MCQS

[ag, guest]

add the ent themes about wax, mastoiditis, throat infection with difficulty swallowing, and maybe more.

[geneid]

Dear friends ,
I am asking all of you who remember the themes and would like to add more to write it down and post it and not to ask me to write it , because i really don't remember moore than what is already posted .
Ahmed

[ROLAND]

THERE WAS ALSO A QUESTION ON FRACTURE MANAGEMENT,, THE CHOICES WERE SOMETHING LIKE THIS

SHOULDER-WRIST SLING
SIMPLE SLING
REASSURE
POP CAST
...
....

1Q. AFTER INJURY, PAIN DISTAL TO RADIUS, INTIAL INVESTIGATIONS SEEM NORMAL. (HER IT IS A SCAPHOID FRACTURE, SO IS THE ANSWER REASSURE/CAST?SINCE THERE WAS NO SCAPHOID CAST SCAPHOID XRAY MENTIONED)
2Q.CLAVICLE OR SOME JOINT DISLOCATION

[vineetgsvm]

the splinter hammerage ques it shud be infective?? endocarditis.plz correct me

[vineetgsvm]

i've copied these ques from othere sites
please don mind if many of these ques r repeat
theme-INTIAL management of mi<gtn,streptokinase,alteplase,asprin and morphine were not in choices>
1>patient with preivious h/o mi treated with thrombolysis now presents with st segment elevation

other random questions that i can remember --
theme-cause of anemia
1>pat with celiac ds presenting with microcytic anemia<fe def.d/t malabsorption>
2>macrocytic anemeia with intrinsic fact antibody positive <pernicious>
3>vegan wtih macrocytic anemia

theme-management of arrythmias
1>af with bp 100/80<heparin +cardioversion> only chioce with cardioversion in it
theme-post mi complications
1> 5 days after mi patient with mi presents with collapse +psm murmur<heart rupture.vsd>
choices were.heart rupture,af,heart block ,pe
2> post mi with pulse 32<h.block ?
3> post mi with irregularly irregular pulse <af>
then there was a question about investigations...
1> post cholecystectomy patient of mitral valve ds presents with feature of stroke what investion to be done

2> a question with carotid bruit + h/o colapse< dopller flow study neck ..carotid stenosis>
3>a question of infective endocarditis < blood culture>

RESPIRATORY SYSTEM-
there was a theme on which pneumonia it is ..< confusing theme:(>
options were..staph aureus,strepto pyogenes.streppneumoniae.mucoplasma.legionella.chlamaydia.etc..
1> pat with dry cough +bilateral infilterates
another theme was identify organism --
1> causing cellulitis<strep .pyogenes>
2> axillary abcess< staph aureus>
dun remember more right now
a theme on management on asthma..
1>asthma + h/o allegy to aspirin <sod.cromoglycolate>
2> pat well maintained on 1000ugm inhaled steriod but develops thrush <reduce dose>
3>pateint on inhaled b2 blokers but having nocturnal s/s + requiring 2-3 time dosing< add long acting inhaled b2 bloker>

GIT
theme on constipation --most appropriate investigation
1>girl child with abdominal pain .rest all normal
2> dun remember exact ..someone with chronic constipation with palpable hard feaces < not sure about exact >
options were...rectal biopsy,reassure,barium meal + follow through , nm studies of gut ,sigmoidoscopy , ct scan , u/s abdomen , etc.>

3> there wasa theme on git conditions too
1>guy with loose stools +blood +progressive h/o < ca. rectum ..cant remember fully >
2> splash in pan type picture < diverticulitis ..not sure..>
3> someone with h/o chronic constipation+ hard stool passage now presenting with h/o bleeding per rectum<heamorroids>
4> lady with h/o travel abroad had a episode of loose motions there them was alright comes back and has similar episode < campylobacter ..not sure..this was the only option of infective agent>

