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EMQS with answers January 2003 PLAB

Paper January 2003 PLAB


Paper January 2003 PLAB
Theme 3. Fractures Of Wrist Joint
http://www.aippg.com/plab-uk/
http://www.aippg.net/forum/viewforum.php?f=2 A. X -ray of wrist scaphoid view
B. Refer to ortho doctor immediately
C. Bandage & discharge
Theme 1. Shock D. Isotope scan
E
A. Septic -gram -ve septicemia
B. Cardiogenic
C. Hypovolemic 9. Boy fell from tree now has come with
D. Anaphylaxis painful wrist x- ray taken was normal
E 10. Pt had a fall x- ray shows perilunate
fracture .
1. A young boy after eating peanuts suddenly 11. Pt had a fall x ray normal , tenderness in
develop difficulty of breathing with red anatomical snuff box
oedematous lips.
12. Pt had a fall, X-ray showed
2. Pt had an accident & fracture of pelvis & femur displacement of the radius
,B.P-100/70, Pulse-90
3. Pt had an M.I. & then is in shock now
4. A middle aged man has been operated for a
perforated gall bladder. He becomes
progressively drowsy with warm peripheries. BP
90/60, PR 110
Theme 4. Relation To Obesity

A. Obstructive sleep apnoea


B. Type 1 DM
C. Type 2 DM
Theme 2. Epistaxis D. Alcohol
E. Cushing’s
A. Anterior nasal packing F. Hypothyroidism
B. Post nasal packing G. Polycystic Ovary Disease
C. Neomycin cream
D. Pinching of the nose
E. Reassurance
F. Vit k 13. Wt loss would help night sleep & this
G. FFP condition & improve family relations
H. Ice pack on the nose 14. Wt loss would even help to stop the
medications
5. Pt on warfarin , comes with you with nose bleeds 15. Stop of this would help in wt loss &
INR is 0.9 vitamin deficiency
6. Boy has come with slight bleeding from nose 2 16. Surgery in this condition in a female
days ago. On examination of the nose showed would help in wt loss & improve this
redness & crusting. condition
7. Pt cam e with BP-230/110, bleeding from nose, his
circulatory system has been stabilized, nose ant.
packing done ? but he continues to bleed
8. Girl has come with slight bleeding from ant part of
nose . by the time she reaches a-e bleeding has
stopped

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Theme 5. Delayed Milestone Theme 7. Diagnosis Of Psychiatric


Disease
A. Fragile x syndrome A. Post-traumatic disorder
B. Tay-sachs disease B. Post natal-psychosis
C. Bacterial meningitis C. Thou gh -broadcasting ,
D. Hypothyroidim D. Insertion ,
E. Prematurity E. Echo
F. Duchennes muscular atrophy F. Hallucination
G. Fetus alcohol syndrome G. Illusion
H. Paranoid delusions
I. Judgment
17. A 4 yrs old boy can write his name & draw a J. Insight
circle & square; he walks with a lordosis & he K. Low mood
cannot run.
L. Flight of ideas
18. 3 yrs boy, has delayed milestones his uncle & &
28. Pt keeps on talking to you non stop &
brother also have this condition
jumps from one topic to another
19. Girl can sort out cube 4 9 & is 97 percentile for
29. Pt after the birth of her child feels sad &
her weight, but her head circumference is lower
does not want to feed the baby
than normal
30. Pt has the believe that his neighbor is
20. A six months old child, can smile, but has head
planning an attack
lag.
31. A old woman has been admitted & feels
21. Child was normal but then delayed milestones
that the staff of the hospital knows what
after a fever
she is thinking all the time.
32. Pt who lost her husband is sad now &
Theme 6. Psychiatric Management How Can You avoids eye contact
Help These Pts 33. A man has psychiatric problem & he
knows that he need a treatment
A. Methadone
B. P ropanolol Theme 8 Vomitting In Pregnancy
C. Diazepam
D. Acomprosate A. Hyperemesis gravidum
B. Hydatid form mole
E. Zopiclone
F. Risperidone C. Cholecystitis
G. Amitryptilline D. Chloecystic pregancy
E. Brain tumour
F. pre eclampsia
22. A girl has oral numbness & limb paraesthesias G. migraine
after an argument with her friend
34. 12 weeks pregnant woman has been
23. Pt a heroin addict - now in ward in withdrawal continuously vomiting , comes with a
wants u to help him furred tongue & signs of dehydration &
uremia.
24. An alcoholic now has been detoxified feel that he
wants to remain off it but is scare he may 35. A 14 weeks pregnant woman comes to
relapse you with severe vomiting , u.s of uterus
shows absence of f.h.s. & the uterine is
25. Female with s-s of pain in chest; tightness,
18 weeks to date.
feeling like dying & sinking feeling, wants some
medication for her condition. 36. Pt comes to u with severe vomitting
,diziness & photohobia. She is in the 34
26. Pt has to go for an interview has sweaty palms &
week ,she tells you that she had these
palpitations asks for your help.
symptoms since 14 weeks & o/e her
27. Pt having restlessness, pacing up & down after pulse rate is 60 /min
death of her husband with difficulty in falling
37. A pregnant woman had a nauseous &
asleep .
vomit since week 18 & these symptom s

