mok @ Oo ” PLAB TRAINER TIME ALLOWED: 3 HOURS PLAB i, MOCK -2 [ovarian carcinoma ot Options: at e Pelvic USG Pelvic CT yas CA 125 CA 153 Laparotomy Laparoscopy 7 Paracentesis OFmon® Instructions: Instructions: For each patient described below, choose the single most appropriate investigation from the above list of options, Each option may be used once, more than ance or not at all 7 1. Alady with family history of ovarian carcinoma, Pelvic USG fails to reveal any abnormalitye oe (6) ‘Alady had undergone abdominal hysterectomy with bilateral salpingo-oophorectomy i 1 ovary. Now comes for fallow up, Her CA125 had with omentectomy for carcinoma of come to normal levels after surgery- \ f A lady underwent debulking surgery for ovarian carcinoma now presents with signs of ff intestinal obstruction.+N cavahd 2) Adenodrnd 3) uncen + palpitations Options: A. Atrial fibrillation E. Ventricular fibrillation 8. Complete heart block F. Ventricular tachycardia C. Supraventricular tachycardia G._ Wenckebach phenomena D. Ventricular ectopics Instructions: For each patient described below, choose the single most likely underlying rhythm ‘once, or not at all. 4. A76 year old man is on the coronary care unit two days after an acute myocardial infarction. He tells you that he had an episode of rapid pounding in the chest lasting for | 1. ow about a minute. He remains conscious throughout. 5 fy) Pmicinon ® shock = ’ ve be 5A 68 year ‘old man on treatment for an i emergency department. He has had palpita sturbance from the above list of options, each option may be used once; more thar ~~ aw irregular heart beat comes to the accidents and itions for the last three hours. On examination you find that his pulse Is regular and is 154 beats/ minute. Carotid sinus message settle his ST pulse down to 80 beats/minute 6. A70year old woman with longstanding anxiety is seen in the out patients department. often, This particularly occurs when she is ac ‘She complains of her heart skipping {ying to get to sleep. The palpitations are never sustained. wees!” ase « aye BE re - javpe > Areadiort 2o NE a> Reamuvonee. 7. A28 year old man presents with a iwo light headed but is otherwise well. On examination his pulse is 170 beats/mi regular, and his blood pressure is 100/68 mmhg. He has had two similar inute ai uur history of zapid palpitations. He feels a litle ind episodes in the past 8. A74 year old men with angina presents with feeling unwell with a history of slow pounding in his cheste Mis angina has been worse lately and he has been prescribed COPY AA 6 9. Apatient with a lesion on the left side of the mouth, on protrusion of the tongue It is deviated on the left, what nerve is damaged? A. Hypoglossal. ( oumyrplyy Ha wanes tl ean gee 8 c o. EB Glossopharyngeal. Facial (Mandibular branch) Vagus. Trigiminal deviate te e\ected Side 10. A patient with perioral itching, bronchospasm (anaphylactic picture). What Is the best al mooe> 11. A woman with increasing forgetfulness, lethargy and tiredness. She has given up her management? Adrenaline 0.5 mi of 1 in 1000 im Salbutamol. Hydrocortisone Antibiotics. Mg Sulphate. Job as a teacher in the university. She has increasing dyspnoea and breathlessness on exertion. Her only medication is L-Thyroxine. There is no neurological abnorm: Which single test will help to establish her diagnosis? Moo@> 112. Each year 950,000 people develop myocardial infraction in a population of 250,000 million, Of these 215,000 die. 112500 in the first hour. What is the incidence of the MRI Scan of the head. Erythrocyte sedimentation rate (ESR). Hb concentration. ‘Thyroid function test. Vitamin B12 level. myocardial infraction? "OO > 112,500 in 215,000 112,500 in 250,000 215,000 in 950,000 215,000 in 250,000 950,000 in 250,000 [medance. {3 cates Poptakroe wes)[ Diagnosis of jaundice in childhood Options G. Glucose-6-phosphate dehydrogenase Deficiency G6PD H. hepatitis A infection A, Alpha 1- antitrypsin deficiency 8, Biliary atrasia C. Breast milk jaundice 1. Hypothyroidism . D. Congenital sphercytosis J. Physiological jaundice E. Congenital viral infection K. Rhesus haemolytic disease F. Galactosaemia L. Urinary tract infection ase ( Instructions: * gach patient described balow, choose the single most likely diagnosis from the above ie of options, each option may be used once, more than once, of not at all 43. A previously well 20 year old girl presents with a two day history of nausea, anorexia, 4 low grade fever and loose stools. She has yellow sclera and is tender in the right upper quadrant on abdominal palpation. at we &® © At birth a baby boy at 38 weeks gestation weighs 1.8 kg, He has hepatospleenomegaly @A C airash. Blood tests show raised level of bilirubin end liver enzymes. owe ineecrtos (a We cane Mee ek proivatly aa get inf frome haath) K 15. Ababy girl on the post natal word becomes progressively more jaundiced and pale. A cord blood tested at birth is coomb's positive. ‘ A six week old formula fed baby boy is fund at child health surveillance to be deeply Jaundiced. HisGeight gain 1s poorfand his stools are pales ~. 