-PLAB 1 Recall JUNE 2017

JUNE 2017 PLAB 1 Recalls

Hello everyone! After discussing the questions with my other study partners, I was able to recall more than 195 questions from the June 2017 PLAB 1 exam. I have arranged them in this file with the possible stem I could remember. I hope it is of help for the current and future PLABBers. By the way, the highlighted parts are the questions either I made them wrong or am not sure about the answers. If you are going through the recalls, please keep us in your prayers and pray for our pass in the exam 😊 Regards, Afghan boy anonymous B.A

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Woman planning on pregnancy. When to check the ovulation day for a 32-day period. A girl with cystic fibrosis. The parents ask the chances of the future children getting affected. Key: 1:4 A baby vomiting, long stem with lab results. Hypokalemia was noticed. Key: pyloric stenosis The baby is hungry, vomiting. The lips were cracked. What is the immediate investigation: Urea and electrolytes Pyloric stenosis clinical feature, asking for abnormality: metabolic alkalosis 5 years old with lesions on some were crusted and others were weeping. chickenpox. Oral acyclovir 20 years old patient comes with swelling of the parotid and now suffers from orchitis. Management: Analgesia Lateral cutaneous nerve of thigh ERCP shows stone in a duct opening to second part of duodenum. What is the duct called: Hepatopancreatic ampulla Patient present with pain anterior to lateral malleolus. Key: Anterior talo-fibular ligament Sensation of the medial side of forearm, intrinsic muscles of the hand were affected. Abduction of the fingers were also affected. Options were: Forearm median nerve: others say T2 root The patient could not close they eyes. Key is Facial nerve palsy The patient presented with symptoms of Bell’s palsy two days after the onset. rx: prednisolone Paracetamol poisoning after 12 hours. Management: N acetyl cysteine Second question: Paracetamol poisoning after 12 hours. Management: N acetyl cysteine Patient comes with swelling in the scrotum which resolves on lying down. Asking for diagnosis: Varicocele A patient with a bluish swelling and bag of worms’ appearance on the scrotum. What is investigation of choice: Ultrasound scan for varicocele Patient in emergency, with symptoms of Asthma, drowsy and confused: Iv Salbutamol infusion or neb salbutamol Asthma: oral prednisolone, salbutamol n oxygen given: IV magnesium Asthma, eczema: oral chlorpheniramine Asthma, he is on SABA, inhaled steroids, exercise induced, nocturnal cough, patient gets symptoms on mild exertion: theophylline?? LABA according to the steps of a chronic asthma management Asthma on SABA. Next step: inhaled steroids Asthma, fracture, pain: paracetamol

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Sick looking child, fever, drooling of saliva (typical picture of epiglottitis): intubation IM adrenaline for child, stridor Dexamethasone for croup (bark like cough) Girl 14, boyfriend 15, asking for COCP: reject, tell parents, call police. KEY: give the pills and encourage to involve the parents Mortality rate in a population of 250 million, 950000 had MI, 250000 died. Absolute risk (10/1000 in treatment grp who died, 10/1000 in the non-treated died) ??? relative risk 2?? A person brought his wife who left alcohol for a few days. Fearful, agitated, anxiety: benzodiazepine A married woman, depressed (thinks she has cancer like her husband), on TCA for 3 weeks and there are signs of improvement, lost husband, now some weird thoughts: continue TCA Haloperidol injection for an agitated and violent schizophrenic patient Parkinsonism clinical features of medicines. What is the underlying condition. Key: schizophrenia Celiac disease presents with biopsy taken from gut had lymphocytosis picture: Lymphoma Arrhythmia picture, low blood pressure, palpitation (unstable so treat as SVT): DC shock Brady Arrhythmia picture HEART RATE 35 cool peripheries and signs of cardiogenic shock: amiodarone or atropine Sertraline for post MI depression Suicidal thoughts: no option of ECT so choose SSRI Suicidal thoughts, depression: risk increases with: alcohol no option of previous history of suicide Patient with anxiety, long term treatment: fluoxetine Agoraphobia picture Bipolar picture Patient on lithium has tremors n other side effects (like nausea n vomiting) medication of lithium above 1000, side effects: lithium toxicity 2 days old, deafness: brain evoked Laryngeal ca picture: risk factor: cigarettes Hematuria painless above 50: flexible cystoscopy Flexible cystoscopy second question Fever, rigors, south Africa: Malaria Fever, confusion, travel: Malaria Travel to Europe, now in UK: bloating, diarrhea: Giardia??? E-coli not in the options

