
492,sh-353) Intracranial hypertension
 Vasectomy ** (dt-494,sh-371) Vomiting (progesterone only)
Erythema nodosum/ Extrapyramidal
 Non scalpel vasectomy*** (dt-494,sh-
effects
372) Sensitivity to light
 Tubectomy ** (dt-496)

 Modified pomeroy’s method of sterili-

zation ** (dt-496,sh-365)

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 Medical tubectomy (dt-497)

 Laproscopic sterilization*** (dt-498,sh-  Medical abortion- it is a type of non

367) surgical abortion in which abortifacint
pharmaceutical drugs are used to in-
 Complications of laproscopic steriliza- duse abortion.
tion ** (dt-499,sh-368)
 Progesterone: actions
 Post partum sterilization (dt-500,sh-
PROGESTE:
364)
Produce cervical mucous
 Male pill (dt-501,sh-353)
Relax uterine smooth muscle
 Centchroman/ saheli*** (dt-501)
Oxycotin sensitivity down
 Medical abortion *** (dt-501,sh-375)
Gonadotropin [FSH, LH] secretions
 Depot provera (dt-491,sh-348,150)
down
 Gossypol (dt-503)
Endometrial spiral arteries and secre-
OTHER tions up

 Methotrexate (dt-513,516,sh-301) Sustain pregnancy

 HCG * (dt-511) Temperature up / Tit development

 Clomiphene citrate ** (dt-242,sh-113) Excitability of myometrium down

 Progesterone challenge test (dt-


469,sh-112)

 Mifepristone*** (dt-492,537,sh-

354,375)

 Leucorrhoea (dt-551)

 GnRH analogue (dt-252,525,sh-

201,173)

 Ethacridine lactate (sh-380)

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OPERATIVE GYNAECOLOGY

 Dilation and curettage * (dt-585,sh-

394)  Prolactin and oxytocin: Functions

 Hysterosalpingogram(HSG) (dt-
588,sh-117)
 Biopsy cervix (dt-589)
PROlactin stimulates mammary
glands to PROduce milk and
Oxytocin stimulates mammary glands
to OOze milk.

 Cone biopsy (dt-589,sh-393)  Physiologic causes of Prolactinoma

7S
 Myomectomy* (dt-604,sh-391) Sex
 Hysterectomy (dt-593,sh-383) Stress
Sleep
Surgery
Suckling
Second half of the cycle
ENDOSCOPIC SURGERY IN GYNAE-

COLOGY

 LAVH * (dt-617,sh-389)

 Hysteroscopy *** (dt-122,619,sh-404)

 Staging laprotomy (dt-,sh-391)

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Essay questions

1. 55 yr old obese, hypertensive and di-  Other symptoms of prolapsed of

abetic lady complaining of of bleeding uterus ?

per vaginum  What is the management of pro-

 What is the most possible diagno- lapsed in this woman ?

sis?

 Discuss the clinical features of that 5. A 24yr old woman married for 5yrs

condition ? with infertility

 Investigations?  How will you investigate the male

 Steps of abdominal hysterectomy partner ?

?  Describe one test to diagnose ovu-

lation?

2. What are the common causes of me-  How will treat her if she is having bi-

trorrhagia ? lateral tubal block ?

 Explain c/f?

 Investigations? 6. A 35yr old nulliparous lady comes with

h/o menorrhagia, dysmenorrhoea and

3. Management of one of the common mass abdomen

condition in a 40yr old multiparous  D/d ?

women coming with metrorrhagia?  How will you evaluate the lady ?

 Most probable diagnosis ?

4. 60 yr old woman complaining of mass  How will you manage this condition?

coming per vagina

 What is the most possible diagno- 7. A 60yr old lady is admitted with pro-

sis? gressive distensionof the abdomen

 D/d ? and loss of weight of short duration

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 What are the differential diagno-

sis? 11. A 42yr lady P2L2 both FTND last

 What clinical features help you to child birth 8yrs back, who is sterilized,

diagnose the condition ? presents with menorrhagia and disme-

 What are the investigations ? norrhagia of 2-3yr duration, she was

 How will you manage the case ? found to be anaemic, systemic exami-

8. A 45yr old lady with c/o post coital nation reveals no abnormalities. Pelvic

bleding exmn – not done

 How will you evaluate her ?  Investigations ?

 What are the common causes of  Diagnosis?

such complaints ?  Treatment ?

 What is the etiology of ca cervix ?

 How will you manage CA insitu 12. A 60yr old woman presents with pro-

cervix ? gressive distension of abdomen and

loss of weight of short duration. D/d ?

9. A 55yr old nulliparous obese, diabetic  Clinical findings?

lady who attained menopause 8yrs  Diagnosis?>

back presents with complaints of  Investigations ?

bleeding per vaginum  Treatment?

 What is the most probable diagno-

sis ? 13. A 44yr old nulliparous woman present-

 What are the investigations ? ing with menorrhagia for 6 months

 What is the management ?  Possibilities?

 Most important investigations ?

10. A 45 yr old para, sterilized present with  Medical treatment of menorrha-

mass per abdomen USG reveals a gia?

mass with solid areas close to the ute-

rus with ascitis. 14. A 44 yr old parous woman on routine

Diagnosis ? benign / malignant ? cervical cytology screening was found

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to have grade III CIN. She is asymp-

tomatic.

 Grades of CIN ?

 How will you proceed with the in-

vestigations in this patient ?

 Lymphatic drainage of cervix ?

 Structures removed in radical hys-

terectomy ?

15. A 53yr old woman who had meno-

pause at 47yrs now complaints of va-

ginal bleeding.

 Define post menopausal bleeding ?

 Important cause of post menopaus-

al bleeding ?

 Aetiological factors in CA endome-

trium ?

16.

17.

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Case taking format

Name : Ms/Mrs age: address : occupation :

Name & occupation of husband:

Blood group:

She is …………..(G,P,L)

Postmenopausal/ not

Admitted on:

Presenting complaints:

1. Discharge per veginal 3. Pain

 Amount (profuse/scanty)  Relation with menstrual cycle

 Color (whitish/greenish/ blood  Nature, intensity, onset, location

stained)  Relation to food, posture

 Nature (mucoid/ curdy/frothy) ,urination

 Odour(offensive/ urinary)  Aggrevating and relieving fac-

 Relation to menstrual cycle tors

 Associated symptoms ( burn-  Other associations

ing pain)  Fever

 Associated with micturition 4. Dyspareunia

/defeacation  Superficial/ deep

2. Bleeding per vaginal 5. Infertility

 Amount & no: of days (no: of  Frequency & timing of coitus

pads used) 6. Urinary symptoms

 Relation to menstruation  Burning pain

 Passage of clots  Frequency

 Associated pain / discharge/ fe-  Retension

ver  Incontinence

 Enuresis

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7. Bowel symptoms 9. Fever

 Constipation 10. Back ache (commonly in POP)

 Diarrhoea 11.

