plab paper maybe feb 2009

8/6/2019 Plab Paper Maybe Feb 2009

http://slidepdf.com/reader/full/plab-paper-maybe-feb-2009 1/25

I remember that theme and I wasnt sure about one question which has got red cell cast and s.creatine and urea raised.

typical case of diabetic ketoacidosis ,what investigattion.Arterial blood gasesserum acide concentration

unfortunately i chose 2nd despite i knew its wrong!

Hello, i recall a theme on hematuria, it was on the page before the last.

Breast abcess organism -> Staph. aureus-UTI theme-Hematuria theme-progesterone 21 test in a 32 cycle length -> 25 as we all agreed before!-Theme cranial nerves-Theme on Anatomy : in anaphylaxis intubate... in pneumothorax needle go thru..... somethinglike that-Theme on same old Psychiatry questions, pressure of speech, thought broadcasting i think etc..-Another theme on Psychiatry but more specifically on anxiety and panic attacks

well, there has been repeatitive questions but only the ones which we couldnt find their answersbefore, like the UTI theme,Choose the right antibiotic in each of these cases:- child with nitrites in urine- child with protues- child with e.coli

5 different cases of burns ,, management asked5 cases of how to correct dehydration in a child

I can not remember any exact questionthere was a theme of fractures,

theme of prescribing in renal desiases,alcohol and drug misuse - questions where i was strugling were:patient with amphetamines misuse and is not ready to stop it, want to have a safer optionIs it metadone?a patient with alcohol problems is not ready for strong body reactions, wants to stop alcoholWhat is it?

the questions about cranial nerves were:a patient with fixed and dilated pupila rash on the frontal part of the face and painful corneaa patient with deviation of the tong

theme of Antibiotics for pneumonia

anemia theme(megaloblatic anemia,intrinsic facor deficiency,)obsessive compulsive disorder anxietytoxocology(alcohol withdrawal,opiate addiction,acomprosatebacterial vaginosis diagnosis and treatmenta,clamyedia treat ments,swabculture where shoulsd ittake fromherpes symplexectopic pregnency diagnosis(beta HCg)and laperoscopic diagnosis after uss of ectopic



Anatomy (in anaphylaxix where should trachiostomy done(cricothyroid,2 trachial ring?)laperoscopy where should it insert(lenia aliba)tention pneumothorax(where shouls needlego(intercostal musles)lumbar puncture where should it go(via intercostal musls?cystic fibrosisglutenaminosentesisvwf deficiencyinr valueschron diseaseeye symptoms in hypothyroidismconjuncivitis diagnosis and treatmentachronic chest infection in hiv positiv pt(pneumosystic)cystic fibrosis pt with green sputumlegionella treat mentspost partum-8days pneumoniaecg peri carditis ask about sandle pattersectopicaf sinus tachycardia diagnosis

cardiac temponade(low heat sounds)endometritis after wide epispre eclampsia(visual disturbances)treatmenta for prevent eclampsiadehydration(severe bolus infusion)oral rehydrationiv antibiotic for diarrhoea with skin leasonmeningitis diagnosisencephalitis diagnosis(confusion)head injury(detoriation in 48 hrs(edh)seizure (ct investigation)scaphoid fracturehumerus head injury

ulnar fracture

CRANIAL NERVE DAMAGEFACIAL FALSYOPTIC NACSSERY NERVE

ancylosing spondilitis -eye disesaseinvestigation x ray lumbahyperprolactinemia ct pitutaryasthma using short acting b2 agonist with low dose steroid,with night symptoms with mid exerciseindused asth ma .what should add on that regime

sle diagnosis in renal investigation,as well as chronic renal failure with invetigatin resuls andtubular acidosi with invetigation resultshemolitic uremic xn with investigation and acue GNdiabeti ketoasidosis (absolute insulin deficiency)DM with relative deficiencyincreased glucocorticoidincreased thyroxin(hyperthroidism symptoms)

paper was not bad overall simple and conceptual questions which we tend to forget easily same



old important topics were repeated1.pneumonia types and management2.depression,psychosis,schizophrenia,alcohol intoxication3.cns disorders4.MI, angina,imp investigations according to cause in CVS5.Paediatrics s very imp diarrhea,vomiting,rehydration,antibiotics in uti,cystic fibrosis6.gynaecological disorders,breast abscess,ectopic pregnancy,problems post and intrapartum7.surgery hernia,imp anatomical landmarks for certain procedures8.orthopaedics fractures colles,clavicle,n shoulder dislocationsthasnx God not a single question from epidimeology

organism in breast abscess,hematuria once after injury investigaton

chest pain? theme ;;qwaves and st dep;ression in lead 2 ,3 1nd avf >inferior mist depression in leeds v1- v4 i wrote posterior but actually it was anterior sba: an afro crebian women with typ;e 1 DM is going 4 febroid surgery wots themost imppt preopinvestigation-op;tion werea: capilary blood glucoseb:coag screen

sickling test and it was the answe,

q 199: pt presented with blow on abdo/somewhere,there was perneal bruise and rectal exam wasnormal,option wereascending urogram,us abdo,catheterisation,surapubic catheter and q200: pt had blow on lower back,presented with one episode of haemuturia other wisenormal wat was the answer

hi every 1 finally paper z over few past paper qfracture schapoidsupracondylar fracture

ulnar fracturehumerus neck fractureBLOODpernacious anemiaanaplastic anemiavit 12 diet deficiencyCVSpericarditis saddle shapecardiac temponadeventricular anuresymsRESPhiv...pnemocysticcystic fibrosis with green sputum and on floxacillin prophylixix.... pseudomonas got this one wrong

child with ear problem and resp symptoms... streptococcusmycoplasm pneumonia for bilateral patchy lesionclithromicin in penicillin allergic ptboy on ahort acting b agonist and inhaled steroids drug 2 add.... long acting betaantagonisttreatmen of misotheloma ..i wrote aspiration since he was brethless with large left sided effusionDermatology QON Psoriasis with family historyerythema nodosumpremathamin for old man with scabiesPYSCI Q



flight of ideaspressure of speachpanic disorder paranoid dulisionagoraphobiaocdsocial anxietyLIVERincreasing jaundic ... ca pancreasGIT

