AMC QUESTION BANK CLINICALS/MCQS

AMC QUESTION BANK CLINICALS/MCQS

-------------------------------------------------------------------------------:all of the following are the signs of Ischaemia of the lower limb EXCEPT A .Ulcer at Halluces B .Intermittent claudication c .Rest pain *** d. Ulcer above medial malleolus e .Hair loss on lower limb A painful lump in the groin of sudden onset in an otherwise healthy young man is MOST .2 ?LIKELY to be a. Direct Inguinal hernia b .Indirect Inguinal hernia c .Femoral hernia d. Enlarged groin lymph node e. Spigelian hernia i'll go for indirect inguinal hernia(more likely to strangulate)..dont know abt spigelian ..hernia A patient had undergone a partial gastrectomy 24 hours ago. His fluid input is 2 Lt and.3 urineoutputs is 2 Lt., Naso gastric aspiration- 700 ml and drain 500 ml. His K is 3.5, Na 130 and Cl is 80.Which of the following is the MOST appropriate fluid replacement ?regimen a..2L N. saline + 1L 5% Dextrose + 50 mmol KCI b.2L N. saline + 2L 5% Dextrose + 50 mmol KCI c.3L N. saline + 1L 5% Dextrose + 50 mmol KCI ****d.3L N. saline + 2L 5% Dextrose + 100 mmol KCI e.2L N. saline + 2L 5% Dextrose + 100 mmol KCI agreee A 46 years old woman had left mastectomy done for breast cancer two years ago.Now .4 she comes to you with a painless, firm and mobile lump in her right breast. She is ?otherwise well. What is the MOST LIKELY diagnosis a.New primary cancer in the right breast *** b Metastases from the previous breast cancer c.Benign growth d.Metastasis from another malignant tumour elsewhere e.Lymph node swelling there must be some remnants left which gave rise to metastasis

?An X ray showing dislocation of shoulder. Which of the following is CORRECT .5 .a. Posterior Dislocation of the shoulder **.b.Sensory loss of the lateral aspect of the arm c.Weakness of the hand .d.Sensory loss of the medial aspect of the arm e.Fracture of the Humerus Which of the following is MOST suggestive of disruption of deep layers of a post operative 6 ?abdominal wound a. Persistent pain in wound b.serosanguineous discharge c. Persistent abdominal distension *** d.Gaping in the skin after the removal of the sutures e.Unexplained fever and tachycardia not sure - i want to disuss about IUGR in gest. DM WILLIAM'S obstetrics says that there in unexplained fetal demise not known to be due to .causes like IUGR,placental insuffeciency etc so guys there is "NO IUGR" in gest DM PAED A 14 years old girl has breast enlargement, normal growth of pubic and axillary hair but she is still ?not menstruating. Which of the following is CORRECT a.She is likely to start menstruating two years after the start of pubic hair growth b.She is likely to start menstruating two years after the start of axillary hair growth .c.She is likely to start menstruating within two years from the time of her breast budding .d..She is likely to start menstruating within two years from growth spurt *** e.This is a case of delayed puberty thelarche is first to come(which has already developed).last to develop is menarche..so this is a case of pubertal delay

A 16 years old girl presents with fever, headache and rash on her body. She also has ?profuse bleeding from all venipuncture sites. What is the MOST probable diagnosis a.Thrombocytopenia b.'Disseminated Intravascular coagulation *** c.Henoch Schonlein Purpura d.Allergic reaction why fever in thrombocytopenia?moreover age group belongs to HSP.also know that HSP is one the most common cause of purpura in this age group A 12 months old baby has fever. Recently, two other family members had an upper respiratory tract infection. On examination of the baby you find that his body temperature is 37.5 CTand chest auscultation reveals bilateral wheezing. What is the MOST LIKELY ?cause *** a.Acute bronchiolitis b.Viral croup c.Bronchial Asthma d.Pneumonia e.Foreign body age group suggests it A neonate with cough and fever is found to be grunting. Chest X ray shows round lesions ?with little pleural effusion. Which of the following is the BEST the treatment ?? a.Crystalline Penicillin b.Gentamycin d.Amoxicillin *** e.Flucloxacillin

as staph is common cause of pneumonia in this age grp.Plz correct me A ten years old girl has a history of repeated episodes of hemiparesis from which she ?recovers completely. What is the MOST LIKELY diagnosis a.Middle cerebral artery occlusion ** b.Petit mal epilepsy ?? c.Migraine d.Subarachnoid haemorrhage migraine is unlikely in this age grp but it rarely presents with hemiparesis...can hemiaparesis be present in petit mal epilepsy..if yes then this is the answer

The parents with their 10 years old child come to see you with complaints that the child has enuresis since birth. The child has no problems during the day time. Physical examination does not reveal any other abnormality. Which of the following statements is ?TRUE in more than 20 % of such cases a.He has chronic pyelonephritis b.He has congenital abnormalities of the urinary tract **** c.There is an associated family history .d.he has small urinary bladder e.It is associated with spina bifida occulta .enuresis is frequently found in patients with disturbed family env A 5 years old boy presents with vomiting every morning and morning headache for the last ?two weeks. What is the MOST LIKELY cause a.Meningitis b.Migraine ** c.Craniopharyngioma d.MeduJloblastoma e.Wilm's tumour ..will check and tell but most likely the ansewer is craniopha An adolescent boy complains of slight pain in the right knee which gets worse after exercise. On examination you find a lump on the tibia tubercle with slight tenderness. The boy can't remember if ?he has had any recent trauma. Which of the following statements is CORRECT a.Reassure that there is nothing wrong *** b.Biopsy should be done to exclude malignancy c.Knee aspirate shows organism d. Osteochondritis is the most likely cause

A 6 day old baby who is suspected to have Down's syndrome presents with non projectile bilestained vomiting for the last two days. On abdominal examination you find an olive shapedpalpable mass in the epigastrium. Which of the following is the MOST LIKELY ?diagnosis a.Volvulus ***.b.Duodenal Atresia c.Intussusception d.Malabsorption A two years old child presents with failure to thrive for the last 6 months and right buttock wasting. He passes bulky stools 2-3 times a day. Which of the following is the MOST

?appropriate investigation a.C13 breath test *** b.Duodenal biopsy c.Stool culture d.Stool microscopy e.Sweat test A diabetic mother gives birth to a child weight 4240 gm and with an Apgar score of 7/10. On examination you find cyanosis of his hands and feet and the child is jittery. Axillary temperature measure shows a reading of 37.2 C. His condition improved after meconium ?aspiration and 100% O2. Which of the following is the MOST LIKELY cause a.Hypoglycaemia *** b.Heart disease .c.Lung disease d.Hyperglycaemia .e.His jaundice is caused by breast milk cyanotic heart disease may be the cause which is common in baby of diabetic mother A six years old boy presents with delayed development of speech after a period of normal development. On examination you find that he avoids eye contact and reveals a history of ?unusual liking for dinosaurs. Which of the following is the MOST LIKELY diagnosis *** a.Autism b.ADHD c.Deafness regression of normal milestones which are already developed is a feature of autism A young woman with anovulatory cycles for the long time is MOST LIKELY to develop ?which of the following a.Cervical cancer b.Endometrial Cancer *** c.Ovarian cancer d.Vaginal cancer e.Cancer of the Vulva

