MCQ exam march 2007 recalls

Discussion in 'Australian Medical Council (AMC) EXAM' started by Dr. Prasan, Mar 26, 2007.

  1. Dr. Prasan

    Dr. Prasan Guest

    hi, I have taken MCQ exam on 24 march 2007, shall post a few questions with ans , pl. correct me. .

    on 5th day after appendectomy with tachycardia and fever (mastery)
    -chest infection
    -urinary infection
    -dvt
    -wound infection


    tach & low grade fever are symptoms of PE but pt who just had appendectomy usualy move in a couple of days after the surgery cuz of the huge use of laproscopy now ,can be wound infection can be chest infection ,but i think it cant be UTI?

    an old man with fractured vertebrae....his blood film shows Howell jolly bodies with microcytic anemia also shows s/s of anemia and angular stomitis, weight loss how u will investigate ?
    -bone marrow scan
    -bone scan
    -colonoscopy

    angular stomatitis can be cause by IDA ,b12 def & vit c ,d def

    Howell jolly bodies can be found with hyposplenism, hereditary spherocytosis and sickle cell anemia.

    but pt had # vert so vit d deficiency suspected & also had macrocytic anaemia so b12 def suspected

    so malaborption is the right thing but the 3 options dont get me to that answer
    any clues to help me solve that mystery

    one was a 4 yr old child with past history of atopic eczema now came with fever lethargy his upper limbs and trunk are still eczematous and now for the first time a mid diastolc murmur is diagnosed whats diagnosis
    -bacterial endocarditis
    -rheumatic fever
    -kawasaki diesease

    condition which typically produce profuse watery discharge per rectum to the level to produce electrolyte imbalance.
    a.colonic polyp b. pelvic abscess c.carcinoma.
    6.in a study the mean of the systolic BP of the patients under the study was 115.standard deviation was15.this means that 95% of the patients under the study had a BP between
    a.100-130 b85-145 c.90-100


    a lady with history ofpain and stiffness of joints for a few weeks.while playing golf she had sudden onset of pain and swelling in calf.what is the diagnosis
    a.ruptured popliteal bursa b.spontaneous haematoma c.achilles tendonitis


    A 50 YRS LADY WITH A WEIGHT OF 125KG HAS SECONDARY AMMENORHEA FOR PAST 12 MONTHS. WHATS THE LEVEL OF HER HORMONES.
    a. normal estrogen, high fsh
    b. very low estrogen, very high fsh
    c. marginly low estrogen, slightly high fsh
    d. low estrogen, low fsh.

    now choice (b) should be the response for post menopausal levels.....but they have given weight as 125kg, n there is a theory that in obese women, significant amount of aromatization occurs from androgen to estrogen.....this make choice (c) also a contender


    WHICH OF THIS IS LEAST LIKE TO BE IN A WOMAN WITH POLYCYSTIC OVARIAN SYND AS COMPARE TO NORMAL WOMEN
    A. endometrial ca
    B. breast cancer
    C. diabetes ]
    D. hyretension
    E. ovarian ca
    Polycystic ovary syndrome affects about 7 to 10% of women. A common cause is excess production of luteinizing hormone by the pituitary gland. The excess luteinizing hormone increases the production of male hormones (androgens). If the disorder is not treated, some of the male hormones may be converted to estrogen. Not enough progesterone is produced to balance the estrogen's effects. If this situation continues a long time, the lining of the uterus (endometrium) may become extremely thickened (a condition called endometrial hyperplasia). Also, the risk of cancer of the lining of the uterus (endometrial cancer) may be increased.



    WHICH OF THE FOLLOWING IS THE SINGLE MOST CRUCIAL FACTOR IN OUTCOME OF SUCCESSFUL CARDIAC RESUCITATION
    A. mouth to mouth breathing
    B. defibrilation
    C. external chest compression*
    D early hospitalisation

    i think its defib


    ROULEAUX FORMATION :This occurs when red blood cells stack on top of each other when seen on peripheral blood film.It is a blood film equivalent of raised ESR .


    most common cause of HIGH ESR
    malignancy :malignant lymphoma

    well i concluded it was lymphoma due to coeliac disease (may be iam wrong )but now it looks like to me lymphoma

    also coeliac disease can cause non hodgkin lymphoma of small intestine in long standing cases

    a man was treated for cellulites of leg with antibiotics. After few days he presented with hypotention and tachycardia.his leg was dusky in colour and crepitus was present.what is the immediate management.
    a.continue antibiotics
    b.wound debridement
    c.hyperbarric oxygen
    d.antitoxin


    PICTURE of an adult man. Center of the umbilicus is red. Erythema of the surrounding skin.
    A.omphalitis B.obstructed paraumbilical hernia c.necrotising faciitis
    d.herpes zoster e.?


    .what is the most important adverse effect of GA over epidural Anaesthesia in normal labour?
    a.maternal hypotention
    b.thiopentone has direct respiratory depressant action on foetus
    c.increase bleeding


    child presented with undescended testis at 6 weeks. What will you do
    a.do an immediate orchidopexy
    b. wait till 4 years and then do orchidopexy
    c. encourage the mother to massage the inguinal region to ‘milk down’ the testis and review after 2 months
    d. review after 6 months .


    a 4 year old child with lacerated wound after falling on garden bed. He has taken dtpa at 2 and 4 months. After that no vaccination was given. What will you do
    a.give antibiotics b.give immunoglobulins cgive dtpa and Ig
    d.dtpa and booster after 2 months e.give dtpa.

    two darkish brown spots was found on the leg of a lady on examination. She did not notice any change in appearance of those spots for the past years. What is the diagnosis
    a.benign junctional naevi b.melanoma c.???spots d?

    a pregnant lady presents at 26 weeks with hydrops fetalis. Which investigation will help you in the management
    a.coomb’s test (?? Direct or indirect) b.IgM and Ig G for parvovirus
    (there were 3 questions of hydrops fetalis. Sorry I don’t remember them



    a man was treated for cellulites of leg with antibiotics. After few days he presented with hypotention and tachycardia.his leg was dusky in colour and crepitus was present.what is the immediate management. ( MASTERY)
    a.continue antibiotics
    b.wound debridement
    c.hyperbarric oxygen
    d.antitoxin

    the man is in septic shock ,so ABC which i cant see from ur comments ,if the ICU option was there i would choose it
    but any way i will continue AB ,surgical review will be needed & tetanus should be give in indicated as per emedicine
  2. Dr. Seema.