COELIC DISEASEendoQUESabsulut deficiency...for kitosisrelativ ansulin deficiency for type 2 dibetesglococoticoid excesscatacholamin excessinsulin excessQ FOR INVESTIGATIONdibetic ketoacidosis check arterial gas analysis

for lady with type1 diabetes preop investigation for myomectomy i went for hba1c levelMISLINIOUS Qstaphlococcus aurious for abscess25 ovulation day in 32 day cycleamniocentasis at 16 weekfor amphatamin naltrioxonfor withdral clorodizeperoxidefor alcohol unplasent effect acomprosatefor craving disulfaramtb for multiple nodulespancost tumor thyroid tumor for lidlag 3 nerve palcy investigatin..thyroid function test

fabrile convulsionsencephalitisextradural hematomaBURN UNITFOR FULL thickness burn in arm escharotomyfor child with crying morphinfor person with pain and redness of skin paracatamol

there were few questions on diagnosis of deafnesspost traumatic sn deafness prebycusis,functional deafness

1-for child with ear infection and resp prob the answer should b h influenza2-boy on ahort acting b agonist and inhaled steroids drug 2 add.... long acting betaantagonist

q was that he was taking low dose steroids and answer was increase steroid dose

3-staphlococcus aurious for abscessq was that she after giving birth so group b strpto

what was the answer to uti with leucocytes and nitrates?



what about that smoker lady who had horseness and bilaterlal enlarged lymph nodes?what was the etest to check restricted eye movements and difficulty in looking upwr-----was ittensilon test?what about that q in ehich lady had abd pain and on us there was thick uterus but no free abdfluid?

I remmber alsothat theme : in cardiology a man after MI with regular ECG found ST elevation in V1234and the answer was venticular anurysm

old lady from nursing home with scabies,they asked whats the initial tretment for her symptoms,

chices were permethrin and chlorphenramine..i wrote chlorphnrmine......anybody?

permethrine is specific tx,but for her intitial syptoms its h1 blocker i think...agreed?

*a theme on ovarian cancer investigations...*a man has prostate cancer strong family hx,he is worried,DRE normal what u do next...i wrote PSA... agreed?*a theme on MI's ECG findings wre given,lead 2 3 avf elevation,there was no inferrior wall MI in options so i wrote posterior wall infarction..gus was there inferior wall MI given in options coz i looked but couldnt find it in options...was itthere?*can we give morphine to a 4 yr old child?

heme on fractures of uper limb,*a man cant lift his hand from the table.....was it colles?

there was 1 very tricky SBA,giving sceniorio of and alcoholic in hypglcemia,asking WHATSHOULD BE THE 1ST IMMEDIATE IV THERAPY....choices were:

thiaminedextrosei wrote thiamine....

*inspiratory and expiratory stridor with mass in front of neck..i wrote thyrod cancer among the options*an SBA on wernick encephelopathy

*a small child with focal seizure for 5 min after which he is confused and doesnt recognize hismother,2 days back he had minor concusion of head...i wrote extradural hematoma...



Cranial nerve lesions:

Options:A)accesory nerveB)optic nerveC)hypoglossal nerveD)glossopharyngeal nerveE)occulomotor nerveF)vestibulo-cochlear nerveG)trigeminal nerveH)facial nerveI)trocheal nerve

1) pt has problem in moving shoulder after getting stabbed in neck..(answer-A)2)pt with some lesion of fore-head which has effected cornea as well..(answer-G)3)pt with drooling of saliva+can't open his eyes..(answer-H)4)pt's tongue devites to left side on protrusion..(answer-C)5)pt has diplopia on looking upward +fixed dilation of pupils..(answer-E)

day 21 serum progesterone should be the answer watever the length a cycle is.no we have to subtract 7 from the length of the cycle to find the day for checking progesteronelevel so the answer was 25th day

what was the ans of ques on deafneess where pt had head injury..the answer was - stop warfarin &start heparin

i think it was bacterial conjuctivitis . becuz it was sticky purulent dischrge

there was a question regarding causative organism of pt with COPD,who is on floucloacilinprophylaxis. wats was the answer- H.influenzae or pseudomoas?

ENT questions

otosclerosissensoryneural deafness ?prsbycusis

OPTHALMOLOGYprolferative retinopathymaccular degenaration?

NEUROLOGYMS inv....MRI brain ?

in opthalmology theme there was question abt pt on crticosteriods,red reflex absent... was it

cataract?yes i aswered cataract too QA.

oh yes the ENT theme, i believe there was a pregnant woman with deafness, i chooseotosclerosisanother man with a head trauma has developed hearing loss as well, i was confused whether tochoose head trauma or someother choice which i totally forgot what it was. because it would betoo easy it the hx said head trauma and the answer would be head trauma, wouldnt it?



