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					Calendar Event: March 10, 2006

I SPENT ABOUT 4-5 HRS ARRANGING THIS
I'VE PUT ALL THE QUESTIONS TOGETHER, PLEASE HELP TO ADD THE REST IN A NEAT WAY THX
HOPE YOU GUYS FIND IT USEFUL




management of anxiety.


1** a lawyer getting fearful and anxious to talk in public which was affecting her career.
2** a female getting increasingly anxious, tearful and unable to cope with anything., early morning
waking and hardly any sleep at night
3** mother had to fly to attend daughter s wedding in 2weeks but is fearful of getting into the
plane.
4** man admitted in the ward is delirious.......



5** A young boy (sorry forgotten the age) has a painless soft swelling in the rt. scrotum, it is blue
in colour and compressible.
wat is the best management?
1. surgical exploration
2. ct abd.
3. hernoitomy
4. reassurance
5. antibiotics



theme: X ray picture for the following clinical pictures

6** driver in a car acident hit the steering wheel, B.p and pulse in both arms were different.

options
widened mediastinum
globular heart shadow.



theme : palliative management.

this is a repeat theme.
7*** man having untractable hiccough
8*** terminal stage breast CA women having malodourous discharge causing trouble.
9*** Lung Ca treated with radiaotheraphy leads to super vena cava syndrome.
10** bleeding per rectum following Rx for IBD/ or some such condition with radiotheraphy.
11** dont remember.

options:
haloperidol
hyoscine
dexamethazone tablets
prednislone suppository
metronidazole topical

there were Qs on abd. pain in a female

12***. about a typical presentation of acute appendicitis.
13***. typical presentation of ruptured ectopic
14***. abt ruptured peptic ulcer-typical Q.
15***. pancreatitis


theme on urinary retention.
16***. 85yr old bedridden man with palpable distended bladder, stoke pt., with a soft indenting
mass felt on the LIF. no loss of wt or bldg p/r.

ans was fecal impaction.

another theme on hematuria.
17***. 55y man with macroscopic hematuria........ i think ans was bladder ca
18***. man has hematuria and mass felt in lt. loin.........i think ans was renal cell ca.
19***. one Q on ureteric colic

eme: Chest X ray findings:
20***- Male with antero septal infarction----Normal Chest xray
21***- 2- Women undergoing oesophageal dilatation, now unwell -----free mediastinal gas
22***- Patient with Hx of diverticulitis, now present with rigid abdomen-----Gas under diaphragm
23***- Women stabbed in chest---now breathless----Pneumothorax
24***- Patient, fever 39 C, mid zone consolidation---pneumonia

Theme: Oncological Emergencies:
25*** - Fungating odour from breast---metronidazole gel
26***- Haloperidol-----intractable hiccups
27*** Man presents with signs of sup vena cava Obs , has Hx of bronchial Ca--- dexamethasone
tablets
28***- Man underwent radiotherapy for prostate CA, now comes with P/R bleeding----Prednisolone
supp
29***- Increased thirst, polyurea, with Hx of some CA-------Bisphosphonates

Theme: Burns:
30***- 2 yr child, cant get I/V line----interosseous line
31***- Child aged 12…cant get IV line----Central venous line
32***- Child with burns on chest, upper limbs 10 %-----20 ml /? Bolus
33***- Burns patient with soot, signed nasal hairs, noisy breathing-----Endo intubation
34***- Burns child, low BP--------Dobutamine

Theme: Toxicity:
35***- arrythymiasm dry mouth---amytriptiline
36***- pin point pupils, hypotension------Morphine
37***- Ataxia, slurred speech ----alcohol
38***- Visual disturbances, bradycardia-----Digoxin
39***- Hypotension only, no dec R/R-----atenolol

Theme: Antibody:
39***- telengectisias, raynaud’s phenomena------Anti centromere Antibody ( got this one wrong)
40***- female, pruritis, increased gamma GT------Antimitochondrial antibody
41***- rash on cheeks, photophobia-----Anti dsDNA
42***- Something about thyroid Sx----anti thyroid peroxidase
43***- Male patient, pale looking, with some paresthesia..?? in lowerlimbs---antibody to intrinsic
factor

Theme: orthopaedics:
44***- Achilles tendon rupture-----surgical repair
45***- Child, pain in knee while playing football, next day walking normal, only pain, no swelling,
pain not relieved by paracetamol-----Ibuprofen
46***- Child, pain in knee, already getting 50% NO and 02, patella found to be laterally shifted----
manipulation???
47***- Female, 14 weeks pregnant, falls, with swelling on ankle------crutches weight bearing
support
Theme: Inguinal swelling:
48***- female with swelling in inguinal region, abdominal pain and distension----hernia repair (
urgent)
49***- ship yard worker, with discomfort swelling in inguinal region -----Hernai repair ( planned)
50***- child 9 month old, on crying, swelling appears----Herniotomy
51***- Female with Hx of MI, had hysterectomy done, lower abd scar, swelling protruding beneath
it, reducible------abdominal support
52***- Male 9 yr old, swelling inguinal region-----Hernia repair (planned


53*** one typical Q about ruptured aortic anuerysm: pulsatile abd. mass with low bp and increased
pulse. young man thin and tall.


Qs on imaging of spinal cord lesions like :
54*** .back pain, weakness in knees and ankles.
55*** .some Q about optic neuritis few yrs back and now some lesion.......i m sorry abt this group
of Qs, i really cannot recall much.
options were
ct brain
mri brain
mri spinal cord.
mri cervical spine
mri lumbar spime
mri lumbosacral spine
xray lumbar spine. WAS THE ANSWER FOR THE YOUNG MAN WITH ANKYLOSING SPONDYLITIS (AS
U CAN TELL FROM HISTORY)


A repeat theme abt electrolyte imbalance
56*** villous adenoma- hypokalemia
57*** pyloric stenosis , vomitting, dehydration- metabolis alkalosis
58*** post radiation confusion, constipation, thirst in a female rx for breast ca- hypercalcemia
59*** after operation breathlessness and jvp raised………….fluid overload

60*** Child sits at back of class, cant read the black board----spectacles with concave lens
61*** Patient, headache, pain in eye since 2-3 days, dilated and fixed pupil-------Glaucoma surgery
62*** Patient with SLE on steroids, presents with bilateral opacities------cataract operation with
lens implantation
63*** Man, can see distant vision well, but cant read newspaperin artificial light----**i think its
astigmatism *** cylindrical lens

another repeat theme abt vaginal infections/discharge.
64*** clue cells in the smear of the discharge- bacterial vaginosis.
65*** white discharge in a female which shows mycelia on microscopy- candida
66*** vulval shallow painful ulcers- herpes
67*** last one was iwth h/o PID and on investigation no gonococcus found ...........ans chlamydia.