    Dr. Seema. Guest

    RECALL FROM MARCH ,24/2007 mcq exam.

    an old man with fractured vertebrae....his blood film shows Howell jolly bodies with microcytic anemia also shows s/s of anemia and angular stomitis, weight loss how u will investigate ?
    -bone marrow scan
    -bone scan
    -colonoscopy

    an old man with bone pain and s/s of anemia (some more description i dont remember )how u will investigate ?
    -PS antigen
    -colonoscopy
    these were 2 different questions

    about 3 questions with history of smoking
    one lead u to metastatic CA of lung
    one to squamous ca of mouth
    one to ca of lung

    3 questions which take u to Crohns Diesease
    out of two by telling about fistula

    one was a 4 yr old child with past history of atopic eczema now came with fever lethargy his upper limbs and trunk are still eczematous and now for the first time a mid diastolc murmur is diagnosed whats diagnosis
    -bacterial endocarditis
    -rheumatic fever
    -kawasaki diesease

    an alcoholic old man came with weakness (in nov2006 this man had low platelets )
    blood Biochemistry was given and blood film is normochromic normocytic (this was same in both papers )........i know this caz i went in both exams
    what he has
    -chronic aleukemic leukemia
    -primary thrombocytopenia
    -b12 deficiency
    -haematological change due to liver disease
    -(or u will get )haemotological change due to alcohol
    in my both papers these options were also changed
    see ME-90 AMC book that will help u in finding right answer but they have changed the blood picture from macrocytosis to normocytic these both can be in alcoholics

    a young man have epilepsy since 10 years and was stable on carbamazepine for last 3 years now hes getting a morning fit what u will do
    -increase dose of carbamazepine
    -decease dose
    -add phenytoin to it
    -look for carbamezepine anticonvulsatory plasma level
    these options were long descriptions not that simple
    plz do find correct answers with reasons and facts

    there were 5 or 6 questions about pancreatitis ,appendicitis,cholecystitis ,diverticulitis
    read thier s/s by differentiating them also by differrentiating thier Biochemistry and presence of dark urine in what cases its present

    look x rays for pneumonia
    -streptoccocol
    -staphyloccocal
    -mycoplasma
    -pneumothorax
    -TB

    DO read basics about ECGs they were simple not very complicated
    -WPW
    -MI
    -LBBB
    -LVH
    -AF

    OR 4 questions about epilepsy
    not scaring u but there was also one EEG with one of the options

    one growth chart of a child about his weight and height well it looked normal to me i dont know what others thought of it

    also do read abot CTG what options can make it normal and what can make an infant hypoxic with clear concepts

    one qustion was a patient taking aspirin, simvastatin ,atenolol, frusemide ,slow K ,diclophenac now he presents with oliguria .whats causing oliguria (it was mastery ....well I dont think it should be mastery question but AMC dont take suggestions from me in making thier paper )
    I dont know the previous recall question is wrong or whatever but the previous option K+rimipril+atenonol was not there
    -there were 2 options with slow K i dont remember thier combinations now
    -and only one option with ramipril which i marked it was ramipril+frusemide+declophenac
    I dont know if i was wrong

    another mastery was most accurate method of finding gestational age
    18 week ultrasound
    (in nov paper it came with different options and diff scenerio)

    X ray of shoulder dislocation what can happen
    -loss of sensation on upper part of shoulder
    -no more sensation on lower forearm
    -no sensation on medial part of upper arm
    other 2 options were totally diff from previous recall
    (in nov this question was without x ray and options were bit diff)

    so they r continously changing scenerios and options and stems
  3. Dr. Seema.

    Dr. Seema. Guest

    ECGs out of 4 were mastery

    2 CT scans both mastery

    about 8 x rays

    i dont know what others think but they have completed about almost every topic

    first paper was 50 % recall
    second was about only 10% recall
    and it was tough

    if u want to do recalls i think 2006 r very important but also do try to understand the questions and look for correct answers also do 2005 recalls but about the rest from 2001-2002 just go trough them dont spend too much time on them caz if they were give the qustions from them it will be same recall but from recent recalls they r changing stems

    about 3 questions were from congenital heart dieseases all mastery
    -VSD
    -Tetralogy of fallot
    -coarctation of aorta

    s/s of rectal ca mastery
    -rectal bleeding,diarrhoe ,peri rectal pain
    -change in bowel habit with sence of incomplete defecation
    find correct one from these (most common presentation


    on 5th day after appendectomy with tachycardia and fever (mastery)
    -chest infection
    -urinary infection
    -dvt
    -wound infection
    see SU-127 AMC book u will get answer

    do read this book they r still giving questions from book but in a very complecated way

    fig of leg with chronic venous insufficiency pg 262 AMC book (non mastery )
    -arterial insufficiency (what do u think)
    -haemorrhage from calf vein (it was a long descriptive sentence dont remember it completely)
    do read this picture they r giving it

    now iam telling u guys but i got both of these mcqs wrong in my paper

    A man called u in morning at 10 and said hes feeling nausea and vomiting havenot eat anything
    hes having sweats since last evening and checked his blood sugar its 10 mmol (MASTERY)
    -take his insulin
    -go to nearby hospital
  4. Dr. Prasan

    Dr. Prasan Guest

    patient was taking antidepressents for 2 yrs now want to stop medication (mastery)
    -gradient decrease in 2 weeks
    -he can still have depression in later life

    my advice is read thouroughly every topic in details this AMC book about 3 or 4 times and u must know every major topic with s/s .investigations and t/m .not only recaals will help u .they look very easy when someone else write them over here but in actual paper the case is different
  5. Dr. Bela

    Dr. Bela Guest

    one qustion was a patient taking aspirin, simvastatin ,atenolol, frusemide ,slow K ,diclophenac now he presents with oliguria .whats causing oliguria (it was mastery ....well I dont think it should be mastery question but AMC dont take suggestions from me in making thier paper )
    I dont know the previous recall question is wrong or whatever but the previous option K+rimipril+atenonol was not there
    -there were 2 options with slow K i dont remember thier combinations now
    -and only one option with ramipril which i marked it was ramipril+frusemide+declophenac
    I dont know if i was wrong

    another mastery was most accurate method of finding gestational age
    18 week ultrasound
    (in nov paper it came with different options and diff scenerio)

