AMC MCQ

Wednesday, November 4, 2009 MCQS WITH ANSWERS PSYCHIATRY 1.A lady with a previous divorce now comes to you with a seductive behaviour a. Narcistic b. Histrionic c. Borderline 2.In Australia bush fire are common either accidentally or some people lighting fire deliberately. Which is true regarding pyromaniacs? a. Done for notoriety or publicity b. To hide their acts c. As they like to play with fire d. Set fire and get panic attacks e. For satisfaction 3.Depersonalization may occur in a. Schizophrenia b. Ecstatic religious experience c. Depression d. Post traumatic disorder e. All of the above 4.A middle aged lady present to you with nausea dyspepsia abdominal distention. distention. She had a past history of going to many doctors and being treated for many disorders. she has been treated by a rheumatologist for aches and pains, cardiologist for her palpitations and gave her propanolol without improvement , a neurologist for her epilepsy. On examination you find a tense anxious woman in spite of her daily dose of benzodiazepine. There are scar from appendectomy and hysterectomy operations. What is the most appropriate diagnosis? a. Munchausen syndrome b. Conversion disorder c. Hypochondriasis d. factitious disorder, e. Neurotic anxiety 5.Many psychopharmacologic substance are lipophilic the advantage is a. better absorbed with meals b. promptly binds with with free fatty acids c. more resistant to be metabolized by thae liver d. the pass rapidly to the brain and to the blood e. a drug which has a long life and needs to be

given once a day daily 6. Lithium: a. loses it effectiveness over the time b. is non addictive c. works better in women than men d. interaction with NSAIDS 7. morbid jealousy a. alcoholism b. schizophrenia c. depression d. obsessive compulsive e. mania 8. A 40 yr old male school teacher who has recently separated separated from his wife was; prescribed imipramine 25 mg for his depression. He had a road accident in which he hurt his child. He was admitted to hospital for taking an overdose of imipramine with alcohol. He does not give consent to go for psychiatric counselling or to be admitted hospital for further treatment. Your next step in the management of this patient is: a. Ask him to go to alcoholics anonymous b. Increase the dose of Amitriptyline to 125 mg and send him home c. Change to another drug d. Retain him in the hospital against his using he Mental health act e. Contact his wife and try to persuade her to t o return to him f. Alcohol counselling 9.A 46 year old widow consults you for advice on management of insomnia, indifferent appetite; recent weight loss of 5 kg., headaches and tearfulness. 4 weeks ago her only son died after subarachnoid haemorrhage. Since then she had experienced auditory hallucination, of her son's voice calling out her name and had felt his presence in their living room. Your initial management of this woman would involve: a. Grief counselling and a brief course of benzodiazepine b. Grief counselling and a brief course of TCA c. Grief counselling and a brief course of

phenothiazine‟s

d. Referral to psychiatrist e. Referral for hospitalisation and treatment 10.Depersonalization 10.Deperso nalization may occur in: a. schizophrenia b. ecstatic religious experience

c. depression d post traumatic disorder e.A11 of the above 11. A 36 yr old engineer is due to give an speech soon and is reluctant to be exposed to people. At the same time, he does not want to sign cheques or write anything in public. He also thinks his, boas is controlling what he is doing although he knows that there is no motive for that because he is a very good worker. He realizes there is no reason to act this way, Lately he has been avoiding to go to the canteen with his mates and takes alcohol to cope with the situation. What he is suffering from? a. Social phobia b. agoraphobia d. antisocial personality disorder e. panic disorder f. paranoid disorder 12. Deinstitutionalisation means: a. Transferring a patient from a psychiatric hospital to a community based facility. b . Put him in prison hospital hospital c. discharge the patient to a nursing home d. Put patient in a psychiatric hospital e. psychiatric patients are not permitted to vote 13.Lithium: a. loses its effectiveness over the time b. Is non-addictive c. works better in women than men d. Interaction with NSAIDS causes increase in lithium levels e. Lithium toxicity 14.Cognitive therapy has good results in: a. depression b- chronic pain c. social phobia d. bulimia e. all of the above 15. Many psychopharmacologic substance are lipophilic. The advantage is: a. better absorbed with meals b. promptly bind to free fatty acids c. more resistant to be metabolised by the liver they pass rapidly to the blood and to the brain e. a drug has a long life and needs to be given once a day only 16. Psychiatric treatment in women is more commonly found in: a. first trimester of pregnancy

b. second trimester c. third trimester d. puerperium e.6 weeks after the first control 17.Regarding depression, depression, what is true? a. onset in winter, disappear in summer b. -onset in autumn, disappear in summer c. onset in summer; disappear in winter d. onset in summer, disappear in autumn e. onset in spring, disappear in winter 18. Despite obvious to the contrary, a 16 w old female with anorexia nervosa, thinks she is overweight. This is an example of : a. delusion b. obsession c. over valued idea d. rumination e. hallucination 19. A 35 year old female secretary, unmarried, complains of feeling of mass or lump on her neck : a. psychological (Globus Hystericus) b. inflamed tonsils c. lingual thyroid d. hyperthyroidism e. goitre 20.In generalized anxiety disorder, what Will develop in the next follow : a. Schizophrenia b. bipolar manic depression. depressive illness mania phobia. 21. Using the WHO criteria, what is the most common symptoms of schizophren schizophrenia? ia? a. Flat affect b. Auditory Hallucination c. Visual hallucination d. Lack of insight e. Suicidal ideation 22. Exposure to stimuli and response prevention is the treatment of a. Obsessive-compulsive disorder b. Agoraphobia c. Depression d. Bipolar manic depression e. Schizophrenia 23.Morbid jealousy, associated with: a. alcoholism b. schizophrenia

c. depression d post traumatic disorder e.A11 of the above 11. A 36 yr old engineer is due to give an speech soon and is reluctant to be exposed to people. At the same time, he does not want to sign cheques or write anything in public. He also thinks his, boas is controlling what he is doing although he knows that there is no motive for that because he is a very good worker. He realizes there is no reason to act this way, Lately he has been avoiding to go to the canteen with his mates and takes alcohol to cope with the situation. What he is suffering from? a. Social phobia b. agoraphobia d. antisocial personality disorder e. panic disorder f. paranoid disorder 12. Deinstitutionalisation means: a. Transferring a patient from a psychiatric hospital to a community based facility. b . Put him in prison hospital hospital c. discharge the patient to a nursing home d. Put patient in a psychiatric hospital e. psychiatric patients are not permitted to vote 13.Lithium: a. loses its effectiveness over the time b. Is non-addictive c. works better in women than men d. Interaction with NSAIDS causes increase in lithium levels e. Lithium toxicity 14.Cognitive therapy has good results in: a. depression b- chronic pain c. social phobia d. bulimia e. all of the above 15. Many psychopharmacologic substance are lipophilic. The advantage is: a. better absorbed with meals b. promptly bind to free fatty acids c. more resistant to be metabolised by the liver they pass rapidly to the blood and to the brain e. a drug has a long life and needs to be given once a day only 16. Psychiatric treatment in women is more commonly found in: a. first trimester of pregnancy

b. second trimester c. third trimester d. puerperium e.6 weeks after the first control 17.Regarding depression, depression, what is true? a. onset in winter, disappear in summer b. -onset in autumn, disappear in summer c. onset in summer; disappear in winter d. onset in summer, disappear in autumn e. onset in spring, disappear in winter 18. Despite obvious to the contrary, a 16 w old female with anorexia nervosa, thinks she is overweight. This is an example of : a. delusion b. obsession c. over valued idea d. rumination e. hallucination 19. A 35 year old female secretary, unmarried, complains of feeling of mass or lump on her neck : a. psychological (Globus Hystericus) b. inflamed tonsils c. lingual thyroid d. hyperthyroidism e. goitre 20.In generalized anxiety disorder, what Will develop in the next follow : a. Schizophrenia b. bipolar manic depression. depressive illness mania phobia. 21. Using the WHO criteria, what is the most common symptoms of schizophren schizophrenia? ia? a. Flat affect b. Auditory Hallucination c. Visual hallucination d. Lack of insight e. Suicidal ideation 22. Exposure to stimuli and response prevention is the treatment of a. Obsessive-compulsive disorder b. Agoraphobia c. Depression d. Bipolar manic depression e. Schizophrenia 23.Morbid jealousy, associated with: a. alcoholism b. schizophrenia

c. depression d. obsessive compulsive e. mania 24.WOF may be treated with ECT a. puerperal depression b. catatonic schizophrenia c. mania d. acute schizophrenia e. all of the above 25.A 1 yr old child of normal intelligence becomes withdrawn and shows deterioration in his school work. What is most likely: a. schizophrenia b. response to stress *in the family c. normal variance of adolescence d. Migraine 26. Anorexia nervosa is characterized characterized by all of the following except. 1. 90% of those affected are females 2. raised FSH is pathognomonic 3. not eating or recognizing hunger 27. Fluoxetine is a new antidepressant unrelated to TC.A but with similar pharmacologic action. What is its mechanism of action? a. inhibits uptake of dopamine b. inhibits uptake of norepephrine c. inhibits uptake of serotonin d. inhibit uptake of epinephrine 28.Apatient maintained on lithium li thium carbonate was given an NSAIDS and developed then Most likely explanation for this : - lithium toxicity - toxicity to NSAIDs 29. In married couple, the most likely cause of inhibited sexual excitement is? a. fear of pregnancy b. marital discord c. empty nest syndrome d. organic disorder 30.A Malaysian university student who is working as a waiter, whose girlfriend went home to attend her father's funeral became irritable, restless and unable to sleep. He complains that his companions are talking behind his back and plotting against him what is your diagnosis? a. reactive psychosis b. grief reaction c. onset schizophrenia

d. suspicious cannabis e. panic psychosis 31. A 45 yr old salesman comes to you with complaints of difficulty of getting to sleep, waking up with nightmares & loss of weight. What is your diagnosis'? - anxiety - depression 32. The most common cause of vaginismus : -- Phobia - schizophrenia 33. In borderline personality. What is correct? a. antisocial with difficulty in establishing a relationship b. histrionic personality c. social withdrawal d. identification problem – e. tendency to self harm 34. What is correct of obsessive rumination? a. compulsive hand washing b. repetitive, persistent sexual fantasy c. 35. A 35 yr old man maintained on lithium was admitted for an infection. HIV test taken and done without his consent turned up positive. What is correct in this case? a. stop lithium and start AZT b. Tell the patient he has AIDS and extract a history of his sexual contacts/partners c. It is unlawful to do the test t est without consent and pre treatment counselling d. Inform the staff of the patient condition 36. A 65 yr old Greek lady living in Australia since 34 yrs ago has been living alone. She now seems to answer voices and does strange things. The most likely a. paranoid delusions b. migrant psychosis c. Capgras syndrome d. Paraphilia e. Frigoli 37. A 23 yr old male unemployed is complaining about his nose. He says that he can't get a good job because of his nose. He He also said he can't can't get a girl friend , and is demanding about a reduction of his nose. The doctors an opinion is that the nose looks normal. What is your management? a. refer to p1'astic surgeon b. refer to psychiatry

d. try a short course of... e. explain him very gently that his nose looks normal and try to find out what social causes and difficulties about his work. 38. What is delusion? a. False Belief b. False thought c. Sexual Fantasy 39. Most appropriate re :post partum psychosis is:a. family counselling b. ask mother to stop breastfeeding c. admit to hospital d. psychiatric treatment to the mother e. treat and send home 40. A 85 YO old man with progressive loss of memory for recent events, unable to do any calculations is disoriented for time, WOF is correct? 1. frontal lobe tumour 2. Alzheimer‟s 3. Multi infarct Dementia 4. Due to old age 41. A young girl with running nose; diarrhoea. sweating; lacrimation, and abdominal pain. WOF is the cause'? a. heroin withdrawal b. cocaine c. LSD d. marijuana e. amphetamine 42. Endogenous depression. WOF is true? a. Early morning waking b. Difficulty in initial sleep c. Dreams with content involving death patient d. Somnolence in the early part of day e. None of Above 43. Basis of Dopamine theory of Scz: a. Phenothiazine can cause Parkinson like syndrome b. Amphetamine can cause schizophrenia c. Anticholinergic drug can cause delirium. c. Tricyclic Antidepressants have anticholinergic effects. d. Imipramine helps in obsessive neurosis. 44 Acute alcoholic hallucination can be differentiated from delirium tremens by the fact that: A. It occurs following ingestion of small amount of

ethanol whereas DT is a withdrawal syndrome. c. Unilateral tinnitus is pathognomic of alcohol hallucination. d. Unilateral auditory hallucination is path gnomic of alcoholic, hallucination. e. The sensorial remain clear despite the presence of terrifying auditory hallucination. f. The hallucination of alcoholic is visual and unpleasant. 45. WOF is character characteristic istic of schizophrenia schizophrenia'? '? a auditory hallucination b. Depersonalisation d. antisocial behaviour e. flight of ideas f. all of the above 46 A 70 yr old male taking Aldomet for hypertension for the last 10 Years starts to isolate himself and is suffering from deafness: He feels that people are speaking about him. What is most likely diagnosis: a. Symptoms of Aldomet b. reaction to deafness c. atherosclerotic dementia d. senile dementia e. senile paraphrenia

