SYNAPSE A Final Year MBBS Companion

An IMA MSN intiative

Building bridges to brighter horizon

Compendium of model question papers of all Medical
Colleges across kerala, by weightage
Medicine : 200 marks

CARDIOVASCULAR SYSTEM
NERVOUS SYSTEM
ENDOCRINOLOGY
HEMATOLOGY
CLINICAL MEDICINE
GIT & HEPATOBILIARY SYSTEM
NEPHROLOGY
AETCOM
INFECTIOUS DISEASES
RHEUMATOLOGY AND IMMUNOLOGY
POISONING
NUTRITION
EMERGENCY MEDICINE
AETCOM
RESPIRATORY MEDICINE DERMATOLOGY AND PSYCHIATRY

Surgery : 200 marks

1. REST OF THE TOPICS

2. ORAL CAVITY+ GIT+ GENITOURINARY+ ANAESTHESIA+ RADIOLOGY+ ORTHO

OBGY 200 marks

1. OBS AND SOCIAL OBSTETRICS
2. GYNEC AND FAMILY WELFARE

Pediatrics : 100 marks

1. PEDIATRICS AND NEONATOLOGY

Topics may overlap in both papers.

 Published by
Indian Medical Association
Medical Students Network
Kerala

Editorial board

Viswanath kannan- PIMS

Jeevan Jacob Paul- GMC EKM
Jania S- Travancore Medical College
Adithya Krishna Shaji- SNIMS
Mithra Thampi- KMCT
Ashley Roy- GMC Manjeri
Mohammed Thameem- GMC TVM
Akash S Kumar- DMMC Wayanad
Gayathri Santosh- Travancore Medical College

Contributors

Adarsh S- Malabar
Medical College
Adithya sabu - PK Das
Kritharth Tandon -Pk Das
Mohammed sujin -KMCT
Dr Vinoj- SMC karakonam
 Designing team
Aiswarya Jayaprakash- MMC
Kripa Gireesh- SGMC
Arjun T- PKDIMS
Srigavi - AIMS
Sahana-karuna medical college
Sanjay krishna v emc
Devika Vijay - KMCT
Sandra Jose - GMC Kannur
Arjun chandran- DMMC wayanad
Ashish Lazar-Smcsi Karakonam
Adithyan K.J - karuna medical college
Ajmi A R - SUTAMS
Ajmal Thaha - GMC Kannur
Nikhitha R -GMC Palakkad
Subijith B -SNIMS
Anisha CN - Mzmc
Bonu K Baby- Pushpagiri
Basija Sibin - GMC Manjeri
Abhishek Chandran- SNIMS
Anushwara- AMC
Abigail Hero- GMC EKM
Nikhitha R-GMC Palakkad
Thomas Pious: PMC, Thiruvalla
Sann Mariya-TDMC Alappuzha
Nasha Ahamed - GMC Manjeri
Riya Susan Mathew- Mt. Zion
Nada Fathima- Travancore Medical College
Dilna Manoj- MMC
Antonio Paul- BCMCH
Fahadhah Hamza- Travancore Medical College
Afsana Fathima A- Travancore Medical College
INDEX
MEDICINE PAPER 1
LONG ESSAY
SHORT ESSAY
ONE WORD
SHORT ANSWERS

MEDICINE PAPER 2
LONG ESSAY
SHORT ESSAY
ONE WORD
SHORT ANSWERS

OBG
LONG ESSAY
SHORT ESSAY
SHORT ANSWER
ONE MARK
DRAW AND LABEL

PAEDIATRICS AND NEONATOLOGY

LONG ESSAY
SHORT ESSAY
SHORT ANSWER
ONE WORD

SURGERY PAPER 1
LONG ESSAY
SHORT ESSAY
SHORT ANSWER
ONE WORD

SURGERY PAPER 2
LONG ESSAY
SHORT ESSAY
SHORT ANSWER
ONE WORD
Paper-1 long essays

Essay (10 marks)

1) Organophosphorus poisoning

a) Clinical features (4)

b) Treatment (3)

c) Complications (3)

2) A 30 year old male diabetic patient presented to the emergency department with
abdominal pain, nausea and vomiting. Patient also had altered sensorium. he had a recent
lower
respiratory tract infection

a) What is your diagnosis ?(2)

b) Differential diagnosis(2)

c) What are the 3 important clinical factors to be rectified (2)

d) Management(4)

3).A 25yrs old female presents to the casualty with a history of acute onset of
breathlessness which is associated with a BP level of 220/120mmHg.

On examination patient is dyspnoeic, tachypnoeic, tachycardia+ CVS-Mild cardiomegaly - no

valvular lesions auscultated

S3 gallop+

Resp system Bilateral basal crepitations +

Abdomen a bruit is auscultated on left side of abdomen, above and lateral to the

umbilicus

Serum creatinine 2.1 mg/dl

1. What are the likely diagnoses

2. How will you manage the episode of acute breathlessness

3. What are the investigations you will do in this

case 4. Describe the long term management of this

case

4) Describe the pathophysiology of Myasthenia

gravis Clinical presentation of this disease

Investigations and management

5)A 36 year old male patient attended the emergency department with c/o upper abdominal pain
and vomiting for the last eight hours. The problem followed an episode of binge drinking on the
previous night. On close questioning he said that the pain radiates to the back. No past history
of similar pain or any other significant comorbidity. On examination pulse rate- 96/minute, BP-
142/86 mmHg, afebrile. P/A- diffuse upper abdominal tenderness and guarding present. No
rebound tenderness, no mass. Bowel sounds are sluggish.

