emqs march 9th

[drshan]

Management of Poisoning in Children.
a. ABG. b. Blood Slide Microscopy. c. Serum Creatinine levels. d. Serum Oestradiol levels. e. ECG. f. EEG. g. Serum Salicylate levels. h. Serum Iron levels. i. Toxicology screening. j. U & E.
1. A 4 yr old child was playing with a bottle of Asprin tablets and is brought to the A&E by the mother with tachopnoea, vomiting, dehydration and sweating.
2. A 6yr old child accidentally swallows five combined oral contrceptive pills and is brought to the A&E.
3. A heavily pregnant lady brings her 2yr old son to the A&E in a serious condition. His vomitus is dark brown in colour.
4. A 7 yr old girl swallowed some tablets which her father was taking for treatment of depression, which he is suffering since a long time. She is brought to the A&E and she looks drowsy and ill.
5. A 12 yr old boy drinks a bottle full of vodka and is brought to the A&E in a comatose condition.

Dementia.
a. Myxoedema. b. Pseudo-dementia. c. C-J Disease. d. Lewy Body dementia. e. Alzheimer's dementia. f. Frontal lobe dementia. g. Multi Infarct Dementia. h. HIV dementia. i. Schizophrenia.
6. This type of dementia is a/w hypertension.
7. This is the commonest cause of dementia in UK.
8. This is characterised by senile plaques and neurofibrillary tangles.
9. This is characterised by early changes in personality, usually of loss of inhibitions, but with a normal cognition.
10. This may respond to treatment with antidepressant drugs.

Investigations for Post Operative Complications.
a. Chest X-ray. b. Blood Glucose levels. c. Serum Creatinine. d. USG Abdomen. e. ECG. f. EEG. g. Wound Swab. h. Doppler USG. i. Full Blood Count. j. Blood Culture. k. MSU Culture. l. V / Q Scan.
11. A 50 yr old woman underwent surgery for Ca. Rectum, 10 days back. She has low grade fever of 37.5 deg. C and is complaining of pain in the left calf. She has oedema of the left leg and ankle.
12. A 24 yr old man underwent appendicectomy 7 days back. He was making good recovery, but suddenly developed high fever. On examn. there is no abnormality except for slight lower abdominal tenderness.
13. A 55 yr old man underwent emergency repair for an abdominal aortic aneurysmal rupture. Before the surgery his BP was 60/40 mm Hg. During the surgery and after, his blood pressure was satisfactory, but his urine output was < 5ml in the first hour after surgery.
14. A 75 yr old woman underwent left hemicolectomy for Ca. Sigmoid Colon. On the 4th day after surgery she becomes sick. On examn. she is having fever 38.6 deg C , BP. 60/40 mm Hg., PR. 130 / min., her hands and feet are warm.
15. A 64 yr old woman underwent an emergency laprotomy for peritonitis. On the 6th day after surgery she is noted to a have a serosanguinous discharge from the wound. There is no surrounding erythema & she has normal temperature.

Management of Weight Loss.
a. Total Parenteral Nutrition. b. Low fat diet. c. Low protein diet + Antibiotics. d. High Calorie diet. e. Lactose free diet. f. Enteral feeding by oral route. g. Percutaneous Gastrostomy. h. Gluten free diet. i. Enteral feeding using a fine nasogastric tube.
16. A 74 yr old patient who underwent resection of the colon and ileostomy for carcinoma is now in the ITU as he develops septicaemia. He has not been eating anything since the past 2 weeks.
17. A 68 yr old male patient suffered a haemorrhagic stroke. After 5 days he is offered food, but is found to be still aspirating fluids.
18. A 60 yr old patient with long standing Parkinson's disease presents with intractable dysphagia.
19. A 70 yr old heavy alcoholic presents with hepatic encephalopathy, he has jaundice and ascites.
20. A 5 yr old girl comes with a history of abdominal pain, steatorrhoea, vomiting, poor growth and apthus ulcers. Jejunal Biopsy shows villous atrophy.