?In which of the following conditions you will find DECREASED amniotic fluid (a.Foetus's Bladder neck obstruction of the foetus(renal agenesis b.T.O fistula c.Rhesus incompatibity d.Multiple pregnancy explanation-since baby bathes in amniotic fluid it absorbs and excrets only amniotic fluid.so in renal agenesis no urine is produced therefore amniotic fluid is reduced(oligohydramnios)..in esophageal atresia amniotic fluid is not absorbed causing polyhydramnios

A 52 years old obese post menopausal woman presents with no signs of Menopause and ?amenorrhoea. What could be the cause A Low oestrogen and Low FSH B High oestrogen and high FSH c. Normal oestrogen and high FSH *** d.High oestrogen and low FSH e.Low oestrogen and High FSH since hot flushes and other symptoms are produced due to high amt of FSH..here the case is revrsed

A 16 years old student asks for a prescription for contraceptive pill. She says she doesn't ?have sexual partner. Which of the following is the MOST APPROPRIATE management a. Oral contraceptive pill b.Minipill c.Depot d.Oral contraceptive pill + condoms .e.Call her parents ????why does she need a contraceptive pill if she has no partner ocp is the best bet for emergencies ?A pregnant woman in 1st trimester is found to have CIN III. What is your NEXT step a. Terminate the pregnancy b. Cone biopsy c.Hysterectomy d.Colposcopy e.Observe not sure A pregnant woman in 1st trimester presents with skin dimpling over the right breast. .14 Examination and clinical tests reveals cancer of the right breast. Which of the following is ?your management a.Terminate the pregnancy b.Start radiotherapy ??? c.Wait till delivery and then start the treatment d.Surgery ...if dimpling is present it means it is T4..why surgery if T4 A 19 years old female comes to your clinic for consultation. She has never had periods. On examination her breast development is normal. Pubic and axillary hair growth is also normal. The development of her genitals is also in normal range. What is the MOST LIKELY cause of her ?amenorrhea a. Turner's syndrome b. Prolactinoma c. Absent uterus ***d. Pituitary lesion e. Lesion in Hypothalamus you cant be sure whether it is imperforate or not A 42 years man who is a patient of yours is arrested for attacking his wife in a supermarket. The police come to you and ask you to write a report about this patient. ?Which of the following is TRUE for good practice a.You will write a report about the patient's bad mental state b.You will tell the patient never to come to your surgery again .c.You will write a general, unbiased and balanced report about health of the patient d.You will tell the police that you don't want to give any reports e. Arrange for a meeting with the patient !!!please tell me where to read ethics from guys Which of the following will cause SEROTONIN syndrome if given together with SSRI like ?Fluoxetine EXCEPT

a.L-tryptophan b.Haloperidol c.Moclobemide d. Chlorpromazine' e.Citalopram no idea...what is sertonin syndrome In Australia , almost every year there are several incidences of bush fire. Usually it is caused by ?young people and teenagers. Which of the following is TRUE **** . a. Juvenile pyromania is the main cause of fires in Australia b. It is due to accidental fire caused by youngster who get scared after the fire starts to.spread uncontrollably and they run away c.It has no serious consequences .d.Youngsters like to ignite and play with fire e.It is done to hide crimes A schizophrenic woman thinks that she is perfectly well and denies any illness. She also refuses to ? take medication and thinks that she can talk with Angels. What is this called in Psychiatry

a.Lack of insight b.Overvalued idea c.Rejection d.Delusion ****e..Formal thought

?which is the best nerve in grafting *** a) median nerve b)radial nerve c) digital nerve thicker nerves are better for grafts

?patient presents with sudden rupture of extensor pollicis longus tendon,dx ***a) tendonities b) tenosynovitis c) RA not very sure but more likely A patient with cancer breast develop osteoprposis.what is the treatment *** a) bisphosphonate

b) cyclical estrogen and progesterone c) continuous estrogen and progesterone increase diatery calcium 2000g / day You are called to review a patient who developed restlessness and difficulty breathing eight hours ?after thyroidectomy. What will you do FIRST .a. Endotracheal intubation b.Remove superficial sutures *** c.Remove superficial and deep sutures d.Salbutamol inhalation as patient probably has Asthma A 43 years old man was brought to the emergency department with severe upper abdominal pain and signs of shock. Physical examination reveals abdominal wall rigidity and guarding. Which of ?the following is the MOST LIKELY Diagnosis *** a.Perforated gastric ulcer b.Penetrating duodenal ulcer c. Mesenteric ischemia d. Acute pancreatitis patient is in shock with upper abdominal pain..guarding and rigidity is suggestive of ..peritonitis A young male fell from a height but sustained minor injuries. After two hours he lost consciousness and was brought to you in Northern Queensland hospital with limited radiographic facilities by his friend. On examination you find that his pupils are fixed and dilated. What is our ?NEXT step .a.Arrange for transportation to another hospital by helicopter b.Give IV mannitol *** c Give IV corticosteroid d. d Burr holes case of EDH

An elderly man came to see you with complaints of sudden pain in the lower back while lifting a heavy box. On examination you find that the lumbar spine has limited movement with pain in his lower back on movement. There are no neurological abnormalities. What is ?the NEXT investigation that you'll do *** a.X Ray of the lumbar spine b.CTScan c.MRI of the spine d.Lumbar puncture A 70 years old woman had Upper GIB. She was on treatment with NSAID for knee pain which was stopped a few months ago. You do an endoscopy of upper Gl tract and find a duodenal ulcer with ?recent bleeding. What is the BEST management *** a.Omeprazol I.V. + Ampicillin + Metronidazole .b.Omeprazol I.V c.Highly selective vagotomy d.Vagotomy e.Ranitidine I.V. + Ampicillin + Metronidazole highly selective vagotomy will only stop the acid secretion.ideally somatostatin infusion or

application of adrenaline locally should be done otherwise conventional therapy for ulcer is recommended ?Which of the following is MOST COMMON cause of acute pancreatitis ,a.Gallstones b.Cholecystitis *** c.Alcohol abuse d.Spicy food e.Gastroenteritis ? What is the MOST COMMON cause of death after burn injury in Australia ***a.Shock b.Respiratory failure c.Cardiac failure d.Renal failure most likely hypovolemic shock

?patient presents with sudden rupture of extensor pollicis longus tendon,dx a) tendonities b) tenosynovitis c) RA Probably A patient with cancer breast develop osteoprposis.what is the treatment a) bisphosphonate b) cyclical estrogen and progesterone c) continuous estrogen and progesterone d)increase diatery calcium 2000g / day obvious choice You are called to review a patient who developed restlessness and difficulty breathing eight hours ?after thyroidectomy. What will you do FIRST .a. Endotracheal intubation b.Remove superficial sutures c.Remove superficial and deep sutures d.Salbutamol inhalation as patient probably has Asthma This is hypoparathyroidism secondary to surgery leading to hypocalcemia and eventually life threatening laryngeal edema

A young male fell from a height but sustained minor injuries. After two hours he lost consciousness and was brought to you in Northern Queensland hospital with limited radiographic facilities by his friend. On examination you find that his pupils are fixed and dilated. What is our ?NEXT step .a.Arrange for transportation to another hospital by helicopter b.Give IV mannitol .c Give IV corticosteroid d d Burr holes

