PLAB TRAINER OURS LOWE 4+ patient with lesion on the left side of the mouth, on Protrusian of the tongue [E'S deviated to the fet, what nerve is damaged? 2) Hyposlossai 5) Glossopharyngee| Facial (mandibular branch) @) Vagus ®) 7. A patient with perioral itching, bronchospasm (anaphylactic picture). What is the best inltal management? (Repeat March 05 q2? with variation) 2) Adrenaline 0.5 mi of + in 1000 Lm ©) Salbutama) ©) Hydrocortisone ©) Antibiotics ®) FA 24 Ve ait develops an itchy scaly patch on her scalp She had a similar patch on het scalp that had spontaneously two years ago. fierce has a similar undiagnosed [ah on the extensor aspects of her eldows an knees ‘What is the single most likely agnosis? (Repeat Nov 04 g 143, an 09 recal) a) Eczema +) Fungal infection ©) Impetigo @) Lichen Planus ©) Psoriasis 4k, A woman with increasing forgetfulness, Jethargy and tiredness. She has Jeb as 3 teacher in the university. She has increasing dj 2) MRI scan of the head D) Erythrocyte sedimentation rate ©) Hb concentration 4) Thyroid function test ©) Vitamin 812 level5. Each year 950,000 people develop myocardial infarction in 2 population of 250,000 milion, Of these 215,000 die, 112,500 in the first hour. What is the incidence of myocardial infarction? an * a) 112,500 in 215,000 bb) 112,500 in 250,000 ©) 215,000 in 950,000 ) 215,000 in 250,000 ¢ e) 950,000 in 250,000 6. Awoman with a diagnosis of mild ulcerative colitis is not on any treatment. She develops diarthoza and mucus stool in the last three months. Alf ather examinations are normal. Her Hb is 9.6 gm. What is the single best treatment? a— b) Ferrous sulphate °) ¢) e) Mesalazine 7. Apperson (? post op) injured the shoulder, he cannot shrug the shoulder or lift the tip of the shoulder. What nerve is damaged? a) Accessory b) axillary ©) Radial 4d) Suprescapulsr 2) Musculocutaneous 8. A smoker with several ulcers in the mouth with 2 white striae, there are several ulcers in the under surface of the tongue. What is the diagnosis? (Repeat Jen 07 recat) 2) Aphthous ulcer b) Lichen Planus ) Karposis sarcoma ) e) Cancer of the mouth 9. A patient post prostatectomy with a history of DVT. What is the therapeutic INR in management? a) 12 b) 23 o) 34 0) 45 wesend Person with fong standing 1 cm lesion on the ?hend /arm that has started Bleeding on touching. What is the diagnosis? @) Basal celi carcinoma ©) Karposis sarcoma ©) Malignant melanoma a ©) Squamous cell carcinoma gh wth central clearing since 3 weeks and the lesion 14. Aman with a lesion on the thi alse and generalised aches. What is the test te has been spreading. He also hes diagnose his lesion? 2) Skin Biopsy 8) Skin scrapping and cutture © Lyme Serology ¢) Antibacterial culture e)- ser Betson with acute onset of red eye, pain and bury vision. He has periorbital grceme, etc. What Is best intial managernent? 2) Put patient in a dark room with reduced light 2) ¥ morphine and routine ophthalmological referral ©) Lv morphine and emergency ophthalmological referra) ©) iv. morphine and antibiotics ®)im morphine Forgetfulness, poor sleep, lass of 413. A 60 year old man presents with increasing answers every question with "I don’t rest. He shows psychomotor retardation arc} know, What single diay 2) Depression b) Dementia ©) Bipolar affective disorder ©) Normal aging process ©) Panic disorder ‘SNOs'S explains his condition? (Repeat Nov 04 with variation)414. A boy is brought to the’ ABE , he has felt unwell for a few days and is now voriting His pulse rate 's 100 beats /min and his capillary refill is 3 seconds. He is confused and his arterial blood gas results are: Ph= 7.25 Base excess What Is the single correct interpretation of the blood gas result? (Repeat Nov a) Metabolic acicos's b) Metabolic alkalosis ©) Normal d)_ Respiratory acidosis &) Respiratory alkalosis, 049 84) 45. A 60 y/o man with a long standing COPD is complaining of blurry vision visual disturbance. He is on multiple medications for his COPD. Which of his medication is responsible for his visual disturbance? a) Theophyline b) Corticostercia ©) Oxygen @) Beta agonist ©) ipatropium bromide 16. A four month old baby is brought in with acute nose bleeding. He is naw stable. What is the singie action that can stop the nose bleeding? (Repeat Jan 07 recall) 2) Tce pack b) Pinch the bridge of the nose ©) Pinch the soft tissue of the nose d) Anterior packing e) Reassure 17. A young woman who swaliowed 2400grams of paracetamol following an argument \with her boyfriend. She is now stable and her drug levels are below the treatment threshold with N-Acetyicysteine. She says she is ready to go home. What is the next action in management? a) Discharge and out patient follow up b) Refer to community mental health team ) Detain under the mental health act d) Refer to psychiatrist °)face, Seana ait with a crested lesion on the nek, soreaing from her neck to her years & otherwise neal. Wich inestgation wl etait the agen Simin ye > Seep Dit cane Dosienlcine 8 2B sere a rer 7 TEE Seetnr S Speing wteshy) sega miner with diagnosis of transitional eal cancer ofthe biadder. Whats the ‘single mast important risk factor for his condition? 8) Coaimines€ Oreaamice mein Smoking Pp ©) Famiy history BS a 9 fare aman Who has had ecampsia, Whatisthe single best treatment to prevent future nis? 2) Alpha methy! dopa ) iv hydralazine e (CY magnesium suphate @) a 22. patient is cena sear wth a rest om laryoss, What the no Seppe monaserea ay Retr Hope . severe IM LN Cea preter for coleacony (vege mild macternle 156 (psey) ©) Rept scan fonts ©) Repent sneer ne monte ©) Repestscar ye has been gras shaving beast mit jaundice. she 2. A four week old baby gi Single mast appropriate management? (Nov Of repeat) otherwise wel. What is the G cote rast esting 2) Bxchangetrneison yp Increase uid ntake Phototherapy ©) Stop breastfeeding23..A 1 y/o boy Is brought to the A and E department with a 5 day history of diarrhea and vomiting, For 24 hrs he has been unable to tolerate any oral fluids. In the last hour he has become drowsy, hs skin tugor is reduced and his skin in mottled. His eyes are sunken. His heart rate is 180 beats / min and capillary refill is prolonged. (Nov 04 repeat) What is the single most appropriate initial treatment? 2) Intravenous iV fluid bolus over 20 mins b) iv sehydrate over 48hrs ©) iv fluids over 4hours 2) Naso gastric rehydrete over 24 hrs €) Oral rehydration solution over 48 hrs 24, A 17 y/o Girl presents with a 5 day history of urinary frequency and dysurla. She has a weight of 20kg despite good appetite. She had been taking ‘over the counter preparation for premenstrual tension for several months. Urinalysis shows no glycosuria but is positive for nitrates. What is the single most likely diagnosis? (Repeat Nov 04) a) Diabetes insipidus b) Diabetes metitus ©) Diuretic therapy ) Psychogenic prophylaxis €) Urinary tract infection, 25. A 4yfo is brought to the Accident and Emergency department by ambulance. His mother reports that he has been unwell wth 2 sore throat for eight hours. He is sitting con hs mother’s knee and is tolerating an oxygen mask but looks unwell. He has constant noisy breathing and he is drooling saliva. His temperature is 39degrees Celsius. What Is the single most important diagnosis to rule out? (Repeat march 05 q 90) @) acute asthma yonchiolits ©) croup }) epigiottitis 2) tonsilitis 26. A man complaining of severe eye pain and blumy vision, he also takes pain killers for his long standing back pain, what's the cinical condition? (repeat Jan 07 recall) a) Episcleritis ») itis Q 3) e)27,12 years od boy, present with testclar ain without 2 Hstory of reumay Nes 3febrle end _on examination the Rt testisis slightly higher than Lt. one . What is the diagnosis? (Repeat Jan 07 recall) a) testicular torsion b)epidydmidorchitis 6) teratoma d) seminoma @) varicocele to A&E by mother with a condition of expiratory wheeze, 28. A 4 wk old baby brought the last 3-5 days. Cough, and nasal discharge and aiso vornits efter feeding for ‘What Is the most likely diagnosis? 