Get Through PLAB Part 1 - 500 Single Best Answer Questions (April 5, 2006)_(1853156388)_(CRC Press).pdf

Get Through PLAB Part 1 is an essential revision tool for all candidates preparing for the examination. PLAB Part 1 consists of 70% extended matching questions and 30% single best answer (SBA) questions. As a companion text to the bestselling PLAB: 1000 Extended Matching Questions , this book provides 500 practice SBA questions covering topics that reflect the current PLAB syllabus and presented in a format identical to the exam itself. The author, Una Coales, who has taken and successfully passed the exam herself, offers helpful hints and tips on what to expect and how to negotiate the examination successfully. Get Through PLAB Part 1 is recommended to all candidates sitting the PLAB Part 1 exam, and their trainers. Cover Half Title Title Copyright Contents Preface Dedication Recommended Texts and References 500 Single Best Answer Questions A 59-year-old post-menopausal woman presents with a month of PV bleeding. On speculum exam, the cervix appears normal and there is no vaginal discharge. woman reports she has missed the first pill in her second pill pack. She had unprotected sexual intercourse (UPSI) 2 days ago. has been getting progressively more confused over the past few months. She is disoriented to time, place and person and often wanders the streets aim- lessly. a past history of febrile convulsions. His lastconvulsion was 6 months ago. There is also a family historyof epilepsy. man presents with right-sided hemiparesis.There is a bruit on neck auscultation. a foot drop and is unable to dorsiflex or everthis left ankle. Sensation is lost over the front and lateral sideof the leg and dorsum of the foot. A 22-month-old girl has severe dehydration. You are unableto gain peripheral venous access. A 55-year-old man presents with sudden onset of lower back oVo)pain, loss of perineal sensation and urinary incontinence. A 45-year-old businessman returns from Nigeria with highfever, confusion and rigors. A 30-year-old pregnant woman presents with numbness andtingling in her right hand involving the lateral three fingers. A 22-year-old man sustains a femoral shaft fracture whilerollerblading and is brought to A&E confused and agitated. A 50-year-old obese man presents with severe central chestpain radiating to his back. He is a heavy smoker and drinker. stress incontinence.What is the SINGLE most appropriate form of treatment } A 15-year-old boy presents to A&E with severe asthma. Heis using his accessory muscles of respiration and is unable tospeak in sentences. a degloving injury to the lower leg andpelvic fractures. BP is 80/40 and JVP is 2. Urinary A 7-year-old boy presents with persistent nocturnal enuresis. V)There is a family history of enuresis. MSU shows no growth. A 30-year-old man presents with haematuria and BP of180/100. On exam, you palpate bilateral irregular abdominalmasses. A 15-year-old girl with a neural tube defect is brought in byher mother for advice on urinary incontinence. Ondigital rectal exam, you palpate a firm nodule on theprostate. A 40-year-old triathlon athlete complains of pain in his side.He cannot keep still. An 8-year-old boy is wheelchair bound with a neural tubedefect. He is found to be persistently incontinent of urine.MSU shows no growth. bicyclist was struck by a car and presents withperineal bruising. He has been unable to void for the past 2hours. On rectal exam, his prostate is noted to be highriding. 94. A 70-year-old man on the Geriatric ward develops confusion.On exam, the bladder is palpable at the umbilicus. OBG/GYN A 38-year-old married working mother of 3 asks for contraception.She states she had a pill-failure in the past and has ahistory of heavy periods. A 36-year-old woman is found to have blocked fallopiantubes on laparoscopy and hysterosalpingography. The uterusis normal. Respiratory A 55-year-old woman post-hysterectomy complains ofpleuritic chest pain and coughing up blood. An insulation company worker presents with cervical lymphnodes and SOB. CXR reveals bilateral pulmonary fibrosisand mild pleural effusion. A 30-year-old woman presents with 2 weeks of fever, rigorsand productive rusty cough. CXR shows a left lower lobeconsolidation. A 10-year-old boy has SOB and wheezing when playing football. Pediatrics A 9-month-old baby is brought in to A&E, as the baby isinconsolable. The mother notes that the baby has a distendedabdomen and reports that the baby is vomiting and cannotkeep food down. AXR shows a transverse line just below theumbilicus. GI A 40-year-old man presents with BRBPR, constipation anddiarrhoea. Sigmoidoscopy reveals an ulcerated stricture inthe sigmoid colon. A 70-year-old woman presents with dysphagia and regurgitation. A 50-year-old alcoholic presents