Plab Themes

Theme- 15 the management of head injury A CT scan B Neck collar C MRI D Skull X-ray E Discharge home with head injury F Admit overnight for observation G Suction of skull vault H Antibiotics I Intracranial pressure monitoring 1. Following an alcoholic binge a 36 year old male falls and comes to Casualty with a cut in his temporal region his Glasgow Coma Scale is normal and his neck is cleared by the orthopedic SHO . 2. An 8 year old boy falls off a swing at his school. He is brought to Casualty by one of his teachers. He has a bruise over his right eye but the examination is otherwise normal. He is fully conscious with no history of blackouts since the accident. A skull X-ray is performed, which is normal. 3. A young woman is involved in an RTA and is brought in with a Glasgow Coma Scale of 6 A CT scan shows evidence of diffuse cerebral edema but no evidence of haemorrhage. She has bilateral papilledema. 4. A young man is involved in a fight and suffers a blow to the back of the head. A skull X-ray reveals a depressed fracture of the occiput. His Glasgow Coma Scale on admission is 14 but falls rapidly within an hour . Theme-32 treatment of limb ischemia A Amputation B Arteriography C Bypass graft D Intrarterial vasodilator E Femoral embolectomy F Advise stop smoking and exercise G Fasciotomy 1. man involved in road traffic accident is found to have comminuted fractures of the tibia and fibula. he develops rapid swelling of the lower limb below the knee. Arterial pulses are absent below the knee 2. An elderly male develops pain in his thigh and leg when walking for approximately 20 meters. This pain resolves with rest. He is a long time smoker. n examination his dorsalis pedis pulse on the affected side is absent 3. A 70 year old with known atrial fibrillation on treatment develop a sudden cold leg . Pulses are absent in the level at and below the knee. 4. A 67 year old male with a history of peripheral vascular disease develops sever ulceration and Cellulitis in his left foot and extending up his left leg above the left ankle.. The popliteal pulse is absent on that side. he has a history of ulceration on the Contralateral side which resolved following a bypass graft operation on that side. A-Thallium scan B-PSA C-Transrectal U/S D-Transrectal biopsy E-Transrectal resection. F-Gallium scan G-HLA status H-Bones survey

I20 Man 60 years with Prostatic symptoms consult for sudden onset of backache. 21 Man c/o dribbling, hesitancy frequency his PSA is 120[raised]. 22 A man having adenocarcinoma prostate spread to pelvis side walls will be given chemotherapy Analgesia. 23 A 75-year-old mentally retarted man having nocturia, & hesitancy. THEME: Breast investigations A- U/S B- Mammography C- Wide excision D- Cystic aspiration cytology FNAC E- Stereotactic needle biopsy. F- Stereotactic core biopsy. G- Family history 94 95 96 97

A woman has lump in her breast and she is afraid of needles A woman has diffuse nodularity and changes with menstrual cycle. A 2 cm irregular swelling in a breast with no axillary lymph nodes. On mammography a woman has multiple wide spread calcifications breast which are not localized.

THEME: Breast investigations A- U/S B- Mammography C- Wide excision D- Cystic aspiration cytology FNAC E- Stereotactic needle biopsy. F- Stereotactic core biopsy. G- Family history 94 95 96 97

A woman has lump in her breast and she is afraid of needles A woman has diffuse nodularity and changes with menstrual cycle. A 2 cm irregular swelling in a breast with no axillary lymph nodes. On mammography a woman has multiple wide spread calcifications breast which are not localized.

These were frm Jan 2002. Theme- 1 : Dysphagia : DX A. Hysteria B. Globus hystericus C. Achalasia Cardia D. CA Esophagus E. CA Pharynx F. Peptic Stricture G. Malignant Stricture H. Corrosives I. Bolus impaction J. GERD K. Pill Stricture L. Barrett’s Oesophagus 1. An elderly lady complaints of retrosternal burning , especially at night which is aggravated by drinking and on further questioning says that she might have feeling of food sticking in her throat. There is no H/O regurgitation of food. 2. A 70-yr-old man with weight loss has difficulty in swallowing both solids and liquids. 3. A 55-yr-old man has a problem in initiating the swallowing. After the food is taken in, there is no