1)What is the most probable clinical diagnosis ?(1)

2)What are the differential diagnosis ?(1)
3)Enumerate the investigations to be sent from ER.(3)
4)Discuss the etiology of the disease and all other possible causes (2)
5)How will you manage the condition and discuss the possible complications(3)

6)A20 year old girl presents with pain in the right iliac fossa for the last 24 hours. The pain was
initially around the umbilicus and then shifted to RIF. Pain was followed by vomiting and
fever. Her LMP was 10 days back. There is no h/o similar pain in the past or significant
comorbidities.
On examination PR-96/minute, BP-130/76 mmHg, temperature 101 degree F, P/A-
tenderness in RIF +, rebound tenderness +, guarding +, no generalized rigidity, no palpable
mass.

1. What is the possible diagnosis?(1)

2. What are the differential diagnosis to consider?
3. Enumerate the investigations to be done from ER 7-3 (2)

4. What is the most appropriate management .(2)

5. Discuss the possible complications and their management

7). A 45 year old migrant worker presents with fever with chills and myalgia of five days
duration. He had retro-orbital pain, skin rashes and gum bleed on presentation. (2+2+3+4+4)
a. What are the possible differential diagnosis in our community?

b. Discuss the clinical features and complications of any one of these diseases.

c. How will you investigate?

d. Discuss the management of any one of these diseases.

e. Discuss briefly the preventive measures of infectious diseases in general.

8)A 24 year old pregnant lady presents with headache of six days, seizures since two days and
altered sensorium since one day.

a. What is the probable diagnosis?

(1+2+3+4+5)

b. What are the differential diagnosis?

e. How will you investigate?

d. What are the risk factors for this condition?

e. How will you manage this patient?

9)A 62 year old male patient was brought to emergency department in an unconscious state.
On examination patient's GCS was 8 and there was severe jaundice. Abdomen examination
showed signs of free fluid and liver span was 5cm.

1. What is the most probable diagnosis?

2. What are the other clinical signs seen in such a patient?

3. What are the investigations to be done in this patient?

4. How do you treat this patient?

5. What are the complications of this condition (1+3+4+4+3 = 15 marks)

10)A 67 years old male patient presented to the emergency department with history of
sudden onset weakness of the right side of the body for the past two hours duration. Patient
is a known
diabetic and hypertensive for ten years. On examination the BP was 196/110mmHg and the
muscle power on the right side was grade 2/5 with extensor plantar response on the right
side.

1. What is the most probable diagnosis?

2. What are the investigations to be done in this patient?

3. How do you treat this patient?

4. What are the complications of this condition? 5. How do you prevent recurrence of this
condition?

(2+4+4+2+3=15 marks)

11)1. A 45 year male presenting with progressive numbness from the feet ascending
upwards started 3 months ago. H/O back pain &dragging of his Rt foot, now complaining of
weakness of both legs. Experiencing difficulty in micturition since a week, and now
retention since 1 day

(15)

a) Discuss the diagnosis giving reasons

(3)

b) Describe the nature of the disorder and expected examination findings

(3)

c) Discuss the different varieties of this disorder & its causes.

(6)

d) Draw relevant pictures to substantiate your diagnosis.

(3)

I2) A 56 year male executive who developed acute chest pain > 30 mts while in a meeting
at Mumbai. Colleagues took him to a nearby hospital where ECG showed ST elevation as
evidence of CAD. (15)

a) Describe the pathogenesis of acute coronary syndrome.

(3)
b) Define acute coronary syndrome, its various subtypes & how to distinguish between them.

(4)

c) How do you work up this patient & manage him

(5)

d) How do you disclose the diagnosis to his wife who has just arrived & discuss cardiac
rehabilitation.

(3)

13)1. A 45 year male presenting with progressive numbness from the feet ascending
upwards started 3 months ago. H/O back pain &dragging of his Rt foot, now complaining of
weakness of both legs. Experiencing difficulty in micturition since a week, and now
retention since 1 day

(15)

a) Discuss the diagnosis giving reasons

(3)

b) Describe the nature of the disorder and expected examination findings

(3)

c) Discuss the different varieties of this disorder & its causes.

(6)

d) Draw relevant pictures to substantiate your diagnosis.

(3)

14)A 56 year male executive who developed acute chest pain > 30 mts while in a meeting
at Mumbai. Colleagues took him to a nearby hospital where ECG showed ST elevation as
evidence of CAD. (15)

a) Describe the pathogenesis of acute coronary syndrome.

(3)
b) Define acute coronary syndrome, its various subtypes & how to distinguish between them.

(4)

c) How do you work up this patient & manage him

(5)

d) How do you disclose the diagnosis to his wife who has just arrived & discuss cardiac
rehabilitation.