This is epidural hemorrhage - so need burr hole operation. Clue - lucid interval followed by .unconciousness An elderly man came to see you with complaints of sudden pain in the lower back while lifting a heavy box. On examination you find that the lumbar spine has limited movement with pain in his lower back on movement. There are no neurological abnormalities. What is ?the NEXT investigation that you'll do a.X Ray of the lumbar spine c.MRI of the spine d.Lumbar puncture Since the patient is more than 50 years of age - this is a red flag sign (Davidson 19th page [snip]). So patent has to be evaluated with investigation. Patient needs both Xray and .MRI(Davidson page [snip]). Since it is the next investigation in the question - I go for xray

A 70 years old woman had Upper GIB. She was on treatment with NSAID for knee pain which was stopped a few months ago. You do an endoscopy of upper Gl tract and find a duodenal ulcer with ?recent bleeding. What is the BEST management a.Omeprazol I.V. + Ampicillin + Metronidazole .b.Omeprazol I.V c.Highly selective vagotomy d.Vagotomy e.Ranitidine I.V. + Ampicillin + Metronidazole Bleeding has stopped. So now the patient needs treatment for healing of ulcer as well as .eradication therapy for H. pylori ?Which of the following is MOST COMMON cause of acute pancreatitis ,a.Gallstones b.Cholecystitis c.Alcohol abuse d.Spicy food e.Gastroenteritis ? What is the MOST COMMON cause of death after burn injury in Australia a.Shock b.Respiratory failure c.Cardiac failure d.?Renal failure Its a guess. I assume that being a country with good medical facilities - fluid resuscitation should be available and shock should be treated. But renal failure in burn can be caused by .shock, myoglobinuria, hemoglobinuria etc PAED A 14 years old girl has breast enlargement, normal growth of pubic and axillary hair but she is still

?not menstruating. Which of the following is CORRECT a.She is likely to start menstruating two years after the start of pubic hair growth b.She is likely to start menstruating two years after the start of axillary hair growth .c.She is likely to start menstruating within two years from the time of her breast budding .d..She is likely to start menstruating within two years from growth spurt e.This is a case of delayed puberty Reference Robertson page 156

A 16 years old girl presents with fever, headache and rash on her body. She also has ?profuse bleeding from all venipuncture sites. What is the MOST probable diagnosis a.Thrombocytopenia b.'Disseminated Intravascular coagulation c.Henoch Schonlein Purpura d.Allergic reaction Meningococcal infection leading to DIC A 12 months old baby has fever. Recently, two other family members had an upper respiratory tract infection. On examination of the baby you find that his body temperature is 37.5 CTand chest auscultation reveals bilateral wheezing. What is the MOST LIKELY ?cause a.Acute bronchiolitis b.Viral croup c.Bronchial Asthma d.Pneumonia e.Foreign body Viral ailment caused by RSV in children leading to wheezing. Some of these children will go .on to develop asthma when adult A neonate with cough and fever is found to be grunting. Chest X ray shows round lesions ?with little pleural effusion. Which of the following is the BEST the treatment a.Crystalline Penicillin b.Gentamycin d.Amoxicillin e.Flucloxacillin I am not sure. But considering that E.coli and gm negative organism are the commonest .bacterial etiology in this group - I go for Gentamycin A ten years old girl has a history of repeated episodes of hemiparesis from which she ?recovers completely. What is the MOST LIKELY diagnosis a.Middle cerebral artery occlusion b.Petit mal epilepsy c.Migraine d.Subarachnoid haemorrhage ?Don't know. Anyone The parents with their 10 years old child come to see you with complaints that the child has enuresis since birth. The child has no problems during the day time. Physical examination does not reveal any other abnormality. Which of the following statements is ?TRUE in more than 20 % of such cases a.He has chronic pyelonephritis

b.He has congenital abnormalities of the urinary tract c.There is an associated family history .d.he has small urinary bladder e.It is associated with spina bifida occulta A 5 years old boy presents with vomiting every morning and morning headache for the last ?two weeks. What is the MOST LIKELY cause a.Meningitis b.Migraine c.Craniopharyngioma d.MeduJloblastoma e.Wilm's tumour Morning headache and morning vomiting suggestive of brain tumor. Medulloblastoma is a common childhood tumor An adolescent boy complains of slight pain in the right knee which gets worse after exercise. On examination you find a lump on the tibia tubercle with slight tenderness. The boy can't remember if ?he has had any recent trauma. Which of the following statements is CORRECT a.Reassure that there is nothing wrong b.Biopsy should be done to exclude malignancy c.Knee aspirate shows organism d. Osteochondritis is the most likely cause This is Osgood Schlatter Diseas. It is self limiting. Only conservative treatment is required in most of the cases. Osteochondritis presents with locked knee, knee effusion etc.(John (Murtag 739 A 6 day old baby who is suspected to have Down's syndrome presents with non projectile bilestained vomiting for the last two days. On abdominal examination you find an olive shapedpalpable mass in the epigastrium. Which of the following is the MOST LIKELY ?diagnosis a.Volvulus .b.Duodenal Atresia c.Intussusception d.Malabsorption Common complication of Down's syndrome A two years old child presents with failure to thrive for the last 6 months and right buttock wasting. He passes bulky stools 2-3 times a day. Which of the following is the MOST ?appropriate investigation a.C13 breath test b.Duodenal biopsy c.Stool culture d.Stool microscopy e.Sweat test It seems like a coeliac diseas. But only thing that is puzzling is one sided buttock wasting .(which should be both sided(Robertson clinical example page 571 A diabetic mother gives birth to a child weight 4240 gm and with an Apgar score of 7/10. On examination you find cyanosis of his hands and feet and the child is jittery. Axillary

temperature measure shows a reading of 37.2 C. His condition improved after meconium ?aspiration and 100% O2. Which of the following is the MOST LIKELY cause a.?Hypoglycaemia b.Heart disease .c.Lung disease d.Hyperglycaemia .e.His jaundice is caused by breast milk Hypoglycemia is common in infant of Diabetic mothers, so is polycythemia. Probably the .child was jittery due to hypoglycemia. Not sure though A six years old boy presents with delayed development of speech after a period of normal development. On examination you find that he avoids eye contact and reveals a history of ?unusual liking for dinosaurs. Which of the following is the MOST LIKELY diagnosis a.Autism b.ADHD c.Deafness Obs A young woman with anovulatory cycles for the long time is MOST LIKELY to develop ?which of the following a.Cervical cancer b.Endometrial Cancer c.Ovarian cancer d.Vaginal cancer e.Cancer of the Vulva ?In which of the following conditions you will find DECREASED amniotic fluid a.Foetus's Bladder neck obstruction of the foetus b.T.O fistula c.Rhesus incompatibity d.Multiple pregnancy A 52 years old obese post menopausal woman presents with no signs of Menopause and ?amenorrhoea. What could be the cause A Low oestrogen and Low FSH B High oestrogen and high FSH c. Normal oestrogen and high FSH d.High oestrogen and low FSH e.Low oestrogen and High FSH A 16 years old student asks for a prescription for contraceptive pill. She says she doesn't have ?sexual partner. Which of the following is the MOST APPROPRIATE management a. Oral contraceptive pill b.Minipill c.Depot d.Oral contraceptive pill + condoms .e.Call her parents ?A pregnant woman in 1st trimester is found to have CIN III. What is your NEXT step a. Terminate the pregnancy b. Cone biopsy c.Hysterectomy d.Colposcopy e.?Observe A pregnant woman in 1st trimester presents with skin dimpling over the right breast. .14