NEPHROLOGY

theme management of carcinoma prostate..
1>male with ca prostate known now comming with hip and back pain < bone scans ..not sure..?>
2> in humerus we find 2 lessions ..osteoscerotic < full skeletal survey >
3>male with s/s of bhp + increase of s/s on beer ingestion < bph ..this might be in diff theme but am writing it here only .>
4> male with s/s of prostate + on u/s some nodularity i prostate next step < biopsy prostate>

theme on cause of urinary retention
1> bladder palpable till umblicus + h/o constipation with palpable sigmiod colon < dunno about it wrote neurological cause thinking it to be umn lession of lower spinal cord ....no idea at all..>
2> bladder outflow obst with bph s/s< bph >
3> a question with clot retention h/o

theme on post op complications .< investigations>
1>hystrectomy lady with wound infection < wound swab >
2> person with anterior resection done now comes with left leg edema +one more s/s dun recall < i wrote doppler studies to asses blood flow of leg ...not sure >
anotehr theme on diagnosis of cause of post op complications..

3>patient with genral anesthesia + now presenting with pulm.edema< fluid overload >

a theme on management of bleeding...
1> patient on warfarin with inr 9.4 +nose bleed but its controlled now < in options we had vit k1 as well as ffp ..ohcm says we sud give both..there was an option of do nothing too..i dunno wot to do of this
2> child with swollen joints+ grandpa had same h/o<factor 8 >

a theme on inveatigation of posioning..
1> tricyclic antidepressants + person drowsy
2>5 ocp pills taken by a girl<estradiol levels>
3>pregnant lady bring boy h/o vomitiing of reddish brown color < toxicology screen / serum iron levels >

CNS

a theme on management
1>of status epilepticus < iv lorazepam >
2> febrile convulsions with viens collapsed < diazepam per -rectally>

G/OBS
theme on miscarriages
1> lady with antiphospolipid syndrome< arprin>
rest qustions already mentiond by u guys above so wotn repeat

a theme on management of hernia..
options were..herinotomy ..herniotomy+orchidopexy..planned hernia repair ..emergency hernia repair ...reassure.abdomial support...truss
1> lady wtih mi + incisional hernia< abd support >
2> a case of strangulated hernia< immediate repair >
3> 5 monts old chid with hernia persitant ..but appeared on crying..<herniotmy/observe???>
4> a 4 year child with reducible hernia testis in scrotum < herniotomy?>
5> steel factory/some other factory worker with intermittent hernia< planned surgery>

.

theme 1
trauma= investigation
ct abdomen, chest x-ray,
1/a kid from a rta has upper abdom tenderness. He is vomiting , tachcardia
2/ a kid from RTA pain in abdomen pain in shoulder
{2 more don’t remember. I was stuck on the 1st qs, esp with no option for u/s}

theme 5
headache= investigation
ct, mri, temporal biopsy, ocular pressure
1/ 44 yr w/ h/o of migraine.. now has a sudden pain in r eye for 36 hrs.
2/ 72 lady w/ h/o of migraine aches all over has a headache 7 some vision problem
3/ 85 lady w/ h/o of headache accompanied a few times with vision problem now has a head ache
( 2 more qs..don’t remember, qs were all clouded with migraine… real brain twister)


Arthritis= etiology
r.a, oseoarth, psoriasis, pseudo, gout, reactive, septic…..a few more
1/pt w/ pitting fingers
2/Pt w/ h/o of gout
3/Pt. 27 postpartum, symmetrical small joint swelling, w/ oedema ??
4/Pt with steroids now having a painful joint .. its hot & tender
5/Pt with a long h/o of a joint problem..
( not sure if I rembered the qs correctly)

theme =last one
hernias=management
hernia repair+ oorchidectomy, hernia repair + orchidexy, traus, immed s hrnia repair, planned hernia repair, hernitomy, observe.
1/lady w/ 24 hrs vomiting, has an irreducible lump ..
2/a 9 month boy has a swelling , coz he was crying a lot
3/a 5 yr boy has a swelling



dementia=types
1/vascular= tia
2/alzeimers= most common
3/alzehmers= neurofibrillary fibres
4/frontal lobe= intellig spared..



