plab 2016 nov

1. A 4 month old child weighs 4.1kg. She presents with multiple bruises on her left and right lower leg. Her left ankle is swollen and she appears irritable. She also has a runny nose. What is the most likely diagnosis? Hemophilia thrombocytopenia Non accidental injury 2. A 60 year old man experienced sudden painless loss of vision. On examination, multiple flame shaped hemorrhages were seen. What is the most likely diagnosis? Central retinal artery occlusion Central retinal vein occlusion 3. Patient with bilateral cerebellar-pontine tumors, bilateral sensorineural hearing loss and cafe au lait spots is pregnant. What are the chances of her child having the condition? 1:2 1:4 2:3 1:8 4. A young girl has cystic fibrosis. Her 14 year old sister does not have the disease and wants to know the chances of her having the gene for the disease. None of her parents are affected. What are the chances of the 14 year old girl being a carrier? A. 1:2 B. 1:4 C. Nil D. 100% E. 2:3 5. A 26 year old man travelled from New York to the U.K on business. He had night sweats, fever and lymphadenopathy for 3 weeks. What is the most likely diagnosis? Tuberculosis Lymphoma 6. 44 year old woman presents with unilateral headache and photophobia after tingling and numbess of her hand. What is the most likely diagnosis? TIA Migraine Meningitis Stroke 7. Patient had a deep cut on her palm. She has inability to extend the distal phalanx of her ring finger. What is affected? digitorum profundus 8. A woman of child bearing age has extensive fibroids which have distorted her uterine cavity. She says she has difficulty in remembering to take pills. What is the best contraception for her? Implanon Depot provera IUS (Mirena) COCP POP 9. A patient presents with right sided hemiplegia and aphasia. Symptoms resolved in 6 hours. What is the best scoring method to assess his risk for future stroke? ABCD2

10. 60 year old patient had a cystoscopy and he was found to have transitional cell carcinoma. He has smoked for 15 years and works in a coal factory. What is the greatest risk factor for TCC? Smoking Coal dust exposure 11. You are a junior doctor suspecting one of your colleagues to be under the influence of recreational drugs. What will you do? A. Inform police B. Confront your colleague directly first C. Inform senior consultant D. Seek more evidence first 12. A primigravida in 28 weeks gestation having BP 150/100 mmHg. What will you give for blood pressure? A. Labetalol B. Hydralazine C. Indapamide D. Losartan 13. Child presents after taking OD of medicines belonging to his grandmother, who is a patient of epilepsy, atrial fibrillation and hypertension. She cannot tell which medicines are missing. The child is hypotensive, dilated pupils and with extra systoles on ECG. Which drug has he taken? A. Amitriptyline B. Carbamazepine C. Digoxin D. Metoprolol 14. Male with increase thirst and increase micturation. Has an intracranial tumour. Where would it be found? Diencelhalon Midbrain Medulla Pons 15. A patient had a fly enter his ear. What to do next: Removal with forceps Removal under general anesthesia Administer mineral oil 16. Pregnant lady 28 wks gestation , Hb 11 ... MCHC normal range , MHC normal What to do - check serum iron -check serum Ferritin -explain normal physiological phenomenon 17. Women with prescribed antibiotics. She is on COCP. What advice would u give ? No extra precaution needed 18. bilateral shin lesions scenario of sarcoidosis. How to Diagnosis? Serum ACE levels CT scan 19. unilateral loss of vision, pain on eye movement, fundoscopy normal. Diagnosis? Retrobulbar neuritis 20. Woman went to Bangkok didnt have malaria prophylaxis - Malaria

