Posted by PLAB TUTOR on August 07, 2001 at 15:42:10:
JULY 24,2001 EMQS kindly donated by Wilf
Guys,I sincerely hope thes qns.help you all in your
prep.too.Regardless of what happens on the 31 AUG.(fingers xd),I am largely
indebted to this site(and esp.the PLAB TUTOR)for being a gateway to a pool of
EMQS/other relevant info.
Plab tutor,this is the way I felt I could reciprocate your generosity to us.Loads of thanks for broadening my,and our, academic envelope
May the other july candidates fine-tune some of the qns.,if necessary.And good luck to all july candidates!!!
Regards,wilf.
JULY 24,2001 EMQS
THEME1
PRESCRIPTION AND RENAL FAILURE
pick the appropriate drug responsible for the side effect.(options-ciclosporin,bendrofluazide,spirinolactone,cyclophosphamide,captopril,gentamycin..)
1.A ?60 yr old woman hypertensive was started on antihypertensive 2 weeks ago.Now has a creatinine level of 500 micromol/l
2.A child with recurrent nephrotic syndrome is brought for treatment.3 weeks after start of treatment,he now has massive haematuria.
3.A patient in severe renal failure has K+ level of 2.5mmol/l.
4.Patient c/o ataxia and ?tinnitus+/-?hearing loss.He has moderate renal failure.
THEME 2
INVEST/MGT OF CYSTITIS
(CT,cystoscopy,U/S kidney and bladder,MSU after 3/52,MSU monthly for 6/12,MSU culture)
6.A 3 yr old boy has a first confirmed UTI.Abdomen U/S is normal.
7.A female presents with freq.dysuria.This is the 3rd episode,@ time E.coli confirmed.
8.A 70 yr old with prostatic symptoms.Urine culture is negative.
9 A 25 yr old male has a first confirmed UTI.IVU is normal.
THEME 3
DD of vomiting in children
(GER,G/E,pyloric stenosis,,intussuseption,UTI,,DM..)
10.A 3/52 old presents with projectile vomiting ,appearing hungry after each emesis.O/E-deH2O,mass in abd.
11.A ?yr old child presents with vomiting ,crying and lifting her legs.Nappy is stained red.O/E-sausage-shaped mass P/A.
12A 3/12 child is brought with recurrent vomiting,but is otherwise thriving well and healthy.The symptom seems to subside when the child is strapped in baby’s seat.
13.Child with features suggestive of infection(can’t recall the wording of this qn.)
14.Child with vomiting etc.Brother had a similar problem 2/52 ago(rest of the wordings out of my mind)
THEME 4
DD OF ACUTE DYSPNOEA(DATA INTERPRETATION-CO2,O2,CXR,ECG)
Options were:(anxiety,asthma,p.embolism,cor pulmonale,aspiration pneumonia..)
15.Patient had bilateral fluffy opacities.Had low o2,normal co2.
16Pt with acute shortness of breath,wheeze.CXR-normal,low o2,?co2.PEFR-120 ml/min.
17Pt with NO other abnormalities apart from acute dyspnoea.CXR-N,low co2,high 02.ECG-sinus tachycardia.
18An alcoholic admitted semi-comatose.low o2…..??
THEME 5
MGT OF XPLE TRAUMA
Choose next appropriate next action
(Gain IV access+N/S,Gain IV access+blood transfusion,apply external pressure,needle thoracostomy,chest drain,maintain open airway,intubation+ventilation,splint fracture)
19Pt involved inRTA,neck immobilised .Has massive head and facial injuries,together with noisy breathing despite adminstration of 100% o2.
20.Girl in RTA.Neck is immobilised and line established.Has deformed ,swollen thigh,pale.
21.Known asthmatic patient involved in RTA.Has a Rt-sided chest pain and hyperesonance on the same side.Trachea is deviated to the left.
22A 19 yr old has fallen off her horse.Neck is immobilised+100% o2.Has left upper abd.pain,is pale and tachycardic.
23.A 15 yr old girl has cut her wrist and bled profusely.She is pale,tachycardic and does not want to live.