brain patho
astrocytoma, menigioma, g.multiforme, multiple sclerosis,
1/demyelination
2/ papenheimor body
3/ huge mass covering grey & white matter


pneumonia
strep, stap, pseudo, p.carinii, t.b
1/cystic fibrosis severe cough
2/young man with sudden onset cough fever & chest pain
3/pt, loosing wt, fever cough
4/pt. w/ x-ray show bilateral

pph


theme
constipation=diag
1/child with papable urinary bladder, painless dissted sigmoid loop.. anus is fine

etiology
lady w/ hypothyroidism= hormonal
pt. w/ infect endo= infection
pt with post valve prosthesis now has fever & new murmur= infection
pt with cusp valve= congenital

.
.





.

--------------------------------------------------------------------------------

statistics of psychiatric disorders in UK:

alzhiemers, pseudodementia, alcohol, frontoparietal, picks etc
-commonest dementia in UK
-dementia with neurofibrillarytangles
-dementia treated with anti depressants
-dementia with early cognitive imparirment

treatment of psychiatric disorders
ect, fluoxetin, maoi, lithium, tricyclics,psychodynamic psychotherapy etc

-female with post natal blues before now presents with post partum depression. thinks that husband is going to kill baby
-female very depressed and already on antideps npow stops eating
-man with manic depressive symptoms
-man with dep and psychomotor retardation like symptoms
-cant remember all

theme on diagnosis of psychiatric disorders

mania, paranoid schizo, and other options
cant get the leads and stems

theme on vaginal discharges treatment/investigations given as options

.


.
.





.

--------------------------------------------------------------------------------

Theme:Causative agent
a)strep pneumonia
b)clostridium difficille
c)strp pyogenes
d)staph aureus


1)a patient in hospital on antibiotics developed diarrohea--c.deficille
2)a patient having cellulitis on hand-strep pyogenes
3)a patient with pneumonia-strep pneumonia
4)patient having pus from axilla-staph aureus

Theme:Joint problems

a)septic arthritis
b)degenerative osteoarthritis
c)chondromalacia patella
d)gout
1)old patient has knee problem for 10 years not hot or swollen-- chondromalacia patella
2)patient on steroids has hot swollen knee-

POISONING
MOST LIKELY INVESTIGATION

* a child was found playing with aspirin tablets ......no obvious symptom seen
* a teenage girl took some of her mom s tabets after a fight with boyfriend now having palpitation
* a child took some of her pregnant mom, tablets now coming with vomiting of brown material

POST MYOCARDIAL COMPLICATIONS

*a patinet coming with heart rate of 40 permin
* a patient with apex beat displaced to left side
* a patient with pansystolic murmur

DIAGNOSIS OF GYNAE PROBLEM

* patient recently divorced having many sexual partners cervix bleeds on touching......
* patinet 65 something yr coming with bleeding post coitus which she has after 10 yrs
* patient with discharge having endometrial thickening
* pateint on contraceptives havcing asoem cervical symptom

MANAGEMENT /TRATEMENT OF EPILEPSY

* a child coming with fits to A& E i/v access failed
* a petinet coming with histiry of absences epsidoes in skool reproducable on hyperventilation
* a woman with 25 min of epilepsy with loss od consciousness
* a young man with one episode of fits abt to start university

MANAGEMENT OF BLEEDING

a patient with HO/O i think atrial fibrillation now coming with bleeding and INR of 9
* a boy with episode of bleed.maternal uncle had same problem

WHICH DIET WILL U GIVE

* a girl with jejunous villous atrophy
* a man with cirrhosis
*

CAUSE OF DEFIENCIENTY OF FOLLOWING

* a woman with celiac disease havning macrocytic anema
*a vegan with macricytic aneman with normal folate

.

.




.

