Posted by Jillobi on June 06, 2002 at 11:16:52:
May 2002 PLAB MCQS
Topic : Vulvar conditions in children
The different presentations
fungal infection, as a nappy rash, sexual abuse, personal hygiene.
Topic : Management of Head injuries
Post operative care
The investigation of of gynecological diseases
a. cytology
b. histology
c. cancer affinity genes (both breast and cervical)
d. estradiol level
e testosterone level
f. prolactin level
g .pelvic u/s
1 A woman tells you that her mother died of cervical cancer. She also has two cousins that have had cervical cancer. She is worried about herelf and her daughter.
Answer : a cytology(smear)
2 A woman comes to you with a cervical discharge. On examination you find a cyst in the cervix.
Answer : Nabothian cysts may be seen in the cervix, but they are typically asymptomatic, without any discharge. So, maybe this is a kind of carcinoma, then answer should be histology
3. A 55 yr old woman comes to you with occasional bleeding. Histology of the endometrium shows endometrial proliferation. The rest of the examination is normal. not pelvic ultrasound
Answer : again histology - (OHCM-in any postmenopausal bleeding suspect endometrial ca)
4. A woman has a history of psychiatric problems and is on treatment on haloperidol. She now complains of a breast discharge.
Answer : Prolactin level (side effect of all antipsychotics)
Topic: vaccination in children
options
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 with cry for two hours in last dose is due for mmr,pertusis
continue as per schedule
crying for quite a period could be a problem,but for 2hours it doesn't count
INCONSOLABLE CRYING is a C/I to pertussis vaccine,is two hrs
still consolable
A c/i for vaccination is..
persistent, inconsolable crying lasting for 3 or more hours, occurring within 48 hours of dose
2 baby with acute otitus media,and family hx of egg allergy is due for mmr
continue as per schedule
any acute febrile disease is a matter of delay
3 baby with hx of cerebral palsy is due for mmr
continue as per schedule
h/o cerebral palsy is not a c/i
4 baby with aids is due for mmr
delay vaccine
acquired immunodeficiency sufferers are subject to vaccination
the BNF says give inactivated vaccines to hiv positive children , pl discuss , dont you think since everybody follows the BNF as the standard of practising we should stick to inactivated vaccines for HIV positive subjects
5. about family h/o egg allergy.
OHCS f/o of egg allergy for MMRI vaccination(but not for flu) is not a c/i. Only if there was an anaphylactic reaction.
http://www.cdc.gov/nip/recs/contraindications.pdf
Topic : Antenatal diagnosis
a SPINA BI FIDA
b DOWN,S SYNDROM
c DUCHENEMUSCULAR DYSTROPHY
d THALASEMIA
e CEREBRAL PALSY
1.MOTHER WHO HAVE ONE SON WITH DISEASE AND NOW AGAIN PREGNANT HAVING SON THIS TIME ALSO WANT TO KNOW WEATHER HE HAVE THE DISEASE OR NOT
duchene (X-linked)
2.MOTHER WHO HAVE TRIPPLE TEST POSITIVE.
down's
a mom with high HCG and low alpha feto protein
The AFP marker (Alphafetoprotein) is found to be at higher levels in mothers carrying a foetus with an open neural tube defect. The reason for this is that the neural tube is open within the amniotic sac and the AFP protein that is produced by the foetus can leak into the amniotic fluid and then onwards into the mother's bloodstream.
The same AFP protein is found in relatively low levels(!!!!!!!!!!!!!!!that's what q is asking for) in a foetus that has the Trisomy 21 defect. The AFP marker in conjunction with information on the age and ethnicity of the parents can help determine a 'high risk' Trisomy 21 pregnancy.
The HCG marker (Human Chorionic Gonadotropin). B-HCG Levels in Pregnancy the levels of ß-hCG should drop away 8-9 weeks (from conception) into the pregnancy as the placenta takes over production of progesterone. A foetus with Trisomy 21 produces high levels of b-hCG, so if higher than expected levels of ß-hCG are found between 15 and 22 weeks, then this combined with information about the mother may indicate a Down Syndrome foetus.