2) Bronchiolitis, b) Croup ©) Bronche pulmonary dysplasia 4) bronchitis 29, 30 \¥/o women was treated successfully for CIN2 two years back. She was 2 Peja smoker and discontinued smoking few months back. She was op or! ne et al ese years, but now her Parner uses condoms. She fs anwous 25 er stint died of ovarian carcinoma at the age of 48, (repeat July 05) a noe most important factor which pits her at risk of ovarian cancer is a) Age b) Family istory o) Gn a) Smoking @) Oral contraceptives 430. A Patient presents with hyperventilation and clasis signs of pane attack. Whats the single most appropriate management? Rebreath into an airbag Diazepam Salbutamol mpoe>EMQ's ‘Sélection of tests in diagnosing dizziness (repeat April 01 493-978: jen 04) Options ‘A Ambulatory blood pressure monitoring 8 Ambulatory electrocarciagram (ECG) C Galoric testing D Carotid sinus massage Computed tomography (CT) scan -chocardiogram G Electroencephalogram (EEG) H Full blood count (FBC) I Resting electrocardiogram (ECG) 3 Serum drug levels k Serum urea and electrolytes LL Standing and lying biood pressure M Thyroid function test N Tuning fork tests brain Instruction cribed below complaining of dizziness, choose the SENGLE most For each patient desc ach option may be used once, more discriminatory test from the above list of options. than once, oF not at all. treated with bendrofluazide, 34, An 84-year-old woman with a history of hypertension, jetting up in the morning presents with dizziness an¢ falls. The symptoms are worse on a! 32. A 69-year-old man presents with a progressive history of angina and clzziness on exertion, He has a heart murmur istory of 2 mild stroke, which occurred five years ago, «33. A 70-year-old woman has a his increasing breathlessness and light headedness. She is taking aspirin. She complains of Jd man has been treated for seizures following @ stroke six months 34. A735 jzziness and poor balance, He has earlier. Over the past two weeks, he has developed di nystagmus on examination. history of stable angina for which he Is taking isosorbide- ts with a two-month history of dizziness and 35. A 65-year-old man has @ mononitrate and aspirin. He presen! palpitations lasting a few hours. These occur almost everyday.Selection of tests for acute testicular pais (repeat Apri! 01 ~962-65) Options A Computed tomography 5 B Cystoscopy C Duplex scan D Exploratory surgery E Herniogram F Intravenous urogram (IVU) G Magnetic resonance imaging (MRI) H Plain radiograph Prostatic biopsy J Selective angiography Technetium isotope scan L Tumor marker measurement M Ultrasound scan oF scrotum N Urethral swab O Urethrogram P Urine microscopy and culture Instruction For each patient described below, choose the SINGLE most appropriate initial investigation from the above list of options. Each option may be used once, more than once, or not at al. 36. A 35-year-old man hes just returned from a 10-day business trip abroad. He complains of discomfort in the groin and scrotum and pain on passing urine, On examination he is tender on palpation of the right epididymis and there is @ discharge from the external urethral meats, 37. A 14-year-old boy presents with a two-hour history of severe left testicular pain. He has no urinary symptoms and otherwise is fit and well. On exerination the right testes is normal but the left hemi-scratum is swollen and acutely tender. 38, Afra 75-year-old man retums the day after having had a right-sided hydrocele aspirated at the clinic. He complains of pain in the scrotum, which he has noted to be swollen. On examination, there is a tender swelling in the right side of the scrotum. 39, An 80-year-old man complains of testicular pain three days post-operatively. On ‘examination his temperature Is 380C. He has an in-dwelling urinary catheter end both testes are tender. IndwellingDiagnosis of anxiaty (repeat fpci 01 @174-176 with variation on q177& Jan 04) Options A. Acute stress cisorder 8, Agoraphobia Alcohol withdrawal D. Generalized anxiety disorder E, Obsessive compulsive disorder (OCD) F. Panic disorder H. Post traumatic stress disorder (PTSD) 1. Psychotic disorder J. Social phobia K. Substance misuse L Thyratoxicosis Instruction For each patient described below, choose the SINGLE most likely dlagnosis from the above list of options. Each option may be used once, more than once, or not at al. 40. A 30-year-old women has experienced restlessness, muscle tension and sleep cisturbance on mast days over the last six montis. She worries excessively about a number of everyday events and activities, and is unable to control these feelings, impairing her ability to hold down her job. 41, A 26-year-old political refugee has sought asylum in the UK and complains of poor concentration. He keeps getting thoughts of his famity whom he saw Killed in a poitical coup. He is unable to sieep and feels hopeless about his survival. Beceuse of ths he is afraid to go out. 42, A 30-year-old man is becoming coricerned about the safety of his family. He has been checking the locks of the door every hour during the night. He becomes very anxious if his wife tries to stop him 43. A 48-year-old woman, always socially withdrawn, has stopped going out of the house, She is afraid to socialize because she fears that people wil crticize her.Side Effects of anti-epileptics (repeat with variation July 05) Options A. Carbamazepine B, Sodium Valproate C. Phenytoin D, Ethosuximide E. Vigabatrin, F. Tigabain G. Vigabatrin H, Phenobarbitone 1 ne J, Clonazepam Instructions For each patient below, choose the single most ikely drug causing 44, An epileptic patient with raised levels of urea, and creatinine. 45, A boy on treatment for generalized tonic clonic epilepsy devel ‘failure in few weeks of starting treatment. 46. A woman on treatment for epilepsy develops gum hyperplasiaDiagnosis of Endocrine abnormalities (reset April 01 @31-26) Options 1, Adrenaline B. Adrenacorticotropic hormone (ACTH) Aldosterone 9. Calettonin E. Cortisol Follicle stimulating hormone (FSH) G. Glucagon hormone H Insulin 1. Luteinising hormone (LH) 5. Prolactin i. Serum parathyroid hormone L. Somatostatin M, Testosterone N. Thyroid stimulating hormone (TSH) (0. Thyrotrophin releasing hormone P. Thyroxine Instructions For each patient described below, choose the SINGLE hormone most likely to be zbnormal from the above Ist of options. Each option may be used once, more than fonce, or nat at all 487. A 55-year-old woman presents with Increasing obesity. On examination, she has central obesity with a round moon face, She is hypertensive and has glucosurla. 