[ibas]

Hi friends,
I rememberd some of the missing questions and added them in the themes. some questions r not answered.kindly go through .only 33 more to figure out. i hope we can finish in a day or 2.
regards
ibas



1.theme: mx of miscarriage
options:
a. cervical encirclage
b. low dose aspirin
c. bed rest
d. reassurance
e. warfarin
f. antibiotics
g. heparin

1-female with history of 3 abortions, last one at 18 wks. preseents now at 14 wks for regular check up,o/e cervix admits one finger,and is 1cm long. ( Circlage)
2- female had p/h/o of premature rupture of membranes at 23 wks with infection followed by abortion. ur advice? ( Bed Rest )
3- female with p/h/o 2 abortions midtrimester with +ve lupus aanticoagulant. now she wants to try for pregnancy again. ( aspirin )
4- anothr female with p/h/o abortion, no specific cause that needed RX ( reassurance )
5.female with 3 previous normal preg. now 2 abortions... uterus distorted with multiple fibroids(myomectomy)


2. theme: pathology of lesions in CNS
options:
a. berry aneurrysm
b. multiple sclerrosis
c. alzheimeers demntia
d. toxoplasmosis
e. meninngioma
f. glioblastoma multiforrme
g. cerebrral inffarct
h. cerebral hage
i. sec carcinoma

6- " chracterised by large areas of demyelination tthruout the brain" ( Mutiple Sclerosis )
7- " shows glandular structures lined by columnar epithelium with pleomoprhic cells" Secondary Carcinoma )
8- " a wedge shaped area of discoloration involving botth gray and white matter" ( Infarct )
9- " a well defined lesion with psammoma bodies" ( Meningioma )
10- " present at the junction of int carotid art and middle cerebral art" ( Berry Aneursym)


3.THEME:DIAGNOSIS OF EYE CONDITIONS
corneal abrasion
dendritic ulcer
foreign body
viral conjunctivitis
limbal dermoid
pterygium
interstitial keartitis
band keratopathy

11-metal sheet worker complains of pain photophobia and lacrimation(don rem. if this was there):foriegn body
12-. fleshy b/l swe lling on the white of the eye:pterygium
13-.pain photophobia lacrimation following vesicular eruptions on face: dendritic ulcer
14-mother complains of continuous pain lacrimation photophobia? for 6 months . she was been injured by her childs nail in the eye 1 year back??
foreign body/ band keratopathy
15-.h/o sorethroat flu like symptoms now red eye: viral conjunctivitis

4.THEME:DIANOSIS OF FRACTURES
a.#transverse ulna
b. #clavicle
c.#spiral humerus
d.#neck of humerus
e.#scaphoid
f.benett's #
g.#supracondylar humerus
h.
16-.lady oversteps the footpath while carrying her shopping and falls.
presents with pain in arm but no deformity and movements r slightly restricted.: #clavicle
17-.girl aged 16 years falls on the outstretched hand and complains of pain from shoulder to the elbow: supracondylar humerus
18-.man hit by baseball bat protectshimself using his hand : #trnsvese
ulna
19-.man with some history of injury and now not able toraise his wrist off the table: spiral # humerus
20-.man with h/o fall now presents with swelling and tenderness distal to radius . initial x ray normal.: #scaphoid

5.THEME: UPPER GI DX
Aa.barrett's esophagus
b.achalsia
c.plummer vinson syndrome
d.
21- Transformation of squamous to columnar epithelium:barrett's
22- s/s achalasia
23- post cricoid webs,. glossitis.fe def. anemia: plummer vinson
24.features of hiatus hernia
25.hyaloid fibrosis (scleroderma)

6. THEME:SCINTIFIC BASIS OF HEART DISEASE
a. hormonal
b.autoimmune
c.infective

26 - palpitation , wt loss despite increased diet:hormonal
27 - splinter haemorrage , clubbing: infective
28 – recently prosthetic valve implanted , now pyrexia, murmur:infective
29-bicuspid valve(congenital)
30-dilated cardiomyopathi\y (alcoholic...dunno the exact answer!)