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Maculopapular Rash, fever, Thailand: Dengue Episodes of abdominal pain and increased amylase. All other investigations normal. Options were alcohol, viral, bacterial…? (maybe chronic pancreatitis) Junior doctor, off, in a restaurant, sees a patient’s notes on one of the tables: call the police, inform the restaurant owner, open note and call GP, take note back to the hospital Lady unconscious, suicidal note: treat the patient till your best, wait till she recovers, calling relatives n taking consent Post-mortem death due to asbestosis: coroner Glaucoma case: measure Intraocular pressure Anterior uveitis: irregular pupil hypertensive retinopathy. Patient on nifedipine 150/90 blood pressure, dot n blot hemorrhages and macular exudates Lady on thyrotoxicosis symptoms with history of URTI: subacute thyroiditis On Amlodipine, painless, bilateral ankle edema, no raised JVP: SE of Amlodipine ACE Inhibitors and STATIN. DM patient with micro albuminuria, cholesterol raised, blood glucose normal IV drug abuser, Mid diastolic murmur, mitral valve problem: infective endocarditis PR normal, Long QT, in a child, fainting attacks since childhood: asystole no complete heart block in options, V Fib, V tach Old patient with Heart failure, syncope, reason: Stoke Adams or vasovagal? Pneumonia, cough, on ACE i: Keep the medication or withdraw lisinopril Harsh pan systolic, acyanotic: VSD Fever, chest clear pain increases with respiration: pericarditis Intercostal artery in chest drain SVT ECG adenosine Reflex anoxic seizure (temper tantrums, episode after a finger prick in a young child) Reflex anoxic seizure: I choose tonic-clonic (teacher sees boy falling down n going stiff but becomes normal soon) RA medication, low MCV: anemia of chronic disease or chronic gi bleed Driver, urticaria, non-sedative that doesn’t disturb driving: ceterizine, chlorpheniramine, steroid tablets, steroid cream Alcohol dependency definitive: GGT or drinking alcohol the first thing in the morning Tracheal deviation: tension Pneumothorax management Subcapsular hematoma: observe in surgery Cardiac tamponade: TIA driving: 1 month

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Over 35 years old patient, spoonful sputum of 18 months: COPD or bronchiectasis COPD non-responsive to some treatments nebulizers, steroids. Options were NIPPV or LTOT Flu plus bilateral cavitation: staph pneumonia PCA of Morphine after gangrenous appendix Patient controlled Codeine sulphate on oral, cannot tolerate: change to IV Inferior MI, morphine route: IV Antibiotics during induction of anesthesia BCC Melanoma: all ABCD GIVEN Depth of the cancer Painless vulvar ulcers: none of the options fit the picture Painful male ulcer: HSV PID treatment: ofloxacin plus metro Risk of ectopic: PID Lung cancer: adrenal insufficiency Lung cancer: SCC: hypercalcemia Lung Cancer: SIADH Prostate cancer treatment procedure: hyponatremia Meningitis: ceftriaxone Meningitis, neck stiffness, vomiting, headache, photophobia: ceftriaxone or Dexa (million-dollar question) Meningitis (no signs of raised ICP): LP Meningitis CSF: gram positive diplococci: streptococcus Intracranial pressure increased: Dexa Diploic or cerebral veins: old man presented with confusion days later after a fall Subdural hematoma Pulmonary embolism: 5 days operation Stony dull percussion with CXR showing fluid levels (Pleural effusion): pleural aspiration During surgery sugars elevated what would u do? FBS after operation Diabetes: stress hyperglycemia Pneumonia follow up: chest x ray Diabetes on gliclazide on operation what will u do: give insulin, dextrose and K or stop OHA??? Fasting blood glucose taken once: repeat the test Impaired glucose tolerance Alcoholic Tremor, hypoglycemic blood glucose 3.5, Wernicke’s, confusion and ataxia. What’s initial management: glucose or thiamine Alcoholic withdrawal, what to add: thiamine IV drug abuser, HB core antigen positive: HBV