MEDICINE 1. In dislocation of shoulder, which nerve is liable to be injured? i njured? a. Radial b. Axillary c. Musculocutaneous d. Ulnar e. Brachial plexus 2. Which of the following is likely to damage an artery? a. Anterior Dislocation shoulder b. Posterior dislocation shoulder c. Anterior dislocation hip d. Posterior dislocation hip e. Posterior dislocation knee 3. In Colles Fracture, the distal segment is displaced: a. Backwards and ulnarwards b. Backwards and radially c. Forwards and ulnarwards d. Forwards and radially e. Minimally displaced 4. An 18-month-old is brought to you by the

mother for breast enlargement. Tanner 3. No pubic hair or axillary hair is seen. No other abnormality is seen. What is your diagnosis? a. Precocious puberty b. Idiopathic thelarche c. Congenital adrenal hyperplasia d. Breast tumour e. Mastitis 5. A 21-year-old child is brought to you for having loose motions for 3 days. The stool contains undigested food material. No vomiting. Thriving well. What is he suffering from? a. Cystic fibrosis b. Coeliac disease c. Gastroenteritis d. Toddlers diarrhoea e. IBS 6. A large man presents with big face broad hands thick and oily skin and hoarse voice. What is the initial investigation of choice? a. GTT + GH b. Insulin challenge test + GH c. GH+ cortisol d. GH e. GTT 7. Regarding heparin induced thrombocytopenia, what is true? a. Purpura b. Joint bleeding c. Ecchymosis d. Thrombosis e. Hematuria 8. Regarding ADHD, what is correct? a. Age 5-7 years b. Reading difficulties c. Social withdrawal d. Females affected more than Males e. Prevalence is 15% 9. All the following can cause dysphagia except: a. Oesophageal cancer b. Achalasia c. Oesophageal varices

d. Barrett‟s oesophagus

e. Hiatus hernia 10.A 6 week old is brought to you for not having passed motion for last 4 days. He has been feeding well, and is gaining weight. Otherwise well and active. What is the most probable explanation?

a. Hirsprung‟s disease

b. Normal variant c. Hypothyroidism d. Acquired constipation e. Foreign body 11. A man returns after a trip to India. Now has 3 days diarrhoea with blood in stools. Looks run out and dehydrated. Noted to have fever. What is most correct? a. Giardia infection b. Amoebiasis c. E. coli gastroenteritis d. Viral diarrhoea e. Cholera 12. In a 40 years old lady, all the following may be the cause of menorrhagia except: a. Hormonal response to uterus b. Subserous fibroid c. Intermural fibroid d. Adenomyosis e. Endometriosis 13. 3 month old comes with unilateral eye discharge. What is the most possible cause: a. Chlamydia infection b. Gonococcus c. Ophthalmia neonatorum d. Blocked nasolacrimal duct e. Normal variant *14. A 6-month-old presents with SOB. There was a birthday party at home yesterday. On examination, child is wheezing. What is most initial investigation? a. Sweat test b. Bronchogram c. CXR d. Inspiratory and Expiratory Rontogram e. PEFR measurement 15. A mother brings her 3-year-old baby girl with unilateral nasal discharge off and on for last 3 months. Secretion is foul smelling and at times copious. Baby is uncooperative. What is the initial investigation of choice? a. CXR b. indirect laryngoscopy c. Examination under GA 16. A 6-year-old girl wakes up at night c/o sever pain in her calves. Mother rubs her calves and she feel fine, goes to sleep. This has been happening for a number of days now. At daytime she is active and playing. All of the following are true except:

a. Ca and CK will be abnormal b. No investigations are needed c. Family Hx will be positive d. Reassurance is the treatment. 17. Which vaccination should not be given to a child who is under remission on chemotherapy for CLL? a. Polio b. MMR c. HiB d. DPT 18.Solitary mobile carcinoma breast lump. No axillary lymphadenopathy. Which of the following is a prognostic marker? a. Age > 45 b. Neu2 / HER oncogene status c. Oestrogen level 19. All can occur with chronic limb ischemia except: a. Great Toe gangrene b. Pallor c. Ulcer on medial side of leg above malleolus d. Rest pain e. Intermittent claudication *22. 40 year old with acute painful testis:* a. Varicocele b. Hydrocele c. Epididymoorchitis d. Torsion e. Tumour 23. WOF is true regarding a 2cm kidney stone in the pelvis seen in KUB examination.: a. Expectant treatment is right b. It is a urate stone c. Lithotripsy d. Open surgery 24. Patient can’t dorsiflex or evert his foot. What is wrong? a. L4 b. L5 c. Tibial nerve d. Peroneal nerve e. Sciatic nerve 25. Body dysmorphia is seen in AOF except: a. Anorexia nervosa b. Acromegaly c. Non dominant parietal lobe lesion d. Dominant parietal lobe lesion e. Narcissistic personality disorder 26. 6 year old child comes to you with up rolling

if eyes, neck stiffness, protruded tongue, rigid body and face tilted to one side. Had vomiting and was being treated by the GP. What is the cause?

a. Huntington‟s chorea

b. Epilepsy c. Reaction to metoclopramide d. Gastritis 27. Lung cancer associated with non-smokers: a. Sq. cell Ca. b. Adenocarcinoma c. Small cell Ca. d. Oat cell Ca. e. Large cell Ca. 28. All of the following cause gynecomastia except : a. spironolactone b. cimetidine c. digoxin d. alpha methyldopa e. labetolol 29.A young female presents with 24 hour h/o sore throat. Later she develops proteinuria and some hematuria. What is the most probable cause? a. Glomerulonephritis b. IgA Nephropathy c. Nephrotic syndrome d. HTN 30.What is the most important step in psychotherapy? a. Detailed history b. Isolation c. History from friends and relatives. d. Developing relationship e. Investigations 31. When do we use Psychodynamic Psychotherapy? a. Obsessive Compulsive Disorder b. Bipolar Disorder c. Schizophrenia d. Depression e. Anorexia Nervosa 32. You are asked to examine a person. He is cut off from the world since he was teen. Lives alone and wants to be alone. No friends. Family wants to support but he refuses to get any help. He doesn’t have any thought disorder or perceptional symptoms, but his affect is blunt. What would be the most probable diagnosis?

a. Chronic schizophrenia b. Major depression c. Narcissistic Personality d. Bipolar disorder 33.Regarding Billing’s method of contraception, AOF are true except: a. Cervical mucus has to be palpated b. Unsafe sex, if it becomes more c. Safe sex after 2-3 days of becoming more d. Since it considers the cervical mucus, it is same contraception in regular, irregular and lactational menstrual periods. 34.Regarding Levonorgestral containing IUCD, AOF are true except: a. Light periods b. Amenorrhoea c. Decreased risk of cervical carcinoma d. Decreased risk of sexually transmitted diseases e. Decreased risk of ectopic pregnancy 35.Spleenectomy in spherocytosis will do all the following except: a. Normalize anaemia b. Normalize spherocytosis 36. An 8-year-old child presents to the ED with bilateral tonsillitis with greyish white exudates. He has cervical lymphadenopathy, fever and hepatosplenomegaly. What is the probable cause? a. EBV b. CMV c. Diphtheria d. Bacterial 37. A young child with 2-week h/o dry cough with whop, and some times vomits. What is true about this patient? a. Will have cough for the next 4 weeks b. Amoxicillin should be started c. D & T vaccine should be given immediately 38. A patient with pyloric stenosis, vomiting for 4 days now presents to ED with mother. He is dull lethargic, skin turgor is lost, and BP is 90/50. What is the most initial choice of fluid in this patient? a. Normal saline

b. Hartman‟s solution c. Ringer‟s lactate solution

d. Dextrose 5% and Normal saline 39.Regarding diffuse fibrosing alveolitis what is true? a. Decreased FEV1 / FEV

b. Decreased TLC c. Decreased Expansion d. Decreased O2 tension e. Hypercarbia 40.Psychiatric side effect of corticosteroids? Withdrawal causes delirium 41. A patient is suffering from cyclical mastalgia. Routine treatment fails. What is your next management? a. NSAID b. Bromocriptine c. Danazol d. Progesterone e. Lasix 42.Regarding CPR, WOF statement is most correct? a. Adrenaline should be given every 10 minutes b. Bicarbonate is mandatory c. ECM only pumps ½ of the cardiac output in one stroke d. ECG is necessary before cardio-version. 43. Patient with grandiose character. Doesn’t care about others. Feels himself to be unique: a. Histrionic personality b. Schizoid c. Narsistic d. Delusional e. Borderline 44.Picture of CT Scan showing two white spots just lateral to the midline. A patient 59 year old presents with sudden onset of left hand weakness. What could be the possible cause? a. SDH b. SAH c. Intra cerebral haemorrhage d. Cerebral infarct 45. WOF has the least risk of having congenital malformation at birth. a. Chromosomal abnormality AD, AR, Sex linked recessive b. Rubella at 18 weeks 46. What is the most likely cause of post coital bleeding? a. Endometrial Carcinoma b. Vaginal candidiasis c. Cervical polyp d. Fibroid 47. Regarding thyroid cancer, all are true except:

a. Enlarged thyroid b. Solitary nodule c. Hot nodule d. Change in voice e. Tracheal compression 48. Patient presents with fever, tachycardia (Pulse 110/mt), Tremors, and palpable & tender thyroid. On investigation, there is no radioactive iodine uptake. What is the possible treatment? a. Carbimazole b. I131 c. Beta-Blocker + Paracetamol d. Thyroxine 49. A women has bilateral suppurative inflammatory lesion on the axilla and groin. What is true? a. Actinomycosis b. Fungal infection – Mycosis Fungoides c. Suppurative Hidradenitis d. Multiple lymphadenopathy with abscess e. Pilonidal sinus 50. An old man who was operated for aortic aneurysm 3 weeks ago, presents to the ED with irregular pulse, restlessness, abdominal distension and not having passed flatus and motions for last 2 days. WOF is the most possible cause? a. Rupture of suture site b. Mesenteric artery embolism c. Urinary retention d. Diverticulosis 51 Why do we do an ultra sound in a patient with sign symptoms of biliary disease? a. To visualize stones in the GB or CBD b. To visualize pancreatic cancer c. To see the dilation of bile tree d. To locate the hepatic cancer e. To visualize the GB pathology 52. A seventy-year lady who is alcoholic and smokes > 20 cigarettes a day, presents to you with tiredness and fatigue. She also complains of weakness in limbs. Her Hb was 98, MCV 110, and platelets were decreased. What is the most possible cause? a. AoCD b. IDA c. Alcoholism d. Pernicious Anaemia e. Auto immune Haemolytic Anaemia 53. A young female on oral contraceptive misses

one tablet while in the mid cycle. Had coitus the same day, and takes the ‘missed’ tablet 12 hours later. Then continues with rest of her tablets. She has spotting on the third day of coitus. What will be your advice? a. Continue with the OCP. b. Change to different contraceptive drug. 54. AOF are the features of basal ganglion except: a. Ataxia b. Tremor c. Bradykinesia d. Chorea e. Rigidity 55.Most common cause of bowel obstruction in Australia assuming that he as not undergone any abdominal surgery, is: a. Volvulus b. Intersuseption c. Groin hernia d. Internal hernia e. Tumours 56. A patient presents with wasting of small muscles of hand with thenar sparing. What is the most probable diagnosis? a. Ulnar N b. Median N c. Axillary N d. Musculocutaneous N 57. Picture on Page 206 of AMC. Picture of scalp showing white scaly lesion. a. Psoriasis b. Alopecia Areata c. Pediculosis d. Tinea Capitis 58. A young couple wants to adopt abstinence as contraception. Assuming the female is having a regular monthly cycle of 28 days, you would advice them to avoid sex on AOF days except: a. Day 4 – 17 b. Day 8 – 17 c. Day 10 – 19 d. Day 12 – 19 e. Day 17 - 21 59. Most common cause of cholecystitis in Australia a. Gall stone at out flow b. Gall stone in CBD c. Pancreatitis d. Tumour

e. Hepatitis 60.WOF is expected to happen after splenectomy for spherocytosis? a. RBC life span improves b. Leukopenia c. Reduction in anaemia d. Reduction of spherocytes e. Reduction in fragility of RBCs. 61.What is the cause of majority of HbsAg patients in Chinese population? a. Blood product b. IVDU c. Child birth d. Sexual spread e. Haemophilia 62. A 60 years old female patient of RA takes 5mg of Prednisolone tabs BD for last 10 years. Now she comes to you complaining sudden onset of pain and swelling of her right knee, which is warm and tender. Your management would be: a. Increase dose of NSAID b. Decrease dose of NSAID c. IV Antibiotics & hospitalisation d. Knee X Ray for unrecognised trauma e. Knee aspiration for cytology. 63. A 12 year old is having pain in his hip. His mother noticed a limp. He is afebrile, and the general examination is normal. What is the most probable cause of his symptoms? a. Slipped upper femoral epiphysis b. Perthes disease c. Non specific synovitis d. Osteomyelitis 64. Photo of viral wart on the eyelid of a young female. a. Wart b. Molluscum contagiosum c. Herpes simplex d. Skin tag 65. AOF cause gynecomastia, except: a. Spironolactone b. Digoxin c. Methyldopa d. Labetolol 66. A 41 week primi comes to you complaining of no fetal movements for last 24 hrs. FHS is 140/mt, CTG is normal, and rest of the examination is normal. You send her home. Next day she rings you stating that there is again no fetal

movement for the last 24 hrs. What will be you next step of management? a. Tell her that all her examinations are fine, & she should not worry b. Ask her to wait for another 24 hrs. c. Admit labour ward and induce labour. d. Immediate LSCS 67. Picture of supracondylar fracture (AMC Book): A young girl fall on her out stretched hand. What will be your management? a. Neurological study to check the Median Nerve involvement b. Fasciotomy c. # Reduction and assessment of circulation d. Back slab and review in 24 hours 68. Many people attended a dinner party on a week end. 10% had diarrhoea. Most of them recovered spontaneously, but few needed hospitalisation for severe dehydration. What is the most probable cause? a. Giardia b. Salmonella c. Clostridium d. Shigella 69.Complication of # of epiphyseal plate a. Retardation of longitudinal growth b. Joint stiffness c. Malunion d. Non-union e. Avascular necrosis 70.4 day old full term baby normal at birth. Suddenly collapse at cot. O/E baby is peripherally cyanosed , no pulse and respiratory distress. Diagnosis? a. Pulmonary Hypertension

b. Fallot‟s Tetralogy

c. PDA d. CHD e. Lt Heart hyperplasia. f. Transposition of great vessels

MEDICINE, SURGERY , OBSTETRICS AND PSYCHIATRY 1. An elderly woman can read the newspaper, but has halos in bright sunlight.