1

68*** Man with increasing abdominal distention, general condition well, spider nevi present, which
Rx would u like to start-
a-cephalosporin
b-spironolactone ( is this right)
c-vitamin K

69***

Child brought with 8 hr Hx of sorethroat, saliva dribbling, what to do next?
a- Call anesthetist ( right ans) **EPIGLOTTITIS
b- Give penicillin
C- do a mouth examination
70***
Child 18 months old episode of sweet getting stuck up In the throat, has been cleared now, parents
are worried and ask if it happens again, what do we do?

a- hemilich meneuvre
b- back blows with chest compression with patient on laps ( right ans)


typical Qs on asthama

71*** pt symptomatic despite using 2-3 times inhaled bronchodilator , also wheeze at night
72*** women with chronic asthama comes with severe wheeze and cough.-nebulised beta blocker.
73*** pt develpos oral candidiasis while being stable using 1000microg of steroid

74***
Female 68 yrs old, has had a low level Right forearm FRACTURE , what will u do to prevent more
fractures in future:?
A calcitonin
B Ca + suppl
C Bisphosphonates ( I think this is right b/c acc to OHCS…they reduce risk of hip and wrist #)
D HRT *** IS THIS ALSO AN ANSWER??????


Theme about ENT :

79*** - teacher, presents with hoarseness-----vocalcord nodules
80*** - smoker, 8 weeks Hx of hoarseness-----laryngeal CA
81*** - Hoarseness following thyroidectomy----recurrent laryngeal nerve palsy
82*** - 1 week Hx of resp tract infection, coryza------acute laryngitis
83*** - Female, husband died 5 weeks agom whispers on and off, can cough normally-----
functional dysphonia


organisms responsible for:

84*** swollen leg hot, painful and indurated. STREP PYOGENES
85*** axillary abcess STAPH AUREUS
86*** i think there was one on candida ???
87*** pt previously healthy with dry cough, increasing breathlessness, x-ray shows patchy
consolidation all over the lung feild.......(MYCOPLASMA))))
88*** PT ON ANTIBIOTIC develops diarrhoea -> clost. difficile

89*** there was a Q in the hematuria theme:
Asian male with cough and loss of wt shows microscopic hematuria.
ans: kidney TB


There was an SBA:

90*** A man brings his wife into A&E after finding her unconscious at home. He says that at
breakfast time, she had complained of a sudden headache and had vomitted. She took paracetamol
and aspirin for the pain. She is now in A&E with a low GCS.

What is the single most appropriate Inx:

A. ECG
B. Drug levels
C. FBC
D. CT head (right ans)
91*** there was a question regarding a young child with non blanching erythematous papules on
the lower extremities with facial erythema. what investigation will u do for him?????

92*** child with 5 % burns what is the treatment of choice?

93*** child with ???? orbital tumor, as understood from the history, or proptosis, what is the best
investigation to be done --> CT scan i believe.

94*** and a child whos short for his age with some other features--> not typical of cystic fibrosis,
but i believe that was the closest answer.

95 *** psychiatry.
the pt whos anorexic. --> compulsory detention was my answer. b/c in ohcs it mentions, if there is
any danger to one owns life we must detain.

96*** and other psychi question regarding the pt in the medical ward had an operation or
something done for him. and hes worried or in panic. what method of treatment will u use.


Theme: Toxicity:
97*** - arrythymiasm dry mouth---amytriptiline
98*** - pin point pupils, hypotension------Morphine
99*** - Ataxia, slurred speech ----alcohol
100** - Visual disturbances, bradycardia-----Digoxin
101** - Hypotension only, no dec R/R-----atenolol
102** - liver failure after 4 days....paracetamol


Theme: Antibody:

103**    -   telengectisias, raynaud’s phenomena------Anti centromere Antibody ( got this one wrong)
104**    -   female, pruritis, increased gamma GT------Antimitochondrial antibody
105**    -   rash on cheeks, photophobia-----Anti dsDNA
106**    -   Something about thyroid Sx----anti thyroid peroxidase
107**    -   Male patient, pale looking, with some paresthesia..?? in lowerlimbs---antibody to intrinsic
factor

DEMENTIA THEME (REPEAT)

108**    .   Most common form of dementia in UK ............ Alzheimer's Dementia
109**    .   Characterized by neurofibrillary tangles and senile plaques....... Alzheimer's
110**    .   Hypertensive patient ............ multi infarct
111**    .   Respond to anti depressant............ pseudodementia
112**    .   Increased disinhibition and preservation of intellect....... frontal

113** one was the SBA for the child who plays football, then developed itchiness - something like
that

114** BEST TIME TO MEASURE SERUM PROGESTERONE FOR MARKING OVULATION

Answer... 21 day Progesterone

115** QUESTION ON HOW TO MONITOR A PATIENT (MOLAR PREGNANCY AS DEDUCED FROM THE
HISTORY)
A)SERUM HCG
B) URINARY HCG


116** something about a gardener who got a thorn prick...in A&E initial resuscitaion done...getting
his finger dressed....and suddenly develops perioral itching ,hunger and collapses? He was given
anti tetanus and penciliin oral
Answer is anaphlaxis other close option was staphlocoocus sepsis but anaphlaxis is da right answer
options....anaphylaxis...cant remember all of them



117** girl complaining of primary dysmenorrhea
118** women aged 30 compalinign of menorrhagia

Options
a.mefenamic acid
b.TRANEXAMIC ACID
c.norethisterone releasing IUCD
D. cocp


119** - 123** ANAEMIA THEME

Options
a.iron deficiency due to malabsorption
b.iron def due to diet
c.B12 def due to diet
d.B12 def due to malabsorption
e. intrinsic factor deficient
1.person on vegan diet with macroytosis and anemia ....... b12 diet def.
2. Pernicios anemia one....... b12 malabsorption
3. .patient complaining of weight loss,loss stools with microcytinc hypochromic anemia with anti
endomysial antibodies positive! .... iron malabsoprtion


124**- 127** THEME on Myocardial complications came
with choices such as -Ventricular rupture
-dresslers syndrome
-etc

128** occupational asthma, where the patients symptoms are resolved after he goes on holiday


129** There was also a cardiology theme........ I remember only 1 question sumthing abt SVT and
carotid sinus massage and valsalva man. unsuccessful..............next step................ADENOSINE
(no doubt abt that)


130** Pt, 20s, female, with wt loss and loose bowel motion with mucus for 3 months. Lower
abdominal pain also.
My answer::: Inflammatory bowel DISEASE...

