PLAB 1: QUESTIONS FROM PAST PAPERS

Discussion in 'Plab 1 and 2 forum' started by Guest, Apr 9, 2010.

  1. Guest

    Guest Guest

    PLAB 1: QUESTIONS FROM PAST PAPERS

    Theme: DIAGNOSIS OF FRACTÃœRES
    a) Fracture distal end of radius
    b) Metacarpal fracture
    c) Supracondylar fracture of homerus
    d) Scaphoid fracture
    e) Posterior dislocation of shoulder joint
    f) Ant dislocation of shoulder joint
    g) Peri-lunate fracture

    6) A man complained of pain in hand after punching a wall yesterday,.
    7) A young girl feil from a tree and now complains of pain in the arm. her radial pulse cannot be feit
    8) A man having seizures canie to the A&E cornplaining of pain in the shoulder, There was no obvious visible deformity.
    9) Au old lady complained of pain in the wrist and hand after she feil on an outstretched hand. her wrist and hand are swollen.

    X-ray af wrist scaphoid view
    B. Refer to orthopaedics doctor immediately
    C. Bandage & discharge
    D Isotope scan
    9) Boy feil from tree now has come with painful wrist x-ray taken was normal
    10/Pt had a fall x- ray shows perilunate fracture .
    11. Pthad a fall x ray normal, tenderness in anatomical snuff box.
    12. Pthad a fall, X-ray showed displacement of the radius

    ANSWERS

    6.B
    7.C
    8.E
    9.A

    9.D
    10.B
    11.A
    12.B
  2. Guest

    Guest Guest

    Metacarpal fracture
    Trauma to the hand is exceedingly common, not infrequently resulting in metacarpal and phalangeal fractures and dislocations. Most of these injuries can be managed nonoperatively, utilizing immobilization or controlled mobilization. For certain intra-articular fractures, displaced and angulated fractures, unstable fracture patterns, combined or open injuries, as well as irreducible and unstable dislocations, surgical intervention may be required for restoration of function and appearance.

    Supracondylar Fractures
    Unlike adults children usually sustain fractures in the upper limb. Of all the fractures in the upper limb the supracondylar fracture of the humerus is not only the most common injury but can result in serious complications if not treated appropriately. In general fractures in children are treated conservatively. Surgical treatment is reserved for some physeal injuries, fractures associated with neurovascular compromise, open fractures and certain special circumstances such as fractures around the hip.

    The management of supracondylar fractures of the humerus has evolved from a purely conservative approach to a more aggressive approach in recent years. When deciding on the appropriate treatment for these fractures it is useful to classify these fractures into three groups. Group 1- undisplaced fractures (Gartland type 1), Group 2 – partially displaced fractures (Gartland type 2) and Group 3 –completely displaced fractures (Gartland type 3). Needless to say undisplaced fractures should be treated conservatively with protection in a backslab or a cast for a period of about 3 weeks. In the case of partially displaced fractures the majority can be treated by closed reduction usually under general anaesthetic followed by immobilisation for about 3 weeks.

    Posterior (backward) Posterior dislocation of shoulder joint
    Posterior dislocations are occasionally due to electrocution or seizure and may be caused by strength imbalance of the rotator cuff muscles. Posterior dislocations often go unnoticed, especially in an elderly patient and in the unconscious trauma patient. An average interval of 1 year was discovered between injury and diagnosis of posterior dislocation in a series of 40 patients.

    Anterior dislocation of shoulder (forward)

    Over 95% of shoulder dislocation cases are anterior. Most anterior dislocations are sub-coracoid. Sub-glenoid; subclavicular; and, very rarely, intrathoracic or retroperitoneal dislocations may occur.
    It can result in damage to the axillary artery.

    Treatment dislocation of shoulder

    Prompt professional medical treatment should be sought for any suspected dislocation injury. Usually, a dislocated shoulder is kept in its current position by use of a splint or sling (however, see below). A pillow between the arm and torso may provide support and increase comfort. Ice may help reduce pain.

    Emergency department care is focused on returning the shoulder to its normal position via processes known as reduction. Normally, closed reduction, in which several methods are used to manipulate the bone and joint from the outside, is used. A variety of techniques exist, but some are preferred due to fewer complications or easier execution. In cases where closed reduction is not successful, surgical open reduction may be needed. Following reduction, X-Ray imaging is often used to ensure that the reduction was successful and there are no fractures.
  3. Guest

    Guest Guest

    Colles' fracture, a fracture of the lower end of the radius with displacement of the distal fragment dorsally Transverse fracture of the radius just above the wrist with displacement of hand backward and outward (dorsal displacement of the distal fragment). Complications may include residual deformity, loss of mobility, median and ulnar nerve injury, pain in the wrist, numbness in the fingers, shoulder-hand syndrome, and rupture of the extensor pollicis longus tendon.

    Treatment:Colles' fracture
    Treatment may range from simple immobilization with a splint and sling to a lightweight fiberglass cast. If cast immobilization is insufficient to repair the fracture, surgical intervention with internal fixation with pins, or a plate and screws may be necessary.
  4. Guest

    Guest Guest

    Scaphoid fracture is the commonest fracture seen among the wrist bone and usually caused by falling on an outstretched hand. It is the most important wrist bone and acts as the keystone that links all the wrist bones together. Diagnosis of a scaphoid fracture can be made with X-ray but 10-15% of fracture is not shown in early X-ray. Those fractures not seen on x-ray are clearly and easily identified by MRI scan

    Clinical injuries of the carpal scaphoid are frequently seen at accident and emergency departments. Some exhibit delayed radiographic visualization of a fracture. The radioisotope bone scan is a sensitive test and increased uptake is observed in healing fractures. Twenty-three patients with an initial diagnosis of clinical fractures of the scaphoid were studied clinically, radiologically and independently by 99Tcm-MDP isotope scans. Three-quarters of the patients required only 1 month's management.

    The radius and scaphoid articulate deep to the snuffbox to form the basis of the wrist joint. In the event of a fall onto an outstretched hand, this is the area through which the brunt of the force will focus. This results in these two bones being the most often fractured of the wrist. In a case where there is localized tenderness within the snuffbox, knowledge of wrist Anatomy leads to the speedy conclusion that the fracture is likely to be of the scaphoid. This is understandable as the scaphoid is a small, oddly shaped bone whose purpose is to facilitate mobility rather than confer stability to the wrist joint.
  5. Guest

    Guest Guest

    SOME MORE Qs

    orthopaedics :
    44. Achiiles tendon rupture surgical repair
    45. Child, pain in knee while playing football, next day walking normal, oniy pain, no sweliing, pain not relieved by paracetamol—Ibuprofen
    46. Child, pain in knee, already getting 50% NO and 02, patella found to be laterally shifted—manipulation???
    47. Female, 14 weeks pregnant, falls, with sweliing on ankle—crutches weight bearing support