7.THEME: DX OF ANEMIA
a.fe def. dietary
b.fe def. malabsorption
c. b12def. malabsorption
d.b12def. dietary
e. folate def.
f. aplastic anemia
g.aml.
h.cml
31 - ntrinsic factor antibodies with macrocytosis: b12 malabsorption
32 -Complete vegans with macrocytosis: dietary b12
33 - microcytic hypochromic anemia with endomysial antibodies: fe def. malabs.
34- platelet countlymphocyte count 500*10^9 all high splenomegaly :cml
35 - all blood cells low:aplastic anemia

8.Theme-INTIAL management of mi
<gtn,streptokinase,alteplase,asprin and morphine were not in choices>
36. patient with h/o mi (streptokinase)
37. patient with preivious h/o mi treated with thrombolysis now presents with st segment elevation (isosorbide mononitrite)
38.- Post mi pt with narrow complex tachycardia..(adenosine)
39.af with bp 100/80<heparin +cardioversion> only chioce with cardioversion in it

9.Theme-diagnosis
40.- 5 days after mi patient with mi presents with collapse +psm murmur<heart rupture.vsd>
41- post mi with pulse 32<h.block ?
42 - post mi with irregularly irregular pulse <vf>



10.Theme - investigations...
43. post cholecystectomy patient of mitral valve ds presents with feature of stroke what investion to be done (Blood Culture)
44.a question with carotid bruit + h/o colapse< dopller flow study neck ..carotid stenosis>
45.a question of infective endocarditis < blood culture>

11.RESPIRATORY SYSTEM-
there was a theme on which pneumonia it is :
46. pat with dry cough +bilateral interstitial infiltrates (Pneumocystis carinii)
47.pt with cough and bilateral patchy consolidation (mycoplasma pneumoniae)
48.pt with h/o travel, d/v, respiratory s/s (legionella)
49. cystic fibrosis severe cough ( Pseudomonas )
50. pt. With loss of weight , cough , hemoptsis ( TB )
12.Theme on infections
51. causing cellulitis<strep .pyogenes>
52. Axillary abcess< staph aureus>
53.old lady on cefuroxime with h/o bloody diarrhoea ( clostridium difficile)
54. pt with travel history, bloody diarrhoea (campylobacter)

13.Theme on management on asthma..
55. asthma + h/o allegy to aspirin <sod.cromoglycolate>
56. pat well maintained on 1000ugm inhaled steriod but develops thrush <reduce dose>
57.pateint on inhaled b2 blokers but having nocturnal s/s + requiring 2-3 time dosing< Inhaled Steriod )
58.p/h/o asthma on medication now with wheeze and dyspnoea (nebulised b2 agonist)
59.pt on inhaled steroids and b2 agonists symptoms not controlled. (long acting inhaled b2 agonist)

14.theme on constipation --most appropriate investigation
60. girl child with weekly abdominal pain. no d/v.. normal clincal finding.. (no need for investigation)
61. 2yr old child with chronic constipation with normal anus (rectal biopsy)
62.some features sugestive of upper gi endoscopic investigation

15.theme management of carcinoma prostate..
63. male with ca prostate known now comming with hip and back pain < isotopebone scans >
64.in humerus we find 2 lessions ..osteoscerotic < full skeletal survey >
65.male with s/s of prostate + on u/s some nodularity i prostate next step < biopsy prostate>
66.male with family h/o prostate ca. prostate not enlarged on p/r (psa)

16.theme on cause of urinary retention
67. bladder palpable till umblicus + h/o constipation with palpable sigmiod colon < feacal impaction)
68. bladder outflow obst with bph s/s< bph >
69.bladder ca awaiting surgery with sudden onset of anuria (clot retention)
17. Theme gi bleed
70.guy with loose stools, blood, progressive feeling of incomplete defaecation (ca rectum)
71. faeces coated with blood and splash in pan ( haemorrhoids ?)
72.pt with h/o chronic constipation , hard stool passage now presenting with bleeding pr (haemorrhoids)

18.Theme on post op complications .< investigations>
73. hystrectomy lady with wound infection < wound swab >
74.person with anterior resection done now comes with left leg edema +one more s/s dun recall < i wrote doppler studies to asses blood flow of leg ...not sure >
75. perforated appendix post operatively presents with pyrexia with no abvious cause (usg abdomen)

