PFMSG FORUM

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THEME 1:CAUSES OF DYSPHAGIA

a) Parkinsonism
b) Motor Neuron Disease
c) Stroke
d) Achalasia
e) Chagas disease
f) Esophageal carcinoma
g) Reflux esophagitis
h) Pharyngeal carcinoma
i) Scleroderma
j) Foreign body


1) A man complaints of dysphagia He is unable to protrude his tongue and has difficulty in speaking. He is unable to move his all 4 limbs.
2) A man complaints of sudden dysphagia, he cannot protrude his tongue and has difficulty in speaking.
3) A 110kg lady complains of many years of heartburn but now complains of painful dyspahgia. Barrium swallow doesn’t show any stricture.
4) A man complaints of dysphagia, he has foetor oris and there is occasional regurgitation of undigested food particles.
5) A man complains of sudden dysphagia after eating meat and chips. There is dribbling of saliva.


THEME 2 : DIAGNOSIS OF FRACTURES

a) Fracture distal end of radius
b) Metacarpal fracture
c) Supracondylar fracture of humerus
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 fell from a tree and now complains of pain in the arm. her radial pulse cannot be felt .
8) A man having seizures came to the A&E complaining of pain in the shoulder. There was no obvious visible deformity.
9) An old lady complained of pain in the wrist and hand after she fell on an outstretched hand. her wrist and hand are swollen.
10) A 3 yr old girl tripped while holding her mothers hand. She has not used her arm since then.



THEME 3:






11) A pt with chronic constipation, and severe pain when defecating./ Pain is sever and cannot undergo examination
12) Patient with severe anal pain and a swelling in the peri-anal region#
13) Patient with weight loss and change in bowel habits. Sigmoidoscopy shows ulcer
14) Patient with bleeding rectum. And features of Crohn’s
15) Sudden deep pain faecal shooting pain.


THEME 4: Contraception- mechanism of action



16) Depot vera
17) OCP
18) Post-coital pill


THEME 5: Cell of origin








19) Lipoma
20) Glioblastoma multiforme
21) Myeloma
22) AML
23) Rhabdomyosarcoma


THEME 6: Ascites











24) A man with some cancer developing ascites
25) Ascites with numerous neutrophils
26) Immigrant from India developing exudative ascites and loss of weight
27) Signs of CCF with ascites
28) Chronic stigmamat of liver diseases and ascites



THEME 7:













29) A boy with learning disabilities and staff are concerned about increasing number of head bangings
30) A man with schizophrenia hears voices telling him to have bleach.
31) a 17 yr old girl whose parents separated is brought to the A&E after she took 5 tablets of diazepam.
32) A man is admitted to a surgical ward after an accident where he sustained a minor injury. After few days he is unsmiling and unresponsive to staff.
33) A 27 yr old has 2 small children . She has no family support. She is recovering from influenza and her washing machine has broken down. She comes to A& E saying she took 8 aspirin tablets.


Theme 8 ain Relief
a) Paracetamol oral
b) IV morphine
c) SC morphine
d) oral morphine
e) oral diclofenac
f) codeineand paracetamol
g) diclofenac pr
h) carbamazepine

34) A 8 yr old boy is being investigated for failure to thrive, complains of ear pain.
35) A young lady felt dizzy and she fell down. She has swelling in her ankle and pain, but she is able to walk.
36) Child presenting with s/s of appendicitis.
37) A pt with s/s of MI.
38) A pt with Ca bronchus, now c/o pain and it is intolerable to Paracetamol and brufen.
39) Post herpetic neuralgia


Theme 9 Eye Investigations




40) Typical history of temporal arteritis.
41) Pt with intermittent episodes of amaurosis fugax.
42) Upper lobe hemianopia
43) s/s of acromegaly

Theme 10 Ear Treatment

a) Amoxcillin
b) Oral acyclovir
c) Topical acyclovir
d) Paracetamol
e) Flucloxacillin
f) Immediate referral to specialist
g) Routine referral to specialist


44) Diabetic pt with features suggestive of furunculosis.
45) A pt had syringing done and complains of sudden acute pain now.
46) A pt with varicella and has vesicles on the pinna and the eardrum.
47) A pt with a chronic history and on exam has a scarred eardrum and has a mass seen.


Theme 11 Preop care

a) Cancel the operation
b) ECG recording for 24 hrs
c) cardiology opinion
d) BP record for 24 hrs




48) A pt admitted for a prostectomy and his BP is 190/110 the previous day.
49) A pt with controlled angina since 10 yrs. Has had 2 attacks of angina in the last one week. He is posted for a prostaectomy.





Theme 12 Obs & Gynae Treatnent

a) Calcium supplement
b) HRT
c) Vaginal lubricant
d) Vaginal estrogen




50) A 55 yr old female who attained menopause 2 yrs ago . Family history of osteoporosis present. She is worried and has come for counseling.
51) A 32 yr old pt with family history of osteoporosis and she has lactose intolerance.
52) A pt who has postmenopausal dyspareunia, urine culture is negative. She is not willing to take systemic hormones.