Examination and clinical tests reveals cancer of the right breast. Which of the following is ?your management a.Terminate the pregnancy b.Start radiotherapy c.Wait till delivery and then start the treatment d.?Surgery A 42 years man who is a patient of yours is arrested for attacking his wife in a supermarket. The police come to you and ask you to write a report about this patient. ?Which of the following is TRUE for good practice a.You will write a report about the patient's bad mental state b.You will tell the patient never to come to your surgery again .c.You will write a general, unbiased and balanced report about health of the patient d.You will tell the police that you don't want to give any reports e. Arrange for a meeting with the patient Which of the following will cause SEROTONIN syndrome if given together with SSRI like ?Fluoxetine EXCEPT a.L-tryptophan b.Haloperidol c.Moclobemide d. Chlorpromazine' e.Citalopram Dont know In Australia , almost every year there are several incidences of bush fire. Usually it is caused by ?young people and teenagers. Which of the following is TRUE . a. ?Juvenile pyromania is the main cause of fires in Australia b. It is due to accidental fire caused by youngster who get scared after the fire starts to .spread uncontrollably and they run away c.It has no serious consequences .d.Youngsters like to ignite and play with fire e.It is done to hide crimes A schizophrenic woman thinks that she is perfectly well and denies any illness. She also refuses to ? take medication and thinks that she can talk with Angels. What is this called in Psychiatry

a.Lack of insight b.Overvalued idea c.Rejection d.Delusion [e..Formal thought disorder [/b

You are called to review a patient who developed restlessness and difficulty breathing eight hours ?after thyroidectomy. What will you do FIRST a. ENDOTRACHEAL INTUBATION b.Remove superficial sutures c.Remove superficial and deep sutures d.Salbutamol inhalation as patient probably has Asthma

This is hypoparathyroidism secondary to surgery leading to hypocalcemia and eventually (life threatening laryngeal SPASM(not edema

CAUSE OF ACUTE PANCREATITIS Gall Stone: At least 30-40% of cases. In some series it has been placed as high as 90% Alcoholism: At least 25% of cases

Lady Talking with the angels A schizophrenic woman thinks that she is perfectly well and denies any illness. She also refuses to ? take medication and thinks that she can talk with Angels. What is this called in Psychiatry

a.Lack of insight b.Overvalued idea c.Rejection d.Delusion e..Formal thought disorder .Actually it is lack of insight I am quoting from Oxford Core Psychiatry p18 .As s technical term insight means a correct awareness of one's own mental condition" :It is best described in terms of four criteria .Awareness of oneself as presenting phenomena that other people consider abnormal .1 .Recognition that these phenomena are abnormal .2 Acceptance that these abnormal phenomena are caused by one's own mental illness .3

.Awareness that treatment is required .4

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:Posted: Fri Sep 29, 2006 1:00 pm Post subject -------------------------------------------------------------------------------You are called to review a patient who developed restlessness and difficulty breathing eight hours ?after thyroidectomy. What will you do FIRST .a. Endotracheal intubation b.Remove superficial sutures c.Remove superficial and deep sutures d.Salbutamol inhalation as patient probably has Asthma

A 70 years old woman had Upper GIB. She was on treatment with NSAID for knee pain which was stopped a few months ago. You do an endoscopy of upper Gl tract and find a duodenal ulcer with ?recent bleeding. What is the BEST management a.Omeprazol I.V. + Ampicillin + Metronidazole .b.Omeprazol I.V c.Highly selective vagotomy d.Vagotomy e.Ranitidine I.V. + Ampicillin + Metronidazole The treatment for NSAID induced ulcer includes giving PPI and if pain can not be tolerated give NSAID+PPI. No mention of giving antibiotics. --- Toronto notes A two years old child presents with failure to thrive for the last 6 months and right buttock wasting. He passes bulky stools 2-3 times a day. Which of the following is the MOST ?appropriate investigation a.C13 breath test *****b.Duodenal biopsy c.Stool culture

d.Stool microscopy e.Sweat test Celiac dse does have failure to thrive, muscle wasting and flat buttocks. ----Nelson's pediatrics

A ten years old girl has a history of repeated episodes of hemiparesis from which she ?recovers completely. What is the MOST LIKELY diagnosis a.Middle cerebral artery occlusion b.Petit mal epilepsy **** c.Migraine d.Subarachnoid haemorrhage Atypical migraine can present with hemisensory loss or hemiparesis ---Adams A young woman with anovulatory cycles for the long time is MOST LIKELY to develop ?which of the following a.Cervical cancer b.Endometrial Cancer c.Ovarian cancer d.Vaginal cancer e.Cancer of the Vulva

A schizophrenic woman thinks that she is perfectly well and denies any illness. She also refuses to ? take medication and thinks that she can talk with Angels. What is this called in Psychiatry

?????------ a.Lack of insight b.Overvalued idea ?c.Rejection Havila- yr comment d.Delusion ????-----e..Formal thought disorder

?patient presents with sudden rupture of extensor pollicis longus tendon,dx ??-----a) tendonities b) tenosynovitis Trick again ????-----c) RA ? What is the MOST COMMON cause of death after burn injury in Australia a.Shock b.Respiratory failure c.Cardiac failure d.?Renal failure A 14 years old girl has breast enlargement, normal growth of pubic and axillary hair but she is still ?not menstruating. Which of the following is CORRECT a.She is likely to start menstruating two years after the start of pubic hair growth b.She is likely to start menstruating two years after the start of axillary hair growth

c.She is likely to start menstruating within two years from the time of her breast budding. (*****( this one also correct .d..She is likely to start menstruating within two years from growth spurt ******* e.This is a case of delayed puberty A 16 years old girl presents with fever, headache and rash on her body. She also has ?profuse bleeding from all venipuncture sites. What is the MOST probable diagnosis a.Thrombocytopenia (b.'Disseminated Intravascular coagulation******( cooldude-U r wrong c.Henoch Schonlein Purpura d.Allergic reaction Meningococcal infection leading to DIC A neonate with cough and fever is found to be grunting. Chest X ray shows round lesions ?with little pleural effusion. Which of the following is the BEST the treatment ******a.Crystalline Penicillin b.Gentamycin Havila- your comment d.Amoxicillin ****e.Flucloxacillin A ten years old girl has a history of repeated episodes of hemiparesis from which she ?recovers completely. What is the MOST LIKELY diagnosis a.Middle cerebral artery occlusion b.Petit mal epilepsy ?????? c.Migraine d.Subarachnoid haemorrhage An adolescent boy complains of slight pain in the right knee which ***gets worse after exercise. On examination you find a lump on the tibia tubercle with slight tenderness. The boy can't remember if ?he has had any recent trauma. Which of the following statements is CORRECT a.Reassure that there is nothing wrong b.Biopsy should be done to exclude malignancy ----????something wrong- the boy has symptom c.Knee aspirate shows organism d. Osteochondritis is the most likely cause A two years old child presents with ***failure to thrive for the last 6 months and **right buttock wasting. He passes ***bulky stools 2-3 times a day. Which of the following is the ?MOST appropriate investigation a.C13 breath test ???----b.Duodenal biopsy c.Stool culture d.Stool microscopy ??---------------- e.Sweat test A diabetic mother gives birth to a child weight 4240 gm and with an Apgar score of 7/10. On examination you find cyanosis of his hands and feet and the child is jittery. Axillary temperature measure shows a reading of 37.2 C. His condition improved after meconium ?aspiration and 100% O2. Which of the following is the MOST LIKELY cause (a.Hypoglycaemia******** ( we are sure- cooldude b.Heart disease .c.Lung disease d.Hyperglycaemia