    X ray of shoulder dislocation what can happen
    -loss of sensation on upper part of shoulder
    -no more sensation on lower forearm
    -no sensation on medial part of upper arm
    other 2 options were totally diff from previous recall
    (in nov this question was without x ray and options were bit diff)

    so they r continously changing scenerios and options and stems
  6. Guest

    Guest Guest

    WHICH OF THE FOLLOWING IS THE SINGLE MOST CRUCIAL FACTOR IN OUTCOME OF SUCCESSFUL CARDIAC RESUCITATION
    A. mouth to mouth breathing
    B. defibrilation
    C. external chest compression*
    D early hospitalisation
    CHILD SAY 2-4 WORDS N OBEYS SIMPLE COMMANDS. AGE
    18 months, 2 yrs, 3 yrs,4yrs
    CHILD CAN WALK HOLDING TO SOMETHING N CAN SAY MOM-DAD.AGE
    6 months, *12 months,18months,2 yrs
    SCENARIO OF SLE. Rx
    Nasids, oral prednisalone..... i answered prednis. i think i should be nsaids
    PICTURE OF BOWEN DISEASE
    PICTURE OF NECK SWELLING. INVESTIGATION( THERE WAS NO PAIN)
    i think parotid sialography
    PICTURE OF CH VENOUS INSUFFICIENCY. WHAT CAUSE COLOUR CHANGE
    hemosedrin
    SCENARIO OF OSGOOD-SCHALLER SYNDROME
    SCENARIO OF SEPTIC ARTHRITIS
    CANT DORSIFLEX WRIST
    n. interossus post lesion
    SCENARIO OF RITTERS SYND WHICH HAS CLINICALLY PROVEN NEGATIVE IONOTROPIC EFFECT
  7. Guest

    Guest Guest

    another question was what cause secondary ammenorrhoea in hyperprolactinemia
    -interference in secretion of FSH and LH
    -interference in secretion of GNRH
    -increase secretion of FSH and LH
    -increase prolactin

    another was about hormonal level in menopause
    so do get to know what r different hormonal levels in different gynaecological conditions
  8. Guest

    Guest Guest

    Q - s/s of temporal arteritis (they have also combined s/s of polymyalgia rheumatica in that question )

    Q- s/s of thyrotoxicosis

    CT -(M) with scenario of subarachnoid hmg

    CT-(M ) with scenario of TIA

    about 4 or 5 questions of medicolegal aspects

    -a man has cancer and also dementia his wife doesnt want him to know

    a woman has cancer her son doesnt want her to know

    Q-whose conscent is least likely acceptable
    -mother on phone
    -grand mother (whose not guardian )

    Q -16 yr asked for contraception
    -give her ocp
    -give her ocp and to use condom

    Q-a girl getting admitted to psychiatric unit what contraception most suitable
    -refer her to gynaecologist
    -refer her to gynaecologist for IUCD

    S/S of lower limb ischemia except
    -an ulcer on great toe
    -a deep ulcer on medial malleolus
    -calf claudication
    -rest pain
    -loss of hair

    picture of cellulitis from anthology book

    pic of bowen diesease

    pic of another ulcer on leg pg 407 anthology (chronic venous ulcer )they asked for t/m

    well........some questions were familiar and some were u have never seen before

    in 300 mcqs i dont think there was any major topic which amc had left behind and didnt ask in exam

    about 3 or 4 ques of TIA with diff scenarios for
    -posterior cerebral inferior artery occlusion
    -carotid artery stenosis
    -one another ques was for carotid artery stenosis management
    -one was for vertebrobasilar artery thrombosis

    and some were with totally different presentations i dont remember them

    Q- for UTI thier t/m
  9. John.

    John. Guest

    - what can not come down with vagina
    -rectum (rectocele)
    -bladder (cystocele)
    -left colon (enterocele )
    -cervix
    -urethra
    look at pg 315 of llewellyn jones for answer

    Q- an old man (above 60 )with no previous medical history got collapsed and before that he had jerks in whole body then became un conscious he was brought to emergency while taking history u noticed twitching of his hand
    (iam sorry i dont remember any of options )

    Q- after eating carrot cake man got collapsed (mastery ) what caused this
    -gluten
    -dairy products
    -nuts
    -carrot
    -sodium glutamate

    Q-a man with history of COPD was found in his garden wandering and was confused on presentation
    -CO2 narcosis

    Q- for compound fracture of tibia and fibula
    -antitetnus and antibiotics

    Q-a child with laceration on arm he is fully immunized
    -tetnus booster

    Q- 7 yr old girl was fine before but was always a difficult child now parents brought her shes hyperactive, doesnt like changes ,very fond of dinasours and bob the builder ,do same movements ....her teacher says she doesnt like tasks ,likes to play alone and goes under her desk.
    (i read it 3 or 4 times caz it was confusing both for autism and ADHD and it was the case and was the exact age)
    -retts syndrome
    -asperger syndrome
    -ADHD
    -autistic spectrum disorder



    Q- a child just came into forester care his forester mother says hes aggressive and hyperactive and his teacher says he doent pay attention in school
    -give him trial of methylphenidate
    -do his developmental assesment with peadiatrician
    -this can be the reaction for forester care and review after 2 weeks
    -get some more .................from mother and teacher
  10. John.

    John. Guest

    Q-a lady on routine investigation has found 1.5 cm adrenal tumour
    -repeat CT in 6 months

    Q-a man has found with 2.5 cm renal stone
    -extracorpeal lithotripsy

    (since 2005 nov i have seen both of these questions in almost every paper also in nov 2006)

    picture of perianal hematoma
    -incision under general anasthesia

    50 yr woman with blood stained nipple discharge (M)
    -intraductal papilloma

    psychodynamic therapy most useful for
    -OCD
    -schizophrenia

    Q- a girl had quit her job and fights with her boy friend she thinks one day she would have lot of money
    -delusional disorder
    -mania

    Q- a man comes for his injection at yr surgery and salutes for 3 or 4 times before entering he does this every time
    -mannerism
    -previous army traiing
    -OCD
  11. Dr.ASN

    Dr.ASN Guest

    -t/m of mastalgia
    -danazol

    Q-whats diagnostic in achalasia
    -shoulder sign

    Q-in oesophageal ulcer
    -vomiting soon after meal
    -vomiting after one hour

