PLAB 1700C Flashcards
A 23 yo girl presented with perioral paresthesia and carpopedal spasm 20 mins after a huge argument with her boyfriend. What is the next step for this pt?
a. SSRI
b. Diazepam
c. Rebreath into a paper bag
d. Propranolol
e. Alprazolam
Q. 1. What is the key?
Q. 2. What is the likely diagnosis?
Ans. 1. The key is C. Rebreathin in paper bag. [hyperventilation causes CO2 washout and respiratory alkalosis. If you continue breathing and rebreathing in paper bag it will allow CO2 concentration to rise in paper bag and as you rebreath this again and again you will regain some washed out CO2 and thus relief to this alkalosis].
Ans. 2. The girl may have anxiety disorder when it precipitates leads to hyperventilation syndrome. X
A 25 yo woman has been feeling anxious and nervous for the last few months. She also complains of palpitations and tremors. Her symptoms last for a few minutes and are very hard to control. She tells you that taking alcohol initially helped her relieve her symptoms but now this effect is wearing off and she has her symptoms even after drinking alcohol. What is the dx?
a. Panic disorder
b. Depression
c. OCD
d. Alcohol addiction
e. GAD
Ans. The key is A. Panic disorder.
A 2yo child is very naughty. His teacher complains that he is easily distracted. His parents say that he can’t do a particular task for a long time. He sometimes hurts himself and breaks many things. This causes many troubles at home. What is the dx?
a. ASD
b. Dyslexia
c. ADHD
d. Antisocial personality disorder
e. Oppositional defiant
Ans. The key is C. ADHD (Attention deficit hyperreactive disorder).
A 79 yo lady who is otherwise well recently started abdominal pain. She is afebrile and complains that she passed air bubbles during urination. A urethral catheter showed fecal leakage in the urinary bag. What is the likely pathology?
a. Diuretics
b. CD
c. Rectosigmoid tumor
d. Large bowel perforation
e. UC
Ans. The key is B. CD. [debate came that Crohn’s disease cannot occur in 79 yrs but this is not the case! “Crohn’s disease can occur at any age, but is most frequently diagnosed in people ages 15 - 35. About 10% of patients are children under age 18”.
[http://www.nytimes.com/health/guides/disease/crohns-disease/risk-factors.html]. So I think it can occur in this age also and the feature like fistula is a common association of CD].
A 2 month child with diarrhea and vomiting for 6 days is brought in looking lethargic. What is the
appropriate initial inv?
a. BUE
b. Random blood sugar
c. CBC
d. CXR
e. AXR
Ans. The key is A. BUE. [Electrolyte imbalance should be checked in this baby presenting with diarrhea and vomiting for considerable time].
A 72 yo man fell while shopping and hurt his knee. His vitals are fine. He speaks in a low voice and is very slow to give answers. What is the most probable dx?
a. Alzheimers
b. Vascular demetia
c. TIA
d. Pseudo-dementia
e. Picks dementia
Q. 1. What is the key?
Q. 2. What are the points in favour?
Ans. 1. The key is A. Alzheimers.
Ans. 2. Points in favour: i) age 72 yrs ii) fall iii) loss or slowness of speech.
why not vascular? in vascular: i) confusion ii) disorientation iii)loss of vision
why not pseudodementia? in pseudo i) onset is short and abrupt ii associated depression
why not picks i) dementia and aphasia
Why not TIA? In TIA complete resolution of symptom!! But here symptoms are persistent.
A 47 yo man met with a RTA. He has multiple injuries. Pelvic fx is confirmed. He has not passed urine in the last 4 hrs. What is the next appropriate management for this pt?
a. Urethral catheter
b. Suprapubic catheter
c. IV fluids
d. IV furosemide
e. Insulin
Q. 1. What is the key?
Q. 2. What is the reason of this management?
Ans. 1. The key is B. Suprapubic catheter.
Ans. 2. In pelvic fracture there is chance of urethral rupture and hence displacement of urethral catheter while try to place it.