(3)

15)Write an essay on the clinical features, complications, investigation and management

of Acute renal failure.

(15 marks)

16)A 30 year old patient with history of NSAID abuse was brought to casualty with history of
abdominal pain for 2 weeks and hematemesis and melena for 2 days. On examination the
patient has pallor, pulse rate of 108 and Bp of 88/72 mm of

Hg.

1. What is the most likely complete diagnosisA 79 year old man presented with 2 months history
of bone pain and fatigue He was pale on examination. His blood investigations showed
Hemoglobin 6 gm%, ESR 120 mm/hr, serum creatinine-6 mg/dl, serum calcium-16 mg/dL.. X
Ray of skull and pelvis showed lytic lesions.

a. What is the most probable diagnosis?

b. What are the clinical manifestations of this disease?

c. How will you investigate this case?

d. Discuss the treatment.

e. Draw and label the structure of an immunoglobulin molecule. (2+3+3+4+3=15 Marks)

17)25 year old female with rheumatic heart disease presented with history of on and off fever
with chills and fatigue of 1 month. Un examinanon she had paltor, petechial hemorrhages in
lower limbs and splenomegaly. Auscultation revealed a pansystolic murmur and a fnid-
diastolic murmur in mitral area. Urinalysis showed microscopie hematuria.

a. What is the most probable diagnosis?

b. What are the clinical manifestations of this disease?

c. How will you confirm the diagnosis?

d. Discuss the treatment.

e. What are the complications of this condition?

+3+3+4+3-15 Marks)

18)Discuss the various other causes and diagnosis in such clinical situation

3. How will you investigate this patient?

4. How will you manage this patient?

(2+4+3+6-15 marks)

19)1. A 50 year old farmer was found unconscious at his residence and was height by he
neighbor to our emergency department. Our ED resident on examination of the patient and
that patient was having excessive sweating, kerosene order of math, Inating from no His GCS
was 5/15 and pupils were pin point. ECG was takim which was dowing so bradycardia and
recorded blood pressure from emergency department w

(152-30)

a) What is your diagnosis and describe the Pathophysiology?

b) What are the relevant investigations and write a treatment protocol for your dipas
Discusses briefly on Glasgow coma scale

dy Name 4 causes for bradycardia in adults

(3-4-4-4)

20.A 18 year old young female who was having heavy menstrual bleeding for 3 days daring
her monthly menstrual cycle came to your outpatiety dipertown with history of unexplained
stig
exertional dyspnea, difficulty in concentration in his studies, palpitation. She also pres history
of eating non edible substances like pencil nib, clay, chalk etc. She also gives history of restles
her legs during sleep which often disturbs her sleeps in

a) What is your probable diagnosis?

b) What all investigations you need to confirm your diagnosis c) What are the neurological
manifestations of your diagnosis?

d) Enumerate a treatment plan and a diet plan for the patient

21) A obese 55-year-old female patient suddenly develops acute severe dypnoea and
hypotension 2 days after undergoing a cholecystectomy. There is mild jugular venous
distension with prominent a waves. The lung fields are clear (3+4+4+4-15) ECG shows sinus
tachycardia
and right bundle branch block

a) What is your diagnosis and justify the diagnosis

b) List the common risk factors for this condition

c) List the investigations and mention abnormalities expected

d) How will you treat this patient ?

22 A 65 years old man who is a chronic alcoholic presents with the history of tarry black stools
and fresh blood vomiting since 2 days. On examination he is ill looking, pale and has
tachycardia. He has ascites but no palpable spleen. His blood pressure is 90/60 mm Hg.

Answer the following:

(2+3+5+5-15)

a) What is your likely diagnosis

b) What steps should be taken immediately in the management

c) How will you treat this condition

d) What are the complication of this condition

23)A35Y A 35 year old female with history of progressive exertional breathlessness comes
to the casualty. She gives history of palpitations for twojkeek, and hemoptysis for two days.
On
further questioning, she says she had childhood (arthritis) and was given Injections for a few
years. O/E, pulse-114/mt, irregularly irregular. Apex in the 5th LICS, in the MCL, tapping in
character.

Chest-Clear.

a b) What is the criteria for the diagnosis of the basic disease?

) What is the probable diagnosis. What is your rationale for the same?

c) What are the relevant investigations and their expected results? d) What are
the management options available for this patient?

e) What is the regimen for prophylaxis of the disease?

2+3+4+4+2=15marks

24.A 45 yr old male, with history of chronic alcohol intake for 15 years, is brought to the casualty
in a state of disorientation. His relatives say he has been having a fever for the past three days,
with constipation decreased sleep, and that he had a seizure that morning. O/E drowsy, febrile.
Icterus present. Abdomen is distended.

a) What is your probable diagnosis. What is your rationale for the same?

b) What are the clinical features expected when the patient is examined?

c) How will you investigate this patient?

d) List the complications of this condition.

e) How will you manage this patient?

25)A 75-year-old male is admitted with stroke.

(2x15-30)

A. Classify cerebrovascular accident.

(5)
B. Describe the blood supply of the frontal lobe.

