Posted by Johann on June 01, 2002 at 12:45:24:
A child presented with a middle ear pain. On examination there was a swelling extending from mastoid process to the angle of mandible. Whats the treatment?
simple mastodities.
Admit for parenteral antibiotics if does not work mastoidectomy.
hey thst right
its mastoidits treat with antibiotics and if not mastoidectomy
well in a previous paper they had asked the choice of antibiotic
choices were
1. amox
2.ampi
3.cephalosporins (cant remember which gen)
4.augmentin (amox+clavulinic acid
5 peniciilin
well there were conflicting answers
whts the choice of treatment for acute/chronic otitis media, and others in ent simialr when the above drugs are the choice
cluutz
the ans. is I/V antibiotics(e.g AMPICILLIN)& MYRINGOTOMY..if resolution doesn't occur then matoidectomy
Options included:
Schizophrenia, Cyclothymia, bipolar depression, seasonal depression,alcoholism,Bulimia...
Questions:
More common at about 20yrs than 40yrs.
More common in younger women than older women
More common in women than in man...
That's all i remeber on that theme.
An 80 year old women came for 2 hrs epistaxis.
Possible answers:
Coagulopathy?
Hypertension?
There's another question which i can't quite rememebr about a woman on long term catheterisation, and suffering from Multiple Sclerosis. If i rememeber correctly, she was supposed to be on antibiotics but still there was pyourea.The task was next line of mgt.
Any May Plabbers remember that question?
It didn't have that option. I think the options included:
.Catheter specimen mc&s
.Bladder washout with chlorhexidine or something like that
.Bladder washout with ?Sodium citrate.
16 Investigation of needle injuries
A. hep B antibody
B. hep C antibody
C. hep C RNA(polymerase reaction)
D. HIV antibody
E. hep E antigen
F. hep Eantibody
1.a nurse previously immunized with hep B get pricked by pt who is known HIV
positive.She has been given prophylactic azt ,what else should be done to know her
status.
2.a surgeon is pricked by hep C positive pt.
3.a man with hep B carrier state.he wants to know his status
1-D
2-c
3-E,,indicates infectiousity
17 Causes of pneumonia
A. leoginella
B. h-influenza
C. mycobacterium TB
D. streptococcus
E. staphyococcus
F. micoplasma
1.alcoholic pt with productive cough for many months now c/o occasional blood in
sputum and wt loss.X ray =b/l upper zone shadowing
=================================C
2.a pt with h/o COPD comes with chest pain and green sputum production---------------IN COPDers common organisms are Staphylococcus ,strep and Pseudomonas ,,however it loks like that in PLAB green sputum means strep..
3.man comes from holidays c/o cough and chest pain ,x-rays shows patchy
consolidation
============================A
4.a man with s/s of pneumonias came with cold agglutinins positive
==============================MYCO //F
5.a man with rigors and fever .X-ray shows rt middle zone consolidation, no previous
illness
PNEUMONIA +TOXIC PATIENT =STAPHYLOCOCCS
18 Diagnosis of breast diseases{DISCXUSED B$}}
A. fibroadenoma
B. ductal ectasia
C. breast ca
D. cyclical mastalgia
E. paget’s disease of nipple
F. eczema
1.a pt comes with h/o breast pain and nodularities , she is having these symptoms
every month.
2.pt with mass in the upper outer quadrant ,no pain and tenderness, but some axillary
lymphnodes are enlarged
3.young pt comes with 2cm mass in lower quadrant of breast no pain and no other
positive findings
4.middle age pt comes with breast nipple discharge, which is sometimes bloody, skin
around nipple is fine ,she has both nipple retracted, with no other positive finding.
5.old pt with nipple discharge and skin excoriation, redness and inflammation in right
breast
a man with hep B carrier state.he wants to know his status.
regarding this qwe need to test HBsAg. if this is persist for more than 6 months, it would define as carrier status and impies chronicity of process.