There was a man with seizures and decreased level of serum glucose, i dont know if i shouldnthave but it made me go into an absent seizure myself! icon_smile.gif i chose the absoluteincrease in insulin, couldnt match a better choice. hope it's right~!

*a 25 year old man on fundoscopy had microaneurysms and hemorrhages or something likethat...

i wrote diabetic retinopathy.

Yeh I think that was diabetic retinopathy cos other options were quite out of the context...Dont remeber wat were the options where girl took illegal substance

yes i think it was diabetic retinopathy becuz of micro aneurysms& haemorrhages.wat was the answer for yellow spots in the centre of retina.. macular degeneration?

Also there was a man whose vision doesnt improve with glasses... was tht a tumor?

diabetic retinopathy right

macular degeneration right.the girl on drugs had a midline neck multinodular swelling, painless. obviously, the druggie thingmight have been a distraction, they do that in PLAB1.the answer to that was - check thy. hormone levels..

pseudomonas correct.otosclerosis correct.head trauma [extremely stupid question] correct.cataract correct.

There was a man with generalised seizures and decreased level of serum glucose - tough one. i

got it wrong, think i marked something like a pit. tumor or summat.

there was a question: a post-morteum report. An old man who had amnesia, and died of intestinalobstruction, the pathologist report stated that there were multiple nodules (not sure here)scattered in the liver, urmm, with center depressions of 0.0016 mm? was it like that?options were:A-HCCB-CirrhosisC-Secondary CA

secondary CA ...becoz in carcinod syndrome pt present with liver metastasis.

patient with amphetamines misuse and is not ready to stop it, want to have a safer option

Is it metadone?

no its dexamphetamine.

a patient with alcohol problems is not ready for strong body reactions, wants to stop alcoholWhat is it?

acamprosate.



disulphiram would cause those bad reactions.

theme on burns

superfecial burn with erythema on dorsum of the hand,no blisters what was the treatment

dress it with antibacterial(something like that) or just paracetamol?

other one partial and full thickness burn with signs of compartment syndrom is it escharotomy?

SBA

lady with Heavy vaginal bleeding with clots ,treatment?I think it was combined pils, am I right?

concerning the ovulation day.. i think the right answer is 21 and this question is repeated..in any lady for any test of ovulation.. 14 days "luteal phase time" are substracted from the nextexpected menstruation.. and the time of ovulation ranges till 48 hours.. so applying it here.. 32-

14= 18 and if u add 2 days it will be 20.. so 21 one is the nearest and usually made a day after tobe sure of ovulation and calculation mistakes

i guess combined pills too,

superficial burn in a child with erythema.. i guess paracetamol is suiting because it mentioned thechild was crying and irritable

man worked in ship yard for many years came with pluritic pain and unilateral plural effusion,what treatment will relief his symptoms

Although i answered chemotherapy cos its case of mesothelioma but i think that was trick coswhat will relief his his symptoms(plural effusion) would be plural fluid aspiration. what do you

think?

for the first one.. i wrote mid ulnar fracture

the second one.. since there's no deformity.. i went for spiral fracture of the humerus... first, ithought about proximal humeral fracture but in this type of fracture.. it has 4 subtypes accordingto Neer's 4 segment classification, 1 fragment fracture, 2, 3 and 4 fragment fracture.. the only onewhich can be treated with collar and cuff since there's not displacement is 1 fragment fracture..but other types need internal fixation as there's deformity to be corrected and it can't be doneexternally especially when greater tuberosity is affected..

aspiration. 'immediate relief of symptoms' was the question.

man who raised hand above head - ulnar fracture.

clots - cocp.

child burn - paracetamol.

compartment forearm - escharotomy.



soot in mouth - intubate.

man with hand burn no blisters - dressing

progesterone test for ovulation - 25 days.32 minus 7 days.

exactly 25.

ref - OHCS.

*the lady with heavy bleeding with clots: i think antifibrinolytics ( Tranexemic acid)*man with mesothelioma: I wrote Pleural flud aspiration

Fracture theme:* man couldn't raise his wrist from the table, they said some injury around the shoulder, so I wroteHumeral Neck fracture*the guy who got hit by the bat: Ulnar fracture*the old lady who fell down and now had slight restriction of movements: Fracture of the clavicle

*the 8 yr old girl or boy who fell down the tree: Supracondylar fracture* the first one with the boy who had some pain around the wrist: I thought it wud be Scaphoidfracture (not sure)

or fracture I had this papers and the answers were as follow ,but dont take it guarantee cos noone is 100% sure

the pld lady tripped while shopping is fracture neck of humerousunlar fracture as all answered itdrop wrist cos of radial nerve lesion which is common with spiral fracture of humerous

fracture scaphoid with little odeam

fell on outstrech hand and abscent radial pulse is supracondylar fracture.

he guy with DVT INR in preassessment should be?

i checked it now.. u r right, the test is mid luteal as they say.. 7 days.. but the reference i readgyne from wasn't OHCS and it says it should be taken in serial samples starting from day after ovulation ending with midluteal sample for a thorough confirmation..

the case with DKA and asked for investigation i have practiced it before but answered wrong .