The UE3 marker (Unconjugated Estriol) is another hormone produced by the foetus and placenta but is not used to specifically indicate an anomaly, rather it is used as a reference against the other two markers to increase the accuracy of the information provided thus reducing the number of false results (details on results follow).
SO ,THE ANSWER to q2 IS DOWN'S=Trisomy 21
3.MOTHER WAS ADVISED TO HAVE FOLIC ACID IN HER PREGNANCY
spina bifida
4.MAOTHER WHO HAS ALPHA FETO PROTEIN LEVEL HIGH
spina bifida
Topic: Diagnosis of psychiatry disorder
options
a .anxiety depressive disorder
b.major depression
c.depression with somatic symptoms
d.depression with psychotic symptoms
e.schizophrenia
f. post natal depression
g .puerpaeral psychosis
1 .a man presents to u with his wife saying she is depressed and wants to be alone,she has hx of hospiatl admission two yrs back with s/s of agitation ,aggresivness,and delusions
depression with psychotic symptoms
2 .a man who was previously well presents with low mood and depressed,he receently has some financil loss and his home is repossessed.
major depression
anxiety depressive
#2 as I remember in major depression there must be somatic symptoms(weight loss,insomnia,etc),can't see any here.
What d'u say
3 .a woman after the delivery of baby presents with feeling alone and not talking to her husband,she is not really intrested in feeding her baby.
post natal depression
postnatal depression
4 .30 yr old man comes with complains that he thinks his thought have been taken away
schizo
good old schizophrenia
Topic: treatment of shingles
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 specialist opinion
1.an old woman has signs suggestive of shingles in the thoracic dermatome. She has had this for many years and she is now complaining of pain.
carbamazepin and refer to neurologist
post-herpetic neuralgia is resistant to simple analgesia,but anticonvulsants can be useful.When they are also failing,a surgical removal of ganglia is the only savour,so refer to specialist
2. A pregnant woman comes to you with shingles in the thoracic dermatome
varicella
pregnant women with shingles must take varicella Ig for their babies(so whom shall we treat, mum or baby?)What's your answer, then, darsh
3. a boy with lymphoma has shingles , A boy with lymphoma admitted in the ward.he gives h/o contact with a pt with herpes.
probable ans.varicella ig
acyclovir 7 days
both with immunodeficiency,here the drug of choice is acyclovir, which is given 5-7days, not less than that.
in that case,ok,Ig for prophylaxis.
What are the other answers,anu?
4. a patient with HIV has shingles
4i/v acyclovir
both with immunodeficiency,here the drug of choice is acyclovir, which is given 5-7days, not less than that.
4-i dont know wether it is iv acyclovir or oral acyclovir for 7 days
Topic: 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 e antibody
1. A nurse who has been previously immunized with hepatitis B gets a needle prick from a needle used on a patient who is known HIV positive. She has been given prohylactic AZT. What else should be done to know her status ?
HIV a/bodies and follow-ups every 3 months for CD4 cells count (which reminds me -what is the normal range of CD4s?)
2 A surgeon suffers a needle prick from a needle used on a patient who is known Hep C positive.
Hep C RNA(earlier test than serology)
3. A man know to be a Hepatitis B carrier wants to know his status
HBsAg
HBe ab as he is already a carrier and wants to know if he is infective or not
ok, darsh,you're right!
The Hepatitis 'e' antigen (HBeAg) is a peptide and normally detectable in the bloodstream when the hepatitis B virus is actively reproducing, this in turn leads to the person being much more infectious and at a greater risk of progression to liver disease. The exact function of this non structural protein is unknown, however it is thought that HBe may be influential in suppressing the immune systems response to HBV infection(?). HBeAg is generally detectable at the same time as HBsAg and disappears before HBsAg disappears. The presence of HBeAg in chronic infection is generally taken to indicate that HBV is actively reproducing and there is a higher probability of liver damage. In acute infection HBeAg is generally only transiently present.