A. Cataract B. Glaucoma C. Presbyopia D. Macular Degeneration 2. Which of the following drugs decrease renin: A. Beta Blockers B. ACE Inhibitors C. Spironolactone D. Hydralazine E. Centrally acting antihypertensives. 3. Newborn with respiratory distress , faint breath sounds on the left and with a scaphoid abdomen A. Meconium aspiration syndrome B. Situs inversus C. Diaphragmatic hernia 4. Which nerve gives the sensation of taste to the anterior 2/3rd of tongue. A. Trigeminal nerve B. Facial nerve C. Hypoglossal nerve D. Glossopharyngeal nerve 5. A Patient who underwent a cholecystectomy, now comes with jaundice .what is the investigation of choice. A. Oral cholecystogram B. CT scan C. Ultrasound D. Sr. Creatinine E. Upper GI Studies 6. Regarding pseudobulbar palsy AOF is true …except A. Wasting and fasciculation of tongue B. Jaw jerk decreased C. Loss of sphincter control D. Gag reflex present 7. Regarding ACE Inhibitors, which is not true : A. Used in the treatment of heart failure B. Used as first line in the treatment of Hypertension C. Used in Diabetics D. Cannot be used in the treatment of Aortic stenosis. 8. Regarding CRF and Calcium metabolism A. Ca is decreased B. Ca is increased C. There is no relation between CRF and Ca D. Causes Osteomalacia. 9. Most significant complication of massive

blood transfusion. ( *) A. Pulmonary oedema B. Change in acid base balance C. DIC and coagulation defect D. Increased CVP 10. Regarding CRF and Potassium all of the following reduce potassium except (treatment of hyperkalemia) * A. Calcium Carbonate B. Glucose and Insulin C. Dialysis D. Resonium E. Sodium Bicarbonate 11. 55year old patient with dysphagia for solids with a previous history of reflux A. Carcinoma oesophagus B. Stricture C. Scleroderma D. Achalasia \

E. Raynaud‟s syndrome

12. An infant came with pneumonia , X ray showed consolidation of a lobe with round translucencies and a small pleural effusion. What is the treatment of choice? A. Crystalline penicillin B. Flucloxicillin C. Amoxicillin / clavulanic acid D. Tetracycline 13. A new born was peripherally cyanosed and crying lustily ..the axillary temperature recorded was 37.2degrees what would be the next step( *) A. Take an x ray B. reassure C. oxygen D. urine culture 14. 34 year old lady on phenytoin wants to take OCP’S what can be prescribed A. Microgynon 30 B. Microgynon 50 C. Triphasic D. Oetradiol patches E. Progesterone only pill 15. 6 months old boy brought by his mother with a temperature of 38.9degrees with bilateral wheezing .his resp. rate was 36/min .other members in the family had a h/o similar illness. There is family h/o asthma. What is the diagnosis? A. Asthma

B. Foreign body C. Bronchiolitis D. Pneumonia 16. 16 weeks p regnant lady came for a check up ,for the diagnosis of foetal anencephaly all are true except A. increased alpha feto protein B. increased beta HCG C. nuchal thickness D. decreased alpha fetoprotein 17. Regarding tubal pregnancy most suggestive is (*) A. – ve beta HCG B. ultrasound showing empty uterus C. ultrasound showing tubal mass D. CT scan 18. 10 weeks old child with persistent unilateral eye discharge responding to antibiotics but recurring A. nasolacrimal duct obstruction B. gonococcus C. Chlamydia 19. unilateral foul smelling ,bloodstained discharge from nose A. foreign body B. nasal polyps C. Atopy D. Rhinitis 20. 10 year old came to your surgery with scrotal pain .on examination both testis are in the scrotum , next management : A. do an ultrasound B. arrange surgery C. write some analgesic and send him home D. do nothing it will go away E. tell his mother to review back again when the pain recurs 21. 19 year old girl had a binge of drinking the previous night with lower abdominal tenderness and all investigations and testis are normal (*) A. treat as gastroenteritis B. tell her it is due to alcohol C. not sure of diagnosis ;come back for review D. Give analgesic and antiemetic and send her home. 22. Reversal of non depolarising skeletal muscle blockade A. Pyridostigmine B. Neostigmine

C. Atropine D. Benzhexol 23. differentiation between schizophrenia and shcizophreniform disorders is by (*) A. affective symptoms B. duration of symptoms C. lack of insight D. female and male ratio 24. A lady with a previous divorce now comes to you with a seductive behaviour A. Narcicistic B. Histrionic C. Borderline 25. In Australia bush fires are common either accidentally or due to some people lighting fire deliberately, which is true regarding pyromaniacs. A. Done for notoriety and publicity B. To hide their acts C. As they like to play with fire D. Set fire and get panic attacks E. For satisfaction. 26. People living near airport have(*) A. Explosive personality B. Insomnia C. Agitated D. Depression 27. Regarding panic attacks all are true except (*) A. 20% have had at least one attack in their lifetime. B. With out agoraphobia it is equal in male and female C. Always avoid precipitating factors D. Usually occurs in the twenties 28. Regarding treatment of chronic duodenal ulcer A. eradication of H pylori B. H2 blockers C. PPI D. Selective vagotomy 29. 4 year old boy with fever and malaise , lymphocyte count – normal, platelets decreased ,Hb decreased A. ALL B. Infectious mononucleosis

C. Hodgkin‟s disease

30. Pregnant lady with Group B strep infection, what is true. A. Penicillin to be given as prophylaxis B. Bolus dose of penicillin before labour

C. Take a swab and if B strep present then tr eat. 31. Regarding MI , maximum deaths occur in (*) A. with in 1st 2 hrs B. 2 to 12hrs C. 12 to 24hrs D. 2 to 7days E. after discharge 32. A case of stable angina with chest pain. On examination enzymes, ECG are normal but as you were examining him he belches and says he feels better - what would you do (*) A. Admit to coronary care Unit and do ECG monitoring. B. send him home with appointment to cardiologist C. refer to gastroenterologist D. if enzymes normal then probably no cardiac 33. With regard to primary health care all are true except(*) A. 1/3rd of population come to a GP with psychiatric symptoms. B. Most patients are psychotic C. Only few are referred to psychiatrists D. Alcoholics and drug abuse frequently

overlooked by GP‟s

34. A patient with known Park inson’s disease for 2 yrs on long term treatment now comes with tongue protruding out. What would you do ? A. Decrease levodopa +carbidopa B. Increase levodopa + carbidopa C. Stop levodopa +carbidopa D. Treat with chlorpromazine 35. In a case of twin pregnancy all are true except A. asymmetrical growth retardation B. anaemia in pregnancy C. premature labour D. acute polyhydramnios E. 2nd twin foetal malformation. 36. 60 yr old female with diarrhoea and profuse mucous discharge .what could be the cause A. Cr on‟s disease B. ulcerative colitis C. villous adenoma D. rectal Ca E. acute mesenteric ischaemia 37. How do you differentiate between anorectal and colorectal cause of bleeding(*) A. Blood mixed with stools

B. Fresh bright bleeding C. Mucoid discharge D. Pain during defecation 38. most common cause of severe chest pain in pericarditis A. viral pericarditis B. tuberculosis C. Mycoplasma D. Uraemia E. MI 39. all of the following are causes of supraclavicular mass except (*) A. stomach Ca B. cervical rib C. breast Ca D. subclavian thrombosis E. subclavian artery aneurysm 40. which of the following has worst prognosis A. advanced breast Ca B. choriocarcinoma

C. Hodgkin‟s lymphoma

D. Non-Hodgkin lymphoma E. Prostate carcinoma 41. Which of the following does not metastasise to brain A. Malignant melanoma B. Prostatic Ca C. Lung Ca D. Breast Ca 42. 40 yr old lady with a 2 cm palpable breast lump on the right side .What is the next step.(*) A. FNAC B. Ultrasound C. Lumpectomy D. Mammography E. Radical mastectomy 43. A lady with a palpable breast lump, FNAC showed few malignant cells regarding conservative surgery what is true? (*) A. Assess for oestrogen receptors B. Bone marrow biopsy C. Axillary lymph node sampling D. Mammography 44. A lady with a breast cancer on left side operated 2yrs ago now detects a small lump on the right side .how do you explain the lump A. Cancer arising de novo B. Fibroadenoma C. Metastasis from the previous one

45. facial nerve palsy can be associated with all of the following except A. chronic parotitis B. Ca parotid C. Acoustic neuroma D. # base of the skull 46. A middle aged woman with deafness and loss of corneal reflex but with no tinnitus A. vestibular neuronitis

B. Meniere‟s disease

C. Acoustic neuroma D. Multiple sclerosis 47. Ptosis ,dysphagia ,ataxia ,on the same side and spinothalamic loss on the opposite side: A. vertebral artery occlusion B. basilar artery occlusion C. MS – midbrain D. Posterior communicating artery s yndrome (PICA) 48. 22yr old lady with diplopia. On closing the right eye ,the medial side of the image is lost ( i.e diplopia on looking laterally ) what is the diagnosis A. left 6th nerve palsy B. left 3rd nerve palsy C. right 6th nerve palsy D. posterior cranial fossa tumour 49. Regarding a patient with hepatoma , which of the following is least likely A. Hepatitis B B. Hepatitis C C. Hemochromatosis D. CMV E. Alcoholic cirrhosis 50. In which of the following cell mediated immunity is lost first followed by loss of humoral immunity (*) A. CLL B. HIV C. RA 51. which of the following is not a carcinogen (*) A. EBV B. CMV C. Hep C D. HIV 52. Picture of a lesion at the lateral angle of the eye what is the treatment ( it’s a BCC) : A. Surgical removal B. Excision and radiation C. Cryotherapy

D. Chemotherapy E. Local steroids 53. Picture of swelling at the outer angle of the eye .it is described as being hard and present since birth: A. Osteoma B. Sebaceous cyst C. Lipoma 54. picture of a large swelling on the back near the left scapula A. lipoma B. sebaceous cyst C. 2ndary breast 55. Picture of the face with a non itchy rash like lesion on the cheeks, forehead. A. SLE B. Seborrheic dermatitis C. Acne rosacea D. Dermatomyositis 56. post operative specimen ( testicle with epididymis ) A. TB B. Epididymoorchitis C. Teratoma D. Torsion of testis E. seminoma 57. A chest x ray of a child showing consolidation > neutrophils increased. What could be the cause A. Klebsiella pneumonia B. Group B streptococcus C. Staphylococcus D. Mycoplasma pneumonia 58. A lesion (looks like an ulcer) diagnosis? A. Amelanotic melanoma B. Implantation dermoid C. Basal cell carcinoma 59. ECG- patient is a diabetic and he is dyspnoeic .diagnosis(*) A. Inferior wall MI B. Anterior wall MI C. Pericarditis D. WPW syndrome E. Pulmonary embolism 60. ECG patient has palpitations, otherwise normal (*) A. Atrial fibrillation B. Atrial flutter with variable block C. WPW syndrome with accelerated beats 61. ECG patient comes with sweating ,

palpitations A. Ventricular ectopic B. Ventricular tachycardia C. Atrial fibrillation D. RBBB 62. How do you treat WPW in a patient with a previous history of collapse? A. Beta blockers B. Cardioversion C. Radiofrequency ablation abnormal tract D. Surgical ablation D. Long term verapamil 63. 40 yr old man with SVT 160/min ..Patient not arousable , Treatment is A. cardioversion B. adenosine C. procainamide D. verapamil E. take an ECG 64. A child with heart rate of 220/min otherwise normal , how do you manage A. cold stimulus B. Valsalva C. Verapamil D. DC shock 65. All of the following are side effects of depot medroxyprogesterone , except(*) A. Amenorrhoea B. Weight gain C. Depression D. Used with oestrogen causes stratification and cornification of vagina E. hypotension 66. 20yr old man came with pain referring from groin to loin to tip of penis brought a sample of urine mixed with blood and asks for a shot of pethidine to relieve his pain. What is the next step A. give him an injection of pethidine to relieve his pain B. KUB C. Ultrasound abdomen D. Examine fresh urine sample 67. 12yr old boy with bee sting with wheeze ,with swollen lips ,tachycardia , restless, immediate treatment(*) A. adrenaline IM B. hydrocortisone IV C. oxygen D. antihistamine E. give NSAID and send him home