.e.His jaundice is caused by breast milk A ***young woman with **anovulatory cycles for the long time is MOST LIKELY to develop ?which of the following a.Cervical cancer (b.Endometrial Cancer ( age is older ********* c.Ovarian cancer d.Vaginal cancer e.Cancer of the Vulva A 52 years old ***obese post menopausal woman presents with **no signs of Menopause ?and **amenorrhoea. What could be the cause A Low oestrogen and Low FSH *****B High oestrogen and high FSH c. Normal oestrogen and high FSH d.High oestrogen and low FSH e.Low oestrogen and High FSH A 16 years old student asks for a prescription for contraceptive pill. She says she doesn't have ?sexual partner. Which of the following is the MOST APPROPRIATE management a. Oral contraceptive pill**** ( here in OZ-- sexually active since 11yrof age-- cool-dude-(follow her request (b.Minipill ( by the way what is that?-- haven't read c.Depot d.Oral contraceptive pill + condoms ?A pregnant woman in 1st trimester is found to have CIN III. What is your NEXT step a. Terminate the pregnancy b. Cone biopsy c.Hysterectomy help d.Colposcopy eObserve A pregnant woman in 1st trimester presents with skin dimpling over the right breast. .14 Examination and clinical tests reveals cancer of the right breast. Which of the following is ?your management a.Terminate the pregnancy b.Start radiotherapy (c.Wait till delivery and then start the treatment*** ( I can agree with cool-dude Which of the following will cause SEROTONIN syndrome if given together with SSRI like ?Fluoxetine EXCEPT a.L-tryptophan b.Haloperidol c.Moclobemide d. Chlorpromazine' e.Citalopram A schizophrenic woman thinks that she is perfectly well and denies any illness. She also refuses to ? take medication and thinks that she can talk with Angels. What is this called in Psychiatry

(a.Lack of insight *****( most likely

b.Overvalued idea c.Rejection d.Delusion **** e..Formal thought disorder A ten years old girl has a history of repeated episodes of hemiparesis from which she ?recovers completely. What is the MOST LIKELY diagnosis a.Middle cerebral artery occlusion b.Petit mal epilepsy c.Migraine i think hemiplegic migraine not sure d.Subarachnoid haemorrhage

A 70 years old woman had Upper GIB. She was on treatment with NSAID for knee pain which was stopped a few months ago. You do an endoscopy of upper Gl tract and find a duodenal ulcer with ?recent bleeding. What is the BEST management a.Omeprazol I.V. + Ampicillin + Metronidazole .b.Omeprazol I.V c.Highly selective vagotomy d.Vagotomy e.Ranitidine I.V. + Ampicillin + Metronidazole The treatment for NSAID induced ulcer includes giving PPI and if pain can not be tolerated give NSAID+PPI. No mention of giving antibiotics. --- Toronto notes All patients with proven acute or chronic duodenal ulcer and those with gastric ulcer who (are H pylori positive should be offered eradicaiton of H. pylori. (Davidson 20th p887 Omeprazole for healing of ulcer and amoxy+metro for eradication of H. pylori

A two years old child presents with failure to thrive for the last 6 months and right buttock wasting. He passes bulky stools 2-3 times a day. Which of the following is the MOST ?appropriate investigation a.C13 breath test *****b.Duodenal biopsy c.Stool culture d.Stool microscopy e.Sweat test Celiac dse does have failure to thrive, muscle wasting and flat buttocks. ----Nelson's pediatrics

A young woman with anovulatory cycles for the long time is MOST LIKELY to develop ?which of the following a.Cervical cancer b.Endometrial Cancer c.Ovarian cancer d.Vaginal cancer e.Cancer of the Vulva

Development of endometrial carcinoma is related to unopposed action of estrogen. It is (more likely to occur in women who are relatively infertile.(LJ 281

A young woman with anovulatory cycles for the long time is MOST LIKELY to develop ?which of the following a.Cervical cancer b.Endometrial Cancer c.Ovarian cancer d.Vaginal cancer e.Cancer of the Vulva I think I ignored the age factor here. So, now I think ovarian carcinoma should be a better !option here. Sorry .I am following your questions Bulimia .Please note that I have attached references to a lot of my answers Regarding your post op fluid therapy question(Bulimia) - I went through the AMC commentary you referred to. That was a different scenerio. A man who was dehydrated and had pyloric stenosis. This is not the same as post op fluid therapy. I request you to go through the perioperative and postoperative care from SCOTT before you make up your .mind

a lady came to you at 12 weeks pregnancy for antenatal check.Her 1st child was born with spina bifida.Which of the following investigation would not be useful in assesing the second ...baby

a-maternal triple or tetra test at 16-18 week b-amniocentesis for acetylcholine estrase at 11-13 weeks ?? c-USG for nuchal fold measurement at 11-13 weeks d-USG for spinal abnormalities at 16-18 weeks ?? e-Do chorion villous sampling at 8-10 weeks

Back to top gorani Guest

Posted: Fri Sep 29, 2006 1:02 pm Post subject: Spigelian hernia -------------------------------------------------------------------------------Spigelian hernia

A Spigelian hernia is an acquired ventral hernia through the linea semilunaris, the line where the sheaths of the lateral abdominal muscles fuse to form the lateral rectus sheath. Spigelian hernias are nearly always found above the level of the inferior epigastric vessels, and most often occur where the semicircular line - fold of Douglas - cross the linea semilunaris. Commonly, the patient is over the age of 50 years. Men and women are .equally affected The patient presents with pain that is localised to the hernial site and is aggravated by any movement that raises intra-abdominal pressure. Later, the pain becomes more dull, .constant, and diffuse A soft, reducible mass may be present in the lower abdominal area which disappears on pressure. When the mass is reduced, the hernial orifice can usually be palpated. Diagnosis is more difficult when the hernia dissects within the layers of the abdominal wall - internal and external obliques - or may be located at a distance from the linea semilunaris. .Ultrasound and CT scan may help to confirm the diagnosis Spigelian hernias have a high incidence of incarceration and should be repaired. Treatment .is by primary aponeurotic closure

Back to top gorani Guest

:Posted: Fri Sep 29, 2006 1:03 pm Post subject -------------------------------------------------------------------------------?patient presents with sudden rupture of extensor pollicis longus tendon,dx ?a) tendonities b) tenosynovitis ???c) RA A patient with cancer breast develop osteoprposis.what is the treatment a) bisphosphonate b) cyclical estrogen and progesterone c) continuous estrogen and progesterone increase diatery calcium 2000g / day You are called to review a patient who developed restlessness and difficulty breathing eight hours ?after thyroidectomy. What will you do FIRST .a. Endotracheal intubation b.Remove superficial sutures c.Remove superficial and deep sutures d.Salbutamol inhalation as patient probably has Asthma A 43 years old man was brought to the emergency department with severe upper abdominal pain and signs of shock. Physical examination reveals abdominal wall rigidity and guarding. Which of ?the following is the MOST LIKELY Diagnosis a.Perforated gastric ulcer b.Penetrating duodenal ulcer c. Mesenteric ischemia d. Acute pancreatitis A young male fell from a height but sustained minor injuries. After two hours he lost consciousness and was brought to you in Northern Queensland hospital with limited radiographic facilities by his friend. On examination you find that his pupils are fixed and dilated. What is our ?NEXT step .a.Arrange for transportation to another hospital by helicopter b.Give IV mannitol c Give IV corticosteroid d. d Burr holes