8. Mass descending per vagina

Menstrual history

Marital history

Obstetric history

 No of deliveries (G,P,L)  Any h/o prolonged labour(prolongd labr

 Patient’s age @ each delivery leads to birth asphyxia – causes de-

 Type of delivery(normal/ c-section) layed milestones)

 Delivery-(home/ hospital)  Antenatal period was unevent ful /not

 Birth weigth of babies  Any abortions

 Conducted by local dhais / not  Last child birth

 normal mile stones of development

Past history

Family history

Personal history

GENERAL EXAMINATION

Patient conscious,cooperative,well oriented

Height,weight, BMI:

Pallor ,icterus, cyanosis, clubbing, lymphadenopathy, edema (PICCLE)

Skin,hair, nail thyroid and breast

VITAL SIGNS

Pulse:…………..BP:…ryt arm sitting. Respiration :……………….. Temperature:…………

OTHER SYSTEMS

CVS- normal S1, S2 heard,no murmer

RESP: normal vesicular sounds are heard

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GIT:normal bowel sounds are heard ,,no hepatomegaly, no splenomegaly

CNS:

ABDOMINAL EXAMINATION (after evacuation of bladder)

 Inspection

 Abdomen distended /not

 Umbilicus central/not everted/ inverted

 All quadrants moves equal with respiration

 Any visible pulsations/ engorged veins (in case of previous surgery – scars)

 Hernia orifices normal/not

 Visible swelling- shape,size, site(involving areas) ,edges, pressure effects

 Palpation

 Local rise of Temperature (temp & tenderness relevant in DUB)

 Tenderness, guarding, rigidity.

 Any mass –with size corresponds to ….. weeks of gestation

 ( oval mass of size 9*7cm in the ryt iliac fossa(or involving areas), firm in consis-

tency, all borders are palpable, mobility, fluctuation

 Percussion

 Dullness/tympanic note over the areas

 Shifting dullness present/not

 Auscultation

 Normal bowel sounds heard/ not

 Local examination

 Hair / mons pubis/ labium majora, minora/ any mass protruding / introitus-(normal/

gapping)

 Per speculum

 Cervix –erosions/ulcerations

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 Bleeding / Discharge

 Mass protruding(gradeI &II of POP)

 Bimanual examination ( in obstetrics—per vaginal)

 Fornix -free

 Retroverted

 Adnexa-mass/ tenderness

 Atrophy (--postmenopausal )

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PAEDIATRICS

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SYLLABUS
According to KUHS,

Theory Paper 40
Theory- Internal assessment 10
Viva voce 10
Practicals- Internal assessment 10
Practicals 30
TOTAL 100

QUESTION PAPER MODEL

I Essay 1×10 10
II Short notes (4 nos) 4×3 12
III Draw and label 2×2 4
IV Answer briefly 5×2 10
V One word answers 4×1 4
TOTAL 40

PRACTICALS

Long case 15
Short case 10
OSCE (3 Stations) 5
Instruments 2.5 10
Viva Drugs 2.5
Nutrition 2.5
X-ray 2.5

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IMPORTANT TOPICS

opg-O P GHAI ESSENTIAL PE-

DIATRICS-8TH EDITION  Short stature: differen-

tial ABCDEFG:
Alone (neglected infant)
NORMAL GROWTH Bone dysplasias (rickets, scoliosis,
 Factors affecting growth and retarda- mucopolysaccharidoses)
Chromosomal (Turner's, Down's)
tion ** (opg-7) Delayed growth
Endocrine (low growth hormone,
 Head circumference ** (opg-12)
Cushing's, hypothyroid)
 Midarm circumference *** (opg-12) Familial
GI malabsorption (celiac, Crohn's)
 BMI *(opg-13)

 Laws of growth (opg-9)  Pediatric milestones in develop-

ment
 Anthropometry * (opg-)
1 year: -single words
 Autism (opg-) 2 years: -2 word sentences -
understands 2 step commands
DISORDERS OF GROWTH
3 years: -3 word combos
 Short stature** (opg-35) -repeats 3 digits
-rides tricycle
 Failure to thrive * (opg-38)
4 years: -draws square
NORMAL DEVELOPMENT -counts 4objects
 Developmental milestones of a 4

month old baby(opg-49)

 Study the –gross motor, fine mo-

tor,social & language etc developmen-

tal milestones (opg-49)

 Pincer grasp (opg-50)

 Causes of global developmental delay

(opg-53)

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DEVELOPMENTAL DISORDERS

 Enuresis *** (opg-504)

 Breath holding spells (opg-58)  Head circumference with age ·

Remember 3, 9, and multiples
 ADHD * (opg-59)
of 5:
 Causes of dyslexia(opg-60) Newborn 35 cm
3 mos 40 cm
 Autism (opg-61) 9 mos 45 cm
 Juvenile delinquency (opg-62) 3 yrs 50 cm
9 yrs 55cm
FLUID AND ELECTROLYTE DISTUR-

BANCE  Weights of children with

age Newborn 3 kg
 Hyperkalaemia (opg-78) 6 mos 6 kg (2x birth wt at 6 mos)
NUTRITION 1 yr 10 kg (3x birth wt at 1 yr)
3 yrs 15 kg (odd yrs, add 5 kg until 11
 Digestability quotient (opg-89) yrs)
 Biological value(opg-89) 5 yrs 20 kg
7 yrs 25 kg
 Net protein utilization (opg-89) 9 yrs 30 kg
 Balanced diet (opg-91) 11 yrs 35 kg (add 10 kg thereafter)
13 yrs 45 kg
 Complementary feeding (opg-99) 15 yrs 55 kg
 WHO & IAP classification of malnutri- 17 yrs 65kg

tion (opg-97)  The new born baby

 Age independent anthropometric mea- Resuscitation – Indications
Mnemonic: IF KEMPT
surements** (opg-97) I Instrumental delivery
 Mid upperarm circumference *** F Fetal distress
K Known congenital abnormality
(opg-97) E Emergency caesarean section
 Kwashiorkar *** (opg-99) M Multiple births
P Prematurity
 SAM **** (opg-97) T Thick meconium stains the
 SAM-D/D, management & complica- liquor

tions * (opg-98) 
 Anaemia prophylaxis programme (opg-

109)

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MICRONUTRIENTS IN HEALTH & DIS-

