PLAB 1700G Flashcards
A 65yo woman had an excision of colonic tumor 3yrs ago. Now she is losing weight and feels lethargic. Exam: pale but no abdominal findings. What is the most appropriate inv?
a. CA 125
b. CA 153
c. CA 199
d. CEA
e. AFP
Ans. The key is D. CEA. [CA 125 = ovarian cancer; CA 153 = cancer breast; CA 199 = pancreatic cancer; CEA = colorectal carcinoma; AFP = hepatocellular carcinoma].
A 46yo African-Caribbean man is found to have BP=160/90mmHg on 3 separate occasions. What
is the best initial tx?
a. ACEi
b. Beta-blockers
c. ARBs
d. None
e. CCB
Ans. The key is E. CCB. [If age less than 55 years but Afro-Caribbean origin then CCB].
A 39yo woman will undergo tubal sterilization and she wants to know the failure rate of this type of sterilization.
a. 1:50
b. 1:200
c. 1:500
d. 1:1000
e. 1:5000
Ans. The key is B. 1:200.
Which of the following reflexes and innervating spinal nerves are correctly paired?
a. Anal reflex – S1
b. Ankle jerk – L5
c. Biceps jerk – C7 & C8
d. Knee jerk – L3 & L4
e. Triceps jerk – T1
Ans. The key is D. Knee jerk – L3 & L4. [Anal reflex – S2-4; Ankle jerk – S1-2; Biceps jerk – C5-6; Knee jerk – L3-4; Triceps jerk – C7].
A 62yo man with rheumatoid arthritis struck his hand against a door. He subsequently found that although he could extend the interphalangeal joint of his right thumb, the MCP joint of the thumb remained flex. What is the single most likely tendon to have been damaged?
a. Extensor carpi ulnaris
b. Extensor digitorum
c. Extensor indicis
d. Extensor pollicis brevis
e. Extensor pollicis longus
Ans. The key is D. Extensor pollicis brevis. [Action of extensor pollicis brevis = extension of thumb at metacarpophalangeal joint. Extensor pollicis longus = extends the terminal phalanx of the thumb].
A 68yo lady complains of falls to the ground without any warning, maintains consciousness and no confusion. She says this has occurred at number of times. What is the dx?
a. Stokes Adams attack
b. Hypoglycemia
c. Vasovagal syncope
d. Drop attacks
e. Epilepsy
Ans. The key is D. Drop attacks. [Drop attacks are sudden spontaneous falls while standing or walking, with complete recovery in seconds or minutes. There is usually no recognized loss of consciousness, and the event is remembered].
A 50yo man complains of being pursued by the police for a crime he denies committing. He has poor concentration and impaired short-term memory. He admits to drinking large amounts of alcohol for the last 20yrs. What is the most probable dx?
a. Dementia
b. Hallucination
c. Wernicke’s encephalopathy
d. Schizophrenia
e. Korsakoff psychosis
Ans. The key is E. Korsakoff psychosis. [Dementia, i.e. short term memory loss is seen in korsakoff psychosis].
A pt with prv hx of HTN, the membranes have ruptured and the cervix is 3cm dilated. 4h later on examination showed that the cervix was still 3cm dilated. What is the single most appropriate management for her labor?
a. Repeat vaginal examination in 4h
b. CTG
c. C-section
d. External rotation
e. IV syntocin drip
Ans. The key is E. IV syntocinon drip. [There is no progress of labour in 4 hours. Hence syntocinon drip should be given].
A 6yo girl has had 2 short episodes of cough and wheeze over the last 12m. These 2 acute episodes responded quickly to bronchodilator, she has no symptoms or abnormal physical signs. She has slight eczema and her mother has asthma. What is the single most appropriate inv?
a. CXR
b. Peak flow rate diary
c. Pulse oximetry
d. Spirometry
e. Sweat test
Ans. The key is D. Spirometry. [spirometry is the preferred initial test (if available) to assess the presence and severity of airflow obstruction less effort dependent and more repeatable though less applicable in acute severe asthma].
A 45yo man had recently started taking anti-HTN therapy. 6m later his RBS=14mmol/l. Which single drug is most likely to have caused this?
a. Amlodipine
b. Bendroflumethiazide
c. Doxazosin
d. Lorsartan
e. Ramipril
Ans. The key is B. Bendroflumethiazide. [High blood sugar is a well known side effect of bendroflumethiazide].
A 27yo waitress has pelvic pain, dysmenorrhea and increasingly heavy periods. She also complains of dyspareunia. There is generalized pelvic tenderness without peritonism. Pelvic US is normal. What is the most likely dx?
a. Endometriosis
b. Uterine fibroid
c. Pelvic congestion syndrome
d. PID
e. Tubal pregnancy
Ans. The key is C. Pelvic congestion syndrome. [In pelvic congestion syndrome there develops varicose veins in the lower abdomen from prolonged standing (as occurred here in a waitress who remains standing for long) with some pain syndromes like pelvic pain, dysmenorrea, dyspareunia and generalized pelvic tenderness without peritonism. Also there may be associated menorrhagia].