    Q- about case study

    Q- about incidence and prevalence
  12. Dr.ASN

    Dr.ASN Guest

    WHICH NERVE HAS BEST REPAIR POTENTIAL
    n. digitalis
    * WHICH IS NOT INCLUDED IN APGAR SCORE
    excessive crying
    *PROFUSE BLEEDING PER RECTUM AFTER RADIOTHERAPY FOR CERVICAL CARCINOMA
    proctitis, diverticulitis, rectal ca
    DESCRIPTION OF BRANCHIAL CYST. WHAT TO DO
    fnac, usg, ct
    WHICH CAN LEAD TO THROMBOSIS IN A MAJOR LEG ARTERY
    knee dislocation, patella fracture, hip fracture, femur shaft fracture, femur head fracture.


    and yes, the sillest qs that can be asked in a medical exam of an international level:

    HOW CAN WE DECREASE THE ALCOHOL CONSUPTION IN SOCIETY
    a. only selected stores should sell it
    b. a total ban on its consumption
    c. increasing the tax duty ........ thnx god, it wasnt mastery.... u can ask this qs from any layman n u will get all kind of replies...whats its relation in regard to practice medicine in Australia ....well, a big mystery atleast for me
  13. Dr.ASN

    Dr.ASN Guest

    1.Which of the following conditions is not associated with erythema nodosum
    A,pneumonia b.rheumatic fever c.yersenia d.sarcoidosis
    2.a patient with parotid carcinoma will have which of the following
    a.drooping of lower eyelid b.drooping of the angle of mouth
    c ? d?
    3.a picture of a man with the tongue deviated to right. The question was which side is the lesion and to which side is the tongue deviated.
    4. a man with difficulty in extending the wrist and fingers. All other movement and sensations are normal. Reflexes normal. What is the lesion?
    a.radial n 2.ulnar n 3.median n 2.posterior interroseous nerve
  14. Ze

    Ze Guest

    These were all REAL ONES from the March Exam - new candidates

    Use these stems & read in a bit details
  15. a pregnant lady presents at 26 weeks with hydrops fetalis. Which investigation will help you in the management
    a.coomb’s test (?? Direct or indirect) b.IgM and Ig G for parvovirus

    Hydrops foetalis is the most severe manifestation of haemolytic disease in the foetus or neonate. There is gross oedema of the whole foetal body and hepatosplenomegaly associated with severe anaemia.

    I dont remember what was this exact question in paper but i do remember there was something like that

    if there is hydrops fetalis suspected the test to confirm it it
    -fetal cord blood sampling
    (as also written in OG-17 in sase of rh incompability)

    Fetus is hydropic if its Hb is less than 40 g /l and may die in utero.

    T/M
    -if pregnancy has advanced to 32 weeks it should be terminated
    -if earlier than 32 weeks fetal blood transfusion can be given into umblical vein under ultrasound
    (llewellyn jones )pg 132

    tests for parvovirus r carried out in case of slapped check syndrome

    most accurate estimate of fetal gestational age is acheived by the use of ultrasound examination prior to 18 weeks

    in nov exam this question was most accurate method at 18 weeks
    -by transvaginal ultrasound
    -by abdominal ultrasound

    I asked this question at course and medical educator over there said

    -if its BEFORE 18 weeks most reliable is transvaginal ultrasound
    -if its AT 18 weeks most reliable is abdominal ultrasound


    SORE THROAT

    -if it is streptoccocal it cause enlarged tonsillar lymph nodes

    -if it is infectious mononucleosis it cause posterior cervical lymph nodes lymphadenopathry

    -if it is in Diphtheria it cause enlarged cervical lymph nodes

    murtagh pages 816-817

    so in most of the caeses of sore throat there can be the swelling of cervical lymph nodes

    I think it depends on the location of swelling it should be mentioned in a question,

    Thyroglossal cysts r midline structures

    regarding the OCP they act on
    hypotahalmus,
    cervix,pituatay
    endometrium ??//

    think mainly on Hypothalamus ...but also on endometruim.
    I dont know realy what to choose.!!!

    This is from William's..
    The contraceptive actions of combination oral contraceptives are multiple, but the most important effect is to prevent ovulation by suppression of hypothalamic gonadotropin-releasing factors, which in turn prevents pituitary secretion of follicle-stimulating and luteinizing hormones. Progestin prevents ovulation by suppressing luteinizing hormone. Progestins also thicken cervical mucus, thereby retarding sperm passage. In addition, they render the endometrium unfavorable to implantation. Estrogen prevents ovulation by suppressing the release of follicle-stimulating hormone. A second effect is to stabilize the endometrium, which prevents breakthrough bleeding


    for branchial cyst


    ASPIRATION is usually diagnostic (saying of world recognized well known annotated AMCQ blackwell publishing approved by us all amc candidates )

    SU-15

    also confirms cystic nature of lump and presence of cholestrol crystals (on microscopy)

    T/M :surgical excision


    PROFUSE BLEEDING PER RECTUM AFTER RADIOTHERAPY FOR CERVICAL CARCINOMA
    proctitis, diverticulitis, rectal ca


    PICTURE of an adult man. Center of the umbilicus is red. Erythema of the surrounding skin.
    A.omphalitis B.obstructed paraumbilical hernia c.necrotising faciitis
    d.herpes zoster e.?


    .what is the most important adverse effect of GA over epidural Anaesthesia in normal labour?
    a.maternal hypotention
    b.thiopentone has direct respiratory depressant action on foetus
    c.increase bleeding


    a man was treated for cellulites of leg with antibiotics. After few days he presented with hypotention and tachycardia.his leg was dusky in colour and crepitus was present.what is the immediate management. ( MASTERY)
    a.continue antibiotics
    b.wound debridement
    c.hyperbarric oxygen
    d.antitoxin


    a child presented with undescended testis at 6 weeks. What will you do
    a.do an immediate orchidopexy
    b. wait till 4 years and then do orchidopexy
    c. encourage the mother to massage the inguinal region to ‘milk down’ the testis and review after 2 months
    d. review after 6 months e??[/b]


    THE ANSWER SHOULD BE (C)...ORCHIDOPEXY IS NOT DONE TILL 18 MONTHS OF AGE.... CHOICE (D) COULD BE ANOTHER OPTION
    FIRST OF ALL U DO IS MILKING DOWN THE TESTIS TO RULE OUT RETRACTIBLE TESTIS...IF U FAIL, GIVE AT LEAST 1 YR FOR TESTIS TO DESCEND DOWN BY THEIR OWN.... THEN ONLY SURGERY( BUT NO WAITING TILL 4 YRS)



    a 4 year old child with lacerated wound after falling on garden bed. He has taken dtpa at 2 and 4 months. After that no vaccination was given. What will you do
    a.give antibiotics b.give immunoglobulins cgive dtpa and Ig
    d.dtpa and booster after 2 months e.give dtpa.