THEME 6-
DD OF ALTERED BOWEL HABIT
(Ca rectum,ca caecum,IBS with diarrhoea,IBS with constipation,faecal impaction,diverticulosis)
24.A 19 yr old female c/o a 1 yr history of bloody diarrhoea and tenesmus.Has pale skin lesions on the skin.O/E-sigmoidoscopy shows inflammation and granulomata
25.65 yr old with wt.loss,Rt-sided pain,tenesmus.O/E-mass in the rectum
26.18 yr old presents with frequent diarrhoea for about 3/52,relieved by defaecation.Sigmoidoscopy is normal.
27.?80 yr old c/o diarrhoea and urinary retention
THEME-7-
DD OF ACUTE URINARY RETENTION
(ureteric colic,ca prostate,BPH,UTI,stricture..)
28.A patient of multiple sclerosis has had urinary catheterisation for 4 years with intermittent obstruction
29.60 yr old c/o frequency ,dysuria.PSA is 120ng/l,also has back pain
30.Female patient c/o sever flank pain,is restless and the pain radiates to the groin.
THEME 8
INVEST/MGT OF MENINGITIS
next most appropriate action.Options(ZN,reduce fluid intake,CT,parenteral penicillin,iv aciclovir,rifampicin..)
31.A young boy back from holiday in N.Africa presents with night fever,weight loss.Began on antibiotics with minimal improvement.CSF shows:protein-960mg/dl,glucose-2mmol/l,cells-? Lymphocytes
32.A boy on treatment for meningitis .Initially improving ,but now developing swinging fever,headache ,vomiting.
33.A pt on appropriate antibiotics for meningitis now has Na+-125mmol/l
34.Lady presents with occipital headache.neck stiffness but no fever.
35.Young patient suspected of having meningitis has purpuric rash.GP calls for the ambulance but asks for your advice.
THEME 9-
DD OF SHOCK
(anaphylaxis,tension pneumothorax,aortic aneurysm,rup.ectopic pregnancy,salpingitis,acute pancreatitis,adrenal insufficiency)
36.Pt stabbed in right chest.U/S showed no free fluidP/A,patient is breathless,pale.
37.woman h/o 8/52 amenorrhoea presents with abd.pain rigidity and is pale.
38.Pt with h/o suggestive of atherosclerosis,now presenting with shock.
39.Pt.admitted with suspected tetanus and is given tetanus immunoglobulin and an antibiotic to which he is not allergic.?hrs later the patient is breathless and tachycardic
40.A known asthmatic on treatment with inhaled B2agonist and steroid.Now presents with hypotension.
THEME 10
INVEST.OF AA
(Abd.U/S,spiral CT,IVU,coronary angiography,echo,plain abd x-ray..)
41.A 60 yr old attends A/E and it is thought he may have AA.
42.A pt is to have a repair of his AA but wants to r/o renal involvement.
43.A pt is to have a repair of of his AA but also has severe myocardial ischaemia
44.Pt with AA has unstable angina
45.Pt suspected of having aortic dissection c/o abd.pain yesterday,but is now haemodynamically stable.
THEME 11-
INVEST/DD OF XNIC ABD.PAIN
(mesenteric angiogram,perf.P.U,…..)
46.A pt presents with intermittent abd. Pain for about 30min. after meals .Also has h/o abd.pain radiating to the back.O/E-abd.bruit.Also has interm.claudication
47.Pt on antacids for xnic epigastric pain presents with acute abd.pain,rigidity and is pale.
THEME 12-
DD OF FRACTURES IN CHILDREN
(Fractures of the :scaphoid,shaft radius/ulna,shaft of humerus,neck of humerus,supracondylar humeral fracture..)