Hernia and Treatment.
a. Truss. b. Herniotomy. c. Elective herniorraphy. d. Herniotomy & Orchiopexy. e. Herniorraphy & Orchidectomy. f. Urgent Herniorraphy. j. Abdominal Binder. k. Elective herniorraphy.
21. A 45 yr old mechanic presents with a reducible swelling in the groin, impulse on coughing is present. He has mild dragging pain in the abdomen, otherwise he is normal.
22. A 9 month old child is brought to the A&E with an irreducible firm swelling, which descends into the left groin when the child is crying.
23. A 38 yr old lady presents with an irreducible hernia in the right groin region. She is vomiting and has constipation since the last 3 days. Her abdomen is distended and is tender to palpation.
24. A 68 yr old woman is a known smoker. She had an attack of MI 10 yrs back and is known to have peripheral vascular disease. She presents with a reducible herniation over the incision region of a surgery which she underwent in childhood.

Haemorrhagic Disorders.
a. Warfarin. b. Vit. K. c. Vit. C. d. Vit. E. e. FFP. f. Heparin. g. Factor 8. h.
25. A 10 yr old boy presents with bleeding into his knee joints. On investigation his bleeding time is found to be normal, but his clotting time is prolonged. His grand father is also known to have the same disorder.
26. A 34 yr old woman presents with perifollicular hemorrhages. Serum coagulation factor levels are normal.
27. A 45 yr old male patient has Mitral Stenosis and Atrial Fibrillation, he presents with epistasis and his blood pressure is normal. The bleeding stops on packing the nose. His INR is 9.4.
28. A 48 yr old woman undergoes hystrectomy. She has 2 attacks of TIA from which she has recovered. On examn. she is found to have an irregular pulse.

Miscarriage
a. Low Dose Asprin. b. Cx. Encirclage. c. Counselling. d. Progestagens. e. Heparin. f. Warfarin. g. Reassurance. h. Bed rest. i. Myomectomy. j. Removal of Ut. Septum.
29. A 26 yr old has had 3 previous miscarriages in the 18th week period. She presents now at 14 wks with watery discharge pv. The cervix is 1cm long and admits one finger.
30. A 23 yr old patient has antiphospholipid antibodies and presents with recurrent episodes of thrombosis. She has a past history of abortion. She is planning for another pregnancy, and comes to you for advice.
31. A 25yr old patient has a still birth at 10wks pregnancy previously. She is now worried about her present pregnancy.
32. A 38 yr old patient has 3 children delilvered normally, but now presents with 2 large fibroids occupying the intrauterine space and distorting it.

Management of Asthma.
a. Antibiotic. b. Inhaled Cromoglycate. c. Inhaled Long acting B agonist. d. Inhaled short acting B agonist. e. Inhaled steroid. f. IV. Steroid. g. Leukotriene antagoinist. h. Nebulised B agonist. i. Oral Steroid. j. Oral theophylline. k. Reduce inhaled steroid.
33. A 25 yr old man is taking inhaled B agonist 3 times in a day. Still he wakes up at night with wheezing.
34. A 36 yr old woman is a known asthmatic. She is on treatment with oral steroids. She presents to the A&E breathless and wheezing.
35. A 7 yr old child has intermittent asthma, he has been using inhaled B agonists and oral steroids. He is allergic to asprin and is still having symptoms.
36. A 45 yr old man suffering from chronic asthma is unwell, he has pyrexia and green sputum. His PEFR is <80% of his normal value.
37. A 44 yr old woman is symptom free on 1000 micrograms of inhaled beclomethasone. She now has oral thrush.

Management of Seizures.
a. Carbamazepine. b. Phenobarbitone. c. Ethosuximide. d. IV Diazepam. e. IM Diazepam. f. Oral Diazepam. g. Rectal Diazepam. h. Non Pharmacological intervention. i. Lamotrigine. j. Paraldehyde. k. Valproate. l. Phenytoin.
38. A 4 yr old child has abscence seizures. These are a/w episodes of hyperventillation.
39. A 24 yr old male has an attack of tonic clonic convulsions for the first time.
40. A child of 9 years has tonic clonic convulsions, but it is not possible to get an IV access.
41. A 34 yr old female is having continuous seizures without any gap.

Post partum Haemorrhage.
a.Ut. Atony. b. Large Placental surface. c. Placenta praevia. d. Ut. rupture. e. D I C. f. Vaginal or Cx. tears. g. Endometritis. h. Retained products of conception. i. Septic abortion.
42. A 24yr old lady presents with vaginal bleeding and pyrexia 10 days after normal delivery.
43. A 23yr old patient undergoes rotational forceps delivery which is followed by bleeding.
44. A 25yr old primi undergoes a prolonged labour of 28 hours it is followed by PPH.
45. A 32 yr old diabetic woman delivers a 4.2kg baby, the uterus is normally involuted and retracted, but she has vaginal bleeding post delivery.
46. A 30 yr old female delivers a still born baby after 3 days of IUD. This is followed by PPH.