19. theme on diagnosis of cause of post op complications..
76.patient with genral anesthesia + now presenting with pulm.edema< fluid overload >

20.Theme on management of bleeding...
77. patient on warfarin with inr 9.4 +nose bleed but its controlled now < Vitamin K >
78- child with swollen joints+ grandpa had same h/o<factor 8 >
21. Theme on Earache management
79girl with fever, earache not able to swallow (admit for parenteral antibiotics)
80.pain after swimming. wax is seen (syringing)
81.rugby player - small ragged perforation in the tympanic membrane (ear pack)
82.pt with fever chills tenderness over mastoid antrum (surgery )
83.pt came with pain in maxillary sinus. h/o dental procedure.. (amox + metronidazole)

22.a theme on inveatigation of posioning..
84 -tricyclic antidepressants + person drowsy <ECG >
85 - 5 ocp pills taken by a girl<estradiol levels/Reassure>
86. pregnant lady bring boy h/o vomitiing of reddish brown color < serum iron levels )
87.child of a drug abuser presents with drowsiness recurrent apnoeic episodes (toxicology)
88.aspirin overdose (serum salicylate level)

CNS

23 theme on management
89 - of status epilepticus < iv lorazepam >
90- febrile convulsions with viens collapsed < diazepam per -rectally>
91. Absent seizures (ethosuximide)
92.a college student have first episode of generalised convulsions ( no pharmaceutical intervention at present)

24.A theme on management of hernia..
options were..herinotomy ..herniotomy+orchidopexy..planned hernia repair ..emergency hernia repair ...reassure.abdomial support...truss

93- lady wtih mi + incisional hernia< abd support >
94- a case of strangulated hernia< immediate repair >
95- 5 monts old chid with hernia persitant ..but appeared on crying..<Give Sedation and Wait >
96- a 4 year child with reducible hernia testis in scrotum < herniotomy>
97- steel factory/some other factory worker with intermittent hernia< planned surgery>


25.Theme headache= investigation
ct, mri, temporal biopsy, ocular pressure
98- 44 yr w/ h/o of migraine.. now has a sudden pain in r eye for 36 hrs.
99- 72 lady w/ h/o of migraine aches all over has a headache with some vision fortification (measure intra ocular pressure)
100- 85 lady w/ h/o of headache accompanied a few times with vision problem now has a head ache

26.Theme Trauma investigation
101. a kid from a rta has upper abdom tenderness. He is vomiting , tachcardia ( CT Abdomen )
102 a kid from RTA pain in upper abdomen with pain in lt shoulder tip. ( CT abdomen )
103 elderly man tripped over a footstep and has dev now diff in breathing and cantt swallow his saliva. o/e one of his dentures is missing ( Chest X Ray )
104 man has a kick in loin region, dev hematturia,no blood at urethral meatus, no perineal injury seen. ( Pelvic CT )



27.Arthritis= etiology
r.a, oseoarth, psoriasis, pseudo, gout, reactive, septic…..a few more
105- pt w/ pitting fingers ( Psoriasis )
106. Pt w/ h/o of gout
107. Pt. 27 postpartum, symmetrical small joint swelling, w/ oedema (rheumatoid arthritis)
108. Pt with steroids now having a painful joint it is hot & tender ( septic Arthritis )
109. Pt with a long h/o of a joint problem.. (degenerative osteoarthritis)


28.Dementia=types
110.hypertensive pt ( Vascular)
111.most common in uk ( alzeimers)
112.neurofibrillary tangles (alzehmers)
113.personality change with intelligent sparing ( frontal lobe)
114. dementia tht cud be treated with anti depressants (pseudodementia)

29.treatment of psychiatric disorders
ect, fluoxetin, maoi, lithium, tricyclics,psychodynamic psychotherapy etc

115 -female with post natal blues before now presents with post partum depression. thinks that husband is going to kill baby . she is on anti depressant already (cognitive and behavioral therapy)
116 -female very depressed and already on antideps npow stops eating (ect)
117 -man with manic depressive symptoms (lithium)
118 - man with dep and psychomotor retardation like symptoms
30.DIAGNOSIS OF GYNAE PROBLEM

