Posted by Raymond on April 17, 2002 at 13:02:20:
PLAB-MARCH 20, 2002 PAPER
THEME 1:Diagnosis of hearing loss:
1.Acoustic neuroma 2.Blast injury 3.petrous temporal bone fracture 4.wax impaction 5.Acute otitis media 6.ototoxicity
1.Man treated with gentamicin for peritonitis for 10 days presents with deafness.
2.Manwith poor physical hygiene presents with pain and deafness after taking a shower.
3.Woman presents with deafness and corneal anaesthesia.On MRI, a widened internal auditory meatus is seen.
4.Male,20 years ,with h/o head injury ,bruising on the side of head complains of hearing loss.
ANS...1.ototoxicity 2.wax impaction 3.acoustic neuroma 4.petrous temporal bone fracture
THEME 2:Diagnosis of epistaxis:
1.Nasopharyngeal angiofibroma 2.Carcinoma maxillary antrum 3.Nasal polyposis 4.orf 5.Septal perforation 6.Coagulopathy 7.anticoagulant overdose 8.sarcoidosis 9.Trauma 10.HTN
5.A sheep farmer with a bleeding polyp on anterior part of nasal septum.
6.Man working in a chrome factory presents with whistling sound on talking
7.Man with prosthetic heart valve presents with epistaxis.
8.Man who is involved in furninture making presents with recurrent epistaxis and anaesthesia of right cheek.
9.80 year old man with history of epistaxis since 2 hours.
ANS....5.orf or nasal polyposis 6.Nasal perforation 7.anticoagulant overdose 8.Carcinoma maxillary antrum 9.HTN
THEME 3:Mechanism of action of drugs:
1.Ipratropium 2.Amoxycillin 3.Salbutamol 4.Doxapram 5.Theophylline 6.Trimethoprim
10.B2 agonist
11.Antimuscarinic
12.interferes with cellwall synthesis
13.Increases the activity of respiratory muscles
ANS....10.Salbutamol 11.Ipratropium 12.Amoxycillin 4.Doxapram
THEME 4:Drugs used in management of asthma:
1.Nebulised B2 agonist 2.Inhaled shortacting B2 3.Inhaled longacting B2 4.Oral short acting B2 5.Oral longacting B2 6.Leukotriene antagonist 7.Na cromoglycate 8.Oral theophylline 9.Aspirin 10.IV B-blockers 11.Ca channel antagonists
14.1st line drug used in treating mild asthma.
15.Not given in a chronic asthmatic after a myocardial infarction.
16.Used to control acute severe asthma in a 15 year old with severe breathlessness in A and E.
17.Used to control intermittent night wheeze in a person using inhaled high dose steroids presently.
ANS...14.Inhaled shortacting B2 15.IV B-blockers 16.Nebulised B2 agonist 17.Inhaled longacting B2
THEME 5:Diagnosis of electrolyte disturbances:
1.Metabolic acidosis 2.Metabolic alkalosis 3.Renal failure 4.Fluid overload 5.Hypokalemia 6.Respiratory acidosis
18.Man with pyloric stenosis,profuse vomiting,hypokalaemia and increased bicarbonate.
19.Man who is not able to pass urine,tired,complains of hiccups[other fearutes of uraemia which i don't remember]
20.Man with villous adenoma, profuse diarrhoea.
21.Female,24 hours after hysterectomy complains of breathlessness, increased JVP.
ANS....18.Metabolic alkalosis 19.Metabolic acidosis or renal failure 20.Hypokalemia 21.Fluid overload
THEME 6:Diagnosis of unconscious patients:
1.Subdural hematoma 2.Extradural hematoma 3.Mild injury 4.Moderate injury 5.Fracture base of skull
22.A chroni alcoholic with h/o recurrent falls comes to A and E with complaints of ataxia.Blood glucose is 7.
23.A 17 year old rugby player becomes unconscious after a fall.aftr sometime,he recovers,gives his name and address to the people in the ambulance.later condition deteriorates.
24.A child becomes unconscious after falling off his bicycle ,later he is better and active.Only complaint is headache.