(5)

C. Choose 5 appropriate investigations in a 35-year-old person with Stroke (5)

26.A 56-year-old male is diagnosed to have diabetes mellitus type 2 and systemic

hypertension A. Justify the use of ACEI in this patient

B. Choose two appropriate oral hypoglycaemic agents for him

C. Discuss the counterregulatory hormone response to hypoglycaemia

27. A-45 year-old man presented with sudden croat of brief loss of consciousness fofowed by
weakness of right upper and lower lentes. On examination he was able to understand shat
others sebule to speak by himself, he was having hypertonia is the form of spasticity is the
right per and lower the was celensor

(a) What is the most likely neurological diagnosis? (2)

(b) How do you localise the lesion in the branco capsule (3)

(c) How will you investigate the case? Mention the firings expected (2)

(6) What are the therapeutic approaches for the management? What is the real? (3)

(e) What is the emergency treatment available now? What are the precautions to be taken? (2)

(1) What are the complications you may expect while treating this pater? (3)

28.1. A 70 year old female presents with intermittent fever, severe low back ache and
tiredness for over 6 months. On examination, she looks very pale. Lab evaluation reveals, Hb 6
gm%,
ESR 120 mm/hr, serum creatinine 2.5 mg/dl., serum calcium 11.2 mg/dL, albumin 2.6 mg/dl,
and globulin 4.0 mg/dL. Bone x-ray shows lesions. Now answer these questions:

A) What is the probable diagnosis in this lady?

(1+2+4+4+4=15)

B) What may be the radiological findings?

C) How will you confirm the diagnosis?

D) How will you treat this pationt?

E) Name any four complications.

29.iscuss the common causes, clinical features, investigations and management of Addison's
disease. Write briefly on Addisonian crisis. (2+3+3+3+4=15)

30)
A 70 year old female presents with intermittent fever, severe low back ache and tiredness for
over 6 months. On examination, she looks very pale. Lab evaluation reveals, Hb 6 gm%, ESR
120 mm/hr, serum creatinine 2.5 mg/dl., serum calcium 11.2 mg/dL, albumin 2.6 mg/dl, and
globulin 4.0 mg/dL. Bone x-ray shows lesions. Now answer these questions:

A) What is the probable diagnosis in this lady?

(1+2+4+4+4=15)

B) What may be the radiological findings?

C) How will you confirm the diagnosis?

D) How will you treat this pationt?

E) Name any four complications.

31. Discuss the common causes, clinical features, investigations and management of
Addison's disease. Write briefly on Addisonian crisis. (2+3+3+3+4=15)

32)14 year old girl came with upper abdominal pain and repeated vomiting. She was recently
noticed to have polyuria and weight loss. Examination revealed fruity odour in the mouth apart
from severe dehydration

a) Most probable diagnosis

b) Evaluate for alternative possibilities

Management of current complication

d) Treatment of underlying disease

33.2140 year old male presented with generalized edema and decreased urine output for one
month. On examination BP 120/80. Proteinurea of 3.5 gm/24 hours and serum albumin
2 gms. Answer the following

a) What is the likely diagnosis

b) How do you investigate this patient

c) What differential diagnosis will you consider

d) How are you going to treat this patient

34)A 48 year old man prevents with suckten onset werkness of right upper limb and LAO be is
conscious and with Pale of 80/min d lower limb for high volume and BP 170/40 Power is in tight
upper la limb and 55 on the left side

a) What is the most probable diagnosis?

b) What is the most likely underlying cause?

<Mention the common causes of this condition in a 40 year old male

What are the cardiovascular examination findings to be expected in this man?

Discuss the investigations in this patient?

(2+2+3+2+3+3)

Outline the management.

35. A 55 year old lady has swelling and pain of both hands and wrists for past 6 months. She
feels the fingers are stiff in the morning on waking up and become better after an hour or so. On
examination she has tenderness and swelling of both wrist joints.

a). What is the most probable diagnosis?

b) How will do differentiate between articular and periarticular disease

Discuss the differences between inflammatory and degenerative arthritis

d) Outline the criteria to diagnose this disease

)Discuss the management of this disease.

Discuss an extra articular features of this indse

(2+2+2+3+3+3)

36.) 45 year-old female presented with complaints of weight gain over fast few months and
incidentally detected hig

readings. On probing she says she was taking over the counter medication for low backache
since 5 to 6 years. On examina

her BMI is 29 kg/m³, striae present over the abdomen, raised skin fold noted at the nape of
the neck. BP 160/90 mmhg

basic investigation revealed deranged glycemic profile and mild hypokalemia.

1+5+2+5+2=15

a) What is your most probable diagnosis?

b) What are the clinical manifestations of the above condition?

c) List the causes for the above condition

d) What investigations will you do for further evaluation?

e) List 4 endocrine causes of hypertension

37.A 30 yr old female presented with weight loss, intermittent palpitations. Feeling of
warmth and increased frequency of stools since 3 months. Her family members noticed
that her eye appears to be bulged out.

aj What is the most probable diagnosis?

b) What is the most common Antibody associated with this condition

2+2+5+6-15 Marks

What are the expected clinical findings in this patient?

d) What is the treatment for the above condition and mechanism of action of the drug?