problem in rest of the swallowing. 4. A 22-yr-old girl gives history of difficulty swallowing liquids. On second thoughts she says that she might as well be having difficulty with swallowing of solids lately. Theme- 10 : Trauma : Investigations A. IVU B. Nephrectomy C. USG D. Splenectomy E. Laparotomy F. Urethrogram G. Suprapubic catheterization H. Foley’s catheterization 1. There is history of kick in the back. No bruises but the patient presents to A & E with haematuria. 2. There is history of multiple rib fractures on left lower chest. The patients presents with left sided abdominal pain. 3. A man has history of perineal injury and now presents with urinary retention for 2 hours. No abnormality was found on PR. ( Nothing was mentioned about blood at urinary meatus). THEME 31 :OESPHAGUS Options A. Candidiasis B. EBV C. Diffuse esophageal spasm D. Achalasia cardia E. CA. Oesophagus F. Pharyngeal pouch G. Barrett’s Oesophagitis H. Gastric ulcer I. Ruptured esophagus 150. A known HIV +ve patient, consult for pain in swallowing & some lesion in mouth. The underlying tissue is red when the lesion is taken off. 151. A pt comes with dysphagia for solids for 5 years now C/O regurgitation. When he eats & it gets relieved a few hours after meal. 152. A 65 yr old male patient c/o weight loss, difficulty in swallowing solids. 153. A pt c/o intermittent dysphagia for both solids & liquids & chest pain no history of weight loss. 154. A pt c/o difficulty in swallowing & filling defect on barium swallow. 155. Pt c/o regurgitations symptoms associated with CA Theme : Ischaemic limb A. Stop smoking B. Amputation C. Angiography D. Duplex scan E. Intrarterial vasodilator F. Chemical sympathectomy G. Angioplasty H. Ca++ channel blockers I. Antibiotics 167. A 40 year old female, C/O sudden severe pain, pale pulseless lower limbs, can hardly move her foot 168. A 45 yr old man has been suffering from intermittent claudication, it is getting worse now. 169. 53 yr male, history of fem pop ______ on leg presented with progressive cellulites. Ulcer on shin no dorsalis pulse.

170. 45-yr old smoker c/o pain both calf on walking uphill 400 yards. o/e absent dorsalis pedis, other pulses normal. 171. A 25 yr old man after an RTA with fracture both bones leg. O/E no pluses in foot. Options A Abdominal computed tomography (CT) scan B Abdominal ultrasound C Barium enema D Cystoscopy E Faecal fat content F Intravenous urogram (IVU) G Laporoscopy H Laparotomy I Liver function tests J Lumbar spine x-ray K Mesenteric angiogram L Oral Cholecystogram M Small bowel enema N Technetium isotopic liver Scan (Tc99m). O Upper gastrointestinal endoscopy Instruction 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 once, or not at all. 137. A 55-year-old woman presents with a six-month history of severe central abdominal pain, which comes on 30-minutes after meals. She has lost 10-kg in weight, and on examination of her abdomen there is a bruit in the epigastrium. She also suffers from intermittent claudication. 138. A 25-year-old teacher complains that she has had central abdominal discomfort of six-month duration, intermittent abdominal distension and alteration in bowel habit. On examination, there is a palpable swelling in the right iliac fossa. A Barium enema carried out showed no abnormality. 1 ct to see aneurism 2 smallbowel anema? wt u think parazim Theme-39: Psychological diagnosing: A- Korsakoff’s psychosis, B- Delirium tremens, C- Alcoholic confusional state D- Alcoholic intoxication E-Schizophrenia F- Delirium G- Paranoid delusions H- Lewy body dementia I- Depression J-Drug induced Man thinks some people have got into his house so wanders in the street & vows to take revenge. A pt was brought to A&E with some symptoms of Parkinson’s, wandering in the street & claims that some people are in his home & is afraid of going home A young pt with auditory hallucinations A 25 year old alcoholic patient, doing crazy things A 68 yr old man chronic alcoholic & continues to drink having confusion An elderly man with increasing confusion was brought to A&E by his wife. Theme-40: Treatment of psychological disorders:

Cognitive therapy Behavioral therapy Cognitive & behavioral therapy Fluoexetine ECT Amitriptyline Imipramine CBT Imipramine Lithium Psychiatric consultation Beta Blockers A young boy irritable, & brought to shrink for shouting absentees at school. A nurse that recently washes & cleanness everything more than usual, like washing hands & so on An old lady with depression having suicidal risk & doesn’t eat A women depressed 3-months after parturition & is breast feeding, telling that some body is trying to kill her baby, not interested in anything & crying often. Pt with moderate depression has responded to antidepressants & now has MI & getting treated for CCF Hypertensive pt, with medications of fibrillation now depressed. Theme-41: cause of suicide / Suicidal risks: Life event; Criminal record; Bad physical health; Unemployment; Isolation Depression 60- A 28 year old man was sentenced to the prison for the armed robbery of bank. Now suicides by cutting his wrist veins with piece of glass in jail. His mother died 3 months ago, 61- A woman with low mood, who sleeps too much & denies to eat wants to die now cut her veins. Ans: 1-g 2-h 3-e 4-a 5-a? 6- H? A mother who gave birth a couple of weeks ago feels as though she doesn't like the baby and doesn't want to feed it. Those thoughts keep coming back to her very often and she does not like these thoughts. How will the doctor explain her symptoms to her? C A. Delusions B. Hallucinations C. Obsessions D. Illusions E. Psychosis During the past three to four years a middle aged man has had two episodes of mania and three of depression with several hospital admissions. What is the best management in this case? A. Flupentixol B. Chlorpromazine. C. Lithium D. ECT E. Haloperidol