    two darkish brown spots was found on the leg of a lady on examination. She did not notice any change in appearance of those spots for the past years. What is the diagnosis
    a.benign junctional naevi b.melanoma c.???spots d?

    a pregnant lady presents at 26 weeks with hydrops fetalis. Which investigation will help you in the management
    a.coomb’s test (?? Direct or indirect) b.IgM and Ig G for parvovirus
    (there were 3 questions of hydrops fetalis. Sorry I don’t remember them)


    .which if the most important factor for osteoporosis in women
    a.menopause in 40 years
    b.BMI <20 C.?
  16. Ze

    Ze Guest

    regarding guardianship- & responsible person to give consent is at the back of anthology book

    Rana- I was telling U that we can skip clinical Exam
  17. aashish

    aashish Guest

    there was another qs regarding the complication of undesecnded testis in a new born......

    well its the second most common anomaly following indirect ingoinal hernia in peadriatic surgery n the problms associated wth its non descent r as follows:

    - testicular dysplasia

    - trauma thru direct violence

    - risk of malignancy 5-10 greater thn in normal

    the optimal age for surgery is 12-18 mnths.

    i guess thn the correct answer for this qs wud be "malignancy"
  18. rana faisal

    rana faisal Guest

    Q- A 70 yr old woman has an ulcer above her medial malleolus of 12 months duration .There is surrounding pigmentation,dermatitis,and induration.There is likely to be
    1-thrombosis of deep venous system
    2-varicosities of short saphenous system
    3-incompetence of a perforating vein
    4-malignant change in the ulcer

    ANSWER
    This patient has late changes seen in the post phelebitic limb, namely pigmentation (secondary to haemosiderin deposition ), stasis dermatitis, induration (secondary to oedema induced fobrosis and ulceration .The ulceration is a result of poor skin nutrition and often associated with adjacent incompetent perforating veins .
    (3 is correct )
    The destruction of deep venous valvular system produces a high pressure in the subcutaneous tissues ,venous stasis and diminished oxygenation of adjacent tissues .In those who do not have deep venous thrombosis .
    (1 is correct )
    there is a failure at sephanofemoral junction with reflux into long saphenous vein
    (2 is false )
    Malignant change in chronic venous ulcer is very rare and only occurs after many years duration
    (4 is false )
    However it is a wise precaution to biopsy long standing ulcers which r not healing.




    Q-Which of the following statements concerning varicose ulcers is /are true?
    1-the usual site is on or just below the medial malleollus
    2-if the pain from the ulcer is not relieved by 48 hrs of bed rest there may be other factors involved apart from venous stasis
    3-split skin grafts do not take well on these ulcers
    4-skin cancer is a well -recognized complication of chronic venous ulceration.

    ANSWER
    Varicose ulcers characteristically occur a few centimeters above the medial malleolus
    (1 is wrong )
    A venous ulcer per se without infection or oedema is painless.If such an ulcer is still painful after bed rest then it is likely that there is some other factor involved in the etilogy of the ulcer (e.g ischaemia ), or infection is present .
    (2 is true )
    Provided that there is adequate oxygenation and nourishment of the underlying tissue ,and that the ulcer bed is free from infection , skin grafting on varicose ulcers will succeed .
    (3 is wrong )
    If the skin perfussion pressure is less than 40mm Hg the graft will not take and the ulcer may not heal of its own accord.In such cases surgical manoeuvers such as ligation of perforating veins or femoropopliteal bypass for arterial insufficiency will need to be considered.

    Q-A 53 yrs old man presented with gangrenous toe. He has palpable dorsalis pedis and posterior tibial pulses .Likely causes include
    1- Raynauds disease
    2-Buergers disease
    3-peripheral neuropathy
    4-diabetic vascular disease
    ANSWER
    Diabetic vascular disease is the most likely cause of a gangrenous toe in a middle -aged man with palpable foot pulses.
    (4 is correct )
    In diabetics foot pulses are usually present and a microangiopathy produces small vessel occlusion.
    Raynauds disease is unusual in men and usually involves the upper extremities
    (1 is incorrect )
    whilst thromboangitis obliterans (Buergers disease ) will normally result in disappearance of the foot pulses
    (2 is incorrect )
    Peripheral neuropathy may be associated with diabetic vascular disease but is not the prime cause of gangrene in toe.


    now the on line harrison pasted part regarding peripheral vascular disease

    Peripheral Vascular Disease

    Atherosclerosis is markedly accelerated in the larger arteries. It is often diffuse, with localized enhancement in certain areas of turbulent blood flow, such as at the bifurcation of the aorta or other large vessels. Clinical manifestations of peripheral vascular disease include ischemia of the lower extremities, impotence, and intestinal angina.

    The incidence of gangrene of the feet in people with diabetes is 30 times that in age-matched controls. The factors responsible for the development of this condition, in addition to peripheral vascular disease, are small vessel disease, peripheral neuropathy with loss of both pain sensation, and neurogenic inflammatory responses and secondary infection. In two-thirds of patients with ischemic gangrene, pedal pulses are not palpable. In the remaining one-third who have palpable pulses, reduced blood flow through these vessels can be demonstrated by plethysmographic or Doppler ultrasound examination. Prevention of foot injury is imperative. Agents that reduce peripheral blood flow such as tobacco and propranolol should be avoided. Control of other risk factors such as hypertension is essential. Cholesterol-lowering agents are useful as adjunctive therapy when early ischemic signs are detected and when dyslipidemia is present. Patients should be advised to seek immediate medical care if a diabetic foot ulcer develops. Improvement in peripheral blood flow with endarterectomy and bypass operations is possible in certain patients.


    from gp note book

    diabetic gangrene
    Diabetic gangrene results from three factors:

    trophic changes - caused by peripheral neuritis
    ischaemia - caused by atheroma in the arteries
    lowered resistance to infection - caused by excess sugar in the tissues