68. Young man with tachycardia, BP 90/70,Pulse 140 difficulty in breathing (*) A. start two IV line to Hartmann B. wide bore needle C. tube drainage 69. RTA respiratory distress mediastinal shift to opposite side with emphysema in the neck .what is the diagnosis A. Tension pneumothorax B. Hemothorax C. Cardiac tamponade D. Bronchial tear 70. Newborn male with normal genitalia , which is true A. 47xxy B. 46xy with androgen insensitivity C. mother treatment with cyproterone from 8 weeks 71. 16yr old girl came with her mother with no menstrual , breast development is normal (testicular feminisation) A. 45xo B. 46xy C. Turner syndrome 72. After MVA a patient is dyspnoeic BP 100/70, HR 110/min, Breath sounds decreased on left side, heart sounds normal, JVP raised, next step in management (*) A. IV fluids B. Wide bore thoracostomy C. Tube thoracostomy 73. A patient with excruciating chest pain and a diastolic murmur .what does the X-ray show (*) A. widening of mediastinum B. increased left ventricular size C. trachea shifted to left 74. A child with fever malaise, sore throat …white papillae on the tongue and later a sandpapery rash...what is the diagnosis A. measles B. rubella C. scarlet fever 75. A child with fever of 3 days duration and a rash develops when fever subsides A. Rubella B. Roseola C. Erythema multiforme 76. An unconscious man (a known COPD case) was brought to the emergency, on examination

there was a bruise on the parietal area and needle mark in the cubital fossa. His ABG was as follows (PH: 7.26, PCO2: 60, PO2: 50) His previous ABG showed (PH: 7.35, PCO2: 30, PO2: 60) .what is the diagnosis? (*) A. Narcotic B. Subdural haemorrhage C. Subarachnoid haemorrhage 77. 16 weeks pregnant woman with proteinuria 3 +, hematuria, and hypertension (*) A. PIH B. Pre-existing renal disease C. Essential hypertension D. Pregnancy will continue until term 78. Which of the following is familial A. papillary carcinoma B. medullary carcinoma C. follicular Ca D. anaplastic E. secondary Ca of thyroid 79. A patient with HIV and cough (respiratory symptoms) has a Mantoux 5mm +ve , what is the next step A. INH prophylaxis B. Zidovudine C. Interferon 80. Patient with HIV +ve status ..what is true (*) A. Life long infectivity B. He has AIDS C. Can transmit through saliva D. He should avoid sexual intercourse 81. Tremor can be present in all of the following except A. hyperthyroidism B. hypothyroidism C. benign essential tremor D. Parkinsonism E. chronic liver disease 82. A lady with tremor on lifting the phone and disappears when she looks at her hand with mild rigidity of the hand but no cogwheel rigidity. What is the treatment? A. Propranolol B. Benzhexol C. Levodopa 83. Complication of # of epiphyseal plate A. retardation of longitudinal growth B. joint stiffness C. malunion

D. non-union E. avascular necrosis 84. which of the following does not have any interaction A. warfarin & Isosorbitrate B. verapamil & metoprolol C. erythromycin & terfenadine D. digoxin & amiodarone 85. 12yr old child weight 90th percentile with a limp

A. Perthes‟s disease

B. slipped capital femoral epiphyses C. tibial synovitis 86. 13yr old child which would be the appropriate bone age for a normal adult height A. 9yr old B. 13yr old C. 18yr old 87. Regarding mammography, what is true? A. It is painless B. Can diagnose breast Ca earlier than selfexamination C. More diagnostic for 70yr old D. Definitive diagnosis of Ca breast 88. 10 days old boy with vomiting, serum potassium is 7.7; serum Na is 118.what is the diagnosis. A. Pyloric stenosis B. congenital adrenal hyperplasia C. SIADH D. Posterior cranial fossa tumour 89. A young boy has fever and limp. There is tenderness at one point in the tibia; all movements are full except flexion which is restricted to 30degrees. what is the diagnosis? A. Septic arthritis B. Osteomyelitis C. Perthes disease 90. 6 hours after difficult catheterisation, a patient developed fever with chills A. suppurative urethritis B. gram negative septicaemia (bacteremia) C. haemorrhage 91. Regarding hemochromatosis , diagnostic investigation is A. Sr. ferritin B. Transferrin C. Sr .Iron D. Liver biopsy 92. In Australia the common cause of iron

deficiency is A. Nutritional deficiency B. Malabsorption C. Diarrhoea 93. most common cause of bleeding P/R in children A. fistula in ano B. fissure in ano C. haemorrhoid 94. Patient with depression is treated with antidepressants; following a course of treatment she now wants to stop the drug .What do you advice? A. Follow up every week B. Follow up every month C. Admission to hospital 95. Child with abdominal mass and with metastasis to skull A. neuroblastoma

B. Willm‟s tumour

C. retinoblastoma 96. A child babbles , sits for sometime unsupported ,stands with support and holds an object by the palm .what is the age (*) A. 5 months B. 7 months C. 1year D. 18 mon. 97. A patient with dysthymia for 2years ..treatment is (*) A. SSRI + SSRI+ benzodiazepine B. SSRI cognitive + behaviour therapy C. SSRI D. Antipsychotics +SSRI 98. A young patient vomits 1Litre of blood and has 2 times malaena. what is next appropriate step A. Gastroscopy B. Immediate surgery C. Barium meal 99. old lady with knee swelling and has weekly positive birefringent crystals ,the crystals contain A. calcium pyrophosphate dihydrate B. calcium hydroxyapatite C. urate 100. A patient is worried about the (sexual dysfunction and depression) side effects of sertraline. What would be the advice regarding the same to the patient?

A. It is only side effect of antidepressant B. both these side effects are not related to sertraline 101. Young man after a RTA was found unconscious only responds to painful stimuli and eye cold stimuli what is the GCS score A. GCS >3 B. 3 to 6 C. 6 to 9 102. child with fever and blisters in the palm and sole and mouth ,there is lymphadenopathy

A. Coxsackie‟s

B. Kawasaki C. Herpes 103. All of the following are scaly lesions except A. Keratoacanthoma B. Squamous cell Ca C. Pityriasis rosea D. Psoriasis 104. Rash similar to syphilis except A. Infectious mononucleosis B. Atopic eczema C. Discoid eczema D. Tinea corporis 105. Pregnant lady with carpel tunnel syndrome .what is true? A. Surgical intervention is rarely needed B. Splinting in hyperextension C. Surgical correction 106. what is typical feature of carpal tunnel syndrome A. severe pain awakening the patient at night B. pain in the ring and little finger C. paresthesia restricted to median nerve D. history of myxedema 107. 3rd day blues what is correct? (*) A. Occurs at least in 50% after delivery

B. More common following “C “section

C. Always lead to psychosis D. Results in more premature malformed children 108. regarding child abuse A. more common in deformed ,premature and LBW children B. toddlers are more commonly affected C. majority patients would have a psychiatric disorder D. other children in the family wont get affected 109. confidentiality can be broken in which of the following situations A. child abuse

B. when the police comes to ask C. insurance matters 110. all are hepatotoxic except A. paracetamol

B. OCP‟S

C. Halothane D. INH 111. carcinomatous change can occur in all except A. Sjogren‟s s yndrome B. thyrotoxicosis C. coeliac disease 112. 2yr old child with chronic respiratory infection, what would you do? A. Sweat chloride test B. X ray chest C. Barium meal 113. Child with chronic cough and rectal prolapse, diagnosis? A. Congenital megacolon B. Cystic fibrosis C. Whooping cough 114. 6 weeks old child on breast feeding with 4 days constipation and thriving well diagnosis? (*)

A. Hirschsprung‟s disease

B. normal variant C. hypothyroidism D. acquired constipation 115. Which of the following is not associated with brain metastasis? A. Small cell Ca B. Breast Ca C. Renal Ca D. Lung Ca 116. An elderly patient ,known case of Ca rectum , on morphine has chronic constipation and was treated with lactulose but was not responding .what is the next step A. Arrange a surgical consultation B. Enema C. P/R examination D. Modify diet 117. All of the following are associated with Raynaud’s except A. RA B. SLE C. Scleroderma D. Dermatomyositis E. Ankylosing spondylitis

118. cause of diarrhoea in an old bed ridden patient A. faecal impaction B. Carcinoma C. Constipation 119. Haemolytic anaemia all are true except A. Increased urobilinogen B. Icterus and clear urine C. MCV decreased 120. A child ingested washing powder half an hour ago next management(*) A. Admit to hospital and possible endoscopy B. Charcoal C. Sent him home D. Syrup of ipecacuanha E. Observe 121. Mother of an 18 month child was concerned as it was not babbling .audiological assessment was done when he was 10 months old .what is the next step A. Arrange audiometry B. Repeat hearing test C. Reassure the mother 122. 71/2 yr old girl attained menarche; her mother noticed the breast growth and axillary hair growth 6 months ago. A. premature puberty B. undiagnosed congenital adrenal hyperplasia C. turner syndrome 123. In a young female patient what is the most common cause of subarachnoid haemorrhage? A. Ruptured aneurysms B. Av malformations C. Mycotic aneurysms D. trauma 124. A neonate few hours after birth developed cyanosis which was not responding to oxygen. NO murmer is there. Diagnosis? (*) A. Transposition of great vessels

B. Tetralogy of fallot‟s

C. VSD D. ASD 125. Lung Carcinoma seen in non smokers A. Adenocarcinoma B. Squamous cell carcinoma C. Small cell ca. D. Basal cell ca. 126. A child has facial movements and it is increased on watching TV (question on tics). They are present even during examination.

A. Myoclonic epilepsy B. Tics C. Partial complex epilepsy D. Panic attack 127. In TNM staging which has a better prognosis A. T1 N0 M0 B. T1 N1 M0 C. T1 NI MI 128. 60 yr old female patient had repeated bilateral thrombophlebitis and DVT cause A. pancreatic Cancer B. ovarian cancer C. protein c deficiency 129. Most common cause of central cyanosis A. Left to right shunt B. Right to left shunt C. CO poisoning 130. Regarding immunology what is correct? A. Ig G associated with atopic eczema B. Delayed hypersensitivity is T cell mediated 131. Why is it difficult to differentiate beta HCG and LH A. FSH high B. LH high C. Prolactin high D. Progesterone low 132. Young hypertensive male with proteinuria, hematuria and upper respiratory infection for 2 days .Diagnosis? A. Ig A nephropathy B. Glomerulonephritis C. Nephrotic syndrome D. Acute pyelonephritis E. Membrane nephropathy 133. All of these can cause gynecomastia except A. Spironolactone B. Cimetidine C. Labetolol D. Digoxin E. methyldopa 134. which of the following is least likely associated with primary hypothyroidism A. 72y/o with multinodular goitre B. 28 y/o with menorrhagia C. 9y/o with retarded bone age D. 16y/o with anovulatory cycles 135. which of the following is incorrect : A. alcohol reduces triglycerides

B. olive oil decreases HDL C. increased LDL/HDL ratio is good D. Taking 300 gms of fish daily does not reduce cholesterol 136. Point prevalence in schizophrenia means the A. Current cases at that time B. Cases in one year C. The total number of cases 137. Regarding Diabetes mellitus what is true? (*) A. At least take 100gms of carbohydrate everyday to prevent ketonuria. B. If one parent has diabetes there is 1:8 chance of getting affected.