EASE

 WHO classification of xerophthalmia*  APGAR score compo-

nents APGAR:
(opg-111) Appearance: cyanosis--peripheral,
 Bitot’s spot (opg-111) central, none
Pulse: pulse rate
 Vit A prophylaxis** (opg-111) Grimace: response to stimulation
 Rickets- c/f, Rx ** (opg-113) Activity: movement of the baby (mus-
cle tone)
 Radiological & metabolic changes in Respiration: respiratory rate
rickets* (opg-114)
 Neonatal resuscitation: successive
 Rachitic and scorbutic rosary (opg- steps "Do What
114) Pediatricians Say To, Or Be Inviting
Costly Malpractice":
 Scurvy (opg-120) Drying
 Beri beri * (opg-117) Warming
Positioning
 Role of vit E (opg-116) Suctioning
Tactile stimulation
 Anti oxidant action of vit E (opg-116)
Oxygen
 Zinc-action * (opg-121) Bagging
Intubate endotracheally
 Acrodermatitis enteropathica* (opg-
Chest compressions
121) Medications
 Selenium –use (opg-122)

 Iodine-use * (opg-122)  Vitamin toxicities: neonatal Excess

vitamin A: Anomalies
(teratogenic)
NEONATOLOGY Excess vitamin E: Enterocolitis (ne-
crotizing enterocolitis)
 APGAR score ** (opg-126)
Excess vitamin K: Kernicterus
 TABC resuscitation (opg-126) (hemolysis)

 5 cleans in delivery room(opg-133)

 Erythema toxicum (opg-135)

 Physiological jaundice** (opg-172)

 Danger signs in newborn* (opg-)

 Anterior fontanelle** (opg-140)

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 Caphalhematoma** (opg-141)

 Moro reflex *** (opg-143)  Breast feeding-advantages of

BREASTMILK!
 Neonatal reflex ** (opg-152)
―BREASTMILK‖
 Kangaroo mother care (opg-148) B Bonding
R Reduced solute
 Signs of proper attachment in breast E Eczema
A Allergy protection
feeding (opg-154) S Sterilization not required
 Advantages of breast feeding*** (opg- T Taurine
M Macrophages
150) I Immunoglobulin A; higher IQ
L Lactoperoxidase, Lysosymes, Lacto-
 Nutritional aspect of breast milk (opg- ferrrin and
Long chain fatty acids
153) K Cot death (lower incidence)
 Colostrum * (opg-152)
 Breast feeding: contraindicated
 BFHI ** (opg-161) drugs BREAST:
Bromocriptine/ Benzodiazepines
 Prematurity (opg-124)
Radioactive isotopes/ Rizatriptan
 CSF findings in normal child(opg-164) Ergotamine/ Ethosuximide
Amiodarone/ Amphetamines
 Birth asphyxia (opg-166)
Stimulant laxatives/ Sex hormones
 Bilirubin encephalopathy (opg-172) Tetracycline/ Tretinoin

 Kernicterus ** (opg-173)
 Breast feeding: benefits
 Phototherapy * (opg-175) ABCDEFGH:-
Infant:
 ELBW (opg-125)
Allergic condition reduced
 Neonatal resuscitation (opg-125) Best food for infant
Close relationship with mother
 Respiratory distress in new born (opg- Development of IQ, jaws, mouth
168) · Mother:
Econmical
IMMUNITY & IMMUNISATION Fitness: quick return to pre-pregnancy
 Universal immunization programme* body shape
Guards against cancer: breast, ovary,
(opg-205) uterus
 Cold chain* (opg-205) Hemorrhage (postpartum) reduced

 BCG vaccination (opg-190)

 Pulse polio immunization (opg-191) *

 OPV** (opg-191)

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 Vaccine vial monitor (opg-205)

 DTP vaccine-complications * (opg-  Bilirubin: phototherapy BiLirUbin

absorbs light maximally in the
193) BLUe range.
 Measeles vaccine (opg-195)
 Nappy rash
 MMR vaccine* (opg-195) ―PEE-SAC‖
P Psoriasis
 Rubella vaccine (opg-195) E Eczema
E Excoriation (e.g. due to diarrhoea, acid
 Congenital rubella syndrome (opg-
stools,
195) disaccharide intolerance, etc.)
S Seborrhoeic dermatitis
 Hepatitis B vaccine* (opg-196) A Ammoniacal dermatitis
C Candidiasis
 National immunization schedule *
 TORCH infections
(opg-206)
Perinatal infections passed from mother
 Management of a baby born to HbSAg to child.
mother (opg-197) TORCH
Toxoplasmosis / Toxoplasma gondii
 Management of dog bite (opg-103)
Other infections e.g. HIV, coxsackie vi-
 HIB vaccine* (opg-199) rus, syphilis, varicella-zoster virus
Rubella

Cytomegalovirus
INFECTIONS & INFESTATIONS Herpes simplex virus-2
 PUO (opg-211)

 Measles (opg-213)

 Koplik’s spot (opg-213)

 Complications of measles(opg-214)

 Polio myelitis (opg-217)

 AFP *** (opg-592)

 Different causes of AFP (opg-592)

 AFP surveillance*** (opg-219,592)

 Dengue –transmission (opg-224)

 Dengue haemorrhgic fever (opg-225)

 DHF-Rx *(opg-227)

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 AIDS diagnosis of HIV in children*

(opg-234)
 Placenta-crossing organisms/ an-
 ELISA (opg-235)
tenatal Infections STARCH:
 Complications of chickenpox (opg-214) Syphilis
Toxoplasmosis
 Complications of measles (opg-213) AIDS (HIV)
 Mantoux test * (opg-254) Rubella
CMV
 Rifampicin (opg-256) Herpes/ Hepatitis
 Category I & III anti Tb treatment (opg-
 Psedomonas aeruginosa: features
257) ―AERUGINOSA:‖
 DOTS (opg-257) Aerobic
Exotoxin A
 Complications of diphtheria** (opg- Rod/ Resistance
242) UTIs, burns, injuries
Green-blue dressings
 Complications of whooping cough * Iron-containing lesions
(opg-243) Negative gram
Odor of grapes
 C/F of enteric fever – lab investiga- Slime capsule sometimes (in CF pt)
tions, transmission etc. (opg-244) Adherin pili

 Typhoid fever – Rx * (opg-243)

 Malaria (opg-260)

 Cerebral malaria * (opg-261,266)

 QBC (opg-261)

 Treatment of p.vivax malaria** (opg-

266)

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DISEASE OF GASTRO INTESTINAL
SYSTEM
 Causes of constipation in an infant
(opg-283)
 Hirschprung disease (opg-285)
 Acute intussusceptions in an in-
fant(opg-287)
 Key signs of dehydration (opg-73)
 Oral rehydration solution * (opg-294)
 Composition of WHO ORS ** (opg-
294)
 ORT** (opg-294)
 ReSoMal
 Management of diarrhoea ** (opg-293)
 Persistent diarrhoea (opg-297)
 Lactose intolerance * (opg-297)
 4 causes of hepatomegaly
 4 causes of splenomegaly
 Liver cirrhosis*
 Hepatic encephalopathy (opg-317)
 Acute fulminant liver cell failure (opg-
313)
 Wilson’s disease* (opg-320)
HEMATOLOGICAL DISORDERS
 Iron deficiency anaemia* (opg-334)
 Anaemia prophylaxis programme (opg-
109)
 Nutritional anaemia –Rx ** (opg-313)
 Chronic diarrhoea
Mnemonic: 5 Cʼs
Inflammatory causes of chronic diar-
rhoea include:
C Crohnʼs disease
C Ulcerative Colitis
C Cyanosis
 Pyloric stenosis features
The three P‗s
Palpable mass
Peristalsis visible
Projectile vomiting (3-7 weeks af-
ter birth)