    NOW IAM COMING TO THE QUESTION OF OUR EXAM WHICH WAS ALSO MASTERY
    S/S of lower limb ischemia except
    -an ulcer on great toe
    -a deep ulcer on medial malleolus
    -calf claudication
    -rest pain
    -loss of hair
    (that was the recall by me after 2 days of exam ....also on page 2 of this forum)

    so now if the ulcer on great toe is due to gangrene and due to lower limb ischemia and off course main reason due to diabetic vascular diesease butr not due to diabetic neuropathy (as in last mcq from petter devit )

    then i think the except option is
    -ulcer on medial malleolus
    (now i dont remember if in the options it waqs ulcer ABOVE medial malleolus ....which makes it most common site for varicose venous ulcer )
    the point i remember accurately is in options it was deep ulcer and iam now not confirmed about its site

    i hope if someone would help me in recalling exact option or site of ulcer

    previously this question was coming with option of
    -ulcer over first metatarsal on sole of foot (which we all know is also due to diabetes )and thats due to both diabetic neuropathy and peripheral vascular disease as also given in annotated in
    SU-35

    in same mcq there r features of venous ulcers
    -typically situated around ankle
    -skin pigmentation
    -dependant oedema
    -scaling dermatitis
    -subcutaneous fat atrophy

    As i do understand this mcq in this exam now they r asking for differentiating features b/w arterial and venous ulcers ......unlike in previous mcq with option of ulcer on first metatarsal head where they r asking for differenciation b/w arterial and diabetic neuropathic ulcers

    well so much confusing and its hard to say anything with certainety or for sure unless we dont know the exact statements in a question in paper
    .....only minor things r changing answers .....so please do take yr time in reading a question ....read it properly ....also those who r going to give this exam and those who wont make it this time (dont even know about myself )

    also the other one of pneumothorax also requires proper understanding of question they can never give 2 options which would be both can be correct there must be for sure something that cant be.....must be given in options may be if space would be correct then not the site of tube or if the site would be correct then not the correct space
    ....most important is do read carefully now AMC is changing even thier favourite questions with different and new options
  19. rana faisal

    rana faisal Guest

    PNEUMOTHORAX

    according to THERAPEUTIC GUIDELINES AUSTRALIAN

    -insertion of an intercostal catheter or needle either in 2nd intercostal space anteriorly in md-clavicular line

    -or in the axilla in 5th or 6th intercostal space

    also with the reference from DAVIDSON

    an intercostal drain should be inserted in the 4th,5th or 6th intercostal space in mid axillary line.

    (so it means if they have given the option of 2nd intercostal space its mid-clavicular line and if 5th or 6th space its mid axillary line )


    NOW THE ONLINE HARRISON
    Treatment

    An asymptomatic pneumothorax that is less than 20 percent of the volume of the affected side may be followed clinically with no therapy and with serial radiographic studies every 4 h. Any pneumothorax with severe respiratory distress and clinical deterioration needs emergency treatment. When there are mediastinal shift and cardiovascular collapse, rapid decompression at the fourth intercostal space with a 21-gauge needle alone or attached to a three-way stopcock and a large syringe can be lifesaving.

    Indications for thoracostomy tube placement are post-decompression of a tension pneumothorax or relief of respiratory compromise for simple pneumothorax, hemopneumothorax, or pleural fluid. The same equipment used for adults is required. A 10-French chest tube is used for infants weighing less than 1500 g, whereas a 12-French chest tube is appropriate for infants weighing more 1500 g. The procedure is similar to that in adults and is described in Chap. 259. Placement of the tube can be at the second or third intercostal space in the midclavicular line or at the fifth or sixth intercostal space in the anterior axillary line. The same precaution regarding avoidance of injury to the intercostal nerve, artery, and vein, which run on the lower edge of the rib, is required. The skin wound is similarly closed, and the chest tube is severed. The position of the chest tube is verified with a chest x-ray. The lung should re-expand promptly after evacuation of the air in the pleural space.

    (i marked fifth intercostal space mid axillary line now i got confused caz as i do remember in my paper the option with 6th intercostal space was with mid clavicular line as the site was wrong (as its actually mid -axillary line ) so i didnt mark it


    The treatment of spontaneous pneumothoraces varies depending on the patient's symptoms and condition, the degree of collapse, the cause, and the estimate of the chance of recurrence. Small (< 20–25%), stable, asymptomatic pneumothoraces in otherwise healthy patients can be followed (often on an outpatient basis) with the expectation of complete resolution within several weeks, since air is normally reabsorbed at a rate of 1–1.25% per day. Larger asymptomatic pneumothoraces taking longer than 2–3 weeks to resolve place the patient at risk for developing trapped lung as a result of deposition of fibrin on the visceral pleura. These patients—as well as patients with symptoms, increasing pneumothoraces, or pneumothoraces associated with pleural effusions—should have them evacuated. In highly selected patients this can be accomplished with simple aspiration as long as the immediate and 2-hour delayed chest radiographs document reexpansion. It should be emphasized, however, that some small breaks in the visceral pleural seal once the lung collapses and can reopen with reexpansion. The chance of recurrence is 20–50% with this method, and follow-up x-ray is therefore mandatory after 24 hours.

    Most patients with significant pneumothoraces (> 30%) require placement of a closed-chest catheter (8–20F) for acceptable reexpansion. This catheter then can be placed either to underwater suction drainage or to a Heimlich (one-way) valve. If a Heimlich valve maintains full expansion, the patient may be treated as an outpatient; however, if a Heimlich valve fails to reexpand the lung fully or if the patient's condition is not optimal, admission to hospital and underwater chest tube suction drainage is required. Unless some contraindication exists, chest tubes should be placed in the midaxillary line at the level of the fifth intercostal space (nipple line). In women the breast tissue should be retracted medially and avoided in the dissection to the chest wall. Placement with the use of blunt clamp dissection avoids the dangers of trocar insertion and should almost always be used. Following resolution of any air leakage, the tube may be taken off suction (water seal) and removed if the lung remains fully inflated. In patients with classic spontaneous pneumothoraces, the chance of recurrence increases with each episode. Following a single episode, the risk of a recurrent pneumothorax is 40–50%. After two episodes the risk increases to 50–75%, and with three previous episodes the risk is in excess of 80%. Currently, most first-time patients are treated initially with simple chest tube drainage; however, with subsequent recurrences, additional therapy generally is indicated. Furthermore, with the development of video-assisted thoracic surgery (VATS), some feel that a more aggressive approach should be taken even for first-time pneumothoraces
  20. Guest

    Guest Guest

    . scenario on nueroblastoma.

