PLAB 1: 15 June recall
Referred pain from ovarian ca. - obturator n?
Pt with influenza like illness then vesicles and pain on the back and in a band across the front between xiphisternum and umbilicus. -T8
1)1st pregnancy with vomiting... Hyperemesis gravidarum
2)2nd pregnancy with vomiting, usg-hyperechogenic shadow...Molar pregnancy
3) Pregnancy with seizure...Immediate treatment...IV MgSO4
4) 32 wks Pregnancy anaemia, MCHC, MCV- normal...No treatment required
5) Pregnancy anaemia, MCHC, MCV- normal...reassure it is dilutional anaemia
4) Pregnancy with bleeding, anaemia, low platelets, increased bilirubin, AST-normal, APTT,PT increased...DIC
5) Pregnancy with sudden onset uterine bleeding, uterus tender, no previous LSCS...Placenta Abruption
6) Prenancy with uterine bleeding after sexual intercourse...diagnostic test...Transvaginal USG(placenta previa)
7) 12 wks pregnancy with abdominal pain, previous hx of PID...Dx...ectopic pregnacy
8) 58 year woman, intermittent mentrual bleeding, brown vaginal d/c...diagnostic test...Transvaginal usg and endometrial biopsy
9) 55 year woman with post menopausal symptoms...Tx..Raloxifene
10) Woman with infertility...What test...Mid luteal progestrone test
11) young woman with ectopic pregnancy...what previous factor most likely exacerbate... Chlamydia PID
12) Pregnancy with hyperemesis gravidirum...?Fluid should be given...Normal saline 0.9%
13) a woman with breast ca spread to lung, liver and bone. Increasing constipation, weakness, thirst, anorexia for 3 days. Only taking haloperidol for hiccough. Today more disorientated. ?Likely dx....brain metastasis, hypercalcaemia (I chose 1st option becoz of weakness and disorientated)
14) Bone metastasis, most commonest cancer...Breast
15) Breast feeding mother with fever, crack nipple, breast is swollen and hard....causal organism...Staphylococcus aureus
16) HIV with ring enhancing lesion CT scan...Tx...pyrimethamine sulfadiazine
17) young woman after giving birth came with menstrual bleeding, OCP doesn't help. Needed another drug to help. Still want to have children in the future... pregestrogen only pill.
18) young child woke up with pain in testis, tenderness on palpation. size normal...Emg surgery
18) Adult man, came with pain in testis, thickening half of testis and heat present...options...Analgisia and advice or antibiotics (epididym-oorchitis)
19) Urethritis...? common complication...options...cystitis, epididymoorchitis
20) Female, colicky abdominal pain at RIF, mobile mass...Dx...ovarian torsion
21) young, breathless and wheeze after playing football. Wht is investigation?
22) young, cough at night, breathlessness after playing football. Wht is investigation?...Lung function test
23) RTA, fracture femur, breathlessness, trachia deviated, breast sound reduced one side of lung, BP reducing...needle thoracocentasis
24) Tall pt, breathless, resonant percussion...I/v...CXR
25) Stabbed wound to chest, pale, BP reducing, neck veins dilated, breast sounds heard and resonant percussion...cardiac temponade
26) Palpitation after post MI...most likely complication....AF
27) Post MI, pansystolic murmur radiated to axilla...papillary m/s rupture
27) A lady with AF, PSM radiated to axilla...Dx...Mitral Regurgitation
28) ECG...irregular rhythm with saw tooth...Atrial fluter
29) Old man, syncope at the garden, breathlessness, cystolic murmur on examination...I/V...Echo
30) Pt with hypertension, feel dizziness for 3 wks. Regular taking bendroflumethizide, atenolol, iso mononitrite. What I/V?...24ECG monitoring
31) similar question again
32) pt breathlessness on exertion, examination normal...i/v...excercise ECG
33) Open appendicentomy for gangrenous appendicitis complicated by peritonitis...post op analgesia...options..diclofenic suppository, IV morphine
34) woman with breast ca, radiotherapy, swelling arms...Dx...lymphoedema
35) Squamous lung ca with 1st chemo completed. prev radiotherapy 10 years ago. recurrent breathlessness, anorexia...Mx...dexamethaxone oral
36) Terminal care for Advanced ca, not controlled by oral morphine...Gabapetin
37) 67year man, progressive dysphagia only to solids, weight loss...Dx...oesophagial ca