 Features of Down‘s syndrome
My CHILD HAS a PROBLEM
Congenital heart disease / Cataracts
Hypotonia / Hyperthyroidism
Incure 5th finger / Increased gap be-
tween 1st and 2nd toes
Leukaemia (risk x2) / Lung problems
Duodenal atresia / Delayed development
Hirshsprung‘s disease / Hearing loss
Alzheimer‘s disease / Alantoaxial insta-
bility
Short neck / Squint
Protruding tongue / Palmar crease
Roung face / Rolling eye (nystagmus)
Oblique eye fissure / Occiput flat
Behavioural difficulties
Low nasal bridge / Language problem
Epicanthic fold / Ear folded
Mental retardation / Myoclonus
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 Hemolytic anaemia-lab , Rx * (opg-

337)  Causes of respiratory failure

 Hereditary spherocytosis(opg-338) Mnemonic: PC FED BRAHMS
P Pneumonia
 Thalassemia(opg-341) C Cystic fibrosis/Croup
 Immune thrombocytopenic purpura** F Foreign body
E Epiglottitis
(opg-351) D Drug ingestion
DISEASES OF EAR, NOSE & THROAT B Bronchiolitis
R Raised ICP
 Croup ** (opg-368) A Asthma
 Management of acute epiglotitis* (opg- H Head injury
M Meningitis/muscle weakness
368) S Severe cardiac failure
 Causes of a/c stridor ** (opg-368)
 Presentation of asthma
DISORDERS OF RESPIRATORY SYS- Mnemonic: CWS
TEM C Cough (dry/nocturnal/worse
with exercise)
 Pneumonia ** (opg-377) W Wheeze
 Very severe pneumonia (opg-377) S Shortness of breath

 Pneumonia-lab diagnosis, Rx (opg-

378)  Stridor causes

 Mycoplasma pneumonia (opg-379) Stridor is‖ A Very WELSH Condition‖

Acute epiglotitis (acute stridor)
 ARI ** -CP (opg-380)
Vocal cord paralysis (chronic stri-
 Bronchiolitis **-D/D, investigations, Rx dor)
(opg-381) Web, laryngeal (chronic)
External compression e.g. vascu-
 Bronchial asthma* (opg-382) lar ring (chronic)
 Treatment of acute severe asthma**** Laryngomalacia (chronic)
Subglottic stenosis (chronic)
(opg-387,390)
Hypocalcaemia (chronic)
 Status asthmaticus ** (opg-385) Croup (acute)



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DISORDERS OF CARDIO VASCULAR

SYSTEM  Fallot‘s tetralogy

 Rheumatic fever ** (opg-433) Fallot‘s trilogy is Right ventricular hyper-
trophy, ASD and Pulmonary
 Jones criteria *** (opg-433) stenosis – RAP. Then there‘s this:

 Rheumatic carditis-C/F, Rx (opg-434) ―Fella‘s Blue – Pull His Vesd Right

Over‖
 Prophylaxis & prevention of rheumatic
Fella‘s Fallot‘s
fever*** (opg-438) Blue Cyanotic
Pull his Pulmonary stenosis
 Collapsing pulse VeSD- VSD (ventricular septal defect)
Right -Right ventricular hypertrophy
 Infective endocarditis ** (opg-443) Over - Over-riding aorta
 NADAS criteria (opg-406)  Cyanotic heart diseases: 5 types ·
 Eisenmenger’s complex (opg-428) 5 T's:
Tetralogy of Fallot
 Management of CHF * (opg-398) Transposition of the great arteries
 Common congenital heart diseases Truncus arteriosus
Tricuspid atresia, pulmonary aTresia
(opg-400) Total anomalous pulmonary venous
 Complications of CHD ** (opg-410) drainage

 PDA (opg-417)

 TOF **– c/f, compli ** (opg-420)  Haematuria: differential in chil-

dren ABCDEFGHIJK:
 Cyanotic spells (opg-411) RX * Anatomy (cysts, etc)
 Murmurs of AR, MR, AS, MS, PDA, Bladder (cystitis)
Cancer (Wilm's tumour)
TOF, ASD, VSD * (opg-413,415,418) Drug related (cyclophosphamide)
DISORDERS OF KIDNEY & URINARY Exercise induced
Factitious (Munchausen by proxy)
TRACT Glomerulonephritis
 Proteinuria* (opg-473) Haematology (bleeding disorder,
sickle cell)
 Acute glomeruloneophritis ***- c/f, in- Infection (UTI)
vestigations, Rx (opg-474) In Jury (trauma)
Kidney stones (hypercalciuria)
 Nephrotic syndrome** - Mx *** (opg- 
477)

 Indications for renal biopsy in nephritic

& nephritic syndrome (opg-474)

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 UTI ** (opg-483)

 Vesico ureteric reflux ** (opg-485)

 Posterior urethral valve ** (opg-506)  Cerebral palsy (CP): most likely

cause CP: Cerebral
Palsy
Child Premature
ENDOCRINE & METABOLIC DISORD-
· The premature brain is more prone
ERS to all the possible insults.
 Cretinism * (opg-519)
 Developmental assessment
 Congenital hypothyroidism* (opg-516) Primitive reflexes
Mnemonic: MPRAG
 Drug therapy in hyperthyroidism (opg-
M Moro
517) P Placing reflex
R Rooting
 Undescended testes (opg-540)
A Atonic neck reflex
G Grasp reflex
CENTRAL NERVOUS SYSTEM
 Clinical presentation of brain tu-
 Causes of convulsions in child- mours
ren*(opg-553) Mnemonic: BAN HENS
B Blurred vision
 Febrile convulsions** (opg-556) A Ataxia (clumsiness)
 Prevention of febrile seizures (opg- N Nystagmus
H Headache
557)
E Endocrine dysfunction
 Absence seizures *(opg-558) N Nausea and vomiting
 Atypical febrile seizure(opg-556) S Squint (6th nerve palsy)

 Petit mall seizures (opg-558)

 Neonatal seizures** (opg-558)
 Infantile myoclonic seizures (opg-559)
 Acute bacterial meningitis *** (opg-
563)
 Meningitis- investigations, Rx , comp*
(opg-554)
 Kernig sign (opg-564)
 Cerebral palsy types
―SADAM‖
Spastic – increased tone
Athetoid / Dyskinetic – involuntary and
uncontrolled movements
Ataxic – cerebellar damage difficulty with
fine motor skills and balance
Mixed


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 CSF findings in meningitis * and in

normal case (opg-164)