    2.orbital floor fracture...

    3.swelling moving with degluatination--papillary carcinoma secondary.

    4. thyrocid cancer surgery-c/i---vocal cord paralysis.

    5.chronic duodenal ulcer---urea breath test..

    6. pyloric stenosis----large vomit about 1 hr after taking the food....

    7....a scenario on lady feels deperonalisation===complex partial seizures.

    8.a scenario on absent seizures---may recover spontaneously,,,,,,,,,,,
  21. Guest

    Guest Guest

    WITH BACK PAIN WITH NEUROLOGICAL SIGNS IE BOWEL AND BLADDER INVOLV. WE START WITH PLAIN X RAY SPINE.

    IF NEUROLOGCIAL INVOL. PRESENT- START WITH MRI.

    2. THOUGH UNDESCENDED TESTES IS ASSCOIATED WITH SEMINOMA AND ECTOPIC TESTIS WITH TORSION , YET MAXIMUM REISK IN CASE OF UNDESCENDED TESTES---------------INDIRECT INGUINAL HERNIA

    3. ORCHIDOPEXY CAN BE DONE AT SIX MONTH AGE =======REASON BEING RISK OF TRAUMA( UNDESNDED TESTES, RISK OF INFERTILITY AS WELL AS TORSION )>>>>>>>>>

    major source of radiation per capita ------background radiation.

    the other option for rectal ca was

    - rectal bleeding,diarrhoea ,perianal pain perianal pain usually dosent presents as the common symptom and constipation is rather more common than diarrohea ( as such carcinma causes annular constriction of the lumen.
  22. Guest

    Guest Guest

    Inactive Tuberculosis

    Definition: Resolution of tuberculosis is seldom complete. The usual residual changes include walled-off, caseous necrosis, thin- or thick-walled cavities, emphysema, bronchiectasis, obliterative bronchiolitis, focal pleural and parenchymal scars, and focal calcifications.


    Treatment for inactive TB In the US, treatment is recommended for those with inactive TB to prevent the development of active TB. In other countries where TB is more prevalent, treatment for inactive TB is not available or recommended because active TB is the greater priority.

    An inexpensive antibiotic called isoniazid (INH) is recommended to eliminate TB germs. INH is recommended for people with:

    Known recent infection (a positive skin test within two years of previous negative skin test)
    Evidence of previous TB on chest x-ray
    Other medical conditions that compromise the immune system, including:
    Certain types of cancer
    Diabetes
    HIV infection
    Rapid weight loss
    Certain medications (e.g. cortisone treatment)
    INH must be taken daily for nine months. To avoid side effects, you should also take vitamin B6 (10-50 mg) daily, eat a balanced diet, avoid Tylenol (acetaminophen) and avoid daily consumption of alcohol.
  23. Guest

    Guest Guest

    . fracturepelvis. Patient wants to void but cant. Blood in meatus. What will you do?
    Thought suprapubic catheterization is the initial step.(given in bailey).

    .drugs not given together. Did you mean lithium and sertraline?
    Was there a choice of TCA(don’t remember the drug name)+sertraline.
    SSRI inhibits the metabolism of TCA. Hence should not be given together.


    . isn’t undescended testis associated with neoplasm too. What is the most frequent complication of undescended testis in a child?

    .orchidopexy is not usually done before 2 years (bailey). In this q I think the child’s age was 6 weeks.

    . is it the question of back pain related to spine. Isn’t MRI the investigation of choice.

    . can it be early onset cerebral palsy????

    .risk factor for osteoporosis in women.
    Menopause at 40 years was a choice. Why not that.

    .no wrist extension.normal refluxes. --- post int nerve.(I marked it wrong too)

    . MMR is contraindicated in anaphylaxis induced by egg(given in OHCS
  24. Guest

    Guest Guest

    The clinical features of radial nerve palsy depend upon the site of the injury.

    Lesions in or above the axilla result in paralysis and wasting of all the muscles innervated. Clinically, this is manifest as:

    weakness of forearm extension and flexion - triceps and brachioradialis
    wrist drop and finger drop - paralysis of the extensors of the wrist and digits
    weakness of the long thumb abductor and extensor muscles
    sensory loss on the dorsum of hand and forearm appropriate to the cutaneous distribution - see radial nerve Anatomy
    Lesions around the humerus often do not affect the triceps and may also spare brachioradialis and extensor carpi radialis longus. The picture more closely resembles posterior interosseous palsy.

    Posterior interosseous palsy results from entrapment of the nerve at its point of entry into the supinator muscles. It is often due to a dislocation or fracture of the elbow. Presentation is with weakness of finger extension, and of thumb extension and abduction. There is little or no wrist drop, and usually, no sensory loss.

    Investigation of extension of the thumb and fingers must be done carefully since the interossei - ulnar nerve - produce extension of the middle and distal phalanges.



    undescended testes most common association is indirect hernia not malignancy i think. malignancy occurs if u dont correct it .but hernia is present from the onset in 90%cases .they coexist .and optimal time for orchidopexy 6 to 18 mo pg 1077 j murtajh .
    any more comments plz


    one q from zax plz .why is that prognosis for infertility is good in maldescent as compared to un
    and why mal are easy to place back as compared to un pg 198 david hull .thx bye
  25. Guest

    Guest Guest

    1.case about coxeilla burnetti--- dairy farmer.

    2. scenario on rash, jaundice( ictohamerroghagic fever)_ leptospiriasis.

    3. hepatitis c- except--------materno fetal transfer.

    4.pleuritic pain + dullness- ---pneumonia.

    5. rt sided cancer( may be caecal)-----tiredness and lethargy.


    6. common causes of small bowel obstruction --------adhesion.


    7. a scenario on trichtotillomalia.

    8. enuresis---------- related to family history( poistive).

    9. diabetes____________measure HBAIC...........
  26. Guest

    Guest Guest

    Initial Management of Open Fractures

    Open fractures, which may be complicated by subsequent osteomyelitis, warrant prompt and meticulous attention. The most important elements in the treatment of open fractures, aside from tetanus prophylaxis that applies generally to any wound, are irrigation, debridement, and antibiotics provided as soon as is practical. Although irrigation and debridement might be performed in the operating room, antibiotics can be administered in the emergency department.