The average age of patients presenting with schizophrenia is a)20-30 years b) 30-40 years c) 40-60 years d) over 60 years ans 20 -30 years During the past three to four years a middle aged man has had two episodes of mania and three of depression with several hospital admissions. What is the best management in this case? A. Flupentixol B. Chlorpromazine. C. Lithium D. ECT E. Haloperidol 2006 hi i think the ans is lithium bcoz pt has ups and low in his mood so it is bipolar corret me if i am wrong this shiuld be lithium,coz in first shouldnt use ect/ in other question it should obsessive,coz the thoughts comes and go.and it unable to stop.if it is postpartum psychosis startin 3rd day after delivery.blues usually withing 48 hrs.it should have manic depressive/schio affective Theme: Psychiatric disorders in pregnancy and the puerperium A. 'baby blues' B. Chronic schizophrenia C. Depressive illness D. Munchausen's disease E. Neurotic Disorder F. Personality disorder G. Phobic disorder H. Postnatal depression I. Postpartum thyroiditis J. Puerperal psychosis K. Sheehan's syndrome 1. A 19 year old living alone, 2 weeks following the delivery of her first child complains of difficulty sleeping, tearfulness and anxiety that she is incapable of looking after her baby 2. A 36 year old solicitor, 3 days after an emergency Caeserean Section for fetal distress, suddenly becomes aggressive and abusive to staff and her partner. She threatens to strangle her baby 3. A 36 year old solicitor, 3 days after an emergency Caeserean Section for fetal distress, suddenly becomes aggressive and abusive to staff and her partner. She threatens to strangle her baby 4. A 32 year old 6 weeks following the vaginal delivery of her 5th child, which was complicated by a large postpartum haemorrhage, presents to her general practitioner complaining of lethargy, loss of libido and difficulty in bonding with her new baby. She looks extremely pale although her haemoglobin is normal. 5. A socially withdrawn 42 year old, living alone presents to the antenatal clinic at 26 weeks with dishevelled appearance and exhibiting poor personal hygiene. Prior to this visit, she has not attended for antenatal care and is unresponsive throughout the interview, failing to make any eye contact. Ans: HJAKB

drug side effects: 1==A pt receiving treatment for bipolar affective disorder his tsh level is increased and t3 and t4 levels are reduced. Ans: lithium. -2== Pt: having extrapyramidal effects complains of reduced sexual libido and erectile impotence his prolactin is raised. Ans: chlorpromazine. 3==A pt on treatment for depression complains of dry mouth, blurred vision, constipation and tremors. Ans: Amitriptyline. -4== Pt: with h/o of schizophrenia receiving an antipsychotic agent becomes physically unwell and is found to have an elevated body temp: unstable blood pressure excessive sweating and a raised white blood cell count and raised cpk. woman after pregnanacy becomes very fearful and sleepless and avoids going out.has frequent emotional outbursts,sleeeplessness and clings to her child claiming inadequate bonding etc. 1postpartum psychoses 2.normal reaction 3.depression 4.acute stress reaction Theme 16 Psychiatry a) Acute confusional state b) PTSD c) drug induced psychosis d) Mania e) schizophrenia

65) A Pt undergone surgery for some condition and is receiving medicines for pain relief. On 3rd postop day he has features of delirium tremens. 66) A kosovian who gets startled easily when he hears any loud noises etc 67) A person who is being stopped by the police and goes on talking jumping from one topic to another. 6 Something about a man running to the police station and saying that his house is not safe, but on checking that’s not the case.