48. A 42-year-old man is found at routine medical exemination to have a blood pressure cof 170/420 mm Hg, He nas been complaining of intermittent headaches and pelptetions for some months. 449. A 60-year-old woman is Found to have and elevated calcium eve! on a routine biochemical profile, Repeated measurements confirm the finding. 50. A 40-year-old man presents with thirst, polyuria and marked muscle weakness. His blood pressure ig 150/110-mmHg. His serum sodium concentration is normal and his ‘serum potassium concentratian Is low. His blood glucose is norrnalPathology: celts of origin (repeat July Options ‘A. Adipocyte B. Ganglion eels C. Plasma cells D. Megakaryoblast E Skeletal muscle ce F. Lymphocytes G. Erythrobiast F. Monocytes I. Schwenn cells, 3. Neutrophil precursors K. Astrocytes Lnythrogyte Precursor M. Lymphocyte Precursor NN. Smooth muscle cell Instruction; fg ach ofthe presentation below choose the Single most likely cells of origin from ‘the above ist of options. Each option may be used once, more than once or ret etal, 54. fn elderly man with bone paln & visual fss. Pathologist gives a diagnosis of ‘multiple myeloma after bone marrow biopsy. 22. A young male with recent onset seizures. Following a Brain biopsy, a diagnosis of Glioblastoma muttiforme is given, 53. A young female with lymph node enlargement snd splenomegaly. Bone marrow ©xamination confirms the diagnosis to be acute myeloid leukemia. 34. A small baby with a paravaginal mass. Biopsy of the mass was done to come to a diagnosis of rliaisdomyasarcoma. 55. ASS year old man presents with dizziness, cropping of the angle of the ma Jnvestigations show acoustic neuroma. sed 7 osSpeech disorder in children (repeat July 01 q18-21) Options A Arrange hearing test B Arrange magnetic resonance Imaging (MRI) brain scan C Broad spectrum antibiotic D Reassure E Refer for developmental assessment F Refer to Department of Child Psychiatry G Refer to ear, noose and throat (ENT ) surgeon H Refer to social services T Refer to speech therapist Instruction For each child described below, choose the SINGLE most appropriate management. strategy fram the above list of options. Each option may be used once, more than once, or not at all. 56. A mother is concerned that her 18-month-old san has vocabulary of ten words but cannot form a sentence. 57. A mother presents with her six-month-old son who is not vocalizing. She has also noticed that he does not respond to loud noises. His motor milestones are normal 58. A mother presents with her 12-month-old daughter. The child has no meaningful words, is unable to sit unaided and cannot play with her toys. She dose not laugh, and has poor interaction with siblings. 59. A mother presents with her three-year-old son who has indistinct nasal speech, He snores at night, and has restless sleep, He is tired by day.Diagnosis of a altered bowet habit (repeat July 01922-26) Options A Carcinoma of the Caecum B Carcinoma of the rectum C Coeliac disease D Crohn's colts E Depression’ F Diabetes melitus G Hirschsprung's disease H Hyperthyroidism T Hypothyroidism 1 Irritable bowel syndrome with constipation K Irritable bowel syndrome with diarrhoea L Terminal ifeal Crohn's disease M Ulcerative colitis Instruction 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, ar not at all. 60. A 19-year-old undergraduate gives a one month history to blood diarrhoea and is opening her bowels 0 times a day. She has urgency and tenesmus, Recta histology shows inflammation and granulomata. ‘61. ab year-old man presents with a six-week history of urgent loose biood stained stools, He has tenesmus and urgency. Rectal exerination suggests the presence of a mass 62, ABB-year-old undergraduate presents with a three-year history of recurrent ierthoea with sorte mucus and left iliac fossa pain relieved by defecation. Sigmoicoscopy examination is normal. 63. A 50-year-old housewife presents with 18-months history of increasing lethargy, weight gain and constipation. 64, A 25-year-old woman presents with Iron and folate deficlency anaemia, Loose pale stools and weight loss. Sigmoldoscopy is normal.Causes of Urinary tract calculi (repeat mer 06 434-36) Options A Bladder Diverticulum B. Cystinuria ©. Dehydration D. Gout E, High calcium diet FL Mik alkali syndrome G. Myeloma H. Over-treatment with vitamin d I. Primary hyperparathyroiism 3. Infections i. Renal tubular acidosis For each patient described below, choose the SINGLE most likely aetiology the above list of options. Each option may be used once, more than once or not all 65. A 43 year old woman with bone pain, two previous episodes of pancreatitis and hhypicalcaeria presents with a right ureteric stone. 66. A 70 year old man with @ previous history of calculus in his left ureter presents with left renai colic. He has a history of intermittent swelling and pain in his right knee. 67. A 69 year old woman with a one year history of weight loss, proteinuria, anaemia and bone pain presents with left ureteric colic. Her erythrocyte sedimentation rate (ESR) IS 110 mm in the first hour.Sclectior. of tracts for chronic abdaminat pata (repeat mar 04 q 141-148 with variation on 142) Options Abdominal ultrasound scan Abdominal X-Rey Barium meal and follow through Blood culture Chest Ray Endomysial antibody Liver function tests (LFTs) Lower gastrointestinal endoscopy None Nuclear medicine (NM) imaging of small bowel Rectal biopsy Stool test for reducing sugars Upper gastrointestina! (GI) endoscony Instruction For each child described below, choose the SINGLE most appropriate test from the 2bove list of options. Each option may be used once, more than ance or not t a. 68. A six year old gir! presents with chronic recurrent weekly abdominal pain that does not stop her activities. She has no associated vomiting or diarrhea and no ‘weight loss. There are no ebnormal findings on physical examination. ‘69. A four year old girl presents with abdominal pain for the past two years. She is ‘on regular treatment with lactulose for chronic constipation, but with no response. She has a distended abdomen with palpable feeces, The rectum is normal. 70. A 12 yeer old gil has had episodic upper abdominal burning pain for the past year. She has rio weight loss, but the pain is worse before meals and can be relieved by antacids. There is mild epigastric tenderness. 74. A two year old girl has had abdominal discomfort, vomiting, loose stools and {eilure to thrive for the past six months. She has a distended abdomen, no jegaly and a normal anus organFractures Diagnosis (repeat mar 04 q66-70) Options Bennett's fractures Colles’ fractures Fractured 5” metacarpal Fractured clavicle Fractufed humeral neck Fractured radial head Fractured scaphoid Mallet finger Spiral fracture of the humerus Supracondylar fracture of the humerus Transverse fracture of the ulna gom> ASM anm » Instruction For each patient described below, choose the SINGLE most /ikely diagnosis from the above list of options. Each option may be used once, more than once, or not at al 72, An 18 year old man fell off @ ladder. He complains of paln In his right wrist. There Is tenderness just distal to the radius but little swelling. 