    Early administration of antibiotics can help prevent or reduce the clinical manifestations of bacterial contamination in open fractures.4–5 The longer the interval between the time of injury and the initiation of antibiotic therapy, the less effective such therapy is likely to be. Exactly what constitutes the ideal antibiotic is controversial. An accepted combination is a first-generation cephalosporin plus an aminoglycoside, but this is by no means the only regimen in use. Aerobic and anaerobic wound cultures can be obtained before antibiotics are administered.

    Antibiotics by themselves are not a substitute for irrigation and debridement, both of which have been well demonstrated to be crucial to reducing the incidence of osteomyelitis in open fractures by reducing bacterial contamination and the potential for bacterial colonization.6–7 Irrigation should be extensive to (1) make the area more visible to inspection for foreign material, (2) float out nonviable tissue or at least float it into the field of vision so it can be removed, and (3) float out contaminated blood clots and bits of tissue. Pulsatile pumps may increase the effectiveness of irrigation provided the stream is not too forceful. Excessive force may pack debris farther into the recesses of the wound.

    Debridement of minor wounds that overlie a fracture sometimes may be performed in the emergency department. When tissue damage is moderate or severe, formal debridement and irrigation are commonly performed in the operating room.
    ( on -line Harrison )
  27. Guest

    Guest Guest

    Ultrasonography

    Ultrasonography is now the most widely used technique for determination of gestational age. Fetal crown to rump length can be measured at 5–13 weeks and is the most accurate means to determine gestational age. Beyond 13 weeks, measurement of fetal biparietal diameter is used in conjunction with the femur length and abdominal circumference to assess gestational age and/or interval fetal growth. Beyond 30 weeks, the accuracy of gestational age assessment by ultrasound is much less.

    Ultrasound is used to measure fetal growth parameters, to estimate fetal weight, to access fetal Anatomy , and to measure amniotic fluid volume. Fetal well-being can also be evaluated by measuring biophysical characteristics
  28. Guest

    Guest Guest

    120. cerebral palsy= except > 95% intellectual diability.

    In this q, there was an option stating the progressive nature of the disease.....i marked that option because cerebral palsy by defination is permanent and non progressive .

    33. SUBMANDIBULAR SWEELING- INTRAL ORAL X RAY.

    for me it was parotid swelling as they have clearly mentioned that there was no pain.....stones in sub mand r very painful...so answer should be parotid sialography

    74. ORCHIDOPEXY- IMMEDIATE SURGERY.
    it was scenario of a 8 week old child..... cant do immediate surgery...orchidipexy is done around 1-1.5 yrs

    94.RT SIDE TONUGE DEVIATION + RT SIDE LESION.
    for me it seemed that it was left sided deviation n left sided lesion(which ofcourse i wrote)......may be i was sitting more towards the left side of screen.
  29. Guest

    Guest Guest

    153
    pnemocystis carnii pneumonia.

    154. pateients treated with gonorrohea what to next- trace contacts .....

    156. neural tube defects- except low afp.

    157. neural tube defects- MSAFP- 16 WEEKS.

    158. CHRONIC VENOUS INSUFFEICNECY- HEMOSIDERIN.

    159. VENOUS ULCERATION EXCEPT- TOPICAL ANTIBIOTICS.

    160 . ISCHAEMIC ULCER EXCEPT- ULCER ON GREAT TOE....
  30. Guest

    Guest Guest

    --------------------------------------------------------------------------------

    . CONSERVATIVE MANGEMENT FAILED MASTITIS- DANAZOL.

    .CTG SEEMED TO BE NORMAL.

    . GROWTH CURVE SEEMS NORMAL. FOR WEIGHT AS BABY WAS PREMATURE AND DVELOPEMENT GOES WITH SAME MATURITY.

    .TCA ( IMIPRAMINE ) POISONING- ACTIVATED CHARCOAL.

    .PREGANT LADY FALLS UNCONCIOUS- WHAT TO DO SYMPTOM DIARY.( I FEEL SAME AS WE USE FOR PMS).
    . SCENARIO OF PHYSIOLOGICAL JAUNDICE( 3RD DAY).

    .SCENARIO OF GESATIONAL AGE RH O -IVE AT 28 WEEKS LOOKS AS 34 WEEKS, CAUSE-- HYDROPS FETALIS.RH ISSO.

    .PATIENT WITH HOMONOMUS HEMINOPIA- WHAT TO DO-- CONSULT OCCUPATIONAL THERAPIST.

    . PATIENT WITH PANCREATIC CANCER TO BE OPERATED- LOOK FOR GAURDIANSHIP.
  31. Guest

    Guest Guest

    140.MITRAL STENOSIS- MURMUR 5 MID CLAVICULAR LINE CARDIAC APEX.

    141. PULMONARY EMBOLISM - PULMONARY ANGIOGRAPHY, NO V/Q SCAN GIVEN.

    142. DIABETES PAITIENT WITH FOOT ULCER- WHAT TO DO. WOUND SWAB AND CULTURE.

    143.JOINT ASPIRATION - R/A.

    144. HIP FLEXED WITH FEVER- SEPTIC ARTHRITIS.


    150. HOW TO MEASURE FLUID INTAKE IN A PATIENT WITH RENAL FAILURE---URINE OUTPUT.

    151. ANOREXIA NERVOSA WHAT IS THERE- FEELS MORE COLD.

    152. VISUAL AND AUDITORY HALLUCINATIONS- AMPHETAMINE.

    153. ANTIDOTE FOR MIDAZOLAM - FLUMAZENIL.

    154.DRUGS NOT USED IN PYCHOSIS- AZISULPRIDE
  32. Q-A 53 yrs old man presented with gangrenous toe. He has palpable dorsalis pedis and posterior tibial pulses .Likely causes include
    1- Raynauds disease
    2-Buergers disease
    3-peripheral neuropathy
    4-diabetic vascular disease..

    Davidson...18th
    The diabetic foot....
    Pure ischemia account for minorty of foot ulcer in DM ,with must being either neuropathic or neuro-ischemic..
    Moreover Diabetic vascular Dis assocaited with no or less pulse.
    Also have a look at the fig of "causes of lower leg ulceration" pg839 (I dont have the newedition).


    S/S of lower limb ischemia except
    -an ulcer on great toe
    -a deep ulcer on medial malleolus
    -calf claudication
    -rest pain
    -loss of hair

    mallous not common for neuropathy. but often seen with Ischemic ulcer..

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