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PLAB 1 Question 5

PLAB 1 questions

Question.

A 56-year-old male, diabetic, is presenting with recurrent brief headache for 3 weeks, affecting one side of the head and almost always around mouth, increasing with eating and loud laughing and resolves in minutes. On examination his temperature is 37.1C, random capillary glucose is 7.5 mmol/l, and his blood pressure is 110/70 mmHg. No neck stiffness, skin rash, or facial oedema. What is the most appropriate treatment?

      1. Psychotherapy
      2. Prednisolone
      3. Carbamazepine
      4. Sumatriptan
      5. Losartan
    • Answer.

      c. 

       
      Explanation.

      Trigeminal neuralgia usually presents with paroxysms of intense, stabbing pain, in the trigeminal nerve distribution, typically affecting the mandibular or maxillary divisions on one side. It can be triggered with Washing the affected area, shaving, eating, and laughing. It’s more common in males above 50 years old. Diagnosis depends on looking for a secondary cause Compressing the trigeminal root by anomalous or aneurysmal intracranial vessels or a tumour, zoster, or skull base malformation. MRI Is necessary to exclude secondary causes. Carbamazepine is the first line treatment. Surgery may be needed in refractory cases.
       

PLAB 1 Question 52019-04-25T08:22:44+00:00

PLAB 1 Question 4

PLAB 1 questions

Question.

A 65-year-old gentleman with no previous surgical history, underwent total hip replacement. He complains of abdominal distension, constipation and vomiting but no significant pain 2 days after surgery. Examination reveals absent bowel sounds and xray abdomen shows multiple gas, fluid levels in small and large bowel. Most appropriate initital management in this case could be

    1. Urgent exploratory laparotomy
    2. NG tube, electrolyte and fluid balance
    3. Broad spectrum Antibiotics
    4. Rectal tube and decompression

Answer.

b. 

 
Explanation.

Diagnois here is ileus. Conservative management, initially.
 

PLAB 1 Question 42019-04-25T08:09:07+00:00

PLAB 1 Question 3

PLAB 1 questions

Question.

A 67 year old retired taxi driver with a history of a previous myocardial infarction presents to the emergency department with severe abdominal pain. He complained of bloody diarrhea earlier in the day. On examination he is found to have severe generalized abdominal tenderness. His bloods shows a WCC of 20 × 109 cells/l and a lactate of 5 mmol/L. A triple phase CT shows bowel ischemia from the splenic flexure to the proximal part of the rectum. Which vessel is likely to be compromised?

    1. Superior mesenteric artery
    2. Inferior mesenteric artery
    3. Left colic artery
    4. Coeliac axis
    5. Middle colic artery

Answer.

b. 

 
Explanation.

The inferior mesenteric artery supplies the large bowel from the splenic flexure to the superior part of the rectum. The superior mesenteric artery supplies the lower part of the duodenum to the middle third of the transverse colon. The coeliac axis supplies many structures and this includes the proximal half of the duodenum. The middle colic and left colic artery are branches of the superior mesenteric artery and inferior mesenteric artery respectively.
 

PLAB 1 Question 32019-04-25T07:34:02+00:00

PLAB 1 Question 2

PLAB 1 questions

Question.

A 85 year old man is due for elective right hip arthroplasty.

What nerve is at risk of injury at the back of the hip during this procedure?

    1. Femoral Nerve
    2. Lateral cutaneous femoral nerve
    3. Sciatic nerve
    4. Pudendal Nerve
    5. Peroneal nerve

Answer.

b. 

 
Explanation.

During the posterior approach to the hip, the most predictable course of the sciatic nerve is deep to the piriformis and superficial to the short external rotators exiting above the superior gemellus at the back of the acetabulum. As such, most recommend identification of the sciatic nerve by palpation in hip replacement.

 

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PLAB 1 Question 22019-04-09T15:27:31+00:00

Core pharmacology. Is a benediction in order?

Question.

A young patient’s median nerve is injured by a supracondylor fracture of the humerus. The resulting motor deficits may include all of the following EXCEPT which one?

  1. Weakness of pronation
  2. Weakness of ulnar deviation of the wrist
  3. Loss of thumb opposition
  4. Loss of abduction of the index and middle fingers
  5. Loss of index and middle finger flexion

(more…)

Core pharmacology. Is a benediction in order?2019-01-21T14:58:24+00:00

Core Physiology: Cerebral blood flow

Question.

Which one of the following is NOT correct regarding the cerebral circulation?

  1. Cerebral oxygen consumption is about 20% of total body oxygen consumption
  2. The brain uses glucose as its main energy source
  3. Autoregulation maintains a constant cerebral blood flow for mean arterial pressures (MAP) between 60-160mmHg.
  4. Cerebral blood flow is very sensitive to arterial pO2
  5. Local metabolites, ADP, K+ and H+ ions, all increase cerebral blood flow

(more…)

Core Physiology: Cerebral blood flow2018-04-13T12:05:23+00:00

Core Physiology: Gentamycin – static or synergistic?

Question.

Which one of the following is true regarding the use of gentamicin?

  1. It is bacteriostatic
  2. It has synergistic effects when used along with penicillin
  3. It is effective against anaerobes
  4. Nephrotoxicity is dose related
  5. Ototoxicity is rare

(more…)

Core Physiology: Gentamycin – static or synergistic?2018-04-13T12:04:41+00:00

Core Physiology: Laryngeal anatomy.

FRCEM primary larynx, revision question

Question.

Regarding the anatomy of the larynx, which one of the following statements is FALSE?

  1. It joins the top of the trachea at the level of C6
  2. The vocal cords lie inferior to the epiglottis
  3. The glossopharyngeal nerve (CN IX) provides both motor and sensory innervation to the larynx
  4. The vocal cords abduct during respiration but adduct during phonation
  5. The cricoid cartilage lies below the thyroid cartilage

 

 

 

 

 

 

 

 

Answer.

C

Explanation.

The anatomy of the larynx is complicated. It lies inferior to the hyoid bone, anterior to the lower pharynx and joins to the top of the trachea at C6 level.

 Three unpaired cartilages make up its external form:

(1) epiglottis (a flap of elastic cartilage covered by mucous membrane which is attached to the anterior thyroid cartilage)

(2) thyroid cartilage; and

(3) cricoid cartilage (most inferior and separated from the thyroid cartilage above by the cricothyroid membrane).

The three paired cartilages (the arytenoids, corniculate and cuneiform) are smaller, located posteriorly within the larynx, and function in movement of the vocal cords.

The extrinsic muscles of the larynx (infrahyoid, suprahyoid and stylopharangeus) move the larynx as a whole during swallowing. The intrinsic muscles (the arytenoids, cricoarytenoids, thyroarytenoids and cricothyroid) abduct, adduct, relax and tense the vocal cords during speech and respiration. The vocal cords are relaxed and abducted during respiration and adducted and tensed during phonation.

 

During swallowing the backward movement of the tongue and upward movement of the larynx forces the epiglottis down over the superior laryngeal opening to prevent swallowed matter from entering the trachea. 

The vagus nerve (CN X) provides motor and sensory innervation to the larynx via its superior laryngeal branch (motor to cricothyroid and sensory to the superior larynx above the vocal cords), and its recurrent laryngeal branch (motor to all the intrinsic muscles of the larynx except cricothyroid and sensory to the larynx below the vocal cords).

 

 

Core Physiology: Laryngeal anatomy.2018-11-05T14:56:30+00:00
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