 Raised intracranial tension –c/f * (opg-
570)
 Pseudotumour cerebri (opg-575)
 AFP** (opg-592)
 AFP surveillance ** (opg-593)
 D/D of AFP** (opg-592)
NEUROMUSCULAR DISORDERS
 Floppy infant (opg-588)
CHILDHOOD MALIGNANCIES
 ALL *** - c/f (opg-599)
 Kawasaki disease
This is also known as mucocutaneous
lymph node syndrome. The CRESTS
signs apply here:
―CRESTS‖
C Cervical lymphadenopathy; C-reactive
protein
raised
R Rash (widespread, polymorphic)
E Eyes (bilateral, non-exudative con-
junctivitis)
S Strawberry tongue; red lips
T Temperature raised (persists over 5
days, unresponsive to antibiotics and an-
tipyretics)
S Sausage-like fingers/toes from oe-
dema
Skin on palms/soles peeling

RHEUMATOLOGICAL DIORDERS
 Features of Downʼs Syndrome
 SLE (opg-628) Mnemonic: DOWNS
 Kawasaki disease (opg-631) D -Dysplastic ears/Dysplastic
pelvis (seen on X-ray)
 HSP ** (opg-632) O -Occiput is flat/Overly large
GENETIC DIORDERS tongue
W- Widely spaced 1st and 2nd
 Sex chromosomal anomalies* (opg-
toes and a high-arched pal-
636) ate/Weak/ʼfloppyʼ baby
 Down’s syndrome** (opg-637) (hypotonia)
N -Neck skin abundant
 Turner’s syndrome (opg-640) S - Short, broad hands with sin-
 PCR* gle palmar crease/Slanting
eyes/Speckled iris
 Klinefelter’s syndrome ** (opg-640)
(Brushfieldʼs spots)
 Marfan’s syndrome* 

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INBORN ERRORS OF METABOLISM, 

SKIN DISORDERS, EYE DISORDERS . 

POISONINGS,INJURIES & ACCIDENTS 

 Kerosene poisoning ** (opg-702) 

COMMON MEDICAL PROCEDURS 

 Contraindications for lumbar puncture* 

(opg-732) 

 Bone marrow aspiration (opg-736) 

RATIONAL DRUG THERAPY 

 MRSA (opg-) 

 ACE inhibitors 

 Cephalosporins(opg-742) 

 4 hepato toxic drugs- 

NSAIDs,isoniazid,dapsone, halothane 

 Nephrotoxic drugs- 

Gentamicin,cyclosporine, cisplatin, 

amphotericine, indomethacin

COMMUNITY PAEDIATRICS

 IMNCI (opg-751)

 Infant mortality rate (opg-2)

 UIP (opg-205)

 Mid day school meal programme (opg-

109)

 Polio eradication programme (opg-

192)

 PHC

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ESSAY QUESTIONS
1. A 15 days old baby is brought with yel-
lowish discolouration of eyes and skin
 Is it physiological/ pathological ?
 What are the probable cases?
 What are the investigations ?
 What history will you specifically
ask for ?
PATHOLOGICAL JAUNDICE
2. What are the causes of acute flaccid
paralysis in a 5yr old boy ?
 Describe the clinical features of
poliomyelitis ?
 Enumerate the likely complica-
tions ?
 Management of poliomyelitis ?
3. A 5yr old is brought with fever of 2
weeks duration and pain abdomen on
and off. Physiological examination re-
vealed mild pallor, hepatomegaly of
4cms and splenomegaly of 3cm.
 write the most probable diagno-
sis?
 d/d ?
 investigations ?
ENTERIC FEVER
4. A 9month old infant is brought with wa-
tery diarrhea and vomiting. On exami-
nation child is thirsty, irritable, and oral
mucous membrane dry.
 What is the diagnosis?
 Treatment ?
 Criteria from discharge from hos-
pital ?
 What instructions will you give to
the mother ?
5. A 1yr old weighing 8kg presents to the
hospital with a 1day history of vomiting
and watery diarrhea following an URTI.
On examination he was found to be
moderately dehydrated.
 What are the signs of dehydration
you are likely to find in this child ?
 What are the important investiga-
tions you order and what are the
likely results ?
6. A 9month old baby brought with history
of becoming pale and not doing well.
There is no history of bleeding from
any site . There is a history of a sibling
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death due to similar illness. On ex- STAPHYLOCOCCAL PNEU-

amination there is severe pallor and MONIA

moderate splenomagaly.

 What are the probable diagnosis? 9. A 4month old baby is brought with a

 What investigations will you do to history of cold, cough and difficulty in

diagnose this condition? breathing. On examination his RR-

 Management ? 66/min, he has intercostals and sub-

HEREDITORY SPHEROCY- costal recession. His chest looks

TOSIS prominent and hyperresonant to per-

cussion. Auscultation reveals a scat-

7. A 4yr old girl is brought with purpura tered rhonchi.

and gum bleeding. On examination  Diagnosis?

there is no lymphadenopathy, bone  D/d ?

tenderness or hepato splenomegaly.  Chest X ray findings ?

 What is the clinical diagnosis?  Management ?

 Investigations ? Acute bronchiolitis

 d/d?

 Treatment ? 10. A 5 year old boy is admitted with fever,

ITP cough and edema. He had one epi-

sode of edema earlier also and was on

8. 1yr old child is brought with pyoderma, some medication

fever cough. On examination he is  Probable diagnosis?

cyanosed, respiratory rate is 62/min,  Investigations ?

grunting and chest retractions are  Treatment ?

present. IE ON CHD

 What is the diagnosis?

 Treatment ? 11. A1 ½ yr old child is brought with fail-

 Investigations ? ure to thrive, difficulty in breast feeding

and recurrent respiratory infections.

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o/e there is a pansystolic murmer in  How will you confirm your diag-

the lower left sterna border. nosis?

 Diagnosis? ALL

 Investigations ?

 Treatment ? 15. A 5year old child is brought with joint

 Complications of this condition ? pain, high coloured urine. She had

VSD WITH CCF sore throat 10days back. o/e skin rash

present in the lower limbs

12. A 9 month old healthy infant is brought  Diagnosis?

with uprolling of eyes and brief tonic  Investigations ?

clonic convulsions. His temp is 103°F.  Treatment?

 Diagnosis?  d/d ?

 d/d? HSP

 investigations ? 16.

 what advice will you give for ? 17.

FEBRILE CONVULSIONS 18.

19.

13. A 6month old baby is brought with his-

tory of fever of 2 days durations re-

fused to feed, extreme irritability and

convulsions ?

MENINGITIS

14. A 5yr old child is brought with bleed-

ing gums.she also has irregular fever,

tiredness and body pain for the last

3months.

 Diagnosis?

 Investigations?