A 49 yo pt presents with right hypochondriac pain. Inv show a big gallstone. What is the most appropriate management?
a. Lap Cholecystectomy
b. Reassure
c. Low fat diet
d. Ursodeoxycholic acid
e. Emergency laparotomy
Q. 1. What is the key?
Q. 2. Points in favour?
Ans. 1. The key is A. Lap Cholecystectomy.
Ans. 2. i) as symptomatic only reassurence is not appropriate ii) as big stone ursodyoxycholic acid is less effective iii) less invasiv is preferred so laparoscopic rather than laparotomy.
In a man who is neglected and alcohol dependent, whith high suicidal risk, which factor can increase this risk further?
a. Alcohol dependence
b. SSRI
c. S]moking
d. Agoraphobia
e. Court involvement
Ans. The key is A. Alcohol dependence. This is wrong key!! Correct key should be B. SSRI. [He is already alcohol dependent. So further (additional) risk factor is SSRI (SSRI has well known risk of developing suicidal ideation].
A 71 yo man presents with coarse tremor. He is on some meds. Which one can be the reason for the tremor?
a. Lithium
b. Diazepam
c. Fluoxetine
d. Imipramine
e. Haloperidol
Ans. The key is A. Lithium. Actually in therapeutic dose lithium causes fine tremor but in toxic dose it causes coarse tremor. So the probable answer is lithium.
A young woman complains of diarrhea, abdominal cramps and mouth ulcers. AXR shows distended transverse colon with globet cell depletion on rectal biopsy. What is the most probable dx?
a. CD
b. UC
c. Bowel Ca
d. Bowel obstruction
e. IBS
Q. 1. What is the key?
Q. 2. What are points in favour?
Ans. 1. The key is B. UC.
Ans. 2. In UC there is goblet cell depletion and less mucous production in contrast with CD where there may be goblet cell hyperplasia and mucous secretion is not reduced. Please note aphthous ulcer can develop in both CD and UC.
After eating a cookie at a garden party, a child began to cough and went blue. The mother also noticed that there were swollen patches on the skin. What is the dx?
a. Allergic reaction
b. Aspiration of food
c. Cyanotic heart disease
d. Trachea-esophageal fistula
e. Achalasia cardia
Ans. The key is A. Allergic reaction.
A 70 yo man presents with balance difficulties, vomiting and nausea. Which of the following is the best inv?
a. MRI cerebellum
b. CT cerebellum
c. Skull XR
d. LP
e. Blood culture
Ans. The key is A. MRI cerebellum. [Balance difficulties, vomitin and nausea suggests cerebellar lesion. In posterior fossa lesion MRI is preferred].
A 2 yo pt presents with colicky pain which radiates from loin to groin. He complains of similar episodes in the past. Inv has been done and 7mm stone was found in the ureter. What is the most appropriate management?
a. Percutaneous nephrolithiotomy
b. Open surgery
c. Ureteroscopy or laser
d. Conservative tx
e. ESWL
Q. 1. What is the key?
Q. 2. What treatments are recommended for different sized stones in Adults?
Ans. 1. The key is E. ESWL. Probably a wrong key! The correct key is C. Ureteroscopy or laser. [For 6-16 mm stone in pediatric group ureteroscopy is the treatment of choice. So answer here is C. Ureteroscopy or laser].
Ans. 2. Stones < 5mm: pass spontaneously, Increase fluid intake.
Stones 5mm-10mm /pain not resolving: medical expulsive therapy—> Nifedipine or Tamsulosin(and/or prednisolone).
Stones 10mm-2cm: ESWL or Ureteroscopy using dormia basket.
Stones > 2cm/large/multiple/complex: Percutaneous nephrolithotomy.
A footballer has been struck in the groin by a kick and a presents with severe pain and mild swelling in the scrotum. What is the most appropriate next step?
a. USG
b. Doppler
c. Exploratory surgery
d. IV fluids
e. Antibiotics
Ans. The key is C. Exploratory surgery. [To exclude torsion].