    Fractures - diagnosis : Options
    A Bennett's fracture G Fractured Scaphoid
    B Celles'fracture H Mallet finger
    C Fractured 5* Metacarpal I Spiral fracture of the humerus
    D Fractured clavicle J Supraeondylar fracture of the humerus
    E Fractured humeral neck K Transverse fracture of the ulna
    F Fractured radial head
    Instruction
    For each patiënt described below, choose the SINGLE most likely diagnostic from the above the list above. Each option may be used once, more than once, or not at all
    66 An 18 year old man fell off a ladder. He complains of pain in his right wrist There is tenderness just distal to the radius but little swelling.
    67 A 78 year old woman tripped over an uneven paving stone and feil while carrying her shopping. She complains of pain at her right shoulder but there is no deformity and her range of movement is only slightly reduced.
    68 A six year old gjrl fell from a swing onto her outstretched hand. She is tender from her shoulder to her lower forearm and is reluctant to move er arm.
    69 A 45 year old man had fallen down the stairs the previous day whilst hè was drank. He complains of pain near his shoulder and has difficulty lifting his wrist off the table.
    70 A 25 year old man was attacked with a baseball bat. He complains of pain in his right forearm which hè had raised to protect himself

    66 G
    67 E
    68 J
    69 I
    70 K
  6. Guest

    Guest Guest

    Perilunate dislocations and perilunate fracture dislocations are the most devastating closed injuries of the wrist. They often are missed on initial evaluation, leading to devastating complications. These injuries occur as the final stage of a spectrum of injuries progressing around the wrist in a radial-to-ulnar direction.

    The perilunate dislocation and the perilunate fracture dislocation are injuries that involve traumatic rupture of the radioscaphocapitate (RSC) ligament, the scapholunate interosseous ligament, and the lunotriquetral interosseous ligament. Fractures of the radial styloid, the scaphoid, the trapezium, the capitate, and the triquetrum also may be associated with the dorsal or the volar perilunate dislocation. The result of perilunate dislocation and of perilunate fracture dislocation is an extremely unstable wrist, potentially producing devastating complications.

    The carpus is composed of 2 rows of bones: the proximal carpal row (scaphoid, lunate, and triquetrum) and the distal carpal row (trapezium, trapezoid, capitate, and hamate).14 The wrist joint is composed of 2 types of ligaments, intrinsic and extrinsic. The intrinsic ligaments are short, stout ligaments that stabilize adjacent carpal bones, while the extrinsic ligaments span the proximal carpal row and the distal carpal row.
  7. Guest

    Guest Guest

    One hundred fractures of the distal radius with dorsal displacement were treated by closed reduction and a plaster cast. The mean age of the patients was 55 years. Radiographs were taken after 1,2 and 5 weeks to evaluate the frequency of early and late displacement. Dorsal angulation occurred in 71 patients, shortening of the radius in 47 and flattening of the radial angle in 32. Late displacement was more frequent than early. Statistical analysis showed a greater incidence of secondary shortening in Older's types III and IV fractures. The severity of the initial radial shortening was the most reliable indication of instability.
  8. Guest

    Guest Guest

    “More fracture parts correlated with a higher percentage of displaced fractures at presentation,” If initially displaced, operative fixation yields the highest radiographic success rate. After closed reduction treatment, the rate of secondary displacement correlates with an increasing number of fracture parts. Lastly, operative fixation was effective regardless of the number of parts at presentation.”Fifty-three percent of two-part, 72% of three-part and 96% of more-than three-part fractures at presentation, were radiographically displaced. Eighty-one percent of closed reductions secondarily displaced after initial treatment, as compared to only 18% of operative fixations. Fractures with an intra-articular component displayed an even greater difference, with 83% displaced after closed reduction, compared to 8% after operative treatment.
  9. Guest

    Guest Guest

    It has been assumed that patellofemoral pain syndrome results from patellar malalignment. The precise role the vastus medialis obliquus plays in mediating the underlying pathologic abnormality is unclearThe patella, or kneecap, is one of three bones that come together at the knee joint. All of these bones have a layer of cartilage at points where their surfaces come into contact. The patella is also enveloped by a tendon. This tendon connects the quadriceps muscle of the thigh to the shin bone (tibia) below the knee.
  10. Guest

    Guest Guest

    What causes patellar subluxation?
    There are dozens of factors implicated in the cause of patellar subluxation. The bottom line is that it is probably the contribution of several factors that lead to instablitiy of the kneecap. Possible factors include:

    o A wider pelvis
    o A shallow groove for the kneecap
    o Abnormalaties in gait


    What else may be causing kneecap pain?
    The most common cause of kneecap pain is chondromalacia, or an irritation of the cartilage on the undersurface of the kneecap. Patellar subluxation and chondromalacia can go hand in hand, but they should be considered separate entities. That said, if chondromalacia is being caused by subluxation, then the instability of the kneecap must be addressed for treatment to be successful. Other causes of kneecap pain include osteoarthritis, patellar tendonitis (Jumper's knee), and plica syndrome.
  11. Guest

    Guest Guest

    Bennett's fracture is a fracture of the base of the first metacarpal bone which extends into the carpometacarpal (CMC) joint. This intra-articular fracture is the most common type of fracture of the thumb, and is nearly always accompanied by some degree of subluxation or frank dislocation of the carpometacarpal joint.

    In the case of the Bennett's fracture, the proximal metacarpal fragment remains attached to the anterior oblique ligament, which in turn is attached to the tubercle of the trapezium bone of the CMC joint. This ligamentous attachment ensures that the proximal fragment remains in its correct anatomical position.

    The distal fragment of the first metacarpal bone possesses the majority of the articular surface of the first CMC joint. Unlike the proximal fracture fragment, strong ligaments and muscle tendons of the hand tend to pull this fragment out of its correct anatomical position.

    Fractured humeral neck
    Fractures with more than two fragments displaced more than 1 cm or associated with shoulder dislocation would most likely require an operation to assess the damage further. A fracture which is only displaced a little may be treated conservatively, i.e. without surgery. Impacted fractures heal quickly and are supported in a broad arm sling. Displaced fractures are best treated with a collar can cuff which will allow gravity to correct and misalignment / angulation.

    For the first two weeks the arm should be kept in a sling underneath clothes for additional protection. After two week penular exercises of the shoulder joint can begin. From four weeks a collar and cuff can be worn outside clothes and then gradually removed in stages over the next two weeks as the arm progresses.

    Greater tuberosity fractures

    Displacement of greater tuberosity fractures usually is posterior and superior. Attempts at closed reduction typically are unsuccessful, except in cases with an associated anterior dislocation, in which closed reduction of the fragment may be adequate. However, close scrutiny of the lateral y-view and the axillary view are needed to avoid persistent posterior displacement that can heal in a malunited position and lead to a mechanical block of motion. Up to 8% of greater tuberosity fractures are associated with an anterior dislocation; these fractures have the highest incidence of axillary nerve injury.

    To optimize shoulder function, open treatment is recommended for greater tuberosity fractures displaced 5 mm or more. The type of greater tuberosity fracture influences surgical approach and fixation. Fragment sizes may vary from small to large. A small fragment that is displaced primarily superiorly is a result of an avulsion of the supraspinatus muscle. This fracture is approached anterosuperiorly, much like a rotator cuff repair, complete with an acromioplasty.

