PFMSG FORUM

[drwatson]

Plab 1 May 2006 RECALLS

MANAGEMENT:
1-fear of spiders----behaviour therapy
2-lawyer scared of giving her speech in court---desensitization
3-woman scared of flying to go to daughter's wedding in 15 days---(OHCM says tht if she has to fly soon do hypnotherapy,otherwise behaviour thrapy,dont know if 15 days classifies as soon or not)
4-diabetic in coma,BLOOD GLUCOSE is 2 mmol/l---50% dextrose drip
5-woman after cholecystectomy,has pinpoint pupils---naloxone

DIAGNOSIS:
6-girl comes to A&E,has deep and sighing respiration-diabetic ketoacidosis
7-woman comes with severe headache,no vomiting or stiff neck---subarachnoid H
8-man goes to tropics for 3 weeks,comes with wt loss,anorexia,diarrhea---Hep B,giardiasis,malaria...not sure
9-a girl presents with fever,vomiting and keeps pulling on her left ear ---OTITIS media,OTITIS externa,foreign body...not sure of ans.
10-child presents with bilateral yellow discharge from both ears---OTITIS media,OTITIS externa,foreign body...not sure of ans.

INVESTIGATIONS:
11-old woman has mild headaches+aches and pains---ESR
12-Woman with signs of migraine---cerebral angiography(i read somewhere tht in inv of migraine u should do carotid angiography to rule out TIA),CT,X-ray,ESR...not sure of ans.
13-man with wt loss,change in bowel habit and fresh rectal bleeding---prednisolone suppository,large bowel enema,refer to surgeon...not sure of ans.

MANAGEMENT:
14-child with signs of appendicitis---I.V morphine(i wrote)other options were I.M morphone,paracetamol oral,paracetamol rectal
15-child being investigated for failure to thrive,complains of left sided earache---paracetamol rectal(i wrote since i figured he would probably throw up oral since he has failure to thrive)but can also be paracetamol oral.
16-man comes to A&E with sever crushing chest pain(MI)---morphine I.V

DIAGNOSIS:
17-HIV pt with bilateral infiltrates---pneumocyctis carnii pneumonia
18-child with pneumonia has empyema---haemophillus influenza
19-girl with cystic fibrosis on flucoxacillin prophylaxis---staph aureus(psedomonas aerugenosa was not an option)
20-woman with fever,pleural rub----pneumonia(i wrote)other options were pulm embolism,pleural effusion,pulm. edema.

MANAGEMENT:
21-child with lot of resp.symptoms but oxygen saturation was 62%---high flow oxygen mask.
22-child with severe burns on face and throat,oxygen saturation normal---intubate immediately

DIAGNOSIS OF VAGINAL DISCHARGE:
23-vaginal discharge with mycelia---candidiasis
24-vaginal discharge with clue cells---bacterial vaginosis
25-whitish vaginal discharge after intercourse---cervical ectropion
26-vaginal discharge with abd.pain and dysparunia,gonorrhea culture -ve---chlamydia
27-vaginal discharge + shallow ulcers at the vagina---herpes simplex

DIAGNOSIS:
28-Woman who is a long time smoker comes with abd. pain and diarrhea---crohn's disease(cannot be ulcerative colitis because smoking protects from ulcerative colitis)
29-a man comes to A&E after RTA,on auscultation of his chest,bowel sounds are heard---diaphragmatic rupture
30-boy falls from a tree,has bruises and pain on right side of abd,has paradoxical breathing---fractured ribs
31-vertigo following URTI but no vomiting---vestibular neuronitis

INVESTIGATIONS:
32-child has runny nose ,fever,last week was treated for laryngotracheobronchitis---throat swab culture,chest x-ray +blood culture...not sure of ans.this theme had 2 more questions which i neither knew nor can remember.
33-
34-

TYPE OF CELLS DIAGNOSIS:
35-a girl comes with history of epistaxis and bleeding ---platelet deficiency
36-a man gets jaundice everytime he gets sick---target cells(i wrote) other options were--- plateless excess
granulocytes without blasts
atypical lymphocytes
spherocytes
oval macrocytes
37-a man presents with splenomegaly but no lymphadenopathy---same options as above but dont know ans.
there were 2 more questions in this theme but i can recall them.
38-
39-

SHINGLES TREATEMENT:
40-shingles in pregnant woman,last trimester---varicella Immunoglobulin
41-shingles in immunocmprimised child---urgent specialist referal
42-shingles in elderly woman,since 2 days---aciclovir 7 days/2 days/not sure.
43-shingles in young woman since 2 days---aciclovir 7 days/2 days/not sure.
44-woman after attack of shingles,has no pain but has some discolouration at the site of shingles blisters---reassurance.