A 14yo girl is clinically obese. She has not started her periods yet and has severe acne. Among her inv, a high insulin level is found. What is the most probable dx?
a. Cushing’s syndrome
b. Grave’s disease
c. Acquired hypothyroidism
d. PCOS
e. Addison’s disease
Ans. The key is D. PCOS. [It is not cushing’s as insulin levels in cushing’s are not usually raised! Here obesity, primary amenorrhea , acne and particularly high level of insulin makes the likely diagnosis to PCOS].
An 18yo girl with primary amenorrhea complains of severe abdominal pain every 4-8weeks which is now getting worse. Exam: lower abdominal mass is felt. What is the most probable dx?
a. Ectopic pregnancy
b. Ovarian carcinoma
c. Hematometrium
d. Biliary colic
e. Renal carcinoma
Ans. The key is C. Hematometrium. [Primary amenorrhea and periodic pain indicate hematometrium either secondary to imperforated hymen or vaginal septum].
A 14yo boy with asthma suddenly developed chest pain and increasing breathlessness during a game of football. When seen in the ED he was not cyanosed. He has reduced breath sounds on the right side. His oxygen saturation is 94% on air. What is the single most appropriate inv?
a. Capillary blood gases
b. CXR
c. CT chest
d. Exercise challenge
e. MRI chest
Ans. The key is B. CXR. [Asthma is a predisposing factor for spontaneous pneumothorax. The presentation indicates pneumothorax for which most appropriate investigation is CXR].
A 36yo woman was recently admitted to a psychiatric ward. She believes that the staff and other pts know exactly what she is thinking all the time. What is the most likely symptom this pt is suffering from?
a. Thought insertion
b. Thought withdrawal
c. Thought block
d. Though broadcasting
e. Hallucination
Ans. The key is D. Thought broadcasting.
A 60yo woman is admitted to the hospital after a fall. She is noted to have poor eye contact. When asked how she is feeling, she admits to feeling low in mood and losing enjoyment in all her usual hobbies. She has also found it difficult to concentrate, feels that she is not good at anything, feels guilty over minor issues and feels very negative about the future. What is the
most likely dx?
a. Mild depression
b. Moderate depression
c. Severe depression
d. Psychosis
e. Seasonal depression
Ans. The key is A. Mild depression. [Mild depression: i)Low mood ii) Anhedonia iii) Guilt iv) Hopelessness v) Worthlessness vi) Inability to concentrate].
A 70yo woman lives in a nursing home following a stroke has developed reddish scaly rash on her trunk. She has many scratch marks on her limbs and trunk with scaling lesions on her hands and feet. What is the single most appropriate initial tx?
a. Aqueous cream
b. Chlorphenaramine
c. Coal tar
d. 1% hydrocortisone ointment
e. Permethrin
Ans. The key is E. Permethrine. [This is a case of scabies and scaly rash denotes the infection of most severe type the crusted or Norwegian scabies. Should be treated with permethrine].
A 16yo boy following a RTA was brought to the ED with a swelling and deformity in his right thigh. Exam: airway is patent and is found to have a pulseless leg. Which structure is involved in this fx?
a. Femoral artery
b. Posterior tibial artery
c. Common peroneal nerve
d. Dorsalis pedis
Ans. The key is A. Femoral artery.
A man sat cross-legged for about 30mins. After this he was unable to dorsiflex his left foot and had loss of sensation in the web space between the big toe and the 2nd toe. He also has sensory loss on the same side of the foot after 2h. Which of the following was affected?
a. Femoral nerve
b. Sural nerve
c. Peroneal nerve
d. Sciatic nerve
Ans. The key is C. Peroneal nerve. [Common peroneal nerve winds round the fibular neck at knee joint and when a man sits cross legged for a considerable time pressure exerted on the nerve may cause nerve palsi].
A 25yo woman is presenting with diarrhea and abdominal bloating over the last 4m. Exam: she
has blistering rash over her elbows. Biochemistry: low serum albumin, calcium and folate conc. On jejunal biopsy, there is shortening of the villi and lymphocytosis. What is the most likely dx?
a. Celiac disease
b. Whipple’s disease
c. Crohn’s disease
d. Tropical sprue
e. Giardiasis
f. Cystic fibrosis
Ans. The key is A. Celiac disease. [diarrhea, abdominal bloating, blistering skin rash over elbow (Dermatitis herpetiformis), low serum albumin, calcium and folate conc. Supported by shortening of villi and lymphocytosis on jejuna biopsy is classic presentation of celiac disease].
