Each questions 25 marks
1. Obstetric – g5p4 29 weeks POG diagnosed with placenta previa Type 2 and booking Hb was 12g/dL and Blood group Rhesus negative.
-Ask relevant history (5m)
-Presented with mild pv bleed.
-Give your management plan. (9m)
Discharge at 33 weeks POG due to stop bleeding and the placenta “migrated” to upper uterus.
Presented again at 36wk with pv bleed and appeared to be pale.
-Give three differential diagnosis. (3m)
Blood result showed low haemoglobin level 7g/dl, normal platelet count, normal INR and aPTT.
-Outline your management plan. (8m)
2. Paediatric – Macrosomic baby 4.5kg, spontaneous delivery, 30yo primid mother.Apgar 1st min-1, 5th min-3
-Ask 5 irelevant history(antenatal, intrapartum) (5m)
-Developed seizure for 10 minutes and aborted with medication.
Given reult of ABG after 40 mins
-Intepret the ABG: decompensated metabolic acidosis (2m)
-What is the possible cause of seizure? (2m)
-Give two important investigations to rule out other causes of the seizure (2m)
Baby develop epilepsy and treated with antiepileptic.
At 4 month of age during follow up, seizure frequency increase,global developmental delay, failure to thrive.
-List 4 problems from the above information. (4m)
-What 3 other steps to evaluate (through Hx and PE) (6m)
-Give your management plan. (4m)
3. PCM – 11-year-old girl, Headache and body ache, upper abdominal pain with vomiting. face flushed. No sorethroat runny nose or cough. Concentrated urine, but no dysuria. Haematocrit increases（0.45）, Platelet(100) and WBC decrease(3).
-Give 3 differential diagnoses. (3m)
-interpret the lab result
examination showed pt’s face flushed and tender liver 2cm from costal margin.
-what is your provisional diagnosis, give reasons why. (4m)
-outline your management.
her parents refused to admission.
-how would you respond.(4m)
4. Surgery – Breast lump. 3cm X 3cm. No palpable lymph node. Not fixed to skin and muscle.
-Give 6 risk factors of breast cancer. (6m)
She was sent for mammogram and trucut biopsy.
-give 3 features suggestive of malignancy on mammogram (3m)
-What is her clinical stage of breast cancer.
-why is it mportant to stage patient.
She had wide local excision and sentinel node biopsy.
-what are the 5 pathological finding that determines her prognosis (5m)
-outline your management.
5. Psychiatry – 30-year-old lady, brought by friend because she threatened to jump off a building. In the A&E, she looked confused and talking to herself.
-What is your immediate management. (4m)
She has been staying in her own rom for past 1 months, talking about suicide and sometimes seen talking to herself.
-What are the 5 things you want to ask in history (5m)
-Give 3 differentials. (3m)
Further history : she has been hearing voices talking about her. Her mood is normal. She believes people are trying to pass her a message through their actions. She saw some bird nest outside her windows and believe it’s a sign 2014 is the year earth is destroyed. That’s why she wants to kill herself.
-State your provisional dx and reasons. (4m)
-Outline your management for her.
Her employer called wanting to know why is she absent from work.
-How would you respond. (4m)
6. Ortho – Lady had an accident, car driver, anterior collision by a van, knee hit on dashboard, dashboard injury, hip sustained injury.
Presented with left intenal rotated hip with shorted limb
-Outline the initial management of the patient
-Based on information provided, What is the likely diagnosis?
-Describe the picture shown (adducted, internally rotated, partially flexed left hip)
-Describe the radiograph (head of femur out of acetabulum, located above it)
-What is the management for the hip problem in the A&E.
-What is the common manoeuvre used to treat the above hip problem. Describe briefly.
-What are 4 complications related to this hip injury.
END 🙂
-Unlucky Student
Unlucky Student 