131** Pt , asthmatic, on inhalers of steriods and beta agonists, still symptomatic
My answer::: Oral theophylline (agree with yasir)

132** eldery pt, after stroke, in some kind of a hostel or eldery care house, developed sever itching
and erythema on her body, lines on her hand and feet.
My answer::: ***chlorpheneramine*****..



Other questions in asthma theme

133** . pt symptomatic despite using 2-3 times inhaled bronchodilator , also wheeze at night----
inhaled corticosteroids
134** . women with chronic asthama comes with severe wheeze and cough.----nebulised beta
blocker.
135** . pt develpos oral candidiasis while being stable using 1000microg of steroid---decrease
inhaled steroids


136** A man brings his wife into A&E after finding her unconscious at home. He says that at
breakfast time, she had complained of a sudden headache and had vomitted. HER MOTHER DIED AT
THE AGE 40 SUDDEN DEATH She took paracetamol and aspirin for the pain. She is now in A&E with
a low GCS.
IT COULD BE A RUTURED BERRY ANEURYSM --> SUBARACHNOID HAEMORRHAGE.

137** ADULT POLYCYSTIC kidney DISEASE (U make it out from history)


138**- 141** investigation of neck masses

1.branchial cyst
2.cystic hygroma
3.thyroglossal cyst
4.hard thyroid mass

options were
a.biopsy
b.fine needle aspiration cytology
c.ultrasound
d.aspiration with cytology and microscopy



142** diagnostic x ray finding of a patient with signs and symptoms of tuberculosis...cant
remember the exact scenario

options
a.apical granuloma on CXR
b.pleural effusion
c.bilateral hilar lymphadenopathy --> S A R C O I D O S I S


143** patient with excessive bronchial secretions....not able to expectorate....the answer was
hyoscine



144**

A young woman fainted in the street and was brought into A&E. She weighs 33kg. She is alert and
well in A&E and states she is on a diet and admits to not eating or drinking anything for 48 hrs. She
says she wants to reach her target weight of 30kg. She is annoyed she has been brought to the
hospital and adamantly states she wants to leave. What is the most appropriate step?

A. Detain her under the mental Health Act. (CORRECT ANSWER I THINK)
B. Refer to dietician
C. Refer to her GP
D. Allow her to be discharged
E. I cant remember


145**-147** Diagnosis of Diabetes

A Conns Syn
B Cushings Syn
C Cystic Fibrosis
D Diabetes Insipidus
E Impaired Glucose Tolerance
F Type 1 Diabetes
G Type 2 Diabetes
H Nephrotic Syn

1. A 30 yr old business man has palpitations and urinary frequency. He is sweating. His urine
dipstick is +ve for glucose and ketones. His plasma glucose is 26mmol.
ans) type 1 diabetes

2. A 65 yr old woman has a recurrent vaginal itch. she has BMI of 33. Random BLOOD GLUCOSE is
15 mmol.
ans) type 2 diabetes

3. A 55 yr old man has glycosuria. After a two hr glucose tolerance test, his plasma glucose is
9mmol.
ans) impaired glucose tolerance


148** about salicylate poisoning
determine the acid base abnormality

Options
a.met acidosis
b.metabolic alkalosis
c.resp acidosis
d.resp alkalosis

dont remember, exact stem of the question, but i also chose metabolic acidosis as my answer


149** SBA abt the man with the panic attack?
Rebreath into an airbag IS THE TREATMENT


150** a young child with 5% (I DONT REMEMBER 10%) burns --> CAN ANY1 PLEASE TELL US
WHAT THE ANSWER FOR THIS WAS??
WAS ADMISSION ONE OF THE CHOICES??????


151** a man in fire accident with soot particles-anaes help?.

Q.134…. Infertility in a female with normal regular 32 day cyle……… ans.. 25 day progesterone

U have added 2 question in da theme of "Spinal cord lession""

Q. Diagnosis of MS.... mri of brain
Q. Diagnosis of Ankylosing Spondylitis.... X ray lumbosacral spine
Q. Diagnosis... with some problem in pituitary..... MRI pituitary
** ONE QUESTION ON BROCAS AREA REMEMBER THAT???????

** I THINK THERE WAS ALSO A QUESTION ON OBSTRUCTIVE SLEEP APNEA, TO DIAGNOSE IT.
IS THAT RIGHT AHMADDD?

** IN NEUROLOGY, PATIENT WITH CEREBELLAR SIGNS.
WHICH ARTERAIL TERRITORY?
A) LATERAL MEDULLARY SYNDROME
B) POST CEREBELLAR ARTERY????