48.A 7/7 old baby cries whenever lifted.Labour was difficult
49.Young girl tripped while holding mother’s hand.Now can’t use arm at all
50.Young boy fell off horse onto his hand.Now c/o mild tenderness but able to use forearm
51.Young patient fell on outstretched hand and now has absent radial pulse
THEME-13-
MULTIPLE SCLEROSIS-ANATOMICAL SITES INVOLVED
(cerebellum,optic disc,optic nerve,optic radiation,cerebral cortex,brain stem,cervical spinal cord,thoracic spinal cord)
52.Known patient of multiple sclerosis now c/o urinary incontinence,weakness in all 4 limbs and difficulty walking
53.Pt has nystagmus,diplopia,and +ve past pointing.
54.Pt has repeated attacks of M/S,and now has pale temporal disc
55.Pt c/o blurring of vision ,papilledema,pain in eye
THEME-14-
DD OF CHRONIC NEUROLOGICAL DISEASES(Alzheimer’s,multiple sclerosis,mysthaenia gravis,….)
56.Pt gets diplopia when he works very hard
57.Pt with attacks of numbness in left hand and right sided headache
THEME-15-
MGT OF BURNS
(iv fluids,escharotomy,admit to hospital,COHb level,iv blood transfusion,deroof blister,aspirate blister..)
58.Pt after escaping from fire in a building has singed nostrils..
59.Pt has a large tense blister
60.Pt has partial thickness burns on the anterior chest and upper thighs
61.An adult patient has circumferential burns(both FT+PT)from the elbow to the fingers,covering them completely
THEME –16-
DD OF HEARING TESTS
(bilateral sensory deafness,bilateral conductive deafness,bilateral total deafness,unilateral sensory deafness,unilateral conductive deafness..)
62.otosclerosis
63.presbycusis
64.OM with effusion
65.acoustic neuroma
66.noise-induced hearing loss
THEME-17-BIOSTATISTICS
(specificity,sensitivity,mode.mean,medin,chi-square..)
67.The measure of detecting sth. Which is actually present
68.measure…of dispersion..
THEME-18-
EPIDEMIOLOGY IN CARDIAC CONDNS
(IHD,atrial fibrillation,warfarin,……
69.The single largest cause of death in adults in the UK
70.warfarin decreases the incidence of stroke by about 30%
71.inteferes with the function of vitamin K
THEME-19-
MGT OF MI(diuretic,thrombolysis,b-blockers,nitrates,o2,cardiac pacing..)
72.A patient who developed MI one month ago is now breathless and has basal crackles
73.Pt presents with one and a half hours of epigastric pain radiating to his arm.ECG shows acute inferior MI.O2+analgesia have already been given
74.Pt recovering from MI has a heart rate of 36/min
THEME-20-CAUSATION OF DISEASES(skin-to-skin,close community contact,animal-to-human,tinea,female mite,immuno deficiency,blood..)
75.scabbies
76.candidal nappy rash
77.impetigo
78.toxoplasmosis
79.A first year university student develops headache,fever,photophobia, in the 1st week of term
THEME-21-
MGT OF SPEECH DISORDERS
(hearing test,speech therapy,reassure,refer to ENT ,milestone assessment..)
80.Pt has nasal speech,snores at night.Day time he is sleepy
81.?yrs been developing well,but now has decreased hearing.Motor function is normal
82.18/12 old patient still says a few words,…mother is worried
THEME-22-
TRANSMISSION OF DISEASES
(HPV,faecal-oral,blood-borne…..)
83.warts
84.typhoid fever
85.hepatitis C
THEME-23-
MGT OF ACUTE PSYCHOSES
(hospital hostel,family therapy,supportive counselling,rehabilitation,education,oral antipsychotic,risk management strategy,detention under mental health act,ECT,pschiatric general wards)
86.A schzizophrenic who stabbed his mother’s hand with a screw driver was recently admitted and treated with depot injection antipsychotic.He is now symptom-free and ready for discharge
87.Pt(schizo) has had about 8 admissions in the last 5 years.He is uncompliant with drugs….
88.Young patient now 25 yrs was diagnosed with schizo.at 15,but despite different medications has not recovered fully.The family is very supportive.
89.Pt ? yr old is admitted depressed and has not been eating /drinking for many days.Has lost weight.
90.Pt with features of paranoid schizo.