Diagnosis of Anaemia.
a. Apastic anaemia. b. Pernicious anaemia. c. Sideroblastic anaemia. d. Sickle cell anaemia. e. Vit. B12 malabsorption. f. Vit. B12 dietary def. g. Decreased Fe Intake. h. Plummer vinson synd. i. Fe malabsorption. j. Haemolytic anaemia. k. Heriditary Sphaerocytosis. l. Folate def.
47. A 42 yr old vegan has macrocytic anaemia. His blood folate levels are normal.
48. A 50 yr old female presents with pallor and fatigue, blood smear shows microcytic and hypochromasia. She has post cricoid webs and has difficulty in swallowing.
49. A 32 yr old female presents with macrocytosis, she has anti intrinsic factor antibodies.
50. A 23 yr old patient has iron deficiency anaemia, he has diarrhoea and is sensitive to gluten containing diets.
51. A 54 yr old patient is on cyclophosphamide therapy, he presents with a platelet count of 25 * 10 ^ 9, and a WBC count of 2 * 10 ^ 9.

Acid Base Disturbances.
a. Metabolic Acidosis. b. Metabolic Alkalosis. c. Respiratory Acidosis. d. Respiratory Alkalosis.
e. Hypokalemia. f. Renal failure. g. Dehydration. h. Fluid Overload.
52. A 5 yr old child has projectile vomiting due to pyloric stenosis with hypokalemia and base excess.
53. A 43yr old man has profuse diarrhoea and is dehydrated. He has a villous adenoma of the colon.
54. A 56yr old man has pulmonary embolism. He has tachycardia, hypotension and breathlessness and dyspnoea.
55. A 45yr old man presents with pallor, fatigue and has a dry skin and is anuric since the past 3 days.
56. A 46 yr old woman undergoes cholecystectomy under general anaesthesia. Post operatively she presents with breathlessness and peripheral oedema and crepitations in the lungs.

Management of Ear ache.
a. Admit & IV antibiotics. b. Oral Amoxycillin. c. Oral Amoxycillin + Metronidazole. d. Syringing. e. Pack the ear. f. Surgical intervention. g. Out patient review.
57. A 32 yr old boxer has bleeding in the ear after an injury sustained in a boxing match.
58. A 24 yr old man newly joins swimming classes and presents with earache and dimished hearing. On examn. he is found to be normal except for some wax in the ear.
59. A 33 yr old female undergoes root canal treatment at a dentist. 5 days afterwards she has tenderness over the maxillary sinus a/w earache.
60. A 34 yr old woman presents with high fever, vomitings, headache and rigors. She has already been having earache along with ear dishcarge.
61. A 14 yr old girl has ear discharge and loss of hearing in her right ear, on examn. there is tympanic membrane perforation.

Management of Depression.
a. Couple therapy. b. Abrecation. c. Cognitive Behaviour therapy. d. Psychodynamic Psychotherapy. e. Hypnotherapy. f. Maritial therapy. g. Flupenthixol. h. E C T. i. Imipramine.
62. A 25 yr old mother, had puerperal blues in her first pregnancy. Now in her second pregancy after delivery, she has lost weight and beleives that her husband intends to kill her and her baby. She feels completely worthless. She is currently on antidepressant medication.
63. A 68 yr old female has received treatment for depression at the age of 30 in 10 cycles. She presents now with loss of interest in her activities and refuses to eat or drink any thing.
64. A 15 yr old boy feels that he is a complete failure, despite his cleverness and knowledge. He feels that he is not worth doing anything and cannot do anything successfully.
65. A 23 yr old female is always tearful and weeping. She cries on her own, without any reason and is not able to do any work.