A 47 yo ex-soldier suffers from low mood and anxiety. He can’t forget the images he faces before and has always had flashbacks. He is not able to watch the news because there are usually some reports about war. What is he suffering from?
a. Depression
b. PTSD
c. Panic attack
d. Agoraphobia
e. GAD
Ans. The key is B. PTSD. [repeated flashbacks and tendency to avoid the thoughts of stressor is diagnostic of PTSD].
A 36 yo woman has recently spent a lot of money on buying clothes. She goes out almost every night with her friends. She believes that she knows better than her friends, so she should choose the restaurant for eating out. She gave hx of having low mood at 12 yo. What’s the dx?
a. Mania
b. Depression
c. Bipolar affective disorder
d. Borderline personality disorder
e. Dysthymia
Ans. The key is C. Bipolar affective disorder. [Initial depressive episode (may be befor a long) followed by mania is bipolar affective disorder].
A 28 yo female presents with a 3m hx of diarrhea. She complains of abdominal discomfort and passing stool 20x/day. Exam=febrile. Barium enema shows cobblestone mucosa. What is the most likely dx?
a. Ameoba
b. Colon Ca
c. GE
d. CD
e. UC
Ans. The key is D. CD. [Hx of diarrhea, abdominal discomfort, and patient being febrile indicate gut inflammation and cobblestone appearance on barium enema is suggestive of CD].
A child is brought in with high grade fever, runny nose and bark-like cough. He is also drooling. What is the most appropriate tx for this child?
a. Corticosteroids
b. Paracetamol
c. Adrenaline nebulizer
d. IV antibiotics
e. Intubation under GA
Ans. The key is E. Intubation under GA. This is a wrong key! In epiglottitis there is no cough and bark like cough is diagnostic of croup! So the correct key should be a. Corticosteroids. [high fever, bark-like cough, drooling in a child suggest croup which is treated with corticosteroids].
A 78yo lady on warfarin for atrial fibrillation lives in a care home. She presents with hx of progressive confusion for three days. She was also noticed to have bruises on her arms. INR = 7. What is the most probable dx?
a. Alzheimers
b. Delirium
c. Subdural hemorrhage
d. Vascular dementia
e. Pick’s dementia
Ans. The key is C. Subdural haemorrhage. [Age 78 yrs, living in a care home where unnoticed trivial injury is possible (like fall), warfarine and high INR is potential risk factor of subdural haemorrhage suggested by bruises on arms also].
A 28 yo drug user presents to the ED with collapse and anuria. His serum K+ = 7.5mmol/L. CXR = early pulmonary edema. What is the next appropriate management?
a. Urgent hemodialysis
b. IV calcium gluconate
c. IV insulin + dextrose
d. Furosemide
e. IV NS 0.9%
Ans. The key is B. IV calcium gluconate. [IV calcium gluconate isgiven to ]. Protectthe heart from lethal arrhythmia or cardiac arrest from high potassium level and used to buy time while definitive management is being taken. Actually calcium gluconate don’t lower the potassium level that much but protect the heart from arrhythmia].
A 32 yo woman suffers an episode of severe occipital headache with vomiting and loss of consciousness. She is brought to the hospital where she is found to be conscious and completely alert. Exam: normal pulse & BP. No abnormal neurological signs. What is the next step in management?
a. Admission for observation
b. CT brain
c. MRI head
d. Reassurance and discharge
e. XR skull
Ans. The key is B. CT brain. [basilar migraine can cause severe headache and LOC. But there occurs no neurological deficit and on recovering from unconsciousness becomes completely alert. But to diagnose basilar migraine there should at least history of two migraine attacks with aura. As here diagnostic criteria of basilar migraine is not fulfilled we can not discharge the patient without neuroimaging like CT or MRI].
A 25 yo woman was brought to the ED by her boyfriend. She has many superficial lacerations on her forearm. She is so distressed and constantly says her boyfriend is going to end the relationship. She denies trying to end her life. What is the most likely dx?
a. Acute psychosis
b. Severe depression
c. Psychotic depression
d. Borderline personality disorder
e. Schizophrenia
Ans. The key is D. Borderline personality disorder. [ Borderline personality disorder: Act impulsively and develop intense but short-lived emotional attachment to others. They are usually attention seekers but not suicidal].