with mild jaundice and V)epistaxis. A 40-year-old man returns from Africa with high swingingpyrexia and diarrhoea. On exam, there is tenderness in theright upper quadrant of the abdomen. A 35-year-old woman complains of severe pain on defecation.She is unable to tolerate digital rectal examination. Shehas a history of constipation. A 70-year-old woman being treated for temporal arteritis V)now presents with fever, severe upper abdominal pain andvomiting. A 25-year-old man complains of bouts of alternating intermittentdiarrhoea and constipation for the past month. Hedescribes a sensation of incomplete evacuation and bloating.Symptoms are relieved by defecation. Sigmoidoscopy isnormal. A 50-year-old man post-op cholecystectomy presents withfever, jaundice and dark urine. A 26-year-old man with NIDDM and a history ofhaemochromatosis now presents with jaundice. A 9-month-old baby is brought in to A&E, as the baby isinconsolable. The mother notes that the baby has a distendedabdomen and reports that the baby is vomiting and cannotkeep food down. AXR shows a transverse line just below theumbilicus. A 55-year-old man with new-onset dyspepsia reports norelief with antacids. A 50-year-old woman post oesophagectomy for oesophagealcarcinoma presents with a BP of 80/50 in the recovery room.She is on a morphine drip for pain. Hb is 10 gm/dl. Shesuddenly loses consciousness. A 30-year-old man presents with bloody diarrhoea and V)mucus stools. Histology shows crypt abscesses and granularinflammatory mucosa. A 30-year-old female complains of persistent fever and diarrhoea.On examination she is noted to have a fistulo in anoand perianal skin tags. A 50-year-old man complains of pain on defecation. Onexamination there is a tender reddish blue swelling near theanal verge. jaundice 79. A 4-day-old breast-fed baby presents with jaundice. Themother is concerned, as her baby has also lost 250 g inweight. Stools are not pale. A 17-day-old breast-fed baby presents with jaundice. The V)mother is concerned, as the stools are clay-coloured. 85. A 6-week-old baby is brought in by her mother, who is concernedas the baby is always hungry and cannot keep milkdown. Mother denies that the baby has been vomiting bile.On examination, a small mass is palpated in the upperabdomen. 86. A 14-year-old boy complains of sudden pain in his groinafter cycling 10 miles. 88. A 16-year-old girl who had recently had a sore throat now V)complains of severe left-sided upper abdominal pain. Onexamination, there is pallor. BP 60/40 PI30. Abdomen istense and rigid, with no bowel sounds. CVS palpitations at rest. Restingpulse is 70 and regular. Holter ECG shows irregularitiesassociated with the palpitations. pleuritic chest pain 5 daysafter an MI and is found to have persistent ST elevation onECG. Pain is worse with movement. A 56-year-old IDDM male presents with persistently elevatedBP of 180/110. Blood tests are unremarkable. A 58-year-old male heavy smoker states that his right big toe V)becomes pale and painful when walking. A 45-year-old man with a history of heart failure now presentswith moderate to severe depression. A 60-year-old man presents with severe SOB with basal V)crepitation on auscultation. BP is 160/110 with a pulse of100. CXR confirms suspicions. A 69-year-old man with a history of intermittent claudicationnow reports severe back pain. On exam, BP is 90/50. CNS student back from a hiking holidayin Massachusetts presents with bilateral facial nerve palsyand a raised pink annular lesion on her lower leg. She saysthis was all preceded by flu-like symptoms. A 55-year-old male presents with TIA and is found to have apulse rate of 100 with irregular rhythm. A 70-year-old woman being treated for temporal arteritis V)now presents with fever, severe upper abdominal pain andvomiting. An 80-year-old woman notes that she had trouble puttingup her curtains yesterday evening. She states she loses herbalance and falls. A 5-year-old boy is noted to have a clumsy gait and mildscoliosis. When he gets up off the floor, he uses his handsto climb up his legs. 92. A 60-year-old man complains of blurred speech and weakness,and tingling of his left arm. The episode lasted 3 hours. 94. A 70-year-old man on the Geriatric ward develops confusion.On exam, the bladder is palpable at the umbilicus. 