Pathological Basis.
a. Hiatus hernia. b. Multiple Sclerosis. c. Secondary Ca. d. Meningioma. e. Medulloblastoma. f.Astrocytoma. g. Berry aneurysm. h. Alzheimer's dementia. i. S L E. j. Scleroderma. k. Barretts oesophagus. i. Plummer vinson syndrome. j. Gastric ulcer.
66. Demylination of nerve fibres.
67. A circumscribed and limited lesion with glandular columnar cells with pleomorphic nuclei.
68. A tumor present on the outer aspect of the brain, with pressure over the brain. Psammoma bodies are present.
69. An organ protrusion into the thoracic cavity.
70. A layer of submucosal fibrosis.
71. Change in squamous epithelium to columnar epithelium.
72. It is present inbetween the Middle cerebral artery and the Anterior cerebral artery.

Rash.
a. ALL. b. CML. c. Measles. d. Meningococcal Septicaemia. e. H S Purpura. f. Idiopathic Thrombocytopaenic Purpura. g. Haemophilia. h. D I C. i. Ac. Glomerulonephritis.
72. A 14 yr old boy has recently joined a school dorm. He develops fever and rash. He has been vaccinated against Meningococcus C.
73. A 32 yr old patient presents with petichiae and has a WBC count of 20 * 10 ^9. He has lymphadenopathy and splenomegaly.
74. A 6 yr old child develops rash on his legs along with abdominal pain, proteinuria & diarrhoea.
75. A 33 yr old patient presents with a very low platelet count and has rash and purpura on the body.

Pain Releif.
a. IV NSAIDs. b. IM NSAIDs. c. B Blockers. d. Oral Dexamethasone. e. Morphine. f. PCA-Morphine. g. Radiotherapy. h. Nerve blocks.
76. A 70 yr old male is a known smoker and presents with small cell Ca. lung. He has bone pain and backache.
77. A 45 yr old male has lumbar backache, with pain radiating to the thigh, he undergoes laminectomy and discectomy for a prolapsed intervertebral disc, but has no relief.
78. A 34 yr old patient develops very severe headache followed by neck rigidity & is found to have a S A H.
79. A 24 yr old female has migraine. It is getting worser and she is taking more time off her work.

Scientific Basis.
a. Atheroma. b. Degenerative. c. Nutritional. d. Neoplastic. e. Infective. f. Autoimmune. g. Ventricular rupture. h. Ventricular infarction.
80. A 24yr old female presents with pyrexia, finger swelling and splinter haemorrhages.
81. A 34yr old patient underwent valvular replacement surgery, afterwards she presents with a newly developed murmur and altered intensity of heart sounds.
82. A patient following Myocardial Infarction develops pansystolic murmur, ^ JVP.
83. A 60 yr old man who is on his own, with no one to look after him, has ^JVP, pedal oedema and spider naevi. On C-XR he is found to have massive cardiomegaly.

Child problems.
a. Gilles de la Tourette Synd. b. Rectal biopsy. c. Barium enema. d. Barium meal follow through. e. Upper GI endoscopy. f. Lower GI endoscopy. g. Lumbar puncture. h. Blood culture. i. Blood Glucose levels.
84. A 8 yr old child presents with epigastric pain a/w food. It appears before eating and is releived by eating food.
85. A 9 yr old child has mild photophobia and is unwell. He develops pyrexia and has a non blanching rash.
86. A child has been loosing weight since the last 6 months. He is brought to the A&E confused and is taking deep breaths. On examn. he is dehydrated.
87. A 6 yr old child had been having repeated constipation which is not being releived by treatment with laxatives. There are no ano-rectal anomolies.

Vaginal Bleeding.
a. Endometrial polyp. b. Cervical polyp. c. CIN. d. Cervical Ca. e. Endometrial Ca. f. Cx Ectropion.
88. A 62 yr old lady presents with post coital bleeding. She has been having intercourse for the first time in 10 years.
89. An elderly lady presents with bleeding pv. Her endometrial thickness is 12mm on USG.
90. A sexually active woman presnts with bleeding on touching the cervix, she has recently change her partner.
91. A 30 yr old is on OC pills and is referred by the GP as she bleeds on touching the cervix while taking a smear.

Rectal Bleeding.
a. Haemorrhoids. b. Diverticulitis. c. Diverticulosis. d. U C. e. Campylobacter jejuni. f. Ca Colon.
92. A 28 yr old woman returns from Thailand and presents with vomiting and bloody diarrhoea.
93. A patient presents with constipation and bright rectal bleeding while passing stools.
94. A 54 yr old man presents with altered bowel habits and bleeding pr.