C. You can‟t give insulin until level comes to

normal. 138. Regarding diabetic foot ,all are true ,except (*) A. 50% mortality following amputation B. If the pulse is present patient is unlikely to have it. C. To have diabetic foot controlling glucose level can help 139. Regarding 80% carotid artery stenosis. What is true? (*) A. The incidence of stroke will be halved B. 40% stroke with out treatment C. 50% incidence of stroke after endarterectomy D. 40% death will occur within 30days 140. Spiral # of humerus which nerve damaged A. Radial B. Ulnar C. Median

D. Volkmann‟s ischemia contracture

141. 50 yr old patient wakes up at night due to pain in the calf which is relieved by walking. What is the cause? A. Ischemic pain

B. Raynaud‟s phenomenon

C. Muscular cramps D. DVT E. Intermittent claudication 142. A patient with pain in the calf worsened by elevation of feet A. Ischemia B. Nocturnal cramps C. DVT 143. Which of the following feature is unlikely to be due to arterial ischemia

A. Pain along the buttock and thigh after exertion B. Weakness of the buttock and thigh C. Shooting pain from buttock and thigh D. Leg paralysis 144. Most common feature of rectal carcinoma A. Tenesmus B. Bleeding C. Incomplete defecation D. rectal prolapse 145. A patient after MVA sustained a pelvic # and has blood in the external meatus ,initial investigation of choice is (*) A. Urethrogram B. CT scan C. Cystoscopy D. Catherisation E. IVU 146. Regarding uncomplicated haemorrhoids all are true except A. Pain B. Pruritus C. Bleeding D. Prolapse E. Mucus discharge 147. Regarding PMS what is true? A. 5% have very severe symptoms B. 40% have PMS C. all patients with PMS always have dysmenorrhoea 148. Patient mechanic with penetrating hand injury. What is true? (*) A. Drainage should be done from extensor surface B. It indicates that there is extension of the palmar abscess into extensor aspect C. The swelling is due to oedema D. It indicates the involvement of extensor tendons 149. Apathetic and dull are the negative symptoms of schizophrenia. Which is the other negative symptom (*) A. Catatonia B. Blunted affect C. Cataplexy 150. A patient who is aware about his own problems during treatment .what is it ? (*) A. Instinct B. Insight C. Pseudo altruism D. Intellectualisation 151. In chronic liver failure (obstructive jaundice) what’s true

A. Vitamin K absorption is reduced B. Prothrombin cannot be converted to thrombin C. Chronic hepatitis 152. In hemochromatosis after venesection all are true except A. Skin pigmentation becomes normal B. Cardiac siderosis is reversible C. Hepatoma can be cured 153. In hemochromatosis A. size of the liver is decreased following treatment 154. A patient with perforated peptic ulcer all are correct except A. Patient remembers exactly the moment of rupture B. Back pain C. Vomiting D. Board like rigidity E. Guarding 155. Concerning cluster headache all are correct except A. vomiting B. treat with methysergide C. occurs after 3-4 hrs of falling asleep D. occurs at the same time of the day 156. A young man with throat infection in child hood and was treated with penicillin ..He now comes with a fear of developing a rash due to penicillin as he was influenced by his friends words. What does he have? A. Induced delusion B. Hypochondriasis 157. young man with needle marks and pin point pupils ,gag reflexes are normal ,no extensor plantar reflexes(*) A. opiate ingestion B. temporoparietal # 158. A young man with left sucking wound in the chest .After initial airway resuscitation and circulation management what is the next step(*) C. A. Debridement and closure B. Pressure bandage C. IV fluids 159. Which infection is least likely during childbirth? A. Syphilis B. Gonorrhoea C. Streptococcal D. HIV

E. Herpes 160. Appropriate Estimation of the foetal gestational age is by (*) A. Transvaginal ultrasound at 8 weeks B. Bimanual examinations at 8 weeks C. Ultrasound at 18 weeks D. Transvaginal ultrasound at 18 weeks 161. Regarding OCP what is the absolute contraindication? A. Focal migrainous hemiplegia B. Hypertension C. Diabetes 162. Regarding OCP what is correct? (*)

A. All the progesterone‟s except cyproterone have

.how do you treat? A. Chromosomal analysis B. Cervical stitch C. Complete bed rest 169. Regarding Mullerian agenesis all of the following is true except A. Short vagina B. Normal breast development C. X linked recessive 170. What would be the most likely cause for bloody discharge from the nipple in a 50 year old lady? A. Intraductal papilloma B. Intraductal carcinoma

derived from testosterone B. Derive from oestrogen C. Derive from progesterone 163. Young man with severe joint pain and profuse bleeding from venipuncture site. Diagnosis? (*) A. DIC B. Thrombophlebitis C. Clotting defect 164. All are true regarding DIC except (*) A. Fibrin decreased B. FDP decreased C. PTT increased 165. intermittent claudication commonest site A. profunda femoris B. superficial femoral artery C. posterior tibial artery D. bifurcation of abdominal aorta E. external iliac artery 166. Which defence mechanism is mature? A. Denial B. Projection C. Introjection D. Humour 167. Undescended testis is most commonly associated with (*) A. Torsion of testis B. Spermatogenesis will be perfect if the operation is done before 3 years C. Development delay of the child D. Acute epididymitis E. Hernia 168. G3P0 pregnant lady came to you at 16 weeks pregnancy .She had two spontaneous abortions at 17 and 18 weeks in the previous pregnancies

D. Fibrocystic disease 171. The relative marker in Hepatocellular carcinoma is A. PSA B. CA125 C. CEA D. CA153 E. AFP 172. Treatment of seminoma stage 2 with metastasis to the para-aortic lymph nodes A. Radio therapy to testis and nodes B. Surgery and radiation to Para aortic nodes C. Chemotherapy D. Surgery 173. 70 year old woman with vaginal prolapse with ring pessary what is the complication (*) A. atrophic vaginitis B. cervical carcinoma C. decubitus ulcer D. carcinoma of vagina 174. After splenectomy you expect all of the following except (*) A. Life long increased risk of infection B. Transient increased platelets to predispose to thrombosis C. Persistent decrease of RBC life span D. Decrease in anaemia 175. Diabetic mother after prolonged labour delivered a jittery baby which responds to oxygen ..what is the diagnosis A. Hyperglycaemia B. Hypoglycaemia C. Meconium aspiration D. Hyperbilirubinemia

C. Paget‟s disease

176. Splenectomy is most beneficial in which of the following A. Haemophilia B. Chronic ITP C. Myelofibrosis 177. A middle aged man unable to fall asleep has night mares and remembers his daily activities diagnosis? A. Anxiety disorder B. Depression C. OCD D. Insomnia 178. Alcoholism is associated with all of the following except A. Substance abuse (benzodiazepine) B. Depression C. OCD 179. Proteinuria is seen in all of the following except A. congenital nephritis B. RPGN C. UTI D. RA E. Horseshoe kidney 180. Tourette syndrome ; all are correct except A. Motor and vocal tics are seen B. 2 or more bouts per day C. the person is not distressed with vocal tics D. coprolalia is less than 10% E. onset always less than 18 years of age 181. A 35 year old lady has a grey greenish vaginal discharge, microscopy shows clue cells, and she responded well to metronidazole .diagnosis (*) A. Chlamydia B. Bacterial vaginosis C. Trichomoniasis D. Moniliasis 182. Regarding stammering which is correct A. spontaneous resolution at 16years B. resolution after 2 year. C. No resolution in life D. Operative measure 183. Still birth after a normal delivery. all of the following tests are done except A. Kleihaur test B. Chromosomal analysis C. Foetal parts D. Maternal antibodies E. Foetal post-mortem

184. Polyhydramnios all are true except A. Rh incompatibility B. Oesophageal atresia C. bladder neck obstruction D. Anencephaly 185. Polyhydramnios see in all except A. Diabetes B. Multiple pregnancy C. Cardiac anomalies D. Hydrops fetalis 186. Child with greyish tonsillar exudate and atypical lymphocytes A. Infectious mononucleosis B. CMV C. ALL 187. Urge incontinence all are true except (*) A. Colposuspension B. Taping the vagina C. Pelvic exercise D. Weighted vaginal cones 188. (Regarding Rubella and pregnancy) a kindergarten teacher 6 weeks pregnant had one of her student with rubella .all are true except A. immunoglobulins B. IgG is increased initially then IgM C. Antibody measure and repeat SRH after 10 days D. If mother infected early then child can have microcephaly, seizures and cataracts 189. A patient with pyloric stenosis vomiting a lot and vomitus contains undigested food material taken 2 days back. What is the initial management? A. Normal saline

B. Hartmann‟s

C. Ringer lactate 190. daily requirement of potassium A. 50mmol B. 1gm C. 30mmol 191. In pyloric stenosis vomiting is A. Intermittent B. Occurs 1hour after food C. 2 days after food 192. A man with abdominal pain x ray showed multiple fluid levels .what is the management A. 2 litres RL

B. 2 litres Hartmann‟s before surgery C. 2 litres Hartmann‟s after surgery D. 2 litres Hartmann‟s after surgery

193. regarding antibiotic prophylaxis what is

true A. single dose is sufficient when compared to multidose B. urologic surgery needs a culture for the specific antibiotic 194. 4 year old child constipated ,rectum empty and sphincter tone lax ,mass at the apex of rectum

A. Hirschsprung‟s

B. acquired megacolon C. hypothyroidism 195. hypercalcemia seen in all except A. hyperparathyroidism B. pancreatitis C. RTA 196. 3 year old girl with periorbital oedema ,protein 3+, all are true except A. prednisolone will impr

answers..psychiatry 1...b 2...e The diagnostic criteria for pyromania are: deliberate and purposeful firesetting on more than one occasion; tension or emotional arousal before the act; intense interest, curiosity or fascination about fire (which can include fire equipment and the consequences of fire); pleasure, gratification or relief when setting or witnessing fires and their aftermath; the firesetting is not done for another motive such as financial gain, anger or revenge, to gain recognition or to relieve boredom, and is not done in response to a delusion or hallucination or due to impaired judgment (such as through intoxication); and the firesetting is not better accounted for by conduct disorder, antisocial personality disorder or a manic episode. 3...c 4...a 5...d 6...b 7...b 8...d 9...a 10...c

11...f 12...a 13...b 14...e 15...e 16...e 6 weeks post partum 17...b...not sure ,this is what happens in seasonal dysthymic disorder 18...a Delusion A delusion is commonly defined as a fixed false belief and is used in everyday language to describe a belief that is either false, fanciful or derived from deception. 19... 20...e 21...d 22...a 23...b...also in alcoholism and cocaine addiction 24...e 25...b 26...b 27...c 28...developed what 29...a???? 32....fear is a common cause 33...a 35...c 37...b 38...a 39...d 41...a 43...a 44...a 45...a 46...b

MEDICINE 1...b....in ant.dislocations 3...c 4...c 5...d 6...a 7...d 8...a 9...c 10...b 11...c 12...b 13...d

14...d 15...c 16...b 17...b 18...c 19...c 22...c 23...c 24...d 26...c 27...e... 28...e 29...a 30...d 31...e....not sure 32...b.......not sure 34...d 35...b 36...c 37...a 38...d 39...c 41...c 43...c 44...c 46...c 47...c 48...c 49...c 50...b 51...c 52...d...???? 53...advice to stop taking pills from the this pack that will initiate bleeding and start another . 54...a 55...c 56...a 57...d 58...c 59...a??? 60...c 61...??? 62...e 63...a 65...d 66...c ....its 41 weeks! 67...c..b/c volkmann contractures r common in this injury 68...b 69...a though all epiphyseal # dont cause growth

retardation..it depends on severity of injury, invovement of growth plate 70...e....if it is "hypoplasia MEDICINE, SURGERY , OBSTETRICS AND PSYCHIATRY 1...b 2...a 3...c 4...b 5...c...US ????? 6...all r false except d 7...d...afterload reducers r not used in AS. 8...d 9...b 10...a 11...a 12...c caused in this age group by S. pnemoniae, H.influenzae and staphlococcus. 13...b...excessive crying causes cyanosis 14...b 15...c???? 16...c 17...c??? 18...a 19...a 20...b...b/c the most common cause of scrotal pain in infants and children is torsion f testes 22...b ... 23...b 24...b 25...c 26...b 28...d???? 30...b 31...a 32...c ????? anyone?? 33...b 34...c 35...e 37...b 38...e 39...d 40...a 41...b 42...a 43...c 44...a 45...a 46...d ...c can also be true b/c sometimes acoustic neuroma patients dont complain of tinnitis.

47...D PICA =posterior inf cerebellar artery . Lateral medullary syndrome (also called Wallenberg's syndrome and posterior inferior cerebellar artery syndrome) is a disease in which the patient has difficulty with swallowing or speaking or both owing to one or more patches of dead tissue (known as an infarct) caused by interrupted blood supply to parts of the brain. This syndrome is characterized by sensory deficits affecting the trunk and extremities on the opposite side of the infarct and sensory and motor deficits affecting the face and cranial nerves on the same side with the infarct. Other clinical symptoms and findings are ataxia, facial pain, vertigo, nystagmus, Horner's syndrome, diplopia and dysphagia. The cause of this syndrome is usually the occlusion of the posterior inferior cerebellar artery (PICA) at its origin. The affected persons have difficulty in swallowing (dysphagia) resulting from involvement of the nucleus ambiguus, and slurred speech (dysphonia, dysarthria). Damage to the spinal trigeminal nucleus causes absence of pain on the ipsilateral side of the face, as well as an absent corneal reflex. The spinothalamic tract is damaged, resulting in loss of pain and temperature sensation to the opposite side of the body. The damage to the cerebellum or the inferior cerebellar peduncle can cause ataxia. 48...c 49..d 50...b 51...b 52...a 54...a 57...d??? 62...c 63...a 65...e 66...d 67...O2 then adrenaline 69...a 74...c 75...b 76...a

77...b 78...b 79...a 80...a 81...b 82...a 83...a 84...a 86...b 87...b 88...b 89...b 90...b Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 10:09 AM Labels: MCQs, Study Material

Tuesday, October 6, 2009 HIV AND "SKIN" Fungal/yeast

1 Candida (oral or oesophageal) 2 Tinea infections (corporis, cruris, pedis, interdigitale etc) 3 Pityriasis versicolor 4 Seborrhoeic dermatitis (especially when severe or recalcitrant) 5 Pityrosporum folliculitis Viral

1 Herpes zoster 2 Herpes simplex 3 Viral wart infections 4 Molluscum contagiosum Bacterial 5 Staphylococcus aureusimpetigo, chronic folliculitis

Mycobacterial 6 M tuberculosis Infestations 7 Scabies (especially Norwegian scabies) Other

4. Cryptococcal meningitis. This presents with headache, with or without classical signs of meningism. Occasionally rapid progression occurs, and the patient may present in coma. 5. Cerebral toxoplasmosis. This may present with headache, fever, lethargy and confusion, progressing to fits and coma.

