Examine for MBBS, By:Dr. Sajid Mumtaz Sodhar

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MEDICINE FOR M,B;B,S:

MEDICINE FOR M,B;B,S DR. Sajid Mumtaz Sodhar Internist, especial interest in Diabetology & Neurology, Dr. Mumtaz Sodhar Medical Center Mehar , Sindh , Pakistan

CARDIOVASCULAR:

CARDIOVASCULAR INTRODUCTION MAY I EXAMINE YOU? 45 DEGREES INSPECTION (SOB, SCARS, MALAR FLUSH, ANKLE OEDEMA) ALWAYS LOOK AROUND THE BED, INHALERS, OXYGEN, DIET DRINKS ETC

EXAMINATION:

EXAMINATION LOOK AT THE HANDS FINGER CLUBBING CYANOSIS SPLINTER HAEMORRAGES PALE

PULSE:

PULSE RATE RHYTMN CHARACTER BRACHIAL/CAROTID VOLUME COLLAPSING PULSE

CAUSES OF IRREGULAR IRREGULAR PULSE :

CAUSES OF IRREGULAR IRREGULAR PULSE ATRIAL FIBRILLATION, VE’S, ATRIAL FLUTTER WITH VAR BLOCK, CHB CAUSES OF AF ISCHAMIC HEART DISEASE RHEUMATIC HEART DISEASE THYROID NO CAUSE CARDIOMYOPATHY WPW INFECTION ASD

COLLAPSING PULSE:

COLLAPSING PULSE AORTIC REGURG LOOK FOR CORRIGAN’S SIGN PDA PAGETS PREGNANCY RUPTURED ANEURYSM OF AORTIC SINUS FEVER ANAEMIA

RADIO-FEMORAL DELAY:

RADIO-FEMORAL DELAY COARCTATION OF THE AORTA ASK WHILE EXAMINING THE PULSE CAN YOU CHECK FOR THIS

BLOOD PRESSURE:

BLOOD PRESSURE ALWAYS REMEMBER TO ASK IF YOU CAN CHECK THE BLOOD PRESSURE

JVP:

JVP INTERNAL JUGULAR BETWEEN THE TWO HEADS EQUAL TO PRESSURES IN THE RIGHT ATRIUM a WAVE = ATRAL CONTRACTION v WAVE= ATRIAL FILLING DURING VENTRICLAR SYSTOLE,TRICUSPID VALVE IS CLOSED

CAUSES OF A RAISED JVP:

CAUSES OF A RAISED JVP HEART FAILURE –ELEVATION, SUSTAINED HJR PE – ELEVATED PERICARDIAL EFFUSION-ELEVATED, PROMINENT Y DESCENT CONSTRICTIVE PERICARDITIS-ELEVATED KUSSMAULS, PARADOXICAL RISE ON INSPIRATION AF NO a WAVES TRICUSPID STENOSIS- GIANT a WAVES TRICUSPID REGURG- GIANT v WAVES COMPLETE HEART BLOCK- CANNON WAVES

APEX BEAT:

APEX BEAT LOOK FOR STERNOTOMY SCARS LOOK FOR THORACOTOMY SCARS POSITION AND CHARACTER CHECK FOR HEAVES OR THRILLS

HEART SOUNDS:

HEART SOUNDS PALPATE THE CAROTID SIMULTANEOUSLY COMMENT ON I AND II OR ADDITIONAL MURMURS

MURMURS:

MURMURS STENOSIS- APEX LEFT LATERAL USE THE BELL REMEMBER CHANGES IN BREATHING INSPIRATION RIGHT HEART MURMURS GET LOUDER EXPIRATION LEFT SIDE MURMURS GET LOUDER PANSYSTOLIC MURMUR APEX, AXILLA EARLY DIASTOLIC AORTIC REGURG 3 RD ICS SIT FORWARD ON EXP

GRADING OF MURMURS:

GRADING OF MURMURS 1. FAINT 2. FAINT BUT EASILY DETECTED 3. POMINENT BUT NOT LOUD 4. LOUD THRILL 5. VERY LOUD 6. LOUD WITHOUT CONTACT

REMEMBER:

REMEMBER LUNG BASES SACRAL OEDEMA HEPATOSPLENOMEGALY FAILURE PERIPHERAL PULSES

MITRAL STENOSIS:

MITRAL STENOSIS MALAR FLUSH PULSE- IRREGULR IRREGULAR RAISED JVP TAPPING APEX NOT DISPLACED LEFT PARASTERNAL HEAVE(RIGHT VENTRICULAR ENLARGEMENT) LOUD 1 ST HS OPENING SNAP

MITRAL STENOSIS:

MITRAL STENOSIS CAUSES- RHD TAPPING APEX BEAT -DUE TO ACCENTUATED 1 ST HS OPENING SNAP OPENING OF A STENOSED VALVE – PLIABLE, ABSENT IN DIFFUSELY CALCIFIED VALVE LOUD 1 ST – VALVES ARE MOBILE PRESYSTOLIC ACCENTUATION- SINUS RHYTMN DUE TO THE ATRIAL SYSTOLE WHICH INCREASES FLOW ACROSS A STENOTIC VALVE

COMLICATIONS:

COMLICATIONS LEFT ATRIAL ENLARGEMENT AF PULMONARY HTN TR RHF

SEVERITY:

SEVERITY NARROWER DISTANCE BETWEEN 2 ND HS AND OS LONGER THE DIASTOLIC MURMUR

MITRAL REGURG:

MITRAL REGURG PERIPHERAL PULSES- NORMAL JERKY DUE TO REDUCED SYSTOLIC EJECTION TIME SECONDARY TO A LARGE VOLUME OF BLOOD REGURG INTO LEFT ATRIUM APEX BEAT- DISPLACED 1 ST HS SOFT 3 RD HS PSM -> AXILLA LOUDER ON EXP

CAUSES OF MR:

CAUSES OF MR MITRAL VALVE PROLAPSE RHD LEFT VENTRICLAR DILATATION CORONARY DISEASE ANNULAR CALCIFICATION ENDOCARDITIS PAPILLARY MUSCLE RUPTURE CARDIOMYOPATHY CONNECTIVE TISSUE DISORDER TRAUMA MYXOMATOUS DEGENERATION

CAUSES OF PSM:

CAUSES OF PSM MR TR VSD HOCM

AORTIC REGURG:

AORTIC REGURG PULSE- LARGE VOLUME, COLLAPSING CORRIGAN’S APEX DISPLACED OUTWARDS, FORCEFUL EDM- LSE SIT FORWARD EXPIRATION

Aortic Regurgitation:

Aortic Regurgitation WIDE PULSE PRESSURE FEMORALS- PISTOL SHOTS(TRAUBE’S) TO AND FRO MURMUR (DUROZIEZ’S) CORRIGANS – CAROTID PULSATION QUINCKE’S UVULA PULSATIONS (MULLER’S) ARGYLL ROBERTSON PUPIL MARFANS ANK SPOND, RA

Causes Of Aortic Regurgitation:

Causes Of Aortic Regurgitation RF HTN ATHEROSCLEROSIS ENDOCARDITIS SYPHILIS MARFANS RA ANK SPOND TRAUMA AORTIC DISSECTION

SEVERITY:

SEVERITY WIDE PULSE PRESSURE SOFT 2 ND HS 3 RD HS AUSTIN FLINT MURMUR LVF LONGER + LOUDER

AORTIC STENOSIS:

AORTIC STENOSIS LOW VOLUME SLOW RISING APEX- HEAVING, NOT DISPLACED SOFT 2 ND EJECTION CLICK S4 MAY BE HEARD ESM NARROW PULSE PRESSURE REVERSE SPLITTING

CAUSES OF AORTIC STENOSIS:

CAUSES OF AORTIC STENOSIS RHEUMATIC DEGENERATIVE CALCIFICATION OF A BICUSPID VALVE

OTHER CAUSES OF ESM:

OTHER CAUSES OF ESM PULM STENOSIS HOCM SUPRAVALVULAR STENOSIS

SYMPTOMS:

SYMPTOMS FATIGUE ANGINA DYSPNOEA SYNCOPE DEATH

INVESTIGATIONS:

INVESTIGATIONS ECG CXR ECHO CATH EST BE CAREFUL IF SYMPTOMATIC

TRICUSPID REGURGITATION:

TRICUSPID REGURGITATION CAUSES FUNCTIONAL PULMONARY HTN CCF RHD ENDOCARDITIS – DRUG ADDICTS

VSD:

VSD PSM AT LSE LOUD P2 OF PULM HTN MAY HAVE CCF LOUDNESS DOES NOT MEAN SEVERE

CAUSES OF VSD:

CAUSES OF VSD CONGENITAL RUPTURE AFTER MI 50% MAY CLOSE SPONTANEOUSLY COMPLICATIONS ARE CCF AORTIC REGURG SBE PULM HTN

INFECTIVE ENDOCARDITIS:

INFECTIVE ENDOCARDITIS ANAEMIA CLUBBING SPLINTER HAEMORRAGES- EMBOLISM OSLER NODES- INFLAMMATION OF EMBOLI JANEWAY LESIONS PETECHIAE ROTH SPOTS SPLENOMEGALY HAEMATURIA DENTAL FBP- NORMOCYTIC NORMOCHROMIC ESR BLOOD CULTURES ECHO/ TOE

COMLICATIONS OF SBE:

COMLICATIONS OF SBE CARDIAC FAILURE RENAL PAIN CEREBRAL ANEURYSMS MYCOTIC ANEURYSMS VALVE ABSCESS

HOCM:

HOCM PULSE JERKY DOUBLE APICAL- LEFT VENTRICULAR HEAVE WITH PROM PRESYSTOLIC PULSE PSM- SOFTER ON SQUATTING 4 TH HS FAMILY HISTORY

RESPIRATORY:

RESPIRATORY INTRO SITTING POSITION SPUTUM CUP BREATHLESS WASTING ASYMMETRICAL BREATHING COUNT RESP

HANDS:

HANDS CLUBBING CYANOSIS TAR BOUNDING PULSE ASTERIXIS TONGUE – CYANOSIS EYES- PALLOR, HORNERS

EXAMINATION :

EXAMINATION LOOK FOR NECK VEINS CERVICAL LYMPH TRACHEA DEVIATION PALPATE MOVEMENTS OF BOTH SIDES VOCAL FREMITUS PERCUSSION AUSCULTATION

PLEURAL EFFUSION:

PLEURAL EFFUSION LOOK FOR DECREASED MOVEMENT TRACHEAL DEVIATION ASPIRATION MARKS STONY DULL DECREASED VOCAL RESONANCE FIND THE UPPER LEVEL BRONCIAL BREATHING SIGNS OF RA, TAR, LYMPH NODES, RADIATION BURNS, MASTECTOMY

CAUSES OF DULLNESS:

CAUSES OF DULLNESS PLEURAL EFFUSION PLEURAL THICKENING CONSOLODATION COLLAPSE RAISED HEMIDIAPHRAGM

INVESTIGATIONS:

INVESTIGATIONS CXR TAP SEND FOR PROTEIN, LDH, GLUCOSE, BACTERIOLOGY, CYTOLOGY PH IF EMPYEMA AMYLASE IN NG, PANCREATITIS, OESOPHAGEAL RUPTURE RHEUMATOID FACTOR

TRANSUDATE:

TRANSUDATE NEPHROTIC SYNDROME CARDIAC FAILURE LIVER FAILURE HYPOTHYROID CONSTRICTIVE PERICARDITIS MEIGS

EXUDATE:

EXUDATE CA SECONDARIES PNEUMONIA PE TB RA SLE LYMPHOMA MESOTHELIOMA

PROGNOSIS:

PROGNOSIS POOR IN NG PEURAL FLUID LOW GLUCOSE LOW pH

HAEMORRAGIC FLUID:

HAEMORRAGIC FLUID PE NG TB

REMEMBER OCCUPATION :

REMEMBER OCCUPATION EG SHIP BUILDING

BRONCHIECTASIS:

BRONCHIECTASIS LOOK FOR SPUTUM CUP FINGER CLUBBING BILATERAL COARSE CREPS LATE INSP CREPS

BRONCHIECTASIS:

BRONCHIECTASIS DEF - CHRONIC NECROTIZING INFECTION OF THE BRONCHI AND BRONCHIOLES LEADING TO ABNORMAL, PERMANENT DILATATION OF THE AIRWAYS

CAUSES:

CAUSES PNEUMONIA MEASLES PERTUSSIS TB MECHANICAL OBSTRUCTION ASPERGILLOSIS KARTAGENERS CYSTIC FIBROSIS IDIOPATHIC

INVESTIGATION:

INVESTIGATION FBP SPUTUM CXR CT

COMPLICATIONS:

COMPLICATIONS PNEUMONIA PLEURAL EFFUSION PNEUMOTHORAX SINUSITIS HAEMOPTYSIS BRAIN ABSCESS AMYLOIDOSIS

TREATMENT:

TREATMENT POSTURAL DRAINAGE ANTIBIOTICS NEBS SURGERY

CONSOLIDATION:

CONSOLIDATION SPUTUM TACHYNOEA REDUCED MOVEMENT ON AFFECTED SIDE TRACHEAL CENTRAL DECREASED PERCUSSION BRONHIAL BREATHING CREPS

CAUSES:

CAUSES PNEUMONIA CARCINOMA PE

FIBROSING ALVEOLITIS:

FIBROSING ALVEOLITIS TACHYNOEA CLUBBING CENTRAL CYANOSIS BILATERAL BASAL FINE END INSP CREPS DO NOT DISAPPEAR ON COUGHING

SIGNS:

SIGNS HANDS - RA, SYSTEMIC SCLEROSIS FACE - RASH OF SLE MOUTH - DRY OF SJOGRENS PULMONARY HTN - a WAVE IN JVP, LEFT PARASTERNAL HEAVE AND P2 LOOK FOR CAUSES - DRUGS EG AMIODARONE

PROGNOSIS:

PROGNOSIS 50% SURVIVAL AFTER 5 YEARS INCREASE RISK OF CA

ABDOMEN:

ABDOMEN

EXAMINATION:

EXAMINATION LYING FLAT DO NOT EXPOSE GENITALIA COMFORTABLE LOOK AROUND THE BED

HANDS:

HANDS CLUBBING LEUCONYCIA PALMAR ERYTHEMA DUPUTRYENS HEPATIC FLAP PIGMENTATION SCRATCH MARKS

EXAMINATION:

EXAMINATION NODES TONGUE EYES - JAUNDICE, XANTHELASMA ANAEMIA SPIDER NAEVIA ACANTHOSIS NIGRICANS GYNAECOMASTIA

EXAMINATION OF ABDOMEN:

EXAMINATION OF ABDOMEN MOVEMENTS MASS VEINS PERISTALSIS HERNIA

ASK IF THERE IS ANY PAIN:

ASK IF THERE IS ANY PAIN

PALPATION:

PALPATION KNEEL DOWN ALWAYS LOOK AT THE PATIENT SUPERFICIAL THEN DEEP ALL QUADRANTS

PALPATE:

PALPATE MASS - CHARACTERISTICS LIVER - PERCUSSION SPLEEN KIDNEYS LYMPH NODES HERNIAL ORFICES TESTICULAR ATROPHY

PERCUSSION:

PERCUSSION SHIFTING DULLNESS

AUSCULTATE:

AUSCULTATE LIVER BRUIT BOWEL SOUNDS RENAL BRUIT

LEG OEDEMA PR :

LEG OEDEMA PR

HEPATOMEGALY:

HEPATOMEGALY SIZE TENDERNESS- CHF OR ACUTE HEPATITIS SURFACE - SMOOTH OR IRREGULAR PERCUSS AUSULTATE- ALCOHOLIC HEPATITIS OR CA FOR BRUIT

CAUSES:

CAUSES CHF CIRRHOSIS SECONDARIES INFECTIVE HEPATITIS MYELOPROLIFERATIVE DISORDERS SARCOID HAEMACHROMATOSIS PBC AMYLOID TUMOURS

CAUSES OF HEPATIC ENCEPHALOPATHY:

CAUSES OF HEPATIC ENCEPHALOPATHY INFECTION DIURETICS, ELECTROLYTE IMBALANCE DIARROHEA AND VOMITING SEDATIVES GI BLEED ABDOMINAL PARACENTESIS SURGERY

CAUSE OF ASCITES:

CAUSE OF ASCITES LIVER FAILURE + PORTAL HTN SECONDARY HYPERALDOSTERONISM DECREASED METABOLISM OF ALDOSTERONE BY LIVER DECREASED METABOLISM OF ADH LOW ALBUMIN LYMPHATIC OBSTRUCTION

HAEMACHROMATOSIS:

HAEMACHROMATOSIS MALE PIGMENTED PALMAR ERYTHEMA AND SPIDER ANAEMIA JAUNDICE ASCITES HEPATOMEGALY LOSS OF SEXUAL HAIR TESTICULAR ATROPHY JOINT PAIN- PSEUDOGOUT CARDIOMYOPATHY DIABETES

INVESTIGATIONS:

INVESTIGATIONS AUTOSOMAL RECESSIVE MOSTLY HLA-A3 CHROMOSOME 6 TRANSFERRIN INCREASED SERUM FERRITIN RAISED GENE TESTING LIVER BIOPSY

TREATMENT:

TREATMENT VENESECTION

RISK:

RISK X200 RISK OF HEP CA

PBC:

PBC MIDDLE-AGED WOMEN CLUBBING PIGMENTED XANTHELASMA ICTERUS SCRATCH HEPATOSPLENOMEGALY

PBC:

PBC XANTHOMATA- JOINTS - SKIN FOLDS - AREA OF TRAUMA LOOK FOR OTHER AUTOIMMUNE DISEASES PROXIMAL MUSCLE WEAKNESS – OSTEOMALACIA PERIPHERAL NEUROPHATHY AMA – M2 OBSTRUCTIVE PICTURE LIVER TRANSPLANTATION

LOOK FOR:

LOOK FOR AUTOIMMUNE CONDITIONS PROXIMAL MUSCLE WEAKNESS DUE TO OSTEOMALACIA PERIPHERAL NEUROPATHY

PBC:

PBC ANTI-MITOCHONDRIAL ABS CURE IS TRANSPLANTATION

SPLENOMEGALY:

SPLENOMEGALY DIFF FROM KIDNEY KIDNEY BALLOTABLE NOTCH CAN’T GET ABOVE DULL TO PERCUSSION MOVES WITH RESP

LOOK FOR:

LOOK FOR LYMPH NODES ANAEMIA JAUNDICE PLETHORIC (PRV) SPLINTER HAEMORRAGES RHEUMATOID

CAUSES:

CAUSES CML MALARIA KALA-AZAR PRV MYELOFIBROSIS PORTAL HTN SARCOID AMYLOID ENDOCARDITIS INFECTIOUS MONONUCLEOSIS FELTYS CLL ITP

KIDNEYS:

KIDNEYS LOOK FOR AV FISTULA LOOK FOR TRANSPLANTED KIDNEY 3 RD NERVE PALSY ASSOC WITH POLYCYSTIC KIDNEY (BERRY) BP FHX ANAEMIA

ABDOMINAL MASSES:

ABDOMINAL MASSES EPIGASRTIC -CA STOMACH -CA PANCREAS -AAA -RETROPERITONEAL LYMPHADENOPATHY

ABDOMINAL MASSES:

ABDOMINAL MASSES RT ILIAC FOSSA- CROHNS CA CAECUM LYMPH NODES TRANSPLANTED KID APPENDIX ABSCESS OVARIAN NG CARCINOID AMOEBIAS

CAUSES OF PTOSIS:

CAUSES OF PTOSIS UNILATERAL 3 RD NERVE PALSY HORNERS MYASTHENIA CONGENITAL IDIOPATHIC BILATERAL MYASTHENIA DYSTROPHIA OCULAR MYOPATHY SYPHILIS CONGENITAL BILATERAL HORNERS IN SYRINGOMYELIA

HORNERS:

HORNERS MIOSIS PARTIAL PTOSIS ENOPTHALMOS ANHYDROSIS

CAUSES:

CAUSES PANCOAST TUMOUR CERVICAL SYMPATHECTOMY CAROTID ANERUYSMS SYRINGOMYELIA LESION OF BRAINSTEM TRAUMA

HOLMES- ADIE:

HOLMES- ADIE YOUNG WOMAN DILATED PUPIL PUPIL REACTS SLOWLY DECREASED REFLEXES BENIGN

DILATED PUPIL:

DILATED PUPIL EYE DROPS 3 RD NERVE HOLMES – ADIE LENS IMPLANT DEATH SYMPATHETIC OVERACTIVITY

SMALL PUPIL:

SMALL PUPIL OLD AGE EYE DROPS HORNERS ARGYLL ROB PONTINE NARCOTICS

DIABETIC EYES:

DIABETIC EYES BACKGROUND RETINOPATHY PREPROLIFERATIVE PROLIFERATIVE

PAPILLOEDEMA:

PAPILLOEDEMA SOL HTN RETINOPATHY BIH INCREASED ICP HEAD INJURY CAUSING CEREBRAL OEDEMA CO RETENTION THYROID VIT A INTOXICATION CENTRAL RETINAL VEIN THRMBOSIS MUTIPLE MYELOMA

OPTIC ATROPHY:

OPTIC ATROPHY MS OPTIC NERVE COMPRESSION GLAUCOMA TOXINS ISCHAEMIA HEREDITARY PAGETS VIT B12 DEF

LOWER 7TH:

LOWER 7TH LOOK IN THE EARS PAROTID GLAND ENLARGEMENT TASTE (INVOLVING CHORDA TYMPANI) HEARING (HYPERACUUSIS DUE TO STAPEDIUS) URINE - DIABETES

CAUSES OF BILATERAL:

CAUSES OF BILATERAL GUILLAN BARRE SARCOIDOSIS MYASTHENIA MAY MIMIC

UNILATERAL PALSY:

UNILATERAL PALSY LLS HERPES CEREBELLOPONTINE TUMOURS POLIO OTITIS MEDIA SKULL FRACTURE

DYSTROPHIA MYOTONICA:

DYSTROPHIA MYOTONICA SHAKING HANDS FRONTAL BALDNESS PTOSIS CATARACTS EXPRESSIONLESS

DYSTROPIA MYOTONICA:

DYSTROPIA MYOTONICA TEST POWER DECREASED REFLEXES ASK ABOUT SWALLOWING URINE - GLUCOSE LOW IQ GYNAECOMASTIA TESTICULAR ATROPHY

DYSTROPHIA MYOTONICA:

DYSTROPHIA MYOTONICA A D CARDIOMYOPATHY CHEST INFECTION

PROXIMAL MYOPATHY:

PROXIMAL MYOPATHY DIABETES CUSHINGS THYROID POLYMYOSITIS DRUG CARCINOMA OSTEOMALACIA HEREDITARY

WASTING SMALL MUSCLES OF THE HAND:

WASTING SMALL MUSCLES OF THE HAND RHEUMATOID OLD AGE CERVICAL SPONDYLOSIS BILATERAL CERVICAL RIBS MND SYRINGOMYELIA CHARCOT GUILLAN NERVE PALSIES PANCOASTS

NEUROFIBROMATOSIS:

NEUROFIBROMATOSIS AXILLA FOR FRECKLES VISUAL ACUITY - GLIOMA ACOSTIS NEUROMA IRIS FOR LISCH NODULES KYPOSCOLIOSIS BLOOD PRESSURE

LOOK FOR:

LOOK FOR 6 OR MORE CAFÉ AU LAIT 2 OR MORE NEUROFIBROMAS AXILLA FRECKLING OPTIC GLIOMA

SPEECH:

SPEECH COMPREHENSION PUT OUT TONGUE SHUT YOUR EYES ORIENTATION TIME , DATE

SPEECH:

SPEECH NAME FAMILIAR OBJECTS ARTICULATION MENTAL SCORE EXPRESSIVE - BROCA FRONTOPARIETAL RECEPTIVE - WERNICKE’S SUPERIOR TEMPORAL

PARKINSONS:

PARKINSONS EXPRESSIONLESS- HYPERMYMIA DROOLING PILL ROLLING BRADYKINESIA TONE- COG WHEEL GLABELLAR TAP - CONTINUE MYERSON’S SIGN WALK MICRGRAPHIA

As a DOCTOR, Are We Honest To Our Profession, when we Do Our Medical Practice, Ponder On It..:

As a DOCTOR, Are We Honest To Our Profession, when we Do Our Medical Practice, Ponder On It..