95. A 50-year-old woman reports an episode of sudden loss ofconsciousness. She only recalls her heart thumping prior tothe event and her face looking flushed upon recovery. suffers from the most common form of dementia, a dementiacharacterised by neurofibrillary tangles and senile plaques. Endo A 33-year-old woman is found to have a solitary 2.5 cmnodule in the left side of the thyroid. A 40-year-old woman suffering from asthma is also noted tobe hyperthyroid. DM A 50-year-old NIDDM patient brings in a letter from hisoptician, which states he has extensive proliferative retinopathy. Derma A 55-year-old naval seaman presents with a rash on his forehead.He states that he has had the rash for years and oftenforgets to wear his cap while on duty. 59. A 1-year-old develops swollen lips after eating peanuts. A 10-year-old boy is brought into Casualty in the British Isles V)by his parents following a weaver fish sting on the localbeach. A 55-year-old woman presents with a plaque-like lesion onher lower calf and a painless ulcer on the sole of her foot. A 75-year-old female resident of a nursing home presentswith intractable itching. On exam, there are burrowsbetween her fingers. A 1-week-old boy is brought to Casualty by his Koreanfather, as he is concerned about a nontender bluish patch onthe baby’s right buttock cheek. He is worried, as his wife issuffering from postnatal depression. Allergy 61. An 8-year-old boy is suspected to be allergic to strawberries. Trauma A 30-year-old pedestrian involved in a RTA is brought intoA&E with loss of consciousness. He regains consciousnessand complains of headache, and has neck stiffness on exam.He has a deep laceration to his right temple. A 20-year-old cyclist is hit by an oncoming vehicle and nowpresents with loss of consciousness. On exam, there is bloodbehind the eardrum and periorbital ecchymoses. bicyclist was struck by a car and presents withperineal bruising. He has been unable to void for the past 2hours. On rectal exam, his prostate is noted to be highriding. An 80-year-old female resident of a nursing home is seen inCasualty for generalised bruising. A month prior she wasadmitted for a femoral neck fracture sustained falling out ofbed. A year ago she sustained a Colles fracture after trippingover her feet. A 5-year-old girl presents after a fall on her right arm off aswing. On examination there is no swelling or deformity, butthe forearm is extremely tender. A 6-year-old girl is brought into Casualty by her nanny, complainingof arm pain and inability to use her arm. The nannyexplains that she was twirling the child around like an aeroplane. 86. A 14-year-old boy complains of sudden pain in his groinafter cycling 10 miles. Infectious A 50-year-old Iranian farmer presents with fever, rigors andhepatosplenomegaly. A 22-year-old man reports that he was bitten by a stray dog. Psychiatry A 45-year-old man with a history of heart failure now presentswith moderate to severe depression. A 15-year-old girl is brought in by her family as they are concernedshe is anorexic and depressed. BMI is 15. She has nosuicidal ideation. A 60-year-old married woman is brought in by her husbandas he reports that she is behaving oddly. She has suddenlybeen making inappropriate sexual remarks in public. She hasalways been a shy person and now is extremely extrovert. A 45-year-old alcoholic male would like medication to helphim abstain from drinking. He attends AA and has beensober for 1 week. Ophthalmo 46. A 30-year-old man with ankylosing spondylitis now presentswith eye pain and redness. A 30-year-old banker complains of headaches and blurryvision. He sits in front of his VDU screen for 8 hours a daychecking the stock market. A 70-year-old woman reports tunnel vision and seeing haloesaround lights with vision worse in the evening. A 77-year-old man reports difficulty reading the newspaperwith missing words, seeing straight lines as wavy and anempty spot in the centre of his vision. A 40-year-old woman complains of pain on sideways movementof her eyes and decreased colour vision. Rheumatology A 69-year-old man with a history of intermittent claudicationnow reports severe back pain. On exam, BP is 90/50. overdosing No label is found on the bottle. The patient is notedto be in heart block, and has a palpable bladder and dilatedpupils. ENT A 30-year-old woman develops bilateral conductive hearingloss after giving birth. On examination the tympanic membranesappear normal. 74. A 50-year-old woman complains of tinnitus, vertigo anddeafness. It is so disabling that she is house-bound. Deafnessimproves gradually. 89. A 4-year-old girl presents with nasal speech and snoring. Themother is concerned as the child is somnolent during the dayand the teachers find her inattentive. 90. A 5-year-old child is brought in by the mother, as she is concernedthat the child is falling behind at school. She thinksthe child’s hearing may be affected. The child has no earache.On examination, tympanic membranes are dull. burns 72. A10-year-old child presents with 15% body surface area burns. V) A 50-year-old burns victim needs to be commenced on IVfluids. 91. A 29-year-old woman, with a family history of breast cancerin her mother at age 35, would like to be screened for breastcarcinoma. Answers to 500 Single Best Answer Questions