________________________
Rough guess:
18 Diagnosis of breast diseases{DISCXUSED B$}}
1.a pt comes with h/o breast pain and nodularities , she is having these symptoms
every month.
D. cyclical mastalgia
2.pt with mass in the upper outer quadrant ,no pain and tenderness, but some axillary lymphnodes are enlarged
C. breast ca
3.young pt comes with 2cm mass in lower quadrant of breast no pain and no other
positive findings
A. fibroadenoma
4.middle age pt comes with breast nipple discharge, which is sometimes bloody, skin
around nipple is fine ,she has both nipple retracted, with no other positive finding.
B. ductal ectasia
5.old pt with nipple discharge and skin excoriation, redness and inflammation in right
breast
E. paget’s disease of nipple
pneumonia
1. Clinically when asked abt causes of pneumonia we dont talk about TB in the same vein as we would talk about the gm+ves and gm -ves .OHCM has the definition as an acute process. TB typically would be described as unilateral ,apical , cavitation or shadowing +its chronic presentation. I dont know if the question and its answers were the correct presentations from past exam. however for the sake of the forum TB SHOULD BE UNWILLINGLY GET ACCEPTED.
5.Rigors and fever =toxic synd but more commonly wityh gm-ves eg klebsiella. The toxic ones even staph/klebsiella would cause typically bilateral cavitating lesions. BUT STILL AS I SAID B4 I WILL ACCEPT GRUDGINGLY
ALI +Y.K
The patient is already acarrier ,thats given therfore no need to checkagain on hbsag, in fact check if he is still infectious by hbeab.
retracted nipple in this case is a sign of periductal mastitis/ductal ectasia where the ducts are dilated with intraductal inflammation sometimes oozing out a bloody discharge.a Bx specimen shoud be taken and once confirmed there is no treatment unfortunately
May 2002 PLAB Part 1 Exam
1 Deafness(DISCUSSED B4}
A. b/l conductive deafness
B. b/l sensorineural deafness
C. uni/lat conductive deafness
D. uni/lat sensorineural deafness
E. total deafness
1.acoustic neuroma
2.presbyosis
3.otosclerosis
4 noise induced deafness
5.otitis media with effusion
2 GIT diagnosis
A. Chron’s disease
B. ulcerative colitis
C. angiodysplasia
D. intussusception
1.pt with h/o alternate bowel habits, most of time bloody diarrhoea, histology shows
rose thorn ulcers
ANSWER:A
2.pt with bloody diarrhoea, histology shows crypt abscess
ANS:B
3.baby, crying too much, plain x-ray shows transverse line just below umbilicus
ANS:D??WHAT IS THIS RADIOLOGICAL SIGN ??
4.old man with iron deficiency anaemia, colonoscopy up till hepatic flexure was
normal
ANS:C ,,SEE YESTERDAY DISCUSSION
3 Vaccination in children (DISCUSSED B4)
A. continue as per schedule
B. delay vaccine for two wks
C. give inactivated vaccine
D. try lower dose
E. don’t vaccinate
1.baby who cried for two hours last time is due for MMR, pertusis
2.baby with acute otitis media, and family h/o egg allergy is due for MMR
3baby with h/o cerebral palsy is due for MMR
4.baby with AIDS is due for MMR
4 Prenatal pathology
A. Spina bifida
B. Down’s
C. Duchene muscular dystrophy
D. Thalassemia
E. Cerebral palsy
1.mother who has a son with this disease, now pregnant with a male baby, want to
know if he has this disease too ,,,
CAN BE ANYTHING !!!!!1
theme deafness
q1 d acoustic neuromais slow growing neurofibroma arise from vestibular nerve giving progressive ipsilateral tinnitus and sensineural deafness .mri is best test and Rx is surgery if possible
q2 b ie senile deafness gradual in onset and there is b/l
sensorineural deafness, hearing is most affected in the presence of background noise Rx is hearing aids
q3 a conductive deafnesss is bilateral in otosclerosis usually appear in adult life and worse by pregnancy,
conductive deafness is better in background noise rx is hearing aids and surgery
q4 b
q5 c
theme git diagnosis
q1 a
q2 b
q3 d
q4 c
theme vaccination in children
q1 a
q2 a
q3 a
q4 a
theme prenatal pathology
q1 c ie only in male babies
q2 b
q3 a ie for neural tube defect
q4 a
1 Deafness(DISCUSSED B4}
agree with saj
************
2 GIT diagnosis:
3- x ray shows absent gas pattern over the caecum and the ascending colon..!