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have got worse since two weeks & she is
anorexic, vomiting & slightly jaundice. Theme 9. Nerve Injury

A. Axillary
B. Musculocutaneous
C. Radial
D. Ulnar
E. Common peroneal nerve
F. Sciatic
38. Pt has history of fracture shoulder now
has decreased sens ation on the lateral
aspect of the deltoid muscle
39. Pt had fracture of fibula or at level of
fibula & now lost his dorsiflex &
sensation loss on the lateral side of his
low leg.
40. Pt had fracture of medial epicondyle &
now come with decreased sensation of
th th
5 & 4 finger
41. Pt has some fracture of humerus &
comes with s/s/ of wrist drop
42. Old man had a fall & fracture or
dislocation of hip now has weakness in
his hamstring.

Theme 10. Pain relief

A. Allopurinol
B. Radio therapy
C. TENS
D. I/m diam orphine
E. Oral NSAIDs
F. Paracetamol
G. Prednisolone
H. Physiotherapy
I. Home exercise
J. I/M steroids in joint
43. Pt with CA-prostate & now has 2 aries to
back with severe pain, no NSAIDs,
morphine has helped? wants to
continue his work.
44. Pt with ca lung with 2 aries now has
come with an unilateral swollen arm , all
other medications have failed ( i.e
nsaids & morphine )
45. 50 yr old woman has come with painful
shoulder joint & hip joint
46. 30 yr old busy executive has got pain on
lateral aspect of thigh . he shows no
improvement with nsaids . x ray taken
was normal

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47. A man is on Fresmide & got pain in his joint
Theme 11. MECHANISM OF ABORTION

a. Immunological
b. Genetic
c. Anatomical
d. Endocrine
e. Drug-induced
f

48. Pt having 6 abortions in mid trimester


49. Pt having some problem with the
deformed child (She married her cousin)
50. Pt has recurrent abortions, is obese &
hirsutism.

Theme 12. Investigation Of Leg Ulcers

A. Pyoderma gangrenosum
B. Bowen’s disease
C. Venous stasis
D. Arteriography
E. Melanoma biopsy
F

51. Pt having pain on walking. His leg & foot


are pale & with the 4th & 5th digit
blackened
52. Pt with diarrhea. abdominal pain had a
small round (with central necrotic tissue)
53. Female fat obese & having edema of leg
now has a small ulcer on medial aspect
of her ankle.
54. 60 Yrs old man with a pigmented skin
lesion on his shin.

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Theme 13. Head Pathology Theme 15. Management Of Injuries