- Dengue 21. Kid vomiting, passes 2-3 stools in days ( pyloric stenosis) . how to diagnose? US abdomen 22. Lady with petechial rash and menorrhagia, Hb wcc normal, Plt 14. Diagnosis? ITP 23. One scenario was pt after antibiotics develops lesions /rash with necrotic base after antibiotic therapy .. mucosa n genital not involved ? - erythemia multiforme -erythema nodosum -erythemia migrans 24. a child unable to climb stairs and diminished deep tendon reflexes Duchene muscular dystrophy GBS 25. Child with painful crusted lesions on face and neck. Face is hot. Impetigo Measels Chicken pox 26. Depression post MI Sertraline 27. Patient with cervical spondylitis, develop eye pain, irregular pupils - iridocyclitis 28. 35 yr old man with allergy, he has wheeze, stridor and dyspnea. What to give him: A. Intramuscular adrenaline 1:1000 B. Intravenous adrenaline 1:1000 29. Woman feeling weak malaise. Amenorrhoea 10 months. BMI 30-32. Low potassium 2.5 - cushing disease -Pcos - Primary hyperaldosteronism 30. Female with malodorous clear vaginal discharge. pH>? Diagnosis?? Candida Gardnella Trichomonas vaginalis 31. Young male after RTA, Breathless, right side chest pain, fracture in 5 n 6 rib. Wht to do next? analgesia Intubate 32. Pt with back pain , after recent shifting to new house ..what to do ? - mobilise and analgesia -bed rest - manipulation -acupuncture 33. Young man, testicular swelling few months, can get above it. -Hydrocele

34. Pt with fracture of distal radius ... dorsal angulation >10 degrees . No neurovascular compromise mentioned .treatment ? - arm slab - close reduction -ORIF 35. Swelling on anterior neck triangle . Increase in size recently , transilluminating branchial cyst cystic hygroma 36. Post RTA, patient with femoral shaft fracture. Which artery involved -Femoral a. 37. Wrist drop and loss of sensation on the space between thumb and index finger Radial 38. Fluctuating swelling lower border of knee. Which bursa Prepatellar.. 39. Man, chronic smoker. Then there's postural drop in BP. Sitting 140/80, lying 110/70. I think. They ask for electrolyte Imbalance -Hyponatremia -Hyperkalemia 40. Man alcoholic, GCS fluctuating, muttering etc -Capillary blood glucose 41. Young lady with bilateral iliac fossa pain and vaginal discharge. What antibiotics to give: A. Ciprofloxacin + metronidazole B Doxicycline + Ceftriaxone + metronidazole C. Doxicycline + metronidazole + ciprofloxacin 42. Women with breast ca had mastectomy with clearance develop swollen upper limb -Lymphedema 43. Ataxia, nystagmus and vertigo. Where is the lesion. Cerebellum, brainstem 44. Post MI scenario. BP low with broad complex tacyarryhtmia. Unconscious with shallow breathing (respi rate 4/min) -DC shock -Intubation and ventilation 45. Diabetic lady had weakness with slurred speech. - Stroke 46. Painless vaginal bleeding in 32 weeks. pregnant the single most diagnostic test... Trans vaginal US Trans Abd. US 47. Hyperemesis gravidarum patient-fluid of choice normal saline. 48. A case about submandibular calculus- pain after having large meal. 49. 40 year old lady with occasional dizziness tinnitus and hearing loss. Diagnosis? Menieres disease Acoustic neuroma 50. Adult patient with ear pain, loss of hearing. Otoscopy showed vesicals in ear

Ramsay hunt syndrome 51. Moderate dyskaryosis. Management? Colposcopy in 4 weeks 52. Patient after party, can see colors. Which drug? Heroin Cocaine LSD Cannabis 53. RIF mass with round tenderness and guarding for the past 2 weeks. Diagnosis? Appendicular mass 54. Classic picture with transmular involvement. Diagnosis? Cohrn disease Ulcerative colitis 55. Very high ferritin, at risk of which cancer? Liver Pancreas 56. Female on treatment of PID now is ill, abd pain etc. best investigation ? Ultrasound 57. child with febrile convulsion. What advice will u give to parents ? can reoccur with fever until age of 6 can reoccur until age of 10 58. Child, doesn’t play with his siblings, vocal delay etc etc etc. diagnosis ? Autism spectrum disorder 59. Patient bitten by human. Hep B Hep A 60. Sparse hair, cold extremities etc etc features of hypothyroidism. Investigation? Thyroid function test 61. A girl who eats a lot and vomits, took her mirror off and stopped going out because she thinks everybody looks at her. Diagnosis? Bulimia nervosa Body dismorphic disorder 62. Primary male infertility with azoopermia. Test to confirm diagnosis? FSH Testosterone 63. Classic scenario of Hypochondriac patient 64. Boy with offensive unilateral discharge from nose from last few months. Cause? Foreign body Rhinitis Polyp 65. ACEI for microalbuminuria 66. Female, afraid to go outside house. Only goes with her husband. Diagnosis? Agoraphobia 67. Old man with previous suicidal attempt. What will increase suicide risk? Family history Lack of social contact Previous suicidal attempts 68. Another suicidal risk question .