An elderly man came to see you with complaints of sudden pain in the lower back while lifting a heavy box. On examination you find that the lumbar spine has limited movement with pain in his lower back on movement. There are no neurological abnormalities. What is ?the NEXT investigation that you'll do a.X Ray of the lumbar spine b.CTScan c.MRI of the spine d.Lumbar puncture A 70 years old woman had Upper GIB. She was on treatment with NSAID for knee pain which was stopped a few months ago. You do an endoscopy of upper Gl tract and find a duodenal ulcer with ?recent bleeding. What is the BEST management a.Omeprazol I.V. + Ampicillin + Metronidazole .b.Omeprazol I.V c.Highly selective vagotomy d.Vagotomy e.Ranitidine I.V. + Ampicillin + Metronidazole

?Which of the following is MOST COMMON cause of acute pancreatitis ,a.Gallstones b.Cholecystitis c.Alcohol abuse d.Spicy food e.Gastroenteritis ? What is the MOST COMMON cause of death after burn injury in Australia ???a.Shock ???b.Respiratory failure c.Cardiac failure d.Renal failure PAED A 14 years old girl has breast enlargement, normal growth of pubic and axillary hair but she is still ?not menstruating. Which of the following is CORRECT a.She is likely to start menstruating two years after the start of pubic hair growth b.She is likely to start menstruating two years after the start of axillary hair growth .c.She is likely to start menstruating within two years from the time of her breast budding .d..She is likely to start menstruating within two years from growth spurt e.This is a case of delayed puberty

A 16 years old girl presents with fever, headache and rash on her body. She also has ?profuse bleeding from all venipuncture sites. What is the MOST probable diagnosis a.Thrombocytopenia b.'Disseminated Intravascular coagulation c.Henoch Schonlein Purpura d.Allergic reaction A 12 months old baby has fever. Recently, two other family members had an upper respiratory tract infection. On examination of the baby you find that his body temperature is 37.5 CTand chest auscultation reveals bilateral wheezing. What is the MOST LIKELY ?cause

a.Acute bronchiolitis b.Viral croup c.Bronchial Asthma d.Pneumonia e.Foreign body A neonate with cough and fever is found to be grunting. Chest X ray shows round lesions ?with little pleural effusion. Which of the following is the BEST the treatment a.Crystalline Penicillin b.Gentamycin d.Amoxicillin e.Flucloxacillin A ten years old girl has a history of repeated episodes of hemiparesis from which she ?recovers completely. What is the MOST LIKELY diagnosis a.Middle cerebral artery occlusion b.Petit mal epilepsy c.Migraine d.Subarachnoid haemorrhage The parents with their 10 years old child come to see you with complaints that the child has enuresis since birth. The child has no problems during the day time. Physical examination does not reveal any other abnormality. Which of the following statements is ?TRUE in more than 20 % of such cases a.He has chronic pyelonephritis b.He has congenital abnormalities of the urinary tract c.There is an associated family history .d.he has small urinary bladder e.It is associated with spina bifida occulta A 5 years old boy presents with vomiting every morning and morning headache for the last ?two weeks. What is the MOST LIKELY cause a.Meningitis b.Migraine c.Craniopharyngioma d.MeduJloblastoma e.Wilm's tumour An adolescent boy complains of slight pain in the right knee which gets worse after exercise. On examination you find a lump on the tibia tubercle with slight tenderness. The boy can't remember if ?he has had any recent trauma. Which of the following statements is CORRECT a.Reassure that there is nothing wrong b.Biopsy should be done to exclude malignancy c.Knee aspirate shows organism d. Osteochondritis is the most likely cause A 6 day old baby who is suspected to have Down's syndrome presents with non projectile bilestained vomiting for the last two days. On abdominal examination you find an olive shapedpalpable mass in the epigastrium. Which of the following is the MOST LIKELY ?diagnosis a.Volvulus .b.Duodenal Atresia c.Intussusception d.Malabsorption A two years old child presents with failure to thrive for the last 6 months and right buttock

wasting. He passes bulky stools 2-3 times a day. Which of the following is the MOST ?appropriate investigation a.C13 breath test b.Duodenal biopsy c.Stool culture d.Stool microscopy e.Sweat test A diabetic mother gives birth to a child weight 4240 gm and with an Apgar score of 7/10. On examination you find cyanosis of his hands and feet and the child is jittery. Axillary temperature measure shows a reading of 37.2 C. His condition improved after meconium ?aspiration and 100% O2. Which of the following is the MOST LIKELY cause a.Hypoglycaemia b.Heart disease .c.Lung disease d.Hyperglycaemia .e.His jaundice is caused by breast milk A six years old boy presents with delayed development of speech after a period of normal development. On examination you find that he avoids eye contact and reveals a history of ?unusual liking for dinosaurs. Which of the following is the MOST LIKELY diagnosis a.Autism b.ADHD c.Deafness Obs A young woman with anovulatory cycles for the long time is MOST LIKELY to develop ?which of the following a.Cervical cancer b.Endometrial Cancer c.Ovarian cancer d.Vaginal cancer e.Cancer of the Vulva ?In which of the following conditions you will find DECREASED amniotic fluid a.Foetus's Bladder neck obstruction of the foetus b.T.O fistula c.Rhesus incompatibity d.Multiple pregnancy A 52 years old obese post menopausal woman presents with no signs of Menopause and ?amenorrhoea. What could be the cause A Low oestrogen and Low FSH B High oestrogen and high FSH * c. Normal oestrogen and high FSH d.High oestrogen and low FSH e.Low oestrogen and High FSH A 16 years old student asks for a prescription for contraceptive pill. She says she doesn't have ?sexual partner. Which of the following is the MOST APPROPRIATE management a. Oral contraceptive pill b.Minipill c.Depot d.Oral contraceptive pill + condoms .e.Call her parents ?A pregnant woman in 1st trimester is found to have CIN III. What is your NEXT step

a. Terminate the pregnancy b. Cone biopsy c.Hysterectomy d.Colposcopy e.Observe A pregnant woman in 1st trimester presents with skin dimpling over the right breast. .14 Examination and clinical tests reveals cancer of the right breast. Which of the following is ?your management a.Terminate the pregnancy b.Start radiotherapy c.Wait till delivery and then start the treatment d.Surgery A 19 years old female comes to your clinic for consultation. She has never had periods. On examination her breast development is normal. Pubic and axillary hair growth is also normal. The development of her genitals is also in normal range. What is the MOST LIKELY cause of her ?amenorrhea a. Turner's syndrome b. Prolactinoma c. Absent uterus d. Pituitary lesion e. Lesion in Hypothalamus A 42 years man who is a patient of yours is arrested for attacking his wife in a supermarket. The police come to you and ask you to write a report about this patient. ?Which of the following is TRUE for good practice a.You will write a report about the patient's bad mental state b.You will tell the patient never to come to your surgery again .c.You will write a general, unbiased and balanced report about health of the patient d.You will tell the police that you don't want to give any reports e. Arrange for a meeting with the patient Which of the following will cause SEROTONIN syndrome if given together with SSRI like ?Fluoxetine EXCEPT a.L-tryptophan b.Haloperidol c.Moclobemide d. Chlorpromazine' e.Citalopram In Australia , almost every year there are several incidences of bush fire. Usually it is caused by ?young people and teenagers. Which of the following is TRUE . a. Juvenile pyromania is the main cause of fires in Australia b. It is due to accidental fire caused by youngster who get scared after the fire starts to.spread uncontrollably and they run away c.It has no serious consequences .d.Youngsters like to ignite and play with fire e.It is done to hide crimes A schizophrenic woman thinks that she is perfectly well and denies any illness. She also refuses to ? take medication and thinks that she can talk with Angels. What is this called in Psychiatry

a.Lack of insight b.Overvalued idea

c.Rejection d.Delusion e..Formal thought disorder

Back to top ElliEL Guest

:Posted: Sat Sep 30, 2006 12:51 pm Post subject -------------------------------------------------------------------------------Clinical Exam, May 20th , 2006 Sydney

