Ebook Handbook of PLAB (2nd edition): Part 1

(BQ) Part 1 book Handbook of PLAB presents the following contents: Cardiovascular system, respiratory diseases, neurology, hematology, endocrinology, gastroenterology, rheumatology, infectious diseases, oncology, emergencies, ethics, pharmacology.

Handbook of PLAB Handbook of PLAB Second Edition Kunal Goyal MBBS MRCP Specialist Registrar West Midlands Deanery, UK Seema Mittal MBBS Senior House Officer Manchester JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd EMCA House, 23/23B Ansari Road, Daryaganj New Delhi 110 002, India Phones: 23272143, 23272703, 23282021, 23245672, 23245683 Fax: 011-23276490 e-mail: jpmedpub@del2.vsnl.net.in Visit our website: http://www.jpbros.20m.com Branches • 202 Batavia Chambers, Kumara Kruppa Road, Kumara Park East, Bangalore 560 001, Phones: 2285971, 2382956 Tele Fax: 2281761 e-mail: jaypeebc@bgl.vsnl.net.in • 282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza Pantheon Road, Chennai 600 008, Phone: 28262665 Fax: 28262331 e-mail: jpmedpub@md3.vsnl.net.in • 4-2-1067/1-3, Ist Floor, Balaji Building, Ramkote Cross Road, Hyderabad 500 095, Phones: 55610020, 24758498 Fax: 24758499 e-mail: jpmedpub@rediffmail.com • 1A Indian Mirror Street, Wellington Square Kolkata 700 013, Phone: 22451926 Fax: 22456075 e-mail: jpbcal@cal.vsnl.net.in • 106 Amit Industrial Estate, 61 Dr SS Rao Road, Near MGM Hospital Parel, Mumbai 400 012 , Phones: 24124863, 24104532 Fax: 24160828 e-mail: jpmedpub@bom7.vsnl.net.in Handbook of PLAB © 2003, Kunal Goyal, Seema Mittal All rights reserved No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher This book has been published in good faith that the material provided by authors is original Every effort is made to ensure accuracy of material, but the publisher, printer and authors will not be held responsible for any inadvertent error(s) In case of any dispute, all legal matters to be settled under Delhi jurisdiction only First Edition: 2001 Second Edition: 2003 ISBN 81-8061-190-6 Typeset at JPBMP typesetting unit Printed at Gopsons Papers Ltd., Noida Preface to the First Edition Handbook of PLAB is an effort to provide its readers an understanding of the new pattern of this examination from the year 2000 It is the first book of its kind wherein the author has tried his best to make it easily readable and easy to follow It incorporates about 3500 extended matching questions (EMQs) covering all the major topics More stress has been laid on the topics which are rendered important from the point of view of the PLAB examination First timers (beginner aspirants) as well as those who have been preparing already will find the Handbook equally useful The author is quite hopeful that the latter will find it of immense use for revision and refresh whatever they have read before The author got the idea of writing the book when he along with his friends and colleagues was preparing for the PLAB examination This new pattern examination was totally new so the author and his friends had to face a new unknown challenge hence they felt the need of such a book all the more This book has been written with the first hand experience gained by the author himself Learning can be self or from the experience of others The author was not lucky enough to learn from the experience of others so he had to venture himself in the blind alleys However, the experience had been quite useful and hence this book The author is quite hopeful that it will meet the needs of the students in their preparation of the PLAB Candid comments from the readers are most welcome Kunal Goyal Acknowledgements We owe my heartfelt gratitude to: My brother, Amit, whose unconditional support and inspiration has helped me to reach where I an today Our parents who have stood by me at all times All the well wishers for all their support and assistance Mr JP Vij, Chairman and Managing Director of M/s Jaypee Brothers Medical Publishers (P) Ltd., and his team of dedicated staff for their untiring efforts Preface to the Second Edition The huge success of the first edition filled me with enthusiasm, to work hard to update the book When I first wrote the book, being the first one in the field, just after first exam based on new pattern, I realize it had questions, which were difficult and not really suitable for PLAB Over time, we have learnt more about GMC questioning style and topics of interest and importance We have tried our best to add on the relevant questions and change the previous ones to make this book an essential read for all PLAB aspirants First time (beginner aspirants) as well as those who have been prepairing already will find