25.Man with head trauma--GCS found to be 12.
26.Man with GCS=5,hemotympanum.
ANS...22.Subdural hematoma 23.Extradural hematoma 24.mild injury 25.Moderate injury 26.Fracture base of skull
THEME 7:Investigation of unconscious patients:
1.CT skull 2.Blood glucose 3.Lumbar puncture 4.full bloood count 5.serum urea electrolytes
27.A 10 year old girl,unconscious,brought to A and E.She is found to be dehydrated on examination and respiratory rate is 40/min.
28.A young boy is brought to A and E by his grandparents.He is unconscious with a bruise on the temporal area.
29.A 10 year old boy is drowsy,febrile with a rash.
30.A old lady fell and broke her hand one week back.After that slowly increasing confusion .Today her relatives could not wake her up from sleep.
ANS..27.Blood glucose 28.CT skull 29.Lumbar puncture 28.CT skull
THEME 8:Management of burns:
1.referral to burns unit 2.IV opioid 3.Dressing 4.Escharotomy 4.anaesthesia and intubation 6.IV fluids 7.Reassure
31.Man rescued from burning building.Burns on face and anterior chest,soot in pharynx and singed nasal hair,asking about his family members.
32.Baby with less than 3 percent burns on chest and shoulders[scald due to tea falling on him] is irritable,crying ,not allowing examination.
33.Man was electrocuted.Full thickness burn on fingers complaiing of pain.
34.Man with 40 percent burns over trunk an limbs.
35.Man ,slept while sunbathing comes with redness,pain? all over his body.otherwise well.
ANS...am not too sure but 31.anaesthetise+intubate 32.IV opioid 33.Dressing/Referral 34.IV fluids/Referral 35.Reassure
THEME 9:Vaccines:
1.Delay by 2 weeks 2.Omit pertussis and meningitis 3.Give vaccine in hospital 4.Continue as per schedule 5.Give inactivated vaccines
36.Child who is HIV+ is due for MMR.
37.Child due for HiB,DPT etc suffering from acute febrile illness.
38.Child cried for 2 hours after HiB,DPT etc.
39.Family history of egg allergy.child due for MMR.
40.H/O convulsions.Child due for HiB,DPT etc.
ANS...36,38,39,40.Continue as per schedule 37.Delay by 2 weeks
THEME 10:Investigations in postoperative patients:
1.Pulse oximetry 2.Wound swab 3.V/Q scan 4.ECG 5.USG abd+pelvis 6.coronary angiogram 7.serum urea,electrolytes 8.Blood culture 9.MSU 10.Chest X-ray
41.Woman after open cholecystectomy presents with fever,redness, tenderness of wound.
42.Chronic smoker 1 day after splenectomy presents with chest pain and dyspnea.
43.Female after anterior resection of rectum complains of anterior chest pain radiating to her left arm.
44.Man with COPD presents with central cyanosis.
45.Man after appendicectomy presents with rigors,tenesmus,diarrhoea.
46.Female after hysterectomy presents with pallor,tachycardia, hypotension,chestpain and breathlessness... I don't remember this Q well.
ANS....41.Wound swab 42.Chest X-ray or V/Q scan 43.ECG 44.pulse oximetry 45.Abd+pelvic ultrasound 46.]V/Q scan
THEME 11:Contraception:
1.condoms 2.COCP 3.POP's 4.OCP's+condom 5.Depovera 6.Mirena coil 7.Diaphragm 8.IUCD 9.Abstinence
47.A 14 year old girl has just started having sexual relationship with her boyfriend of 2 months.
48.35year old female after her third child wants reliable contraception.She is a smoker and does not want to gain weight.
49.A 18 year old girl has been on OCP's since 2 years ,has to have rifampicin prophylaxis since her roommate has meningitis.
50.Girl with learning disorder begins to find males attractive.Her parents and teachers are worried.
51.Female after her first child wants reliable contraceptionbut wants no chemicals in her body,complains of heavy periodsand dysmenorrhoea,husband does not want to use condoms.