.Febrile Convulsion talk to pt.1

.Mid-cycle bleeding on OCP talk to pt.2

Carpal tunnel syndrome examination.3

PHOTO lump on the neck find primary site,/examination/DDx.4

Benzodiazepines dependency talk to pt / SE.5

.Delirium Examine pt / MS/ Mx.6

Gastrointestinal system examination alcoholic pt.7 .

Headache/Meningitis Take History/Examine the pt/ DDx.8

Enuresis talk to parents.9

Pregancy & Pneumonia pt on Doxycycline History/Examination/Mx.10 Change Doxycycline to Erythromycin (Safe or relatively safe during the pregnancy: /Amoxycillin/Ampicillin/Cephalosporine/Erythomycin/Rifampicin (Trimethoprim/Methyldopa/ - Beischer , p 105

Pain relief in labour talk to pt.who is 20/40 pregnant; P0G1.She is very concerned.11 (about pain in labour. ( Beischer, p. 411 Ask why she is worried about pain? Any particular reason? What is her understanding .about pain relief during the labour ? CS / normal labour Discuss pharmacological, sedative ( Diazepam max 20 mg ) and hypnotics, tranquillisers ( major: phenothiazines - chlorpromazine, promethazine, or minor: diazepam ), ( analgesics (non-narcotic: aspirin, paracetamol, codeine; narcotic: pethidine 50-100 mg IM; Morphine 10-15mg IM; SE: respiratory depression, nausea & vomiting, tachycardia, postural hypotension and delayed gastric emptying). Pethidine is preferred and usually given IM 100 mg; it is given by I>V route in some centres either intermittently in small doses 25mg over 1-2 minutes every 1-3 hours or self administered by the women ( PCA patient controlled analgesia)The usual duration of narcotics drugs is 2-4 hours. Preferably such drugs should not be administered within 1 hour of delivery and if it is the baby should be given Naloxone ( 0.02mg) IM immediately after birth. During this period inhalation or regional block are preferable; Narcotics are CI in women receiving MAO .inhibitors The use of sedatives, hypnotics and minor tranquillisers varies considerably in obstetric practice in different communities. Many practitioners rely on single injection of Pethidine 100 mg IM with either prochlorperazine (Stemetil) 12,5 mg or metoclopramide HCL .(Maxolon) 10 mg epidural analgesia for pain relief in labour Inhalational analgesics: Nitrous Oxide (NO) in concentration of 50% is equivalent to 15 mg of Morphine. Nitrous oxide/oxygen given by mask on demand; It is useful for analgesia during the late first stage and second stage (i.e. during delivery) in a 50-70% concentration with the oxygen. In their late fist stage of labour the women sleeps between contractions but rouses and breathes on the mask when the contraction begins. Advantages: safety, reasonable analgesia, on-toxic and non-irritating to respiratory

passages, quickly absorbed and eliminated, uterine contractions unaffected (no prolongation of labour or postpartum atonicity), vomiting rare; Disadvantages: requirement of machine to deliver the gas and disorientation of some women ;Occasionally, women will not use the mask because of felling of suffocation or because of .disorientation .Mention : Local analgesia/Epidural/Paracervical block. Discuss if you have time Epidural nerve block: the local analgesic is injected extrathecally into epidural space; the extent of analgesia is determined largely by the volume and concentration of drug injected; to control pain of late labour, a block of segments T10 L1 is adequate; for Caesarean section a higher block T8 or even T6 is needed; low dose epidural analgesia (0.125 Bupivacaine) increases mobility in labour and abolish the urge to push (pushing reflex) but not ability to push so that normal spontaneous delivery is still possible. Although epidural analgesia is associated with a higher incidence of forceps delivery it must be recognised that women who require epidural analgesia for pain relief are more likely to require forces delivery, usually because of dystocia resulting from .occipitoposterior position Indication for epidural: pain relief; symptomatic heart disease the pain and distress of labour is relieved, however extreme care is necessary if women has a fixed cardiac output (e.g. mitral or aortic stenosis, pulmonary hypertension); hypertensive disorders (preeclampsia/eclampsia, chronic hypertension), cerebrovascular disease (intracranial aneurism and angioma are usual indication); incoordinate uterine action (elimination of pain and fear often help normalize the activity); breech and twin delivery( opinion is divide on the value of epidural analgesia in these conditions: the relaxation of pelvic floor is advantageous but the lack of stimulus for the woman to push can lead to a higher interference rate; Contraindications for epidural analgesia: opposition by the woman; Recent antepartum haemorrhage( because compensatory vascular reflexes are partly abolished, sudden haemorrhage may produce marked hypotension; suspected cephalopelvic disproportion; sepsis ( in proposed area of operation);sensitivity to local analgesic agents; DIC ( sever preeclampsia - predispose to haemorrhage in the epidural .( space Complication of epidural analgesia: toxicity (from overdosage and/or intravascular injection; hypotension; uterine hypotonia- occurs in 5-10% of women in early labour but usually activity return in 15-30 minutes; collapse (with hypotension and apnoea may be due to toxic effect of the drug); headache (may result from accidental puncture of the dura and leakage of CSF; this can be treated by insertion of epidural at higher level; after the delivery Hartmann solution is infused into epidural catheter; woman should be nursed flat, adequately hydrated aspirin, codeine, paracetamol ; loss of sensation may occur in bladder ( causing over distension);loss of bearing -down reflex, resulting in higher incidence of assisted delivery; backache Majority of the above complications are rare, however they need experienced personnel in this type of analgesia; Advantages of epidural analgesia: woman alert, cooperative reduced risk of inhalation of vomitus; Disadvantage of epidural analgesia: need for skilled personnel, the occasional serious complication, tendency to slow the labour (particularly second stage) increased incidence of operative delivery; intraoperative nausea, vomiting .or restlessness in some women In Caesarean section, regional analgesia has a number of advantages over general anaesthesia participation of the parents in the birth, better postoperative pain relief, early mobility, less fever, blood loss is 50 % less than with general anaesthesia. Disadvantages are that the method may fail, the woman feels pain and may require a general anaesthetic; it is technically more difficult to extract the infants head from the uterus, especially if a Pfannestiniel incision is used, because abdominal muscles are not ;completely relaxed Paracervical block: LA (6-10 mg of 0.25 Bupivacaine) injected beneath the mucosa of ;vagina in each lateral fornix. Acupuncture :Incidence of serious neurological complications due to epidural analgesia .Paraplegia, a severe complication to epidural analgesia rare Because of the rarity of permanent neurological damage resulting from epidural analgesia, it is difficult to estimate its incidence. In a combined series of more than 50 000 epidural anaesthetics, only three patients suffered permanent leg weakness (0.006% - American (Journal of Anaesthesia , Kane 1981