the handbook equally useful We are quite hopeful that the latter will find it of immense use for revision and refresh whatever they have read before I hope all of you enjoy the book, as much as we did revising it We are as always open to candid comments from our readers Kunal Goyal Seema Mittal Contents Cardiovascular System Respiratory Diseases 55 Neurology 96 Hematology 168 Endocrinology 191 Gastroenterology 212 Rheumatology 290 Infectious Diseases 315 Oncology 353 10 Emergencies 366 11 Ethics 386 12 Pharmacology 392 13 Dermatology 412 14 Surgery 440 15 Radiology 531 16 Biochemistry 534 17 Pediatrics 544 18 Orthopedics 600 19 Psychiatry 635 20 Ear, Nose and Throat 662 21 Ophthalmology 682 22 Obstetrics 698 23 Gynecology 736 24 Renal Diseases 779 25 Miscellaneous 816 Answers 829 READER SUGGESTIONS SHEET Please help us to improve the quality of our publications by completing and returning this sheet to us Title/Author: Handbook of PLAB 2/E— by Kunal Goyal and Seema MIttal Your name and address: E-mail address, Phone and Fax: How did you hear about this book? [please tick appropriate box (es)] Direct mail from publisher Conference Bookshop Book review Lecturer recommendation Friends Other (please specify) Website Type of purchase: Direct purchaseBookshop Friends Do you have any brief comments on the book? Please return this sheet to the name and address given below JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD EMCA House, 23/23B Ansari Road, Daryaganj New Delhi 110 002, India one Cardiovascular System THEME: INTERPRETATION OF PULSE RATE Options a b c d e Regular fast palpitations Regular slow palpitations Irregular fast palpitations Dropped beats Regular and pounding For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions Pulsus bigeminus Anxiety Atrial fibrillation Atrial ectopics Atrial flutter Patient on beta blockers THEME: DIAGNOSIS OF APEX BEAT Options a b c d e f Undisplaced, tapping apex Displaced, forceful apex Undisplaced, heaving apex Displaced, hyperdynamic apex Dyskinetic Double impluse Pharmacology 397 26 A 34-year-old woman complains of heartburn, indigestion and reflux with water bash 27 A 4-year-old boy is ferbrile and irritable with a generalised vesicular rash He has a history of a febrile convulsion in the past 28 A 20-year-old student suffers with hay fever She is due to take her final exams and is worried that the hay fever will affect her performance However, she is also worried that medication may make him drowsy 29 A 50-year-old woman has a month history of epigastric pain after meals THEME: PRESCRIBING FOR ALCOHOL AND DRUG ABUSE Options a Acamprosate b Admit and give Benzodiazepines c Benzodiazepine d Disulfiram e Electroconvulsive therapy f Hematinics g Heroin h High potency vitamins i Insulin coma therapy j Lithium k Liver extract l Methadone m Multivitamins n Naltrexone o Refer to substance misuse team p Vitamin K For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 30 A 50-year-old woman presents to the clinic with a history of shakes for 12 hours, which started after she woke up following a 36 hour binge of alcohol at a party 398 Handbook of PLAB 31 A 35-year-old unemployed woman has been in hospital for a period of detoxification due to alcohol She is ready for discharge but wants to remain abstinent after discharge 32 A 30-year-old man wants help in coming off heroin He attends the A&E He has been injecting heroin intermittently for the months His partner is not a drug user and very supportive 33 A 50-year-old filmmaker presents with making up stories to fill the memory gaps She shows global amnesia on testing and there is no impairment of consciousness She gives a history of alcohol abuse and has been hearing voices She is already taking vitamin supplements 34 A 40-year-old man has been admitted to the medical ward with jaundice and a past history of alcohol abuse He is now seeing ants crawling over him and is becoming disturbed and restless THEME: SIDE-EFFECTS OF COMMON DRUGS Options a b c d e f g h i j k Impotence Wasting Deep vein thrombosis Bronchospasm Pseudomembranous colitis Haemorrhagic cystitis Constipation Retrobulbar neuritis Endometrial carcinoma Steven-Johnson syndrome Retroperitoneal fibrosis For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 35 Cimetidine Pharmacology 36 37 38 39 40 41 42 43 399 Cyclophosphamide Diamorphine Amoxycillin Oral contraceptive pill Aspirin Ethambutol Tamoxifen Methysergide THEME: DRUG OF CHOICE Options a Diamorphine IV b Diamorphine IM c Salbutamol nebulisation d Nebulised steroids e Protamine sulphate f Carbamazepine g Donepezil h Methadone i Naltrexone j Vigabatrin k Sulphasalazine l Carbimazole