** THE ONE WITH KERNIGS SIGN +IVE --> DIAGNOSIS WAS MENINGITIS

** PT WITH BLACKOUT INVESTIGATION OF CHOICE****

** THE ONE WITH NITRITE DETECTED IN URINE WHAT WAS THE CAUSE? DO U REMEMBER???
** OVARIAN CANCER --> CA 125
Theme: Gynae & Obs

Q.1 Patient with Breast CA presenting with altered consciouness............cerebral metastasis
Q.2 Pateient with left sided mastectomy and axillary clearance, now presents with swollen left
hand.............lympoedema
Q.3. H/o breast cancer, now presents with polyuria, polydipsia........Hypercalcemia
Q.4. Patient with h/o breast cancer...h/o fall and FRACTURE of femur i think...........pathological
FRACTURE
Q.5 answer was spinal metastasis , dont remember da stem
** ONE QUESTION ON BROCAS AREA REMEMBER THAT??????? Yes that was a patient with some
expressive speech problem and da answer is problem related to Broca's Area

** I THINK THERE WAS ALSO A QUESTION ON OBSTRUCTIVE SLEEP APNEA, TO DIAGNOSE IT.
IS THAT RIGHT AHMADDD? Well i dont remember that

** IN NEUROLOGY, PATIENT WITH CEREBELLAR SIGNS.
WHICH ARTERAIL TERRITORY?
A) LATERAL MEDULLARY SYNDROME
B) POST CEREBELLAR ARTERY???? (this is da right answer)

** THE ONE WITH KERNIGS SIGN +IVE --> DIAGNOSIS WAS MENINGITIS ... Ya and they were
asking for da investigation of choice and my answer was Blood Culture

** PT WITH BLACKOUT INVESTIGATION OF CHOICE**** dont remember da question

** THE ONE WITH NITRITE DETECTED IN URINE WHAT WAS THE CAUSE? DO U REMEMBER???
I think i wrote UTI, other options were
........ Glomerulonephritis
........ Chlamydial Infection
......... UTI
......... Ureteric Colic and others
Diagnosis of Anaemia

A Acute leukaemia
B Anaemia of chronic disease
C Aplastic Anaemia
D Chronic leukaemia
E Dietary folate Defiency
F Dietary Iron Defiency
G Dietary vit b12 defiency
H Folate Defiency due to malabsorption
I Iron Defiency due to gastrointestinal blood loss
J Iron defiency due to malabsorption
K Iron defiency due to menorrhagia
L Pernicious anaemia
M Sickle Cell Anaemia
N Thalassaemia trait
O Vit b12 defiency due to malabsorption

= A 61 yr old man is feeling unwell. Inx show a Hb of 9.6 g/dl with macrocytic red cell indices. He
has a +ve intrinsic factor antibody.

= A 55 yr old woman presents with weight loss and diarrhea. Her Hb is 8.2g/dl with a microcytic
hypochromic blood film. She has a positive anti endomysial antibody.

= A 30 yr old vegan presents with a haemoglobin of 9.5 g/dl. The blood film shows macrocytosis
with a MCV of 108. Plasma and red cell folate levels are normal.

= A 60 y/o man presents feeling unwell with lymphadenopathy and spleenomegaly. His peripheral
lymphocyte count is 500 * 10 9/ L
= A 60 year old man is being treated with cyclophosphamide for fibrosing alveolitis. His Hb level is
6.2 g/dl, with normal red cell parameters, a platelet count of 100 * 10 9 /L and a white cell count of
2.0 * 10 9 /L.
(not sure about the values for this last question)
my answers were
L
J
G
D
C
Yes u have ...........BINGO..

But i wrote

L
J
G
A .......acute leukemia
C
Management of asthma

A Inhaled Cromoglicate
B Inhaled long acting B agonist
C Inhaled short acting B agonist
D Inhaled steroid
F Nebulised beta agonist
G Oral antibiotic
H Oral leukotriene antagonist
I Oral steroid
J Oral theophylline
K Reduce inhaled steroid

Ins: choose most appropraite management (i think)

= A 22 y/o man is required to use beta adrenergics two to three times a day. He wakes with
wheezing at night.

= A 37 y/o woman is a known asthmatic. She is on treatment. She comes to A&E breathless and
Wheezy.

= A 42 y/o man who has intermitent asthma and uses beta agonists and inhaled steroids is allergic
to aspirin. He is still symptomatic.

= A 47 y/o man who suffers from chronic asthma has pyrexia and coughs green sputum. His PEFR
is <80% of his normal value.

= A 46 y/o woman who was symptom free and doing well on 1000ug inhaled beclomethasone has
now developed oral thrush
MY answers .
1. Inhaled steroid
2. Neubulize b-agonists
3. oral theophyllinne
4. Antibiotics
5. Reduce da dose of steroids
MY answers .
1. Inhaled steroid or was it long acting b2 agonist *** dont recall ****
2. Neubulize b-agonists
3. oral theophyllinne
4. Antibiotics
5. Reduce da dose of steroids
The theme with the scrotal swellings ....was that the theme with the hernia's that you are referring
to??
There was an SBA

A boy comes to A&E with a blue swelling in his scrotum and it is compressible. What do you do?

A Refer to Med team
B Surgical exploration
C reassure
Scientific Basis of Electrolyte Abnormalities

A Dehydration
B Fluid Overload
C Hypokalaemia
D Metabolic Acidosis
E Metabolic Alkalosis
F Renal Failure
G Resp Acidosis
H Resp Alkalosis

= A 65 y/o man with a known PUD is admitted with vomitting for a week. He has pyloric stenosis.
He has an increased base excess, hypokalaemia and is dehydrated.

= A woman has a hernia repair and 24 hrs post op she is dyspnoeic and has a raised JVP.

= A man has a villous adenoma of the rectum. He has had profuse watery diarrhea for 2 mths.

There were only three questions in this theme

Q. Asian man, with tender painful LN in supraclavicular area. CXR normal. Ix? I chose Mantoux test.

Q. Young pt, sore throat, LAP, ampicillin caused him a rash, Ix? Monospot test.

Q. young pt, episodic abd pain, all examination and Ix normal, Rx? I chose re assure.

Q. Pt with ascites and liver dis, some guys wrote spironolactone for Rx, I chose cephalosporins to
prevent spontanous bact peritonitis.

Q. pt with HPT and haematuria, his father and sister had the same, Dx? I chose polycystic kidney.

Q. eldery pt, macroscopic haematuria, no other compliant, Dx? I chose bladder Ca.

Q. pt, 60 yrs, LAP and splenomegaly, increase lymphocytes in bld and anemia, Dx? I read some
guys wrote acute leuckemia, come on guys, where are the blasts then? If you found no blasts then
it is chronic.

Q. Pt, with some kind of pain, took NSAID, developed wheezes ans dyspnea, I chose idiosyncratic
drug response. I could be wrong here.