Alcohol dependence 69. Post op 2 days . patient become agitated confused etc etc etc. diagnosis? Delirum tremens 70. Dehydrated child. Maintenance fluid of choice ? Normal saline + dextrose 71. Neck stiffness, non blanching rash, photophobia. What is the causative organism? N. meningitis 72. Patient get hallucinations when going to sleep. Hypnogogic hallucinations 73. Elder female with severe progressive nausea and back pain. Where is the primary cancer? Stomach Breast Pancreas 74. Old female, on steroids, progressive loss of vision in one eye. Diagnosis? Cataract 75. Classic scenario of bipolar disorder 76. Patient on depo porvera for 6 weeks but has intermittent bleeding since then. Reassure Cervical smear 77. Ipsilateral vision loss and CL hemiplegia (something like this.) Internal carotid External carotid Ant. cerebral 78. Female with metastasis, has weakness of her legs, minimal knee and absent ankle tendon reflexes, a palpable bladder, a power of 2/5 at the hip, 3/5 at the knee and ankle, and tenderness over the 2nd lumbar vertebra. Diagnosis ? Paraneoplastic Spinal cord compression 79. Patient after surgery, aggressive etc. but after 2-3 days, came back and thanked the doctor. Diagnosis ? Adjustment disorder PTSD 80. After watching an accident, lost his eye sights . diagnosis ? Conversion disorder 81. Old patient with anemia , increased Ca, disturbed kidney function, hematuria, nocturia, dysuria. Diagnosis? Multiple myeloma Prostate ca Bladder ca 82. Child with vomiting and constipation. K+ - low, Na = low. Other normal. Diagnosis? Hyponatermic dehydration Pyloric stenosis 83. Young female, had abdominal bloating and pain for 9 months. Stool contains mucous but no blood. No diarrhea. Relieved by defecation. Clinical exam remarkable. Diagnosis? Corhn disease Irritable bowel syndrome Ulcerative colitis

84. Nose bleed – pinch the soft part 85. Old man, low mood, feeling guilty towards family. Diagnosis ? Depression 86. A woman 3-5 days after the obstructed labor presents with pain and swelling upto inguinal crease in one leg, blue mottling etc etc. diagnosis? DVT Post phlebitis syndrome Embolus 87. Patient with sudden onsent of headache, photophobia, neck stiffness etc. diagnosis? Subarachnoid Meningitis 88. Old lady with confusion ( probably SDH) etc etc. Best investigation? CT brain 89. Old lady, xray shows opacities, she has pleural fluid . what to do ? Pleural aspiration 90. Young female with irregular heavy painful mensturation. Best contraception? Cocp 91. Post RTA, tender breast lump. Diagnosis? Fat necrosis 92. Healthy child. Normal weight gain. Feeding properly but have jaundice from few days of life till 4 weeks. Diagnosis ? Breastfeeding jaundice 93. 54 year old man, dyspepsia, weight loss and anemia . investigation ? h.pylori test endoscopy breath test 94. Old man with progressive memory loss. Cant remember name or address( something like that), diagnosis? Delirium Alzheimer 95. Patient with facial neurogenic pain (trigeminal neuralgia features), what should be given for pain? Antiepileptic Antidepressant 96. Patient on antidepressant ( have bipolar disorder). What should be given to improve his symptoms etc? Mood stabilizers 97. Young man with sore throat followed in few days by hematuria, HTN, renal symptoms etc. diagnosis? a. Post-streptococcal GM b. IgA nephropathy 98. Pregnant female presented at 16 weeks of gestation. What should be done ? a. Amniocentesis b. Villous sampling 99. A pregnant female, what should she be tested for ? Rubella and syphilis 100. Mechanism of breast cancer spread or something like that asked- infiltration of underlying cells of skin