    The surgical treatment of humeral shaft fractures should be considered for multiple reasons. One indication for surgery is an inability to maintain the fracture in adequate alignment using closed methods. Factors that can account for this inability include the following:

    * Fracture pattern - Displaced, comminuted, or segmental (segmental fractures are at risk of nonunion at 1 fracture site or at both of them)9
    * Prolonged recumbency or an inability to maintain a semisitting or reclined position, as in a patient with multiple traumatic injuries
    * Noncompliance

    Colles's Fracture
    The lower fragment is displaced upward and backward on the shaft of the radius. This causes it to be tilted backward so that the articular surface is rotated on a transverse axis more in the direction of the dorsum than normal and the hand is also carried toward the radial side. The dorsal displacement is due to the direction of the violence and not to muscular action. The radial side of the fragment is displaced upward more than the ulnar because the triangular fibrocartilage retains its radio-ulnar attachments. This prevents the ulnar side from rising, while the radial side is pulled up by the radial flexor and extensor muscles. If the fracture is not extremely close to the joint the brachioradialis will pull the lower fragment toward the radial side and up toward the elbow

    Types of Fractures

    * Nightstick fracture
    o Defined as an isolated midshaft ulnar fracture
    * Monteggia fracture
    o Defined as a fracture of the ulna (usually proximal one third) with dislocation of the radial head.
    * Galeazzi fracture
    o Defined as a fracture of the distal one third of the radius with dislocation of the distal radioulnar joint (DRUJ).

    # Essex-Lopresti fracture

    * This is defined as a fracture of the radial head and dislocation of DRUJ, with partial or complete disruption of radioulnar interosseous membrane.

    * Transverse fracture
    o The fracture is at right angles to the long axis of the bone.
    * Greenstick fracture
    o Fracture on one side of the bone, causing a bend on the other side of the bone.
    * Comminuted fracture
    o A fracture that results in three or more bone fragments.

    Treatment

    * External fixation methods
    o plaster and fiberglass casts
    o cast-braces
    o splints
    * Internal fixation methods
    o metal plates
    o Pins
    o screws

    In medicine, mallet finger, also baseball finger, dropped finger and (more generally) extensor tendon injury, is an injury of the extensor digitorum tendon of the fingers at the distal interphalangeal joint (DIP). It results from hyperflexion of the extensor digitorum tendon, and usually occurs when a ball (such as a softball, basketball, or volleyball), while being caught, hits an outstretched finger and jams it (by rupturing the extensor digitorum tendon).

    Achilles Tendon Rupture Causes

    The Achilles tendon can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Certain illnesses (such as arthritis and diabetes) and medications (such as corticosteroids and some antibiotics) can also increase the risk of rupture.

    * Rupture most commonly occurs in the middle-aged male athlete (the weekend warrior who is engaging in a pickup game of basketball, for example). Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often these are tennis, racquetball, basketball, and badminton.
  12. Guest

    Guest Guest

    Exams and Tests
    Achiiles tendon rupture

    * A physician usually can make this diagnosis with a good physical examination and history. X-rays usually are not taken.

    * A simple test of squeezing the calf muscles while lying on your stomach should indicate if the tendon is still connected (the foot should point). This test isolates the connection between the calf muscle and tendon and eliminates other tendons that may still allow weak movement.

    Inadequate reduction of a fracture, regardless of its cause, may be a prime reason for delayed union or nonunion. It usually
    leads to instability or poor immobilization. In addition, inadequate reduction may be caused by superimposition of soft
    tissues through the fracture area, which may delay healing. Soft tissue disruption usually leads to loss of vascular supply at
    the fracture site. In well-muscled areas, this vascular supply may return quickly. In other areas, such as the distal third of the
    radius and ulna in the dog, in which little muscle is present, this vascular supply may not return.
    NONUNION
    As stated above, the differentiation between delayed union and nonunion is sometimes difficult. Nonunion is defined as the
    cessation of all reparative processes of healing without bony union. Since all of the factors discussed under delayed union
    usually occur to a more severe degree in nonunion, the differentiation between delayed and nonunion is often based on radiographic criteria and time. In humans, failure to show any progressive change in the radiographic appearance for at least3 months after the period of time during which normal fracture union would be thought to have occurred, is evidence of
    nonunion.
  13. Guest

    Guest Guest

    1. Regarding desmoplastic fibroma (Choose a single answer):
    a) Desmoplastic fibroma is a malignant neoplasm.
    b) The most common site of occurence is the ilium.
    c) Curretage is the treatment of choice.
    d) "Pseudo-trabeculae" are a classic feature of desmoplastic fibroma
    1. d

    2. Regarding Ewings sarcoma (Choose a single answer):

    a) Ewings sarcoma is typically a tumor of middle-age and beyond.
    b) Tubular bones are most commonly affected in Ewings sarcoma in patients under 20 years old, with flat bones most commonly affected in those older than 20.
    c) In Ewings sarcoma, bone metastases are uncommon and unlike the primary tumor, are usually blastic when they do occur.
    d) The vast majority of occurrences of Ewings sarcoma in the long bones are of the central diaphyseal type.
    2. b

    3. Regarding osteochondroma

    a) An osteochondroma is a bony projection with a cartilaginous cap arising from a bone preformed in cartilage
    b) Malignant degeneration of osteochondroma to chondrosarcoma occurs in up to 20% of patients with hereditary multiple exostoses.
    c) The cortex and medullary cavity of the host bone are not continuous with the osteochondroma.
    d) The most common sites for osteochondroma are the hands and feet.
    e) Almost all pseudoanerysms complicating osteochondromas arise from the popliteal artery
    f) Benign osteochondromas generally do not demonstrate continued growth after skeletal maturity
    3. a, b, e, f are correct
  14. Guest

    Guest Guest

    Pemphigus vulgaris

    Definition

    Pemphigus vulgaris is an autoimmune disorder that involves blistering of the skin and mucous membrane.
    Causes

    Pemphigus is an autoimmune disorder. The immune system produces antibodies against specific proteins in the skin and mucous membrane. These antibodies create a reaction that cause skin cells to separate. The exact cause is unknown.

    Sometimes pemphigus is caused by certain medications, although this is rare. Medications that may cause this condition
  15. Guest

    Guest Guest

    Most people with rosacea have only mild redness and are never formally diagnosed or treated. There is no single, specific test for rosacea.

    In many cases, simple visual inspection by a trained person is sufficient for diagnosis. In other cases, particularly when pimples or redness on less-common parts of the face are present, a trial of common treatments is useful for confirming a suspected diagnosis.