Management of Chest pain.
a. Heparin. b. Warfarin. c. rtPA. d. Streptokinase. e. rtPA with cardioversion. f. Isosorbide. g. Atenolol. h. Low dose Asprin. i. N T G patch.
95. A 40 yr old male presents with chest pain for 2 hours, now after 1 hour he has no chest pain. But the ECG shows T wave inversion in L II, III, aVF.
96. A patient who had MI after 5 days presents with ST segment depression in V2-4 leads.
97. A patient presents with an irregular pulse, HR. 160 /min., BP. 130/70 mm Hg.
98. A patient has narrow complex tachycardia.

Prostatic Ca.
a. PSA. b. Transrectal USG guided biopsy. c. X ray pelvis and lumbar spine. d. Nuclear bone scan.
99. A patient presents with ^ PSA levels and on rectal examn. has loss of median sulcus.
100. A 56yr old has a family h/o of prostatic Ca. He presents for examination and wants to know if he has prostatic ca. On examn. he is found to have a normal rectal examn and no lymphadenopathy.
101. A patient with Ca. Prostate presents with urinary incontinence along with weakness of lower legs.
102. A patient with Ca. Prostate has # femur.

Infections.
a. Pneumonia. b. Pleural effusion. c. Cardiac tamponade. d. Staph. aureus. e. Strept. viridans. f. Strept. pneumoniae. g. Pseudomonas. h. Mycoplasma pneumoniae. i. P. carinii. j. M. tuberculosis.
103. A 14 yr old boy presents with a circumscribed swelling on his arm. It is erythematous and the margins are very limited. Pyrexia is present.
104. A 25 yr old presents with an axillary abscess.
105. A 34 yr old presents with pleural rub in the mid thoracic region, mild ^ temp. 37.7 deg. C. Otherwise the CVS, Resp, CNS examn. is normal.
106. A patient has cystic fibrosis, and develops lung infection.
107. A 30 yr old patient looses weight within the last 4months, presents with dry cough and bilateral interstitial marking on C-X ray.
108. A 50 kg weight looses 5 kgs weight and has night sweats, fever and hemoptysis & cough. C-X ray shows upper sided lesion.
109. A 20 yr old previously very healthy has gereral malaise, dry cough and breathlessness. No significant changes on examn. C-X ray shows patchy shadowing throughout the lung fields.


Loss of Vision.
a. Keratoconus. b. Interstitial keratitis. c. Degenerative changes. d. F B eye. e. Corneal erosion. f. Herpes zoster.
110. A female patient wakes up from sleep to find blurring of vision along with pain in the eye. 12 months back she was treated for a scratch in the eye by her daughter while playing.
111. A metal worker complains of pain in the eye with tearfullness and blurred vision.
112. A patient presents with pain in the eye and decreased vision. He has painful vesicles on the side of the face.