Do you agree with 2q-RNA and why,plz?
i agree with u for the same reason as it is easy to be done and earlier than anti HCV abs
Diagnosis of breast diseases
a fibroadenoma
b ductal ectasia
c breast ca
d cyclical mastalgia
e paget's disaes of nipple
f eczema
1 a pt comes wity hx of breast pain and nodularities. She has been complaining of this problem over several months.
2. A patient complains of a mass in the upper outer quadrant of the breast. She has no pain or tenderness, but some axillary lymphnodes are enlarged.
3. a young pt complains of a 2cm mass in the lower quadrant of the breast. She has no pain and no other positive findings
4. a middle age patient has a nipple discharge, which is sometime bloody. The skin around the nipple is fine. Both her nippples are retracted. There are no other positive findings.
5. An old patient has a nipple discharge and skin excoriation, redness and inflammation in her right breast
1 cycl.mastalgia
1.ca
2 ca?
beningn mamary dysplasia
ya the Q'S WEREN'T THIS WAY &THE ANS WHAT RORO POSTED R CORRECT EXCEPT FOR THE 2ND ONE.I THINK IT'S FIBROADENOMA
3 fibroadenoma
paget disease
3- cannot be pagets
4 ecsema
why not ductal ectasia in 4??
I take blame,there was no skin disorder,so it is ectasia.
duct papilloma
5 paget's
breast absess
breast abscess , is it becoz redness and inflammation, but old pt ?
a.pancoast tumor
b.gastric carcinoma
c.parotid adenoma
d.mesothelioma
e.gastric ulcer
f . dudenal ulcer
1 .a chinese man presents with u ,with wt loss and vomiting after eating food ,he has this sympotoms for many months
gastric ulcer
why gastric ulcer
2.a shipyard worker presents with mass in supraclavicular reigon,and with some chest symptoms. An x-ray shows pleural thickning on both sides and a pleural effusion on the same side of the mass.
pancoast tumor
mesothelioma
shipyard- then mesothelioma
3. An old woman presents with a mass between the angle of her jaw and ear for many months. His mumps serology is negative
pancoast tumor
would think before choosing parotid adenoma,coz of location(behind the angle of jaw)?, was there smth about mastoid
parotid adenoma
parotid adenoma
ecg
angiography
chest x-ray
1. pt with hx of angina has occasional palpitaions.
causes of pneumonias
legionella
hemophilus-influenza
mycobacterium TB
streptococcus
staphylococcus
mycoplasm
1.alchlic pt with produvctive cough for many months now c/o occasional blood in sputum and wt loss.x ray =b/l upper zone shadowing
mycobacterium
kochs
Reference = Microbiology made Ridiculously Simple.
2.a patient with a hiistory of COPD complains of chest pain and green sputum production
can't see pseudomonas here-green sputum , respiratory diseases all for it
why cant it be staphaureus???
staphaureus
But for ques 2 = Streptococcus
.....In COPD pt...Strep & Staph are most prone...But Green Phelgem is produced by Strep
Good Luck
-well,don't know,maybe strep then.But ...
don't worry guys this them was from fichtest,i was in the exam..
Haemophilius influenzae
agree with S.T .A GREEN PHLEGM is more commonly associated with strept
it's rather confusing a question.Coz most of bacterias causing pneumonia are purulent, therefore most of them will produce GREEN phlegm(green due to neutrophils).Let's drop the colour of sputum ,so where do we start?COPD-most common organisms are Hemophilus,Pseudomonas,Mycoplasma, and the whole lot of Coccs.I wish someone could give me the ultimate right answer!
in copd the commenest of organisms are moraxella catarrhalis and pseudomonas
just went through PARVEEN KUMAR,AND IN PNEUMONIA TOPICS THEY CLEARLY MENTIONED THAT H-INF IS THE COMMONST IN PT WITH COPD....AND ALSO WITH GREEN SPUTUM....
ok, dear bina and dr.tg, then it's Haemophylus.But how about Klebsiella and Pseudomonas, see
http://www.kcom.edu/faculty/chamberlain/Website/pnebact.htm
I just hope this q won't at the real thing!