119. patient recently divorced having many sexual partners cervix bleeds on touching ( Ca cervix )
120. patinet 65 something yr coming with bleeding post coitus which she has after 10 yrs ( atrophic Vaginits )
121. patient with discharge having endometrial thickening ( endometrial carcinoma )
122. pateint on contraceptives havcing asoem cervical symptom
( Cervical Ectropion )

31.Vaginal Discharge

123. a female with green frothy vaginal discharge. (trichomoniasis treatment )
124. diabetic female with symptoms of candidiasis.( treat candidiasis )
125. female with features of (gonorrhea)
126.a female with low abd pain temp of 39c.basic invstg done.admit for parenteral antibiotics

32.PPH

127. afemale who was delivered by rotational forceps. ( trauma )
128. A female with abruption delivered a dead baby . (abruption. )
129. a female delivered by induction of labour after 26 hours.(atonicity )
130. secondary bleeding 10 day after normal delivery uterus well involuted.(retained products)
131. a diabetic delivers a baby of 4.8kgs.ut well contracted.(large placental site. )

33.Renal stones

132. a female pt with stones reccurrent pancreatitis and hypercalcaemia.(pri hyperthyroidism)
133. male with back pain hypercalcaemia esr-108mm.(multiple myeloma )
134. a pt with gout with loin pain .(uric acid )


34.diagnosis of purpuric rashes
options:
a. meningitis
b. NAI
c. ITP
d. HSP
e. measles
f. pertussis
g. ALL
h. CLL
135- 10 yr old boy dev a purpuric rash over his legs,also has intermittent abd and joint pains.neveer been immunised and has a p/h/o allergy. (HSP)
136 - 2 yr old girl has purpuric rashes over her body,cervical LNs are enlarged and spleen palpble. (ALL)
137- 5 yr old boy has purpuric rashes over his body follwing a URTI. FBC is normal exc for low platelets (ITP)
138- 8 yrr old girl dev bruises all over her bboddy of different ages,also has a circular spot on her hand. (non accidental injury)
139- 18 yr old boy dev a purpuric rash and fever after moving in a hall of residence.has a p/h/o vaccination of meningococcal C vaccine. (meningitis)

35.feeding
140 girl with jejunous villous atrophy ( Gluten free diet )
141 a man with cirrhosis ( Low Protein Diet + Antibiotic )
142 man with parkisonism and intractable ddysphagia ( PEG )
143 with h/o stroke still aspirates fluids 5 days after. ( NGT )
144 man after a colonic sx for bowel perforation ( Parenteral )

36.Theme on investigation
145 boy with h/o drinking vodka at party presents with s/s of hypoglycemia <capillary glucose levels>
146 a lady with alzhiemers ds.presents in a and e with collapse.next morning demands sherry with morning tea <blood glucose)

38.Theme diagnosis
147.pt with pyloric stenosis presents with vomiting ( metabolic alkalosis)
148.villous adenoma with profuse watery diarrhoea (hypokalaemia)
149.pt with dry mouth, hiccough.. other features of (renal failure)

39.Theme Management
150. boy after cycling presents with severe pain in scrotum (surgical exploration)
151.male presents with urethral discharge (urethral swab)
152.a male aspirated for hydrocele presents with tender swelling of the scrotum ( surgical exploration)
153.boy testis removed now presents with epigastric mass (CT abdomen)

40.Theme Investigation of neck swelling
154.single nodule in fron of neck (FNAC)
155.swelling between tongue and hyoid bone ( thyroglossal cyst)