m Fluoxetine For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 44 A 60-year-old woman with no previous history is brought to A&E by her husband who says that she has become progressively forgetful and tends to have mood swings 45 A 30-year-old 13 weeks pregnant woman complains of heat intolerance She has lost weight despite a good appetite 400 Handbook of PLAB 46 A 40-year-old woman develops a crushing chest pain associated with nausea and profuse sweating The pain is still present when she arrives in hospital an hour later 47 A 15-year-old known asthmatic is brought to A&E breathless His pulse is 56 No wheezing is heard 48 A 35-year-old woman has been treated for morphine dependence She wants to stay off the drug 49 A 40-year-old woman is suffering from ulcerative colitis 50 A 44-year-old woman complains of morning stiffness of both her knees On examination they are found to be swollen and tender She has lost weight 51 A 30-year-old woman has lost weight since the death of her husband years ago She is withdrawn and has a bleak view of the future THEME: DRUG OVERDOSE Options a b c d e f g h i j k Lithium Aspirin Ethanol Benzodiazepine Tricyclic antidepressants LSD overdose Beta blocker Paracetamol Methanol Amphetamine Digoxin For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 52 A 20-year-old student was admitted to A&E with pyrexia and sweating His pulse was 120 and BP was 100/60 He also complained of deafness and tinitus Pharmacology 401 53 A 35-year-old woman was admitted to A&E unconscious Her temperature was 37.7oC pulse was 130 and BP 95/ 65 Neurological examination showed bilateral extensor plantars Her pupils were dilated ECG showed sinus tachycardia and occasional ventricular ectopics 54 A 62-year-old woman presented with drowsiness and confusion Her pulse was 50 and his BP was 100/70 ECG showed first-degree heart block and widening of QRS interval 55 A 70-year-old man presented with nausea, vomiting and diarrhoea He also complained of blurring vision and flashes of light On examination, he was slightly confused and his pulse was slow and regular 56 A 38-year-old man with long-standing psychiatric illness was admitted with polyuria, diarrhoea, vomiting and coarse tremor involving both hands 57 A 25-year-old waiter developed jaundice, right hypochondrial pain and tenderness, hypoglycaemia and oliguria days after an overdose THEME: 10 DRUG INTERACTIONS Options a Loop diuretics b Allopurinol c NSAIDs d Alcohol e Erythromycin f Amitriptyline g Thiazide diuretic h Ranitidine i Cimetidine j Verapamil k Amiodarone l Chloramphenicol m Omeprazole 402 Handbook of PLAB For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 58 A 35-year-old manic depressive is noted to have high serum levels of lithium and profound hypokalemia Her GP has started her on an antihypertensive 59 A 44-year-old woman on carbamazepine for trigeminal neuralgia now presents with severe dizziness She was recently started on an antibiotic course 60 A 45-year-old man taking phenytoin for epilepsy now presents with ataxia, slurred speech and blurred vision His medications include carbamazepine, tagamet and allopurinol Which among these drugs is responsible for the interaction with phenytoin? 61 A 50-year-old diabetic on metformin presents with lactic acidosis His medication includes erythromycin and paracetamol He also drinks heavily THEME: 11 MANAGEMENT OF DRUG DEPENDENCY Options a b c d e f g h i j k l Disulfiram Methadone Needle exchange programme IV vitamin B12 and thiamine Gradual reducing course of diazepam Outpatient referral to drug dependency team Chlormethiazole Chlordiazepoxide Naloxone Group psychotherapy Inform police Hospital admission For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Pharmacology 403 Questions 62 A 70-year-old woman has taken 20 mg of temazepam at night for the last 30 years She has begun to suffer with falls and has agreed that temazepam might be contributing to this 63 A 26-year-old heroin addict is worried because her partner has been diagnosed as having HIV She is HIV negative She does not feel able to stop using heroin at the present times 64 A 40-year-old man has become increasingly dependent on alcohol since his wife died last year He admits that he has a problem and wishes to stop drinking He does not wish to take anti-depressants 65 A 30-year-old builder was admitted for an elective anterior cruciate ligament repair He admits to drinking at least 60 units of alcohol per week and has no desire to stop You are keen to prevent him from developing withdrawal symptoms as this may impair his recovery from the operation 66 A 63-year-old retired surgeon is admitted