38) young lady with painful dysphagia...appriapriate i/v... barium swallow
39) Female, RHC pain, fever, BMI 33....Dx...cholecystitis
40) Adult, RHC pain with occasional sperocytes, anaemia, high reticulocount...i/v...direct coomb's test
41) child with stridor, breathless while playing a toy. Wht is most diagnostic i/v...options...laryngoscopy, CXR (I chose laryngosocpe)
42) Asthma on maximal dose of salbutamol and steroid inhalers....Mx...oral prednisolone
43) child with difficult breathing and feeding, saliva from mouth...Mx...call anaesthetic
44) child with fever, difficulty breathing and feeding...Dx...bronchilolitis
45) child with repeated vomiting after feeding...i/v...USG abdomen
46) pt with family hx of APC gene...risk of wht ca...Colonic adenocarcinoma
47) Anaemia with sensory impairment at lower legs, MCV increased...Dx...B12 deficiency
48) lady with fresh bleeding per rectum and pain at LIF...Dx...diverticular ds
49) pt with blood toilet pan after defaecation, no pain...Dx...Haemorrhoids
50) pt with intermittent episodes of diarrhoea, blood with mucus in stool...options...acute enteritis, chron's ds, UC ( I chose UC as intermittent with bloody stool)
Emq about nerves and referred pain
Pain to shoulder tip-phrenic
Pregnant women with parasethesia meralghica---is it ilioinguinal
Ovary and thigh------obturator
Iliac fossa and umbilicus ------
Q. A boy was rushed to the Emergency A & E unconscious after he had taken methadone belonging to the sister. He was given naloxone and He regained consciousness. After a while he started getting drowsy again. What is responsible for his present drop in level of consciousness?
A. Naloxone is absorbed faster than methadone
B. Methadone is absorbed faster than Naloxone
C. He has also taken another substance apart from methadone
D. The methadone had already caused some brain damage.
E.....can't remember last option
Q. A man presented at the hospital asking for something to help stop his too much drinking of alcohol. He does not want to be admitted as there's no one to take care of his dog.
A. Refer him to the self-help group????
B. Admit him against his wish for alcohol detoxification
C. Give Disulfiran
Q. A man with anxiety wants treatment for this that will calm him down and help him cope with a job interview he has in 4 days time. What treatment will you give.
A. Psychotherapy???? (not sure if it was one of the options)
Q. A man with hypertension is being treated with thiazide diuretics. What will the serum electorate pictures look like.
A. Sodium high, potassium high
B. Sodium low, potassium high
C. Sodium low, potassium low
D. Sodium high, potassium low.
51) 3 month old child for resuscitation...options...15:2, 15:2 with nose pitched. (ans 15:2 without nose pitch)
52) pt with acute facial oedema after exposing allergin...Mx...0.5ml adrenaline intramuscularly.
53) pt with injury to the hand which is swollen, X-ray normal...Mx...options...arm sling one wk, raise hands for 2 days (ans raise hands 2 days)
54) pt sucidal attack with paracetamol 10 tabs, paracetamol level normal...options...discharge and advice, admission to acute medical ward, call psychiatrist for urgent opinion, refer to clinical psychologist....(Ans..call psychi for urgent opinion)
55) pt parcetamol poisoining 40 tabs, 10 hours ago...Mx...N acetinecystine immediately
56) 82 year lady with Lt severe chest pain, the localised tenderness now only at 6th,7th ribs...options...acute collapse of vertebra, pathological fracture (I think Q has little information and difficult to catch...I answered pathological fracture as ?lung ca)
57) pt with swollen joints, rash at shins.....Wht is CXR...bilateral hilar lymphadenopathy (sarcoidosis)
58) Pt with hypertension on bendroflumethiazide came with red, swollen big toe...i/v...options...jt aspiration, serum uric acid ( ans serum urid acid)
59) pt with OA, previous hx of asthma...wht analgesic...paracetamol
60) pt with haemoptysis, weight loss, anorexia, hilar enlargement in CXR...I/V...options...bronchoscopy, lymphnode biopsy (no CT scan in the options, I chose lymphnode biopsy)