*************
3 Vaccination in children:
agree with saj
*************
4 Prenatal pathology:
THIS IS THE WHOLE THEME!
A. Spina bifida
B. Down’s
C. Duchene muscular dystrophy
D. Thalassemia
E. Cerebral palsy
1.mother who has a son with this disease, now pregnant with a male baby, want to
know if he has this disease too
2.mother has positive triple test (high HCG, low Alpha-fetoprotein)
3.mother was advised to take folic acid in her pregnancy
4.mother with a high alpha-fetoprotein level
1= C??? incomplete question..!
2= B
3= A
4= A (pg 228,166 OHCS)
4 Prenatal pathology
A. Spina bifida
B. Down’s
C. Duchene muscular dystrophy
D. Thalassemia
E. Cerebral palsy
2.mother has positive triple test (high HCG, low Alpha-fetoprotein)
3.mother was advised to take folic acid in her pregnancy
4.mother with a high alpha-fetoprotein level
5 Managment plan for urinary obstruction
answers:
2-Down's syndrome
3-spina bifida
4-spina bifida?
5-??
A. temprory catheterisation
B. intermittent self catheterisations
C. transurethral prostatectomy
D. permanent catheterisation
E. suprapubic catheterisation
1.pt with diabetic neuropathy can not empty his bladder properly and always
complain of residual urine
2.pt comes with acute on chronic retention, and on rectal examination has large
prostate
3.pt comes after RTA and has blood in urinary meatus, urinary retention
ans:
1-B
2-E,FOR IMEDIATE RELIEF THEN PROSATECTOMY LATER ON !
3-E
6 Treatment of dehydration(DISCUSSED B4)
A. ors(60mmol)
B. ors(90mmol)
C. water per os
D. 0.9%saline
E. 9%saline
F. nil by mouth
G. gastrostomy
1.a 6 yr old boy has been left in the car directly under sun for 6 hrs
2.a mother brings 2yr old child who has diarrhoea and vomiting for past 24 hrs
3.a pt is admitted in the hospital with stroke ,now it’s been 1 wk he is on i/v fluids as
his swallowing is not still safe
4.a 24 yr man presents with deep burns on the anterior chest wall and upper limbs
7 Poisoning
A. caffeine
B. cocaine
C. amphetamine
D. marijuana
E. morphine
F. ecstasy
1.student having exam few days ahead comes with anxiety, tremors, and palpitations
2.a man come to accident and emergency and saying he hears voices and sees faces
around .
3.a man with pinpoint pupil
4.young girl found near to night club, unconscious, and hyperkalemia
ANS:
1-A
2-F??
3-E
4-B?
drug overdose
1-A- Caffeine
2-D-Marijuana(a tetra hydro carbon THC,is a stimulant ,sedative and hallucinogen and actions depend on dose .syxs range from depersonilisation,visual hallucinations adn acute paranoid psychosis. Compaired with alcohol which also causes visual and tactile hallucinations without any evidence of psychosis.
3-MORPHINE
4-ECSTASY-(a semi-synthetic hallucinogenic substance-ccausesblurred vision confusion, ataxia,hyperthermia ,arrythmias, dic ,hyperkalemia and acute renal failure mostly abused by young inexperienced girls who are
either found unconcious or survive after ITU admssn.