correct answer was arterial blood gases

Fracture theme:* man couldn't raise his wrist from the table, they said some injury around the shoulder, so I wroteHumeral Neck fracture too*the guy who got hit by the bat: Ulnar fracture*the old lady who fell down and now had slight restriction of movements: if this who have shoulder pain with no deformity, i wrote spiral radial but not sure.. clavicle can be right*the 8 yr old girl or boy who fell down the tree: Supracondylar fracture* the first one with the boy who had some pain around the wrist: I wrote is colle's but i guessscaphoid is the correct



the question about man with hypertention for long time and has microalbuminuria ,blood pressurewas withen normal and some other values what treatment

ACE-------------i chose thisB blocker thiazide

other them the patient with digoxin,frusemid ,..etc what to add

somebody before exam was reading some past papers and that question was there so i learnt theanswer and it was thiazide was it correct?

young man with tight chest and feeling his heart racing but normal ecg and once it was 200 ,itsnot possible to be sinus tachycardia ..i chose pheochromocytoma------ what you think

there was oartic dissection, muffled heart sound was cardiac temponate isn`t it?

somebody tell me for sure the one with CF and on flucloxacillin with green phlem was H.influan.or psuedomonous?

HIV with pnuemonia was pnuemosystic (not carrinni) was different name

he theme about Dyspepsia: causative agent: (I've made mistakes in this one)* the boy who smoked a lot came with pain...: I wrote H.pylori as smoking wasn't there in theoptions*one was lady intolerant to Nsaids: I dont know what is right coz, I couldn't understand the qs( ithink steroids should be its ans)*75 yr old man who had been experiencing dyspepsia since many years and also acid reflux, nowpresent with increasing dysphagia for solids : I wrote Barette's esophagus

*there was one with a man with long term treatment of chronic back pain, now presented withpain in the abdomen: I wrote Nsaids as the ans

was there another one with multiple ulcers i chose gastrinoma.

the question about man with hypertention for long time and has microalbuminuria ,blood pressurewas withen normal and some other values what treatment

ACE-------------i chose this_I TOO CHOSE THISB blocker thiazide

"somebody tell me for sure the one with CF and on flucloxacillin with green phlem was H.influan.or psuedomonous? " YES I THINK PSEUDOMONAS

*MUFFLED HEART SOUND: CARDIAC TAMPONADE*There was one with Lady having 'missed beats' sometimes and then she's a gain well: IS ITVENTRICULAR ECTOPIC?*An elderly 1 month after MI came with palpitations and .....: I wrote VT ( since after MI), is itright?* Another woman who felt palpitations and maybe breathlessnesss, but feels ok after exercisingor walking: is it SVT?



* An athelete qs with sometimes slow pulse , I think,: I wrote SINUS BRADYCARDIA*Another was a woman with palpitations, regular pulse, weight loss, constipation: (it was thyroiddisorder but I was confused in this one) I wrote SINUS TACHYCARDIA?*Another with an old man after colectomy due to colon ca: presnted with irregular pulse, I thinkfaintness too...and some other symptoms: I chose AF

1)man raised his arm to protect himself...so probably ulna is exposed,therefore answer was ulnar fracture

2)72 year old woman fell down,tht was fracture neck of humerus becuz tht is common in femalesin tht age group after sustaining a fall

3)pain distal to radius but no obvious deformity,answer was scaphoid fracture

4)pt who couldnt raise his wrist from table,answer was siral fracture of humerus becuz radialnerve gets damaged(radial groove in humerus)

5)i cant remember the other question..it was related to supraconylar fracture of humerus

QA 5th was a boy fell on outstreched hand and i think it mentioned that radial pulse was abscentwhich is difinetly cos of supracondylar fracture

UTI themi chose

first was trimethoprimthe one with protues i chose gentamycin

i think one i chose vit. c cos there wasnt prophylactic antiboitic in the option with child whichtreated successfuly with uti.

cenario indicated sarcoidosis and asked for the painful,raised skin leasion i chose erythemanodosum right?

and lesion on nose for many years was is BCC?

*a man who had been experiencing back pain since they had shifted ( Disc prolapse). what is themanagement?a)bed rest + analgesiab)early mobilization+analgesiac)wear a corset

d)manipulationetc

Another one:A man 20 yrs, chronic back pain. What wud be theinvestigation of choice?a)Ct lumbre spineb)Xray lumbreC)Mri Lumbre_I think thisetc



yes it was erythema nodosum

& second was basal cell . u r right

renal theme what was the one with red cell cast and s.creatine and uria raised? I THINK IT WASACUTE GN?

m not sure but the one who had chronic back pain but i think he had ankylosing spondylitis sowe'll do x-ray lumbo sacral spine

I chose mobilization and analgesia but not sure at all .yes it was disc prolaps

In OHCS they have written mnagement of Disc prolapse: analgesia + early mobilization aand alsoPhysiotherapyI chose manipulation, but I think 'mobilization + analgesia' wud be the best ans

yeah nephro syndrome was in the options but it was for a different scenario,remember pt. withproteinuria,hyperlipidemia etc..

trauma theme

2cm stab in epigastrium cant remember .

but one with rupture spleen(fracture ribs in left lower ribs) investigation i chose us of theabdomen.

biobsy taken from colon after few days with pain ..etc sounded like gas under diaghram so ichose erect chest xray.

in depression theme.. woman with post natal depression..i wrote fluoxetine.. it's in OHCS

Madiha wat was the answer for the question:SBA-Pt after MI had depression:amitryptillinefluoxetineetc

*I wrote Fluoxetine, suitable for a heart patient.*For the lady with postnatal depression, I chose Interpersonal therapy, as I thought it wouldn't beappropriate to bring her directly on Fluoxetine( that I thought should be the next step)

SBA:*A 30 yr old man took 100 paracetamol tabelets, nowhe's in A n E. You want to give himtreatment but he hassimply refsed and doen't allowany treatment. Next step?a)treat without his consentb)assess his mental state_IS THIS THE ANS?c)leave him as he isd)assess his rights something....

can anyone tell me the answer for the elderly man in his seventies who required pneumonia



vaccine? pneumovax wasn't an option......was it influenza vaccine?