    The disorder can be confused with, and co-exist with acne vulgaris and/or seborrhoeic dermatitis. The presence of rash on the scalp or ears suggests a different or co-existing diagnosis as rosacea is primarily a facial diagnosis, although it may occasionally appear in these other areas.
  16. Guest

    Guest Guest

    Systemic metronidazole is indicated for the treatment of: * Bacterial vaginosis, commonly associated with overgrowth of Gardnerella species and coinfective anaerobes (Mobiluncus, Bacteroides), in symptomatic patients
    * Pelvic inflammatory disease in conjunction with other antibiotics such as ofloxacin, levofloxacin, or ceftriaxone
    * Anaerobic bacterial infections such as Bacteroides fragilis, spp, Fusobacterium spp, Clostridium spp, Peptococcus spp, Peptostreptococcus spp, Prevotella spp, or any other anaerobes in intra-abdominal abscess, peritonitis, empyema, pneumonia, aspiration pneumonia, lung abscess, diabetic foot ulcer, meningitis and brain abscess, bone and joint infections, septicemia, endometritis, tubo-ovarian abscess, or endocarditis
    * Pseudomembranous colitis due to Clostridium difficile
    * Helicobacter pylori eradication therapy, as part of a multi-drug regimen in peptic ulcer disease
  17. Guest

    Guest Guest

    metronidazole
    Amoebiasis: Infections caused by Entamoeba Histolytica.

    Giardiasis: infection of the small intestine caused by the ingestion of infective cysts of a single-celled organism called Giardia lamblia. Giardiasis occurs worldwide with a prevalence of 20–30% in developing countries. The Centers for Disease Control and Prevention reports that in the US Giardia infects over 2.5 million people annually.
  18. Guest

    Guest Guest

    Haemophilus species are small oxidase-positive pleomorphic gram-negative aerobic or facultative anaerobic coccobacilli. They can be divided into 2 strains, encapsulated and unencapsulated. Encapsulated strains (also known as typeable) are surrounded by a polysaccharide capsule that plays an important role in the determination of virulence of the organism. The outer membrane lipo-oligosaccharides (LPS) also contribute to the degree of virulence. The capsular antigens are employed to subdivide encapsulated strains into 6 serotypes designated A through F. Unencapsulated strains lack the polysaccharide capsule and are designated untypeable strains.
  19. Guest

    Guest Guest

    Bronchiectasis is a disease state defined by localized, irreversible dilation of part of the bronchial tree. It is classified as an obstructive lung disease, along with emphysema, bronchitis and cystic fibrosis. Involved bronchi are dilated, inflamed, and easily collapsible, resulting in airflow obstruction and impaired clearance of secretions. Bronchiectasis is associated with a wide range of disorders, but it usually results from necrotizing bacterial infections, such as infections caused by the Staphylococcus or Klebsiella species or Bordetella pertussis. The diagnosis of bronchiectasis is based on the review of clinical history and characteristic patterns in high-resolution CT scan findings
  20. Guest

    Guest Guest

    Questions on
    A. Perinatal Mortality
    B. Late Neonatal death
    C. Perinatal Mortality rate
    D. Stillbirth rate
    E. Perinatal death rate
    F. Stillbirth
    G. Early Neonatal death
    H. Trauma
    I. Infant death
    J. Post neonatal death


    Theme Causes of Pneumonia.
    A. Bacteroides fragilis
    B. Coxiella burneti
    C. Mycoplasma pneumoniae
    D. Haemophilus influenzae
    E. Mycobacterium avium
    F. Mycobacterium tuberculosis
    G Staphylococcus aureus
    H. Pneumocystis carinii
    I. Legionella pneumophila
    J. Mixed growth of organisms
    K. Streptococcus pneumoniae
    L. Escherichia coli


    A 31-year-old man, with no previous history of ill health, reported a dry persistent cough and joint pains. He’d been abroad two weeks before seeking medical advice. On his x-ray a bilateral patchy consolidation was seen and his blood analysis showed an increased antibody titre.

    Mycoplasma pneumoniae.

    Theme Managing Thromboembolic conditions
    A. Streptokinase
    B. Aspirin and Heperin
    C. Glyceryl trinitrate
    D. Abciximab
    E. Chest x-ray
    F. Low dose subcutaneous Heparin
    G. Acetylsalicylic acid
    H. Warfarin
    I. Cefotaxime (IV)
    J. TED (thrombo-emblic deterrent)Stockings
    K. Subcutaneous dose up to 150000U/12 hourly (Low Molecular weight Heparin)
    L. Spiral Computed tomography
    M. Loading dose of 5000U (Unfranchised Heparin)
    N. Fresh frozen plasma
  21. Guest

    Guest Guest

    Symptoms of a peptic ulcer can be

    * abdominal pain, classically epigastric with severity relating to mealtimes, after around 3 hours of taking a meal (duodenal ulcers are classically relieved by food, while gastric ulcers are exacerbated by it);
    * bloating and abdominal fullness;
    * waterbrash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus);
    * nausea, and copious vomiting;
    * loss of appetite and weight loss;
    * hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer, or from damage to the esophagus from severe/continuing vomiting.
    * melena (tarry, foul-smelling feces due to oxidized iron from hemoglobin);
    * rarely, an ulcer can lead to a gastric or duodenal perforation. This is extremely painful and requires immediate surgery.
  22. Guest

    Guest Guest

    Movement of chest wall: Reduced on affected side Mediastinal displacement: Towards opposite side of the lesion Percussion note: Hyper-resonant Breath sounds: Absent Vocal resonance: Absent Added sounds: None A likely aetiology is
    a) Pneumothorax
    b) Interstitial lung disease
    c) Tietze's syndrome
    d) Bronchial asthma
    e) Myasthenia gravis
    f) pulmonary cavitation
    g) Voluntary overbreathing
    h) Lobar pneumonia
    i) Central sleep apnoea
    j) Pleural effusion
    The answer is A

    A patient is severely bradycardic and critically unstable, transcutaneous pacing is not available and the bradycardia doesn't respond to atropine
    a) Atropine
    b) bretylium
    c) Calcium gluconate
    d) Dopamine infusion
    e) Epinephrine IV infusion
    f) transcutaneous cardiac pacing
    g) norepinephrine
    h) amiodarone intravenously
    i) Lidocaine IV infusion
    j) Sodium bicarbonate
    The answer is D

    A 34 year old woman is suspected of having infective endocarditis. Inspection of her nails is likely to reveal
    a) Beau's lines
    b) clubbing
    c) pitting of the nails
    d) longitudinal ridging
    e) splinter hemorrhages
    f) white nails
    g) blue nails
    h) yellow nails
    i) onychogyrphosis
    j) kolonychia
    The answer is E

    INR: Normal APTT: Elevated Thrombin time: Elevated Platelet count: Normal Bleeding time: Normal A likely aetiology is
    a) Waldenström's macroglobulinaemia
    b) Heparin
    c) Sézary cell leukaemia
    d) Pelger-Hüet anomaly
    e) von Willebrand's disease
    f) Haemophilia
    g) HIV infection
    h) Disseminated intravascular coagulation
    i) Acanthocytosis
    j) Vitamin K deficiency
    The answer is B

    12 year old boy ran into a glass door receiving a puncture wound .A very sharp piece of glass had lodged into the side of his face. He did not require sutures and the wound healed well. However, 6 months later, his mother noted that he would sweat profusely on the skin of his face at the site of the old injury. He was diagnosed to be suffering from Frey's syndrome. It was decided that the best treatment would be to avulse the nerve carrying the parasympathetic nerve fibres to the region. Which nerve was to be avulsed?
    a) Accessory nerve
    b) Trochlear nerve
    c) Vagus nerve
    d) Oculomotor nerve
    e) Trigeminal nerve
    f) Great auricular nerve
    g) Auriculotemporal nerve
    h) Olfactory nerve
    i) Abducent nerve
    j) Facial nerve
    The answer is G

