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PLAB Part 1; Free Online Mock Test 23.1 with explanatory answers

Author: RxPG, Posted on Monday, July 07 @ 02:33:20 IST by RxPG  

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PLAB Part 1

Multiple Choice Test



1) A middle-aged woman develops a purulent cough with some hemoptysis. A chest X-ray reveals right upper lobe consolidation.

One answer only.
a. Bronchiectasis
b. Haemophilus influenzae
c. Mycoplasma pneumoniae
d. Staphyloccus aureus
e. Streptococcus pneumoniae
f. Pneumocystis carinii
g. Acid fast bacillus
h. Candidiasis
i. Legionella pneumophila
j. Chlamydia psittaci
k. Chlamydia trachomatis
Streptococcus pneumoniae.

Clinchers

Middle-aged woman: Streptococcal pneumonia affects all ages, but is more common in middle-aged and elderly.

Purulent cough: Mycoplasma, Legionella, Chlamydia and Pneumocystis carinii characteristically presents with dry cough. Streptococcal and staphylococcal generally presents with purulent cough.

Some hemoptysis: Acute bronchitis, pneumonia, neoplasm (primary) hemoptysis in the united kingdom. TB is common in third world countries.

Right upper lobe consolidation: Lobar consolidation is sign of streptococcal pneumonia, more commonly on right side.

CONFUSA

When there is history of hemoptysis, always think of TB and malignancy first.

Investigation of choice

Chest X-ray.

Treatment of choice

Ampicillin or cefuroxime.

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2) A young woman with no relevant medical history develops a severe purulent cough. A chest X-ray reveals multiple cavitating bilateral lung lesions.

One answer only.
a. Bronchiectasis
b. Haemophilus influenzae
c. Mycoplasma pneumoniae
d. Staphyloccus aureus
e. Streptococcus pneumoniae
f. Pneumocystis carinii
g. Acid fast bacillus
h. Candidiasis
i. Legionella pneumophila
j. Chlamydia psittaci
k. Chlamydia trachomatis
Clinchers

Young woman: Staphylococcal pneumonia occurs in young and elderly patients.

No relevant medical history: Helps rule out any chronic condition like tuberculosis, though not that significant.

Severe purulent cough: History of severe purulent cough is common is staphylococcal pneunomia.

Multiple cavitating bilateral lung lesions: Bilateral cavitating bronchopneunomia is characteristic of Staphylococcal pneumonia.

Investigation of choice

Chest X-ray.

Treatment of choice

Flucloxacillin.

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3) A young male prostitute develops a dry cough. A chest X-ray reveals bilateral interstitial infiltrates.

One answer only.
a. Bronchiectasis
b. Haemophilus influenzae
c. Mycoplasma pneumoniae
d. Staphyloccus aureus
e. Streptococcus pneumoniae
f. Pneumocystis carinii
g. Acid fast bacillus
h. Candidiasis
i. Legionella pneumophila
j. Chlamydia psittaci
k. Chlamydia trachomatis
Pneumocystis carinii pneumonia (PCP).

Clinchers

Young male prostitute: Pneumocystis carinii causes pneumonia in the immunosuppressed (e.g. HIV).

Dry cough: Pneumocystis carinii presents with fever, dry cough, exertional dyspnoea, and bilateral crepitation.

Bilateral interstitial infiltrates: In PCP chest X-ray may be normal or bilateral interstial (perihilar) infiltration can be seen.

Investigation of choice

Chest X-ray.

Treatment of choice

High dose co-trimoxazole IV or pentamidine by slow IV for 2-3 weeks. In case of severe hypoxaemia, steroids can be added.

">


4) A young man has recently suffers from a bout of influenza. He now develops a purulent cough.

One answer only.
a. Bronchiectasis
b. Haemophilus influenzae
c. Mycoplasma pneumoniae
d. Staphyloccus aureus
e. Streptococcus pneumoniae
f. Pneumocystis carinii
g. Acid fast bacillus
h. Candidiasis
i. Legionella pneumophila
j. Chlamydia psittaci
k. Chlamydia trachomatis
Clinchers

Young man: Staphylococcal pneumonia occurs in young and elderly patients.

Recently suffers from a bout of influenza: Staphylococcal pneumonia, very commonly present as a compliญcation of influenza infection. More commonly seen in intravenous drug users or patients with underlying disease (e.g. leukemia, lymphoma, cystic fibrosis).

He now develops a purulent cough: History of purulent cough supports the diagnosis of staphylococcal pneumonia.

CONFUSA

Though there should be no confusion in this question, but the diagnosis should be supported with chest X-ray findings. In staphylococcal pneumonia typical bilateral cavitating bronchopneumonia is seen.

Investigation of choice

Chest X-ray.

Treatment of choice

Flucloxacillin.

">


5) Man comes back from a holiday in Malaysia and he develops malaise, fever and dry cough.

One answer only.
a. Bronchiectasis
b. Haemophilus influenzae
c. Mycoplasma pneumoniae
d. Staphyloccus aureus
e. Streptococcus pneumoniae
f. Pneumocystis carinii
g. Acid fast bacillus
h. Candidiasis
i. Legionella pneumophila
j. Chlamydia psittaci
k. Chlamydia trachomatis
Clinchers

Back from holiday to Malaysia: Legionella pneumoญphila colonizes water tanks kept at < 60ฐC (e.g. hotel airconditioning and hot water system). Therefore this is a very good clincher in this question.

Fever, malaise, myalgia: These flu like symptoms often precede dry cough and dyspnoea in Legionella pneumonia.

Bilateral basal consolidation: Chest X-ray showing bilateral basal consolidation is feature of Legionella pneumonia.

CONFUSA

There should be no confusion in this question. This is very commonly asked in PLAB.

Investigation of choice

Chest X-ray and legionella serology.

Treatment of choice

High dose erythromycin.

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This question comes from “RxPG First Aid for PLAB” – Jaypee Publishers, India & Blackwell Science Publishers, Europe and USA

The preface of the book can be read at rxpg.com.



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