ANS..47.OCP's+condom or condom 48.IUCD 49.OCP's+condom or condom 50.Depovera 51.Mirena coil or diaphragm
THEME 12:Dementia Diagnosis:
1.Alzheimer's 2.Multi infarct 3.Lewy body 4.Psuedodementia 5.Frontal dementia 6.CJD 7.Alcoholic dementia
52.Commonest form of dementia in the UK.
53.Characterised by neurofibrillary tangles and senile plaques.
54.may respond to antidepressants.
55.increased disinhibition,preservation of intellect
56.Hypertensive with recurrent faints/HTN is a risk factor...I don't remember the Q well.
ANS...52.and 53.Alzheimer's 54.pseudodementia 55.Frontal dementia 56.Multiinfarct dementia
THEME 13:Sideeffects of antipsychotic drugs:
1.Clonazepine 2.phenelezine 3.Lithium 4.Fluoxetine 5.haloperidol 6.amitryptiline
57.A schizophrenic on longterm treatment complains of impotence,has high prolactin levels,extrapyramidal side effects.
58.Drug with anticholinergic side effects,dry mouth,blurred vision, tremor.
59.Patient on treatment for bipolar disorder, hypothyroidism features
60.Schizophrenic pt under treatment presents with sore throat,decreased WBC,agranulocytosis
61.Schizophrenic pt under treatment presents with fever,increased WBC,Increased muscle creatinine kinase levels.
ANS..57.Haloperidol/chlopramazine 58.amitryptiline 59.Lithium 60.?61.?
THEME 14:Dementia Diagnosis:
1.Alzheimer's 2.Delirium 3.Depression 4.Late onset schizophrenia 5.Frontal dementia 6.Chronic anxiety state 7.Vascular dementia
62.Man living in a hostel,brought to hospital after he collapsed.On the 3rd day,he points out things other people can't see,disorientation in timee and place.
63.80 year old female is on no medication.Cause of concern is that she ws trying to get into a shop at 6:00AM.Neighbours say she's ok ecept her memory is not as good as it used to be since 2 years.She's otherwise well.
64.Female brings her husband to AandE,says he talks about their sex life in public.loss of inhibition,intellect normal.
65.Man has cough and fever since 2 days.Wife notices he has disorientation in tim and place,decreased concentrationand cnfused.He was ok mentally 1 day back.
66.70 year old man says his life is not worth living,his existence is a waste,he performs all is work very slowly,he has lost weight.
67.Man has recurrent attacks of hemiparesis.he cannot find the right word he wants,gets frustated
ANS...62.Delirium 63.Alzheimer's 64.Frontal dementia 65.Delirium 66.Depression 67.cortical ischaemia causing vascular dementia
THEME 15:Diagnosis in trauma patients:
1.Aortic rupture 2.Splenic rupture 3.Diaphragmatic rupture 4.cardiac tamponade 5.Renal contusion 6.Renal pedicle avulsion 7.Bladder rupture
8.Pancreatic rupture
68.Boy was riding his bicycle when he was hit by a car. After examination in A and E,he was found to have left upper quadrant tenderness.
69.Man fell off a ladder,has diffuse pain on right side of the trunk.IVU shows no excretion on right side.
70.Man was stabbed with a 10cm knife in the left upper quadrant,stable for 20min after which BP falls to 90/60mmHg.On USG, no free fluid seen in abdomen.
ANS....68.Splenic rupture 69.Renal contusion/avulsion of pedicle 70.Cardiac tamponade
THEME 16:Cranial nerve palsies:
71.Fracture of anterior cranial fossa,rhinorrhoea,anosmia
72.Cavernous sinus affected,pupil not responding to light and accomodation ,ptosis present.
73.After head trauma,patient cannot shrug his shoulder.
74.Forehead sparing,lower face no voluntary movements.Involuntary movements possible.
75.Fracture of base of skull,loss of taste i anterior two thirds of tongue,deviation of angle of mouth.
