Contraception, CVS and Derma

Contraception

• Missed two pills, unprotected intercourse the previous night: Take two pills together, continue with the remaining nine, and use condoms for the next 7 days as backup.
• For patients with a family history of colorectal cancer, OCPs are appropriate because they decrease the risk of colon cancer.
• A female wanting contraception with a family history of colorectal carcinoma should consider OCPs.

CVS

• SVT with ECG: Treat with adenosine.
• Atrial flutter: Treat with diltiazem or aspirin.
• Inferior wall MI ECG: Indicates inferior wall MI.
• A 60-year-old male with hypertension: Consider CCB like amlodipine as the preferred drug.
• Patient with complaints of leg pain, heaviness, edema, skin pigmentation with the history of DVT: It indicates post-DVT syndrome.
• Typical scenario indicating acute coronary syndrome.
• The patient has heart failure: BNP and Echo should be performed.

Derma

• Psoriasis patient not relieved with steroid treatment: Vitamin D analogue should be administered
• Male patient with hair loss similar to his brother, receding front hairline: Finesteride, steroid injection should be administered

Elderly Care

• Man with anosmia, aggressive behavior: Administer haloperidol IM.

Emergency

• For burns, apply tap water irrigation for first aid.
• Burn on leg and abdomen: Assess the burn area before sending the patient to the hospital.
• Following irritant spills in eyes, wash thoroughly.

Emergency Medicine

• Concerning female patient with medicine overdose from her parents' medications who is now comatose: SSRIs may be the cause
• Uncontrolled DM patient with HbA1c of 8.5% and recurrent UTIs: SGLT21, metformin, gliptins, or gliclazide may be the cause.

Endocrinology

• Thyroid nodule that is firm: Fine needle aspiration cytology (FNAC) is needed for diagnosis.
• Post-radiotherapy for hyperthyroidism, patient develops symptoms of hyperthyroidism: Further thyroid function tests are required like thyroid function testsE
• Diabetic gustatory hyperhidrosis (patient develops hyperhidrosis after eating): Treatment includes using glycopyrrolate, aluminum hydrochloride, or Botox injections.
• Patient with low BP, weakness, fatigue, and hyperkalemia: Suspect Addison's disease and check urinary VMA levels.
• Episodic hypertension with normal BP in between investigations: Check urinary VMA levels.
• When starting ACEI in a diabetic patient, check urinary Albumin Creatinine ratio to determine if it is needed.
• Asymptomatic patient with TSH of 7.6 indicating subclinical hypothyroidism: repeat TSH after 3 months

Endo/Derma

• Patient has hyperhidrosis after eating (diabetic gustatory hyperhidrosis): Topical glycopyrrolate, aluminum chloride, or Botox injection are the treatments

ENT

• Patient has a history of nasal trauma, intra-nasal packing, and now whistling sound: It indicates nasal septal perforation.

GIT

• After needle prick in window period: Test for HBcIgM.
• Monitoring the state of Hepatitis infection: By HepBsAg.
• CLD patient with diffused abdominal pain: Indicates spontaneous bacterial peritonitis.
• Dysphagia to both solids and liquids starting together, with regurgitation of food at night: Consider achalasia.
• Patient with frequent jaundice during stress, isolated hyperbilirubinemia: Likely Gilbert's syndrome.

Gynae

• Fifteen-year-old female with primary amenorrhea and breast buds seen: Investigate with FSH and LH.
• PCO with irregular cycles: Diagnostic test is ultrasound of the pelvis.
• Cycles of 35 days, regular: Order serum progesterone on Day 28, Day 21 or Day 14.
• Adenomyosis definitive treatment: Hysterectomy or hormonal treatment.
• Menorrhagia with 3 children: Treat with IUS (Intrauterine System).
• Fifty-two-year-old female, uterine bleeding after seven months of LMP: Consider mefenamic acid.
• Female with PCO, acne, and hair growth, unwilling to take hormones: Consider spirinolactone.
• PCO: Consider Denezol.
• Definitive treatment for adenomyosis: Hysterectomy.
• Offensive vaginal discharge with an increased amount: indicates Bacterial vaginosis.
• Bacterial vaginosis treatment: Metronidazole.