Theme13 Non acc Injury

a) Refer to childcare center
b) Nutritional assessment
c) Coagulation screen
d) Continue regular child care
e) EUA
f) Inform police
g) CT scan


53) A child is brought with a fracture femur, no evidence of trauma.
54) A bruise is noted on a child’s hand, mother stopped the child from running.
55) A child of unemployed parents, exam reveals no improvement from last check up.
56) A child brought with bleeding p/v and her vagina is sore and shows excoriations.
57) A 18 yr old mother brings her one yr old child to the A&E. Child id drowsy, and left pupil is dilated.



Theme 14 Rheumatology Diagnosis










58) Typical history of RA
59) Typical features of Ank spondylitis
60) Punched out erosions on XR


Theme 15 Relation to obesity

a) Type 1 DM
b) Type 2 DM
c) Alcohol
d) Cushings
e) PCOD
f) Obstructive sleep apnoea



61) Wt loss would help night sleep in this condition and improve marital harmony.
62) Wt loss wld help to stop the medication
63) Stopping this wld help in wt loss and vitamin deficiency.
64) Surgery in this condition will help in wt loss.



Theme 16 Psychiatry

a) Acute confusional state
b) PTSD
c) drug induced psychosis
d) Mania
e) schizophrenia


65) A Pt undergone surgery for some condition and is receiving medicines for pain relief. On 3rd postop day he has features of delirium tremens.
66) A kosovian who gets startled easily when he hears any loud noises etc
67) A person who is being stopped by the police and goes on talking jumping from one topic to another.
68) Something about a man running to the police station and saying that his house is not safe, but on checking that’s not the case.


Theme 17 Surgery

a) Femoral hernia
b) Indirect inguinal hernia
c) Direct inguinal hernia
d) mal-descended testis





69) A lump that is seen below and medial to the pubic tubercle
70) A mass attached to the spermatic cord.







Theme 18 Trauma Organ

a) urethra
b) bladder
c) spleen
d) pancreas
e) kidney
f) diaphragm
g) aorta
h) liver

71) A person who met with a accident and is in A & E with pain in RUQ and hypotension.
72) A builder falls astride on a scaffolding bar.
73) A person after an accident when NGT was tried, not successful.
74) After an accident fullness in the loins & pain.



Theme 19 Scientific basis

a) Obstruction
b) Papillary necrosis
c) Hypercalcemis
d) Infection
e) Dehydration

75) A pt with s/s of sarcoidosis.
76) Something about analgesia
77) A marathon runner.
78) A person having recurrent attacks of UTI.
79) Something about obstruction.


Theme 20) Seizures

a) Check drug level
b) EEG
c) CT
d) MRI

80) Child has had one episode of grand mal epilepsy now presents with another attack.
81) A girl who is being treated for absence seizures has had recurrent seizures and she is obese.
82) A child is unwell since the last few days, is brought to A&E with seizures. Child is irritable.


Theme 21 Seizures

a) Febrile convulsions
b) Petit mal
c) Grand mal
d) Complex seizure
e) Pseudo-seizure

83) A person who has been treated for carcinoma ? now comes with pain and numbness in his left leg and then , can’t remember the next bit.
84) A child having otitis media with seizure
85) A child at school suddenly stops midsentence for a few seconds and then starts off where she stopped.
86) A person with generalised seizures.


Theme 22 Haematuria

a) ASO titer
b) Creatinine clearance
c) USG
d) Cystoscopy

87) A 8 yr old boy comes with complaints of fever, oliguria and edema.
88) A person with hematuria , he says there is family history.
89) A diabetic pt with pitting edema.


Theme 23 Psychiatry

a) Low mood
b) Chronic fatigue syndrome
c) Thought broadcasting
d) Thought insertion
e) Insight
f) Judgment
g) Paranoid delusion

90) A lady who lacks energy and has disheveled hair and appearance.
91) A woman who is admitted and feels that the staff knows what she is thinking.
92) A man has psychiatry problem and he knows he ha sit.
93) A pt keeps on talking and he jumps from one topic to another.


Theme 24 Respiratory Asthma








94) A 6 yr old boy presents with recurrent bouts of asthma, his parents are smokers.
95) A boy presents with recurrent attacks on playing football.
96) A child presents with acute attacks of asthma, her brother rears rabbits during holidays.


Theme 25 Loss of consciousness

a) CO poisoning
b) Hypoglycemia
c) meningitis
d) Subdural haematoma
e) Subarachnoid heamorrhage
f) Intracerbral he

97) An alcoholic who has had falls with fluctuating consciousness.
98) A person who has been hypertensive since last 10 yrs and not on any t/t, presents with sudden loss of consciousness.
99) A student at hostel in the university has come back home, he has fever , rash? ..
100) A 8 yr old child with diabetes
101) A student at the hostel – CO poisoning
102) A person with a severe headache like he has been hit at the back of his head.