4.73. A78 year old woman tripped over an uneven paving stone and fell while carrying her shopping. She complains of pain at her right shoulder but there us no defermity and her renge of movement is only slightly reduced. 74. A six year old git fell from a swing onto her outstretched hand. She Is tender from her shoulder to her lower forearm and is reluctant to move her arm. 75, 45 year old man had fallen down the stairs the previous day whilst he was drunk He complains of pain near his shoulder and has difficity lifting his wrist off the table. 76. A25 year old man was attacked with 2 baseball bat. He complains of pain in his right forearm which he had raised to protect himself.82, A 70 year old man presons with’ Investigation in diagnosis of psychistric conditions, (2 and Nov 08 q 75-79) Options 4 chester 8 Computed tomograpiyy (CT) scan Bectrocerdiagram (ECS) . Bectroencephalogram (EEG) E Liver funion tess (LFTs) F Mental state examination 6. Neuropsychological testing H. Plasma Blond glucose ‘Urea and elecreytes “1. Thyra function tests (TTS) Ie Liver bropsy Instruction For each patient described below, choose the SINGLE most useful investigation in ‘essing Gagnsis from the above lst of options. Each option may be used once, more than once or not ata. 777.73 year old man experiences his frst episode of andaty and fs losing welght ‘despite having a good appette, There i rapid ail brilation but mo ot 78, A7 year ad man has a two year history of apathy, sexta csnhbiton, repetitive speech and Inappropriate behavior. Eecroenceghalogram (EEG) and computed ‘tomography CT sean are norma 179, 69 year od woman, kogwn to have bheime’s disease Is recent in 2 very H. ‘aisle sate sate She ays then Se Vahmoring et tie ay oo 20,72 yar ed waan nc te epee need string and ‘arate lao sere ve coved ay ual There orale wears oe gH ie cual atweotrwe) Focal ‘B88. 7 year old waman dagnosed with severe Azheimers disease presents roms elewe by enna ncntnence al tred conscious. CSS San Fak NEL ot onfusion. H is qaaleobolie since the oH Chagabe avctenphad spat)Management of Depression (resus: ~2- > g 95-99) Options A Abreaction 9. Benoniaepine 8. C Caramazesine D. Cognitive behaviour therapy E Counseling F. Coupe therapy G. Electroconvusive therapy 1. Fupenteo 1. lypnatherapy 3. Insulin coma therapy Ke thiam Le Maral therapy M. Honosmine oxidase(MA0) intbtor IN. Psychodynamic therapy ©. Psychosurgery P. Socium vaipraste @ Trcyaic antidepressant Instruction from ts Sooners bow, choose the SINGLE most appropriate treatment sia th above ist of epcons Each onton may he used once; rere ete me or not at an tg aay omen has topacd emg sd ing. She mas dageesed os npr eon a SeeySg episodes each requiring Bans Sev ong tom eee a : * xg Sa Aas ‘84. A 35 year old man had had four admissions toa psychiatric hospital in the fast 18 wah “tas pple A pn thn eas dean ore eng ne 3 here Shon symptoms ora eee a GI AE:A2 waren ri ret fom te ater te be er eect Megha rein byes ma opy ses Seat Soest Shes cure he hucanas co ee Sets ary of cae ee he ea token i dentist had devo symptoms of lw mood td is convinced tht } fee tae cape ces eo ry Hes intaligent arcuate and feats tat hs aS Ee Se ester ad mekes excuses or not Bg ie xc ashe somata Ret ng 3 cond foo eho no condone ee hase somatic symptoms of depression,sahaviour (repeat mar 04 q 172-174) Diagnosis of Agaressive Options, ‘A Alcohal intoxication B. Alzheimer’s disease C. Concussion . Delidum tremens , Drug-induced psychosis F. Epilepsy G. Fugue state E. Giles de la Tourette's syndrome I. Hypomania K. Lewy body dementia L. Paranoid schizophrenia 1M, Severe dearession Instruction: LE most likely diagnosis from th For each patient described below, choose the SING! ‘more then once, or not at all ‘above list of options. Each option may be used once, ‘8B, A20 year old man is apprehended by the police. He states that he Is being Past by communist agents wna have been controling him. He vows to Kl the agents i she approach tim. 89. 25 year ald single man has recently become Increasingly activo, sleeping | Grnieng more eleohal than Is usual for him, He enters a bank, demanding money because He states that he is the owner of the barik. 90, A16 year eld boy has developed a facial tic and has been muttering and shou obscenities in the street.Management of pationts with weight loss (repeat mar 02, 485, 8, 89, 9°) Options A. Dietary assessment, oral nutritional supplements. B, Entereal feeding by fine bore nasogastric tube . Gluten free diet . High dose vitamin C supplements E. Lactose free ciet F. Low fat diet G. Low protein dlet with antibiotics H. Oral trace element supplements I. Parentreal feeding 13, Percutaneous endoscopic gastrostomy (PEG) K. Very low calorie diet Instruction choose the SINGLE most appropriate course of For each patient described below, ach option may be used ance, more than once action from the above lst of options. or not at al unit after resection of 94. An emaciated 70 year old man who is in the intensive ca the large bowel cancer. 192. A 60 year old woman presents with longstanding Parkinson's disease anc intractable swallowing difficulties. (93, A.47 year old man with 2 history of alcoholism presents with clrhosis and intrectable swallowing difficulties. 94, A two year old gil, who Is below the third centile for height and weigh, resent with clarrhea end jejunal villous atrophy.i (repeat rar 02 oBt, 82, 84, 85) Investigation in 2 post operative pati Option: . abdominal and pelvic ultrasound biood culture + central venous pressure(CVP) measurement . Chest x-ray. Coronary angiography lectrocardiagrephy (ECG) G. Endoscopic retrograde cholangiopancreatography H Full blood count 1. Sigmoidocopy J. Stool culture K. Ventilation/perfusion (V/Q) scan L. Wound swab for microscopy Instruction F each child described below, choose the SINGLE mast appropriate investigation from the above list of options. Each option may be used once, more than once or not at al nd tachycardia 12 hours after 95. A 65 year old man collapses with pallor, hypotension a right hemicolocetomy. He complains of anterior chest pain radiating to his left arm. ‘96. A 30 yeer old man is readmitted with a history of rigor, diarrhoea and tenesmus two ‘weeks after an open cholecystectomy. The wound is red, tender and discharging. 97. An obese 60 year woman presents with right-sided chest pain and breathless 10 days after an abdominal hysterectomy. A chest x-ray is normal. ‘98. A 40 year old longstanding cigarette smoker is noted to have a temperature of 37.8°C the day after a splenectomy. He is complaining of shortness of breath and Bleuritic chest paln. L Scayo @ 208,Diagnosis of Abdominat Injury (repezt Mar 02 q91, 92, 93, & Nov 02 89-71) Options Aortic rupture Bladder rupture Bowel rupture Cardiac tamponade Diaphragm rupture Liver rupture Mesenteric vascular injury Pancreatic confusion Renal contusion Renal pedicle avulsion Splenic rupture Urethral rupture ZO™mgom> Instruction For each patient described below, choose the SINGLE most kely diagnosis from t! above list of options, Each option may be used ence, more than once, or not at al to the A and 199, A 37 year old cyclist is knocked from his bicycle by 2 car. He is bro: E department, . After initial assessment and interventions he is noted to have left upper quadrant tenderness. 