38.
(2+2+2+2)

A 35 year old female patient presents to OPD with complaints of palpitation lethargy and
weight loss. On 1 examination she has protruding eyebalts, Her TSH is 0.01 m

a) What is your diagnosis ?

b) Pathophysiology of this condition.

c) How will you investigate?

d) Explain the management.

e) Management of this condition in a pregnant female.

(2+3+3+4+3)

39) A 20 year old college student presents to casualty with fever, nausea and abdominal pain.
On examination he is icteric. There is similar history in two of his roommates at hostel

a) What is the most likely diagnosis?

b) Common clinical features of this condition.

c) Laboratory abnormalities (including tests to confirm diagnosis)

d) Outline the management.

e) Briefly mention preventive strategies

(2+3+4+3+3)

40) A 22 year old postnatal who deliverergone week back, presents with headache since one
week, siture since 2 days, a daltered sensu sve morning

A) What is the prototile aasis and differelial diagnosis? (mark)

Pi What are the investicates for this patient? (3 marks)

C) What are the risk factors tite this condition? (3 maris)

Dj How do you manage this plent? (4 marks)

E) What are the complications of as condition? (3 marks)

41)A 15 year old boy came with upier abdominal pain and many episodes of vomiting.hc
recently noticed to have polyurie und weight loss. Examination revealed fruity adow icmouth
apart from severe dehydration.

A) What is the most probablemosis? [2 marks)

B) How do you evaluate for alterative possibilities? (4 marks)

C) What is the managemens of current complications? (4 marks)

D) What is the tre for this underlying disease? (5 marks)

42.A 32 year old male presented with breathlessness and palpitations of one day duration.
He has got progressive breathlessness for last one year. There was h/o fever associated with
joint pain at the age of fifteen. O/E soft S1 and a specific systolic murmur over mitral area

(1+3+3+3-10 Marks)

1. What is your complete diagnosis?

2. What are the other clinical findings you will look for?

3. Write investigations required?

4. Write the treatment for this patient

43.A 72year old male presented with weakness left side of his body since 5 am today
morning evolved over five hours associated with deviation of angle of mouth and no
headache, loss of consciousness or loss of speech.

1. What is your complete diagnosis?

(1+3+4+210 Marks)

2. Write your investigations of choices 3. How will you treat this patient?.

4. What are the complications you will expect and how will you prevent them

44)1. A 60-year-old male, chronic alcoholic, was brought to the Emergency Department, in
altered sensorium He was drowsy, his skin and sclera were yellowish, and abdomen was
tensely distended. On examination, asterixis was present. Nasogastric tube insertion
revealed coffee coloured aspirate (2+4+3+2+4-15)
a) What is the complete diagnosis?

b) Describe clinical features of this condition in detail.

c) How will you confirm the diagnosis?

d) Enumerate the complications of this condition.

e) How will you manage this patient?

45. A 65-year-old male, known case of Hypertension, was brought to the ED with acute onset of
vertigo and imbalance in walking since yesterday. On examination, there was loss of pain and
temperature over right side of face and over left half of body. Nasal regurgitation was present
and gag reflex diminished (3+4+2+2+4=15)

a) What is the probable diagnosis and neurological localization?

b) Enumerate clinical signs of this condition with reasoning

c) How do you confirm the diagnosis?

d) How do you manage this condition?

e) Draw the arterial circulation of the brain.

46.
42 Year old male patient presented with progressively increasing abdominal distension followed
by bilateral pedal edema for 3 months duration. Over the past two weeks he started noticing
yellowish discoloration of the eyes and urine. He has given the history of heavy alcohol
consumption for the past 20 years

a) What is the probable diagnosis. Justify your diagnosis?

(5 Marks)

b) How will you investigate this patient?

(5 Marks)

c) Outline the treatment plan?

(5 Marks)

d) What are the complications you anticipate? Briefly note the treatment of each?
(5Marks)

47. A 65 year old male, a smoker and diabetic presented with the complaints of swelling of
feet since a year and breathlessness for 10 months. The breathlessness was initially grade!
NYHA but progressed to grade III NYHA. On examination, patient has bilateral pitting
oedema, raised JVP with Bilateral fine crackles in the lung bases.

Answer the following:

a. What is your most probable diagnosis?

b. Enumerate four causes for the above condition?

c. What is NYHA grading and enumerate the grades?

d. Draw a diagram of JVP and label its parts and denote what each part stands for.

e. List the investigations you will order for this patient

f. How will you manage this patient?

(1+2+2+2+3+5=15)

48. 50 year old lady presented with complaints of fatigue, nausea and decreased appetite
since 9 months. She also gives complaints of swelling all over her body which started around
her eyes and then went on to involve her abdomen and legs. On examination she had severe
anaemia
and anasarca. Her BP was 200/110 mmHg on right arm supine position. Her lab
investigations revealed an Hb of 8 gm/dl and serum Creatinine of 7 mg/dl.

Answer the following

a. What is your most probable diagnosis?

b. Enumerate four causes for the above condition

c. How will you investigate this patient?

d. Formulate a treatment plan for this patient.