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CASE taking FORMAT

Name : Developmental history :

Age:  Gross motor development

Sex:  Fine motor dev

Address:  Social & adaptive

Informant : (reliable/not)  Language

Presenting complaints: Immunization history

History of presenting illness:  Fully immunized to date or not ac-

Past history: cording to the national immuniza-

Antenatal history: tion schedule

 Mention any relevant history from  Look for BCG scar

1st, 2nd, 3rd trimester  Last vaccine taken

Natal history:  Booster doses of any vaccine

 Type of delivery-term/preterm  Pulse polio status

 Normal instrumental deli-  Any optional vaccines taken, if so

very/cesarian why

 Presentation Dietetic history

 Place of delivery  Whether prelacteal feeds given or

 Delivery conducted by:hom/hosp not

  When put to breast

Post natal history  Exclusively breast fed till

 Baby cried soon after birth  Complementary feeding …..at

 Birth weight month with …….

 Any resuscitation required  Breastfeeding stopped at ……..

 Passage of meconium/ urine  Started sharing the family diet at

 Seizure/ jaundice …….

 Exchange transfusion

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 Calculate daily calorie & protein in- 3.HEAD TO FOOT EXAMINATION

take according to new ICMR rec-  Head:

ommendation  size,

 Mention about any inadequacy.  shape

Family history  Anterior fontanella-size,

 Draw pedigree chart closed/ not, bulging/depressed

 Age of parents  Hair: hyperpgmentation, sparseness,

 Consanguinity alopecia, low hair line, pyoderma

 Other chronic illness in the family  Face: any dismorphism

Socio economic history  Eyes: pallor, jaundice, signs of vit A

 Occupation of parents deficiency, cataract, hypertelorism,

 Education of parents slant

 Sanitation  Ears: any anomaly, low et ears

 Environment  Nose: DNS, polyp, depressed nasal

bridge

GENERAL EXAMINATION  Oral cavity: hygiene, dentition, glossi-

1.GENERAL ATTITUDE tis, stomatitis, tonsil, dental caries,

Physical attitude: bedridden/walking/ play- lips, palate

ful/ active/ restless  Neck: lymph nodes, JVP, short neck,

Mental attitude : conscious- webbing

ness/cooperative/ nature of cry  Chest: shape, wide nipple

 Upper Limb: pallor,clubbing, flat nails

2.VITALS  Lower limb: edema

Pulse  Abdomen: distended, dilated veins

Blood pressur:  Genitalia:

Respiratory rate:  Skin: PEM, neurocutaneous markers,

Temperature: pyoderma, rash

 Spine: any deformity

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4.ANTHROPOMETRY

 Weight

 Height

 Head circumference

 Chest circumference

 Mid arm circumference

 Upper segment : lower segment ratio

 Arm span

5.Development al assessment

6.Systemic examination (as per medi-

cine)

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Model question
paper

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MEDICINE PAPER I
(CVS.CNS,GIT, Renal, Fluid & Electrolyte Balance, Genetics and Nutrition)

Essay (2x10=20)

1. 18 years old male came to outpatient department with fever, joint pain and swelling of

right knee and chest pain. On examination there is relative tachycardia, pansystolic

murmur in mitral area and ECG shows prolongation of PR interval. Answer the following:

. What is your diagnosis.

. How do you investigate this patient.

. What are the complications.

. How do you manage this patient. (1 +2+3+4=10)

2. 40 years old male presents with generalized anasarca and decreased urine output for

one month. On examination BP 120/80. Proteinurea of 3.5 gm/24 hours and serum al-

bumin 2gm%

Answer the following:

. What is the likely diagnosis.

. How do you investigate this patient.

. What differential diagnosis will you consider.

. How are you going to treat this patient. (1 +3+3+3=10)

Short notes (20x2=40)

3) mention 4 causes of flapping tremor

4) pellagra.

5) Clinical features of cerebellar ataxia.

6) Clinical features of menigitis.

7) Non cardiac causes of pulmonary oedema.

8)Therapeutic schedule of vitamin B12 .

9 Complications of post streptococcal glomerulonephritis.

10) adult immunisation

11Treatable causes of dementia

12) Hepatitis B vaccination.

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13)ECG findings in hyperkalaemia

14) list four autoimmune disorders.

15)Clinical features of beri beri.

16)4 common causes of upper gastrointestinal diseases

17. Mention four causes of hypothermia.

18)Name four disorders for which obesity is a risk factor.

19)Erythropoietin.

20) List causes of polyuria.

21) Mention four manifestations of adult polycystic kidney disease.

22) List ACE inhibitors

GENERAL MEDICINE - I
Essays: (2x10=20)
1. 52 years old male was admitted to the casualty with one hour history of central chest
pain, nausea and sweating. ECG showed ST segment elevation in leads II, III and AVF.
Answer the following:
_ What is your diagnosis. _ What are the complications
_ Discuss the management. _ What are the life threatening causes for acute chest pain
(1+3+4+3=10)
2. 45 years old male with polyuria and polydypsia came with fasting and post prandial sugar
reports of 140 and 240 mg/dl, respectively. Answer the following:
_ What is your diagnosis _ Describe the diagnostic criteria for this condition
_ What dietary and exercise advice you will give him _ Discuss the management
(1+2+3+4=10)
Short Notes. (2x20=40)
3. Management of Guillian-Barre syndrome (GBS)
4. Amoebic liver abscess
5. Management of status epilepticus
6. Non alcoholic fatty liver disease
7. Bell`s palsy.
8. The cardiac conduction system.

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9. Clinical assessment of cerebellar function

10. Thrombolysis in stroke
11. Symptoms of Crohn's disease
12. Treatment of acute bacterial menigitis
13. Management of hyperkalemia
14. Pharmacotherapy of H. pylori infection
15. Osteoporosis
16. Insulin analogues
17. Clinical features of Cushing's syndrome
18. Wilson’s disease
19. Hyperparathyroidism
20. Treatment of hepatic encephalopathy
21. Enumerate the causes for massive splenomegaly
22. Graves’ ophthalmopathy

MEDICINE PAPER II

Essay (2x10=20)

1. A 24 year old woman presents with purpuric rash on her lower limbs, bleeding from

gums, while brushing since 2weeks. She denies menorrhagiaor hematuria. No his-

tory of preceding fever or upper respiratory tract infection. No history of taking

NSAID or any other medication . answer the following

 What are your differential diagnosis ?

 How do you investigate ?

 How do you treat? (2+4+4)

2. A 20years young boy presented with history of nausea, vomiting & pain abdomen to

emergency department. He also gives history of excessive thirstand loss of weight.

Answer the following

 What are your diagnosis

 How do you investigate ?

