A patient on insulin is booked in for a hernia operation. What is the most appropriate management of insulin?

UK PLAB 1
#1

  1. A 27 year old female who had a Road Traffic accident 7 months ago now complains of attacks of sudden onset rotational vertigo that occurs on sharp movements of her head and neck. Which of the following would be most helpful?
    A. Caloric testing
    B. Hallpike manoeuvre
    C. Gutenberger’s test
    D. Meniere’s test
    E. Otoscopy

  2. A woman presents with alternating episodes of low mood and happiness. When she feels happy she goes on extravagant shopping sprees. What is the most likely diagnosis in this patient?
    A. Depression
    B. Bipolar affective disorder
    C. Schizophrenia
    D. Panic disorder

  3. A 36 year old lady complains of earache and fever. On examination her ear is severely tender and there are vesicles within the ear canal. What is the most likely organism responsible for her condition?
    A. Herpes zoster
    B. Varicella zoster
    C. Herpes simplex
    D. HIV

  4. A patient on insulin is booked in for a hernia operation. What is the most appropriate management of insulin?
    A. Give insulin and saline pre op
    B. Stop insulin for the duration of the operation
    C. Give intravenous insulin + dextrose + saline pre op
    D. Give insulin as usual pre op
    E. None

  5. A 60 year old man presents with dysphagia and pain on swallowing both solids and liquids. A barium meal shows gross dilatation of the oesophagus with a smooth narrowing at the lower end of the oesophagus. What is the SINGLE most likely cause of dysphagia from the given options?
    A. Achalasia
    B. Myasthenia gravis
    C. Oesophageal carcinoma
    D. Oesophageal web
    E. Systemic sclerosis

  6. A 31 year old woman who is 32 weeks pregnant attends antenatal clinic. Her blood result shows Hb 10.7 and MCV 91. What is the most appropriate management for this patient?
    A. Folate supplement
    B. Ferrous sulphate 200mg/24 Po
    C. Iron dextran
    D. No treatment required

  7. A 45 year old man underwent emergency splenectomy following a fall from his bicycle. He smokes five cigarettes a day. Post -operatively despite mobile, he developed swinging pyrexia and a swollen painful left calf. His chest x-ray shows lungs atelectasis and abdominal USG demonstrates a small sub-phrenic collection. What is the SINGLE most likely risk factor for deep vein thrombosis in the patient?
    A. Immobility
    B. Intraperitoneal haemorrhage
    C. Smoking
    D. Splenectomy
    E. Sub-phrenic collection

  8. A man presented with severe unilateral headache. After a while presented with diminished consciousness. CT scan was normal. What is the next best step?
    A. Lumbar puncture
    B. No investigation
    C. MRI

  9. A 75 year old woman from a nursing home is brought to the A/E by her carer who says that she has been confused for four days. She is on Warfarin for atrial fibrillation. Examination is unremarkable except for multiple bruises on her body. Blood investigations reveal an INR of 7.3. What is the most likely diagnosis?
    A. Alcohol intoxication
    B. Urinary tract infection
    C. Subdural haematoma
    D. Dementia

  10. A 40 year old man is having bilateral hilar lymphadenopathy on the CXR. She has rash on each shin and his calcium is found to be high. Which of the following test is appropriate to perform in this patient.
    A. Lymphnode biopsy
    B. U&E
    C. Angiotensin converting enzyme
    D. Serum creatinine