(2+3+5+5=15)

49.50 year old me with the last 15 years de palliness of lacently A few Says later is spread to
other parts of the body and now he has gende but there is frutting
What is the most probable diagnosis (1)

What are the pathological changes expected in the affected organ? (3)

Enumerate other etiologies involved in this particular diagnosis)(0)

How do you investigate? (3)

Give the treatment plan (3

f) What are the complications expected?(3)

50. 65 year old smoker is admitted with abrupt onset dyspons. He was smoking since the age of
20 years and stopped 5 years back when he started developing effort intolerance with cough
with scanty Mucold sputum

a) Give two most important causes for new onset symptoms. (2)

b) How do you differentiate these 2 causes clinically?(3)

What are the findings expected in X-ray chest in both conditions?[3]

d) What could be reason for last 5 year symptoms7(1)

e) Elaborate the line of management in any one of the condition()

What are the complications expected in the condition which you have selected?

51)1. 43year old male is admitted with hematemesis. He is having abdominal distension and
oedema of legs of 6 months duration. His RBS is 426mg/dl. O/E. Icterus, flapping tremore.

a. What is your clinical diagnosis? (2)

b. What is the relevance of history taking in this patient to know the etiology of illness? (3)

c. What are the clinical findings you will look for? (2)

d. How will you investigate?(5)

e. Discuss the management of hematemesis in this patient (3)

52. 34 year old male is admitted with weakness of all 4 limbs of 2 days duration, without any
sensory or bowel bladder involvement. D/E HMF-N, Cranial ns-WNL, b/ flexor plantar
a. What is your clinical diagnosis and anatomical localization?(3)

b. What are the common etiologies for above presentation?(3)

c. How will you investigate this patient? (3)

d. Discuss the management (4)

e. Outline the complications (2)

53.. A 32-year female, presented with exertional dyspnea since 2 years which was gradually
worsening. Since last 2 weeks she complaints of irregular fast palpitations. This was associated
with bilateral pedal edema. She has past history of Rheumatic fever.

On examination

MS

PR:110/minute, irregularly irregular

BP:118/80 mmHg

JVP elevated with absent a waves.

CVS: Parasternal heave, S1 varying intensity, Mid diastolic murmur without presystolic
accentuation in mitral area best heard with breath held in expiration

a) What is the diagnosis? (1 mark)

(IM 1.1, IM1.3, IM 1.5, IM1.7, IM1.8. IM1.25)

b) Enumerate the signs of Right heart failure. (2marks)

c) Mention 2 precipitating factors of heart failure (1 mark)

d) List investigations which are appropriate in this patient. (3marks)

e) Mention briefly treatment of this patient. (3marks)

54.1. A 28-year-old male, residing in Cochin, presented with fever, generalized body pain,
headache, eye pain since three days. He gives history of mosquito bite. History of fever
outbreak around his house present. No history of travel On examination Dengue
Relative bradycardia (+)

(IM 4.3)

a) What is the probable diagnosis? (1 mark)

b) Write the WHO case definition of this condition (3 marks)

c) Enumerate 2 common differential diagnosis of this condition (2

marks) d) Describe the investigations required in this patient (2 marks)

e) How will you treat this patient? (2 marks)

Short essays

1. Clinicalfeaturesofmultiplesclerosis.
2. Jacksonianepilepsy
3. Clinicalfeaturesandmanagementofacutepyelonephritis
4. Cardiopulmonaryresuscitation
5. 5Investigationsandmanagementofinfectiveendocarditis
6. ARDS
7. Prinzmetalangina-Investigationsandmanagement
8. Epilepsy/seizuredisorder-Typesandmanagement
9. Ulcerativecolitis-Investigationsandmanagement
10. . Lupus nephritis- Investigations and management
11. CardiomyopathyTypesandmanagement
12. Clinical features and management of acute thrombotic stroke. 2
13. Clinical features and management of hyperkalemia
14. Clinical features and management of community acquired pneumonia.
15. Renal osteodystrophym
16. Megaloblastic anaemia
17. Atrial fibrillation
18. Treatment of Parkinson's disease
19. Insulin analogues
20. FISH
21. Intensive care management during pandemics
22. Cardiopulmonary resuscitation.
23. Pericardial effusion
24. Renovascular hypertension
25. An 13 year old male presented with exertional clyspnea, PND and pa pitation. On
examination is pulse was irregularly irregular with a pulse deficit of more than 10.
Cardiac examination revealed on: first heart sound, opening snap with a mid diastolic
murmur.