17. Aneighi week old baby boy is nated to be jaundiced. He is breastfeeding well and has birth. His stools are yellow and his urine is pale straw coloureds ere —> Pale sive Dawe> (B18, Awoman with a diagnosis of mild ulcerative colitis is not on any treatment, She £ develops diarrhoea and mucus stools in the last three months, All other examinations are normal. Her Hb is 9.6 . What is the single best treatment? A. Blood transfusion 8, methochorbromide C. Ferrous sulphate. Metronidazole. E. Mesalazine. use i ¢ __..19. Aperson (? post op) injured in the shoulder, he cannot shrug the shoulder or lift the tip ; pr ese of the shoulder. What nerve is damaged? A. Accessory. B, Axillary C. Radial. D. Suprascapular. E. ‘ Musculocutaneous. ue ¢ © 6 @ ‘A smoker with several ulcers in the mouth with a white stria, ther are several ulcers in the under surface of the tongue, What is the diagnosis? A. Apthous ulcer B. Lichen planus C. Kaposis sarcoma. D. Cancer of the mouth E g 21. Apatient post prostatectomy with a history of DVT. What is the therapeutic INR in management? hoews ae 3-4 hy 42 o mein TE B. 23 ase - te Bie C34 ' Sayers seh 0. 4-5 7 O°[Bites and stings Options: G. Lyme's disease serology A. Blood film for malaria parasites H. Magnetic resonance imaging(MRl) of the head 8. Chest x-ray (CXR) C. Fullblood count (FBC) 1. Nasal swab D. Hepatitis A serology J. Skin prick test E. Hepatitis B serology K, Skin swab culture F. Leptospirosis serology _ _ oe ( Instructions: For each patient described below, choose the single most appropriate test from the above list of options, each option may be used once, more than once, or not at all. ' 22. A28 year old police officer is bitten by a heroin addict during the course of an arrest for a theft. The police officer presents to the accident and emergency (A&E) department with 0 te BHler 6 eaote deep wound on his right hand. PH ' = . nese myc et by Senotelyyy ( 23. 26 year old girl has a lesion on her right thigh. She removed an insect from her leg after walking through a forest three weeks ago. The lesion is red and raised. 24, A52 year old business man presents to the accident and emergency (ARE) department With fever and rigors ten days after returning from a trip to Zambia. 6“P25. Aperson with longstanding 1 cm lesion on the ha touching. What is the diegnosis? A. Basal cell carcinoma. 8, Kaposis’ sarcoma. 7 C. Malignant melanoma, D. Squamous cell carcinoma. © 26. Aman with 2 lesion on the thigh with centtal elaaring since 3 Weeks and the lesion has been spreading, He also has lesion? A. Skin biopsy. B._ Skin scrapping and culture C. Lyme serology. D. Antibacterial culture. Ty= Dor gee + Dass years old man presents with acute onset of red eye, pain and bl SEZ What is the best initial management? ‘A. Put patient in a dark room with reduced light. B. IV morphine and routine opthalmological referral. ( C. I morphine and emergency opthalmological referral. D. IV morphine and antibiotics. E, IM morphine. A ‘Malaise and generalized aches! What isthe test to diagnose the 2 | bites vision. He has What is the next action in management? Discharge and outpatient follow up. Refer to community mental health team. Detain under the mental health tearm, Refer to psychiatrist. Group counselling. MONS > 50° aSDiagnosis of neck lumps Options Thyroid carcinoma Goitre cystic hygroma Branchial cyst Tuberculous lyphadenitis lymphoma Stomach carcinoma Zammonay Lung carcinoma Mesothelioma Instructions: For each patient described below, choose the single most likely diagnosis from the above list of options, each option may be used once, more than once, or not at all, ® A lady from Asia with lumps in her neck, FNAC has been done and revealed lesions with centre of casseous material surrounded by fibrosis. 30. 60 years old man with a lump in the supra-ciavicular region. His appetite is decreased and he has lost § kg recently. . 31, Amiddle aged man with a lump in the front of his neck which moves up on swallowing. Ultra sound shows a mass replacing the left lobe of the thyroid and spreading to sternocleidamastaid and adjacent muscles.fy 32. Aboyis brought to the A&E, he has felt unwell fora few days and i / f pulse rate is 100 beats/ minute and his capillary refill is 3 seconds. He is arterial blood gas results are: . pu oat FMS, Ph= 7.25 \ pucotet® Paco2=3.2kpa Pao2=20kpa ye ate eM Base excess=-15 ~ . ZL Nr eat What is the single correct interpretation of the blood gas result? Metabolic acidosis. Metabolic alkalosis Normal. Respiratory disorder. Respiratory alkalosis. Moone, B33. 460 years old man witha long standing COPO is complaining of blurn disturbance. He is on multiple medications for his COPD. Which of his medication is responsible for his visual disturbance? A, Theophylline. . Corticosteroid. coyriee SI? 8 ( C. Oxygen. D & & . Bet agonist. - Cate Ipratroium promide. © 34. Ayoung girl with 2 honey-crusted lesion on the neck, spreading from her neck to her face, She is otherwise normal. Which investigation will establish the diagnosis? x Aye s Viral culture Bacterial culture Skin biopsy. Blood culture Potassium hydroxide test roOneeScientific basis of poisoning Options: Amphetamine Aspirin Barbiturates Ethanol Ethanol Ferrous sulphate 7m OO wp Instructions: For each patient described below, choose the single mos G. Methanol H. Morphine Paracetamol J, Quinine ie¥dlic antidepressants L. Warfarin st likely cause from the above list of options, each option may be used once, more than once, or not at all. 35, Depletion of glutathione stores (reversible by methionine or N-acetyleys steine}. Leading to binding of drug metabolite to hepatic macromolecules. 36. Inhibition of the synthesis of clotting factors by competition with vitamin K. { . a@ 37. Strong afinityfor abindingsite on fiaemoglobin. 4, ¥ Anticholinergic effects leading to loss ofagal tone’ impaired myocar dial contractility SridWelayed conduction in the Bundle of His. qu