Q. pt with exceessive alcohol and smoking with some kind of problem I chose general advice about
life style.
A mother brings her child to A&E two hours after he ingested a large amount of aspirin. What would
the ABG look like?

1.   ph   7.4,   PaCO2   6
2.   ph   7.1,   PaCO2   2
3.   ph   7.2,   PaCO2   12
4.   ph   7.6,   PaCO2   2.5
5.   ph   7.8,   PaCO2   11.5

Q. Pt with ascites and liver dis, some guys wrote spironolactone for Rx, I chose cephalosporins to
prevent spontanous bact peritonitis.
Salicylates stimulate the resp centr, increase the depth and rate of respiration, and induce a
respiratory alkalosis. Compensatory mechanisms, include renal excretion of bicarb and k+, result in
a metabolic acidosis.
.... resp alkalosis and metab acidosis supervene and a mixed acid-base disturbance is observed.
This is what I rem from the MI theme:
There were 5 questions in this theme....

*** One was a man presenting with central chest pain after MI and had an ECG with ST elevation --
--> acute pericarditis.

*** Another one was a man presenting 2 weeks after an anterior MI with fever, chest pain, high
ESR---> basically symptoms of Dressler's.

*** One with a man presenting abt 2 months after an MI with breathlessness and chest pain after
walking up a hill ...this was Right Ventricular Strain I think.

*** There was also another one with a patient presenting with mitral regurgitation...I marked
Papillary muscle ruture.

*** I cant rem the last option but I think it might have been something that pointed to a LV
aneurysm...I rem thinking that because the patient was presenting quite late...at 4-6 weeks or
something like that!
A woman had a 10 year hx of migrane. She now presents with a sudden headache not relieved by
analgesia. What is the single most appropriate investigation?

A. Reassure
B. FBC
C. CT head
Q. 68 posted by drdeeb.
I agree that Spironolactone seems to be a more appropriate choice.
OHCM 6TH ED PG 220
choices of antibiotic for prophylaxis of sbp are ciprofloxacin and cotrimoxazole
Since there is no mention of ascitic tap results the first priority would be to reduce the volume of
the fluid itself so as to decrease the opportunity of sbp developing.
cefuroxime and metronidazole would be used in the treatment of proved sbp ie fever and ascitic
fluid results.
1. Football player who developed itchiness..what treat ment of choice?

2.a petient presenting with cystic hygroma(mentioned n teh question as a transiluminant swelling in
the neck)....name the investigation.....USG?

3.Investigation in th eone presenting with branchial cyst?

4.Investigation in throglossal cyst( patient presenting with neck swelling which moves on protruding
the tongue)

5.there was question about the hard thyroid mass as well..... investigation??....

6.investigation in the one presenting with red hot swollen testis with no vomiting?

7.red hot swollen testis with vomiting....the queston asked abt the investigation !!

8.there was a question about a child presenting with non blanching erythema...what was that
....does anyone remeber the answwer?

9.was extrinsic allergic alveolitis the answer to any of the questions??

10.what was the question stem the answer ro which u all think was Posterior inferior cerebellar
artery synd.??

11.Whats the invest of choice in the patient who presented with migraine????????

12.Investigation in the patient who presented with a supraclavicular mass....???
13.female presenting with depressive symptoms...what the treatment?

14.patient presenting with optic neuritis...and now has some sort of weakness...waht the
investigation...and diagnosis?

15.xray finding in the patient who presented after a car accident and the steering whell hit his lower
ribs????

16.bed ridden man with urinary retention??.....elderly...with a mass on PR examination...wasnt the
answer....benign prostatic hypertrophy??

There was no h/o fever, so i went for spironolactone.... thats da only difference....

1. Football player who developed itchiness..what treat ment of choice? ans) chlorpheneramine

2.a petient presenting with cystic hygroma(mentioned n teh question as a transiluminant swelling in
the neck)....name the investigation.....USG? my ans) U/S same.

3.Investigation in th eone presenting with branchial cyst? ans) ** definately its aspiration

4.Investigation in throglossal cyst( patient presenting with neck swelling which moves on protruding
the tongue) ans) U/S

5.there was question about the hard thyroid mass as well..... investigation??.... BIOPSY (i think was
one of the choices)

6.investigation in the one presenting with red hot swollen testis with no vomiting? dont remember
choices

7.red hot swollen testis with vomiting....the queston asked abt the investigation !!
Still dont remember choices

8.there was a question about a child presenting with non blanching erythema...what was that
....does anyone remeber the answwer?
????? not familiar with question

9.was extrinsic allergic alveolitis the answer to any of the questions?? i remmber seeing it
somewhere in the paper

10.what was the question stem the answer ro which u all think was Posterior inferior cerebellar
artery synd.?? post inf cereb art = lateral medullary syndrome. that was not the answer.
11.Whats the invest of choice in the patient who presented with migraine????????


12.Investigation in the patient who presented with a supraclavicular mass....???

13.female presenting with depressive symptoms...what the treatment?

14.patient presenting with optic neuritis...and now has some sort of weakness...waht the
investigation...and diagnosis?

15.xray finding in the patient who presented after a car accident and the steering whell hit his lower
ribs????

16.bed ridden man with urinary retention??.....elderly...with a mass on PR examination...wasnt the
answer....benign prostatic hypertrophy?? i think so, although some say its faecal impact. dont
remember seeing that option
the the answers ro mi themes were
1.ac. pericarditis
2.papillary muscle rupture
3.dresslers syndrome
4.ventricular aneurysm
5.vetricular strain(not sure if this was ther maybe i got this wrong)
6.ventricle rupture (not sure abt this one either)
Dx in acute dyspnoea

A Asthma
B Hyperventilation
C Tension Pneumothorax
D Simple Pneumothorax
E DKA
F Laryngeal oedema
G LVF
H Pneumonia

