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PLAB May 2003

Author: sunny, Posted on Saturday, June 28 @ 00:27:33 IST by RxPG  

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PLAB Part 1

Theme:Post operative Complications
1.Second post operative day,blood test shows a mcv of 110.
What is it due to?

Theme:Trauma
1.Pt presents to you in A and E with history of trauma .GCS of 10.No focal neurological signs.What is the next step you do?

Theme:ENT
1.A boy with blow to the ear comes with bleeding per ear.I am not sure if they had given perforated ear drum in this same patient.What is the next immediate step you would do?


Theme:Non accidental injuries
1.A baby brought to you whose fundus examination shows retinal haemorrhages.What investigation do you do?
2.Child with blood from mouth brought to you.On exam,you find frenulum tear.Again investigation?
3.A child with recurrent multiple fractures-Looked like osteogenesis imperfecta.What investigation?

Theme:Ectopic
1.IVF patient with 2 embryos implanted 8 weeks ago presents to you with brown vaginal discharge.HCG is positive.What investigation do you do?Investigations were:Colposcopy,USG,etc,etc.

Theme:Pre operative assessment:
1.A patient with long history of asthma waiting for cholecystectomy.Investigation you would do.

Theme:Poisoning
1.A patient with respiratory depression,pin point pupil,etc.
2.Pt presenting with hypotension alone.
3.Pt poisoned with some drug who developed acute liver failure after 4 hours of consumption.
4.Pt with anti cholinergic side effects and arythmias.
5.Arythmia ,change in vision and so on.-Digoxin.

Theme:Side effects of drugs
1.Pt with sudden opisthotonus,akathesia,etc.-Metoclopramide.
2.Side effects of Lithium-tremors,etc.



Theme Burns-management
1.An electrician burnt his fingers of dominant hand
2. A baby with about 3% of burns
3. A 40 yr old man with 40% of scalds
4. The guy with the singed nostrils (repeat)
Theme Fracture-Diagnosis
1. The child with no radial pulse felt(rpt)
2. The POP gets wet and now a fracture earlier none seen(rpt)
3. Baby cries whenever lifted, difficult delivery(rpt)
Theme what will you do next(something along that line)(rpt)
1. a nurse with neddle injury - HIV patient, she is immunised against HepB, what will u look for in the next months.
2. Similar to the above scenario but here the nurse thinks she might already be HIV positive. What will u look for?
3. Hepatitis c case scenario- investigation- rna virus or anti -HCV antibody
4. A needlestick injury from hep B carrier, how do u find out if he is infective?
Theme Haemoptysis
1. a goodpasture's findings with renal findings and haemoptysis
2. a RTA case open reduction few days back - fat embolism like picture
3. the repeated sheep farmer orf, nasal polyp question
Theme Trauma - to add to ramesh's theme
2. The past paper question a child fell from 6 metre high
3. The child ran on a door
4. An alcoholic with falls( not sure if this was a question)
ThemeThere were more than 1 theme on renal medicine( these questions may be mixed up)
1. CA of bladder, painless haematuria - familiar question
2.renal cell carcinoma- triad was given
Theme Viral infection
This theme was a rpt with roseola infantum, meningitis ( with glass test positive not negative as given in past paper)hand foot and mouth disease.
The following questions, i am not sure under what themes they were:
1. A epistaxis with wegeners's picture ( the option was not wegeners but systemic vasculitis.
2. The breast CA lady with thirst, and other hypercalceamic findings - option was hypercalcaemia (rpt)
3.Breast cancer lady with hip pain - metastases or bony infiltration
3.In ENT theme a diver with c/o not able to hear or ear pain. the scenario was like wax impaction.( atleast that is what i answered)
4. Parapharengeal abscess question from past paper was modified and asked as next step in management. Not sure between options: attend outpatient review and surical intervention
5. The abdominal pain with H.pylori management-triple therapy was given as an option.
6. The pastpaper question a child with skin or food allergy-RAST was one of the options.
7. post natal depression scenario from pastpaper
8. a 40 odd year old man with chest pain for 2 hrs and fever. Pericarditis was not an option but MI was.
9. Migraine - drug for treatment
10.Migraine - drug for prophylaxis
11. Trigeminal neuralgia-treatment.
12. The past paper question of a guy stabbed in the abdomen BP dropping but no fluid in USG.-is it mesentric ischemia?
13. The stems from the theme triple blood test - spina bifida, downs and previous boy was affected mum wants to know if this child will be affected too.
14. Under the ENT theme, a lady with dizziness,vertigo and symtoms subsided after she was prescribed betahisdine-next step in management.
15.A man with ataxia, shuffling gait....
I share the views of the other May candidates, the questions were way too familiar but the options were not. It would be better for the july candidates to read a bit about the past questions (which will surely be of help) rather than just the options.