ANS.....71.Olfactory/1st cranial nerve 72.Occulomotor/3rd CN 73.Spinal accessory/11th CN 74.and 75.Facial/7th CN
THEME 17:Management of fractures :
1.Strapping and discharge 2.strapping and review in hospital 3.urgent orthopaedic refferal 4.X-ray wrist including oblique scaphoid view 5.Isotope scan of the wrist
76.Boy falls from a tree.complains of pain in left anatomical fossa.X-rays are normal.
77.Man falls on hand.X-ray shows perilunate dislocation .
78.Man after a fall,pain in anatomical snuffand x-ray shows impacted
distal radius fracture.
79.Man falls on hand,pain in anatomical fossa.
ANS...76.Isotope scan? 77.strap and review in hospital or urgent ortho refferal? 78.urgent ortho refferal 79.X-rays of wrist including oblique view of scaphoid
THEME 18:Child care:
1.Child protection conference 2.Nutritional assessment 3.CT skull 4.Skeletal survey 5.Coagulation profile 6.Continue regular health care
7.Examine under anaesthesia 8.High vaginal swab 9.Gluten free diet
80.Child of unemployed parents,didn't gain weight from 6 months.
81.Child brought to AandE, age 6 months,swollen thigh,X-ray shows transverse fracture of shaft of femur.
82.female child with itching,sore vagina,perineum is red and excoriated.
83.18 year old female brings her baby unconscious to A and E, cyanosed,dilated fixed left pupil.
84.Child with forearm bruise,brought by teacher,Mom says she held her to prevent her from running across the road.
195.Unconscious young boy brought to A and E,febrile,rash,CT-Normal.
198.Young girl,diarrhoea,jejunal villous atrophy on investigation.
ANS...80.Nutritional assessment 81.Skeletal survey 82.Examine under anaesthesia 83.CT skull 84.continue regular health care or coag.profile
195.Lumbar puncture 198.Gluten free diet
THEME 19:Diagnosis of confusion:
1.Schizophrenia 2.Substance abuse 3.Opiate abuse 4.Opiate withdrawal 5.Generalized tonic clonic seizure 6.Panic attack
85.40 year old lady stops talking suddenly,says someone took away her thoughts.
86.17 year old girl comes anxious and tearful to A and E.She is unkempt and dishevelled,says she lost her medication,says she aches all over and demand immediate pain relief.
87.Unconscious boy with pin point pupils,rspiratory rate_4/min.
88.Boy brought by his friend to the A and E.History of suddenly falling to the ground,jerky movements,urine incontinence.He's confused now but neurological examination is normal.
89.Young girl,confused,perioral parasthesia.
ANS...85.Schizophrenia 86.Substance abuse 87.Opiate abuse 88.GCTS 89.Panic attack
THEME 20:Management of eczema:
1.Emollient with 1percent hydrocortisone 2.Emollient with 3 percent beclomethasone 3.Admit in hospital 4.Oral antihistamine 5.Desensitisation 6.oral prednisolone 7.steroids and flucloxacillin
90.A bottlefed baby has developed flexural eczema.His brother has the same history.Family history of asthma.Mom is presently avoiding using soap.
91.Young girl with eczema,treated with emollient and topical hydrocortisone,didn't get better.
92.Young girl with severe eczema,weeping vesicles,skin swab was taken,topical steroids didn't work.
93.Baby with uncontrolled eczema.Mother has 2 more children,She's exhausted,Children have history of the same problem.
94.18 month old baby ,red swollen lips after eating egg.Presently under treatment with emollients and topical hydrocortisone three times a day
ANS...90.E+Hydrocortisone 91.E+Beclomethasone 92.Steroids+flucloxacillin or oral predisolone 93.Hospital admission or oral antihistamine 94.Desensitisation or admission to hospital ????
THEME 21:Investigations:
1.Lyme disease serology 2.Leptospirosis serology 3.viral serology 4.wound swab 5.Lumbar puncture 6.MSU 7.LFT's[liver function tests] 8.Serum urea and electrolytes
95.Girl goes into a forest,remembers getting bitten by a tick,redness near the bite is slowly increasing in size.
96.A policeman bit on his hand by a heroin addict while arresting him.He comes to the A and E ,on examination, a deep wound seen on his hand.