1-topical estrogen(female,74,dysuria)2-16 weeks pregnancy->amniocentesis3-mg sulphate to prevent further eclampsia4-pre eclampsia(8 days postpartum,headache,visual distrurbances)5-endometritis(fever,tender uterus,prolonged delivery and forceps extraction)6-breast milk jaundice-->continue breast feeding7-indirect inguinal hernia->pass through deep inguinal ring8-sweat test in cystic fibrosis9-investigation for CHPS(i made it ct abdomen but i think it is US )10-celiac disease(wasted buttocks)11-child with UTI->trimethoprim12-haemolytic uremic syndrome(anemia,thrombocytopenia,increased urea and creatinine)13-CRF(raised urea,creatinine and K)14-nephrotic syndrome(heavy proteinuria,hypervholesterolemia)15-haematuria,increased blood pressure and urea->renal biopsy16-constipation and failure to thrive ->thyroid function test

17-meningococcal infection(fever,headache,rash)18-reflex anoxic seizure19-proctalgia fugax20-anal fissure(pain with defecation,hard to perform PR coz of spasm)21-acute perianal haematoma22-carcinoma rectum23-treatment of trichomonas vaginalis ->metronidazole24-cervical ectropion25-endocervical swab(bilateral pelvic tenderness and vaginal discharge)

ON ECG st elevation in leeds 2 -3 and avf it was inferior mi and it was in option list

ohcm 7th edition page 84 : the leeds affected reflect the site of infarctinferior: 2 -3 and avf anteroseptal:v1-v4anterolateral:v4-v6 1 and avlposterior: tall Rwaveand st depression in v1-2

theme on anaemia1 pt with macrocytosis and intrinsic factor antibody present..pernicious anemia2 vegan with increased MCV ,...b12 deficiency dt diet3 65 yr old man with splenomegaly,hepatomegaly....chronic leukemia

26-PID ,gonorrhea appeared negative-> chlamydia27-candidiasis(vag. discharge and mycelia)28-herpes simplex(superficial dysparonia and vesicle at introitus)29-ovulation test(progesterone at day 25)30-CA 125(female worried she might have ovarian carcinoma due to family history and pelvic USis negative)31-bacterial vaginosis( clue cells)32-MRI pituitary for features of hyperprolactinemia33-MRI brain for M.S



34-X ray lumbosacral for ankylosing spondylitis35-iritis in ankylosing36-woman in depot provera and menstrual irregularity->reassure37-pernicious anemia(intrinsic factor ab)38-aplastic anemia in patient with cyclophosphamide and pancytopenia39-chronic leukemia(lymphocytes were 500 000)40-staph aureus(organism for breast abscess)41-male with cancer prostate->PSA42-male with cancer prostate and pain in back and hip-> bone scan43-pneumonia allergic to penicillin->erythromycin or clarithromycin(actually not sure if that wasreally in the exam or was something i did before the exam)44-cardiac tamponade(stab 2 cm in sternum)45-RTA ,increasing pain and tenderness over the left lower ribs-> i went with splenectomy46-CXR erect for perforated colon after colonoscope47-antibiotics for conjunctivitis48-psoriasis(female,scaly lesions appear and disappear with family history)49-pulmonary embolus(female,post op,acute dyspnea,leg is normal)50-female 48 hours after CS with 38.1 fever->i went for UTI

the lady who was in nursing home s/s of scabiesohcm page 404 7th edition:only treatment 4 scabies is apply 5%permethrin wash off after 8-12 hours repeat after 7d

pt who was alcoholic and with s/s of hypoglsemic wots the immidiate tx so my dear it was glucosenot vitaminand pt who present with fracture not able to raise elbow was spiral humrus shaft fracture

51-patient with mesothelioma->i went with chemotherapy but i guess it is pleural aspiration52-ECT for depression with suicidal attempt

53-nurse depressed,keeps washing hera hands and cleaning subjects->i did it interpersonaltherapy but i dont think it is the right answer 54-OCD(boss who returns home many time during the day)55-flight of ideas(jumping from one topic to another)56-pressure to speech(speaking with no interruptions)57-insight58-Crohn"s disease59-investigation for rupture urethra->ascending urethrogram60-C T abdomen for kidney injury(haematuria once)61-scaphoid fracture(pain in the wrist just distal to radius after a fall)62-transverse fracture ulna63-spiral fracture humerus(with no deformity)64-supracondylar fracture humerus(pain ina arm and forearm)

65-fracture clavicle(alcoholic fell and cant left his wrist)66-ACEIs for patient with microalbuminuria67-cancer head of pancreas68-ventricular ectopies69-SVT70-sinus tachycardia71-AF (i actually chose it as an answer for 2 questions but i dont think i made it right in thearrhythmia questions at all)72-SLE73-NSAIDs(patient with chronic backaches and haematemsis)