with a short history of bizarre behaviour He claims that the GMC are investigating him for murder and have hired a private detective to follow him He has evidence of coarse tremor, horizontal nystagmus and an ataxic gait His wife says the story about GMC is not true but says her husband has been drinking a lot since retirement 67 A 37-year-old retired professional footballer admits to using cocaine and heroin for the last years He has recently signed a contract to present a sports show on television and wishes to ‘clean his life up’ first His wife and family are supportive of this THEME: 12 WARNINGS FOR SPECIFIC DRUGS Options a Must be taken with food b Must be taken on an empty stomach c Must avoid alcoholic drinks 404 Handbook of PLAB d e f g This drug may colour urine Not to be stopped without doctor’s advice Avoid exposure of the skin to sunlight Take a full glass of water at least 30 minutes before breakfast and remain upright until after breakfast h May reduce effect of OC pills i May cause blue tinted vision j Not to be taken with antacids k Not to be taken with iron tablets For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 68 69 70 71 72 73 Sulfasalazine Chlorpropamide Sildenafil Alendronate Ampicillin Phenytoin THEME: 13 IMPORTANT DRUG INTERACTIONS Options a b c d e f g h i j k l OC pills and erythromycin Warfarin and rifampicin Cyclosporin A and phenytoin Captopril and triamterene Propanolol and verapamil Theophylline and erythromycin Lithium and bendrofluazide Digoxin and frusemide Warfarin and amiodarone Metformin and cimetidine Phenytoin and isoniazid Pencillamine and tetracycline Pharmacology 405 For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 74 An elderly man on treatment for an irregular heart rate develops ankle edema for which he is given a new drug weeks later he develops complete heart block, nausea and complains of seeing ‘yellow’ 75 A patient on treatment for a psychiatric disorder is noted to have hypertension for which she is prescribed a new drug Within a week she develops tremor, agitation and weeks later presents with heart block, seizures and a raised creatinine of 400 76 A young career woman is treated by her GP for a respiratory infection A week later she develops irregular bleeding One month after this, a pregnancy test is positive 77 A man develops a persistent arrhythmia for which DC cardioversion is planned He is commenced on appropriate treatment for weeks leading to cardioversion He plans a holiday during which he contacts tuberculosis One week after starting ATT he develops sudden onset left sided weakness 78 A young woman is on maximal therapy for rheumatoid arthritis She is also on treatment for acne At routine follow-up, her urea is 30 and her creatinine 600 THEME: 14 INVESTIGATION OF DRUG OVERDOSE Options a b c d e f Bleeding time Prothrombin time APTT ECG Serum urea and electrolytes Full blood count 406 Handbook of PLAB g Phenytoin levels h Peak flow measurement i Spirometry For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 79 A 25-year-old girl who has ingested 25 tablets of paracetamol 80 A 16-year-old girl who has ingested 20 tricyclic antidepressants She tells you she wanted to end her life 81 A 25-year-old asthmatic who was on oral theophyllines at home was given IV phenytoin on the ward 82 An 18-year-old nightclub dancer was given a ‘pill’ by a friend This was to help her relax so she could enjoy the night THEME: 15 PRESCRIBING AND LIVER FAILURE Options a Spironolactone 100 mg/day PO b Frusemide 100 mg/day PO c Paracentesis d Paracentesis with albumin infusion e Ciprofloxacin 250 mg PO f Flucloxacillin 500 mg/day PO g Chlorpheniramine 75 mg PO h Cholestyramine g/8h PO i Tetracycline 250 mg/8h PO j Stop warfarin k Increase warfarin dosage l Decrease warfarin dosage m Bedrest, salt and fluid restriction For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Pharmacology 407 Questions 83 A 32-year-old chronic alcoholic is in liver failure He has severe pruritus 84 A 30-year-old chronic alcoholic is on warfarin following an acute MI he suffered months ago He now develops liver cirrhosis 85 A 32-year-old man has had hepatitis B for the last 1-yearand now presents with a grossly distended abdomen and other stigmata of liver disease You are worried he may develop spontaneous bacterial peritonitis 86 A 30-year-old woman presents with a mildly distended abdomen, yellowing of the mucus membranes She is found to have spider naevi on her chest THEME: 16 PRESCRIPTION AND DISEASE Options a Vancomycin b Benzylpenicillin c Erythromycin d Actinomycin e Metronidazole f Amoxycillin g Glyceryl trinitrate h Co-trimoxazole i Zidovudine j