1 Psoriasis

2 Kaposi‟s sarcoma 3 Acne All of these skin conditions can occur without HIV, but consider HIV particularly if they are recalcitrant, recurrent or atypical. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Add to Mixx!

Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 10:43 AM

Thursday, September 24, 2009 EPILEPSY MANAGEMENT Treatment of status epilepticus in hospital.

Posted by BANDA at 10:52 AM

HIV Presentation Acute HIV-related conditions that may present in the emergency department

1. Community acquired bacterial pneumonia. People with HIV, regardless of their level of immunosuppression, are more at risk of bacterial pneumonia. They have similar signs and symptoms to the non-HIV-infected population, eg fever, cough, dyspnoea, increased respiratory rate and sputum production. 2. TB presents with malaise, weight loss, night sweats, fever, cough, sputum production (may be blood-stained), and lymphadenopathy. 3. Pneumocystis pneumonia (PCP) presents with exertional dyspnoea, fever, dry cough, normal auscultation. X-ray typically shows perihilar shadowing (ground glass haze), but may be normal.

1.Immediate measures Secure airway

Give oxygen Assess cardiac and respiratory function Secure iv access Give lorazepam 4 mg iv or diazepam 10 mg iv Repeat after 10 mins if no response 2.In hospital

Take blood for electrolytes, LFT, calcium, glucose, clotting, AED levels and storage for later analysis Measure blood gases Establish aetiology Give thiamine or 50% glucose solution if indicated Within 30 minutes In patients with established epilepsy: give usual AED orally, NG or iv 3.In patients with new-onset epilepsy or if

seizures continue:

fosphenytoin (18 mg/kg phenytoin equivalent), up to 150 mg/min with ECG monitoring or phenytoin 18mg/kg, 50 mg/min with ECG or phenobarbital 15 mg/kg iv, 100 mg/min Longer than ITU may be necessary minutes Anaesthetise with EEG monitoring Midazolam, phenobarbital, propofol, or thiopentone most commonly used Non-convulsive status Augment or reinstate usual AEDs Consider lorazepam or diazepam iv Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 10:12 PM

PNEUMONIA INFECTIOUS AGENTS 1.Haemophilus influenza -Smokers, COPD 2.Mycoplasma --------Young, otherwise healthy patients 3.Legionella --------Epidemic infection in older smokers, particularly when located near infected water sources, such as air-conditioning systems 4.Pneumocystis jiroveci (formerly carinii) pneumonia HIV-positive persons with <200 CD4 cells not on prophylaxis. 5.Coxiella burnetti (Q-fever) Exposure to animals, particularly at the time they are giving birth 6.Klebsiella Alcoholics 7.Staphylococcus aureus Following viral syndromes or viral bronchitis, especially influenza 8.Coccidioidomycosis Exposure to the deserts of the American Southwest, particularly Arizona 9.Chlamydia psittaci Exposure to birds 10.Histoplasma capsulatum Exposure to bat or bird droppings, spelunking (recreational cave exploration) 11.Bordetella pertussis Cough with whoop and post-tussive vomiting 12.Francisella tularensis Hunters, or exposure to

rabbits SARS, Avian injluenza Travel to Southeast Asia 13.Bacillus anthracis, Yersinia pestis, and Francisella tularensis Bioterrorism Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 10:06 PM Labels: MCQs, Medical Exams, Study Material

Sunday, August 16, 2009 ANDROGEN DEFICIENCY IN MALE Symptoms and signs suggestive of androgen deficiency in men

• Incomplete sexual development, eunuchoidism, aspermia

• Reduced sexual desire (libido) and activity • Decreased spontaneous erections • Breast discomfort, gynecomastia • Loss of body (axillary and pubic) hair, reduced shaving

• Very small or shrinking testes (especially < 5 mL)

• Inability to father children, low or zero sperm counts

• Height loss, low -trauma fracture, low bone mineral density

• Reduced muscle bulk and strength • Hot flushes, sweats Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 11:10 PM

Labels: MCQs

• Side effects are usually manageable • Warn of mood changes and the potential risk of

Wednesday, August 12, 2009

depression

AUTOSOMAL DOMINENT CONDITIONS

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Autosomal dominant inheritance is seen in:

Achondroplasia, Acute intermittent porphyria, Adult polycystic kidney disease, Ehlers-Danlos syndrome, Familial adenomatous polyposis, Gilbert's syndrome, Hereditary sensory and motor neuropathy, Hereditary spherocytosis, Huntington's disease, Hyperlipidaemia type II, Malignant hyperthermia, Marfan's syndrome, Myotonia congenita, Myotonic dystrophy, Neurofibromatosis, Osteogenesis imperfecta type 1, Noonan's syndrome, Polyposis coli, Rotor syndrome, Retinoblastoma, Tuberose sclerosis, Von Hippel-Lindau disease, von Willebrand's disease Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 9:47 AM

Saturday, June 6, 2009 ISOTRETINOIN IN ACNE Features of oral isotretinoin treatment

• For patients with severe acne • For patients unresponsive to conventional therapy • For acne patients experiencing psychological

• Warn about contraception and teratogenicity

Posted by BANDA at 5:19 PM

ISOTRETINOIN IN ACNE Features of oral isotretinoin treatment

• For patients with severe acne • For patients unresponsive to conventional therapy • For acne patients experiencing psychological distress

• Extremely effective, as it targets all causes of acne

• Duration of treatment and daily dose are individualised

• Low starting dose is used that may be gradually increased, as tolerated

• Side effects are usually manageable • Warn of mood changes and the potential risk of depression

• Warn about contraception and teratogenicity Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 5:19 PM

distress

ACNE TREATMENT

acne

Tips for antibiotic therapy

• Extremely effective, as it targets all causes of • Duration of treatment and daily dose are individualised

• Low starting dose is used that may be gradually

• Do not use topical and

increased, as tolerated

oral antibiotics at the same time

• Use oral antibiotics for a 6-12-week course

• If a longer course of oral antibiotics is required, use benzoyl peroxide for a week between courses

• Warn of side effects of


antibiotic therapy, particularly photosensitivity with doxycycline



Lethal In Low Doses


ACNE MANAGEMENT IMPORTANT POINTS HISTORY AND EXAMINATION

History

• How long have you had pimples for?

• Are there any triggers? • Is there a family history? • What treatments have you had? How long did you follow each treatment?

Saturday, May 30, 2009

Box 1: Nine ingestants that can be lethal in toddlers in low doses

• Calcium channel blockers • Camphor • Imidazolines (eg, clonidine) • Cyclic antidepressants • Lomotil • Opiates • Salicylates • Sulphonylureas • Toxic alcohols

Note: Not in order of lethality Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 11:45 PM

• What was the most

Friday, May 1, 2009

effective treatment? Why did you stop it?

Preventing Recurrent DVT

• How do you feel about

your skin? Does it stop you from doing anything? Examination

• Assess the severity and whether there is any scarring.

• Determine any

psychological impact.

A patient with successfully treated DVT remains at increased risk of DVT or PE for life and will need prophylaxis at times. Prophylaxis (with, for example, enoxaparin 40mg daily) should begin 12 hours before elective surgery. In orthopaedic surgery, it should be continued at this dose for three weeks after discharge from hospital2.

Early remobilisation and compression stockings should be used routinely for all surgery. Intra-operative calf compression machines are often used in prolonged elective surgery. High-risk medical patients (eg, those likely to be inpatients for more than five days) should receive routine prophylaxis whether or not they have had a prior DVT. Seek advice if the patient has renal impairment because LMW heparins accumulate quickly in patients with moderate to severe renal failure. All women with previous DVT or artificial heart valves should receive daily heparin prophylaxis during pregnancy. Haematological review is recommended in those with diagnosed thrombophilia (deficiency of anti-thrombin III, protein C or S, mutations of factor V or prothrombin genes), as more intense prophylaxis may be needed in some. Patients with a past history of DVT who are planning air travel for more than four hours should be given recommendations in writing: • Self -inject 40mg enoxaparin before each separate flight (not including refuelling stops)

• Ask for a seat with good leg room • Accept every non-alcoholic

beverage offered

• Minimise alcohol consumption • Perform in-seat exercises recommended

by the airline. National guidelines do not recommend frequent walking around the cabin because of the risk of turbulence. Aspirin does more harm than good in air travellers. References Current Diagnosis of Venous Thromboembolism in Primary Care: A Clinical Practice Guideline, American Academy of Family Physicians and the American College of Physicians. Annals of Internal Medicine: p57- 62: Vol 5: No 1: January/February 2007 1. Palareti G., Cosmi B., Legnani C., et al. DDimer

Testing to Determine the Duration of Anticoagulation Therapy. N Engl J Med 2006; 355:1780-1789, Oct 26, 2006. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 7:02 AM

Preventing Recurrent DVT A patient with successfully treated DVT remains at increased risk of DVT or PE for life and will need prophylaxis at times. Prophylaxis (with, for example, enoxaparin 40mg daily) should begin 12 hours before elective surgery. In orthopaedic surgery, it should be continued at this dose for three weeks after discharge from hospital2. Early remobilisation and compression stockings should be used routinely for all surgery. Intra-operative calf compression machines are often used in prolonged elective surgery. High-risk medical patients (eg, those likely to be inpatients for more than five days) should receive routine prophylaxis whether or not they have had a prior DVT. Seek advice if the patient has renal impairment because LMW heparins accumulate quickly in patients with moderate to severe renal failure. All women with previous DVT or artificial heart valves should receive daily heparin prophylaxis during pregnancy. Haematological review is recommended in those with diagnosed thrombophilia (deficiency of anti-thrombin III, protein C or S, mutations of factor V or prothrombin genes), as more intense prophylaxis may be needed in some. Patients with a past history of

DVT who are planning air travel for more than four hours should be given recommendations in writing: • Self -inject 40mg enoxaparin before each separate flight (not including refuelling stops)

• Ask for a seat with good leg room • Accept every non-alcoholic beverage offered

• Minimise alcohol consumption • Perform in-seat exercises recommended

by the airline. National guidelines do not recommend frequent walking around the cabin because of the risk of turbulence. Aspirin does more harm than good in air travellers. References Current Diagnosis of Venous Thromboembolism in Primary Care: A Clinical Practice Guideline, American Academy of Family Physicians and the American College of Physicians. Annals of Internal Medicine: p57- 62: Vol 5: No 1: January/February 2007 1. Palareti G., Cosmi B., Legnani C., et al. DDimer Testing to Determine the Duration of Anticoagulation Therapy. N Engl J Med 2006; 355:1780-1789, Oct 26, 2006. 2. TGA-approved product information for Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 7:02 AM

DVT FACTS 1. The surgical or sick medical patient is the classic high-risk person for DVT. 2.High clinical suspicion and a positive D-dimer mandate further investigation. 3.If suspicion is high, treatment for DVT or PE should be started as soon as the diagnosis is suspected, not delayed for

confirmatory imaging studies. Many DVTs are unprovoked, especially in males. 4.Testing INR too often wastes resources and leaves you making

frequent dose changes to „chase your tail‟.

5.Electing to continue warfarin for 12 months delays recurrence of VTE but does not eliminate it. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 6:52 AM

Friday, April 17, 2009 INVESTIGATIONS OF INFECTIVE SYMPTOMS IN PREGNANCY Clinical presentation Possible diagnosis Investigations Maculopapular rash Rubella IgM and IgG* Parvovirus IgM and IgG* Enterovirus Throat or faecal culture

Vesicular rash Varicella Rash IgM and IgG* if uncertain Enterovirus Throat or faecal culture

Flu-like symptoms CMV IgM and IgG* (fever, myalgia, malaise, LFTs, FBC +/- lymphadenopathy) Toxoplasmosis IgM and IgG* Listeriosis Blood and faecal culture Other viral infections Serology or culture as required

*In parallel with previous antenatal serum and 2-4 weeks later if required


infection with toxoplasmosis, listeria and other infections. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx!

PREPREGNANCY COUNSELLING. Posted by BANDA at 5:35 AM GPs should encourage couples who are planning to conceive to have counselling and testing before conception. Tests for infection should include: • rubella IgG • syphilis serology – TPHA or RPR • hepatitis B serology – hepatitis B surface antigen • hepatitis C serology – hepatitis C antibody

• HIV • varicella – IgG • CMV IgG (in high -risk patients)

Women who have negative rubella serology should be offered MMR vaccine and retested for rubella seroconversion eight weeks later. About 5% will need revaccination. A very small number of women will remain rubella seronegative despite two successive MMR vaccinations. It is unlikely that further vaccination will lead to seroconversion. In these cases it is best to counsel the woman to avoid rubella contact in her subsequent pregnancy. Women found negative to varicella IgG should be offered varicella vaccine with two doses, eight weeks apart. Pregnancy should be delayed until eight weeks after vaccination for rubella or varicella. In those at high risk of CMV infection (carers of young children), CMV IgG should also be measured. Seronegative women should be counselled to practise thorough hygiene when in contact with secretions of newborn infants and toddlers. A pre-pregnancy session will also allow the GP to provide nutritional advice and instructions on ways to minimise risks of

Monday, April 13, 2009 SIGNS OF A PERFORATED EYE

■ an irregular or peaked pupil ■ a shallow anterior chamber compared to the other eye

■ absent or diminished red reflex

■ a boggy haemorrhagic swelling over the sclera

■ uveal tissue, which is dark, lying external to the globe Note: not all these signs need be present. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 6:40 AM

EYE EXAMINATIO TOOLS

■ a vision chart ■ a light source with a cobalt blue filter

■ a means of magnification such as loupes (or a pair of +3.0

“chemist‟s glasses”) ■ amethocaine drops to

anaesthetise the ocular surface

■ fluorescein drops to stain any epithelial defects

■ cycloplegic drops to dil ate the pupil

■ an ophthalmoscope to visualise the red reflex and/or posterior segment of the eye

■ cotton buds to wipe up any secretions and help evert the upper lid.