200. A 47 year old scaffolder falls about four meters onto a scaffold pole injuring his Tight side, After initial assessment he is found to have diffuse right ~sided tenderness. A ‘ten minute intravenous urogram (1VU) shows no excretion on the right side. 101. A 19 year old man is stabbed with a 10cm blade in the left upper abdomen, After nig, An ultrasound remaining stable for 20 minutes his blood pressure drops to 90/60m ‘scan shows no free abdominai blood.Natural history of Epistaxis (repeat Nov 03 q 30-34, (variant in Mar 02 q24-28 May 03 g 81-85) Options A. anticoagulant overdose B. Coagulopathy C. Hypertensive disease D. Local infection E. Maxilary antral carcinoma F. Nasal polyposis G. Nasopharyngeal angiofbroma A. On a k Sarcoidosis Septal perforation Trauma Instruction For each patient described below, choose the SINGLE most likely cause from the above list of options. Each aption may be used ence, more than once, or not at al! 02. ‘4 50 year old furniture maker presents with anesthesia of the left cheek and repeated left sided episodes of epistaxis, AO3. A 23 year old actor presents with repeated eplsodes of eplstanls associated with whistiing on breathing in through the nose. ies 43 Yea" old sheep farmer presents with unilateral epistaxis. Inspection reveals a bleeding polyp attached to the anterior nasal septumn 205. An 80 year old man presents with epistaxis of two hours duration, 4106. A 50 year old man presents with epistaxis. He has an artifical heart valve.Interpretation of Chest X-ray in shock (repeat Nov 03 q 78-80, 82, and Nov 04, May 04) Options Free mediastinal gas Gas beneath the diaphragm Golbuier heart shadow Hilar mass Miltary opacities Normal Right lower lobe collepse/consolidation Right sided complete pneumothorax with midline shift Right sided 10% pneurnothorax with midiine shift armen ey For each patient described below, choose the STRIGLE most likely chest x-ray appearance from the above list of options. Each option may be used once, more thar fonce, or not at all 407. 4 60 year old man with a longstanding history of diverticulitis developed severe ‘bdorninal pain. The following day he attends the Accident end Emergency department Lunwel, with @ pulse rate of 100 beats/min and a blood pressure of 100/80 mmtig. His respiratory rate is 24 beats /minute, His abdomen Is rig 108. A 40 year old man was the driver of 2 car involved in an accident. He hit the steering wheel and complains of central chest pain. His puises and blood pressure ere cifferent in each arm. 409. 4 50 year old man with a history of angina presents with severe crushing left sided chest pain radiating to his back and neck. He has pulse rate of 60 beats /minute and 2 blood pressure of 100/80mmHig, H's electrocardlogramn (ECG) shows 2 posterior infarct 110. A 65 year old worian had an esophageal ditation. She became increasingly unwell following the procedure end collapsed with @ pulse rate of 110 beats /minute and a blood pressure of 110/90 mmifg, Her respiratory rate is 24 beats /minute. Her abdomen is soManagement of septicemia (repeat July 02 q 55- 58 & Jan 04) Options A. Insertion of stent B. Intravenous (IV) catecholamine Intravenous (IV) corticosteroid Intravenous (IV) dobutamine Intravenous (IV) dopamine Laparatomy and excision of dead tissue Oxygen by mask Percutaneaos drainage Ventilation support Wide debridement of soft tissue Fe zammon Instruction For each patient described below, choose the SINGLE most appropriate treatment from the above list of options. Each option may be used once, more than ance, oF not at all, 114. A 60 year old woman has an emergency operstion to remove a perforated gallbladder. She remains unwell during the post operative period with fever and tachycardie. Over a period of 48 hours her breathing becomes laboured and her PaQ2 Crops to 6 kPa despite full support. 212. A 22 year old woman presents with a high fever. She Is recovering from chicken pox and has been scratching some spots on her abdomen. Around one of these there is Blush discoloration of skin. Over the next hour her urine output drops substantially, her temperature continues to rise and. the area of discoloration increases in size, Pancreatitis. Despite early improvement y, he has a high temperature, hy (CT) shows non enhancement of 143. A 22 year old man is admitted with acute his overall condition deteriorates by the sixth da tachycardia and hypotension. Computed tornagrap} the distal pancreas and peri-pancreatic fluid, 214. 8 75 year old wornan has an emergency operation for large bowel obstruction, She {5.nell until the seventh post operative day when she becomes weak and shivery. Her femperature is ralsed and her C-reactive protein has also risen. Ultrasound revesis a left supphrenic collection,Diagnostic tests for patient with chest pain (repeat May 03 qi9 ~ 23 & Nov 02.4 146 -150) Options ‘A. Abdominal Ultrasound B. Blood culture €. Bronchoscopy D. Cardiac enzyme E. Chet xray F. Computerized tomography (CT ) scan G. Electrocardiogram (ECG) H, Full blood count 1. Lumber. puncture J. Oesophago-gastro-duedenoscopy (OGD) K. W/Q scan’ instruction For each patient described below, choose the SENGLE next mast appropriate test from the above list oF options. Each option may be used once, more than once, or not at all 25, A 68 year old man had had malaise for five days and fever for two days. He has a cough and there is dullness to percussion at the left lung base. 416. A.50 year old woman returned by air to the UK from Australia. Three days later she presents with sharp chest pain and breathlessness. Her chest x-ray and electrocardiogram (ECG) are normal. 447. A tall 25 year old man has a sucden pain in the chest and left shoulder and becomes breathless while cycling. 118. A 45 year old manual worker presents with 2 two hour history of chest pain radiating Into his left arm. His ECG IS NORMAL. 119. 4.52 year old obese man has been having episodic anterior chest pain particularly at night, for three weeks. His chest x-ray and ECG are normal,115 with variation) Diagnosis of patpitations (repeat Nov 02 g11-15, & Jan 04 q| Options A. Arniety 8. Atrial frilation C. Complete heart block D. First degree heart block E. Myocardiis F. Pheochromocytoma G. Sinus bradyearcia HL Supraventricular tachycardia 1. Ventricular ectopies Jk Ventricular tachycardia(vT) Instruction Choose the SINGLE most likely diagnosis from the For each patient described below, ‘may be used once, more than once, or not at all, ‘above list oF options, Each option 320.4 42 year old woman presents with 2 history of weightloss, clarchea, sweating and palpitations for two months, An electrocardiogram (ECG) shows she is In sinus rhythm, 321. A 25 year old wornan presents with ‘missed beats at ret which, she tells you, are aggravated by coffee, tiredness and stress but disappear during exercise, schemic heart disease has a fastfegular pulse. He is mmittent palpitations for a couple of 4122. A 62 year old man with otherwise feeling well, He has been aware of inter months. man presents with a history of chest tightness and a feeling his, inutes to an hour. When seen his pulse was 123. A 23 year ol heart is racing. The episodes last for a few mi in sinus rhythm and his ECG was normal. 