Theme 26










103) Post op hernia pt has difficulty in voiding urine.
104) A person in a mining accident
105) A person in an accident with blood seen at the tip of the urethra.
106) pt with frequency and hematuria . On cystoscopy red patches are seen, no infection and no signs of inflammation.
107) Fluid requirement in an Addisonian pt. (levels given)
108) Fluid requirement in a diabetic pt.
109) A person with gastroenteritis since 24 hrs, fluids needed.



Theme 27 Trauma

a) Control bleeding with external pressure
b) Vascular access and infuse normal saline
c) Vascular access and infuse blood
d) Intubate and ventilate
e) Maintain open airway
f) Needle thoracocentesis
g) Splint fracture



110) A 10 yr old boy fell onto broken glass and is bleeding from his wrist.
111) A girl has been hit by a car , neck is immobilized. She is receiving 100%oxygen. Berthing is noisy.
112) A child fell from a horse. Her neck is immobilized and she has been given oxygen. She has a swollen thigh, and she has cool peripheries.
113) A 15 yr old girl has cut her wrists and bled profusely. She is pale and tachycardic.
114) A boy was involved in an accident in which another person was killed. He is brought to A & E with a oxygen mask . He is talking. He is pale and tachycardic.

There were other themes on cervical ca, pregnancy and complications, ECG findings , pulse, BP, JVP,CXR for diff conditions, thyroid..


Theme 28 Infection Diagnosis

a) Lymphoma
b) TB
c) Brucellosis
d) Lyme
e) Plasmodium falciparum
f) Plasmodium vivax
g) Plasmodium ovale


115) A 8 yr old boy from somlia has complaints od haemoptysis, cough and fever.
116) A pt with cervical lymph nodes and has night swets , fever low grade.
117) A person working in a farm comes with splenomegaly and fever.
118) A pt with intermittent fever , splenomegaly
119) Pt with long history of dyspepsia since 10 yrs, takes cimetidine but no relief.
120) A pt who has been on triple therapy for H Pylori comes now with complaints of dyspepsia.


Theme 29 Choose the cell that proliferates .....

1) Adipocyte
2) Lymphocyte
3) Erytroblast
4) Megakaryoblast
5) Monocytes
6) Neuroglial cells
7) Schwann cells
8) Astrocytes
9) Plasmacell
10) Muscle
11) Neutrophil precursors...

a) cell that proliferates in lipo sarcoma
b) multiple myeloma?
c) glioblastoma multiforme
d) AML
e) rhabdomyosarcoma..?

answers.....???
a)adipocyte
b)plasmacell
c)nueroglial cell
d)???/
e)muscle
the ans are:
1. adipocyte
2. plasma cell
3. astrocytes( GBM is classified as a astrocytic tumor)
4. neutrophil precursors,AML has inc myeloblasts which are the first recognisable cells in neutrophlic series
5. muscle


Answers

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1, mnd
2 stroke
3 ?
4, pharngeal pouch
5 foreign body
6 metacarpal
7 supracondylar fra
8 ,postr dislocation
9 fracture distal end of radius
10 pulled elbow
11 ,anal fissure
12 ,perianal hematoma
13 rectal ca
14 crohns
15 , pratalgia fugax
16 ,cervical mucus
17 ,prevents ovulation
18 implantation
19 fat cells
20 astrocyte
21 plasma cell
22 megacaryocyte
23 skeletal muscle
24 carcinomatous peritoneii
25 subacute bac. peritonitis
26 tuberculosis
27 ccf
28 alcohol
29 sedation
30
31,dont remember the ans
32, refer to psy
33 ?
34 oral paracetamol
35 diclofenac
36 codiene n paracetomol?
37 im morphine
38 sc morphine
39 carbamazepine
40 carotid doppler
41 temporal lobe mri
42 pituitary
43 fluclaxacillin
45 , immetiade referal
46 oral acyclovir
47 routine referal
48 ?
49 cardiology opinion
50 ?
51 ?
52 vaginal oestrogen
53 continue child care
54 coagulation screen
55 nutritional ass.
56 refer to child care center
57 ct scan
58 RA
59 anklosing
60. OSTEOSARCOMA??
61.F
62.B
63.C
64.D
65.C
66.B
67.D
68.E
69.A
70.D
71.H
72.A
73
74. E
75.C
76.B
77.E
78.A
79.D
80.C
81.A
82.C
83.E
84.A
85.B
86C
87.A
88.C
89.B
90.A
91.C
92.E
93.G
94.AVOID SMOKING
95.AVOID ALLERGEN??
96.AVOID ALLERGEN
97.D
98.F
99.C
100.B
101.A
102.E
103.POST OP RETENTION
104.CATHETERISE
105.URETRAL RUPTURE,SUPRAPUBIC CATHETERISATION
106.TB
107?
108?
109?
110.A
111.D
112.B
113.C
114.E
115TB
116.A
117C
118MALARIA??
119PROTON PUMP INHIBITORS