A young woman was brought to the hospital. On exam she has low temperature and tremor. She says when she closes her eyes, she can see colors.
What drug has been used?
a. Amphetamines
b. LSD
c. Cocaine
d. Heroine
e. Ecstasy
Ans. The key is B. LSD. [LSD can cause colour in vision].
A lady comes in severe liver disease and hematemesis. Her INR is >10. What should she be given?
a. FFP
b. Steroids
c. Whole blood
d. IV fluids
e. Vit K
Ans. The key is A. FFP.
After eating a cookie at a garden party, a child began to cough and went blue. The mother also noticed that there were swollen patches on the skin. What is the initial management?
a. OTC antihistamine
b. Oxygen
c. Bronchodilators
d. Epinephrine IM
e. Nebulized epinephrine
Ans. The key is D. Epinephrine IM [anaphylaxis with partially blocked airway].
A 63 yo female is noted to have left pupil irresponsive to light and is dilated. What is the most probably dx?
a. Pontine hemorrhage
b. Subdural hemorrhage
c. Cerebellar hemorrhage
d. Extradural hemorrhage
e. Subarachnoid hemorrhage
Ans. The key is D. Extradural hemorrhage. This is a wrong key! Correct key is B. Subdural hemorrhage.
A 28yo business executive presents at the GP asking for some help because she has been arguing
with her boyfriend frequently. She is worried about her weight, and she thinks she may be fat. She has been on a diet and lost 7 kgs in the last 2 months on purpose. She is eating less. She used to do a lot of exercise. Now she says she’s feeling down, has some insomnia and feels tired and without energy. She has not showed up at work. She is worried because recently she got a
loan to buy a luxury car. She can’t be fired. She complains about her low mood. She thinks this is
weird because she used to be extremely productive. She used to work showing an excellent performance at the office. She even received compliments from her boss. How, she says her boyfriend is angry because her apartment is a chaos. Usually she spends a lot of time cleaning it, even upto 3 AM. She liked it to be perfect, but not it’s a mess. On exam: BMI=23, no other signs.
What is the most probably dx?
a. Anorexia nervosa
b. Bipolar disease
c. Binge eating disorder
d. Hyperthyroidism
e. Schizophrenia
Ans. The key is B. Bipolar disorder. [Now she is depressed but before hypomanic which makes the likely dx of bipolar disorder].
A woman brought her husband saying she wants the ‘thing’ on his forehead removed. The husband is refusing tx saying it improves his thinking. What is the most appropriate next step?
a. Assess his mental capacity to refuse tx
b. Remove lesion
c. Refer to ED
d. Mini-mental state exam
e. Refuse surgery and send pt back
Ans. The key is A. Assess his mental capacity to refuse treatment.
A 37 yo man who has many convictions and has been imprisoned many times has a hx of many unsuccessful relationships. He has 2 boys but doesn’t contact them. What is the most probable dx?
a. Borderline personality disorder
b. Schizophrenia
c. Avoidant personality disorder
d. Histrionic personality disorder
e. Antisocial behavior disorder
Ans. Ans. The key is E. Antisocial behavior disorder. [Antisocial personality disorder is a particularly challenging type of personality disorder, characterised by impulsive, irresponsible and often criminal behavior].
A 60 yo man has a pathological rib fx. He also complains of recurrent infection. BMA is done. Labs: Ca2+ = 3.9mmol/L and ALP = 127u/L. what type of cell would be found in abdundance in the marrow smear?
a. Plasma cell
b. Myeloid cell
c. Bence-jones protein
d. Megakaryocytes
e. Reticulocytes
Q. 1. What is the key.
Q. 2. What is the diagnosis?
Q. What are the points in favour of diagnosis?
Ans. 1. The key is A. Plasma cell.
Ans. 2. The diagnosis of multiple myeloma.
Ans. 3. Points in favour: i) age 60 yrs ii) pathological rib fracture (from metastases) iii) recurrent infection (due to B cell dysfunction (manifested as hypogammaglobulinemia), numerical and functional abnormalities of T cells, and dysfunction of natural killer cells), iv) raised calcium level.