101. Few days after Post thyroidectomy. Vomiting with altered blood. Temperature 38.5. management? a. Admit of parenteral antibiotics b. Oral antibiotics and discharge c. Pack the operated site 102. Patient presented after RTA, had glycosuria. Later resolved. Diagnosis? A. DM1 B. DM2 C. Normal stress response 103. Mother of 5 children. Incontinence only when coughing and sneezing . dx? Stress incontinence 104. Pregnant female at 29 weeks has BP of 160/110 and proteinuria 1.5 (not sure). BP at 10 weeks of gestation was 120/80. Diagnosis? a. Pre-eclampsia b. Gestational hypertension 105. Boy don’t want to go to school. Complains of headache and giving some reasons. Mother has depression and recently started medication. Management ? a. Get collateral info from parents and school 106. Typical case of child with odema and proteinuria. Dx ? a. Minimal change disease 107. Another scenario of minimal change disease. Most appropriate investigation? a. Albumin 108. Patient with heart rate over 170, bp- 90.70. on ecg shows atrial fibrillation. Immediate next step ? a. DC cardio b. Iv amiodarone c. Digoxin 109. Patient suffering from motor neuron disease. Cant swallow. Management ? a. Ng tube b. Percutaneous endoscopic gastrostomy 110. Girl, with history of diarrhea, renal impairment. Diagnosis? – HUS 111. Young male, has dysphagia. Initial investigation? – barium swallow 112. An old patient with increasing chest pain, systolic murmur. Diagnosis? a. Aortic stenosis b. Mitral regurgitation 113. Typical scenario of child with fever and cough. Diagnosis? Bronchiolitis 114. Young patient with palpitations. Investigation? 24 hours ECG 115. Indirect hernia. What best describes it ? a. Passes through deep inguinal ring 116. Glucose test value given. Interpretation asked – impaired glucose test 117. Young man, smoker, pneumonia symptoms. Cavitating lesion on xray. Causative organism ? a. Staphylococcal au. b. H. influenza 118. Typical question of patient from nursing home. Itching. Dx ? Scabies 119. 18 months old child. Choking. What to do if same happened at home? a. Back slaps and chest thrusts on Lap 120. Turn to right diplopia and resolves when one eye closed. Cause?

a. Right abductens 121. Ischaemic stroke. On aspirin 75mg. presented about 6 hours later. What would the best next treatment? – a. Clopidogrel b. Aspirin 300mg c. TPA 122. Mode of spread of chicken pox – Air 123. Classic presentation of chicken pox and causative agent asked – Varicella zoster 124. Diabetic patient with painful lesion on anal area, fever. – Peri-anal abcess 125. Patient with progressive ear ache, hearing loss on same side. Moderate tonsillar erythema, several cervical lymphnode. Ear drum is dull inflamed. what is the cause of his ear problem. a. Acute OM b. Glue ear c. Tonsillitis d. Acute OE 126. Post ERCP pancreatitis – small beads visible on pancreas. a. Fat necrosis b. Abscesses 127. A 76yo man suddenly collapsed and died. At post mortem exam, a retroperitoneal hematoma due to ruptured aortic aneurysm was noted. a. Atheroma b. Cystic medial necrosis c. Dissecting aneurysm 128. Woman after mastectomy has loss of sensation on the inner side of arm. reason? a. Axillary b. Costo-brachio c. Brachial plexus 129. Post RTA, BP low, abdominal distension and rigidity. Most appropriate investigation? a. Ct abdomen/pelvic b. US abdomen/pelvic c. Erect Xray d. Diagnostic peritoneal tap 130. Most common cause of kidney transplant in Uk – Diabetes 131. Amitriptyline toxicity, what should be done – ECG 132. Scenario of PCOS 133. Chronic GI bleeding 134. Typical scenario of Hep A IgG positive and Hep B IgG negative. What to do next to confirm diagnosis? a. Hep A IgM 135. Old man, intermittent heamaturia, low back pain, PSA value high. a. BPH b. Bladder stone c. Prostate ca d. Bladder ca e. Uti

