PLAB 1, MAY 2024

Let's add the details for the benefit of the next group; just like the previous group did for us

Rheumatology

  1. Carbamazepine for trigeminal neuralgia -
  2. The treatment for the lady with Raynaud= nifedipine
  3. Osteoarthritis patient pain not controlled, on aspirin for MI. What to give next? Codeine PARACETAMOL
  4. scenario of GIANT CELL ARTERITIS , drug was pred= PREDNISOLONE

Neurology

  1. Pseudodementia
  2. Neuropathy due to chemotherapy
  3. Cyclizine for Parkinson
  4. Old man with warfarin, fell had some neuro symptoms for 4 5 days.  = CT SCAN
  5. antipsychotic induced extrapyramidal symptoms,>Bradykinesia, dysarthria, tremors……….substantia nigra

Cardiology

  1. Reduce long term complication in TIA with Afib=Apixaban
  2. New onset Pansyatolic murmur with fever=Endocarditis, they asked initial ix. Is it blood culture or echo?
  3. That for q risk?17%=statins
  4. chest pain on inspiration,sob,  x 24hrs…Tachycardia= Costochondritis? PE?
  5. Orthostatic hypotension=Indapamide quest?

ECG

  1. Mobitz type 2, brady 36 most next appropriate =Permanent pace maker or IV atropine??
  2. Was there diffuse STE on the ecg?Any answer with pericarditis ?dissection?
  3. Torsade de pointes most likely drug causing this ECG=Citalopram toxicity
  4. 35 or 25 year old lady with chest pain and shortness of breath=PE S1q3t3?
  5. The one with ecg of Hyperkalemia= Ans - urea and electrolytes?
  6. ECG of MI ST-elevation is seen in leads II, III and aVF? = Inferior wall MI

Nephrology

  1. Bloody diarrhea and blood film shows ,schistocytes, helmet cells, Which organism=E.coli HUS
  2. Male 2 days ago urti, mic hematurria=IgA glomerulonephritis ??
  3. Middle age woman with edema, Proteinuria, To confirm diagnosis=Renal biopsy?
  4. Hypertensive renal disease= B/l small kidneys
  5. Woman with costovertebral angle pain, Blood in urine , Fever= CT KUB next investigation

Infectious

  1. Genital herpes: pregnant, discomfort, 2 vulvar blisters
  2. In 30m with anal wart: HPV
  3. CMV in 1 year old baby most common long term complication= hearing loss/deafness
  4. Ut was viral encephalitis right?
  5. Bilateral tonsil enraged with exudate organism= Group A beta-hemolytic streptococcus
  6. Was there any thin and thick firm ? Returned from Africa, took malaria prophylaxis, fever, meningeal signs
  7. doctor pokes himself with the needle of the pacient, do u ask for hiv exams for the pt or ask consultant first?Needel prick from iv drug user= Hiv prophylaxis
  8. High fever, metabolic acidosis, high lactate and low bicarb ?  IV baicarb or iv methypenicilin

Respiratory

  1. Penicillin allergy, Known case of copd, Admitted for chest infection, Drug: doxycycline??
  2. needle decompression but that is in the 5th intercostal so i went with chest drain

becasue the answer was 2nd intercostalChest cannula insertion on left ? Chest drain on that xray?

  1. Man with orthostatic hypotension. Chest image middle lobe mass=hyponatremia
  2. There was a question with recurrent productive cough I think since childhood, cystic fibrosis and bronchiectasis in the options
  3. Life threatening asthma= altered CONSCIOUS LEVEL;
  4. The question with the bloody sputum with fever. Alveolar infiltrates. I think it was third or fourth question in the test.=sputum/bronchoscopy

Gastrointestinal

  1. Appendectomy, mass found,  Biopsy shows transmural infiltration of lymphocytes with granulomata  no necrosis, diagnosis? Crohns
  2. Pt with chronic abdominal pain and difficulty flushing I guess.
  3. Male .. 2 year after trip from Africa rectal bleed .... I did liver biopsy
  4. There was a question about mild /ulcerative colitis treatment, right? Rectal mesalazine
  5. Woman? After eating bloating =celiac
  6. Woman with symptoms of celiac. Which investigation for diagnosis? Ttg, Colonoscopy
  7. Right iliac fossa mass.=One eas ca of cecum.
  8. Villous adenoma=Hypokaemia?