The others-agreed
8 Causes of jaundice in children
A. galactosemia
B. biliary atresia
C. hepatitus A
D. Rh incompatibility
E. hypothyroidism
F. breast milk jaundice
G. UTI
H. viral infections (cong)
1.6 wks old, formula fed infant who has failed to gain weight is noted to have pale
stools and dark urine {B}
2.8 wks old infant who grows normally presents with yellow stools and straw colour
urine(F)
3.a baby is born with Coomb’s test positive{D}
4.a baby born at 38 wk with birth weight of 1.8 kg is found to have jaundice and
generalized purpuric rash(LOOKS LIKE SEPSIS ,,,UTI)
9 Managment of eye condition
A. fluorescent stain
B. x-ray orbit
C. wash the eye
1.gardener comes with an acute blepharospam and photophbia, while trimming in his
garden--------A
2.a factory worker comes with something in his eye,he says it must be some metal
piece.------------B
10 Diagnosis
A. Pancost’s tumour
B. Gastric carcinoma
C. Parotid adenoma
D. mesothelioma
E. Gastric ulcer
F. Duodenal ulcer
a. a chinese man p/w wt loss and vomiting after eating food ,he has this symptoms for
many months
HE SHOULD BE JAPANESE ,STILL THE DX IS IN FAVOUR OF GASTRIC CANCER
b.a shipyard worker presents with mass in supraclavicular region, and with some chest
symptoms.CXR shows pleural thickening on both sides and pleura effusion on the
same side of mass.
MESOTHELIOMA
c.old woman p/w mass between angle of jaw and ear for many months and her mumps
serology is negative-------C
11 Treatment of shock
A. i/v fluids
B. O(-) blood
C. i/v dopamine
1.pt comes in shock, her BP is 90/60 and her pulse is 55,and her CVP is 3 water cm-------IMMEDIATE COLOID INFUSION THEN BLOOD
2.a pt after some chronic illness is in shock her BP is 90/65 and pulse is 60, her CVP
is 18mm???SAME???
3.a pt after aortic aneurysm surgery is in shock------B,IT IS A DESPARATE SITUATION
neonatal jaundice
4. baby born @ 38/40 ,wt 1.8kgs + juandice =IUGR secondary to a congenital infxn(remember TORCHS) .Therefore cong viral should be correct ans
2. Chronic illness, low BP ,low CVP 18mm,-thats severe hypovolemia and all compensatory mechanisms have been put in place , a further colloid infusion would worsen anemia from the chronic illness,therefore in practice i would have both lines.For the question blood tx should take preference.
CAN ANYONE SHOW CLINICAL BRILLIANCE ON THIS ONE
12 Management of conditions in A/e:(Repeat)
1.A boy has 10% scalds.??Admit ??
2.In a baby iv line can’t be put .(Intraosseous infusion)
3.In adult no peripheral line can be put.(Central line)
4. A boy with BP 70/50,in shock.(Bolus 20ml/kg. ).
13 Management of anxiety disorders:(Repeat)
a. lawyer getting nervous on giving speeches.Wants a permanent solutions.---------------{Desensitization)
b.a female is scared of flying.Wants to go to New Zealand for daughter’s marriage.((please give a reference to this question,we haven't yet agreed yet on this frequently epeated question}}
c. An old man had a bout of haematemesis 3 days back& is admitted to hospital. Now