Gynae / ID

• Patient's hemoglobin dropped after medication intake, normal retic count: Primaquine, chloroquine should be administered

Hematology

• Hemoglobin of 7, asymptomatic female: Consider oral iron, IV iron, or blood transfusion.
• Man with hypercalcemia and creatinine issues: Suspect multiple myeloma.
• Female with menorrhagia and low platelets on CBC: ITP or von Willebrand's disease is suspected.
• Female with IDA, hemoglobin 7, asymptomatic: Consider oral iron, IV iron, or blood transfusion.
• Child with multiple infections, CBC showing pancytopenia: Consider ALL (Acute Lymphoblastic Leukemia).
• Female with macrocytic anemia, history of gastrectomy: Indicates subacute combined degeneration of the cord.
• Female with microcytic anemia, normal ferritin, increased HBA2 and HBF: It Indicates Thalassemia minor.

ID

• Patient with a history of splenic rupture, now with low blood pressure and fever: suspect Pneumococcal septicemia.
• Rash on the trunk with cervical lymphadenopathy: Consider Rubella.
• Lactating mother, sputum gram stain positive: Administer INH to the child.
• Man on holidays with swimming in pools, now with fever, rash, lymphadenopathy: Consider Lyme disease, leptospirosis, or malaria.
• Child with pinworms infestation: treat with Mebendazole.
• Snake bite patient develops anaphylaxis, swollen tongue and lips: Administer adrenaline before going to the hospital.
• Case of dog bite where the dog is vaccinated and fine: Administer rabies vaccine, vaccine plus Ig, and Abx.
• Post-herpetic neuralgia treatment: Administer Amitriptyline.
• Meningitis prophylaxis in children: Ciprofloxacin, Rifampicin recommended.
• Diarrhea after taking antibiotics: Consider C. Diff associated diarrhea.
• Child 10 months old with rash: Likely Roseola infantum.

ID / Vaccine

• A 16-year-old man with ALL, which flu vaccine should be given? Intra muscular, and intra nasal

MSK

• Fracture of snuffbox bone: Apply plaster cast below the elbow.
• Achilles tendonitis, patient unable to perform plantar/dorsi flexion: perform ESR
• Polymyositis: Test of choice - ESR
• Giant cell arteritis, headache: Prednisolone should be started immediately.
• Paget's disease scenario, decreased hearing, bone pains: Paget's disease is suspected.
• Sixteen-year-old female with Tietz syndrome: Treat with Ibuprofen.
• Gout patient with a history of duodenal ulcer: Administer colchicine.
• Patient with a T-score of -3.5: Alendronate should be advised.
• Achilles tendon rupture: Needs medical attention.
• Prostatic cancer patient with lumbar pain: Administer Dexamethasone.
• Back pain with sciatic nerve pain radiating to the lateral side of the foot: Spinal stenosis likely.

Neuro

• Cluster headache treatment: Administer 100% oxygen.
• Patient with headache, photophobia, and high blood pressure: Suspect migraine.
• Facial palsy treatment: Prednisolone.
• Continuous headache, night-time pain, morning headache, and nausea: Suspect SOL (Space Occupying Lesion).

Obs

• A patient with a 10 cm dilated cervix, station 0, membrane bulging: Perform amniotomy.
• Postpartum patient with proteinuria: Consider pre-eclampsia, acute glomerulonephritis, or HELP syndrome.