91.??Another qn.was related to a patient who took 5 tabs of diazepam,wants to die???
THEME-24-
MGT OF ANXIETY(beh-cog.therapy,psychoanalysis,desensitisation,supportive therapy,interpersonal therapy,relation therapy)
92.arachnophobia
93.PTSD
94.Bereavement
95.Public speaker who’s anxious
THEME-25-
BASICS OF POISONING(CO,TCA,paracetamol,digoxin,aspirin…..)
96.Interferes with glutathione(reversible by methionine and acetyl cysteine)
97.Interferes with Hb
98.Anticholinergic effects,arrhythmic
99.Pt on treatment for atrial fibrillation,now has palpitations
THEME-26-
INVEST.OF ANAEMIA-
Most app.INITIALinvest (dietary h/o,B12,folate,FBC,schilling’s,test,barium enema,LFT,isotope scan of liver,alcohol history,vitamin C)
100.Patient with atrophic gastritis has megaloblastic anaemia
101.Pt who is a strict vegans has an MCV of 110
102.Pt has both Fe+Folate def.?Radiology/sigmoidoscospy-normal,has pale stools which is difficult to flush away.
103.Elderly patient c/o anaemiaand has bleeding gum
104.Elderly patient in residential homestay c/o tiredness..
105.A patient being investigated for anaemia has normal investigation except raised MCV and raised GGT.
THEME-27-MGT OF ASTHMA
(inhaled long acting b2,inhaled short acting b2,nebulised b2 agonist,oral theophylline,oral steroid,iv hydrocortisone,iv aminophylline,inhaled steroid,inhaled cromolyn,reduce seroid dose)
106.25 yr old patient now has to use inhaled b2 2-3 times a day.
10735 yr old uses b2 agonist+lowdose steroid but symptoms still uncontrolled
108.37 yr old female presents with breathlessness,high RR
109.A patient who was on 1000 microgramof beclomethasone has now developed oral thrush
THEME-28-INITIAL MGT /INVEST IN EYE CONDITIONS
(ESR,CT,intraocular pressure,sjogren’s syndrome,visual acuity assessment,visual fiel mapping..)
110A 70 yr old c/o diplopia,wt loss,anorexia.Then develops sudden left-sided visual loss
111.60 yr old develops tunnel vision,also reports seeing hjaloes
112.50 yr old woman with h/o symmetrical joint pains complains of ?eye symptoms and Schirmer’s test is positive
113.woman,? yrold c/o blurred vision.CT is normal but she has bilateral papilledema
114??A woman who is a Visual Display Operator develops headache when she works several hours
THEME-29-
MGT/INVEST OF HEAD INJURY
(Admit to hosp.,D/C,D/C with advice after normal SXR,CT,iv mannitol,IV dexamathasone,burr hole..)
115.A 2 yr old boy ran and hit his forehead on the door.No h/o LOC,and since then is playing well.No neurological signs.
116.A 12 yr old boy fell from 6 metres.No h/o LOC,but cannot recall events of the incident
117.A 19 yr old involved in an RTA.He is talking,responding and smells of alcohol
THEME-30-
JOINT DISEASE
(gout,pseudogout,inflammatory osteoarthritis,reiter’s,enteropathic arthritis,septic arthritis..)
118.A ?40 yr old hypertensive c/o left knee pain.Also h/o other attacks.Aspirate is cloudy.
119.A young man c/o bilateral symmetrical knee(?ankle)pain.Recently been on holiday to Thailand.
120.A 27 yr old female c/o recurrent bloody diarrhoea.Now has arthritis
THEME-31-CAUSES OF CONFUSION IN THE ELDERLY
(SDH,infection toxicity,hyperthyroidism,hypothyroidism,acute pancreatitis..)
121A chronic alcoholic presents with increasing confusion…
122A patient presents with weight gain,hypothermia and confusion
123.Elderly patient c/o fever (can’t recall the subtle details) and increasing confusion
THEME-32-
INVEST.OF VAG.BLEEDING
(endometrial sampling,serum FSH,serum LH,vaginal U/S,pregnancy test,colposcopy….)