Obese patent / BMI 45 counselling.12

Dizzines/Vertigo 60 yo history/DDX.13

CHEST PAIN: History/ (Pericarditis) DDx: MI/Angina/PE/Aorta dissection .14 year-old train driver, c/o chest pain. From the history: pain for the last 6 hours,-50 constant, 8/10, radiates to the back (alleviating/aggravating factors?). Non-smoker, had history of chest infection a 3/52 ago. Vital signs pulse 96 regular, BP 140/97, Temp. 37.4 C. Physical exam constant noise during auscultation? Not murmur; probably pleural rub ACUTE PERICARDITIS: chest pain, which may be intense, mimicking acute MI, but characteristically sharp, pleuritic and positional (relived by leaning forward) worse on inspiration; fever and palpitations are common Common causes: idiopathic; infections (particularly viral influenza, Coxsackie A/B) acute MI, metastatic neoplasm, radiation therapy for the tumour (up to 20 years earlier), connective tissue disease (SLE, RA) drug reactions (procainamide, hydralazine), .(autoimmune following heart surgery of MI several weeks/months later (Dresslers sy Physical Examination: rapid or irregular pulse, coarse pericardial friction rub which may .vary in intensity and is loudest with pt. sitting forward Laboratory/ECG: Diffuse ST elevation (concave upwards) usually present in all leads except aVR and V1.CXR: increased size of cardiac silhouette if large (> 250 ml) pericardial effusion is present, with water bottle configuration ECHO: most sensitive test for ;detection of pericardial effusion which commonly accompanies acute pericarditis Treatment: Aspirin 650 975 mg qid or NSAID (e.g. indomethacin 25 75 mg qid); for severe refractory pain, Prednisone 40-60mg daily and tapered over several weeks or months. Anticoagulants are relatively contraindicated in acute pericarditis because of risk (of pericardial haemorrhage. ( Harrison, p583

Intusussepction.15

Intermitent claudications.16

Back to top NadiaAl Guest

:Posted: Sat Sep 30, 2006 12:57 pm Post subject -------------------------------------------------------------------------------AMC MCQ EXAM 2004 Melbourne Nadia recollection paper (denotes STAR Questions ( 60 questions - (*) ( ? P - denotes PILOT Questions ( probably will appear as (*) in next exam

:All of the following drugs can cause gynecomastia EXCEPT.1 A/ spironolactone B/ digoxin C/ methyldopa D/ furosemide /E Which of the following joints is not included in rheumatic arthritis and is more common in .2 ?osteoarthritis A/ carpometacarpal joint of the thumb P B/ temporomandibular joint C/ cervical spine /D /E :All of the following statements about intravenous solutions are true EXCEPT .3 A/ normal (0.9%) sodium chloride solution has an approximately 150 mmol/l Na + 150 mmol/l Cl B/ Hartman solution is sodium lactate which consist sodium 135 mmol, calcium 2 mmol and some potassium C/ if 1 litre of Hartman solution is given in 24 hours it will be sufficient for daily potassium (*) requirement D/ N/5 contains 30 ml Cl and 30 ml Sodium

 E/ 5 % dextrose

:Hand X ray, carpal bones, fractured scaphoid. Which of the following is correct.4 A/ it will result in avascular necrosis of distal pole B/ internal fixation is best treatment because of malunion C/crepe bandage from elbow to the wrist (*) D/immobilization from elbow to the end of the thumb for 6 weeks E/ plaster from elbow to the wrist Photo of leg from AMC book ( SU-C130 ) page 262.5 A/ chronic infection B/ necrotizing fasciitis (*) C/chronic venous hypertension D/arterial insufficiency /E

Patient with a fourth attach of gout in the last 2 years. Knee is swollen, painful. What is.6 ?most appropriate management A/ allopurinol in the first 24 hours (*) B/indomethacin 150 mg in the first 24 hours C/hydrocortisone intraarticular D/colchicine /E

:Urticaria can be associated with all of the following EXCEPT.7 A/ vasculitis P B/aspirin sensitivity /C /D /E ?Which cause shock in gall-bladder sepsis .8 A/staphylococcus aureus B/Pseudomonas aeruginosa C/Enterococcus faecalis D/ Escherichia coli P /E

Patient with severe chest pain, radiating to his back. CXR show widened mediastinum,.9 ?diastolic murmur ECG acute inferior M.I. What is appropriate Mx

A/give streptokinase B/give aspirin plus IV morphine C/Give morphine, B-blocker and arrange for T O E /D /E

?What is most likely to become chronic.10 A/Hepatitis A (*) B/ Hepatitis C C/ Hepatitis B D/ EBV /E : Spinal cors lesion at level L4 L5.11 A/ absent knee jerk B/ absent ankle jerk C/ lost of dorsiflexion of the ankle D/ lost of sensation sole of the foot /E

Patient with chronic cardiac failure on Captopril for hypertension. On long-term .12 .Chlorothiazide A/ sodium is reduced B/ K is decreased C/cholesterol is increased /D /E Patient 3 days after cranial surgery. Na 117, Plasma osmolarity 205 Urine osmolarity.13 825 A/ D . III (*) B/ S I A D H C/water intoxication /D /E :All of the following are features of Hypercalcemia EXCEPT .14 A/ depression B/ diarrhoea C/polyuria D/ polydipsia

/E

:Which of the following is the most urgent requirement for the patient in D K A.15 A/ infusion of sodium bicarbonate B/ 5% dextrose (*) C/ infusion of normal saline D/ glucagon Builder come to ER with 15 % of burns, his weight is 80 kg. Which of the following fluid .16 ?replacement will be required for the first 24 hours A/2 L Hartman + 2 L blood B/ 2 L Nacl + 1 L blood C/ 3 L Hartmann + 2 L 5 % Dextrose D/ 3 L Hartmann + 2 L blood /E :After splenectomy for hereditary spherocytosis all can be expected EXCEPT .17 A/ persistence of anaemia B/ persistence of spherocytes C/ normal RBC life span see Merck P 876 D/reticulocytosis /E :Which of the following is not feature of Mycoplasma pneumoniae .18 A/ headache B/pleuritic pain P C/temperature D/ myalgia E/cough Which of the following drugs if stopped during the operation will cause intra operative.19 ?hypertension A/clonidine B/methyldopa C/enalapril D/propranolol E/felodipine :Peripheral pulse will be increased in all of the following EXCEPT .20 A/ A V fistulae B/Paget disease of the bone C/V S D D/patent ductus arteriosus E/ASD

:Q about Pseudobulbar palsy. All is associated EXCEPT .21

A/ gag reflex ( vagus ) P /B /C /D Patient playing game, squash court suddenly pain in ankle, no planar flexion, dorsal.22 :flexion limited and painful A/ rupture of medial ankle ligament B/ complete rupture of Achilles tendon C/ rupture of medial head m. solei /D /E Well established scientist was on overseas scientific meeting where he should give .23 lecture. Suddenly after bout of diarrhoea, and profound humiliation he left meeting. He start to change his dresses at night, wandering through the streets, his behaviour than change as well. In the morning he is again OK. He realised something is wrong with him and after a few