Sunday, April 5, 2009 Diagnosis of metabolic Syndrome The size of the waistline is the key to selecting patients to investigate. People who are genetically predisposed and who take in an excessive amount of calories are most likely to develop this condition. The lean man with a pot belly, a shape seen commonly in general practice, could be considered the most toxic shape of all. Objective assessment of known risk factors (cholesterol, fasting lipids, blood glucose level, blood pressure, smoking, obesity and sedentariness) is also necessary. Risk factors for metabolic syndrome often cluster together and have a multiplicative rather than an additive effect. In women, it is the level of fasting triglycerides, rather than cholesterol, that predicts subsequent cardiovascular disease and death. Waist target parameters have tightened over time and vary according to genetic polymorphism (see table below). If BMI is >30kg/m2, central

obesity can be assumed and waist circumference does not need to be measured. Abnormal blood glucose should be investigated with a glucose tolerance test. About a third of patients with diabetes will be picked up by the glucose tolerance test compared with just focusing on the fasting glucose. Obesity and central adiposity seem to co-segregate, not only with cardiovascular and diabetes risk, but also with an increased risk of certain types of malignancy, such as breast and endometrial cancer. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 7:14 PM

METABOLIC SYNDROME the International Diabetes Federation published a consensus worldwide definition of metabolic syndrome. It is defined as central obesity in concurrence with any two of the following factors: raised triglycerides, reduced HDL cholesterol, raised blood pressure or raised fasting plasma glucose Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 7:06 PM

METABOLIC SYNDROME the International Diabetes Federation published a consensus worldwide definition of metabolic syndrome.

It is defined as central obesity in concurrence with any two of the following factors: raised triglycerides, reduced HDL cholesterol, raised blood pressure or raised fasting plasma glucose Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 7:06 PM

METABOLIC SYNDROME the International Diabetes Federation published a consensus worldwide definition of metabolic syndrome. It is defined as central obesity in concurrence with any two of the following factors: raised triglycerides, reduced HDL cholesterol, raised blood pressure or raised fasting plasma glucose Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 7:06 PM

Friday, April 3, 2009 CASE STUDY CASE ONE

A mother brings her six-year-old son to your emergency department.

other symptoms. What features are present on inspection? He has a torticollis, and is in some degree of pain. What immobilisation is indicated? This child would not fit into a collar. Forcing the issue would create further pain and distress and may exacerbate an injury. He should be allowed to adopt a position of comfort, with padded support if necessary, and given simple analgesia as required. What imaging is indicated? X-rays are indicated as an initial investigation, but should be interpreted with care, with recognition that in this age-group plain X-rays are known to be poorly sensitive. What is the injury? X-rays showed an anterior subluxation of C2 on C3. In this particular case, injury was missed on two presentations, as the treating doctor interpreted the X-rays as normal and

assumed a “muscular strain”. Relying

on negative X-rays in this age group is a classical error – the history and examination (inspection) give the diagnosis. Neck pain after play mishap X-rays are indicated for the boy but should be interpreted with care. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 8:05 AM

He was practising his “Power Ranger” moves in the family‟s

CERVICAL SPINE CLEARING

split-level living room and leapt from the upper to the lower level, landing heavily on his feet. He complains of neck pain but no

1. The awake, alert patient, with no other significant injuries. Bony and ligamentous injury to the cervical spine and its supporting

structures is intrinsically painful and also causes pain because of secondary muscle spasm. Patients in this category can tell you where it hurts, and are able to respond adequately to examination. If these features are present, the neck can be cleared clinically:

■ No midline cervical tenderness ■ No focal neurological deficit ■ Normal alertness ■ No intoxication ■ No painful dis tracting injury ■ 50% or greater active range of movement

in all planes. If any of the first five features are present, standard plain three-view X-rays are indicated. These three views should include a lateral view (to include all seven cervical vertebrae and enough of the first dorsal vertebra to demonstrate alignment), an anterior posterior projection, and an openmouth odontoid view. 2. The mentally obtunded patient .

Thisgroup is the most difficult to assess accurately. They may be affected by intoxicants, head injury, hypoxia, shock or pain, or by a combination of these factors. They need careful clinical assessment and imaging, and are at high risk of having a spinal injury and it may be masked. X-rays are often of sub-standard quality in this group for several reasons, including poor co-operation leading to difficulty visualising C7-T1 junction and difficulty

getting the open mouth “peg view”. Plain

X-rays of good quality, which include the C7/T1 junction and the odontoid peg/C1/occipital junctions, are needed to clear the neck

for most patients and swimmer‟s views

and/or obliques may be needed. Those patients with a significant head injury, requiring CT scanning of the brain, should also have CT scanning of the craniocervical junction and often the rest of the neck as well. Patients with other significant injuries, whether spinal, chest, abdomen or pelvic, often require CT scanning, and clearance of the cervical spine using CT should

be done then. 3. The patient who clearly has a spinal injury. This is the easiest group for decisionmaking! They may have evidence of a spinal cord injury, or displaced fracture on plain X-rays, or other myelopathic or radiculopathic symptoms or signs that will require specialist consultation. They need transfer for detailed imaging such as CT and/or MRI, as well as treatment. 4. The patient with other injuries requiring transfer to a higher-level facility. Plain Xrays should be performed and the need for continued immobilisation discussed with the referral centre. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 7:45 AM

Thursday, April 2, 2009 Non-ulcer dyspepsia

Functional or non-ulcer dyspepsia is defined as at least three months of dyspepsia in which no definite biochemical or structural cause can be found to explain symptoms. There is no confirmatory test and the diagnosis can only be made after exclusion of the aforementioned structural causes. A diagnosis of non-NSAID, non-H pylori ulcer should only be entertained after:

■ exclusion of surreptitious NSAID use ■ careful exclusion of H pyl ori infection by several

biopsies

■ use of more than one H pylori diagnostic test ■ exclusion of confounders that would alter the sensitivity

of these tests, such as concurrent proton pump inhibitor (PPI) use, recent antibiotic therapy or gastrointestinal bleed. Management involves 4-8 weeks of PPI therapy. Although rare, exclusion of gastric carcinoma and other upper gastrointestinal malignancies is important in those

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Gastroenterological Association guidelines summarise as: ■ age older than 55 years with new -onset dyspepsia

peptic ulcer disease (5-15%) ■ gastro-oesophageal reflux disease (5-15%)

with “alarm symptoms”, which the American

■ family history of upper gastrointestinal cancer ■ unintended weight loss ■ gastrointestinal bleeding ■ progressive dysphagia ■ odynophagia ■ unexplained iron-deficiency anemia ■ persistent vomiting ■ palpable lymphadenopathy ■ jaundice. However, the presence of alarm symptoms has been found to have poor predictive value for malignancy – rather they alert the practitioner to the need for early endoscopy to avoid the risk of missing a neoplastic process. Functional dyspepsia can be difficult to manage. There is evidence showing a small benefit with H pylori eradication and PPI therapy. Although impaired gastric emptying is noted in 25-40% of patients with functional dyspepsia, there is inadequate evidence for the efficacy of prokinetic therapy. Despite its similarities to irritable bowel syndrome in pathophysiology, there is also inadequate evidence to support routine use of anti-depressants and psychological therapies, although these should be considered as alternatives for refractory patients. Counselling and reassurance is essential.


Monday, March 30, 2009 EPIGASTRIC PAIN

■ gastric or oesophageal cancer (<2%)

■ gallstones/biliary pain ■ chronic pancreatitis/ pancreatic cancer

■ coeliac disease ■ lactose intolerance ■ medications – digoxin,

theophylline, erythromycin, potassium supplements, corticosteroids and NSAIDs

■ infiltrative diseases of the stomach – eosinophillic gastritis, Crohn‟s disease, sarcoidosis

■ metabolic causes – hypothyroidism, hypercalcaemia, hyperkaelemia, heavy metals

■ hepatoma and

steatohepatitis ■ intestinal angina

■ abdominal wall pain ■ Zollinger -Ellison syndrome ■ diabetic radiculopathy Functional dyspepsia (up to 60%)

■ caffeine, alcohol and smoking can exacerbate symptoms Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to

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PERINATAL DEPRESIION

Saturday, March 28, 2009

■ Women often don‟t recognise themselves as being depressed – they hide their symptoms or present as the baby having the problem.

■ When symptoms (anxiety,

lowered mood, tearfulness, fears of not being able to cope or being a bad mother) are recurrent, severe or continue for more than two weeks, the diagnosis of depression or anxiety disorder must be considered.

■ In PND many anxieties arise

from the lack a balanced perspective. Cognitive behavioural therapy is well suited to address these issues.

■ Maternal depression is associated with poor developmental outcomes for children with

implications for the child‟s education and the potential for mental illness as adults.

■ Mothers‟ groups can be

beneficial if they are specifically for women with PND but general mothers groups can alienate women if they feel different to

the other “coping” mothers. ■ Early detection and treatment

of PND may lead to remission of symptoms and improvement for mother, child and family members, but it does not guarantee a good outcome. For some women, mother-infant or long-term therapy is needed Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to

Dermatology Skin care advice for patients with lymphoedema

■ Keep the skin supple using a non -perfumed moisturising cream such as sorbolene.

■ Avoid drying out your skin and consider using a soap-free alternative.

■ Clean any scratches, grazes or cut s immediately using an antiseptic solution, use an antibacterial cream and cover the area with a clean, dry plaster.

■ Use an electric razor for shaving instead of a wet razor.

■ Avoid tattoos and body piercing. ■ Consider ways to protect the skin, such as wearing gloves while washing dishes, gardening or handling pets. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 6:37 PM

Administration of Anti -D At the first pregnancy consultation the mother's blood group should be determined and blood taken for detection/ measurement of blood group antibodies. For complete and incomplete miscarriages all Rh(D) negative women who have not actively formed their own anti-D should be given 250IU of anti-D. There is insufficient evidence to suggest that a

threatened miscarriage before 12 weeks gestation necessitates use of anti-D, but meta-analyses indicate that antenatal administration of anti-D (for all indications including miscarriage) can result in a 78% reduction in allo-immunisation. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 6:24 PM Labels: AMC, Basics, Clinicals

Wednesday, March 25, 2009 CLINICAL DEFINITION OF MISCARRIAGE Complete miscarriage • No intrauterine gestational sac

• No ovarian/fallopian mass • Products of conception passed • No evidence of POC in uterus • Endometrial thickness <15mm in longitudinal section

Incomplete

• No intrauterine gestational sac miscarriage • No ovarian/fallopian mass • POC passed • More POC seen in uterus Missed miscarriage

• Intact intrauterine gestational sac • Fetal pole seen • No fetal heartbeat • CRL >6mm OR

• Intact intrauterine gestational sac

measuring >20mm

• Fetal pole not seen Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 8:52 AM

HOW TO TREAT MISCARRIAGE INITIAL MANAGEMENT When a woman describes bleeding in early pregnancy the treating doctor must first determine whether she has heavy bleeding and/or severe pain. Saturation of pads and/or passing clots larger than a 20 cent piece implies heavy bleeding. If either is present this scenario must betreated as a clinical emergency. The possibility of cervical shock should always be considered. A speculum examination should be performed, and any products of conception (POC) should be removed from the cervix . This is the only way to reverse shock associated with this condition. Basic life support principles apply. It is important to: • Ensure that the woman has a clear airway and adequate breathing before the speculum examination is performed.

• Gain IV access with a cannula of at least 16G diameter and start IV crystalline fluids at a rate that maintains adequate blood pressure (>100/60) and pulse rate (<100 beats per minute).

• As the IV is inserted, take

blood for blood group typing and FBC, and arrange cross-match of four units of packed cells. If analgesia is required, small bolus doses of IV morphine 2mg titrated to pain at 5minute intervals gives quick relief but should be accompanied by metoclopramide 10mg IV as an anti-emetic. If shock cannot be controlled despite adequate IV fluids and removal of POC, the

■ drug overdose ■ closed head injury The combination of neurological disturbance and evidence of defibrination in a patient with an appropriate history is strongly suggestive of severe envenomation. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 5:04 AM

woman must be prepared for emergency D&C. Surgery should not be delayed due to haemodynamic instability; it should be performed before blood and fluid losses have been replaced. Sometimes surgical evacuation of the uterus is needed to resolve shock. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx!

Labels: Snake Bites, Study Material

Snake Bites Australia How to investigate In managing the patient with suspected snakebite, it is necessary to establish whether significant envenomation has occurred and to attempt to identify the type of snake involved. A significant proportion of

venomous snakebites don‟t result in

envenomation. The use of antivenom should be reserved for those cases with clinical or pathologic evidence of envenomation.