Pharma

• Patient is taking treatment for IBS and develops galactorrhea: Metoclopramide may be the cause.
• Patient is on statin, lipids are controlled, but liver enzymes are elevated (up to 58): Continue statin and monitor liver enzymes
• Patient started on two new medications, atenolol and dutasteride, now feels dizzy: Atenolol may be the cause
• antibiotics for wound on breast aerola, Co-Amoxiclave is indicated

Pic

• Scrofula, a pussy sinus discharge of cervical lymph nodes : TB
• Preorbital cellulitis : test TB

Pic / Eye

• Lesion on face and ears: Milia is suspected.

Pic / Derma

• Tinea corporis infection on the face, small lesion: Treat with local clotrimazole.
• Tinea capitis: Treat with oral itraconazole.
• Lesion under the breast: suspect Candidiasis.
• Discoid lupus treatment: Treat with steroids.
• Acne with papule and pustules, taking topical retinoids: add Doxycycline.

Pic / ENT

• Eighteen-month-old child with a blocked nasolacrimal duct and teary eyes: Probing to be done
• Elderly female, X-Ray PNS of the face, hazy sinuses after hospitalization because of COVID-19 infection with facial pain and eye pain: Fungal sinusitis to be suspected (not confirmed).
• Audiogram shows both lines closed: Sensorineural loss (not confirmed).

Pic / Eye

• Girl with a red eye and irregular pupil: suspect Iritis
• Bilateral red eyes: Treatment involves Sodium chromoglycate eye drops.

Pic / Hematology

• Osteolytic lesions in the pelvis: Indicates Multiple myeloma.

Pic / MSK

• X-ray Spine: suspect Ankylosing spondylitis
• Ankylosing spondylitis diagnosed with MRI: Treat with NSAID

Pic / surgery

• Indicates Anal fissure
• Unable to use the right hand and family conflicts: Conversion disorder is suspected

Psych / Elderly Care

• Elderly with delirium and memory loss, not taking medications to avoid poisoning: Think Alzheimer's, depression, or severe depression.

Psychiatry

• Post-MI depression: Sertraline is recommended.
• Premenstrual syndrome: use SSRI or Venlafaxine.
• OSA patient: diagnose with Polysomnography
• Patient is on methotrexate and has shortness of breath: investigate with CT chest, spirometry

Pulmo

• A young man during playing has no breath sounds on auscultation on the left side: Confirm with CXR
• COPD patient not controlled on laba+lama+ics: add Theophyline
• Asthmatic patient takind ICS not controlled: Consider Salbutamol.
• Patient is a smoker, coughing for more than 3 years with clear sputum: Spirometry should be performed.

Surgery

• Thirty-year-old female wants breast cancer screening with no lump or family history and a positive breast cancer gene: Perform BRCA, ultrasound, and memo.
• Thirty-year-old male with a family history of colorectal carcinoma, father had colorectal carcinoma at age 40: Colonoscopy, sigmoidoscopy, or FOBT is appropriate.
• Female patient with acute epigastric pain relieved by bending forward: Next step is ERCP.
• Investigation for gallstones: Ultrasound of the abdomen should be performed.
• Testicular mass confirmed: Perform the Scrotal ultra sound.

Surgery / Neuro

• Patient drowsy / unconscious and positive Babinski sign, hypertensive: suspect Intracerebral bleeding (means hemorrhagic stroke, epidural, or subdural).

Urology

• Epididymoorchitis : indicates Epididymoorchitis
• Man with bladder symptoms of hesitancy, urgency, and dribbling: First, try Tamsulosin or detrusitol.
• Female with urge incontinence: Solifenacin can be used.
• Ureteric stones of 3mm, after giving pain killer and IV fluids: Observation, cystoureteroscopy, or lithotripsy could be done
• Catheterized patient with cloudy urine, protein positive, no WBC, no bacteria: Change catheter and send for culture (not confirmed).
• Female patient with an upper UTI: Ciprofloxacin is indicated.
• Patient with muscle aches, proteinuria, and urinary casts: perform CPK (myoglobinuria)
• Patient with normal PSA, according to age: No further steps required