** A 19y/o woman comes to A&E unconscious. She has deep sighing resp at 28/min. Temp is 39C--
-> DKA?

** A woman was in a fire. She has singed eyebrows, stidor and soot in mouth and nose --->
Laryngeal Oedema

** A woman has right sided Chest pain and SOB. He has a temp of 39C and pleural rub in rt mid
zone ---> Pneumonia

** An eldery woman is short of breath. She has an apex beat displaced to the left and an apical
systolic murmur ---> LVF

I kinda rem this theme cuz I rem to myself that it was all women patients! Let me know if you guys
think I am hallucinating!
    1.   1. Lawyer fearful and anxious to talk in public……cognitive therapy
         2. Female patient with depressive symptoms
         3. Mother anxious to go on a plane………beta blockers
         4. Man admitted in the ward with presentation of delirium……Diazepam
         5 A young boy has a painless soft swelling in the rt. scrotum, it is blue in colour and
         compressible. What is the best management?
         6 driver in a car accident hit the steering wheel; B.P and pulse in both arms were different.
         Widened mediastinum
         7 Female presenting with lower abdominal pain features of……..ac. appendicitis
         8. Female presenting with lower abdominal pain features of…….ruptured ectopic pregnancy
         9. Female presenting with lower abdominal pain features of……ruptured peptic ulcer
         10. Female presenting with lower abdominal pain features of….pancreatitis
         11. 85yr old bedridden man with palpable distended bladder, stoke pt., with a soft
         indenting mass felt on the LIF. No loss of wt or bleeding p/r. answer was faecal impaction.
         12. 55y man with macroscopic hematuria........ bladder ca
         13. man has hematuria and mass felt in lt. loin.........renal cell ca.
         14. one Q on ureteric colic
         15- Male with antero septal infarction----Normal Chest xray
         16- 2- Women undergoing oesophageal dilatation, now unwell -----free mediastinal gas
         17- Patient with Hx of diverticulitis, now present with rigid abdomen-----Gas under
         diaphragm
         18- Women stabbed in chest---now breathless----Pneumothorax
         19- Patient, fever 39 C, mid zone consolidation---pneumonia
         20 Fungating odour from breast---metronidazole gel
         21 Haloperidol-----intractable hiccups
         22 Man presents with sup. vena cava Obs , has Hx of bronchial Ca--- dexamethasone
         tablets
         23 Man underwent radiotherapy for prostate CA, now with P/R bleeding----Prednisolone
         supp
         24 Increased thirst, polyurea, with Hx of some CA-------Bisphosphonates
         25- 2 yr child, cant get I/V line----interosseous line
         26- Child aged 12…cant get IV line----Central venous line
         27- Child with burns on chest, upper limbs 10 %-----20 ml /Kg
         28- Burns patient with soot, signed nasal hairs, noisy breathing-----Endo intubation
29- Burns child, low BP--------Dobutamine
30- telengectisias, raynaud’s phenomena------Anti centromere Antibody
31- female, pruritis, increased gamma GT------Antimitochondrial antibody
32- rash on cheeks, photophobia-----Anti dsDNA
33- Something about thyroid Sx----anti thyroid peroxidase
34- Male patient, pale looking, with some paresthesia..?? in lowerlimbs---antibody to
intrinsic factor
35- Achilles tendon rupture-----surgical repair
36- Child, pain in knee while playing football, next day walking normal, only pain, no
swelling, pain not relieved by paracetamol-----Ibuprofen
37- Child, pain in knee, already getting 50% NO and 02, patella found to be laterally
shifted----manipulation???
38- Female, 14 wks pregnant, falls, with swelling on ankle--crutches weight bearing support
39- female with swelling in inguinal region, abd. pain and distension--hernia repair (
urgent)
40- ship yard worker, with discomfort swelling in inguinal region ----Hernia repair (
planned)
41- child 9 month old, on crying, swelling appears----Herniotomy
42- Male 9 yr old, swelling inguinal region-----Hernia repair (planned)
43- Female with Hx of MI, had hysterectomy done, lower abd scar, swelling protruding
beneath it, reducible------abdominal support
44 one typical Q about ruptured aortic anuerysm: pulsatile abd. mass with low bp and
increased pulse. young man thin and tall.
45 ankylosing spondylitis….. x-ray lumbosacral spine
46 diagnosis of MS……. MRI brain
47 pituitary fossa problem………MRI pituitary
48 villous adenoma- hypokalemia
49 pyloric stenosis , vomitting, dehydration- metabolis alkalosis
50 post radiation confusion, constipation, thirst in a female rx for breast ca- hypercalcemia
51 after operation breathlessness and jvp raised………….fluid overload
52 Child sits at back of class, cant read the black board----spectacles with concave lens
53 Patient, headache, pain in eye since 2-3 days, dilated & fixed pupil-----Glaucoma
surgery
54 Patient with SLE on steroids, presents with bilateral opacities---ECCO with lens implant
55 Man, can see distant vision well, but cant read newspaperin artificial light----i think its
astigmatism cylindrical lens
56 clue cells in the smear of the discharge- bacterial vaginosis.
57 white discharge in a female which shows mycelia on microscopy- candida
58 vulval shallow painful ulcers- herpes
59 last one was with h/o PID and on investigation no gonococcus found ........ans
chlamydia.
60 Man with increasing abdominal distention, general condition well, spider nevi present,
which Rx would u like to start- spironolactone
61 Child brought with 8 hr Hx of sore throat, saliva dribbling, what to do next? Epiglottis,
call anesthetist
62 Child 18 months old episode of sweet getting stuck up In the throat, has been cleared
now, parents are worried and ask if it happens again, what do we do? Back slaps and chest
thrusts
62 pt symptomatic despite using 2-3 times inhaled bronchodilator , also wheeze at night
…..inhaled corticosteroids
63 women with ch. asthma comes with severe wheeze and cough-nebulised beta agonist
64 pt develops oral candidiasis while being stable using 1000microg of steroid …..decrease
da dose
65 Female 68 yrs old, has had a low level Right forearm FRACTURE , what will u do to
prevent more fractures in future:?
66 - teacher, presents with hoarseness-----vocalcord nodules
67 - smoker, 8 weeks Hx of hoarseness-----laryngeal CA
68 - Hoarseness following thyroidectomy----recurrent laryngeal nerve palsy
69 - 1 week Hx of resp tract infection, coryza------acute laryngitis
70 - Female, husband died 5 weeks agom whispers on and off, can cough normally-----
functional dysphonia
71 swollen leg hot, painful and indurated. STREP PYOGENES
72 axillary abcess STAPH AUREUS
73 i think there was one on candida ???
74 PT ON ANTIBIOTIC develops diarrhoea -> clost. difficile
75 pt previously healthy with dry cough, increasing breathlessness, x-ray shows patchy
consolidation all over the lung feild.......(MYCOPLASMA))))
76 there was a Q in the hematuria: Asian male with cough and loss of wt shows microscopic
hematuria. ans: kidney TB
77 A man brings his wife into A&E after finding her unconscious at home. He says that at
breakfast time, she had complained of a sudden headache and had vomitted. She took
paracetamol and aspirin for the pain. She is now in A&E with a low GCS. CT scan
78 there was a question regarding a young child with non blanching erythematous papules
on the lower extremities with facial erythema. what investigation will u do for him?????
79 child with 5 % burns what is the treatment of choice?
80 child with ???? orbital tumor, as understood from the history, or proptosis, what is the
