15 FEB 2014 RECALLS

1-Pic of dermatofibroma asking diagnosis 2-Ct scan of abdomen with long scenario about obstructive painless jaundice in old lady With mass in RHC asking best management -whipples -choledochojejunostomy -ERCp

3-pic of CRAO with typical cherry red spot asking most app next step -globe massage -hyperbaric oxygen -i/v acetazolamide -atropine 4- typical case of acute pancreatitis with back pain and shock 5-xray abdomen with SBO one from hb 2.103 asking dx 6-another xray with sbo i think not sure no air gas shadowing but scenario with pain vomiting followed by distention asking what next to do -barium enema -barium follow through 7-old recall of sertraline interaction with nifedipine 8-mother came with child for immunization avoiding eye contact leave early what next to do -send midwife for home visit -follow in next visit -other options dont remember 9-mother with kiddo for URTI u explained well and asked her for vaccination she refused what to do -respect her wishes -reinforce her --inform child protection authority

10-Hb 2.072 same pic with central mass that move wih swallowing but here they asked about what next to do -us -FNAC -thyroid function test 11-xray chest with sm confusing bilateral haziness no consolidation in 4 yr ols child with fever productive cough ,and basal crepts on right side asking Mx -penicillin -amoxicillin Tetracycline -doxycycline 12-old lady with husband died 6 weeks back complaining of inability to sleep how to start her management -diazepam -citralopram -haloperidol -lithium 13-women with postnatal followup after 6 wks asking when she can start sexual life as her martial life affecting badly her gynaecologist strictly advice not to start sexuall life until he follows her as she had bad obstructed labour with big epi scar gynac went out of town for further 6 wks what u will do i n this situation -reinforce gynac advice -tell her she can start any time -tell hre she can start if abd exam normal Tell her sher can start if abd and complete pelvic exam normal -she can never never again

14-post partum mother asking about contraception -POP -IUCD -COCP -barrier 15-lady with obesity hirsutism and PCO asking about contraceptive advice -COC -medroxyprogesterone acetate -barrier method 16 pic of gynecomastia in 16 yr old boy athelete taking fluticasane for asthma reason for gynecomastia Anabolic steroid Fluticasne abuse Physiological 17-what more severe if baby cant achieve milestone Hope on one foot Dress without supervision Ride two wheeler bike Make square 18-Hb pic of ct scan that one with cerebral tumor 3.042 19-pic of anal fissure typical case of painful defecation followed by constipation with blood on toilet paper 20-old recall you are intern pt wishes you to witness her will in front of lawyer Witness will Refuse to witnesss

21-preg lady at term ht 163cm with head free floating reason for this Contracted pelvis Previa Macrosomia Brow presentation 22-female wih asthma taking fluticasane and salbutamol now pregnant what you will see for long term mx regading her pregnancy and asthma Fundal height FHS Amniotic fluid index Serial us 23-old recall of thoracic cord compression 24-straight leg raise test asking what will lost Ankle jerk Knee jerk Flexion hip Flexion of knee 25-so many diff q on ECG s i got 6-7 unfortunately all bad quality with 4-5 strips asking mx One q was MI after MONA next Angiography 26 ecg with pt on lots of drugs digoxin etc DM HTN CHF etc asking cause i marked hyperkalemia 27-one torsades de pointes dun know exactly asking cause for it Macrolides SVT very bad only guess by scenario given in 4 yr old child asking mx Immese face in cold water Iv adenosine Iv verapamil Atenolol

28 one ECg i think WPW no delta wave asking dx 29-pt with collapse and history of fall from standing posture on ex all normal but postural hypotension asking mx Fludrocortisones NS Hemaxel 30-mother with child living near mining area asking about mx of lead toxicity asymptomatic pt Check child IQ Refer for bld lead levels Gv charcoal 31-Old man with house renovation with asbestose dust inhaled asking about long term complication how much risk He is at minor risk exposure Send for xray now n 5 yrly Refer to chest physician 32. Mum worried about daughters behavioural changes since she went to law school. She became vegetarian, takes long showers and is introvert. What ho will clarify the dg: a-daughter thinks that all the neighbours have bad thoughts about her\ b-she smoked marihuana in high school c-she recently changed schools 33 lady with marks on face and arms abuse case came for regular checkup admits husband beats her -gv her no. Of social health service -inform police -confront husband 34-pt with severe photophobia regular pupil reactive to light -keratitis -conjunctivitis -glucoma

35-CLD with tense ascitis and low albumin pedal edema asked what next to do -furosemide -spironolactone -paracentesis with iv albumin 36-mother came with child complaining he doesnt listen to her she punish him ,beat with stick due to misbehave locked in room for hours what to do next -inform child protection authority Ask child about his misbehave 37 lady with only fever no pain no foul smelling discharge followed by child birth e vaginal tear asking reason for fever -endometritis -vaginal tear infection -DVT -breast engorgmnt 38 mother wih feeding problem -dont frequently attach baby -dont gv sufficient time for feeding 39-child with pinkish cheeks looking healthy face pic given mother asking when she can go back to school nothing mention about complains i think that was slapped cheeks as nothing else fits -immediately -after 5 days -afetr 7 days After 24 hours 40-breast lump in 25 yr lady firm painful asking dx -cyst -fibroadenoma -caDCIS

