“ornaawe (1) PLAB TRAINER 20111 PLAB 1 MOCK TIME ALLOWED 3 HOURS sl. A45-year-old woman with a history of rheumatoid arthritis presents to the accident and emergency department with a two day history of a hot, painful, swollen right elbow joint. Whatis the most appropriate management? Joint aspiration. Start infliximab. Oral high dose prednisolone. Short course of methotrexate. Depomederone injection. A moop> 2. A 28-year-old man is investigated for recurrent lower pain. A diagnosis of ankylosing spondylitis is suspected Which one of the following investigations is most useful? ESR erythrocyte sedimentation rate. X-ray of the sacro-iliac joints. HLA-B27 testing (yx My 95% X-ray of the thoracic spine. Computerised tomography (CT) of the lumbar spine. 8 mop» 3. Which one of the following antibodies is most specific for limited cutaneous mec systemic sclerosis? Anti-Jo 1 antibodies Rheumatoid factor Anti scl-70 antibodies. Anti-centromere antibodies. Anti-nuclear factor. oF moopp‘Complications of caesarean section _ Options: A. Aspiration pneumonia. G._ Retained products of conception B. Aspiration pneumonitis H. Spontaneous pneumothorax C. Endometritis 1. Urinary tract infection D. Feral Head compression J. Urinary tract injury. E. Pleurisy. K, Uterine rupture F. Pulmonary embolism. Instructions: For each case below, choose the single most appropriate diagnosis from the above list of options. Each option may be used once, more than once, or not at all. 4. A 37-year-old woman had an elective lower segment caesarean section (LSCS) | day ago. You are called to see her as she becomes short of breath with left-sided chest pain and g ‘cough, She has had three other children, two of these bora by LSCS. On examination, she has reduced air entry at both lung bases. Her observations include saturation 92% in air, blood pressure 105/84mmhg, pulse 120 beats/minute and temperature is 37.2°C. 5. You are called to see 2 20-year-old woman 2 hours post LSCS. She has not passed urine. singe her operation, She denies any urinary symptoms preoperatively On examination, she appears unwell, with a temperature of 37.5°C. blood pressure 94/73mmHg, pulse 116 beats J iin and saturations 97% in air . Her abdomen id distended with tendemess in the left flank and suprapubic region. Bowel sounds are not audible 6.425 yr old had an LSCS 24 hrs ago for fetal distress. She now complains of intermittent vaginal bleeding . observations include saturations 98% in air , blood pressure 124/82 mm Hg, pulse 84 beats /min and temperature 37.8°C.. The midwife tells you that she had a Arretspssny te Infor retained placenta , which required manfiel removal in the operating theatre. 4.28 yr old women at 39 weeks of gestation is in labour . She develops abdominal pain and a Blood pressure is 100/42 mmEig , temperature 37.2°C and saturations 99% in air . on examination, her lower abdomen is exquisitely tender. The CTG, which was previously normal, now shows reduced variability, and a late deceleration heart rate of 125 beats / mi develops with slow recovery. She has had one previous LSCS for a breech baby. 8, The women ia case 4 becomes acutely short of breath the recovery Bajand is coughing B Gera general enaesthetiS)On auscultation, she has feduoed air entry atthe right lung base3d diffuse wheeze, Observations include a heart rate of 88beats/min, blood pressure 112/76 mm Hg,, temperature 37.8°C. and saturations 91% in air. 9. A 69 yr old man is diagnosed as having Parkinson’s disease . Which one of the following psychiatric problems is most likely to occur in this patient? A ties B_ psychosis C Mania D Dementia E Depression 10 A 35yr old man with a history of schizophrenia is brought to the emergency department by worried friends due to drowsiness. On examinetion he is generally rigid . A diagnosis of neuroleptic malignant syndrome is suspected. Each one of the following is a feature of newoleplic malignant syBdrome, exept ate aa, Lay Saher of A’ Renal failure > ae oad sigps 5 Pusne oes Teeth sh tng Sted) C Elevated creatine Kinase a Phone Dhan Clatite GRA MEE, Sate nreny, D Usually occurs atier prolonged treatment, E Tachycardia 11. A4j yr old female presents with 3 day history of a dry cough and shortness of breath. ‘This was preceded by flu- like symptoms. On examination there is a symmetrical, erythematous rash with ‘target’ lesions over the whole body . what is the likely organism causing the symptoms? A Pseudomonas B Staplylococeus aureus C Mycoplasma pneumonia, — why)" . D_ Chlamydia Pneumoniae E Legionella pneumophilia.