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Celiac lady with distension when she takes wheat: allergy to milk and white Dilated Transverse colon symptoms of Ulcerative Colitis like bloody diarrhea: UC Increase dysphagia to solids, definitive: endoscopy Dysphagia, CA mid third esophagus: stenting Recurrent epigastric pain, intermittent dysphagia to solids, nocturnal cough: peptic esophagitis I.E GERD 20 years old, OTC drugs, jaundice, total bilirubin increased, AST and ALT normal: gilbert (no g6pd in options) Secondary metastatic deposits in a female. Most probable primary site of cancer: Breast cancer Women with colles fractures: definitive: Dexa scan Women with colles fractures third fracture in the last six months. Osteoporosis suspected, initial: Hypercalcemia or DEXA Thyrotoxicosis picture plus FBC shows decreased B12: investigation: TFT Thyrotoxicosis picture. Asking for the reason for dementia and neuropathy: b12 HB 17.8 Polycythemia picture: hormone, erythropoietin On warfarin, bleeding, INR 7: Prothrombin complex concentrate Elective operation, HB 8.5: defer and investigate 10 days old boy Viral gastroenteritis (hypo Na, hypo K, diarrhea and vomiting Wife died, severe headache: Subarachnoid hemorrhage: Subarachnoid hemorrhage: On warfarin, on h: Subdural hemorrhage Bruises on face or neck INR normal, coming from nursing home. Nonaccidental injury in old Permethrin for scabies Frontotemporal dementia. Inappropriate words Vascular dementia with history of previous MI and step wise deterioration Cervical x ray c7-t1 Post-menopausal comes with Bleeding: US, diagnostic hysteroscopy, MOST APP ANS IS ENDO SAMPLING BUT THT WAS NOT IN THE OPTIONS Infertile, dysmenorrhea, dyspareunia, (endometriosis picture). DEFINITIVE INVESTIGATION: Laparoscopy PATIENT couldn’t flex at PIP AND MCP: Flexor digitorum superficialis 7 years old, Metal spikes, vaccination yes: antibiotics plus immunoglobulin. NO ONLY IG OPTION Women 7-month menorrhagia: coagulation factor Cerebellum symptoms: MRI of the brain Intracerebral hemorrhage: CT brain Breast cancer on radiotherapy: Hypercalcemia Calcium treatment: IV infusion

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A vasculitis picture with hematuria negative ANCA positive ANA: SLE Sjogren treatment for dry eyes. artificial tears Inflammatory Chronic breast cancer: intra epidermal spread of intra ductal Ca Virchow nodes: gastric cancer Post gastric perforation: lesser sac Dribbling in an old man PSA 4.5: Benign Prostatic H Stress incontinence: Pelvic exercise Patient with pelvic fracture, on palpation bladder can be felt immediate management: Urethral catheterization Elderly patient, overflow diarrhea, constipation, fecal impaction and pain: Phosphate enema Proteinuria n edema, definitive diagnosis: Renal biopsy Post streptococcal GN patient which will stop the progression i.e. proteinuria: ACE inhibitor or steroid Adult polycystic kidney: US Family history of renal disease, hematuria in patient APKD: US Burn and sooth: intubation Status epilepticus: IV lorazepam GCS 13 at hospital but rapidly decreased to 8: CT intubation at < or equal 8 but it wasn’t in the options trigeminal neuralgia diagnosis trigeminal neuralgia: Carbamazepine trigeminal neuralgia: Carbamazepine side effect ataxia n nystagmus, dry mouth n blah blah PID not responding tubo-ovarian abscess: US Anti-D after 72 hours Women on 8-week bleeding, viability of pregnancy: trans vaginal US not CTG AS ITS only done previa n abruptio COCP for a young girl with irregular, menorrhagia Diagnostic investigation for a murmur: ECHO Initial treatment for fluid in a child with K 2.8: 0.45ns plus K less than 3 we give oral less than 2.5 IV K no option for 0.9 N/S Tamoxifen: vaginal bleeding Patient hypertensive, hot flushes and night sweating: RX: hrt or clonidine Recurrent miscarriages > 2: Aspirin and heparin Inflammatory changes in cervix: Swab OCD treatment: CBT RTA, tachycardia, tachypnea, fractured 5-7 ribs: o2, analgesia n then surgeon Intubate or analgesia? o2 not in the option DMT1 on insulin develops hypoglycemia at 4 pm: reduce morning insulin dose

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A patient, migraine for 10 years, presented with severe headache that is not relieved easily, no neurological signs. Investigation: None or CT Heart failure, gout treatment. Gout improved, heart failure worsened. Cause: NSAIDS. I choose Colchicine Child, sudden testicular torsion Torsion: immediate referral for exploration Anorexia nervosa CLEAR Bulimia Nervosa CLEAR HB decreased, bilirubin increased, spherocytosis on peripheral film: direct COOMBS AKA direct antiglobulin testing Low back pain after moving the house: give analgesics and keep the patient mobilized after seeing accident patient loses his eyesight: Conversion disorder Ascending paralysis i.e. Gullian Barre Syndrome what is the Pathology: Demyelination Heroin addict wants to quit. Key: Methadone IV drug abuser, which valve will be affected. Key: tricuspid? A picture of DKA asking for initial management. Key: Normal saline Asperger or autism or ADHD? Patient has depression and anxiety. Now has metabolic acidosis. Key: Aspirin weakness of shoulders and ESR high with normal CPK maybe Polymyalgia rheumatica. treatment? steroid Unstable patient, BLOOD PRESSURE was low, pulsatile mass. Management: increase the BLOOD PRESSURE (and then go for surgery) unstable patient with low blood pressure 70/40: dc shock Was there a question about a patient who had an incident with machines. His employer sends him for investigation. All exams were normal. What is next? CT MRI Reassurance?