    A worker in a paint production plant is splashed with a strong alkali. The factory doctor rushes to the scene. What is the treatment of choice?
    a) 10% calcium gluconate administered IV
    b) sodium bicarbonate 1 mEq/kg IV
    c) oral sodium bicarbonate
    d) hypertonic intravenous crystalloid fluid
    e) hypotonic intravenous crystalloid fluid
    f) hydrotherapy
    g) humidified oxygen
    h) non-humidified oxygen
    i) IV methylene blue
    j) oral charcoal
    The answer is F

    A patient with intermittent claudication is found on angiography to have a localised stenosis of his superficial femoral artery with three calf runoff vessels and good vascular supply to the calf and foot. The treatment of choice is
    a) reassurance
    b) warfarin
    c) balloon angioplasty
    d) laparoscopy
    e) bypass grafts
    f) endarterectomy
    g) embolectomy
    h) Blalock-Taussig shunt
    i) venous thrombectomy
    j) intravenous heparin
    The answer is C

    Prostatic carcinoma is most likely to be associated with a raised
    a) antigen CA-125
    b) antigen CA15-3
    c) prostatic specific antigen
    d) serum HCG
    e) serum AFP level
    f) alkaline phosphatase
    g) prostatic endothelin antagonists
    h) hepatocyte growth factor
    i) carcino-embryonic antigen (CEA)
    j) interleukin-6
    The answer is C

    A four year old boy with generalised weakness is suspected of having Duchenne's muscular dystrophy. The most specific diagnostic test to confirm the diagnosis is
    a) muscle biopsy
    b) thyroid microsomal antibody titer
    c) serum complement levels
    d) radiograph of the wrist
    e) erythrocyte sedimentation test
    f) lumbar puncture
    g) Cardiolipin antibody titer
    h) Antinuclear antibody titer
    i) electromyography
    j) Congo red staining of carpal tissue biopsy
    The answer is A

    The differential diagnosis of a confused patient is wide. An understanding of the pathogenesis of confusion helps in eliciting the most likely cause and directing further investigation. For each of the following mechanisms choose the Pathology that is most likely plaques containing abundant lipid-rich, PAS-positive macrophages
    a) Uremia
    b) Hypercalcemia
    c) Septicemia
    d) Bovine Spongiform Encephalopathy
    e) Multiple sclerosis
    f) Lithium toxicity
    g) Hypoglycemia
    h) Hepatic encephalopathy
    i) Alcohol withdrawal
    j) Barbiturate withdrawal
    The answer is E

    41 year old insulin-dependent diabetic man complained of swelling and redness of the left eyelid for several days. Examination of vision, pupils and motility were normal and there was no pain or diplopia on eye movement. The left cheek was tender to palpation. A CT scan was requested by the ENT physician. This showed opacified ethmoid and maxillary sinuses. An endoscopic ethmoidectomy was performed. Light microscopy of ethmoidectomy specimen was stained with H&E. This revealed fungal hyphae invading an arteriole. A likely diagnosis is
    a) Pseudotumor
    b) orbital teratoma
    c) Optic neuritis
    d) sarcoidosis
    e) Optic gliomas
    f) Lymphangiomas
    g) Rhabdomyosarcoma
    h) retinal vascular shunts
    i) Retinoblastoma
    j) Mucormycosis
    The answer is J

    A 6 year old boy complains of painful right testicle and a burning sensation on passing urine. On examination he is noted to have enlargement and edema of the testicle; the edema is involving the entire scrotum. He has a skin rash on his face. He has a low grade fever.The involved testicle is painful to palpation and noted to be elevated in position when compared to the other side. There is an ipsilateral loss of the cremasteric reflex on this left side.
    a) Epididymitis
    b) Orchitis
    c) Acute appendicitis
    d) varicocoele
    e) Torsion of testicular appendix
    f) acute appendicitis
    g) Henoch-Schönlein Purpura
    h) Scrotal hernia
    i) Torsion of the testicle
    j) infected hydrocele
    The answer is I

    A woman in the 34th week of her second pregnancy, develops hypertension with proteinuria, hypertension and acute renal impairment. The hypertension is managed in hospital and the renal impairment resolves. What is the next step?
    a) immediate delivery
    b) intravenous Hydralazine
    c) alpha-blocker
    d) Labetolol
    e) change current treatment immediately
    f) diuretic
    g) Methyldopa
    h) calcium antagonist
    i) angiotensin-converting enzyme inhibitors
    j) angiotensin II receptor antagonist
    The answer is A

    Aniridia is associated with
    a) sickle cell anemia
    b) Alport's syndrome
    c) ureteric lithiasis
    d) Goodpasture's syndrome
    e) Systemic lupus erythematosus
    f) Henoch-Schonlein purpura
    g) Postinfectious glomerulonephritis
    h) hemolytic-uremic syndrome
    i) Wilm's tumour
    j) IgA nephropathy
    The answer is I

    Dipalmitoyl-phosphatidylcholine (lecithin) is a component of a certain secretion, produced by cells containing lamellar bodies. These cells are predominantly found in the
    a) choroid plexus
    b) pituitary gland
    c) pancreas
    d) adrenal gland
    e) liver
    f) esophagus
    g) lung
    h) rectum
    i) bladder
    j) ventricles
    The answer is G

    An elderly lady on long term antibiotics for a cellulitis problem in her right foot develops severe diarrhea. No organism could be identified or cultured in her stools. The most likely causative agent is
    a) Cryptosporidium
    b) Rotavirus group A
    c) Rotavirus group B
    d) Human Immunodeficiency Virus
    e) Clostridium difficile
    f) Shigella
    g) Campylobacter
    h) Giardia
    i) Salmonella
    j) Campylobacter
    The answer is E

    A 55 year old man with diet controlled diabetes is being seen regularly at the cardiac uunit because of several episodes of angina. He has a history of a refractory ventricular arrhythmia that is being treated with amiodarone. Which complication of amiodarone would you most particularly be looking for in this patient?
    a) pulmonary hemorrhage
    b) avascular necrosis of the femoral head
    c) interstitial infiltrates and peripheral consolidation
    d) large pleural effusions
    e) pulmonary edema
    f) massive hilar adenopathy
    g) marked decrease in the glomerular filtration rate
    h) hydronephrosis
    i) pericarditis
    j) pneumothorax
    The answer is C

    An alcoholic is being treated for a generalized tonic-clonic seizure while seeing a Pokemon movie with his grandson. He has no history of a similar episode. The most appropriate management would be
    a) pleurodesis
    b) thoracotomy
    c) prednisone
    d) epinephrine
    e) surgical polypectomy
    f) pleurectomy
    g) pleuroperitoneal shunt
    h) prostacyclin
    i) lorazepam
    j) embolisation
    The answer is I