best investigation to be done --> CT scan i believe.
81 and a child whos short for his age with some other features--> not typical of cystic
fibrosis, but i believe that was the closest answer.
82 the pt whos anorexic. --> compulsory detention was my answer. b/c in ohcs it mentions,
if there is any danger to one owns life we must detain.
83 and other psychi question regarding the pt in the medical ward had an operation or
something done for him. and hes worried or in panic. what method of treatment will u use.
84 - arrythymiasm dry mouth---amytriptiline
85 - pin point pupils, hypotension------Morphine
86 - Ataxia, slurred speech ----alcohol
87 - Visual disturbances, bradycardia-----Digoxin
88 - Hypotension only, no dec R/R-----atenolol
89 - liver failure after 4 days....paracetamol
90 . Most common form of dementia in UK ............ Alzheimer's Dementia
91 . Characterized by neurofibrillary tangles and senile plaques....... Alzheimer's
92 . Hypertensive patient ............ multi infarct
93 . Respond to anti depressant............ pseudodementia
94 . Increased disinhibition and preservation of intellect....... frontal
95 the child who plays football, then developed itchiness - something like that
96 BEST TIME TO MEASURE SERUM PROGESTERONE FOR MARKING OVULATION
Answer... 25 day Progesterone
97 QUESTION ON HOW TO MONITOR A PATIENT (MOLAR PREGNANCY AS DEDUCED FROM
THE HISTORY) …..serum HCG
[snip] something about a gardener who got a thorn prick...in A&E initial resuscitaion
done...getting his finger dressed....and suddenly develops perioral itching ,hunger and
collapses? He was given anti tetanus and penciliin oral ………………Answer is anaphlaxis other
close option was staphlocoocus sepsis but anaphlaxis is da right answer
99 girl complaining of primary dysmenorrhea ….COCP
100 women aged 30 compalinign of menorrhagia …mefanamic acid
101. person on vegan diet with macroytosis and anemia ....... b12 diet def.
102. Pernicios anemia one....... b12 malabsorption
103. patient complaining of weight loss,loss stools with microcytinc hypochromic anemia
with anti endomysial antibodies positive! .... iron malabsoprtion
104. A 60 y/o man presents feeling unwell with lymphadenopathy and spleenomegaly. His
peripheral lymphocyte count is 500 10 9/ L……….ch. leukemia
105. A 60 year old man is being treated with cyclophosphamide for fibrosing alveolitis. His
Hb level is 6.2 g/dl, with normal red cell parameters, a platelet count of 100 10 9 /L and a
white cell count of 2.0 10 9 /L………..aplastic anemia
106. One was a man presenting with central chest pain after MI and had an ECG with ST
elevation ----> acute pericarditis.
107. Another one was a man presenting 2 weeks after an anterior MI with fever, chest pain,
high ESR---> basically symptoms of Dressler's.
108. One with a man presenting abt 2 months after an MI with breathlessness and chest
pain after walking up a hill ...this was Right Ventricular Strain I think.
109. There was also another one with a patient presenting with mitral regurgitation...I
marked Papillary muscle ruture.
110. LV aneurysm...I rem thinking that because the patient was presenting quite late...at
4-6 weeks or something like that
111 There was also a cardiology theme........ I remember only 1 question sumthing abt SVT
and carotid sinus massage and valsalva man. unsuccessful..............next
step................ADENOSINE 112 Pt, 20s, female, with wt loss and loose bowel motion with
mucus for 3 months. Lower abdominal pain also. My answer::: Inflammatory bowel
DISEASE...
113 Pt , asthmatic, on inhalers of steriods and beta agonists, still symptomatic
My answer::: Oral theophylline (agree with yasir)
114 eldery pt, after stroke, in some kind of a hostel or eldery care house, developed sever
itching and erythema on her body, lines on her hand and feet. My answer:::
chlorpheneramine..
115. child presented after a trip in the forest with a bite on the foot......answer probably
was test for lymes dissease....remember this one???
116 ADULT POLYCYSTIC kidney DISEASE (U make it out from history)
117. branchial cyst …….?
118. cystic hygroma ……..?
119. thyroglossal cyst ………..?
120. hard thyroid mass …………..?
121 diagnostic x ray finding of a patient with signs and symptoms of tuberculosis...cant
remember the exact scenario
122 patient with excessive bronchial secretions....not able to expectorate....the answer was
hyoscine
123. scabies …….Malathion
124. A 30 yr old business man has palpitations and urinary frequency. He is sweating. His
urine dipstick is +ve for glucose and ketones. His plasma glucose is 26mmol. ans) type 1
diabetes
125. A 65 yr old woman has a recurrent vaginal itch. she has BMI of 33. Random BLOOD
GLUCOSE is 15 mmol. ans) type 2 diabetes
126. A 55 yr old man has glycosuria. After a two hr glucose tolerance test, his plasma
glucose is 9mmol. ans) impaired glucose tolerance
127 about salicylate poisoning determine the acid base abnormality
128 SBA abt the man with the panic attack? Rebreath into an airbag IS THE TREATMENT
129. Child with h/o orchitis and parotid sweeling……Mumps
130 a man in fire accident with soot particles-anaes help?. 96/130
131 Puerperal Psychosis (Q. 6 months after da birth of baby)
132 A 4 y/o girl has a 2-3 day hx of fever and cough. She has non blanching pin point rash
on her legs --> FBC ( what were the other options?), i think i put fbc too.
133 A young girl presenting with s&s of SLE ---> Auto antibodies. yes agree
134 A young child with s&s of meningitis but no rash --> blood culture / why not LP
135 Patient with Breast CA presenting with altered consciouness............cerebral
metastasis
136 Pateient with left sided mastectomy and axillary clearance, now presents with swollen
left hand.............lympoedema
137 H/o breast cancer, now presents with polyuria, polydipsia........Hypercalcemia
138. Patient with h/o breast cancer...h/o fall and FRACTURE of femur i
think...........pathological FRACTURE
139 answer was spinal metastasis , dont remember da stem
140 OVARIAN CANCER…………………CA 125
141 a patient with some expressive speech problem and da answer is problem related to
Broca's Area
142 occupational asthma, where the patients symptoms are resolved after he goes on
holiday
143 THE ONE WITH KERNIGS SIGN +IVE --> DIAGNOSIS WAS MENINGITIS ... Ya and they
were asking for da investigation of choice and my answer was Blood Culture
144 THE ONE WITH NITRITE DETECTED IN URINE WHAT WAS THE CAUSE? DO U
REMEMBER??? I think i wrote UTI,
145 A 47 y/o man who suffers from chronic asthma has pyrexia and coughs green sputum.
His PEFR is <80% of his normal value
146 A woman gives vaginal birth at term to a baby boy. She has Hepatitis B and is
Concerned about the risk of transmitting it to her baby. What do you do? C Give Hep B
vaccine + Hep B immunoglobulin.
147. young pt, episodic abd pain, all examination and Ix normal, Rx? I chose re assure.
148 Pt of bronchial asthma was on beta agonists and prednisolone, had a surgey. The
following day she had hypotension and potassium imbalance. her drug charts showed that
fluids were adequate and she was on no other medication. (Addisonian crisis)
149. Pt, with some kind of pain, took NSAID, developed wheezes ans dyspnea, I chose
idiosyncratic drug response.???
150. pt with exceessive alcohol and smoking with some kind of problem I chose general
advice about life style
151 A woman has right sided Chest pain and SOB. He has a temp of 39C and pleural rub in
right mid zone ---> Pneumonia
152 An elderly woman is short of breath. She has an apex beat displaced to the left and an
apical systolic murmur ---> LVF