Drug induced psychosis PTSD

Mania Schizophrenia Options A Schizophrenia B Brief reactive psychosis C Bipolar disorder D Major depression E Body dysmorphic disorder F Panic disorder G Post-traumatic stress disorder H Schizoaffective disorder I Delusional disorder J Paranoid schizophrenia K Postpartum depression L Dysthymia For each case 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: 1. A 40-year-old man insists that his wife is unfaithful and sleeping with the entire neighborhood. He is hypersensitive, argumentative, and litigious. His wife has left him due to his behaviour. He functions well at work paranoid schizophrenia Theme: diagnosis of conditions that mimic physical disease Options: A Conversion disorder B Histrionic personality disorder C Body dysmorphic disorder D Briquette’s syndrome E Münchausen syndrome F Hypochondriacal neurosis G Somatoform pain disorder For each case 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: 1. A 40-year-old man insists that his leg is gangrenous and needs to be amputated. On examination, he has normal extremities. 2. A 10-year-old woman presents with a history of multiorgan ailments. She reports that she has always been poorly ever since she was a child. She sees her GP on a regular basis and each time for a different medical symptom. No medical abnormalities can be found. She has multiple surgical scars over her entire body. 3. A 50-year-old man facing redundancy is now paralyzed in both legs and wheelchair-bound. The paralysis and sensory loss is inconsistent with the anatomical distribution of nerves. 4. A 40-year-old woman after failing her driver's test complains of chest pain. No medical cause can be identified. 5. A 50-year-old man insists he has throat cancer. He has shopped around and can find no doctor who will concur with him. He visits his GP frequently 1-c

2-e 3-a 4-a 5-f 93- depression with psychotic symptoms, A- generalized anxiety disorder B-,adjustment disorder C-,major depression D-Bipolar affective disorder Ans: Major depression Suicide & Drug Abuse Options A. Detention under mental health act B. Anti depressant C. Cognitive therapy D. Admit & psychiatric ICU E. Self support therapy F. Behavioural therapy G. Admit & observation H. Amitriptyline hypnosis I. Anti psychotics J. Disulfiram K. Drug misuse center referral L. Methadone M. Alcohol annoymymous (aanon group counseling) N. 130. A schizophrenic pt not taking any drugs tried to hang himself D 131. A businessman after RTA presents to A&E says life is no worth living. B 132. Husband was caught by his wife, when he tried to jump of window, D? 133. A 20 yr old female had 5 mg diazepam & drank whole bottle of whisky (GLEN FIDDDCH), now she wants to die since her boyfriend left her. G 134. An artist just stopped drinking & wants to stay away from it. M 135. A 30 yr old man was found in car when he tried to poison himself with exhaustive gas from car. He is well, but wants to die. D or G? 136. A 40 yr old woman, after major surgery feels bugs crawling all over & feels agitated. ? 137. A 14-year-old boy caught stealing £-40, there are needle marks on his elbow. He wants to stop drug abuse. K Poisoning A. Caffeine B. Cocaine C. Amphetamine D. Marijuana E. Morphine F. Ecstasy

31. A man came to accident & emergency & saying he hears voices & sees faces around. Side effects of Antipsychotic Drugs: A. Clonazepine B. Phenelezine C. Lithium D. Fluoxetine E. Haloperidol F. Amitryptiline 57. A schizophrenic on long-term treatment C/O impotence, has high prolactin levels, extrapyramidal side effects. E 58. Drug with anticholinergic side effects, dry mouth, blurred vision, tremor. F 59. Pt on treatment for bipolar disorder, hypothyroidism features C 60. Schizophrenic pt under treatment presents with sore throat, decreased WBC, agranulocytosis A 61. Schizophrenic pt under treatment presents with fever, increased WBC, Increased muscle creatinine kinase levels. B diagnosis of psychiatric symptoms 1 2 3 4 5

. pt has many ideas and jumps from one topic to another . pt speaks continously and does not get distracted ffrom interventions . pt knows about his psychiatric problem .pt in ward claims that nurse knows what she is hinking . pt having difficulty falling asleep, early morning waking and avoiding eye contact

options; low mood thought insertion thought broadcasting insight flight of ideas pressure of speech concentraction Answers 1: 2: 3: 4: 5:

Filght of ideas Pressure of speech Insight Thought broadcasting Low mood

Psychiatry Next Step. A. Chlorpromazine. B. Clozapine.