    A 40 year old previously healthy man presents with with acute shortness of breath. Which of the following would most useful in excluding pulmonary embolism ?
    a) D-dimer test
    b) Mantoux test
    c) Prophylactic antibiotic treatment during flu season
    d) dilated ophthalmoscopy
    e) BCG immunization
    f) chest x-ray
    g) Mammogram
    h) HIV test
    i) Mantoux test
    j) Influenza immunization
    The answer is A

    A 2 year old has a chronic cough. A frontal radiograph reveals hyperinflation of the left hemithorax. Bilateral decubitus views were obtained. They showed that the right lung becomes appropriately atelectatic with decubitus positioning. However, the left side shows no change in appearance with decubitus positioning. The likely diagnosis is
    a) Choanal Atresia
    b) Laryngomalacia
    c) Tracheoesophageal Fistula
    d) Double aortic arch
    e) Foreign body aspiration
    f) Esophageal duplication
    g) Acute Pharyngitis
    h) Lymphangioma
    i) dermoid cyst
    j) cleft lip
    The answer is E
  23. Guest

    Guest Guest

    D-dimer tests are ordered, along with other laboratory tests and imaging scans, to help rule out, diagnose, and monitor diseases and conditions that cause hypercoagulability, a tendency to clot inappropriately. One of the most common of these conditions is DVT (Deep Vein Thrombosis), which involves clot formation in the deep veins of the body, most frequently in the legs. These clots may grow very large and block blood flow in the legs, causing swelling, pain, and tissue damage. It is possible for a piece of the clot to break off (this broken piece is called an embolus) and travel to other parts of the body, where the clot can cause a PE (Pulmonary embolus or embolism - blood clot in the lungs).
  24. Guest

    Guest Guest

    The person with MS can suffer almost any neurological symptom or sign, including changes in sensation (hypoesthesia and paraesthesia), muscle weakness, muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems in speech (dysarthria) or swallowing (dysphagia), visual problems (nystagmus, optic neuritis, or diplopia), fatigue, acute or chronic pain, and bladder and bowel difficulties. Cognitive impairment of varying degrees and emotional symptoms of depression or unstable mood are also common. Uhthoff's phenomenon, an exacerbation of extant symptoms due to an exposure to higher than usual ambient temperatures, and Lhermitte's sign, an electrical sensation that runs down the back when bending the neck, are particularly characteristic of MS although not specific.
  25. Guest

    Guest Guest

    Nocardiosis
    Clinical Features
    Rare lung infection caused by the gram-positive bacilli Nocardia species (Nocardia asteroides accounts for more than 80% of cases), with an incidence of 500 to 1000 cases per year in the United States
    Inhalation of the saprophytic organisms in decaying organic matter and soil is the main route of infection
    Chronic immunosuppression is secondary to AIDS, Cushing disease, corticosteroid therapy, lymphoma, and chronic granulomatous disease
    At the time of diagnosis, 50% of cases of pulmonary nocardiosis have disseminated to other organs (e.g., skin, bone, kidney, and brain)
  26. Guest

    Guest Guest

    Hodgkin Lymphoma
    Clinical Features
    Most common malignant tumor of the mediastinum
    Occurs predominantly in the anterior compartment
    Lymph nodes and thymus may be involved
    Young women in their 20s and 30s are most commonly affected
    Often presents with B symptoms, including fever, night sweats, weight loss, and fatigue
  27. Guest

    Guest Guest

    Castleman Disease
    Clinical Features
    Reactive condition; also known as angiofollicular lymph node hyperplasia
    Found predominantly involving lymph nodes; occasionally may involve the thymus
    Both sexes may be affected
    Wide age range
    Three types: hyaline vascular, plasma cell, and mixed
    — Hyaline vascular type (about 80% of cases)
    Usually asymptomatic except for effects of compression by mass
    — Plasma cell type
    Patients may have anemia, hypergammaglobulinemia, and fever
    Typically solitary, but multicentric variant does exist
    Figure
  28. Guest

    Guest Guest

    Acanthosis nigricans
    Velvet-like thickening and hyperpigmentation of axillary and other flexural skin.
    Can be hereditary or associated with insulin-resistant states.
    Can occasionally, but rarely, be associated with adenocarcinoma (often gastric).
    Mycosis fungoides
    The most common example of a cutaneous T-cell lymphoma.
    Sézary syndrome variant: generalized erythroderma and greater than 1000/mm3 atypical T lymphocytes with cerebriform nuclei on peripheral blood.
    Lesions vary from flat, scaly patches to “smudgy” plaques, to tumors. Often very pruritic.
  29. Guest

    Guest Guest

    Ventricular tachycardia
    Ventricular tachycardia is a difficult clinical problem for the physician. Its evaluation and treatment are complicated because it often occurs in life-threatening situations that dictate rapid diagnosis and treatment. Patients who have ventricular tachycardia in the absence of coronary artery disease have other cardiac abnormalities, including cardiomyopathy, mitral valve prolapse, valvular heart disease, QT interval prolongation and, in an otherwise normal heart, an abnormality described as primary electrical instability. Other causes of ventricular tachycardia include sarcoidosis, beginning treatment in patients with myxedema and drugs such as digitalis, sympathomimetic amines and antiarrhythmia agents. Occasional runs of tachycardia are initiated by a change in posture, exercise, emotional excitement or vagal stimulation.

    Treatment
    Ventricular tachycardia when sustained but hemodynamically stable is initially treated with lidocaine, procainamide or bretylium. Ventricular tachycardia that is hemodynamically unstable should be treated the same as VF.
  30. Guest

    Guest Guest

    Needle Biopsy of the Pleura or Lung

    If thoracentesis does not uncover the cause of a pleural effusion (a fluid buildup in the space between the two layers of the pleura), a doctor may do a pleural biopsy. First, the skin is cleaned and anesthetized as for thoracentesis. Then using a larger cutting needle, a doctor takes a small sample of tissue from the pleura and sends it to a laboratory to be examined for signs of disorders, such as cancer or tuberculosis. About 80 to 90% of the time, a pleural biopsy is accurate in diagnosing tuberculosis, but it is less accurate for diagnosing cancer and other disorders.
  31. Guest

    Guest Guest

    A bronchoscope can be used to investigate the source of bleeding in the lungs. If a doctor suspects lung cancer, the airways can be examined and specimens can be taken from any areas that look cancerous. Bronchoscopy can be used for collecting the organisms causing pneumonia that are difficult to collect and identify in other ways. Bronchoscopy is especially helpful for obtaining specimens from the lungs in people who have AIDS and other immune deficiencies. When people have been burned or have inhaled smoke, bronchoscopy helps doctors assess for burns and smoke injury of the larynx and airways. Bronchoscopy can help a doctor treat certain conditions.
  32. Guest

    Guest Guest

    Carcinoma of the Endometrium

    Essentials of Diagnosis

    Abnormal bleeding is the presenting sign in 80% of cases.
    Pap smear frequently negative.
    After a negative pregnancy test, endometrial tissue is required to confirm the diagnosis.
    General Considerations