97.A 18 month old baby,drowsy,febrile,headache,CT normal.
196.A chronic alcoholic presents with flapping tremors and confusion.
197.A 70 yr old woman ,confusion,constiption,frequency of urine.
ANS...95.Lyme disease serology 96.Wound swab or viral serology 97.Lumbar puncture 196.LFT's 197.MSU
THEME 22:Mechanisms of hypertension:
1.Renal artery stenosis 2.Conn's syndrome 3.Cushing's syndrome 4.Chronic pyelonephritis 5.Phaeochromocytoma 6.Glomerulonephritis 7.polycystic kidney disease
98.Due to increased catecholamines.
99.Autosomal dominant.
100.Increased production of aldosterone.
101.Deposition of immune complexes on basement membrane.
ANS...98.Phaeochromocytoma 99.PKD 100.Conn's 101.GN
THEME 23:Causes of hemoptysis:
1.Bronchiectasis 2.TB 3.Inhaled foreign 4.pneumonia 5.Pulmonary embolism
102.40 year old man underwent removal of tooth under anaesthesia, presents after one month with coughing up of blood.
103.Female with cough,copious blood tinged sputum..I don't remember this Q well.
104.Female presents with acute pleuritic chest pain,hemoptysis after undergoing hysterectomy.
ANS...102.Inhaled foreign body 103.TB or bronchiectasis 104.PE
THEME 24:Complications of myocardial infarction:
1.Papillary muscle rupture 2.Acute pericarditis 3.PE 4.Acute atrial fibrillation 5.Ventricular fibrillation 6.Congestive cardiac failure
7.Complete heart block
105.Patient,12 hours after MI presents with recurrent chest pain ,breathlessness, heart rate__40/min.
106.Patient with pulmonary edema features presents with irregular pulse,heart rate__140/min
107.Female 10 days after hysterectomy presents with pain in the chest,breathlessness.
108.10 days after MI,female presents with chest pain on inspiration, persistently elevated ST segment on ECG.
109.Patient after MI found to have a harsh pansystolic murmur at the apex.
ANS....105.Complete heart block or CCf 106.Acute AF 107.PE 108.Acute pericarditis 109.Papillary muscle rupture
THEME 25: Investigations :
1.Carotid doppler 2.MRI temporal lobe 3.MRI occipital lobe 4.MRI parietal lobe 5.ESR 6.Echocardiography 7.MRI pitutary 8.Skull X-ray
110.Man with recurrent amaurosis fugax of right eye.
111.Female with scalp tenderness on both sides of the head ,complains of headcahe,sudden loss of vision in one eye.
112.Female comes with complaints of headache,bitemporal hemianopia,increase in shoe size.
113.Female with upper quadrant hemianopia.
114.Female with H/O HTN ,hemiparesis on one side of the body.
ANS..110.Carotid doppler 111.ESR 112.MRi pitutary lobe 113.MRI temporal lobe 114.MRI parietal
THEME 26:Investigation of complications of prostatic carcinoma;
1.PSA 2.Serum acid phosphatase 3.Serum alkaline phosphatase 4.Transrectal ultrasound 5.Abdominal USG 6.Serum calcium 7.Gallium scan 8.Technitium scan
115.80 year old with prostatic ca comes with 4 month h/o low backache .
116.Patient with prostatic carcerhas been treated ,now complains of confusion, thirst, bodyaches,constipation.
117.Man on GnRH's for prostate cancer comes after 2 months for a follow up.
118.Man with prostate Ca which has extended outside the capsule presenting with features of renal failure.
ANS....115.Tecnitium scan 116.Serum calcium 117.Serum acid phophatase or transrectal USG ? 118.Abd.USG ?
THEME 27: Diagnosis of altered bowel habit:
1.Irritable Bowel Syndrome 2.Inflammatory bowel disease 3.Acute gastroenteritis 4.Faecal impaction 5.Carcinoma colon 6.Diverticular disease 7.Diverticulitis
119.Female has h/o loose stools many times a day.On examination,packed solid faeces in rectum.