A 19yo man presents for the 1st time with a firm and unshakable belief that he is being followed by terrorists who are plotting against him. What is the single best term for this man’s condition?
a. Delusion of persecution
b. Delusion of grandeur
c. Delusion of control
d. Delusion of reference
e. Delusion of nihilism
Ans. The key is A. Delusion of persecution. [Delusions of persecution refer to false beliefs or perceptions in which a person believes that they are being treated with malicious intent, hostility, or harassment – despite significant evidence to suggest otherwise].
A 19yo female is brought in by her parents. They are concerned about her BMI which is 12. She is satisfied with it. What is the next step?
a. Psychiatric referral for admission
b. Family counselling
c. Social service
d. Start antidepo
e. Medical admission
Ans. The key is E. Medical admission. [The diagnosis is anorexia nervosa. At this critical low BMI medical admission is indicated to improve her deficiency states and proper nutrition. ((BMI <15kg/m2, rapid weight loss + evidence of system failure) requires urgent referral to eating disorder unit (EDU), medical unit (MU) or paediatric medical wards].
A lady who works at a nursing home presents with itching. Exam: linear tracks on the wrist. She says that 2d ago she had come in contact with a nursing home inmate with similar symptoms. What is the mechanism of itching?
a. Infection
b. Destruction of keratinocytes
c. Allergic reaction
d. Immunosuppression
e. None
Ans. The key is C. Allergic reaction. [The probable diagnosis is scabies in which there is itching due to allergic reaction to mites (Sarcoptes scabii) waste products].
A teacher had a respiratory infection for which she was prescribed antibiotics. After the antibiotic course when she rejoined school, she lost her voice completely. What is the single most appropriate dx?
a. Recurrent laryngeal nerve palsy
b. Angioedema
c. Laryngeal obstruction by medication
d. Laryngitis
e. Functional dysphonia/vocal cords
Ans. The key is E. Functional dysphonia/vocal cords. [Functional dysphonia is poor voice quality without any obvious anatomical, neurological or other organic difficulties affecting the larynx or voice box. It is often secondary to viral infection].
A 43yo lady is admitted with pyrexia, arthropathy, breathlessness and syncope. She was recently dx with pulmonary emboli. There is an early diastolic sound and a mid-diastolic rumble. Her JVP is elevated with prominent a-waves. What is the most likely cause?
a. Mitral regurgitation
b. Ventricular ectopics
c. Pulmonary regurgitation
d. Atrial myxoma
e. Complete heart block
Ans. The key is D. [Pyrexia, arthropathy, breathlessness, syncope and early diastolic sound and a mid diastolic rumble are known features of atrial myxoma].
A 28yo man presents with a maculopapular rash over his trunk and palms. He also has numerous mouth ulcers. He had a penile ulcer which healed 2wks ago. What will you do to confirm the dx?
a. PCR for treponemal and non-treponemal antibiodies
b. Dark ground microscopy from mouth ulcer
c. Blood culture for treponema
d. Dengue fever
Ans. The key is A. PCR for treponomal and non-treponemal antibodies. [Non treponemal antibody test if positive indicate that there may be syphilis and it is not confirmatory alone. That is why treponemal antibody test should also be done to confirm it. On the other hand resolved disease may show negative treponemal test which is confirmed by positive non-treponemal test].
A 34yo man complains of arthralgia, abdominal pain and vomiting, a facial rash that is worse in the summer and hematuria. Urea and creatinine are slightly elevated with urinalysis demonstrating red cell casts. PMH is remarkable for childhood eczema. Which inv is most likely to lead to a dx?
a. US KUB
b. Joint aspiration
c. Auto antibodies
d. IVU
e. Renal biopsy
Ans. The key is C. Auto antibodies. [Likely diagnosis is SLE for which auto antibody (anti ds DNA antibody) should be done].
A 56yo woman has had severe abdominal pain for 24h radiating to her back and is accompanied by nausea and vomiting. She appears to be tachycardic and in shock. She was found to have gallstones, 2yrs ago. What is the most likely inv to confirm dx?
a. US abdomen
b. LFT
c. Serum lipase
d. Angiography
e. CT abdomen
Ans. The key is C. Serum lipase. [The likely diagnosis is pancreatitis hence serum lipase].
A 32yo female with axillary freckles and café au lait spots wants to know the chances of her child also having similar condition.
a. 1:2
b. 1:4
c. No genetic link
d. 1:16
e. Depends on the genetic make up of the partner
Ans. The key is E. Depends on genetic make up of the partner. [Depends on the make up of the partner, ideally it’s 1:2 since it’s autosomal dominant with complete penetrance but if the patients spouse also has neurofibromatosis, it raises it to at least 75% with a possible 100%].