RHEUMATOID:

RHEUMATOID SUBLUXATION OF MCP SWAN NECK BOUTONNIERES Z DEFORMITY SUBLUX AT WRIST NAIL FOLD INFARCTS PALMAR ERYTHEMA

RHEUMATOID ARTHRITIS:

RHEUMATOID ARTHRITIS MUST CHECK FOR NODULES SEROPOSITIVE AGGRESSIVE PERFORM SIMPLE TASKS EXAMINE OTHER JOINTS

ANAEMIA:

ANAEMIA CHRONIC DISEASE PERNICIOUS ANAEMIA FELTYS NSAIDS

PULMONARY:

PULMONARY NODULES EFFUSION FIBROSIS CAPLANS BRONCHIOLITIS OBLITERANS

EYES:

EYES EPISCLERITIS SCLERITIS SCLEROMALACIA SICCA SJOGRENS

ANK SPOND:

ANK SPOND ? MARK POSTURE PROTUBERANT ABDOMEN ASK HIM TO TURN WHOLE BODY TURNS STAND AGAINST A WALL SCHOBERS TEST Schober's test is a test used in rheumatology to measure the ability of a patient to flex his/her lower back .

LOOK FOR:

LOOK FOR IRITIS ANTERIOR UVEITIS AORTIC REGURG APICAL FIBROSIS ACHILLES TENDINITIS

GENETIC :

GENETIC HLA-B27 40% SEVERE DISEASE

SCLERODERMA:

SCLERODERMA TIGHTENING OF HANDS TELANGICTASIA PSEUDOCLUBBING VITILIGO JOINT FOR ARTHRITIS PINCHED NOSE DIFF OPENING MOUTH

ASK ABOUT:

ASK ABOUT DYSPHAGIA RAYNAUDS DRY EYES SWALLOWING BREATHING - FIBROSIS

GOUT:

GOUT ASYMMETRICAL LOOK AT 1ST MTP , HELICES, OLECRANON, ACHILLES NEGATIVE BIFRINGENT DISORDER OF PURINE METABOLISM

THYROID:

THYROID HANDS - SWEATING, TREMOR, WARM SCARS PALMAR ERYTHEMA PULSE NODES GOITRE SEAT UPRIGHT EXOPTHALMOS PALPATE ,WATER

EXAMINE FOR:

EXAMINE FOR SIZE MOBILITY TEXTURE TENDERNESS PEMBERTONS SIGN - RAISE ARMS FOR COMPRESSION PERCUSS FOR RETROSTERNAL BRUITS - GRAVES

EYES:

EYES LID LAG VON GRAEF’ SIGN EXOPTHALMOS LID RETRACTION DALRYMPLES SIGN EXTRAOCCULAR MOVEMENTS CORNEAL INVOLVEMENT PROXIMAL MUSCLES SKIN PRETIB MYXOEDEMA

CUSHINGS:

CUSHINGS MOON FACE BRUISES HIRSUTISM PLETHORIC BUFFALO HUMP STRIAE PROXIMAL MUSCLE WEAKNESS

ASK ABOUT:

ASK ABOUT STEROIDS DIABETES BP LOOK FOR RA , ASTHMA VISUAL FIELDS

CAUSES:

CAUSES STEROIDS PITUITARY ADENOMA- PIT DISEASE ADRENAL CA ADRENAL ADENOMA ECTOPIC CA

ACROMEGALY:

ACROMEGALY FACE SWEATING LARGE HANDS CARPAL TUNNEL PROM SUPRAORBITAL RIDGES LARGE NOSE AND LIPS PROTRUSION OF LOWER JAW WIDE TEETH

LOOK FOR:

LOOK FOR MACROGLOSSIA VISUAL FIELDS ACANTOSIS NIGRICANS ORGANOMEGALY JOINTS- CHONDROCALCINOSIS KYPHOSIS BP DIABETES OLD PHOTOGRAPHS

HYPERTENSIVE FUNDUS:

HYPERTENSIVE FUNDUS GRADE 1 – SILVER WIRING GRADE 2 – AV NIPPING GRADE 3 – HAEMORRAGES (FLAME) +EXUDATES GRADE 4 - PAPILLOEDEMA

DIABETIC EYES:

DIABETIC EYES BACKGROUND/PREPROLIFERATIVE – HAEMORRAGES (MICROANEURYSMS) + EXUDATES PROLIFERATIVE – MALIGNANT RETINOPHATY NEOVASCULARISATION – NEW VESSELS

DOCTOR stands for::

DOCTOR stands for: D- Devoted To Profession O- Obliging To All (Poor or Rich) C- Caring T- Tolerance O- Omnicient (Knowledge) R- Reliable to all ( male or female) “Can We Fulfill This Criteria”

Jasak-um-Allah Khair:

Jasak-um-Allah Khair