Endocrinology

  1. Periorbital pain unsymetriacal pupil, direct eye reflex absent?Anti TPO for grave
  2. DKA= 0.9 % Sodium Chloride first
  3. Addisons disease- pigmentation, hyponatremia, hyperkalemia
  4. Double the dose of hydrocortisone before surgery
  5. Neck mass, dysphagia, normal TFT:  subtotal thyroidectomy
  6. primary hyperparathyroid too right? Primary hyperparathyroidism=Pth 8,Cal 2.8,Phosp 0.8 ?
  7.  Duloxetine for the diabetic neuropathy
  8. diabetic guy with 61hbac who was obese(33BMI)=Metformin

Dermatology

  1. Rugby player ? Eczema vs scabies
  2. Pt with crohn’s disease and rash in axilla =>flexural psoriasis
  3. Child with Molluscum contagiosum (photo)=Reassure?
  4. Melanoma spreading since 2 months urgent referral to dermatologist
  5. Woman who is a taxi driver ,Skin itchy rashes, Non sedating medicine? Cetirizine

Hematology

  1. DIC for septicemia?
  2. Pain relief for sickle cell ?I answered the morphine (again)
  3. One child with suspected ALL= bone marrow biopsy

  1. PE Splenomegaly, Blood pancytopenia, dLFT..Definite diagnostic test? Bone marrow biopsy, liver biopsy

Perioperative

        What was the pre-operative (day case rotator cuff) question the short acting insulin= skip lunch short insulin

Breast Surgery (4 questions)

  1. Bloody discharge around areola etcfistula?? was it CA?
  2. Fibroadenoma(non tender movable mass)
  3. The woman with blood from her nipples= intraductal papilloma
  4. Discharge pus= fistula

Vascular

  1. Pt had a painful, red, warm, swollen arm for three days. Cannula site shows no discharge. give antibiotics?? Remove iv and raise limb?
  2. Patient with cold and pulselessness around the right lower limb, femoral pulse was palpable => Superficial femoral artery occlusion

Ophthalmology

  1. Irregular pupil uveitis
  2. Fixed pupil photo,vomiting: glaucoma
  3. Subconjuctival bleeding eye= reassurance
  4. Bitemporal hemianopia on optic chiasm?

Orthopedics

  1. Chest X ray initial for Pancoast tumor
  2. Lady having back pain after shopping lifting=x ray
  3. Klinfelter syndrome, which rx needed?osteopenic = Vit d and cal
  4. Osteoporosis-bisphosphonate

General Surgery

  1. Dark urine pale stool jaundice=Pancreatic ca??
  2. Saag >11 Ascitic tap clear yellow fluid, Shifting dullness+= gastric ca/HCC?
  3. old man who had incidental finding of  third degree haemorrhoids = no ttment
  4. Post appendicectomy =paralytic ileus?

ENT

  1. Midline moving mass Thyroglissal cyst!??
  2. Urgent Hospital admission for peritonsillar abscess?
  3. Otitis media with effusion?
  4. Pure tone audiometry for old guy with sensorineural hearing loss??
  5. Hallpike test for bppv
  6. Ploysomnography?
  7. Oxymetry after OSA diagnosis
  8. kid with bilateral dull tympanic membrane=Grommet ?
  9. Unilateral hearing loss and tinnitus,Was there an MRI auditory meatus (I think?)
  10. Tympanoplasty done. Altered taste and decreased salivation on tongue=Facial nerve/hypoglossal nerve?

Urology.