120.Female has h/o alternating constipation and diarrhoea,passing hard pellet like stools.
121.Female,22 yr old, with bleeding and mucus per rectum,fever,loss of weight,has never been abroad.
122.80 yr old woman,fever 39 degrees centigrade ,acute generalized abdominal pain,diarrhoea and vomiting,slightly dehydrated.
123.55 yr old man,h/o altered bowel habit from 2 months,anemia,loss of weight.
124.Female cannot pass urine,with distended bladder palpable above the umbilicus,sigmoid colon can be easily felt.
ANS...119.Faecal impaction 120.IBS 121.IBD 122.Acute GE 123.Carcinoma colon 124.Faecal impaction
THEME 28:Management of epilepsy:
1.EEG 2.CT skull 3.Add 2nd drug 4.Check drug levels 5.IV lorazepam 6.Give rectal diazepam tp parents and teach them how to use it 7.Evaluate dose of drug???
125.Boy has fever since 2 days,h/o convulsions since 5 min ,still convulsing in the ambulance,IV line has been established.
126.Boy with past and family h/o febrile convulsions.he's ok now.
127.Young girl on Na Valproate,parents come with complaints of increased seizure frequency and frequent absences from school.On examination,she's mildly obese.
128.12 yr old girl,one episode of grandmal seizure of 3 min duration in her sleep.
ANS...125.IV lorazepam 126.Rectal diazepam to parents 127.assess drug levels/evaluate dose/add 2nd drug ????? 128.EEG
THEME 29:Diagnosis of gynaecological conditions:
1.Endometrial Ca 2.Cervical ectropion 3.Polycystic ovarian disease 4.Cervical Ca 5.Pregnancy 6.Hypothalamus related disorder 7.trauma
129.55 yr old lady with h/o intermittent postmenopausal bleeding.Vaginal and speulum examinations are normal.
130.Young girl has put on weight,hirsutism,oligimenorrhoea
131.Female on OCP's complains ofpost coital bleeding.
132.18 yr old university student with h/o 3 months of amenorrhoea and starvation.
ANS...129.Endometrial Ca 130.PCOD 131.Cervical ectropion 132.Hypothalamus realted disorder.
THEME 30:Feeding:
1.PEG feeding(gastrostomy) 2.Nasogastric tube feeding 3.Parenteral feeding 4.gluten free diet 5.Low protein diet and antibiotics 6.Low calorie diet 7.Lactose free diet
133.Patient with longstanding parkinson's disease with intractable dysphagia.
134.Patient after a stroke,5 days later,fluids still being aspirated from stomach.
135.Man after resection and ileostomy is septicaemic.
136.Man with jaundice and ascites suddenly deteriorates.
137.Girl with diarrhoea and jejunal villous atrophy.
ANS..133.PEG 134.Parenteral 135.Parenteral 136.Low protein diet and antibiotics 137.Gluten free diet
THEME 31: Pain relief:
1.NSAID's 2.Methotrexate 3.Home exercises 4.Local steroid injection 5.Splinting 6.IVbiphophonates
7.Oral steroids 8.Physiotherapy or exercise training ??
138.Busy man with indigestion,acute pain lateral side of hip.
139.Patient with symmetrical polyarthritis,pain does not decrease with simple analgesia.
140.Patient with hot swollen MT joint,pain does not decrease with paracetmol.
141.Pregnant woman with numbness,tingling lateral side of hand[carpal tunnel syndrome feature].
142.Female with hypercalcemia features[thirst,costipation,confusion]
143.Female with 3 month h/o shoulder and hip girdle pain and stiffness.
ANS...138.Local steroid injection 139.Methtrexate or Nsaid's 140.NSAID's 141.splinting 142.IV bisphosphonates 143.Oral steroids
THEME 32: Palliative care:
1.Cyclizine 2.Haloperidal 3.Hyoscine 4.Oral dexamethasone 5.Oral beclamethasone 6.Per rectal predisolone 7.Metronidazole gel 8.Longterm catheterisation 9.Intermittent self catheterisation
144.Patient with intractable hiccups.