Theme Burns-management
1.An electrician burnt his fingers of dominant hand
2. A baby with about 3% of burns
3. A 40 yr old man with 40% of scalds
4. The guy with the singed nostrils (repeat)
Theme Fracture-Diagnosis
1. The child with no radial pulse felt(rpt)
2. The POP gets wet and now a fracture earlier none seen(rpt)
3. Baby cries whenever lifted, difficult delivery(rpt)
Theme what will you do next(something along that line)(rpt)
1. a nurse with neddle injury - HIV patient, she is immunised against HepB, what will u look for in the next months.
2. Similar to the above scenario but here the nurse thinks she might already be HIV positive. What will u look for?
3. Hepatitis c case scenario- investigation- rna virus or anti -HCV antibody
4. A needlestick injury from hep B carrier, how do u find out if he is infective?
Theme Haemoptysis
1. a goodpasture's findings with renal findings and haemoptysis
2. a RTA case open reduction few days back - fat embolism like picture
3. the repeated sheep farmer orf, nasal polyp question
Theme Trauma - to add to ramesh's theme
2. The past paper question a child fell from 6 metre high
3. The child ran on a door
4. An alcoholic with falls( not sure if this was a question)
ThemeThere were more than 1 theme on renal medicine( these questions may be mixed up)
1. CA of bladder, painless haematuria - familiar question
2.renal cell carcinoma- triad was given
Theme Viral infection
This theme was a rpt with roseola infantum, meningitis ( with glass test positive not negative as given in past paper)hand foot and mouth disease.
The following questions, i am not sure under what themes they were:
1. A epistaxis with wegeners's picture ( the option was not wegeners but systemic vasculitis.
2. The breast CA lady with thirst, and other hypercalceamic findings - option was hypercalcaemia (rpt)
3.Breast cancer lady with hip pain - metastases or bony infiltration
3.In ENT theme a diver with c/o not able to hear or ear pain. the scenario was like wax impaction.( atleast that is what i answered)
4. Parapharengeal abscess question from past paper was modified and asked as next step in management. Not sure between options: attend outpatient review and surical intervention
5. The abdominal pain with H.pylori management-triple therapy was given as an option.
6. The pastpaper question a child with skin or food allergy-RAST was one of the options.
7. post natal depression scenario from pastpaper
8. a 40 odd year old man with chest pain for 2 hrs and fever. Pericarditis was not an option but MI was.
9. Migraine - drug for treatment
10.Migraine - drug for prophylaxis
11. Trigeminal neuralgia-treatment.
12. The past paper question of a guy stabbed in the abdomen BP dropping but no fluid in USG.-is it mesentric ischemia?
13. The stems from the theme triple blood test - spina bifida, downs and previous boy was affected mum wants to know if this child will be affected too.
14. Under the ENT theme, a lady with dizziness,vertigo and symtoms subsided after she was prescribed betahisdine-next step in management.
15.A man with ataxia, shuffling gait....
I share the views of the other May candidates, the questions were way too familiar but the options were not. It would be better for the july candidates to read a bit about the past questions (which will surely be of help) rather than just the options.

Theme:Renal system
1.A 40 year old man who was investigated with cystoscopy which was normal,for recurrent haematuria 15 years ago ,now presents with haematuria and his Bp is found to be 180/110.What do think the etiology could be?Options were like membranous nephropathy,Chronic glomerulonephritis,Accelerated malignant hypertension,and so on.