41.Theme Burns
156. pt with singed nostrils, eyebrows, stridor (laryngeal oedema)
157.pt with circumferential burns on his right hand ( escharotomy)
Miscellaneous (i dont remember the themes)
158.male with s/s of bhp + increase of s/s on beer ingestion ( bph )
159.a male with suspicion and schizophernic features (paranoid schizophernia)
160.pt with ticks shouts obscene (gilles la tourrette syndrome)
161.guy presnts with pain after punching his fist on the wall (# metacarpals)
162.Pt with incontinence, bone pain, weakness of lowerlimbs (spinal cord compression)
163.investigation og allergic ? (RAST)
164.widower with bleeding tendencies (vitamin c deficiency)
165.a young boy with some bleeding dyscrasia presents with painful swollen knee joint ( haemarthrosis)
166.a pt with perineal injury now has anuria and palpable bladder. ( suprapubic cystostomy)
167.pt operated for ruptured aortic aneurysm.. hypotensive during and before surgery. now with anuria ( its acute tubular necrosis... answer given was measure creatinine level..)

[Agirdhar]

1)long standing parkinsons disease....PEG feeding
2)After stroke, fluid aspiration from stomach....Parentral feeding
3) Septicemia....Parentral feeding.
4)Diaarhoea and villous atrophy...Gluten free diet.
5)Jaundice with ascites...Low pr. diet.


1) Hiccups,toxic, not able to pass urine...renal failure.
2)Villous adenoma...hypokalemia.
3)Pyloric stenosis,vomiting,hypokalemia...met alkalosis
4)After hysterectomy,breathlessness, increased JVP...Fluid overload.

1) h/o candida infection ...treat for candida.
2) h/o trichomonas....treat for trichomonas.
3) h/o PID....endocervical swab.


1) henoch schonlein purpura...one theme...exactly dont remember.

PPH...
1)Atonic Uterus.
2) large baby in diabetic...large placental site.

1) multiple myeloma...ESR

1) pt with bronchial ca wide spread metastasis to back....no effect with pcm and nsaids and oral morphine....syringe deliver morphine.


br asthma theme...

nebulisation...question not exactly remembered.

Wax in ear...syringing of ear.

torsion testes...surgical exploration.

Urethral swab one question.

Tricyclic intoxication....ECG study.

Doctor with problem in dealing with pts. no past history of treatment....Tricyclic antidepressants.

lady with loss of appetite and severe depression...ECT.

Girl with s/s of depression.....detailed history dont remember...flupenthixol.

Lady with post partum blues...cognitive therapy????

80 yrs old lady with knee pain. knee is inflammed but no rise of temperature....inflammatory or degenerative OA...???dont know.

[purple_queen]

could somebody explain what this fleshy swelling bilaterally on the white of eye is.Are u guys all sure that this is limbal dermoid.Cos this is the first I have heard of limbal dermoid and was thinking it may be pterygium.Could somebody give me a reference please.have not managed to find one.Thanks alot.

[ibas]

hi purple queen,
i think the ans is pterygium. i too havent heard of limbal dermoid.
regards,
ibas

[ibas]

could anybody recall the theme on pain management
regards
ibas

[Guest]

THEME: DX OF ANEMIA
a.fe def. dietary
b.fe def. malabsorption
c. b12def. malabsorption
d.b12def. dietary
e. folate def.
f. aplastic anemia
g.aml.
h.cml
3.microcytic hypochromic anemia with endomysial antibodies: fe def. malabs.


ans: there was another option called ulcerative colitis or coeliac disease and the answer i suppose will be this

[vineet]

theme :pain management
1. old patient with bony metastasis of bronchial carcinoma not relieved by simple analgesic and nsaids( rt)as opoids should be avoided coz of resp. depression

[vineet]

hello guys don't get dried up with the ques. there r still a few them left to overcome
theme:pain relief
2. 45 year old male with lumbar pain with lumbar pain radiating to thigh, not relieved by laminectomy and disectomy but no relief.: nerve block

[geneid]

Dear friends ,
I am really grateful to Ibas who sent to us the whole exam ,
hopefully those of you who have comments or additions can send it and then we can find the rest ( 33 ) questions
Ahmed

[drnig]

dear purple_queen,

I too was confused when everybody put the answer as libal dermoid.
I thought i had got that right.

Limbal dermoid is a differential of limbal growths. pterygium, phlycten, and a big listof other swellings which i dont remember exactly.

The catch was bilateral
which is usually pterygium