C. ECT D. Benzhexol. E. Continue the same drug orally. F. Stop the treatment. G. Hyoscine. H 93. A pt. After treatment with antipsychotic, he develops hyper salivation. G 94. A pt. After treatment with haloperidol, a man develops stiffness of limbs. F 95. A pt. stabbed his father in acute psychosis, & then was treated with anti psychotic, now believes himself to have recovered from the illness.E 96. A pt who has recurrent hiccups, due to anti psychotic treatment. HALOPERIDOL? Next Step In treatment Of Psychiatric Pateints. A. Oral anti psychiatric drug. B. IV anti psych. C. Stop Rx. D. Continue same treatment. E. Review after 3 months. F. Regular visits to Doctor. 115. 30 year old with psychiatric problem on oral anti psychotics. ? 116. Pt who is doing well on anti psych. on his regular visit to GP after 3 months? Management of psychiatric cases Family therapy, Occupational therapy, Genuine mourning, Antidepressants, and so on. 1.A young girl brings her mother who is low in mood for the past 6 months after the death of her father. It is worse in the past 3 months and she is incontinent with few more somatic symptoms How would you help her? A 26 year old woman has been promoted at work to a job that requires regular public speaking. she is worried and anxious about it and feels she will faint. single MOST USEFUL intervention a.CBT b.diazepam c.flouxetne d.psychoanallytic psychotherapy e.relaxation ans d? Poisoning in children: Serum oestriol Serum Fe

Wait & observe Oestrogen levels Blood sugar Salicylate LFTs. ECG. Serum creatinine. Observe A baby was found playing with aspirin pills some hours ago A baby swallowed some OCPs A baby girl seen playing with red tablets which her mother used as she was feeling weak, we are unable to contact mother at the moment A baby swallowed some red tablets of his pregnant mother (Fe level)(measure level) A baby swallowed some TCAs A boy drinks Vodka & is unconsciousness Theme-6: Management of Head Injury: A- Reassure & discharge B- Admit & observe for 6 hours C- Discharge with advice D- Intravenous fluids E- Intubate & ventilate F- Elevate the skull fracture G- Oropharyngeal airway H- Suction of skull vault, I- Immediate CT scan J- Monitor ICP K- Urgently take to operation room L- Burr hole M- CT & observe N- Lumbar puncture An 8-year-old boy falls off a swing at his school. He is brought to A&E by one of his teachers. He has a bruise over his scalp but the examination is otherwise normal. He is fully conscious GCS-14 & with no history of blackouts since the accident. A skull X-ray is performed, which is normal. A young man involved in fight & hit by baseball bat on the back of his head. Skull X-ray revels depressed fracture of occipital bone, its not compound injury, GCS initially was 14 but falls rapidly with in an hour. He has been intubated but he was getting worse. A pt after RTA comes with depressed occipital fracture & a haematoma. His GCS was 15, after some time he develops fit Middle aged man fallen & had temporal area lacerations. His GCS-14. X-Ray Skull shows no fractures. A pt with small skull fracture with GCS-15 & no other neurological signs. A 36-year old male with the h/o recurrent falls & head trauma presents with GCS-14, normal neurological signs, & he smells of alcohol. An 18-tear-old girl fell off horse & lost consciousness, CT showed; no intra cerebral hemorrhage, but

she has diffuse cerebral oedema. (she has bilateral papilloedema) A child, with neck stiffness, consciousness preserved, came to A&E with fever. Investigation for chronic abdominal pain Options A Abdominal computed tomography (CT) scan B Abdominal ultrasound C Barium enema D Cystoscopy E Faecal fat content F Intravenous urogram (IVU) G Laporoscopy H Laparotomy I Liver function tests J Lumbar spine x-ray K Mesenteric angiogram L Oral Cholecystogram M Small bowel enema N Technetium isotopic liver Scan (Tc99m). O Upper gastrointestinal endoscopy

Instruction 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 once, or not at all. 137. A 55-year-old woman presents with a six-month history of severe central abdominal pain, which comes on 30-minutes after meals. She has lost 10-kg in weight, and on examination of her abdomen there is a bruit in the epigastrium. She also suffers from intermittent claudication. 138. A 25-year-old teacher complains that she has had central abdominal discomfort of six-month duration, intermittent abdominal distension and alteration in bowel habit. On examination, there is a palpable swelling in the right iliac fossa. A Barium enema carried out showed no abnormality. Theme-3: The treatment of septicemia A) Percutaneous drainage B) Ventilatory support C) Stent D) Acyclovir E) Open surgical debridement F) Resection of superficial tissue with wide margin G)

4. A middle aged man with acute pancreatitis develops hypotension. On CT he is found to have peripancreatic fluid and a lack of enhancement of the pancreatic tail 5. following a perforated bowel a middle aged man develops severe shock and septicemia as well as a central dark discoloration on his abdomen which is growing larger

1. 2. 3. 4. 5.

Most common dementia in the UK-alzheimer Dementia with neurofibrillary tangles- alzheimer Dementia associated with HPN- multiinfarct dementia Dementia that can be treated with antidepressent-pseudodementia Dementia with intellectual sparing- frontal lobe dementia