Answer the following:

What is your complete diagnosis. (3)

Dicuss its management. (3)

V/hat are its complications. (2)

26. Describe the causes, diagnostic evaluation, treatment and complication of a patient with
Nephrotic syndrome

27. . Myasthenia gravis. (5)

28. Cescr be endocrine causes of hypertension and its management. (5)

29. GG 4 related systemic diseases. (5)

30. Phacornatoses. (5)

31. Complications and management of Crohn's disease

32. Clinical features and complications of Infective endocarditis

33. Diagnosis and management of Thrombotic stroke

34. Hepatic encephalopathy

35. Complications of Diabetes mellitus

36. Clinical features, differential diagnosis and management of thyrotoxicosis.
37. Discuss the differential diagnosis and management of, acute upper gastrointestinal
bleeding
38. Discuss the etiopathogenesis, clinical features, investigations and treatment of
urinary tract infections.
39. Draw Jugular venous pulse and label the waveforms. Mention the reason for each
wave. List 4 causes for elevated JVP.
40. Discuss the clinical features, investigations and treatment of Myasthenia gravis.
41. Discuss the principle and regimen used in post exposure prophylaxis of HIV

42. Approach to a case of pyrexia of unknown origin

43. Discuss on the Management of acute coronary syndrome

44. Discuss the clinical features and management of Vamin A deficiency

45. RPGN etiology, investigations and management

46. Discuss regarding WHO pain ladder

47. . Describe Dukes criteria

48. Enumerate the causes of acute kidney injury.

49. Describe the extra intestinal manifestations of inflammatory bowel disease

50. . Enumerate diagnostic criteria for sdiabetes mellitus

51. 1. Criteria for diagnosis and management of myocardial infarction.
52. Classify pneumonias. Write about the clinical features and investigations in community

53. acquired pneumonia.

54. Write about the investigations and management of diabetic ketoacidosis.

55. What is Gullian Barre Syndrome? What are the types of GBS? How will you treat a
patient

56. • Management of acute upper Gi bleed.

57. 1 Discuss one neurological manifestation of Vitamin B12 deficiency

58. 2Discuss the etiology of falls in the elderly

59. Classify the compensatory mechanisms involved in heart failure

60. Choose 4 appropriate investigations for a patient with hyperthyroidism

61. Prescribe replacement therapy with iron 812 and folate

62. Clinical features investigations and treatment of a patient with Bell's Palsy (1)

63. Symptoms signs and investigations in tron deficiency anemia (8)

64. Compare and contrast symptoms, signs & investigation mus in hypothyroidism and
tryperthynadism (8) (8)

65. How will you take a detailed history of a paint with chronic headache

66. Detail the clinical features and diagnosis of Reumatoid Arthritis

67. Renal replacement therapy.

68. Management of pulmonary thromboembolisn.

69. Compare ulcerative colitis and Crohn's disease.

70. Write about patients' rights and physician's responsibilities

71. Atrial fibrillation

72. Hepatic encephalopathy

73. GBS

74. Seronegative arthritis

75. Management of hemotoxic snake bite
76. Causes and management of Hyperkalemia

77. Clinical features and management of bacterial meningitis

78. Pulmonary arterial hypertension

79. Clinical features of cobra snake bite and management

80. Chronic complications of diabetes mellitus

81. Metabolic syndrome

82. Guillain-Barré syndrome

83. Hypoproliferative anemias

84. . Renal replacement therapy

85. Hypothyroidism
86. Incretin based therapy

87. Occupational lung disease

88. Atrial fibrillation

89. Idiopathic thrombocytopenic purpura

90. Myasthenia gravis

91. 3) Parkinsonism-Pathophysiology, clinical features and
treatment 92.
93. (3+3+2)
94.
95. 4) DKA & HHS-Diagnosis and management

96. 6) Etiology, investigations and management of Chronic Kidney Disease

97. Pathophysiology, clinical features and treatment of a case of heart failure

98. Iron Deficiency Anaemia - Causes, clinical features, investigations, treatment

99. Human immunodeficiency virus (1) and opportunistic infections? Outline the ent

100. Scrubtyphus
101.
Discursetiology,pathophysiokigy,managementandcomplicationsof6)Howdoyou
investigate and manage acuile coronary syndrame (ACS!

102. Howdoyouinvestigateandmanageacaseofpulmonarytubercarethesecondline
ugs in anti tuberculosi tresument (ATTI What is DI 3?
103. HeartFailurewithreducedEjectionFraction(HFrEF)

104. .Parkinson'sdisease

105. Nephroticsyndrome

106. Clinicalfeaturesofcommonvitamindeficiencies

107. PepticUlcerdisease
108. Clinicalfeaturesofacutetheumaticcarditis?

109. Drawandlabelanormaljugularvenouspressuretracing?Mentionfourcausesofa
prominent a wave?

110. Clinicalfeaturesandmanagementofacutesevereasthma?

111. Pathogenesisandmanagementofcovid-19pneumonia?
112.
113. Enumeratetheclinicalfeaturesandinvestigationsofacuteinflammatory
demyelinating poly neuropathy

114. 48Yearoldsmokermalepresentedwithcoughwithstreakyhemoptysisforthelast
two weeks

115. Discussthedifferentialdiagnosisandinvestigationstobedoneinthispatient

116. WhatisHypertrophicpulmonaryosteoarthropathy

117. DiscussthetreatmentplaninParkinson'sdisease

118. ClinicalfeaturesanddiagnostictestsinasuspectedTBmeningitispatient

119. PathogenesisandclinicalfeaturesofAlzheimer'sdisease

120. Neurolepticmalignantsyndrome

121.
Namethepuerperalpsychiatricdisorders.Discusstheclinicalfeaturesofpostpartum
depression
122. Differentialdiagnosisofblisteringskinlesions.WritebrieflyonStevenJohnson
syndrome