A. Laparotomy
A. Intra-cerebral hematoma B. Refer to surgeon
B. Brain stem injury C. Admit & observe
D. Give iv fluids 1 litre in 30 mins
C. Extradural hematoma
E. IV fluids 2 litters in 30 mins
D. Subdural hematoma (SDH) F. Reassurance & send home
E. Acute SDH
F. C hronic SDH 66. Boy has come with injury by fall on handle of
G. Vertebrobasilar ischaemia cycle & had got pain & tenderness in left
H. Migraine upper side of abdomen. U/S of spleen
shows a small sized haematoma or infarct in
I. Depressed fracture of skull the splenic capsule
J. Subarachnoid Hemorrhage
67. Pt with being hit by a ball comes with severe
55. Motor cyclist with accident is brought to A&E with pain in epigastrium
head injury. GCS-3 & his BP-180/100 & Pulse-
68. Pt was stabbed in a fight & now comes with
56/min & his pupil is dilated & sluggish to light,
his omentum (or omentocele outside in the
no neurological sign except his plantars are
umbilical area). His BP is 110/70 & heart
going up. rate 80.
56. Young male 27 after a heavy bout of alcohol fell 69. Pt with h/o fall has come with tenderness in
down on the road & then got up n walked home. left side of abdomen & fracture of 2 right-
His wife found him on the floor & cannot rouse & sided ribs. Pt in shock
has fluctuating consciousness. 70. Pt had (some sort of injur y), after 2- L IV fluid,
57. 67 yrs old man had recent falls, became agitated his BP is low & HR higher.
& confused.
Theme 16. Management investigation of
58. A old lady has dizziness & vertigo & walking seizures
reeling to one side. A. Start anti-convulsants
59. Female at A&E with vomiting & severe pain in B. Reassurance
the back of the head C. Anxiolytic treatment
D. Vulvar surgery
60. Pt hit on the head with a hammer, now comes E. EEG.
with vomiting F. ECG
G. I.V. glucose
61. Young man fell over & there is injury on his
71. A 50 yrs old man had hemoptysis & cough for
temple scalp (he is alert)
some time & now come with a first fit.

Theme 14. Diagnostic tests on loss of vison 72. 8 year girl falls down in the assembly. She is
A. MRI temporal lobe pale & loss consciousness for 1 min. She
often falls in dentist visit.
B. MRI pituitary
C. MRI occipital lobe 73. Boy has period of breath holding spells
D. Doppler carotid artery where he becomes blue & loss
E. ESR consciousness. This happens when he is
separating from his parents.
F. MRI parietal lobe
74. A 30 year female has 2- 3 episodes of falling
62. Pt comes with repeated h/o loss of vision in one down, she also has got a loud murmur in
eye & it improves after a few hours inspiration
63. Pt with bitemporal hemianopia & increase in 75. A 50 yrs woman has episodes of
shoe size. unconsciousness starting in the left thumb
& then going to whole body . she loses
64. Pt has come with vomiting & upper quadranopia consciousness
(not sure of the full question ) 76. A 10 yrs boy behaves strangely (cannot
65. Pt having pain while brushing her hair & now remember exactly), & his teacher says that
he is not concentrating at the moment.
comes with loss of vision in one eye
77. A young man has some kind of fit, his heart
rate drop down to 50/min
78. A young boy has fit, he is a DM, his blood
glucose is 2mmol.

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Theme 17. Haemetemesis Theme 19. Hearing Problem

A. Mallory Weiss tear A. Ototoxicity


B. Alcoholic cirrhosis B. Tilt test (BPV)
C. Gastric erosion C. Salicylate levels
D. Peptic ulcer D. Fracture petrous temporal
E. Duodenal ulcer bone
F. Diverticulosis E. Wax in ears
G. Benign gastric ulcer F. Acoustic neuroma
G. Blast injury
H. Syringing
78. 55 -yrs alcoholic drinking 15-units/day now came
with massive hematemesis
87. Pt on gentamycin comes with ringing of
79. Pt comes with massive hematemesis after eating
ears
a lot & a bout of alcohol
88. Pt with some pathology of ear comes
80. Pt suffering from RA comes with vomiting with with tinnitus & it worsens
streaks of blood
withmovement. the test for it is by
81. A 50 years old manager had epigastric lowering the Pt
discomfort for some time & his stool is tarry. He 89. Pt took some treatment for his should
is otherwise normal.
pain or headache? & now comes with
tininitus
90. A boy was hit & fell & hit somewhere
behind his ear & now comes with
difficulty in hearing & tinnitus
Theme 18. Management Of Drug Side-Effects 91. Vagrant comes to A&E with diminished
hearing particularly after a shower.
A. Drug serum levels
B. Thyroid function tests 92. A Pt who is anesthetic to his cornea
C. Liver function tests reflex has a diminished hearing. CT
D. S Prolactin levels showed a widened ear canal.
E. Urea & electrolytes
F. Increase / decrease levels of insulin
Theme 20. How Would You Help This
Lady
82. Pt on lithium now comes to you with tremors of
hand
A. Home redecoration
83. Pt on lithium now comes with wt gain, slow down B. Advice on posture
C. Neck collar
84. Pt on phenytoin for epilepsy now came with
D. Review the dose of anti
dizziness, blurred vision & ataxia hypertension
85. Male Pt on phenothiazines now comes with a E. Review the dose of anti
painful or lactating breasts? diabetics
F. Rearrange home
86. A man take overdose of his Aspirin. Conscious G. Eye sight test
(did not mention how much & when)