  1. It was tamsulosin for psa dribbling
  2. Oxybutynin b tha?!
  3. That lady with pink colored urine and 3+ blood on urina refer her to the urologist?
  4. The guy with testicular pain=Urgent surgery review?
  5. Post op, UO 50, 70, 0. Onei question had urinary catheter blockade as the  answer?
  6. 60 y/o lady with abdo pain, dysuria, frequency>> next test? Flexible cystoscopy, rigid cystoscopy, u/s KUB, urinalysis

Obstetrics

  1. UTI in first trimester pregnancy = Cefalexin??
  2. Pregnant lady Hb 11.1 I think.no Action
  3. ulcer on gravid vagina, dysuria=Genital herpes
  4. A woman at 37 weeks GA who reduced fetal movements on CTG =LATERAL POSITION
  5. Pregnant 17w testing Amniocentesis?
  6. pregnant with pruritus = Ans bile salts level

Gynecology

  1. Continous HRT for flushes for that 55 year old woman with menstrual period before 8 years
  2. Women with features of UTI and browny discharge?? What next investigation?
  3. Missed pill so take missed pill immediately and 48hrs no intercourse?
  4. GIRL WITH ACNE AND COMEDONES= PCOS
  5. Acute PID= vaginal discharge+generalized lower abdominal pain
  6. Vaginal thrush treatment after Recent course of antibiotic=intravaginal clotrimazole
  7. Cervical ectropion, no bleed on touch.=Reassurance with safety netting?
  8. Woman with bloating etc.  Ca125 >110 Next step.=Us abdo ans pelvis
  9. Female who had removed an implant asking about preconception fertility ?80% will concive naturally
  10. Cervical cancer ( confuse between cig smoking and oral contraceptive ? Smoking cessation for sure We can continue OCPs
  11. Female who had breast cancer complaining of thirst and depression what electrolyte abnormality => hypercalcemia

Pediatrics

  1. Noisy breathing child,Drooling saliva >Epiglottis so call anesthesia team?
  2. Active infection is child 6 weeks old (E.Coli isolated) was it usg?
  3. Mother is worried about baby not gaining weight and she thinks baby has cow milk protein allergy,Continue feeding and stop diary in diet no?
  4. Child with a second seizure at ER= iv Lorazepam??
  5. Prolonged jaundice= continue breastfeeding vs Check LFTs and bilirubin
  6. 15 month old making monosyllabic noises, rest of development was normal.=audiologist
  7. Pediatric patient presenting to ER with febrile seizures=lorazepam
  8. The umbilical granuloma= table salt
  9. Constitutional delay I think teenage boy with no pubic hair short gyneconastia
  10. the girl with food selectivity, =or autism?

Psychiatry

  1. Schizophrenia for that guy with tv and messages ?(3weeks history of hallucinations)
  2. Woman with Social phobia
  3. Post mi antidepressants -sertraline
  4. Postpartum blues?
  5. Psych liasion team?
  6. Risperidone cause high prolactin (820)
  7. Pt insisting that he has HIV=Hypochondriasis
  8. There was a dantlorene (the mdma question)
  9. ADHD=Methylphenidate
  10. The pathway for erectile dysfunction= Mesolimbic pathway
  11. One answer was Delirium with 3 days history of onset?
  12. Question about patient requesting sick leave dt anxiety.. ?Ref occupational health

Pharmacology

  1. Clozapine (FHG) agranulocytosis(Full blood count)
  2. Use of risperidone and failed erection???
  3. Pedeal swelling due to ccb(amlodipine)
  4. Stop ACEI before surgery
  5. Mrsa =Vancomycin(osteomylitis)
  6. Diarrhea and vomiting plus on ssri aspirin and ramipril=stop ramipril
  7. Used for sore throat, Then Jaundice, Plus mildly derranged LFTS, Cholestatic hepatitis=coamoxiclav

Anatomy (3 questions)

  1. Winging of scapula=Long thoracic nerve damage
  2. ANS for hand lateral numbness and unable to touch thumb to little finger=Median nerve
  3. foot drop question after cast=Compression of common peroneal nerve

Emergency medicine

  1. Full thickness burn= Escharotomy
  2. Anemia of chronic disease,RA patient Black tarry stool, who was still in shock after administering multiple RCCs.=laparatomy vs endoscopy
  3. rhabdomyolysis case (both legs mobile, tall t wave in the ECG was given)= Ca gluconate