 Management ? (2+4+4)

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Short notes (20X2=40)

3. Mention x ray chest findiong in emphysema

4. Name antibiotics safe in pregnanacy

5. Scabies

6. Leptospirosis

7. Drugs in gout

8. Cerebral malaria

9. Treatment of H.pylori infection

10. Glycosilated haemoglobin

11. Sub clinical hypothyroidism

12. Pulmonary hypertrophic osteoarthropathy

13. Massive hemoptysis

14. Urticaria

15. Statins

16. Treatment of pneumocystis jeroveci pneumonia

17. Treatment of leprosy

18. Chylothorax

19. Swine flu

20. Lithium

21. Adjustment disorders

22. Treatment of organophosphorous poisoning

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(model)
GENERAL MEDICINE - II

Essays: (2x10=20)
1. 28 years old male found in a drowsy state, was brought to casualty. On examination,
pulse was 48 per minute, blood pressure 112/68 mm of Hg, respiratory rate 28/ minute, pin-
pointed pupils, wide spread fasciculations, and bilateral rales on chest auscultation. Answer
the following
_ What is your diagnosis _ Discuss the patho-physiology of this condition
_ What are the complications that may occur _ Discuss the management
(1+2+3+4=10)
2. 32 years old multi-para came to out patient department with exertional breathlessness
and fatigability. She had been experiencing marked craving for ‘raw rice’. On examination,
had pallor and spoon-shaped nails. Answer the following:
_ What is the most likely diagnosis _ What is the patho-physiology of this disease
_ How will you investigate this lady _ Discuss the management (1+2+3+4=10)

Short Notes. (2x20=40)

3. Management of bronchial asthma.
4. Toxic epidermal necrolysis (TEN)
5. Prophylaxis of venous thrombosis
6. The WHO analgesic ladder
7. Methicillin resistant staph. aureus (MRSA)
8. Peripheral smear and bone marrow in megaloblastic anemia
9. Complications of leptospirosis
10. Treatment of cerebral malaria
11. Peritoneal dialysis
12. Reactive arthritis
13. Chest X-ray in cardiac failure.
14. Drug treatment of depression
15. Aminoglycosides
16. Initiation of anti retroviral therapy.
17. CSF findings in tuberculous meningitis

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18. Clinical features and management of Russell’s viper bite

19. Anaphylaxis
20. DOTS therapy for tuberculosis
21. Enteral tube feeding.
22. Dengue fever.

University 2015

GENERAL SURGERY- I

Structured Essay (5)

1. A 45years old man presented to causality with severe pain in the epigastrium with radia-

tion to back. He gives the history of consumption of alcohol on previous night. What is the

most probable diagnosis. Mention the relevant investigations to confirm the diagnosis. How

will you manage the case.

Short essays (2x6=12)

2. Hydatid Cyst liver

3. lntussusception

Clinical Situation (3)

4. A 65 years old person is referred to you with abdomin al pain of two days duration.

He gives history of intake of analgesies for a long time. His plain x-ray abdomen shows free

gas under ) right dome of diaphragam. What is your diagnosis How will you investigate the

case and mention briefly the treatment

Short notes (5x2=10)

5. lschio-rectal abscess

6. Appendicuiar mass

7. Desmoid tumor

8. Complications of splenectomy

9. Choledochal cyst

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Section B - ORTHOPAEDICS Marks: 30

Essay (6)

1. An 18 years old girl presents with a 3 months history of painful swelling of the distal thigh.

She is ill looking and examination reveals a firm tender swelling localized to the distal

metaphysis of the femur. Discuss i)possible differential diagnosis. ii)Diagnostic workup

iii)Treatment of the likely cause (2*2+2=6)

Short essays (4x3=12)

2. Myositis ossificans

3. Osteoid osteoma

4. Fracture scaphoid.

5. Neuropathic arthritis

Short notes (6x2=12)

6. First aid in suspected cervical spine injury

7. Classification of peripheral nerve injuries

8. 'Pointing' index

9. Diagnosis of hip dysplasia in newborns

10. Congenital muscular torticollis

11. Complications of Colles fracture

(Model )
GENERAL SURGERY - I
SECTION A – SURGERY GIT
Marks:30
Essay: (5)
1. A 60 years old male attends the surgery outpatient department with complaints of loss of
appetite, loss of weight, and early satiety of two months duration. Answer the following:
a. What is the most probable diagnosis.
b. What are the investigations done to diagnose this disease. _
c. What are the investigations done to stage the disease.
d. What is the role of surgery in treating this patient. (1+1+1+2=5)

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Short essays: (2x6=12)

2. Cholelithiasis.
3. Dynamic Intestinal obstruction
Clinical Situation (3)
4. A 32 years old male is brought to the casualty with c/o severe epigastric pain radiating to
the back, along with vomiting, following a bout of alcoholism. Discuss briefly the manage-
ment of this clinical condition.
Short Notes. (5x2=10)
5. Acute appendicitis.
6. Volvulous Sigmoid.
7. Haemorrhoids.
8. Colostomy.
9. Mesenteric cyst.

Section B – Orthopaedics Marks:30

Essay: (6)
1. A 70 years old female attends the orthopaedics casualty with history of fall and com-
plains
of pain right hip, inability to walk and inability to bear weight since 2 days duration. Answer
the following: _ What is the most probable diagnosis _ What is the positio of the lower
limb in this case _ What are the investigations to be done _ What happens to
Shenton’s line _ What is the immediate management _ Describe the surgical
management for this patient
Short essays: (4x3=12)
2. Spina ventosa
3. compound palmar ganglion
4. GCT
5. Fibrous dysplasia
Short Notes. (6x2=12)
6. Ulnar paradox
7. March fracture
8. Tinnel’s sign
9. Holstein Lewis syndrome

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10. Carpel tunnel syndrome

11. Sprain ankle

GENERAL SURGERY - II

Structured Essay (15)

A 56 years old person is presented with pain in right groin and vomiting of two days dura-

tion. He had the history of swelling in the right groin, for the past six years, which was in-

creasing in size on strain and subsides on taking rest, with history of difficulty in passing

urine. Discuss the diagnosis and probable complications if untreated. Discuss the man-

agement and the role of surgery.

Essay:

2 ) enumerate all the different major and minor blood groups. Enumerate various blood

products. Describe the blood transfusion reactions and its management.

Short Essays: (2x4=8)

3) basal cell carcinoma

4)fissure in ano

Short notes:

5) Baker's cyst
6)Pheochromocytoma

7) Tension pneumothorax

8) Carotid body tumor

Answer briefly:

9)Contra indications for laparoscopic surgery

10) clarke's staging of malignant melanoma

11) phymosis

12) Glasgow coma scale

13)Sebaceous cyst

14) dry gangrene

15) Staging of tubercular lymphadenitis

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16) thyroid function tests

17) Cystic hygroma

18)Thiersch graft

(Model)
GENERAL SURGERY - II
Essay: (15)
1. A thirty five years old female attends the surgery out patient department with complaints
of a swelling in the front of neck along, with palpitation, increased appetite, & loss of weight.
Answer the following:
_ Discuss the specific investigations that are helpful in the diagnosis.
_ Discuss the specific treatment options available for this condition.
_ Discuss the specific complications and their treatment, following surgery for this patient.
(5+5+5=15)
2. Discuss the types, the pathophysiology, and management of Shock. (5)
Short essays: (2x4=8)
3. Flail chest.
4. Acute scrotum in a child
Short Notes. (4x3=12)
5. Tuberculous lymphadenitis.
6. Urolithiasis.
7. Phaeochromocytoma.
8. Epidural anaesthesia.
Answer briefly (10x2=20)
9. Extradural haematoma.
10. FAST.
11. Cutaneous squamous cell carcinomas.
12. Acute urinary retention.
13. Incisional hernias.
14. Lymphoedema.
15. Nonsurgical treatment of varicose veins.
16. Acute limb ischaemia.
17. Conservative breast cancer surgery.