93. Lady on Asprin, end of loridazole 7.5 mg


comes to you with repeated falls while
trying to get out of bed
94. Lady on various medication one of them
which is glibenclamide come to you with
sweating & altered consciousness
95. Lady 85 year old lives alone fell down
while trying to put up her curtains. This

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has occurred on another same occasion.
Theme 21. Anal Conditions

A) Anal hematoma
B) Ischaemic colitis
C) Proctalis fugalis
D) CA rectum
E) Sq cell ca of anus
F) Choron’s
G) Ulcerative colitis
H) Anal fissure

96. Pt comes to you a young woman with


electric pain in the rectum
97. Young girl with h/o/ constipation cannot
pass stools. PR is impossible because
of the pain.
98. A young woman has constipation &
painless fresh blood after defecation
99. A woman of 29 of age has diarrhea &
colic abdominal pain with tags in her
anal exam

Theme 22. Diagnosis Of Rectal


Conditions

A) Rectal hematoma
B) Carcinoma of rectum
C) Ischaemia colitis
D) Ulcerative colitis
E) Crohns disease

100. 50 year old Pt with diarrhea & pain in


abdomen
101. On proctosigmoidoscopy an ulcer is
found 10 cm from the rectum
102. Pt has come with pain while
defecating. o/e anal cushions are found
which are purple in color
103. Pt comes with h/o/ fever & diarrhea on
biopsy granuloma found

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Theme 23 Contraception Theme 25. Management of post-


A) Abstinence operation
B) Mirena coil
C) 9 nothistone A) Catecholamine
D) OCPs
B) Dopamine
E) Progesterone only pills
F) IUCD
C) Laparotomy
G) Depot preparations depot vera D) Antibiotics
H) Tubal ligation E) Wide excision of affected tissue
I) Vasectomy F) Percutaneous drainage
J) Rhythm method G) Insert stent
K) Withdrawal H) Excision of the dead tissue
L) Ovulation testing
M) Condom
N) Diaphragm 113. A middle aged woman had operation
on the perforated. She has been unwell
104. A 47 year old woman with 9 month h/o since the operation. She has difficulties
amenorrhea now comes wanting to have in breathing. Despite of the full support
contraception. She says that her husband is not
from the high independent unit, her
reliable with condoms & she doesnt want PO 2 is 6.
chemicals in her body
114. Pt post acute pancreatic attack has on
105. A 26 yrs old lady with irregular periods of 24 to
CT-scan have non-enhanced .behind
40 day variations, she does not want children for the tail of pancreas.
the next two years. She comes to you saying
she wants a natural method of contraception 115. Girl post chicken-pox gets blue
discoloration of skin after scratching ,it
106. 37 yrs old lady with 2 children & a hectic life is spreading at the moment .
style comes to you for contraception. She wants
reliable method since she was pregnant when
she was on the oral combined contraceptive last
time.
Theme 25. NATURE OF ANAEMIA
107. Lady 26 year old .2 kids the youngest 6 months
says she wants to be sterilized. She has A. Folate deficiency
separated from her husband & she does not B. B12
want to put weight on since the oral combined C. Iron deficiency
contraception did before. D. Sickle cell
E. B-thalassemia trait
Theme 24. Investigations for fever F. G-6-PD
G. Hereditary spherocytosis
A) Plasmodium vivax
B) Falciparum ovale
C) Lumbar puncture 116. A boy brough t Hb 8, unconjugate
D) Lyme’s serology bilirubin 120 mother says that anemia
E) Brucellosis is hereditary in the family
108. Pt returned from Zambia now has fever with 117. A Greek boy brought by mother says
rigors & fits that he looks pale inspite of being
normal
109. Young girl with fever, ash & neck stiffness
118. Pt with severe menorrhagia & tired
110. 18 yr old boy has come back from Mexico after
working in a farm there & now has fever with 119. A four year old boy has been having
splenomegaly. funny dietary pattern. He likes cheese
& drinks 2 litters of milk a day. He looks
111. Girl went out in the forest for walk now has a
pale & otherwise normal.
tick bite & has fever at the moment
112. Surgical conditions what is the rx