41-bank manager with performance anxiety and disturbed sleep pattern asking Mx -role p[laying -problm solving 42-typical case of BPD with suicidal ideation ,impulsivity,anger out burst female etc 43-nurse with needle stick injury of hep c pt -serial HCV antibody screen -do HCV RNA now -gv immunoglobulin 44-another case of needle stick injury during changing chamber of dialysis pt -send sample of hepc, hepb , HIV testing -gv antiretroviral immediately -gv antiretroviral plus immunoglobulin immediately Vaccinate her for hep b 45-old pt with normal colono and upper GI endoscopy what next to do -capsule endo 46-21 yr old man with ankle sprain opportunistic screening was asked -FOBT -BP -colonoscopy -serum lipid etc 47-35 yr old lady with LCIS prev pap normal when to repeat smear -after 6 mnth After 1 yr Refer for colpo

48-4 yr child with History of recurrent abd pain since 2 yrs now during this episode pain shifted to left flank what will lead to dx -us at time of pain -erect and supine abd xray -barium meal and follow through 49-2yr old child wandering at home at 6 am with ketones in urine -check urine drug level -check RBS 50-caseof epigastric hernia with lump from umbilicus to xiphisternum in which position best seen -cough in supine position -cough in stnding position Lying with shoulder raised Laying with shoulder and leg raised 51 -45 yr old lady came for screening as her friend recently dx with DM what best to be done FBS 3 yrly OGTT yearly HbA1c yearly 52 neighbour bring pt collapsed at home e oliguria n dehydration how will u manage -1L NS maintaining urine output 1ml/kg /hr -1L NS maintaining urine output 2ml/kg /hr Dextrose saline Hemaxel 53-old lady with collapse after exertion AS AR MS MR

54 -6 wk old child with no FTT parents complaining forceful vomiting after feed on Ex everything normal GORD HPS Duodenal atresia 55-case of duodenal ulcer asking Mx PPI + amoxy+ ca\larithro for 7 to 10 days 56 case of long term peptic ulcer now complaining dysphagia what u will ask to reach dx Vomit immediately after meal Vomit 1 hr after meal Vomit contents eaten 2-3 days back 57-child with asthma on salbutamol wheeze on exertion and exertional symptoms What to gv next -ICS -oral leukotriens Oral steroids 58-preg lady at 28 wks e preterm labour what next to do Oral bethamethasone Salbutamol Nifidipne 59-young lady with amenorrhea for 6 wks e mild vaginal bleed for 12 hrs what will indicate immediate transfer to emergency depart Passage of blood clot Shoulder tip pain Crampy abd pain 60-lady with frequent hand washing Wear gloves CBT

61-case of orthostatic proteinuria 62-case of PSGN with fits after managing HTN what to do next Low salt low protein high fibre diet High prot low salt diet 63-case of PMR with bilateral girdle pain morning stiffness asked Dx 64 pt with thyrotoxicosis now pregnant on carbimazole what would u do Stop carbi and add prednisolone Cont carbi Replace with propanolol Stop carbi No option of stoping carbi n replace with PTU or methimazole 65- pt with sore throat how will u diff btw viral and bacterial Laryngitis Exudates Edema Lymph nodes 66-old lady with painless hematuria best Dx inv Cystoscopy IVP Ct scan 67-VSD kid for tonsillectomy askd prophylaxis Amoxycillion Penicillin Doxycyclin

68 old man see waves of ocean coming towards him asking where will u fing lesion in mRi Occipital lobe Medial temporal lobe Left parietal lobe Frontal lobe 69-pri amenorrhea with mass in RIF what next to do Us Fsh lh etc 70-primi pt with palpitations on exertion on ex systolic murmur audible what next to do Ecg Echo Holter 71 girl with unwanted sex last night in party to whom u will report Sex assault service Child protection authorities Other similar services name given 72- Schizophrenia risk in mother of monozygotic twins that old recall 73 -.a lady 6 wks amenorhea,presented wd PV bleeding ,home preg test was

+ve.USG done corpus luteal cyst in ovary.POD empty ,no fluid.utrus empty wd 12 mm endometrium ..diagnosis Afalse +ve pregnancy test. B.ectopic pregnancy

That is all what i can recall ................ need lots of prayers .....exam was realy very tough ,although recalls came repeatedly but in exam full scenario with multiple options difficult to chose one Time managmnt is very very imp, try to finish first 60 mcqs in 1 hour not more than that .........as i wasted time in beginning then at end was in trouble ..... GOOD LUCK TO ALL OF YOU ... REMEMBER ME IN PRAYERS THANK YOU GOLDSTAR .