1.Snake venom Detection Kit

Monday, March 16, 2009

2.Clotting Studies

Differential Diagnosis of snake bites DIFFERENTIAL DIAGNOSIS OF VENOMOUS SNAKEBITE ■ non-venomous snakebite

■ bite or sting by other venomous creature

(arthropod, including spider, octopus, jellyfish)

■ CVA ■ ascending neuropathy, eg Guillain -Barre syndrome

■ AMI ■ allergic reaction ■ hypoglycaemia/hyperglycaemia

3.Creatinine Kinase-Indicating Myolysis 4.Urinalysis-Haemoglobin,Myoglobin 5.Renal Function-May be impaired secondary to Myoglobinuria or other mechanism. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx!

Posted by BANDA at 4:57 AM Labels: Snake Bites

antivenom, and Victoria, where bites should be treated with combined tiger/brown snake antivenom

Austrlian Snake Bites Overview Effects of Australian snake bite venom are usually species specific, but in general include:

■ neurotoxins ■ procoagulants ■ anti-coagulants ■ rhabdomyolysins ■ haemolysins (weak). Presentation

Symptoms and signs of envenomation may include: ■ EARLY (within 3 0 minutes) - headache, nausea/vomiting, abdominal pain - coagulopathy

How to treat

Identification of snakes is often unreliable: polyvalent antivenom should be used if the type of snake cannot be identified in all areas of Australia apart from Tasmania, where both tiger snake and copperhead bite may be successfully treated with tiger snake antivenom, and Victoria, where bites should be treated with combined tiger/brown snake antivenom.

Important to remember

■ LATE (within several hours)

■ Correct diagnosis of snakebite

- cranial nerve palsies (ptosis, ophthalmoplegia, dysarthria, dysphonia, dysphagia) - limb and truncal weakness - respiratory failure - haemorrhage ■ VERY LATE (delayed presentation, wrong/inadequate treatment) - prolonged paralysis - renal failure - uncontrollable haemorrhage Features suggestive of snakebite Identification of snakes is often unreliable: polyvalent antivenom should be used if the type of snake cannot be identified in all areas of Australia apart from Tasmania, where both tiger snake and copperhead bite may be successfully treated with tiger snake

may be delayed because the bite may not be dramatic or painful, and snake venom generally causes little local pain or tissue destruction.

■ Identification of snakes is often unreliable: polyvalent antivenom should be used if the type of snake cannot be identified in all areas of Australia apart from Tasmania, where both tiger snake and copperhead bite may be successfully treated with tiger snake antivenom.

■ Children are more likely to

sustain multiple bites and may be more quickly and severely affected by snakebite than adults because of their lower body weight.

■ The combination of

neurological disturbance and

evidence of defibrination in a patient with an appropriate history is strongly suggestive of Severe envenomation Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 4:36 AM Labels: Snake Bites

Saturday, February 14, 2009 BRONCHOSCOPY The therapeutic indications for bronchoscopy include:

lung cancer: the type and operability of lung tumours can be assessed pneumonia: good for identifying infecting organism interstitial lung disease: permits histoloy and analysis of bronchoalveolar lavage causes of haemoptysis, cough and recurrent pneumonia Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 10:47 PM

removal of secretions and mucus plugs: often used in ITU pneumonic lobar collapse allergic bronchopulmonary aspergillosis

BROCHODILATORS bronchodilators

removal of foreign bodies stent insertion in benign airways disease: for example in relapsing polychondritis Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 10:51 PM

BRONCHOSCOPY Diagnostic role of flexible bronchoscopy

Bronchodilation is a phenomenon of sympathetic stimulation. Thus drugs which attempt to achieve it include: 1.sympathomimetics salbutamol } beta-2 adrenoceptor terbutaline } agonists fenoterol } rimiterol } salmeterol } adrenaline isoprenaline

2.antimuscarinics

Anticholinergics are drugs which antagonise cholinergic receptors.

or aromatase inhibitors (less so). SSRIs, SNRIs and gabapentin may be useful. Alternatives such as black cohosh have also been suggested. ● Vaginal dryness and dyspareunia. Non -hormonal moisturisers and lubricants; use local oestrogen with caution as there may be systemic absorption.

● Loss of libido resulting from altered body image,

3.xanthinesTypes of sympathomimetic include: Xanthines are compounds which inhibit phosphodiesterase and thus are able to produce bronchodilatation.

radiotherapy, chemotherapy, depression or dyspareunia. Counselling may be helpful, as well as appropriate medical treatment.

● Arthralgia and musculoskeletal symptoms, from aromatase inhibitors and sometimes tamoxifen. Conservative treatment such as paracetamol or NSAIDs if needed.

● Depression and anxiety following the diagnosis,

theophylline aminophylline caffeine, theophylline and tannin Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 10:33 PM

Wednesday, February 11, 2009 LONG TERM SIDE EFFECTS OF TREATMENT OF BREAST CANCER Lymphoedema after axillary dissection and/or radiotherapy. It can arise at any time, even many years after treatment.

● Cardiovascular toxicity after radiotherapy, and increased cardiovascular risk after premature menopause. Treat with appropriate medical and risk-reduction strategies.

● Congestive heart failure associated with

anthracyclines and trastuzumab. Monitor (mandatory with trastuzumab) and manage medically if present.

● DVT, stroke (tamoxifen). Treat as usual if present.

● Hot flushes after premature menopause, tamoxifen

loss of body image, concern about morbidity and mortality, and the direct effects of some treatment. Treat as usual, including supportive counselling and antidepressants if needed.

● Fatigue, associated with the diagnosis and

treatment. Provide support, encourage activity, and rule out psychiatric or biological causes (depression, anaemia, hypothyroidism).

● Weight gain, which can occur with

chemotherapy and possibly with tamoxifen and aromatase inhibitors. Manage as usual with diet and exercise.

● Osteopenia or osteoporosis, associated with treatment-induced menopause and aromatase inhibitors. Monitor bone mineral density and treat as usual, including bisphosphonates if needed. NEJM 2007; 356:2505-13. Drug class Anthracycline Alkylating agent Anti-metabolite - Folic acid analogue - Uracil analogue - Taxane Selective oestrogen receptor modulator Nonsteroidal aromatase inhibitors Steroidal aromatase inactivator Luteinising hormone releasing hormone agonist Monoclonal antibody Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook •

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Sunday, February 1, 2009

RISK FACTORS FOR BREAST CANCER

THE MANAGEMENT OF VARIZELLA ZOSTER VIRUS EXPOSURE AND INFECTION IN PREGNANCY AND NEW BORN PERIOD

Relative risk

GOOD DAY

Advanced age >10 Genes, family history, personal history BRCA1/2 mutation 5-10 Breast cancer in first-degree relative 2 Previous atypical hyperplasia 4-5 Previous breast cancer >4 Breastfeeding for 12 months 0.96 One birth 0.93 Two births 0.84

1.Zoster immunoglobulin (ZIG) should be offered to pregnant, varicella-seronegative women with significant exposure to varicella-zoster virus (VZV) (chickenpox) infection.

Menstrual/reproductive history Menarche before 11 years 3 Menopause after 54 years 2 First child after 30 1.2-1.4 First child after age 40 3 Current use of HRT 1.3-1.6 Current use of oral contraceptive 1.2

3.Intravenous aciclovir should be given to pregnant women who develop complicated varicella at any stage of pregnancy.

OtherLiving in a developed country (?oestrogen exposure) 5 High breast density on mammogram (?oestrogen exposure) >5 Abnormal exposure to ionising radiation 3

5.ZIG should be given to a baby whose mother develops chickenpox up to 7 days before delivery or up to 28 days after delivery.


„Lifestyle‟

High socioeconomic status 2 High postmenopausal BMI 2 High premenopausal BMI <1 One alcoholic drink daily 1.07 Lancet 2005; 265: 1727-1741. Cancer 2004; 101:353-62. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 4:33 AM

2.Oral aciclovir prophylaxis should be considered for susceptible pregnant women exposed to VZV who did not receive ZIG or have risk factors for severe disease.

4.Counselling on the risk of congenital varicella syndrome is recommended for pregnant women who develop chickenpox.

6.Intravenous aciclovir should be given to babies presenting unwell with chickenpox, whether or not they received ZIG. 7.Breastfeeding of babies infected with or exposed to VZV is encouraged. 8.A mother with chickenpox or zoster does not need to be isolated from her own baby. 9.If siblings at home have chickenpox, a newborn baby should be given ZIG if its mother is seronegative. 10.The newborn baby does not need to be isolated from its siblings with chickenpox, whether or not the baby was given ZIG.

11.After significant nursery exposure to VZV, ZIG should be given to seronegative babies and to all babies born before 28 weeks' gestation. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 12:11 PM Labels: AMC, Clinicals, education, MCQs, Medical Exams, Study Material, travel and places

Saturday, January 31, 2009 Asthma Management of Exacerbations GOOD DAY ! ASTHMA Managing exacerbations

SUMMARY OF PRACTICE POINTS LEVEL OF EVIDENCE Management of exacerbations in adults A short (7-10 days) course of oral corticosteroids i s the current standard treatment for adults with moderate-to-severe asthma exacerbations. I When administering a SABA via MDI during an exacerbation, use a spacer . [√] In adults with acute exacerbations not considered severe enough for admission to hospital, high-dose ICS may be effective. II Merely doubling the maintenance ICS dose is not effective in managing exacerbations. II Management of exacerbations in children A short (up to 5 days) course of oral corticosteroids (prednisolone 1 mg/kg up to 60 mg daily) is the current standard treatment for severe exacerbations. Closely monitor response to treatment. I Children who are taking regular preventive

medication should continue taking the same dose during an exacerbation. II When administering a SABA via MDI during an exacerbation, use a spacer. III-1 Merely doubling the maintenance ICS dose is not effective in managing exacerbations in children. II Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 3:35 AM Labels: AMC, MCQs, Study Material

Understanding Cervical Pathology GOOD DAY Cervical pathology ! Hot topic in AMC Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 3:28 AM Labels: AMC, MCQs, Study Material

ASTHMA KEY POINTS GOOD DAY ! ACUTE ASTHMA SUMMARY OF PRACTICE POINTS LEVEL OF EVIDENCE Managing acute asthma in adults

If the patient is acutely distressed, give oxygen and SABA immediately after taking a brief history and physical examination.

[√]

Assess response to treatment using spirometry, oxygen saturation, heart rate, respiratory rate and pulsus paradoxus status.

[√] Wheeze is an unreliable indicator of the severity of an asthma attack and may be absent in severe asthma.

[√]

Ensure every patient receives adequate follow-up after an acute asthma episode, including review of medications, triggers and asthma action plan.

[√]

Managing acute asthma in children If the patient is acutely distressed, give oxygen and SABA immediately after taking a brief history and physical examination.

[√]

Emergency management of acute asthma in a child is based on initial administration of salbutamol 4-6 puffs (< 6 years) or 8-12 puffs (≥6 years) via MDI. I Load the spacer with one puff at a time and give each puff separately. III-1 If treatment with an oral corticosteroid (e.g. prednisolone 1 mg/kg up to 60 mg as a single daily dose) has been initiated for a moderate-to-severe acute episode, continue for up to 5 days. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 3:16 AM

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Thursday, January 29, 2009 Are You Ready GOOD DAY ! I need some feed back from you guys come on.....take it easy. Email this • Email the author • Technorati Links • View CC license • Subscribe to this feed • Sphere: Related Content • Save to del.icio.us • Add to del.icio.us • Digg This! • Share on Facebook • outside.in: geotag this story • Discuss on Newsvine • Stumble It! • Add to Mixx! Posted by BANDA at 1:10 PM Labels: AMC, Basics, Medical Exams

MCQs GOOD DAY ! Hi next to come is MCQ discussion............please mind that you needs to know what exactly is "ASKING".......this will help to select what is the answer.....!!!

By The Way--ELCTRICAL BANDAGE ?


GOOD DAY !


Labels: AMC, Clinicals, MCQs, Study Material

Friday, January 30, 2009

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Labels: AMC, Australia migration, Doctors, MCQs, Medical Exams

Wednesday, January 28, 2009

DOCTOR LOCUMS

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Posted by BANDA at 7:04 AM Labels: AMC, Clinicals

Sunday, January 25, 2009

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ANDROGEN DEFICIENCY IN MALE AUTOSOMAL DOMINENT CONDITIONS June (4) ISOTRETINOIN IN ACNE ISOTRETINOIN IN ACNE ACNE TREATMENT ACNE MANAGEMENT May (4) Lethal In Low Doses Preventing Recurrent DVT Preventing Recurrent DVT DVT FACTS April (11) INVESTIGATIONS OF INFECTIVE SYMPTOMS IN PREGNANCY PREPREGNANCY COUNSELLING. SIGNS OF A PERFORATED EYE EYE EXAMINATIO TOOLS Diagnosis of metabolic Syndrome METABOLIC SYNDROME METABOLIC SYNDROME METABOLIC SYNDROME CASE STUDY CERVICAL SPINE CLEARING Non-ulcer dyspepsia Functional or non-ulcer dyspe... March (9) EPIGASTRIC PAIN PERINATAL DEPRESIION Dermatology Administration of Anti -D CLINICAL DEFINITION OF MISCARRIAGE HOW TO TREAT MISCARRIAGE Differential Diagnosis of snake bites

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2009 (52) ▼ November (1) o MCQS WITH ANSWERS ► October (2) o HIV AND "SKIN" HIV Presentation ► September (2) o EPILEPSY MANAGEMENT PNEUMONIA INFECTIOUS AGENTS o ► August (2) 

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AMC MCQ

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