    1-   Pt of bronchial asthma was on beta agonists and prednisolone, had a surgey. The
         following day she had hypotension and potassium imbalance. her drug charts
         showed that fluids were adequate and she was on no other medication. (Addisonian
         crisis)
    2-   2- an anorexia nervosa pt. now complains of muscke pain and lethargy. Inv?
         a. Muscle CK b. U & E
         my ans: b
    3-   Management of testicular swelling:

         3- child with soft swelling in the scrotum which looks bluish (reassure?-not sure)
         4.a leukaemic child treated with chemo has a large painful testis (biopsy?)
    4-   Ive remembered the investigation of rashes and purpura theme, but of course, it
         may be slightly different.

         ** A 4 y/o girl has a 2-3 day hx of fever and cough. She has non blanching pin
         point rash on her legs --> FBC

         ** A young girl presenting with s&s of SLE ---> Auto antibodies.

         ** A young child with s&s of meningitis but no rash --> blood culture

         ** A boy returning to GP after having amoxicillin prescribed by the GP. He comes
         in now with a widespead large maculopapular rash --> Glandular fever test/
         monospot test/ paul bunnel test.
    5-   ** A 4 y/o girl has a 2-3 day hx of fever and cough. She has non blanching pin
         point rash on her legs --> FBC ( what were the other options?), i think i put fbc
         too.

         ** A young girl presenting with s&s of SLE ---> Auto antibodies. yes agree

         ** A young child with s&s of meningitis but no rash --> blood culture / why not LP

        ** A boy returning to GP after having amoxicillin prescribed by the GP. He comes
        in now with a widespead large maculopapular rash --> Glandular fever test/
        monospot test/ paul bunnel test
    Options:
    a-Upper GI endo
    b-24 hr ph monitoring
    c-Manometry
    d-H pylori serology?

    1- patient has undergone fundoplication...? yrs back, now complaining of epigastric
    pain
    2- patient has been treating himself for dyspeptic Sx for may yrs
    3- patient known case of peptic ulcer disease, comes for followup
    Aetiology of shock:
    a. a pt of bronchial asthma was on beta agonists and prednisolone, had a surgey. The
    following day she had hypotension and potassium imbalance. her drug charts showed
    that fluids were adequate and she was on no other medication. (Addisonian crisis)
    b. a ques on splenic rupture
c. a pt in shock with raised JVP (cardiogenic)
d. a pt with hypotension and bradycardia after head injury (neurogenic)
e. a case of typical anaphylaxis
We were supposed to choose the most DIAGNOSTIC test..

A. Ambulatory oesphageal pH study
B CXR
C H Pylori Serology
D No Investigation
E Upper GI endoscopy
F Oesphageal Manometry
G Barium meal

** An elderly man has a hx of epigastric pain with vomitting. Exam reveals epigastric
tenderness...I choose upper GI endocscopy.

** A woman has epigastric pain and nausea. She has no weight loss. She has a
stressful job and smokes 25 cigarettes a day...I choose H.Pylori Serolgy.

** A woman has had a fundoplication, and she has reflux symptoms now, endoscopy is
normal...I think I choose Manometry..not sure though...because I think ph study can
be done too.

** A guy has been self medicating for indigestion for many years...I think I choose H
pylori serology as well.
think da answer for 4th question is also upper GI endoscopy
da 5th question in this theme , was wid da diagnosis of achlasia
hi i m new to this forum ihaveappeared in PLAB 1 on march8 2006 i m posting few
questions,1- a asthmatic with svt not responding to carotid sinus massage what is
treatment verapamil

2,a patient slow to start with spastic rigidity and writhing movement parkinsons
disease.

3,a asthamatic on steroid after surger develop shock adisonian crisis was not in options
,there was adrenal insufficiency option

a youing gril with seizures ,which were present only in presence of other peoples asking
about investigation 24hrs EEG monitoring
A Child with one month hearing difficulty, came to the GP. What action

1.Adenoidectomy
2.Waiting for a month
3.4. I can't remember

				
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