110-midline laparoscopy(pierce linea alba)111-B12 defeciency (diet),vegan with macrocytic anemia112-iron defeciency(blood loss),i dont remember it and not sure about it113-anaesthesia and intubate for old man who was on fire and coughing rusty sputum114-Basal cell carcinoma115-hepatic metastasis(multiple hepatic focal lesions with umbilication)116-macular degeneration117-diabetic retinopathy118-CT scan for subarachnoid haemorrhge119-treatment for scabies(i made it hydrocortisone ointment but i think it is perimethrin)120-VWD121-paranoid delusion122-agoraphobia123-stop warfarin and add heparin124-foecal impaction management(i did it urinary catheterization aasuming that there isaccompanying urinary retention ,but i think that was an extreme thinking)125-woman with TAH& BSO with ditended dense abdomen->aspirate126-skin swab for viral serology127-a woman with menorrhagia and blod clots->i went for antifibrinolytics128-aortic dissection

129-H pylori infection130-Vit C131-analgesia and mobilisation for backache after moving furniture132-assess his capability to refuse treatment( man with paracetamol suicidal attempt),i dont knowif it is right or not

90-anterior infarction(elevated ST in v1->v4)

i thought that was ventricular aneurysm, after his MI.

he had no signs or symptoms.......

alcoholic who had hypoglycemia had sighns & symptoms of wernick encplpthy...search it in ohcsand ohcs,its somewhere in it... they state:"in alcoholisc/wernick with hypoglycemia...give IV bolus of thiamine 1st then dextrose cozdextrose will worsen wrnick's encplpthy...IV bolus thiamine followd by dextrose..."confirmed...

*IN SCABIES,THEY HAD ASKED FOR INITIAL TREATMENT FOR HER SYMPTOMS I THINKIT SHOULD HAVE BEEN CHLORPHENRAMINE,PERMETHRIN IS THE CURE OF IT BUT ITCHMAY PERSIST FOR WHICH H1 BLOCK(CLRPHNRMNE)IS GIVEN..

*FOR INCONTINENT OLD MAN WHO HAD FECAL IMPACTION ON EXAMINATION,I WENTFOR PHOSPATE ENEMA*FOR THE MAN WHO HAD SOOTY COUHG ETC,I WENT FOR SAFEGUARDING REFERALBUT I THINK IM WRONG AND IT WAS INTUBATION,BUT IMNOT SURE

for amphatamin answer z naltraxon????FOR CF PERSON ON FLOXACILLIN PROPHYLIXIX I WENT WITH staphlococcus aurius as hez on floxacillin.



few more twisted q1....women with multiple lymphnodes on drugs i went wiht tb as tb z commen in drug absers2...child with vomiting containing blood..i wrote endoscopy3.......21 year old girl with heavy bleeding and clots i went with ANTIFIBRINOGEN was thinking of levonorgestril but there was no history of pain and ocps ar not given for clots4 girl with defness after child birth .. i answered congenital sensinural defness coz according toweber test it was sensinural5....child with hearing difficulty noticed by teachers in school answer chronic otitis media witheffusio6which drug to add in 80 year old man already on frusamid gtn i wrote nefadapin as ca blocker ar given in old people after diuretics7women with abd pain after ovarian cancer surgeryans...ivp to see mets8.. got wrong for person on warfarin i answered continue warfarin with hepar people do comment

well for a person with type 1 diabetes with bmi of 32 i wrote hba1c level coz she was admitted for operation and to c her 3 month bloog sugar level we go for this.dont know i am right or wron

for tht SBA, the correct answer was :

evaluate pt's capacity to refuse treatment

5-endometritis(fever,tender uterus,prolonged delivery and forceps extraction)9-investigation for CHPS(i made it ct abdomen but i think it is US )

It's USG only10-celiac disease(wasted buttocks)

104-capillary blood glucose(pre op investigation for obese male ,diabetic with BMI 32)

I think the ans for this is HbA1c since he is obese and we have to know whether he is on regular treatment and also,they have already mentioned that he is diabetic.

that question was about 55 years old man,smokes 20 cigerrts/day,breatless,wt.loss,syncope,orthostatic hypotension..... The answer was Chest X-ray becuz itis the initial investigation for lung cancer.

CHPS.. chronic hypertrophic pyloric stenosis..i made it US.. i guess this was a child presenting with vomiting and haematemsis.. so it soundsmore like CHPS

yup madiha i too read that the glucose/dextrose would worsen the thiamine deficiency...but i readthat in davidson's.something about thiamine being used in carbohydrate metabolism, as a cofactor or summat.

thus the dextrose first wud decrease the b1 even more....

just checked: wiki thiamin, you'd see this:Thiamin pyrophosphate

Thiamin pyrophosphate (TPP), also known as thiamin diphosphate (ThDP) or cocarboxylase, is acoenzyme for several enzymes that catalyze the dehydrogenation (decarboxylation andsubsequent conjugation to Coenzyme A) of alpha-keto acids. Examples include:



* In mammals:o pyruvate dehydrogenase and α-ketoglutarate dehydrogenase (metabolism of carbohydrates)o branched-chain alpha-keto acid dehydrogenaseo 2-hydroxyphytanoyl-CoA lyaseo transketolase (functions in the pentose phosphate pathway to synthesize NADPH

and the pentose sugars deoxyribose and ribose )

think the question was going for an emergency procedure for air way obstructionand that would be cricothyroidotomy in the cricothyroid membrane...concerning tracheostomy it is not an emergency procedure and it is done at the levelof 2nd and 3rd tracheal rings

for the poerson with delerium tremens i wrote clorodizeperoxideit was not wernicks

sorry i disagreedelirium tremens will present with tachycardia, hypotension and tactilehallucinations..hallucinations were absent.. and ataxia were present proving it's Wernick's..reference OHCSit was wernicke"s encephalopathy,not delirium tremens..so the answer was thiamin

another question of an old lady with influenza n after symptomatic trtmnt she againcaught it i went for immunodeficiency can somebody help me in thati wrote reinfection due to low immunity

there was a q with boy treated with antibiotics still presents with cough ct scanbronchoscopy were optionsyes that question was the presentation of foreign body and the answer wasbronchoscopy

african lady posted for myomectomy..which investigation to do in per opoptionscoagulation screensickle cell testingfull blood countdont remem last onei wrote sickle cell testing

on the question of the alcoholic who had been treated. recall the question states thatthe patient no longer had withdrawal symptoms. since thats the case then whychlordiazepoxide? i think it was Vit B cos question emphasized poor nutrition.

the lady with the restricted eye movement was tensilon test. myasthenia gravis was

the diagnosis

urine with leucocytes and nitrites. i think its Proteus

the lady with the restricted eye movement was thyroid tests.

they clearly mentioned lid lag,NO DIPLOPIA,



exophthalmos

what else do you need to think of graves?

myasthenia has diplopia.

HOARSENESS:*a lady 25 yr age,iv drug abuser present with recent onset cough hoarseness andcervical lymphadenopathy...

i wrote hysteria for it...reference OHCM 7th edition pag 568.it states if a patient presents with hoarseness and can cough,it means his adductorsof vocal card are functional and is not true paralysis of adductors..it states it happensin times of stress in young ladies.plz read that page..

yes thats boy age was 3 years but "unfortunately"(lolz)he had unilateral focalseizures not symetrical generalized tonic clonic seizures,thats why it couldnt befeb.convlzns

if so can u remember the the forth choice coz i can't remember what i did it??HbA1Cserum glucosesickle cell testwas it clotting factors??but generally if sickle cell is mandatory, it's not a priority man.. and if she's diabetic,the priority is to control diabetes pre-ops then rule out other possibilities like sicklecell

can any body recall two themes in Obs one with a 14yr. girl having p/v bleeding btuterus bulky n no poc second was a lady with IVF n bleeding there wereinvestigations required in the answer

there was a q related 2 bone scanthere was another q physci answer was adjustment disorde or social phobia for aperson who has difficulty with his new jobinvestigation for cholestasis ultrasoundnurce with ocd ...behaviour therapyamphatamin ....naltraxon or methadon?

yes u were wright in wernick encephalopathy rx of choice is urgent thiamine toprevent irreversible korsakoff syndrom and it on ohcm page 706 7th edition,

the question abt bone scan was... pt with prostatic cancer presents with pain in back&hip

about the pt who changes his job..the answer is social anxiety disorder

ppl i dont know wether m right but for tht female diabetic pt. with high BMI,she wasfrom Africa so i chose sickle test becuz there was no point of mentioning her country



of origin. Isn't it?

Well guys about the african ladyhere's some clear point:

* Page 553 OHCM 7th edition, pre-operative tests.. blood glucose if diabetic thencomes Sickle tests is done in those from africa

* so both answers are correct and it has to be one of them more correct than theother

* if u are a surgeon or anaesthetic, what'll be important for you the most?? or whatwill be the priority??

* i guess a diabetic can never be operated without diabetes level and control.. but toa less extent a history of no chronic anemia, hemolysis or crisis can rule out sicklecell anemia to some extent.. but my point is sickle test can be clearly done but not asimportant as blood glucose in diabetic..doesn't it make sense??

* i think the twist in mentioning the country of origin is to confuse u..

can somebody recall the question of heroin addictionnaltrexone for heroin addiction

A 30 yr old man took 100 paracetamol tabelets, nowhe's in A n E. You want to givehim treatment but he hassimply refsed and doen't allowany treatment. Next step?a)treat without his consentb)assess his mental statec)leave him as he isd)assess his suuccide attempte ... sumthng

i did the mrsa question the sam as u di...take swab from all the staff

what about child with respiratory infection having ear problem

i answered h influenza

a child with pyloric stennosis which one should b the answer

US or upper GI endoscopy?

i went for endoscopy

baby got jaundice after breast feed what should b answer for management cananyone explain pls.continue 2 breast feed, 4 months old child.

A 30 yr old man took 100 paracetamol tabelets, nowhe's in A n E. You want to give



him treatment but he hassimply refsed and doen't allowany treatment. Next step?a)treat without his consentb)assess his mental statec)leave him as he isd)assess his suuccide attempte ... sumthng

Ans: dits a repeat from october 07

some other answers

1-claithromycin again in a legionella suspected case .