124.A 20sth woman who has been on oral contraceptive develops bright red postcoital bleeding(PCB)
125.A 55 yr old female develops a single episode of PMB.She stopped menstruation ? yrs ago.U/S shows endomerial thickness
126.A 49 yr old woman c/o hot flushes,vaginal dryness and her menstruation become irregular ?5/12 ago
THEME-33-
INVEST OF THYROID DISEASE-most app. Next step
(FNA,U/S thyroid,thyroid scan,serum TSH,serum T3..)
127.A woman on thyroxine replacement comes for check-up
128.? Yr old woman ,euthyroid complains of palpitatios,wt.loss and diarrhoea
129.woman,euthyroid has a soft diffuse swelling that moves with swallowing
130.Elderly woman presents with a hard fixed lump/swelling.U/S shows….(can’t recall details…)
THEME-34-
INVEST/MGT OF LUMPS OF THE HEAD+NECK
(cystic hygroma,caratid body tumour,brachial cyst,L/N,carotid artery aneurysm,cx rib,subclavian aneurysm…)
131.Pt with a hard mass fixed under the upper 1/3 of the sternosmastoid muscle….
132.Mass…..pulsatile…..(cant recall the rest of details……))))))
THEME-35-
POST-OP CXPLNS-REPEAT
(DVT,setticaemia,impending wound dehiscence,wound infection,UTI,myocardial infarction,acute tubular necrosis,transfusion reaction,cardiac failure,pelvic abscess…)
133.A 50 yr old woman underwent an anterior resection for carcinoma of the rectum one week ago.Has low grade fever and c/o pain in the calf +tenderness in the calf.
134.A young woman underwent emergency appendicectomy 6/7 ago for perforated appendix.She appeared to be making a good recovery but has developed intermittent pyrexia(up to 39deg.C).O/E-no obvious cause found,but he is tender anteriorly on rectal examination
135An elderly man underwent an emergency repair of an abd.aortic aneurysm.Had been severely hypotensive before and during surgery.After surgery,his blood pressure was satisfactory ,but urine output only 5ml/hr in the first 2 hours.
136.An elderly woman underwent emergency lap. for peritonitis.4th post-op.day she is noted to have sero-sanuinous discharge from the wound,but there is no erythema or tenderness around the wound.
137.A 60 yr old with features of septicaemia(warm peripheries,low BP etc.)
THEME-36-MODE OF INHERITANCE-REPEAT –REPEAT NOV.
(x-linked,aut.dominant,aut.co-dominance.aut.recessive,..)
138.A 4 yr old boy gets haemathrosis with minor trauma.Maternal grand father and uncle had a similar problem
139.A young girl c/o bleeding following dental extraction.Father had a work-up for anaemia and mother had xple transfusion
140.A 15 yr old girl with features of DM
141.An 11 yr old boy presents with increasing difficulty walking.Father died in his 40’s…
*******OTHER REPEATS-CHECK FISCHTEST:********
THEME-38-PROGRESSION OF CA BREAST(NO.S 298-302)
THEME –39-PRESCRIBING FOR PAIN RELIEF(NO.S339-344)
THEME-40-DD OF ACUTE ABD.PAIN IN A YOUNG WOMAN(NO.S 374-379)
I couldn’t adequately GROUP the following qns.,but hope they can be of help too.
*A slim man c/o central chest pain following RTA.He is now pale,tachycardic and has a linear transverse bruising above the umbilicus
*Pt involved in RTA .IVU done shows NO excretion after 10 minutes(renal contusion,renal pedicle laceration)
*Pt started using contact lenses recently.c/o pain in eye.Stained ?green with flouresccein
*A pt involved in an RTA in which a co-passenger died.Has fracture pelvis,and is pale and tachycardic
*Pt with 24 hr h/o of severe abd.painand vomiting.Is restless……
*Pt c/o severe flank pain,is restless and radiates to the groin.Also has haematuria
Good luck to you all.July candidates,may you add or subtract to my EMQS where applicable.Thanks,wilf.