145.patient can't cough up bronchial secretions.noise is distressing to attendants.
146.Patient after radiotherapy for bowel adenocarcinoma comes with bright red rectal bleeding.
147.Patient with SVC obstruction after radiotherapy.
148.female with fungating breast Ca with a bad adour.
192.Man sufferung from multiple sclerosis,spastic paraparesis,residual volume=300ml.
ANS...144.halopridol/cyclizine? 145.Hyoscine 146.Per rectal prednisolone 147.Oral dexamethasone 148.Metronidazole gel 192.Intermittent selfcatheterisation
THEME 33:Anaemia investigations:
1.Blood film for parasites 2.Serum B12 3.Schilling test 4.Bone marrow biopsy 5.Serum/gel electrophoresis 6.Mesenteric angiogram
149.Man with hepatosplenomegaly,fatigue,immature cells seen in blood film.
150.Man returns from Ghana,fever ,rigors
151.Man presents with fatigue and backache[other multiple myeloma features]
152.Old lady with Hb_ 3g/dl,MCV_120fl ,family history presents with fatigue,lethargy
153.Female with past h/o rectal bleeding,normal on endoscopy and enema studies done previously presents with profuse fresh rectal bleebing
154.Hb_8.3g/dl,MCV_82 fl .. i don't remember the rest of the Q
ANS..149.Bone marrow biopsy 150.Blood film for parasites 151.Serum/gel electrophoresis 152.Schilling test 153.Mesenteric angiogram
THEME 34:Management of gynaecology conditions:
1.Vaginal estrogens 2.Infection control 3.Prophylactic antibiotic treatment 4.Ring pessary 5.High fibre diet
155.85 yr old with 14 children,severe heart failure,complains of dysuria,feeling of pressure in lower abdomen.
156.Female with well controlled diabetes mellitus type 2 with recurrent UTI.
157.Female with longstanding irregular bowel habit and recurrent UTI.
158.80 yr old sexually active woman with dyspareunia and recurrent dysuria.
ANS..155.Ring pessary 156.Infection control/prophylactic antibiotics
157.High fibre diet/prophylactic antibiotics 158.Vaginal estrogens
THEME 35:Management of varicose veins:
1.Injection sclerotherapy 2.Graded compression stockings 3.Operation for varicose veins 4.Reduce weight
159.Female with bilateral varicose veins,lipodermatosclerosis.she's using compression stockings .despite that increase in itching and eczema.BMI is 27.
160.75yr old ,underwent 2 operations for varicose veins,presents with painful legs,has h/o heart failure.On examination bilateral gross varicose veins,lipodermatosclerosis,no ulcers.
161.Female with BMI 33,comes with complaints of varicose veins and eczema.
162.Man with varicose veins has to fly for 20 hours .His father has a h/o pulmonary embolism after flying.
ANS...159.Operation 160.Injection sclerotherapy 161.Lose weight 162.Graded compression stockings
THEME 36:Investigations in jaundice:
1.Liver biopsy 2.Liver USG 3.Oral cholecystography 4.Viral serology 5.ERCP 6.Percut.transhepatic cholangiography 7.Serum AMA's
163.Man returned from trip to Asia,complains of anorexia,malaise,dark urine,pale stools.
164.80 yr old man has never been out of UK,one month h/o epigastric pain,dark urine,pale stools,jaundice.
165.Female with fever,rigors,right upper quadrant pain,jaundice,USG is normal.
166.Female ,50 yrs old, 5 yr h/o mild pruritis.h/o pale stools,dark urine,jaundice.
167.Man with h/o hemochromatosis and alcohol addiction presents with jaundice,ascites,variceal bleed.USG is unequivocal,high ferritin level.
ANS...163.Viral serology 164.ERCP 165.Oral cholecystography or Percut.?
166.Serum AMA's 167.Liver biopsy
THEME 37:Management of scrotal pain:
1.MSU 2.Urethral swab 3.Urgent surgical exploration 4.IVU 5.USG
168.Man after trip to Asia presents with red,swollen scrotum.