INVESTIGATIONS:
45-Woman has headache,photophobia,neck stiffness,CT scan normal---Lumbar puncture.
46-a man on treatement with phenothiazine presents with swollen,painful breasts---prolactin levels
47-pt on litium presents with tremors----druug levels
48-pt on lithium presents with wt gain,cold intolerance,menorrahgia---TFT'S
49-a girl with epilepsy presents with seizures,she is on sodium valproate---drug levels.

DIAGNOSIS:
50-man after RTA presents with radio femoral delay----traumatic rupture of the aorta
51-man with breathlessness,trachea shifted to right,hyper resonant percussion---pneumothorax.
52-man with HTN,anemia,thrombocytopenia---haemolytic uraemic syndrome
53-boy with hyperalbuminuria and hypoproteinemia---nephrotic syndrome
54-woman with lost of symptoms and +ve ANA'S----SLE
55-man with uniformly small kidneys on ultrasound with no obstruction and proteinurea---chronic renal failure,other options were multiple myloma,acute glomerulonephritis.

INVESTIGATIONS:
56-Man fell on wrist,anatomical snuff box injury---x-ray scaphoid view
57-man with perilunate disloctaion---urgent orthopaedics referal
58-man with impacted distal radius FRACTURE ---urgent orthopaedics referal
59-child with FRACTURE of femur or some FRACTURE ,i think suspect non-accidental injury---i wrote bone scan because it sounded closest to skeletal survey which we should do in this case but tht was not an option,not sure of the ans.
60-girl with epistaxis and bruising---coagulation profile
61-girl with jerky movement while sleeping---EEG
62-girl with involuntary movements on right arm with gen.tonic clonic seizures---EEG or CT scan,not sure.
63-2 more epilepsy questions,cant remember
64-

ELECTROLYTE INVESTIGATIONS:
65-old lady with constipation and polyuria---parathormone
66-woman with galacctorrhea,ammenorrhea and infertility---prolactin
67-hypernatremia and hypokalemia,plasma renin low---aldosterone(conn's
syndrome)
68-hyponatremia,hyperkalemia,hyperpigmentation---cortisol(addison's disease)
69-smoker with polycythemia---erythropoieten
70-woman,3 months after delivery of twins,foul stools and macrocytosis---coeliac disease

DEMENTIA:
71-alziehmers dementia
72-man with HTN---multi infarct dementia
73-man with dementia and preservation of visuospatial ability---frontal dementia
74-woman with involuntary hand movements---huntingtons disease.

BONE FRACTURE DIAGNOSIS:
75-RTA,difficulty in opening mouth----FRACTURE of mandible
76-injury to back of head,just above insertion of neck muscles---occipital bone F
77-injury from above eyebrow to the paranasal sinus---frontal bone F
78-injury to cheek----maxilla FRACTURE
79-injury to just above the bridge of nose ---nasal bone FRACTURE

BREAST INVESTIGATIONS:
80-lump in breast,woman afraid of needles---mamography
81-lumps in breast,at the time of menstruation they becaome painful---USG
82-lump in breast,attached to SKIN with no nodal involvement---FNAC???not sure
83-pt wants to be satisfied tht lump is not malignant---FNAC or steriotactic core biopsy...not sure.1 more question,i cant remember
84-

PROPHYLAXIS BEFORE SURGERY:
85-candidate for orthopaedic surgery,BMI is 36---lose weight
86-candidate for orthopaedics surgery,history of murmers and childhood rheumatic fever---prophylactic antibiotics
87-man drinks 20 units of alcohol and smoker,considered for surgery---pre-operative referal to addiction centre(not sure)
88-woman comes for abortion,requires Anaesthesia ---VIT K (not sure)
89-man comes for operation for hernia,2 hour long operation---bowel preperation or antibiotics, not sure
90-boy with difficulty in cheweing---dental absess(dont remember question completely)

X-RAY SIGNS DIAGNOSIS:
91-no vascular markings---pneumothorax
92-round shadows in upper lobe of lung---T.B (not sure)
93-hilar lymphadenopathy---sarcoidosis
94-widened mediastinum---aortic dissection
95-bilateral infiltrates---PCP

DIAGNOSIS:
96-klinefelter syndrome sysmtoms
97-sicke cell anemia symtoms
98-alzheimer’s in down’s sysndrome Pt
99-old man has epistaxis,B.P 135/85-----HTN???
100-man with prosethetic heart valves with epistaxis---over anticoagulation
101-atrophic vaginitis signs
102-pt with SLE,multiple opacities---cataract

CONJUNCTIVITIS:
103-red eye ,vision unaffected----sub conjunctival haemorrhage-no treatment
104-girl with itchy eye ,no purulent discharge---viral conjunctivitis????
105-girl with red eye ,cobblestoning---allergic conjunctivitis
106-neonoatal conjunctivitis----topical tetracycline or oral erythromycin,not sure
107-