136. Life threatening asthma – Altered sensorium 137. Old woman with urinary catheter for incontinence becoming confused etc etc a. Delirium b. Picks disease 138. Admitted with pancreatitis twice. No alcohol history given. Paresthesia. a. Thiamine b. Cobalamin c. pyridoxine 139. patient with 40% partial thickness burn. BP 90/60, RR – 20. Fluid management? a. Blood transfusion b. Fluid bolus for shock c. Fluid from time of burn 140. Patient with retrosternal pain on inspiration. Vitals are fine. Little pyrexical. a. Pericarditis b. Esophagitis 141. Patient had tibia closed fracture. On cast. After 4 days complains pain. Limb warm and good pulse. What to do next? a. Increase analgesia b. Reassure and review in a week c. Remove cast 142. 30 year old woman, gradual loss of vision in last 1-2 years, now upto hand movement/ finger counting. Diagnosis ? a. Iritis b. Glaucoma c. Cataract d. Macular degeneration 143. Post gastrostomy, neurological signs etc . a. B12 deficiency b. Folate deficiency 144. Fibroadenoma in a young girl 145. Post op patient. After 5 days develops shortness of breath. PE suspected. Already on LMWH. What to do ? a. Keep on same LMWH and do CTPA b. INCREASE LMWH AND DO CTPA 146. Post op patient on oxygen mask and breathless, abg given. (seemed like a case of atelectasis) a. Chest physiotherapy b. Reduce oxygen 147. Typical scenario of DKA. What should be done – ABG 148. Patient with low Hb, PR mucous, weight loss – cecal carcinoma 149. Alzheimer patient came with her granddaughter. Wants to change her will. a. Proceed with the changes she wants to make b. Tell her she cant make any changes c. Refer the lady to psychiatrist for full capacity assessment 150. 80 year old lady, severe tenderness in 5th n 6th intercoastal space, altered sensation in 5th th and 6 space etc etc something like this . a. Pathological fracture b. Herpes zoster

c. Vertebral compression osteoporotic fracture (cant remember properly) 151. Lady suffering from depression. Doesn’t eat or drink. Don’t want to go out. Mental and physical deteoration getting worst. What to do a. ECT b. CBT c. Urgent NG tube feeding d. TEN 152. Rash on shin – Sarcoidosis 153. Some female with autoimmune hypothyroidism symptoms – pernicious anemia 154. Upper lid ptosis and slight constricted pupil but still react to light and accommodation. Which ganglion involved? a. Otic b. Celiac c. Thoracocervical d. Submandibular 155. Old woman with GI symptoms – Digoxin toxicity 156. Unconscious man with empty beer cans around him, signs of chronic liver disease. Electrolyte imbalance ? a. Hypoglycemia b. Hyperglycemia c. Hypercalcaemia 157. Female on steroids for asthma I think – candida laryngitis 158. Neonate after PROM and premature delivery. Nasal flaring, intercostal recessions, no fever. What to do ? a. CXR b. Blood culture 159. Pregnant woman at 34 weeks gestation presents with tingling and numbness with altered sensation of her right middle and index finger. Tinnel test is negative. What is the most likely diagnosis? Carpal Tunnel Radial nerve entrapment 160. An 18 month old boy pulled over a cup of hot tea. He presents with 6% burn on his chest. What is the treatment? IV fluid calculated from the time of burn No need for IV treatment 161. Took 100 tablets of TCA and now refusing the treatmet a. Observe b. Treat her against her will c. Access her capacity to refuse the treatment 162. Question about syphilis antibodies 163. Purple bag syndrome, not sure if nitrates present or not in dipstick. a. Do nothing b. Culture and CS 164. Before giving lithium – check tft 165. Female on cocp, 1 week after long flight – PE

166. Congenital adrenal hyperplasia – 1:4 ( autosomal recessive) 167. A 12 yo boy had got big ears. His mother wants to take him to private centre for pinnoplasty. The kid thinks that his ears are just okay. what will u do? options included : a. refer the child to private for procedure b. referreal isnt possible without the childs consent c, take the child to be counselled 168. Pt with heart problem and other co morbids in itu , has red wollen painful joint .. what investigation will confirm diagnosis? A. Serum uric acid levels B. Joint aspirate microscopy 169. Pt of rheumatoid arthritis, on methoetrexate , nsaids Labs: hb low , mch low A. Folate def Bvit b 12 C hemolytic anemia D aplastic anemia E. cheonic gi bleeding 170. A situation of chronic liver disease. Spider naevi. Slow growing ascites. Transudate