224.4. 66 year old man presents with 2 history of rheumatic fever in childhood Fee ans Of intermittent fast ictegulr palpitations. She has a systolic murmur racating {0 her axilla and a soft diastolic murmur at the apex.Investigations for paipitations— Options ‘Blood glucose concentration Cardiac enzymes xR Echocardiogram ‘Serum urea and electrolytes concentration ‘Thyroid antibodies |. Thyroid fimetion tests HE. 24hr ambulatory taped electrocardiogram (ECG) empower Instruction For each patient test from the above lst or natat all described below, choose the SINGLE most appropriate diagnosti ‘options. Each option may be used once, more than once, 125, A25 year old women develops lassitude, sseness, purulent sputu iid palptations over a 24 hour period, She had a pulse rete of 88 beats /minute Her electrocardiogram (E0G) shows sinus rhythm. 126. A-45 year old housewife presentS with a history of weight loss over 12. ee She has also noticed that shy loses her temper easily. She has 2 requler pulse rate of 90 beats/ minute, Her ECG shows sinus rhythm. 4127. A60 year old man is referred to outpatients with frequent episaces of brecihfescness and chest pain associated with an iregular heartbeat, He has 2 regular pulse rate of 60 beats minute. His ECG shows sinus rhythm. 4i2s, A.35 year olg woman has woken up five times in the previous month with 2 yaslng of thumping inthe chest. On sting up for about two minutes and ‘Bing few deep breaths the sensation subsides over a further minute, Her ECS shows sinus rythm,‘he diagnosis of vaginal discharge (repest Mer 02 982-85) Options AL Adenomyosis 8. Abroptic vaginitis © Cervical cancer 3. Cervical ectropion E. Cervical intraepithelial neoplasia Chlamydial cervicitis G. Endocervicai polyp H. Endometrial carcinoma L a K c Endometrial polyp Fibroids Functional ovarian cysts Vaginal candidiasis Instruction ibed below, choose the SINGLE most fikety diagnosis from the For each patient descri more than once, or not at all, bove Ist of options. Each optian may be uses once, 228. A 25 year old women who has had several ‘ecent partners has experienced post Coltal bleed on gentie contact. ar32. A 88 year old women presents with posteottel bleeding following her fist episode of Sexual intercourse in 10 years © 231.4 60 year old woman with persistent brown vaginal discharge is referred for @ “ansvaginal ultrasound scan. It reveals endomenns thickness of 12 mm 452. & 30 year old woman on the combined Gral contraceptive pil is referred following routine normal cervical smear test where the doctor noted contact bleedingDiagnosis of central chest pain (repeat mar 03 qt5 49) (NOT USRE) Options Achalasia Angina aoxiety Costochondriis(Tletze's lsease) Dissecting aneurysm Gall stone colic Hiatus hernia Myocarcial infarction Pericarditis Preumonia Preumathorex Pulmonary embolus Rib fractur Unstable angina ZECRUrzanmones Instruction IGLE most likely diagnosis from the For each patient described below, choose the SIN ce, ar not at al ‘above Ist of options, Each option may be used once, more thi 1133, A tll 35 year old man suddenly develops acute localized left sided anterior chest pain with breathlessness whilst walking along the street. int cough and a history of smoking develops 134, A.55 year old woman with 2 persiste and localize creckles. {eft sided chest pain exacerbated by deep breathing with fever 4135. A'50 year old man with diabetes suddenly develops persistent crushing central cchest pain raciating to the neck, 4136, A.35 year old woman taking the combined oral contracentve pil has a sudden rest of central chest pain and presents to the Accident and Emergency Department hypotensive and cyanosed with raised jugular venous pressure(JVP) 5 central chest pain over two or three days which Is 137. A 48 year old man develop friction rub and inverted T waves effected by posture and associated with @ pericardial widely spread through the electrocerdiogram (ECG)Actiological factor in peptic ulceration (repeat Nov 04 9116-120 and Nov 02 @ 100 » 104) Options Achalasia Colurnnar lined esophageal mucosa ( Barrett's oesophagus) Corticosteroia Gastric resection Gastrinoma Helicobacter pylori Non steroidal antiinflammatory (NSAIDS) Opiate Paracetamol Pernicious anemia K, Psychological stress ooresmonep Instructions For each patient described below, choose the SINGLE most important aetiological factor the above list of options. Each option may be used once, more than once or not all 4138. A 20 year old man presents with a 3 month history of epigastric pain waking him 7 at night. He smokes 20 cigarettes a day. 139. A 55 year old woman with lung standing severe lower back pain presents with @ hematemesis, 140. A 63 year old woman with severe rheumatoid arthritis who Is intolerant to non steroidal anti-infiemmatory drugs (resents with persistent upper abdominal paln and anemia, 141. A.50 year old man with primary hyperparathyroidism and a familly history of Pentic ulcer disease presents with severe epigastric pain responding poorly to standard treatment with 2 proton pump inhibitor. 4142. 75 year old man witha 40 year history of heartburn ands acid regurajtation Dresents with a tree month history of increasing dysohacla for ses. w aSciection of diagnostic test for acute dyspnoea (repeat Jul 02g 145-149 & NOV 04 q3-5) A. Arterial blood gases B. Chest xray © Electrocardiogram (ECS) D. Hemoglobin (Hb) E, Magnetic resonance imaging (MRI) scan of the chest F. Peak expiratory Flow G. Pulse oximetry H. Spiral computed tomography (CT) scan of the chest, Instruction For each patient described below, choose the SINGLE mest useful diagnostic test from the above list of options, Each option may be used once, more than once or not at al 4143. 25 year old man presents to Accident and Emergency Department with shoriness of breath of three days curation. He has been coughing curing the night and Using his salbutamol inhaler more frequently 144.4 22 year old man presents to the Accident and Emergency Department with sudden onset of sharp right sides chest pain and shortness of breath. There is Tedluced air entry in the right side of the chest. 145. A 78 yeer old woman Is brought by her family to the Accident and Emergency artment with breathlessness and occasional cough over the previous 72 hours. ‘There are coarse crepitations present at the right lung base, 146. A 26 year old woman who has returned from a holiday in America develops ‘sudden left sided chest pain and breathlessness. Her chest is clear. 