Theme:Fever with rash.
1.A case with cervical lymphadenopathy,conjunctivitis,and a rash on hand which started to peel after the fifth day.-I marked this as Kawasaki disease.
2.Glandular fever was there.-Typical rash after taking ampicillin.
3.Roseola infantum was there.One could recognise easily.

Theme :Conjunctivitis
Options were:Viral,Opthalmia neonatorum,Trachoma,Chemical,Allergic and so on.
1.A conjunctivitis case-which responds to sodium chromoglycate
2.Conjunctivitis where both topical and oral tetracycline is adviced.
3.Conjunctivitis that responds to topical fusidic acid
4.Conjuntivitis where indomethacin is prescribed

Theme:Prenatal diagnosis.
1.A mother in her midtrimester who has her previous child affected(male child)by this disease wants to know if her this baby is affected too.-Duchennes
2.A mother whose triple blood test shows a low alpha feto protein-Down's

Theme:Injuries
1.A 30 years old man with history of trauma to the left upper abdomen with lower ribs fractured-Splenic injury
2.A person stabbed with a 10 cm knife in the left upper abdomen was stable for 20 minutes and then started to collapse.USG shows no free fluid in the abdomen.-I was stuck here for I was looking for hemothorax which wasnot given as an option.Cardiac tamponade,Aortic rupture were there and few more options but I couldn't choose any.
3.The other questions in this theme was quite easy that anyone can answer.

Theme:Anaemia
1.Sickle cell anaemia classical picture was there.
2.Hereditary spherecytosis was there-28 year old female with recurrent history of jaundice in young age now with splenomegaly.


Theme:Investigation of Drug complications
1.Pt on carbamazepine presents with tiredness-Full blood count-as the comp.is aplastic anaemia

Theme:Diagnosis of Psychiatric cases
1.A patient says that somebody blocks his thoughts -Schizophrenia
2.A patient with yearly presentation of low mood,etc-Seasonal affective disorder.
3.Bipolar affective disorder was there-a patient with both mania and depressive features alternating.(Could be even cyclothymia as the less severe form of Bipolar is cyclothmia.Because cyclothymia was an option too.)
4.A lady on the 7th postnatal day presents with low mood,not interested in feeding the child,and sometimes even harmful thoughts towards the baby-Postnatal depression
5.I believe this case was either major or minor depression because both options were given for a case which more commonly affects female than male presenting with symptoms of depression(Reading the case history- it was clear that it was depression-but one should know the criteria to differenciate between the major and minor)


Theme:Management of psychiatric cases
1.Options were Family therapy,occupational therapy,Genuine mourning,Antidepressants,and so on.
a.A young girl brings her mother who is low in mood for the past 6 months after the death of her father.It is worse in the past 3 months and she is incontinent with few more somatic symptoms.How would you help her?I thought antidepressants would be appropriate.I am not sure though.


Theme:Diagnosis of epistaxis
Options were nasopharngeal angiofibroma,Ca maxillary antrum,orf,coagulopathy,hypertension,septal perforation trauma and so on
1.Man working in a chrome factory presents with a whistling sound on talking-septal perforation
2.A sheep farmer with a bleeding ployp on anterior part of nasal septum-orf
3.Man with prosthetic valve presents with epistaxis-coagulopathy.
4.An 80 year old man with epistaxis since 2 hrs-I went for HT(not sure)
5.Man involved in furniture making presents with epistaxis and anaesthesia of rt.cheek.-Ca maxillary antrum

Theme:INVESTIGATIONS FOR ABDOMINAL CONDITIONS
Options were Plain x-ray abdomen,barium enema,upper GI endoscopy,sigmoidoscopy,colonoscopy,small bowel enema and so on
1.A patient presents with increasing constipation,passes stools which is ribbon like.Otherwise he is well.
2.Pt with abdominal pain and vomiting-to me it looked like intestinal obstruction.
3.A pt with history of epigastric pain after food(i vaguely remember as long standing history),and tarry stools.
4.Pt with abdominal pain and altered bowel habits with fistula anal region.



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