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A. Occupational asthma
Theme 26. Dysphagia B. Pneumothorax
A. Achalasia C. Aortic dissection
B. Pill Stricture D. Interstitial ~{~}
C. Barrett’s E. Pulmonary embolism
D. CA esophagus
E. Post cricoid cancer 133. A carpenter has chronic
F. Phar Pouch breathlessness, he does not smoke. He
G. GORD becomes normal when he goes away
120. A 34 yrs aged plump wom an has difficult in for holidays.
swallowing food, particularly after drinking 134. A woman has cough. On examination
alcohol & in the night. she has crept on her lung base. (not
121. A young girl (cannot remember this Q) exactly)

122. 45 yrs old man, he has difficulties in swallowing 135. 50 year old Pt comes with severe pain
the food to start with, but the rest of the swallow in chest & now has breathlessness &
is normal. He does not have regurgitation. difficult in breathing ECG shows gallop
rhythm
123. This Q is about a man has difficult in
swallowing, & there is lump in his throat. 136. A 50 yrs old man had severe chest
pain under the sternal. He late had
124. Pt having difficulty in swallowing specially hemiparesis.
liquids (did not mention about weight loss)

Theme 27. Cervical Pathology


A. Cervical smear
B. Cervical biopsy
C. Colposcopy Theme 29. Asthma in children
125. Young Pt gets post coital bleeding. Speculum
shows cervical ectopic A. Peak flow diary
B. Spirometry
126. Pt attend clinic because of CIN 1 C. Exercise test
127. Pt with CIN -2 what will you do now D. No need investigation
E. CXR
THEME 28. RESPIRATORY DISESE
this was given in an value form EMQ with clinical findings 137. A young girl has 2 episodes of
? ECG & chest X-Ray & temp given in serial order.
breathless so far & she is on short
A. Pneumonia acting bronchodilator & now she is fine.
B. Pulmonary embolism. Mother had eczema.
C. Pulmonary edema
D. Rupture of esophagus 138. Boy comes with sudden breathless &
E. MI trachea deviated to the left -
F. Pneumothorax pneumothorax
128 . Pt with fever? basal consolidation & ECG 139. A girl in the A&E, she is too breathless
normal to have her peak flow checked.
129 . Pt with surgical emphysema (ca nt remember 140. A boy has asthma, & he is given some
the rest --) short acting dilator inhaler. His parents
dont know when he should use it.
130 . Pt with breathlessness & absent markings on
chest x ray
131 . Pt with severe pin in chest & q waves in v 3
132 . Pt with severe pain in chest & q waves in v 1 to
v3

Theme 28. Diagnosis Of Chest Pain

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Theme 30. Anatomy Of Renal Failure Theme 32 Diagnosis Of Hematuria


A. Bladder cancer
A. Bladder B. HSP
B. Prostate C. SLE
C. Parpilla D. Polycystic kidney
D. Medullary
E. Interstitium 150. A smoker with painless Haematuria
F. Ureter 151. A 40 yrs old woman has Haematuria.
G. Renal artery She has got non-blanching purpura
H. Cortex on her legs & back. (it is obviously
HSP, but never come cross with
somebody who is 40!)
141. A woman has not pass her urine for many
hours (not exactly), on examination there is 152. A man with Haematuria, his father or
mass on super pubic somebody has got it.
142. A old man has difficult in passing urine &
dribbling for long time Theme 33. Management of cardiac pts
A. Nitrates
143. A woman of sickle cell disease has not passed B. B-blockers
urine for many hours C. AEC
144. A woman has protein urine & edema D. Surgical intervention
E. Valve replacement
145. Pt with hypertension & small kidney on one side
153. A Pt has angina & he is on nitrates. He
is having pains once a week although
he has been taking his medication
154. A old woman has pains in her chest,
Theme 31. Investigation Of Hem aturia angiograph shows three severe antero-
sclerotic lesions.
A. Ultra sound
B. Microscopy & sedimentation 155. 65 old woman, has murmur &
palpitation {~}..(cannot remember)
C. Anti-strep. Trite
D. Creatinine
E. IVU Theme 34. Investigations for breast lump
F. Urine osmolarity A. FNA
B. Ultra sound
C. Mammograph
146. A man came with Haematuria, he says this runs D. Discharge cytosis
in the family E. CT scan of the spine
147. A boy has fever, oliguria and edema. F. X-ray of the spine
G. Duct-graphy
148. A 56 yrs old woman had operation on her
uterine cancer years ago now comes with
Haematuria 156. A young 24 yrs old woman with a
breast lump. She has other lumps in the
149. A man has been unwell for long time, came with out quarter of her breast.
hypertension & hematuria (cannot remember
exactly, but sounded like he has got DM to 157. A young lady with a breast lump that
me) varies in size according to her menses
158. 56 yrs old woman has blood stained
nipple discharge. The discharge is from
a solitary duct. Ultra sound &
mammography show normal
159).48 yrs old woman has a breast lump in
the upper out quarter of her breast.
Mammograph showed a solid lump.