A 40yo man has pain, redness and swelling over the nasal end of his right lower eyelid. The eye is watery with some purulent discharge. The redness extends on to the nasal peri-orbital area and mucoid discharge can be expressed from the lacrimal punctum. What is the single most appropriate clinical dx?
a. Acute conjunctivitis
b. Acute dacrocystitis
c. Acut iritis
d. Retrobulbar neuritis
e. Scleritis
Ans. The key is B. Acute dacrocystitis.
A 60yo lady has severe chest pain. ECG shows changes of inferior wall MI. ECG also shows progressive prolongation of PR interval until a QRS complex is dropped. What is the most probable dx?
a. Atrial fibrillation
b. VT
c. SVT
d. Mobitz type I 2nd degree heart block
e. Mobitz type II 2nd degree heart block
Ans. The key is D. Mobitz type I 2nd degree heart block. [Inferior MI is frequently associated with conduction defect].
A 52yo woman speaks rapidly without any pause and ignores interruptions. She doesn’t even pause to take enough breaths. What term best describes this kind of speech?
a. Flight of ideas
b. Broca’s aphasia
c. Wernicke’s aphasia
d. Pressure of speech
e. Verbal dysphasia
Ans. The key is D. Pressure of speech.
A 30yo woman has been feeling low and having difficulty in concentrating since her mother passed away 2m ago. She feels lethargic and tends to have breathlessness and tremors from time to time. What is the most likely dx?
a. Adjustment disorder
b. PTSD
c. Panic disorder
d. GAD
e. Bereavement
Ans. The key is A. Adjustment disorder. [When 2 months passed it is no more normal bereavement but major depression or adjustment disorder].
A 32yo man on psychiatric medications complains of inability to ejaculate. Which drug is most likely to cause these symptoms?
a. Lithium
b. Haloperidol
c. Chlorpromazine
d. Fluoxetine
e. Clozapine
Ans. The key is D. Fluoxetine. [SSRIs are frequently associated with delayed ejaculation].
A 4yo boy is brought by his parents with complains of wetting his bed at night and whenever he gets excited. What would be the most appropriate management for this child?
a. Desmopressin
b. Oxybutanin
c. Behavioural therapy
d. Tamsulosin
e. Restrict fluid intake
Ans. The key is C. Behavioural therapy. Probably this is wrong option! There is no correct option for this question. [The question is inappropriate. Child is of 4 yrs of age and before 5 yrs only reassurance, no treatment is indicated].
A 34yo DM pt is undergoing contrast radiography. What measure should be taken to prevent renal damage with contrast dye?
a. Reduce contrast dye
b. Plenty of fluids
c. NSAIDS
d. ACEi
e. IV dextrose
Ans. The key is B. Plenty of fluids.
A 75yo woman presents to the breast clinic having noticed that she has had a blood stained discharge from the left nipple, together with dry skin over the left areola. Exam: blood stained discharge with dry flaky skin noted on the left areola. The nipple was noted to be ulcerated. What is the most appropriate inv?
a. FNAC
b. MRI
c. Punch biopsy
d. Open biopsy
e. Stereotactic biopsy
Ans. The key is C. Punch biopsy. [As the lesion is on the surface punch biopsy can be well obtained].
A 50yo man presents with low mood, poor concentration, anhedonia and insomnia. He has had
2 episodes of increased activity, promiscuity and aggressive behavior in the past. He was arrest 8m ago for trying to rob a bank claiming it as his own. Which drug is most likely to benefit him?
a. Haloperidol
b. Citalopram
c. Desipramine
d. Carbamazepine
e. Ethosuximide
Ans. The key is D. Carbamazepine. [It is a case of bipolar disorder. Mainstay of treatment is mood stabilizers such as i) Lithium carbonate ii) Anticonvulsant medicines iii) Antipsychotic medicines. So from the given options Carbamazepine is the most appropriate drug].
A 25yo woman complains of dizziness, nausea, vomiting, visual disturbances and anxiety which keep coming from time to time. Most of the attacks are a/w sudden change in posture. What is the most likely dx?
a. Panic disorder
b. Carotid sinus syncope
c. BPPV
d. Vertebrobasilar insufficiency
e. Postural hypotension
Ans. The key is C. Benign paroxysmal positional vertigo (BPPV). [Dizziness, nausea, vomiting and nystagmus which keep coming from time to time are common features of BPPV].
A 56yo man was recently put on anti-HTN meds and recent biochemistry on 2 occasions showed: Na+=132, K+=7.6, Urea=11.3, Creat=112. Which of the following drugs is responsible for this result?
a. Amlodipine
b. Bendroflumethiazide
c. Doxazosin
d. Atenolol
e. Ramipril
Ans. The key is E. Ramipril. [ACEI and ARB are known to raise the serum potassium level].