INVESTIGATIONS:
108-Signs of menopause----FHS levels
109-child with hot,swollen joint---joint aspirate
110-3 months after forcep delivery,baby has seizures---CT scan or skull X-ray,not sure
111-2 ear questions
112-
113-man with corneal ulcers,florecein stains eye ,treatment---aciclovir oral or topical,not sure

VESSEL INJURY:
114-man falls on arm,arm swollen and painful----brachichephalic or axillary nerve,not sure
115-man with inguinal hernia,which vessel effected
116-
117-
118-

MANAGEMENT OF HEART DISEASE:
119-man with long runs of SVT---
120-business man with very fast heart rate---
121-cant remember the options,it was too hard
122-
123-
TESTICULAR SWELLINGS IN CHILDREN:
124-
125-
126-
127-

ANTEPARTUM HAEMORRHAGE DIAGNOSIS:
128-woman with previous c-section,presents with massive bleeding in next pregnancy---uterine rupture
129-woman with painless bleeding at 32 weeks---placenta previa
130-
131-

SBA’S:::::::::::::::::::::::::::::::::::::::
132-boy has changed schools,fallen behind in studies,slow at work and scared of going to social events because he thinks he will catch infection
A-phobia
B-obsessive compulsive
C-adjustment problems

133-5 days after birth of a baby,mother is anxious and fearful tht she wont be a good mother,checks on baby many times a night to see if baby is breathing..
A-anxiety disorder
B-obsessive compulsive
C-post partum depression
D-post partum blues
E-post partum phsycosis

134-man has been depndant on alcohol since 15 years..
A-stop alchol
B-control his alcohol
C-asses his intent to leave alcohol

135-child with well controlled asthma,on short acting B-agonists and low dose steroids,has good steroid inhaler technique,now develops night cough and excersise induced asthma..
A-high dose steroids
B-add long acting bronchodilator
C-theophylline
D-montelukast

136-man with recurrent vomiting and abd pain..what could be contributing to his condition???
A-K-3.00
B-Ca-2.00
C-Na-138

137-sick child,10 kg,prescribed antibiotic at 4mg/kg,how many ml antibiotic in 24 hours??i worked out this question but don’t remember it completely,I think the ans was 4ml twice in 24 hours..dont remember the options.

138-man stabbed himself in groin.B.P is 80/60 and pulse is 130..how much blood loss?? ANS---1500 ML.
A-300ML
B-700ML
C-1000 ML
D-1500 ML

139-man with ulcer on tip of ear and on same side of neck..
A-sq.cell ca
B-basal cell ca
C-melanoma
D-keratosis

140-500,000 people in village..1750 diagnosed with lung cancer in 5 years..wt is the annual incidence in a million people???
A-350
B-700
C-1250
D-1750
ANS IS 700---------1750/5=350 in 1 year in 500,000 people
In 100,000 people in 1 year=350+350=700.

141-woman with many features of depression..wt is the likely outcome?-----suicide
A-phsycosis
B-suicide
C-hysteria

142-woman with previous ectopic pregnancy,suspects another ectopic..USG cannot confirm a uterine preg. B-HCG is low…next step??
A-B-HCG and USG after 1 week
B-salpingectomy
C-open tubal preservation surgery

143-treatment of trichomoniasis---metronidazole
A-doxycycline
B-erythromycin
C-metronidazole
D-tetracycline

144-woman with pneumonia,not treated with amoxcicillin----mycoplasma Pneum
A-streptococcal
B-PCP
C-haemophillus

145-man with cervical spondylosis,has a painful eye ,intraocular pressure is 16 mm/hg---iridocyclitis
A-episcleritis
B-conjunctivitis
C-glaucoma
D-iridocyclitis

146-boy with nephrotic syndrome presents for the 3rd time,even after treatment with steroids..wt is his out come???------steroid resistant NS
A-complete cure
B-steroid resistant NS
C-steroid responsive NS

147-old woman living in nursing home has itch on her abdomen,wt INV..------check hands and feet(for scabies )
A-SKIN biopsy
B-SKIN scrapings
C-check hands and feet

148-boy with laryngeotracheobronchitis,if left untreated, wt is the outcome?-----
A-resolution
B-bronchiectasi(I wrote)

149-wt r the histological features of barret’s esophagus,tht point towards malignancy???---sq.mataplasia
A-sq.metaplasia
B-dysplasia
C-adeno ca
D-sq.cell ca

150-how do u treat hot flushes in post-menopausal woman???----estrogen and progesterone
A-estrogen and progesterone
B-clonidine
C-progestin only

151-what cancer in person with adeno polyposis coli gene???----colon ca
A-gastric
B-esophagus
C-colon
D-rectal

152-a man with depression,not eating or drinking----ECT
A-amitryptilline
B-ECT
C-fluoxetine

153-trocar piercing structures B/W umbilicus and ant.superior iliac spine----external oblique aponuerosis and ext oblique muscle.
A-Rectus abdominis
B-linea alba
C-ext and int oblique muscle
D-conjoint tendon