agitated-------------{diazepam}
14 Injuries
A. Nonaccidental injury.
B. Pulled elbow.
C. supracondylar fracture.
D. fracture clavicle.
E. Fracture scaphoid.
F. Greenstick fracture.
1.A 3 month old baby was brought by mother to A/E.She says that it rolled down the
bed & has multiple injuries.???A
2.A 5 year old girl slipped while holding her mothers hand. She is unable to use her
forearm.===================B
3.A boy fell down the tree on his arm .His radial pulse is absent.====================c
4.A child is crying due to pain in his arm.The mother had a prolonged difficult home
delivery.==================D
5. A boy presented to A/E & has his arm in plaster , it became wet. He was treated in
another hospital before, X-ray showed no abnormality then. Now the X-ray shows a
fracture.===================E
6.A boy fell down on his forearm. He has mild tenderness over his wrist but there is
no deformity or swelling.=================F
15. treatment of shingles{{THIS IS A NEW THEME}}
A. Acyclovir for two days
B. Acyclovir for seven days
C. i/v acyclovir
D. steroids oral
E. steroids drops
F. Reassurance and advice
G. Varicella immunoglobilin
H. Treat and refer for sp opinion
1.an old woman having shingles in thoracic dermatome and it’s been now many years
she complain of pain.=================??H{{May be this is justified ,if the GP starts her on carbamazepine for her postherpetic neuralgia ,and then refers her to a specialist pain clinic!!}}
2.a woman pregnant comes to u with shingles in thoracic dermatome.....{{well shingles can transmit VARICELLA ie chicken ox to her Foetus ,therefore she should be treated as if havng chicken pox================B))i have heard of acyclovir for five days !!!but three days or seven!!!i will choose 7 days
3.A boy with lymphoma admitted in the ward, h/o contact with a pt with
herpes(.varicella Ig )agree (passive prophylactic imunization))
4.pt with HIV having shingles===========??iv acyclovir ,,probably it will be more resistant !!
please comment .
19 Investigation of gynaecological diseases
A. cytology
B. histology
C. cancer affinity genes(both breast and cervical)
D. s/estradiol level
E. s/testosterone level
F. prolactin level
G. pelvic u/s
1.a woman , whose mother died of cervical cancer , also has two cousins that have
cervical cancer ,she is worried about herself and her daughter.
*****A (screning PAPP smear)!!
2.a woman with cervical discharge, o/e a cyst in the cervix
*************obtain tissue diagnosis (B)
3.a 55 yr old woman with occasional bleeding, histology shows endometrial
proliferation, rest of examination is normal.??what !!!
rest of examination??i suppose that a hystroscopy +D&C have been taken so what is left ,,may be pelvic U/S
4.a woman having some psychiatry problem taking haloperidol, and c/o discharging
from breast.
**********F
20. Diagnosis of psychiatry disorder
A. anxiety depressive disorder
B. major depression
C. depression with somatic symptoms
D. depression with psychotic symptoms
E. schizophrenia
F. post natal depression
G. puerperal psychosis
1.a man presents with his wife saying she is depressed and wants to be alone, she has
h/o hospital admission two yrs back with s/s of agitation , aggressiveness, and
delusions
2.a man who was previously well presents with low mood and depressed, he recently
has some financial loss and his home is repossessed.
3.a woman after the delivery of baby presents with feeling alone and not talking to her
husband, she is not really interested in feeding her baby.
4.30 yr old man comes with complains that he thinks his thought have been taken
away.
-----------------------------------------------------------
1-D
2-B??
3-F
4-E
21. Causative hormone.
A. ACTH
B. Cortisol
C. Adrenaline
D. Aldosterone,insulin
1.a woman with round face,raised BP, ultrasound shows enlargement of right adrenal
gland.
THIS IS CUSHING'S SYNDROME DUE TO ADRENAL CORTEX ADENOMA,,(b)
2.a patient with raised BP,low potassium,High/normal? sodium.
CONN'S SYNDROME ,,ALDOSTERONE ,,
55 yr old woman, occasional bleeding,histology shows endometrial proliferation,rest of exam normal--this lady is having perimenopausal ovulatory and anovulatory cycles or on exogenous eostrogens either alone or in combination with a progestagen(my assumption). for any other reason including perimenauposal hormonal mx.thats the only reason you can find the problem of endometrial proliferation only. in any case do serum eostrogen
2 psychiatry.
man ,previously well,now depressed with low mood+ his financial probs= MAJOR DEPRESSION
WHO CAN EXPLAIN WHAT ANXIETY DEPRESSION IS BECAUSE THE TERM DOES NOT EXIST IN MY VOCABULARY--DSM-- CLASSIFICATION??
Theme--gynaecological diseases
1)C cancer affinity genes
first line when family history present is genetic testing and counselling.
theme---diagnosis - psychiatry
1)it is a bipolar disorder, manic depressive, so probably option A is the one
2)major depression
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