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160. A old woman had breast cancer which was 167. 52 yo businessman present with fever
operated a few years ago, now she has & rigor after coming back form 10
numbness on her chest. days meeting at Zambia

Theme 35. Diagnosis of gastroenterology


findings

A. Crampy diarrhea
B. Gastroenteritis
C. UTI
D. Carcinoma Colon
E. Acute appendicitis
F. Salmonella infection

161. A young boy has fever, nausea & vomiting for


24 hours
162. A pregnant teacher has diarrhea & vomiting.
The children with her all had same symptoms
163. A young boy has bloody diarrhea & vomiting for
one day

Theme 36. Preparation for pre-operation

A. ECG
B. CXR
C. FBC
D. Blood glucose
E. Angiography
F. CT

164. A old Pt is due for his {~}. Operation. He has


palpitation {~}..
165. A woman due for her operation, she is
amenarrhgic & tired

Theme 37. Bites & Stings

A. Thick & thin blood film


B. Lyme disease serology
C. Leptospirosis serology
D. Hep a serology
E. Hep b serology
F. Skin swab test
G. Skin prick test

165. 28 yrs old policeman is brought to A&E after


bitten by a drug addict while the f catch. There
is a deep wound at his right hand.
166. 16 yo girl after forest walking, she had to
remove an insect form her leg, now present
with red raised ulcer.

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Answers by Dr. Junaid

01-D 47-E 93-D 139 -E


02-C 48-C 94-E 140 -A
03-B 49-B 95-C 141 -A
04-A 50-D 96-C 142 -B
05-D 51-D 97-H 143 -C
06-C 52-A 98-G 144 -H
07-B 53-C 99-F 145 -G
08-A 54-B 100-E 146 -A
09-A 55-C/A 101-D 147 -C
10-B 56-D 102-A 148 -E
11-A 57-F 103E 149 -D
12-B 58-G 104-F 150 -A
13-A 59-J 105-K 151 -B
14-C 60-C 106-G 152 -D
15-D 61-I 107-H 153 -B
16-E 62- 108-B/A 154 -D
17-F 63- 109-C 155 -E
18-A 64- 110-E 156 -A/B
19-G 65- 111-D 157 -B
20-B 66-C 112- 158 -D
21-C 67-C 113-C? 159 -A
22-B 68-A 114-F 160 -E
23-A 69-E 115-E 161 -E
24-D 70-B 116-G 162 -B
25-C 71-E 117-E 163 -A
26-B 72-C 118-C 164 -A
27-C 73-B 119-A 165 -C
28-L 74-D 120-G?
29-K? 75-A 121- 165 -F
30-H .76-E 122-E? 166 -B
31-C 77-F 123-F 167 -A
32- 78-G 124-A 168 -
33-J 79-A 125-A/C 169 -
34-A 80-C 126-B 170 -
35-B 81-D 127-A 171 -
36-G 82-A 128- 172 -
37-D 83-B 129-D 173 -
38-A 84-A 130-F 174 -
39-E 85-D 131-E 175 -
40-D 86-E 132-E 176 -
41-C 87-A 133-A 177 -
42-F 88-B 134- 178 -
43-B 89-C 135-E 179 -
44-G/B? 90-D 136-C 180 -
45-F 91-H/E 137-D 181 -
46-H 92-F 138-E 182 -

12 www.AIPPG.com ™
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