147. A 23 year old man with type 2 diabetes presents with 48 hours of increasing Confusion and breathlessness. His chest Is clear and his blood glucase Concentration is 28 mmol ny wDiagnosis of dementia (repest Jul 04) Option Alcoholic dementie Alzheimer's dementia Creutzfeld Jacob clisease Human immuno deficiency virus (HIV) Huntington's chorea f. Parkinsonism 9. Pick’s disease fh. Repeated head trauma |. Space occupying lesion J. Toxin induced dementia ke Vascular dementia Instruction each patient described below, choose the SERGLE most lllxaly diagnosis from the ‘above list of options. Each option may be used once, more than once, ar not at all, 348, A 71 year old man with no previous immediate history is brought to the accident and Emergency Depariment by his wife who says that he has become progressively more forgetful, tends to lose his temper and is emotionally labile, There iso history of infectious disease or treuma, 149. A 74 year old man presents with weakness in his arm and leg from which he Fecovered within a few days, and short term memory lass, He has an extensor plantar fesponse. He had a similar episode two years ago and became unable to identity objects ‘and to make proper judgments 250. A 38 year old women with hemophilia who received several bioad transfusions @ few years ago presents with irritability and Increasing memory defict. He is unable to ‘speak properiy. He Is on antituberculous treatment. 451, A 44 year old woman presents with memory loss; poor concentration and inability to recognize household objects. She has 2 right -handed involuntary writhing Movement. There is a strong family history of similar complains. 152. A 62 year old man with chronic schizophrenia presents with @ mastilke facie and involuntary pill roling movement in both hands. He complains of chronic cough and forgetfulness. He is on long term antipsychotic medicationManagement plan for efectrotyte atinormaiities (repeat Jul 04 q85 ~ 89 with variation on q 85) Options Fluid restriction Insutin Only Intravenous(IV) glucose 5% Intravenous (IV ) normal saline and hydrocortisone Intravenaus (IV) normal saline and insulin Intravenous (IV) normal saline and potassium supplement Oral potassium chlorice Plasma expanders Refer for immediate r OF some al dialysis Instruction For each patient described below, choose the SINGLE most appropriate management pian from the above list of options. Each option may be used once, ‘more than once, ar not at all 353. A 20 year old woman presents with nausea and vomiting. Investigations show Sodium 129 mrn/! Potassium 5.2mm/l Urea 12mmai/! Glucose 4 mmol/t 154. A 16 year old presents with a two week history of thirst, weight loss and urinary frequency. Investigations show Sodium 148mmoi/! Potassium 5.2 mmol/l Urea 12 mmol/l Glucose 30 mmol! 155. A 20 year old man involved in a road traffic accident suffers multiple fractures and crush injuries. Four days later he is anuric with pulmonary oedema Investigations show Sodium 150 mmol/| Potassium 7.7mmol/| Urea 60 mmoil/ 37456. A 50 year old man has been admitted for investigation for breathlessness end weight loss. He fas been taking a thiazide diuretic for raised blood pressure for 2years. His BP is 150/100 mmHg, Investigations show Sodium 138 mmolf Potassium 2.8 mmol/t Urea 5.8 mmol/l 157. An 8 year old boy with gastroenteritis gave a 2 day history of profuse diarrhoea and vomiting. Investigations show Sodium 148 mmol Potassium 2.2 mmol/! Urea 20 mmoi/!Diagnostic test for headaches relating to eye problems (repeat Ju 02 126-130, NOV 01 9 29 ~33)) Options Colour vision tests ‘Computed tomography (CT) scan af the brain ‘ectroencephalogram (EEG) Ertrooyte sedimentation rate (ESR) Ful Blood count Intra-oeular pressure measurement Serum urea and eletrotyes concentration Visual acuity assessment Visual fld mapping wzommgnee Instruction For each patient described below, choose the SINGLE most appropriate initial test from the above lst of options. Each option may be sed once, more than ance, or not atalh 158. 476 yoar old woman presents with symtams af feting generaly unwell and CeC#t um coke 1D anorexia with weight lass She complains of sudden fss of vison inher let eye. Onthe PM left size the poplar ight reaction i sis (th veriton Et sia) 2, 159. 4.40 year old woman presents with sudden onset of severe occipital headache, 7 photophobia and vemitng, SAW [+ 260.422 yeu old woman complain of stern headsche Wich have proses ‘worsened, She works 2s a visual csplay and (VDU) operator ‘£2161. A 72 yar old women presets with tunnel ard severe headache, nausea and vomniting of recent arse, she has neticed coloured haloes for Sx months. gg 262-427 year old woman presents with severe oming headaches fortwo mnt. /} Full neurological examination is normal apart from bilateral paplloedema, Her blood Pressures 120/70mmHS— CPreuaietunteew wxdtent )Management of burns (repeat Ju 02.q 91-95 and Ju! 04 ¢ 105 to 109) Options ‘A. Anaeshtetic and intubation 1. Bums dressing Debridernent Escharotomy Tce packs, Intravenous fluid resuscitation cra fut resuscitation Pain relief with opiate Reassure and discharge with advice Referral to burns unit Wound irrigation Avmzonmone Instruction For each patient described below, choose the SINGLE most appropriate immediate action from the above ist of options. Each option may be used once, more than once, or not at al. 4 tc SIO 163. A 60 year old man has been rescued! from a house fre. He has facial ang chest burns and is asking about is family Cake signa ap inkadotae suged ~ SOF ) -T_ 168, A 19 year old man fll asleep while sunbathing two days ago. He has diffuse skin — redness with sparing of areas protected by cothing. He Is otherwise well :165. A two year old boy pulls a cup of tea over his shauder and the front of his chest ‘covering an area of less than 39% ofthe total surface area. He Is eying and Luncaoperatve. 166. A.28 year old industria! worker sustains a 40 % scald with hat water to bs trunk {and leg, He has been given analgesia on site 167. A 45 year old electrician has sustained a contact electrical injury to the finger of his dominant hane. There are ful thickness burns tothe pubs of Ns finger and ‘movement s painful. He has been glven adequate analgesia, 9? 40Diagnosis of acute abdomen in younger women (repeat nar 05 q105-110) Options Appendicitis B. Cholecystitis . Constipation. D. Gastroenteritis E, Pancreatitis F. Perforated peptic ulcer G Pneumonia H. Pylenephritis 1. Ruptured ectopic pregnancy J. Salpingitis K. Ureteric colic L. Urinary tract infection Instruction 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 al story of lower abdominal pain. She has jac fossa, 168. A 17 year old giti presents with a 12 hour 2 temperature of 37.8°C. She has tenderness with rebound in the righ 269. A 40 year old woman presents with a six haur history of severe tspper abdominal pain and vorniting. She is shocked with diffuse abdominal tenderness. 170. A 28 year old woman who smokes heavily and takes antacids regularly for indigestion presents with sudden onset of severe abdominal pain. She is lying very stl and is shocked, She has diffuse abdorninal rigidity. She has a normal menstrual period ‘wo weeks ago. 4174. A 22 year old woman with a sudden onset if severe abdominal pain. She complains Of dizziness when she sits up. Her last menstrual period wes eight weeks ago. She Is, Pale and has generalized absiominai tenderness. 