A child presents with blue marks on the sclera, short stature and heart murmur. What is the dx?
a. Osteogenesis imperfect
b. Hypopituitarism
c. VSD
d. Achondrogenesis
e. Dwarfism
Ans. The key is A. Osteogenesis imperfecta.
A 5month child can’t speak but makes sounds. She can hold things with palm, not fingers. Can’t sit independently but can hold her hand and sit when propped up against pillows. How’s the childs development?
a. Normal
b. Delayed speech
c. Delayed sitting
d. Delayed motor development
Ans. The key is A. normal
A 27 yo woman has hit her neck in an RTA without complains of tingling or motor loss. What is the next most appropriate inv?
a. MRI
b. XR
c. CT cervical
d. Diagonal XR
Ans. The key is B. X-ray. [As there is no neurological deficit we can exclude any fracture by x-ray first]. [Diagonal x ray means ,oblique view of cervical spine. By this view we can assess facet joint arthopathy. This doesn’t related to RTA].
A young female who has many superficial lacerations was brought into the ED by her boyfriend for superficially lashing her upper arm. She is adamant and screaming that she is not suicidal but scared her boyfriend wants to leave her. What is the dx?
a. Acute psychosis
b. Severe depression
c. Obsessive
d. Bipolar
e. Borderline personality
f. Schizophrenia
Ans. The key is acute psychosis. Probably this is wrong key! Correct key should be E. Borderline personality disorder. [Borderline personality disorder (BPD), also known as emotionally unstable personality disorder, is a long term pattern of abnormal behavior characterized by unstable relationships with other people, unstable sense of self, and unstable emotions.[3][4] There is often an extreme fear of abandonment, frequent dangerous behavior, a feeling of emptiness, and self-harm].
A 22yo woman was brought by her boyfriend with multiple superficial lacerations. There are scars of old cuts on her forearms. She is distressed because he wants to end the relationship. She denies suicide. What is the most likely dx?
a. Acute psychosis
b. Borderline personality disorder
c. Severe depression
d. Schizoid personality
e. Psychotic depression
Ans. The key is B. Borderline personality. [Borderline personality disorder (BPD), also known as emotionally unstable personality disorder, is a long term pattern of abnormal behavior characterized by unstable relationships with other people, unstable sense of self, and unstable emotions.[3][4] There is often an extreme fear of abandonment, frequent dangerous behavior, a feeling of emptiness, and self-harm].
A 31yo single man lives with his mother. He usually drives to work. He always thinks when the traffic lights change, his mother is calling him, so he drives back home. What is the dx?
a. OCD
b. GAD
c. Schizophrenia
d. Bipolar
e. Cyclothymia
Ans. The key is C. Schizophrenia. [ delusion of reference - he thinks that the changing traffic lights are giving message to him].
A 56yo woman is known case of pernicious anemia. She refuses to take hydroxycobalamin IM as she is needle shy. She asks for oral medication. Why will oral meds be not effective?
a. Intrinsic factor def
b. Malabsorption
c. Irritated gastric mucosa
d. Lack of gastric acidity
Ans. The key is A. Intrinsic factor def. [Vitamin B12 cannot be absorbed without intrinsic factor].
An 11m baby had an apnea event. The parents are worried that if something like this happens in the future, how they are to deal. Advise them about infant CPR.
a. Index and middle finger compression
b. Compression with palm of one hand
c. Compression with palm of two hands
d. Compression with rescue breaths 30:2
e. Compression with rescue breaths 15:2
Ans. The key is A. Index and middle finger compression.
A teacher brings in a child who says she fell down after hitting a table. On probing further, you decide that it was most probably an absence seizure. What led you to this dx?
a. The child had not eaten since morning
b. The child suddenly went blank and there was up-rolling of eyes
c. The child started moving his fingers uncontrollably before he fell
d. The child’s body became rigid and then started to jerk
Ans. The key is B. The child suddenly went blank and there was up-rolling of eyes.
