Onexamination plab questions (git)

Discussion in 'Plab 1 and 2 forum' started by Neha Gupta, Jan 22, 2013.

  1. Neha Gupta

    Neha Gupta Active Member

    A 51-year-old male labourer presents with a haematemesis.
    Which of the following features would categorise him into a high risk group?
    (Please select 1 option)

    A blood pressure of 134/88 mmHg

    A history of ischaemic heart disease

    A plasma glucose of 7.2 mmol/l

    A pulse of 90 beats per minute

    His age
  2. Neha Gupta

    Neha Gupta Active Member

    A 5-year-old boy presents with fever, rash and hepatomegaly.
    He was well until seven days before, when he developed malaise, headache and fever. Subsequently a maculopapular rash had appeared over the trunk. An enlarged liver was noted by the family doctor.
    He had a full term normal delivery with no neonatal problems. His immunisations are up to date. There is no family or social history of note.
    On examination:
    Temperature 38.2°C
    Respiratory rate 20/min
    Pulse 100/min
    He has 2 cm tender hepatomegaly and 3 cm spleen. Full blood count shows occasional atypical lymphocytes, and his AST is slightly elevated. He has marked cervical lymphadenopathy.
    What is the most likely diagnosis?
    (Please select 1 option)

    CMV infection

    Glandular fever

    Hepatitis A infection

    Kawasaki disease

    Toxoplasmosis
  3. Neha Gupta

    Neha Gupta Active Member

    Glandular fever IS Correct

    The history of fever, rash, lymphadenopathy and hepatosplenomegaly are in keeping with a mononucleosis-like illness.
    This suspicion is supported by the atypical lymphocytes and elevated liver enzymes, which suggest a mild hepatitis is present.
    Epstein-Barr virus (EBV), cytomegalovirus (CMV) and toxoplasmosis can cause this picture, the latter two of which may cause teratogenicity in pregnant mothers. Of these, EBV is the commonest to cause symptoms.
  4. Neha Gupta

    Neha Gupta Active Member

    A 51-year-old male labourer presents with a haematemesis.
    Which of the following features would categorise him into a high risk group?
    (Please select 1 option)

    A blood pressure of 134/88 mmHg

    A history of ischaemic heart disease

    A plasma glucose of 7.2 mmol/l

    A pulse of 90 beats per minute

    His age


    "A history of ischaemic heart disease" is the correct answer

    There are a number of available scoring systems which stratify subjects with gastrointestinal bleed into high and low risk groups.
    The Rockall scoring system is based on:
    • Age (the higher the age the worse the prognosis)
    • Comorbidities (ischaemic heart disease [IHD])
    • Presence of shock
    • Endoscopic abnormalities.
    The Canadian Consensus Conference statement utilises a similar system, incorporating endoscopic factors including:
    • Active bleeding
    • Major stigmata of recent haemorrhage
    • Ulcers greater than 2 cm in diameter
    • The location of ulcers in proximity to large arteries.
    The Baylor bleeding score attaches a score to pre- and post- endoscopic features.
    The Blatchford score is based on clinical parameters alone:
    • Elevated blood urea nitrogen
    • Reduced haemoglobin
    • A drop in systolic blood pressure
    • Raised pulse rate
    • The presence of melaena or syncope
    • Evidence of hepatic or cardiac disease.
  5. Neha Gupta

    Neha Gupta Active Member

    A 20-year-old woman was referred for investigation of iron deficiency anaemia. Her mother died aged 28 years from colonic carcinoma complicating Peutz-Jegher syndrome.
    Which is the most likely mode of inheritance of Peutz-Jegher syndrome?
    (Please select 1 option)

    Autosomal dominant

    Autosomal recessive

    Mitochondrial

    Polygenic

    X-linked dominant


    Autosomal dominant IS Correct


    Peutz-Jegher syndrome is a condition characterised by perioral pigmentation and numerous hamartomas of the bowel.
    Originally it was assumed that these did not predispose to malignancy but studies now suggest the contrary.
    The condition is autosomal dominant.

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