Toxicology

  1. CO poisoning sooth in mouth>>>High flow oxygen?intubate?
  2. Nalaxone for pinpoint pupil
  3. Bruises were all around his body and on the floor since 2 days,Substance abuse? Alcohol?
  4. The guy who was in the hospital for 2 days and got hallucination and was agitated and stuff Chlordiazepoxide
  5. Confusion,Ataxia and ophthalmoplegia, = thiamine
  6. Old man taking 6g everyday for 4 days,serum paracetamol level is 15g/Litre-Nacetylcysteine infusion
  7. ECSTACY overdose= Dantrolene
  8. Lithium drug about to start for bipolar disorder -Already done RFT and LFT,next test is -do TFTs
  9. ABG is given and history of tinnitus what is the metabolic disturbance?Respiratory alkalosis for aspirin?

Ethics and Law (5 questions)

  1. Family is Jehovah witness and are against transfusing blood but the girl wants to get blood and be alive = Respect girls (13 years)  wishes and infuse blood
  2. Patient diagnosed with cataract is still driving and refused to inform DVLA.Inform that you(doctor) will tell the DVLa
  3. Osa not diagnosed. Drives lorry. Instructions to give for driving=Stop driving car lAND lorrY?
  4. Elderly man with pneumonia and in the end stage,so doctors think it’s best not to resuscitate him,but he’s clearly not capable and don’t have advance directive and next of kin is daughter who is in France Regarding DNR.... daughter in some France...to complete DNR right is correct option,other options are wait for next of kin,resuscitate,wait for him to improve confusion to get capacoty
  5. 40 y/o Refusing treatment patient with end stage kidney disease and have a kin of friend=check capacity

Palliative care

  1. Cyclizine Palliative patient with vomiting and bowel obstruction , what was the answer??
  2. Ascending sounds heard on auscultation is given in the stem, which means rattling sounds Respiratory secretion=Glycopyrronium
  3. palliative patient with wheezes,=inhaled/nebulised  salbutamol
  4. Cerebral Metastasis  with vomiting and nausea=Dexamethasone
  5. GFR less than 18 Pain management=subcut Alfentanyl?
  6. Senna ? For palliative care(CA ovary?) pt with 4 day constipation. Reduced oral intake for 2 weeks, on morphine x 2
  7. Old lady wit liver mets vomiting 700ml blood and lady became so anxious on seeing the blood= Subcut Midazolam
  8. Palliative patient, breast Mets with recent prophylactic mastectomy confined to L2, treatment or action= radiotherapy
  9. patient takes 10mg  morphine 4 hourly,so what dosage of slow release morphine will u give=30 mg twice daily
  10. Palliative pt unable to swallow dt esophageal tumor compressing oesophagus=Oesophageal stenting

        

Critical care

  1. copd hyperinflated lung xray picture was given=niv(the first question)
  1. Pt had low ph and high co2
  1. PO2 is normal but PH is acidosis and co2 borderline high=increase ventilation

Genetics (3 questions)

  1. X linked recessive disease(succinylcholine apnea),mother is unaffected,father is affected=two brothers unaffected and and two sisters carriers
  2. yeah ,one was homozygous and one was heterozygous=25% for both c.f parents
  3. X linked disease affected Father percentage transmission to  male sons= <1%

Epidemiology (4 questions)

  1. NNT = 1/ (ARC - ART)= 10
  2. Relative risk=
  1. lung cancer 20(with smoking)
  2. lung cancer without smoking(10),
  3. smoking without lung cancer(80),
  4. non smokers without lung cancer(490).
  5. RR of smokers developing lung cancer is ARsmokers/absolute risk non smokers-20/100//10/500-10will be answer.
  1. 10,000 were in screening...
  1. 1000 needed 2nd test .
  2. 100 were positive...
  3. 10 who didn't need 2nd test came positive....
  4. What are False positive,
  5. 900 were ==false positive

10,000 women underwent for cervical cancer screening, 1000 were pre-malignant. Only 100 out of them actually had cancer, confirmed by biopsy. What are the false positive? (900)

  1. Another epidemology question was the cluster randomised control trial.one group were given incentives for a trial of new drug where was other group were not given and compliance is better in the group with incentives.