Misc.
113. A diabetic female has mild lower abdominal pain, since a long time, for which she had antibiotic treatment with not much of a response. She develops vulval swelling and rashes along with vaginal discharge. -- Treat for moniliasis.
114. A female patient has greenish vaginal discharge along with lower abdominal pain. ---Treat for T. vaginalis.
115. A patient has very severe lower abdominal pain along with pyrexia after changing her sexual partner. --- Gonococcus / Chalmydia / E. coli.
116. A 10 yr old is brought to the A&E in a comatose condition, his mother is an IV drug abuser. Next step -- Toxicological Screen.
117. A child has swellings with varied colours on the back of his arm, hand and legs is brought to the A&E. ---Skeletal survey.
118. A small baby on fundoscopy shows multiple retinal haemorrhages, she is unconscious. --- C T Scan.
119. A patient has an episode of epilepsy, following which he has breathlessness and is unable to swallow anything. His dentures are missing. --- C-X ray / X-ray Neck.
120. A patient was wearing a soft neck collar and is involved in a R T A and she had been sitting in the rear seat. After 10 days she presents with neck pain.
121. A 10 yr old child has spasmodic torticolis. -- Physiotherapy / Bed rest / Exercise therapy.
122. A patient has his apical impulse shifted to the Left and has difficulty in breathing and L V H.
123. A patient with Alzheimer's disease presents with coarsening of habits. -- Mental Status Examination.
124. A patient has 3 episodes of loss of consciousness with recovery after 2 hours. On examn. is found to have a carotid bruit. --- Cerebral angiogram / Neck vein angiogram.
125. A patient has an injury on walking astride and presents with inability to pass urine, has an enlarged abdomen. There is no blood at the tip of penis. -- I V U / Cystoscopy.
126. A child has difficulty in standing on his leg and has a # thigh. --- Bone Scan.
127. A post operative patient has inability to pass urine after having surgery. He has an indwelling catheter and loin pain.
128. A 10 yr old boy is knocked down by a car while cycling. He has upper abdominal pain and tenderness. Next investigation is . --- USG Abdomen.
129. A lchild is knocked down and run over by a bus over his thighs, he is tachycardia and hypotension. Next step. --- Ressucitation.
130. Painfull swelling of the knee joint a/w pyrexia. --- Septic arthritis.
131. A 30 yr old has periods of elation and depression. He goes to a bank and demands money from the cashier and says that he is the owner of the Bank. --- Hypomania / Schizophrenia. (Note: Mania or Bipolar disorder options not given)
132. A 65 yr old says that he is loosing weight despite eating well. On examn. he has an irregular pulse and atrial fibrillation. Investigation. --- Thyroid function tests.
133. A 10 yr old child is posted for Herniorraphy. He is clinically normal, but has an irregular pulse. What next. --- 24 hr ECG / EEG / Echocardiography / ECG.
134. A person wants to undergo surgery. He is evaluated and found to be completely normal. His ECG however shows RBBB. Next step. --- Echocardiography / 24 hr ECG.
135. A patient presents with singed eyebrows and soot in the throat and nasal passages. He presents with breathlessness and dyspnoea. --- Laryngeal oedema.
136. A patient undergoes a RTA and has # pelvis. ---- Ressucitation and External Fixation.
137. A patient is unable to pass urine after drinking 5 pints of beer. Earlier he had difficulty in micturition, dribbling and nocturia. ---- B P H / Ca. Prostate.
138. A patient with Bladder Ca. wants to undergo surgery. A day before the admission to hospital he presents with inability to pass urine. --- Bladder Clot.
139. A patient undergoes TURP surgery and presents 5 days latter with bilateral swelling and pain in the testes. He is febrile. --- IV antibiotic / Surgical exploration.
140. A 14 yr old boy presents with unilateral severe pain in the right testis along with vomiting. On examination, the right testis is swollen and tender to palpation. --- Surgical exploration.
141. A patient presents to the A&E on the evening of surgery for right hydrocele, which was tapped. He has a tense scrotal swelling on the right side, the other side is normal. --- Surgical exploration.
142. A patient presents with rigors, pyrexia and has a tender and painful epididymis, on palpation. Investigation. --- MSU culture and microscopy.
143. A patient with myeloma has back pain and presents with ^ ESR, and proteinuria. He has a distended bladder and is unable to pass urine. He has sensory disturbances in his lower legs. --- Spinal Cord Compression.
144. A patient presents with a painless bladder which is distended upto the umbilicus. The patient has been suffering from constipation since the last 3 months and his sigmoid colon is palpable per abdomen.
145. An old aged lady with a long h/o of knee pains is on treatment for it. She presents with stone in the kidney along with loin pain. Cause: ----- Ca+ tablets ingestion.
146. A 68 yr old patient has hypercalcemia, along with low back ache and proteinuria. --- Myeloma.
147. A 3 yr old's father pulls his hand while swinging him in the garden. He has a displacement at the elbow region. --- None / Manipulation / Immobilisation in plaster / In sling / In collar and cuff.
148. A patient falls on an outstretched hand and has pain at the tip of the shoulder joint. All range of movements at the shoulder joint are normal with no deformity except for some pain. --- # Clavicle / # Scaphoid / # Neck of Humerus.
149. A patient has a fall on a outstretched hand. He is unable to lift his wrist placed on the table. --- # Neck Humerus / Spiral # Humerus.
150. A Child falls on an outstretched hand and has pain in the arm. He is unable to move his arm. --- SC # Humerus.
151. A Rugby player injures his hand during the game. He has pain in the region near the lower end of the radius. On the X-ray there is no evidence of #. --- Bennett's #.
152. A person is injured while to protect himself from an assualt on him by a baseball bat. --- # Ulna.