    Adenocarcinoma of the endometrium is the second most common cancer of the female genital tract. It occurs most often in women 50–70 years of age. Some patients will have taken unopposed estrogen in the past; their increased risk appears to persist for 10 or more years after stopping the drug. Obesity, nulliparity, diabetes, and polycystic ovaries with prolonged anovulation and the extended use of tamoxifen for the treatment of breast cancer are also risk factors. Women with a family history of colon cancer (hereditary nonpolyposis colorectal cancer, Lynch syndrome) are at significantly increased risk, with a lifetime incidence as high as 30%.
  33. Guest

    Guest Guest

    Quick demato

    C. Stevens-Johnson syndrome
    Severe form of erythema multiforme involving mucous membranes, and severe plaque formation
    Skin sloughing may be evident; high risk of dehydration
    H/P = similar skin appearance to erythema multiforme, but more severe; more likely to have myalgias, fever, nausea, vomiting, oral pain, and eye pain
    Treatment = stop offending agent; corticosteroids, analgesics, IV fluids; frequently treated in burn unit
    D. Toxic epidermal necrosis (TEN)
    Most severe form of hypersensitivity reaction with significant skin sloughing and full-thickness epidermal necrosis (see Color Figure 10-7)
    Labs = decreased WBC, decreased hemoglobin, decreased hematocrit, increased alanine aminotransferase (ALT), increased aspartate aminotransferase (AST)
    Treatment =
    Stop offending agent
    Treat patient in burn center, IV hydration, corticosteroids, intravenous immune globulin
    Acyclovir may be useful in cases caused by HSV
    E. Seborrheic dermatitis
    Chronic hyperproliferation of epidermis most commonly on scalp or face
    Most common in adolescents and infants
    H/P = pruritus; erythematous plaques with yellow, greasy scales
    Treatment = shampoo containing selenium, tar, or ketoconazole when scalp involved; topical corticosteroids and antifungals used for other regions
    Complications = frequent recurrence
    “Cradle cap” is seborrheic dermatitis of the scalp in infants.
  34. Guest

    Guest Guest

    More q from orthopaedics

    Fractures in children : Options
    A Fracture of davicle F Non accidental injury
    B Fracture of mid radius and ulna G Scaphoid fracture
    C Fracture of neck of humerus H Subluxation of radial head (palled elbow)
    D Fracture of shaft of humerus I Supracondylar fracture of humerus
    E Greens stick fracture of distal radius
    Instruction
    For each patiënt described below, choose the SINGLE mostlikely diagnosis from ( Üie above list of options. Each option may be used onee, more than once, or not at all
    170 A seven day old baby, born after a difficult home delivery, is not moving hi left arm. He cries each time hè is picked up.
    171 A three year old girl tripped while holding her mother's hand she has not used her right arm since.
    172 An eight year old boy fell from a tree. He is in severe pain. The radial pulse is not palpable on the injured arm.
    173 A 16 year old boy feil on his outstretched hand. His forearm was put in a plaster a week ago at another hospital and hè has got it wet He has come to the accident and emergency department to have it repaired. Eh says his initial x- rays were normal. On repeat x - ray, an abnormality is found.
    174 A four year old boy feil in the playground. He has been using his forearm normally but complains of pain. There is no deformity or selling and there is rninimal tenderness on examination.
    175 A three month old baby, whose mother says hè has been crying since hè rolled off the bed two days ago, is found to have bruises on his legs.
    170.A
    171.H
    172.I
    173.G
    174.E
    175.F
  35. Guest

    Guest Guest

    Fracture of davicle
    Treatment usually involves resting the affected extremity and supporting the arm with the use of a sling. In older practice, a figure-8 brace was used, designed to immobilize and retract the shoulder, maintaining symmetric positioning to facilitate healing. More recent clinical studies have shown that the outcomes of this method were not measurably different from simple sling support[citation needed], and due to the movement difficulties caused to the patient, this method has mostly lapsed
  36. Guest

    Guest Guest

    Fracture of davicle
    Clavicles are the most common broken bone in the human body. It is most often fractured in the middle third of its length which is its weakest point. The lateral fragment is depressed by the weight of the arm and is pulled medially and forward by the strong adductor muscles of the shoulder joint, especially the pectoralis major. The part of the clavicle near the center of the body is tilted upwards by the sternocleidomastoid muscle. Children and infants are particularly prone to it. Newborns often present clavicle fractures following a difficult delivery.
  37. Guest

    Guest Guest

    Crohn disease
    Involves any level of gastrointestinal tract from mouth to anus; classically affects the small bowel
    Mesenteric fat of the involved segment wraps around the bowel surface (“creeping fat” or “fat wrapping”)
    Thickened, stiff intestinal wall (stovepipe) with normal-appearing intervening segments (skip lesions)
    Early disease is characterized by aphthous ulcers that progress to discrete ulceration, serpiginous ulcers, linear ulcers, or cobblestoning
    Cobblestoning results from two different ulceration patterns: linear ulcers and small horizontal crevices.
    The sharp demarcation between edematous but otherwise normal mucosa and surrounding ulcers gives the mucosa a cobblestone appearance
  38. Guest

    Guest Guest

    Melanosis Coli
    Clinical Features
    -Associated with chronic laxative ingestion
    (anthraquinones, cascara, sagrada, aloes, senna,
    frangula, rhubarb) that induces apoptosis
    -Patients generally have a history of constipation
  39. Guest

    Guest Guest

    Wernicke encephalopathy
    Wernicke's encephalopathy begins abruptly, usually with eye movement disorders (nystagmus, gaze palsies, and ophthalmoplegia, especially of the lateral rectus muscles), gait ataxia, confusion, confabulation, and short-term memory loss.

    The classic triad of the syndrome is encephalopathy (brain damage), ophthalmoplegia (eye paralysis), and ataxia (loss of coordination). Untreated, it may progress to Korsakoff's psychosis, coma and death.[1][2] The pathological changes seen in Wernicke's encephalopathy are concentrated in the mammillary bodies, cranial nerve nuclei III, IV, VI and VIII, the thalamus, hypothalamus, periaqueductal grey, cerebellar vermis, and the dorsal nucleus of the vagus nerve. The ataxia and ophthalmoparesis are related to lesions in the oculomotor, trochlear, abducens, and vestibular (IIIrd, IVth, VIth, and VIIIth cranial) nerve nuclei.
  40. Guest

    Guest Guest

    Aphasia is an acquired language disorder in which there is an impairment of any language modality. This may include difficulty in producing or comprehending spoken or written languageAphasia usually results from lesions to the language-relevant areas of the frontal, temporal and parietal lobes of the brain, such as Broca's area, Wernicke's area, and the neural pathways between them. These areas are almost always located in the left hemisphere, and in most people this is where the ability to produce and comprehend language is found. However, in a very small number of people, language ability is found in the right hemisphere. In either case, damage to these language areas can be caused by a stroke, traumatic brain injury, or other brain injury.People with aphasia may experience any of the following behaviors due to an acquired brain injury, although some of these symptoms may be due to related or concomitant problems such as dysarthria or apraxia and not primarily due to aphasia.