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18. Submandibular sialadenitis.

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OBSTETRICS AND SOCIAL OBSTETRICS

Essay

1) define normal delivery. Define partogram to depict the events of normal labour and it’s

significance

Short essays (3*4=12)

2)management of accidental haemorrhage

3)parenteral iron therapy in moderate degree anaemia in early third trimester

4)management of HbSAg positive woman in labour

Short notes (2*3=6)

5)resuscitation of new born

6)maternal mortality

Answer briefly (3*2=6)

7)sudden post partum collapse

8)misoprostol

9) techniques of delivering aftercoming head in breech

One word answers (4*1=4)

10)one twin disappears in subsequent scan in second trimester]

11)in interlocking of twins first twin sacrificed to delivery of second twin

12) embryonic demise within 6 weeks of conception

13)death of fetus from 28 weeks to one week after delivery

Draw and label (2*1=2)

14)normal fetal heart rate pattern as recordedin CTG

15)obstetric conjugate

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(Model)
OBSTETRICS & SOCIAL OBSTETRICS - I
Essay: (10)
1. A 25 years old primi gravida presents with headache and vomiting at 36 weeks gestation.
On examination BP 190/110 mm Hg. Uterus 34 weeks. Cephalic presentation FH+. Answer
the following:
_ What is the diagnosis _ What are the maternal complications _ Mention the
investigations to be done _ Describe the management (1+2+3+4=10)
Short essays: (3x4=12)
2. Management of atonic post partum hemorrhage
3. Tests of ante partum fetal surveillance
4. Diagnosis of unruptured ectopic gestation
Short Notes. (2x3=6)
5. Cardiovascular changes in pregnancy
6. External version
Answer briefly (3x2=6)
7. Active management of third stage of labour
8. Diagnosis of GDM
9. Asynclitism
One word answers (4x1=4)
10. 11-14 week scan
11. Characteristic US finding in dichorionic gestation
12. Use of fetal fibronectin
13. Maternal mortality ratio
Draw and label (2x1=2)
14. Anteroposterior diameters of pelvic inlet in sagittal view
15. Early deceleration
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GYNAECOLOGY (FAMILY WELFARE AND DEMOGRAPHY - II

Essay (10)

1)What is fibroid uterus. Discuss it’s etiology, clinical features and management

Short essays (3*4=12)

2)polycycstic ovarian syndrome

3)medical management of endometriosis

4)intra uterine insemination

Short notes (2*3=6)

5)laproscopic sterilisation

6)adenomyosis

Answer briefly (3*2=6)

7)granulose cell tumour

8)sling operations

9)turner’s syndrome

One word answers (4*1=4)

10)red degeneration of fibroid is common in

11)corpus cancer syndrome

12)drug of choice in a post menopausal woman with osteoporosis

13)strawberry appearance on cervix is the characteristic of

Draw and label (2*1=2)

14)microscopic appearance of candida albicans

15)clue cells

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(Model)
GYNAECOLOGY (FAMILY WELFARE AND DEMOGRAPHY - II

Essay: (10)
1. 23 years old lady married 2 years presents with oligomenorrhea and infertility. O/E obese
and hirsuite. Answer the following:
_ What is the most probable diagnosis _ What are the long term consequences.
_ How do you evaluate _ What are the different management options (1+3+3+3=10)
Short essays: (3x4=12)
2. Causes and evaluation of post menopausal bleeding
3. Myomectomy
4. Granulossa cell tumour
Short Notes. (2x3=6)
5. Micro invasive carcinoma
6. LNG IUCD
Answer briefly (3x2=6)
7. Diagnosis of bacterial vaginosus
8. Non contraceptive uses of OC pills
9. Management of missing
One word answers (4x1=4)
10. Management of Bartholin cyst
11. Current surgery for stress urinary incontinence
12. Drug of choice in a postmenopausal woman with osteoporosis
13. The reference point in POP-Q
Draw and label (2x1=2)
14. Transformation zone
15. Ligamentous supports of uterus
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(university)

PAEDIADRICS AND NEONATOLOGY

Essay : (10)

1)What is acute flaccid paralysis. Discuss flaccid paralysis and its surveillance

Short notes: (4x3=12)

2) biochemical changes in rickets

3)Complications of fallot's tetralogy

4)APGAR scroe

5)rheumatic fever prophylaxis

Answer briefly: (5x2=10)

6)Diaonostic criteria of infective endocarditis

7)difference between caput succedaneum and cephalhematoma

8)Oral rehydration therapy

9) Varicella vaccine

10) zinc deficiency in children

Draw and Label (2x2=4)

11) circle of willis

12) peripheral smear picture in iron deficiency anaemia

One word answers: (4x1=4)

13) treatment choice in scrub typhus

14) four causes of respiratory distress in newly born baby

15) when was last case of potiomyelitis reported in lndia

PEDIATRICS AND NEONATOLOGY

Essay: (10)
1. One year old boy admitted with pallor .O/E No bleeding manifestations, severe pallor,
and
tinge of jaundice. No significant lymph node enlargement .P/A Spleen enlarged 5 cm, Liver
span 8 cm, and firm in consistency. Answer the following:
_ What is the most probable diagnosis _ Arguments for your diagnosis and closest

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differential diagnosis _ How will you confirm the diagnosis _ How will you manage the
case _ What are the complications (1+3+2+3+1=10)

Short notes: (4x3=12)

2. How will you evaluate a case of speech delay.
3. How will you manage a case of enteric fever.
4. How will you manage a case of foreign body aspiration in a child.
5. Discuss the main points in counselling mother of a newly diagnosed case of haemophilia
A
Answer briefly: (5x2=10)
6. Preventable causes of mental retardation
7. Chelating agents
8. Complementary feeding
9. National immunisation schedule
Draw and Label (2x2=4)
10. Facial nerve
11. Hook worm ova
12. Diagnostic criteria of rheumatic fever
One word answers: (4x1=4)
13. When and where was the last case of poliomyelitis reported in India.
14. What is the drug of choice in Kawasaki disease.
15. Composition of oral rehydration solution (WHO)
16. Four causes of seizure in newborn baby.
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