72. A 32 year old woman presents with a three hour history of severe right sided abdominal pain, radiating into the groin, She is writhing in pain, She has no abdominal signs. aDiagnosis of speech disorder (repeat Nov 02 ¢ 100- 182 and Jan 04 bq 108 -112) Opitene brainstem stroke cerebral cortical ischaemia Dementia Depression Mania Multiple sclerosis, Parkinson's disease Psychogenic dysphonia Recurrent laryngeal nerve palsy Schizophrenia Stammering ArUZOmMgOwE Instruction E most likely condition from the For each patient described below, choose the SINGLI ‘more than once, or not at ell. above list of options. Each option may be used once, king very rapidly when she suddenly stops. When 273, A42 year old woman Is tal 1d has been emptied of all thoughts. asked why, she says that her min 474, A.60 year old hypertensive man comes to the Accident and Emergency Department having suddenly developed great difficulty. resents with slurring of speech. He is concerned about untelr He had been well previously apart from a transient loss of is normal apart from a mild 275. A38 year old man accusations of being drv vision in the right eye 12months ago. Cinical examination ataxia of the left arm and a pale right optic disc.Management of Labour (rezest similarly in Jan 06 recall) Options Repeat vaginal examination in 4hrs Blood pressure monitoring Cardiac tocograpgy Caesarian section Episiotomy External rotation Fetal scalp biood sample Internal rotation LY syptocin crip (? augmentation of labour) Onmoog> Instruction £8, B2ch patient described below, choose the SINGLE most appropriate action from ‘he above list of options. Each option may be used once, more than once, Or nok st she fas passed show and cervix is 3om dilated 276. A prifsipara, at full term in labour, ae7ih Patent is at term, and in fabour. The head has been delivered, and you suspect shoulder dystocia, the membranes have ruptured, the fiquor contains 178. A patient at term and in labour, meconium but the CTG is normal, cervix is 3em, ertension, the membranes have ruptured later showed that cervix was still 3em 479. A patient with previous history of Hype and cervix is 3cm cllated. Examination 4hrs dilated,Diagnosis of earache (variation on a theme from July 04 and APRIL Oi~ there it wes Rx but here diagnosis) Options ‘A. Acoustle Neuroma A Ottis media 3, Otitis externa C. Herpes simplex virus . Temperomnadibular joint pain E. Trigeminal neuralgia F. Facial nerve pain Instruction For each patient described below, choose the SINGLE most likely diagnosis from the ‘hove lst of options. Each option may be used once, more then once, or not at all 180. A two year old girt with an upper respiratory tract infection is seen in the Accicent ‘and Emergency Department as she Is pulling on her right ear. Examination reveals rhinorthoea and slight pink tympanic membrane jabetic has returned from a holiday in the West Indies. He has 181. A 60 year old ai the external auaitory canal and severe pein both ears with swelling and redness around pain on moving the ear. 1p has pain and some ceafness In her right ear for 24 hows 1182. A 70 year old womer seen in the auditory canal iand a vesicular rash on the right side of her face. Vesicles are n shooting dawn the side of her face and her jaw, 183. A middie aged woman has ps The ear is normal, 184. A middie aged woman has 2 right sided ear ache, the tympanic membrane is normal. Her husband has noticed the she grinds her teeth at night, white sleeping.recall Jan 03) Investigation in (Renal) /ematuria (simil Options A. Anti-strep. Trite B. Ultra sound C. Microscopy and sedimentation D. Urea and Creatinine = Ww F 6. Urine Osmolarity Instruction For each patient described below, choase the SINGLE mast useful diay from the above list of options. Each option may be used once, more than of ostic test ce oF not at all +285. A man come with haematuria; he says this runs in the family 186. A boy has fever, oliguria and oedema. 187. A 56 yrs old woman had operation on her uterine cancer years ago now comes with hematuria, 188. Aman hes been unwell for long time, now comes with hypertension and haematuria (cannot remember exactly, but sounded ke he has gat DM to me) aeInvestigation of Dyspnoea (incomplete theme, cen’t remember t questions) Options A. Sweat test B, Peak expiratory flow rate (PEFR) Sputum for Microbiology D. Sputum for cytology orn Instruction choose the SINGLE most useful diagnostic test For each patient described below, jon may be used once, more than once or not at from the above list of options. Each opti all 489. A.4 month old child presented with fever, cough and dyspnoea, was treated with antiblotics, For the last 6 weeks, despite treatment child has continuous dyspnoea. 190. A child presents with failure to thrive, cough and continuous dyspnce.trangulated hemia H: Sephons varix psoas sheath. Femoral hei J. Varicocele. D: Infection of the groin. iymph nodes inflammati F: Direct hernia from the For each of the scenario below chose the single most likely diagnosi list above 191. A 40 years old manual worker presents with a swelling in the groin. On examination the mass is found to be just above and medial to pubic tubercle. ‘There is a cough impulse and it is reducible, On applying the pressure on the intemal ring, there is no transmission of cough impulse. 192. A 35 years old women presents with the mass in the groin. Oa examination the mass is found to be just below and lateral to the pubic tubercle. ‘There is no cough impulse and it is irreducible. 193. A25 years old man presents with a mass in the groin after heavy lifting On examination the mass is found to be just above and medical to the pubic tubercle. It is reducible. On applying pressure on the internal ring cough impulse is still present. 194. 60 years old man presents with the mass in the groin: On examination the mass lies below the midpoint of the inguinal ligament and is pulsatile. 195. A 36 years old women presents with a swelling in the groin. On examination the swelling is diffuse and soft and lies below the inguinal ligament. It empties with the minimal pressure and refills on release. There is a cough impulse and it disappears on lying down. On the calf of the same leg there are varicosities on the medial aspect.F: Superior oblique muscle of eye A: Inferior oblique muscles of the eye B: Sternocleidomastoid muscles G: Medial rectus Muscle of the eye C; Lateral rectus muscle of the eye Hy; Levator palpebrae Superioris D: Stylopharyngeal muscle s I: inferior rectus Muscle of the eye E: Superior rectus muscle of the eye J; Muscle of mastication Damage to any of the following nerves will lead to weakness of some muscies. ‘Which of the muscles above will be affected if the following nerves are damaged? 196: Accessory nerve. 197: Trochlear nerve. 198: Trigeminal nerve. 199: Abducens nerve. 200: Glossopharyngeal nerve.asd ace beh wi8 30 PR Bik 3k at 4 ate aT D ZEN ae git > ss ss shits heePu Ss Qse Ca coe ae vo NEE R Magy y AFF oX mp ge es mor Be n¢3 acl Te te ms ee 194 eB §B grok 54 SoG eed Fe ary AL for At Ps Gate Tie aS ae aye eo ie (sod ta dD er =e wey oe Be (ea wie falas very SR I € Mou wor | wT ae od {5 5 IBe qe wpe ro us & ist & Wee ee we 133 D ay IPE Ka ISS ae 156 Ce i iste ae ISO pea (78 ae [bolt pe @ (H&E prt (eB per [Fe DIF Cie 1398 esd we (oe & BE (499 BA Bee ae We aye i [90 Bee ny g Bt bee Bre (1 Bye (BI Ife © '1¢6 Iq € lye ip ® ae