2-mycoplasma pnuemoni (bcterial causes theme)

3-pnuemosystic in HIV patient

4-penecillin (case of boy with suspected GN due to streptococcal A infection.5-endoscopy (for child with features of reflex oesophagitis not for pyloric stenosiswhich needs US)6-in trauma theme (I think) features of rupture speen but mentioned his conditionstable I chose US abdomen as mgt.7- Psoriasis child with skin nd scalp rash and her aunt had similar condition8-standing and lying blood pressure measurement(I cnt remember the theme)9-24 hr Ambultory ECG (I cnt remember theme)10-echocardio(in theme with valvl heart lesion)11-Brain tumour(not sure thats in a child with seizure nd focal neurological sign).12-urine cathetarisation(theme with acute urinary retention without mentioningblood on urithral meatus which is contraindication for cathetarisation)I think it was intheme on perinium bruises after trauma.13-reassurance and review after 3 months(lady with amenorrhea after using depoprovera)14-IV ntiboitic for child with features of acute epiglottitis

Sorry if answers are wrong or mixed up with other given answers,

substitution for amphetamine is definitely dexamphetamine........i have observed thispractically

a kid with 4,5 dys history of diarrhea no signs of dehydration thriving well i went forcontinue the normal diet can anybdy recall

About MRSA.. true patient should be isolated in a separate ward.. but i remember thetheme was about a patient who's been diagnosed and treated right??? and the optionwas to transfer all the surgical wardbeside in same page in OHCM.. it says surveillance swabs from patients and staff during outbreaks are to be made as a preventive measure..so i went for this as the patient seemed to me he's treated and must have beenisolated..



i remem one more qus..pt with hist of stroke 6 mths back treated for seizure ,nowsince 2 wks dizziness ,nystagmus,confusoin.i wrote ...drug levelwhat abt others

Pt can not lift the wrist > Its # involving the spiral grove and ulnar nerve> wrist drop

Old lady fell on out streched hand > # neck of humerus

Well guys about the african ladyhere's some clear point:

* Page 553 OHCM 7th edition, pre-operative tests.. blood glucose if diabetic thencomes Sickle tests is done in those from africa

* so both answers are correct and it has to be one of them more correct than theother

* if u are a surgeon or anaesthetic, what'll be important for you the most?? or whatwill be the priority??

* i guess a diabetic can never be operated without diabetes level and control.. but toa less extent a history of no chronic anemia, hemolysis or crisis can rule out sicklecell anemia to some extent.. but my point is sickle test can be clearly done but not asimportant as blood glucose in diabetic..doesn't it make sense??

* i think the twist in mentioning the country of origin is to confuse u..

hi doc aserief i chose blood glusoe for this question but i think i was wrong .ohcm 7thedition on page 326 clearlly written thatin <ahref="http://www.rxpgonline.com/forum105.html">Anaesthesia </a>,when vaso-occlusive events may occur,so all thoseof african descent need a sicklcell test preop.

Hey doctor..i guess the point is so clear.. a diabetic can't be operated without control, right???this is the priority.. and sickle test can be done after.. and the thing is i work in africaand it's a trivial and never been done..i'm asking everybody.. if u are an anesthetic.. which is more important to you?? a

disease already there and need to be controlled.. or a disease might be there andneeds to be screened??

for PYLORIC STENOSIS investigation is ULTRASOUND,not endoscopy.plz read page172 OHCS(specialities)....

it states ultrasound detects it,but is only needed if clinicl examination isnegative.infere urself and read the topic in paeds.



dears most have written MACULAR DEGENRATION for yellow spots on center of retinaof young man(age i dont remeber)in that loss of vision theme...i disagree with that,coz macular degenration happens in late age ONLY...thats why itscalled "AGE RELATED macular degenration...

plz read pag 438 OHCS

Yes

it was Senile Macular Deg, Macula also known as Macula Leutea meaning yellow spot.Only in this condition you get Crumpling of TV screen Picture.

Black against redreflex > Cataract Due to steroids usage

Otherone with Micraneurysm > Dabetic retinopathy

Bacterial conj. ( I may be wrong) But all should look at the question> it is crusting notmatting as it will be in Bacterial conj. Crusting occurs if the secretions are scanty andit is typical of Allergic or viral not as you are all saying Bact conj. If you look at theOHCS , in case of allergic conj Steroid can be used with specialist advice. All you maybe wondering about my argument, Show me one bacterial condition with Itching, anditching was mentioned in the question. Only one clue I am missing is the number of days pt suferred, if it is more then Steroid is the correct answer. GMC is correct andultimate.

the lady with the thick endometrial lining on pelvic uss but no free peritoneal fluid i.eunder the theme of ectopic pregnancy, the thickness is in response to high b-hcg socheck b-hcg. if raised, then high likelihood of ectopic preg. b-hcg 1st thenLaparoscopy to confirm + treat

does crohn affect rectum +bloody diarrhoa?25% of patient with UC have skin tagi think granulomatous lesion was seen in endoscopy.. and this favours crohn'

dis is regarding scabies treatmentto alleviate itch-antihistamine and calamine lotion is giventreatment is wid permerthin ointment as we all knowi guess this qestion was asked in feb 09

progestrone level should be done 7 days before next period.25 day is ans for 32 daycycle.

its so strange no one has mention Gynae questions in which a lady has tranversebaby in the womb waht complication she will have.does any one remember other question regarding cessarian section



hi there was a question about asthma in a child (cannt remember age) has acontrolled asthama and is on loe dose syeroids and short acting bronchodilatorscomes with a complain of cough at night...A..add long acting bronchodilaters orincrease dose of steroids... most people thought increase dose of steroids,,,,y...as ynot add long acting bronchodilators??

he is already on short acting bronchodilator..still c/o night cough..he shd be givenlong acting bronchodilator..i wrote this in exam.

I answered with increase dose of steroid and I passed my exam ,if you go back toOHCM u will see that next step after that is high dose steroid according to British

Thorax guidence.

Iam sure about the answer.

The answer is long acting beta 2 agonist as per the British Thoracic Societyguidelines of asthma management.

well i think the first is usg abdomen and the second Detrusor muscle paralysis

plab paper maybe feb 2009

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