3. a man returning from his holidays complains of a cough and chest pain. x-rays shows patch consolidation
legionella
4. A man with signs and symptoms of pneumonias is cold agglutinins positive
mycoplasma
5. a man has rigors and fever . An x-ray shows right middle zone consolidation, there has been no previous illness
strept
streptococus
Topic : The management of eye conditions
a flourscein stain
b x-ray orbit
c wash the eye
1.gardner come with acute blepherospam and photophbia,while trimming in his garden
fuorescin angiography as it is corneal abrasion
2.a factory worker come with something in his eye according to him it must be some metal piece.
x-ray orbit
3.
a.submandibular gland enlargement
b.parotid adenoma
c.branchial cyst
d.cystic hygroma
e.sternomastoid tr
f lipoma
1 A man with a smooth uniform swelling behind the angle of jaw
parotid adenoma
Topic: treatment of shock
a.i/v fluids
b.O negative blood
c.i/v dopamine
1.pt comes to u in shock,her bp is 90/60 and her pulse is
55,and her cvp is 3mm or cm
CVP normal is 5-10cm water, it's low if hypovolaemia,then answer is a)i/vfluids
2.a pt in after some chronic illness is in shock her b.p is 90/65 and pulse is 60, her cvp 18mm
septic shosk-dopamine
3.a pt after aortic aneurysm surgery is in shock.
b(assume blood lost?)
Topic: Diagnosis of urinary incontinence in women
detrusar instability
stress in continence
vesicovaginal fistula
uti
Topic : causes of jaundice in neonates
galactosemia
biliary atresia
hepatitus
congeital viral infections
rh incompabiltiy
Topic : treatment of burns in children
Diagnosis of arthritis in old hypertensive man with recurrent episodes
Diagnosis of cervical pathology
poisoning (amphatamine,cocaine,alcohol ,caffeine).
lot of confusing questions on head injury (managment)
treatment of shock(cardiogenic,hypovolumeic,etc)
causes of pneumonias
psychiatric disorders (bipolar,depression with psychotic symotoms,anxiety depressive disopder ,schizophrenia,postnatal psychosis,postnatal depression)
These themes are indeed familiar, esp.head injury(no exam without it!),causes of pneumonia, psych, burns.
Theme: poisning
a caffine
b cocaine
c amphatamin
d marijuna
e morhine
f ecstasy
1.student complains of anxiety, tremors,and palpitations. He has an exam a few days ahead
caffeine
2. a man comes to accident and emergency and says he is listening voices and seeing faces around him.
ecstasy
3. a man with pin point pupil
morphine
4. a young girl found out side of a night club, unconscious,and hyperkalemic
amphetamines
ans of 4 is ecstasy b'coz hyperkalemia
Theme : 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 congenital viral infections
1 A 6 week old formula fed infant who has failed to gain weight is noted to have pale stools and dark urine
biliary atresia
2 An 8 wk old infant who has been growing normally presents with yellow stools and a straw colored urine
i wrote uti for the baby with straw colored urine?
Q 2 ANS.breast milk jaundice
3 a baby is born Coomb's test positive
incompatibility
4 a baby born at 38 weeks with a birth weight of 1.8 kg is found to have jaundice and a generalized purparic rash
cong viral inf
Theme : treatment of dehydration
a ors(60mmole)
b ors(90mmole)
c water by mouth
d 0.9%saline
e 9%saline
f nil per oral
g gastrostomy
1.a 6 yr old boy has been left in the car directly under sun for 6 hrs
water by mouth
2.a mother brings two yr old child who has dirrhoea and vomiting for past 24 hr
ors but i dont know 60 or 90 ??
3.a pt is admitted in the hospital with stroke ,now it,s been i wk he is on i/v fluid as his swollw is not stll safe
nil per oral
4.a 24 yr man presents with deep burns on the ant chest wall and upper limbs
0.9%saline
a cop is bitten by a man , what is the answer. swab was one option. for what ?