169.Man with painful red scrotum and vomiting.
170.Man with painless testicular swelling since 2 months.
171.Man with swelling of scrotum since 3 years.
172.Man with no h/o unsafe sex presents with dysuria and urinary frequency.
ANS...168.Urethral swab 169.Uregent scrotal exploration 170.USG 171.syphilis serlogy or USG ? 172.MSU
THEME 38:Diagnosis :
1.Acute pancreatitis 2.Chronic pancreatitis 3.H.pylori infection 4.Pernicious anemia 5.Barrett's esophagus 6.Prostatic Ca 7.BPH 8.Clot retention
173.Condition that can cause necrosis, formation of fluid filled spacesthat can get infected.
174.Condition associated with gatroesophageal reflux,epithelial metaplasia,increased risk of carcinoma.
175.Condition associated with epigastric pain radiating to the back,pale loose stools,associated with alcohol consumption.
176.Condition associated with persistent inflammation,can cause lymphoma.
177.Condition associated with megaloblastic anemia,increased risk of carcinoma.
193.Man,h/o frequency,dribbling,nocturia since 3 years,After having 2 pints of beer,he cannot pass urine.
194.Man who is a chronic smoker is awaiting an operation for resection of a bladder tumor.Suddenly presents with lower abdominal pain and inability to pass urine.
ANS...173.Acute pancreatitis 174.Barrett's 175.Chronic pancreatitis 176.H.pylori infection 177.Pernicious anemia 193.Benign prostatic hyperplasia 195.Clot retention
THEME 39: Diagnosis of thyroid disorders:
1.Anaplastic carcinoma 2.Follicular Ca 3.Papillary Ca 4.Hashimoto's thyroiditis 5.Thyrotoxic goitre 6.Autoimmune hypothyroidism 7.Drug induced thyrotoxicosis.
178.Female,41 yrs old,presents with hard,irregular fixed swelling, stridor,dysphagia since 3 months.
179.Old lady with smooth neck swelling,bradycardia,spare coarse hair,macrocytic anemia.
180.Female on treatment for supraventricular tachycardia complains of seeing dots and glare on driving at night,exophthalmos,no goitre.
181.Female,swelling in the neck,tremor irritability,diarrhoea,bruit.
ANS...178.Anaplatic Ca 179.Hashimoto's or autoimmune ? 180.Drug induced
181.Thyrotoxic goitre[some ppl insisted that Grave's is the right answer for this Q but I don't remember that being given as an option
THEME 40:Complications of breast carcinoma:
1.Pathological fracture 2.cerebral metastases 3.Hypocalcemia 4.Lymphedema 5.Spinal cord compression
182.Female with breast Ca 3 yrs back,was treated with mastectomy and lymph node clearance on the left side,presents with a swollen limb and decreased hand movements.
183.Presents with thirst,confusion,constipation.
184.Presents with weakness of both legs,dificulty walking,urine retention.
185.Presents with headache,confusion.On examination,papilledema present.
186.Presents with features of fracture femur.
ANS....182.Lymphedema 183.Hypercalcemia 184.Spinal cord compression 185.Cerebral metastases 186.Pathological fracture
THEME 41:Next step in management:
1.Insulin and dextrose 2.Dialysis 3.ACE-i 4.Oral azathioprine 5.Fluid challenge[Aggressive treatment with IV fluids] 6.Catheterisation 7.Oral predisolone
187.Patient with diabetes mellitus,moderate renal impairment. Creatinine-350,urea-18,K+-7.9,Na+-142.
188.Patient with multiple myeloma.Increased craetinine and urea levels,Normal K+ and Na+ levels,Ca+-3.5
189.Man cannot pass urine.Creatinine-350,Urea-18,Electrolytes -Normal,
USG--Dilated bladder and ureters.
190.Man with crush injury[i don't remember the rest of the Q]
191.Acute SLE attack with red cell casts in urine.
ANS...187.Insulin and dextrose or dialysis 188.ACE-i or Azathioprine 189.Catheterization 190.Fluid challenge 191.Oral predisolone