Ondansetron k Fluconazole l Imidazole m Verapamil n IV immunoglobulins o Piperacillin p Trimethoprim For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all 408 Handbook of PLAB Questions 87 88 89 90 91 92 93 94 95 96 97 Meningococcal Meningitis Tetanus Trichomonas vaginalis Vincent’s angina Uncomplicated UTI Pseudomembranous colitis (patient is allergic to vancomycin) Sinusitis in patient allergic to penicillin Acute otitis media Acute streptococcal sore throat Pneumocystis Amoebiasis THEME: 17 ADVERSE EFFECTS OF MEDICATIONS Options a b c d e f g h i j k Nifedepine Carbimazole Rifampicin Ampicillin Propanolol Captopril Co-trimoxazole Simvastatin Thiazide diuretic Isoniazid Propyl thiouracil For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 98 A 50-year-old alcoholic was diagnosed to have tuberculosis He was started on some medications then a few months later developed numbness and tingling in both feet Pharmacology 409 99 A 65-year-old diabetic was prescribed a medication for newly diagnosed hypertension She did not tolerate the medication because of persistent dry cough 100 A 14-year-old boy presented to his GP with fever, rash and sore throat The GP diagnosed tonsillitis and started him on an antibiotic He later developed a blotchy purpuric rash all over his body 101 A 52-year-old man who had a triple bypass, complained of myalgia a few weeks after starting a new medication His liver function tests were abnormal 102 A 68-year-old man was started on medication for hypertension He presented later with a tender swollen right first metatarsal joint 103 A 48-year-old woman was recently diagnosed thyrotoxic presented with fever and sore throat THEME: 18 SIDE EFFECTS OF DRUGS Options a b c d e f g h i j Danazol Clomifene citrate Methotrexate GnRH agonists Oxytocin Bromociptine Progestrogens HRT Prednisolone NSAIDs For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 104 Weight gain, acne, growth of facial hair, voice changes, decreased breast size, atrophic vaginitis and dyspareunia 410 Handbook of PLAB 105 Osteoporosis in cases of prolonged use, hot flushes, decreased libido and vaginal dryness 106 Breakthrough bleeding, weight gain, depression, prolonged amenorrhoea after starting treatment 107 Visual disturbances, ovarian hyperstimulation, hot flushes, headache, weight gain, depression and abdominal discomfort 108 May increase the risk of breast carcinoma and deep vein thrombosis Side-effects include weight gain, abdominal discomfort, depression and jaundice 109 Headache, postural hypotension and Raynaud’s phenomenon High doses may cause retroperitoneal fibrosis THEME: 19 PRESCRIBING FOR PAIN RELIEF Options a b c d e f g h i j k l Paracetamol Aspirin Co-proxamol Ibuprofen Diclofenac Tramadol Morphine Diamorphine Nitrous oxide Pethidine Carbamazepine Topical ketoprofen For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 110 A 12-year-old boy has a dental extraction and is complaining of a painful jaw 111 A 70-year-old woman has bone pain from metastatic breast disease Simple analgesia has been ineffective Pharmacology 411 112 A 35-year-old man is admitted with an acutely painful abdomen He has epigastric tenderness His amylase is elevated 113 A 50-year-old woman has severe shooting pains in the left side of her face following an attack of shingles 114 A 21-year-old man has dislocated the terminal phalanx of his left little finger in a fight There does not appear to be a fracture and you wish to give him analgesia to allow reduction of the dislocation THEME: 20 SIDE EFFECTS OF DRUGS Options a b c d e f g h i j k l Amiodarone Aspirin Atenolol Carbimazole Chlorpromazine Erythromycin L-Dopa Lisinopril Lithium Metformin Sulphasalazine Verapamil For each of the situations/conditions given below, choose the one most appropriate/discriminatory option from above The options may be used once, more than once, or not at all Questions 115 Cold hands and feet, fatigue and impotence 116 Peripheral neuropathy, pulmonary fibrosis, hyperthyroidism 117 Postural hypotension, involuntary movements, nausea, discolouration of the urine 118 Thirst, polyuria, tremor, rashes hypothyroidism 119 Sore throat, rash, pruritus and nausea ... Parel, Mumbai 400 012 , Phones: 2 412 4863, 2 410 4532 Fax: 2 416 0828 e-mail: jpmedpub@bom7.vsnl.net.in Handbook of PLAB © 2003, Kunal Goyal, Seema Mittal All rights reserved No part of this publication... 16 8 Endocrinology 19 1 Gastroenterology 212 Rheumatology 290 Infectious Diseases 315 Oncology 353 10 Emergencies 366 11 Ethics 386 12 ... 392 13 Dermatology 412 14 Surgery 440 15 Radiology 5 31 16 Biochemistry 534 17 Pediatrics 544 18 Orthopedics 600 19 Psychiatry