    * inability to comprehend language
    * inability to pronounce, not due to muscle paralysis or weakness
    * inability to speak spontaneously
    * inability to form words
  41. Guest

    Guest Guest

    Occipital Lobe Damage: The occipital lobe contains the main center for processing visual information. If the occipital lobe on both sides of the brain is damaged, people cannot see, even though the eyes themselves are functioning normally. This disorder is called cortical blindness. Some people with cortical blindness are unaware that they cannot see. If the front part is damaged, people have difficulty recognizing familiar objects and faces and accurately interpreting what they see.
  42. Guest

    Guest Guest

    MCQ: Neuropsychological Tests
    Options
    A Cognitive Estimates Test
    B Digit span
    C Go – no go test
    D Mini Mental State Examination
    E National Adult Reading Test
    F Raven’s progressive matrices
    G Rivermead Behavioural Memory Test
    H Stroop Test
    I Wechsler Memory Scale
    J Wisconsin Card Sorting Test

    Lead in: A 54 year man presents with a year’s history of steadily progressive personality change. He has become increasingly apathetic and appears depressed but his main complaint is of increasing frontal headaches. On examination he has word finding difficulties. EEG shows frontal slowing, greater on the left.
    1) You are concerned that he may have an intracranial space occupying lesion. Which test would you use to obtain a quick estimate of his current performance IQ?
    2) The test indicates that his current performance IQ is in the low average range. Which test would enable you to estimate his premorbid IQ, ie. his IQ before any brain damage he may have sustained in recent months/years?
    3) The estimate of his premorbid IQ is 15 points higher than his current performance IQ. It is recommended that he has a full WAIS IQ assessment to measure both performance and verbal IQ. On the WAIS his verbal IQ is found to be impaired over and above his performance IQ
    Which test is part of the WAIS verbal subtests?
    4) An MRI scan shows a large meningioma compressing dorsolateral prefrontal cortex on the left. Which test result is most likely to be impaired?

    Answers:
    1 - F
    2 - E
    3 - B
    4 - J
  43. Guest

    Guest Guest

    A Completion illusion
    B Delusional perception
    C Dysmegalopsia
    D Extracampine hallucination
    E Functional hallucination
    F Haptic hallucination
    G Hygric hallucination
    H Pareidolic illusion
    I Reflex hallucination
    J Synaesthesia
    Lead in: Which of the above descriptive psychopathological terms refers to the following symptoms?
    1) “I hear the voice of my long dead father, as if he were talking to me know, when I hear water running from the bath tap.”
    2) “I hear the voice of my father speaking to me from the other side of the city.”
    3) A young woman describes looking up into the clouds and seeing an image of her fiancé.

    Answers:
    1 - E
    2 - D
    3 - H
  44. Guest

    Guest Guest

    Pseudo hallucinations

    located in subjective space

    - perceived with inner eye (or ear)

    - differs from imagery by being perceived as involuntary


    Functional Hallucinations

    - a normal perceptual stimulus in one modality provokes an hallucination in the same modality. (e.g.: tap and voices)


    Reflex Hallucinations

    - an hallucination in one modality is precipitated by sensory stimuli in other modalities. some authors use the term synaesthesia
  45. Guest

    Guest Guest

    Options
    A Alcohol
    B Childhood sexual abuse
    C Diabetes
    D Having given birth 6 months previously
    E Impaired hearing
    F Loss of mother before age 14
    G Peri-natal hypoxia
    H Reduced visual acuity
    I Regular use of NSAIDs
    J Smoking
    Lead in: Which of the above risk factors is most strongly associated with the following:
    1) A young man with mood-incongruent auditory hallucinations, complex delusions and social withdrawal
    2) A young woman with mood-congruetn delusions, auditory hallucinations nad depressed mood
    3) An older woman with first onset of both somatic and auditory hallucinations and delusions
    4) A cognitively intact older man with visual hallucinations

    Answers:
    1 - G
    2 - D
    3 - E
    4 - H
  46. Guest

    Guest Guest

    Peri-natal hypoxia
    Anoxia or asphyxia during birth has long been known to cause fetal brain injury, the most serious being hypoxic-ischemic encephalopathy, or HIE. [2] Up to three quarters of infants with severe HIE die of multiple organ failure or lung infections caused by dysregulated breathing. Those who survive are commonly left with gross symptoms such as mental retardation, epilepsy, and cerebral palsy. Others may exhibit learning difficulties in later life. These are the most serious effects of hypoxia – a sledge hammer to the brain. What about the more subtle effects? What does perinatal hypoxia do to our later emotional life? And what about hypoxia in the womb, caused by maternal smoking, stress, or other causes?
  47. Guest

    Guest Guest

    Prophylactic treatment of rapid-cycling mood disorder is often effective with:
    a carbamazepine alone
    b haloperidol alone
    c lithium carbonate alone
    d mood stabilising drugs and high doses of L-thyroxine
    e sodium valproate alone
    e F e F e T e F e T
  48. Guest

    Guest Guest

    What is valproate used for?
    Valproate has two main uses. Firstly as a treatment for epilepsy, to help control the fits (seizures or blackouts). Secondly, to help in mood disorders, especially if the person is suffering from mania or hypomania i.e. is ‘high’) and as a longer-term mood stabiliser (and alternative to lithium and carbamazepine). Valproate may also be useful in some other illnesses, particularly when other treatments have not been effective.
  49. Guest

    Guest Guest

    Bipolar disorder is a serious, chronic (long-term) condition where you have periods of depression ('lows') and periods of mania or hypomania ('highs'). Treatment with 'mood stabilisers' such as lithium or anticonvulsant medicines aims to keep your mood within normal limits.
    Mania causes an abnormally 'high' or 'irritable' mood which lasts at least one week - but usually lasts much longer than this. It can develop quite quickly - over a few days or so. When you are 'high' you will usually have at least 3 or 4 of the following:

    * Grand ideas about yourself and your own self-importance.
    * Increased energy. You also tend to move quickly and need less sleep than usual.
    * Be more talkative than usual. You tend to talk quickly.
    * 'Flight of ideas'. You tend to change quickly from one idea to another. You may feel as if your thoughts are racing.
  50. Guest

    Guest Guest

    Acute treatment of rapid-cycling mood disorder is often effective with:
    a lithium therapy alone
    b sodium valproate alone in the hypomanic phase
    c sodium valproate and lithium therapy
    d SSRIs in the depressed phase
    e selective serotonin reuptake inhibitors in ultra-rapid cycling
    d T d F d F d T d T

    Rapid-cycling bipolar disorder is a term which is restricted to:
    a patients who cycle between hypomania and depression each day
    b patients who cycle between hypomania and depression each week
    c patients with features of depression and hypomania at the same time
    d patients who have four or more episodes of depression or hypomania each year
    e patients with mood-incongruent psychotic features as well as hypomania or depression
    a F a F a T a F a T

    Known risk factors for developing rapid-cycling mood disorder include:
    b substance misuse T
    c biochemical evidence of low thyroxine levels T
    d a recent severe life eventT

Share This Page