These are few questions which I remember.They are repeated.
Theme : Diagnosis of injury in children:
1.A 3 month old baby was brought by mother to A/e.She says that it rolled down the bed & has multiple injuries.
Nonaccidental injury.
2. A 5 year old girl slipped while holding her mothers hand.She is unable to use her forearm.
Pulled elbow
3.A boy fell down the tree on his arm .His radial pulse is abent.
supracondylar fracture.
4.A child is crying due to pain in his arm.The mother had a prolonged difficult home delivery.
fracture clavicle.
5. A boy presented to A/E &has his arm in plaster *& it became wet.He was treated in another hospital then , The X-ray showed no abnormality then.Now the X-ray shows an abnormality.
Fracture scaphoid.
6.A boy fell down on his forearm.He has mild tenderness over his wrist but there is no deformity or swelling.
Greenstick fracture.
Theme : There was the theme from Fischtest about Diagnosis of breast conditions.
Theme : New Theme about different investigations about Prostate cancer.
Theme : Preoperative investigations.
Theme : Management of anxiety disorders:(Repeated)
1. Same about lawyer getting nervous on giving speeches.Wants a permanent solutions.
2.a female is scared of flying.Wants to go to newzealand for daughters marriage.
3. An old man had a bout of haematemesis 3 days back& is admitted in hospital. Now agitated.
Management of conditions in A/e:(Repeat)
1. A boy has 10% scalds.
2. In a baby an iv line cannot be put
Intraosseous infusion
3. In ab adult no peripheral line can be put.
Central line
4. A boy withBp 70/50,in shock.
Bolus 20ml/kg
management plan for urinary obstruction
a .temporarary catheterization
b intermittent self catheterization
c transurethral prostectomy
d permenant cathterization
e suprapubic cathetarization
1.pt with diabetic nneurpathy can not empty his bladder properly and always complain of residual urine
intermit.
2.pt comes with acute on chronic retention, and on rectal exa have large prostate
prostatectomy
3.pt comes after a road traffic accident and has blood on his urinary meatus, he is in urinary retention
suprapubic
Theme: git diagnosis
a. Crohn's disease
b. ulcerative colitis
c. angiodysplasia
d. intusuception
e sigmoid ca
f rectum ca
g ceacum ca
1.pt with hx of alternate bowel habits, most of time with bloody diarrhea, over 65 years , histology shows rose thorn ulcers
crohn
age 65 and crohn - non -sense
2. a pt has bloody diarrhea, histology shows crypt abscesses
uc
3. a baby is crying too much, plain x-ray shows transverse line just below ubilicus
intus
4 an old man with iron deficiency anemia has colonoscopy up till the hepatic flexure, this was normal
.
Secondly ans for 4 is Cancer because right side never produces bleeding only hint of Cr is Ferrum dropping
referring to cancer of right gut it is very often there is not blood visiable at all. The patient has anaemia, why?
because he is losing blood but not significant amount (unvisiable).First sign of right gut cancer is not bleeding as a bleeding - Fe problem or anaemia.
5. 3cm ulcerated lesion on 12 cm above the anus on colonoscopy.
Theme: deafness
a b/l conductive deafness
acoustic neuroma
b b/l sensory deafness
presbyosis
noise induced deafness
Exposure to intense noise results in loss of hair cells in the organ of Corti. Although persons vary greatly in susceptibility to noise-induced hearing loss, nearly everyone loses some hearing if exposed to sufficiently intense noise for an adequate time. Any noise > 85 dB is damaging. High-frequency tinnitus usually accompanies the hearing loss. Loss occurs first at 4 kHz and gradually occurs in the lower and higher frequencies as exposure continues. In contrast to most sensorineural hearing losses, loss is less at 8 kHz than at 4 kHz. Blast injury (acoustic trauma) produces the same kind of sensory hearing loss.
So, it Is b/l sensorineural as sun says
c uni/lat conductive deafness
otosclerosis
d uni/lat sensory deafness
noise induced deafness
e total deafness
otitis media with effusion