123. CTimagingfindingsinacuteischemicstroke

124. Enumeratethecausesofreticulonodularpatternofopacitiesinx-rayofthechest

125. Medicalmanagementofchronicstableangina

126. Discussthefocusedclinicalexaminationinanyoungpatientwithsuspected
secondary hypertension
127. ManagementandcomplicationsofchronicHepatitisBinfection.(5+3)

128. AcutePyogenicMeningitis:Causativeorganisms,CSFfindings,Treatmentand
complications (2+2+2+2)

129. Hyponatremia:Classificationofcausesandmanagement.(4+4)

130. HowdoyoudiagnoseapatientashavingDiabetesMellitus?Whataretheacute
complications related to Diabetes Mellitus? (4+4)

131. CausesandmanagementofAcutePancreatitis.(4+4)
132. CNSmanifestationsofHIVinfection
133.
134. ClinicalfeaturesofChronicKidneydisease

135. Diagnosisofacuterheumaticfever

136. 40yearoldbusconductorisdiagnosedtohavesputumpositivepulmonary
tuberculosis. How do you counsel regarding treatment and prognosis?

137. Clinicalfeaturesandinvestigationsisscrubtyphus
138. EtiologicalevaluationofIrondeficiencyanemia

139. ManagementofDKA(Diabetesketoacidosis)

140. Diagnosisandmanagementofmyocardialinfarction

141. Medicalmanagementofchronickidneydisease

142. Hypertensivecrisis
Short answers

1. Auto-immunehemolyticanemia
2. Geneticcounseling

3. Conversiondisorder

4. Typhusfever

5. Extra-articularfeaturesofrheumatoidarthritis

6. StevensJohnsonsyndrome
7. Drawfacialnerve-courseandbranches

8. Osteoarthritis-symptoms,signs,Xrayfindingsandtreatment

9. ManagementofAcutemyocardialinfarctionincasualty

10. . Causes and clinical manifestations of Vit B12 deficiency

11. . Guillain-barre syndrome clinical manifestations and management

12. DMARDS 2

13. Approach and management of acute diarrhoea

14. Acid peptic disease - pathophysiology and management

15. Treatment of status epilepticus

16. Metabolic syndrome

17. Myasthenia gravis. (5)

18. Cescr be endocrine causes of hypertension and its management. (5)

19. GG 4 related systemic diseases. (5)

20. Phacornatoses. (5)

21. Migraine prophylaxis

22. Ventricular tachycardia

23. Management of Hypothyroidism

24. Christmas disease

25. Multiple myeloma

26. TEIR
27. a. Name 2 sulphonylureas. Describe the mechanism of action, clinical use and
adverse effects of sulphonylureas

28. Compare the features of Ulcerative colitis and Crohn's disease.

29. Discuss the causes of anemia in chronic kidney disease.

30. List 4 causes for massive splenomegaly.

31. Discuss the immediate and long term complications of acute stroke.
32. 8. What are the advantages of MRI compared to CT in case of Stroke?

33. Mixed Connective tissue Diseases

34. . Describe the clinical features and complications of Pancreatitis

35. Discuss the different types Headache

36. . Discuss the clinical features and treatment of hyperkalaemia

37. Discuss aetiology and treatment of acute tubular necrosis

38. Enumerate regarding the etiology and treatment of Atrial fibrillation

39. Discuss Causes and treatment of hypocalcemia

40. Discuss the causes and management of aplastic anaemia

41. Causes and clinical findings in Brown Sequard Syndrome. 2. Investigations and
treatment of Helicobacter pylori infection.

42. Treatment of acute ischemic stroke.

43. Clinical features and investigations in Grave's disease. 5 Management and

complications of COPD
44. . Plan Penicillin prophylaxis for a 15-year-old boy diagnosed with acute rheumatic
fever without any features of carditis or valvular heart disease

45. 2. Analyse the CSF results of a patient with acute meningitis

46. 3. Discuss the pathophysiology of anaemia in CKD

47. 4. Discuss the hepatitis serology of a patient with chronic Hepatitis B

48. Classical history and examination findings in a patent with long carily with Rossis due
to pulmonary TB (5)

49. Aetiology, classification and Treatment of spontaneous preumchonx (5)

50. Oral hypoglycemic agents: classification dosage and side effects (5)

51. Cinical symptoms, Investigations and treatment of Tetanus (5)

52. 8. Whipples disease

53. DMARD'S

54. Myasthenia gravis

55. . SLE-systematic feature and diagnosis

56. Management of hyponatremia

57. Role of genetics in cancer

58. Falls in the elderly

59. Principles of ethics

60. ) Contraindications of thrombolyús in acute stroke

61. Differentiate crohn's disease from ulcerative colitis

62. Light's criteria

63. Role of Physician as a communicator

64. Management of Snake Bite.
65.
66. 9) Salient differences between Crohn's disease and ulcerative colitis.

67. Acute Rheumatic fever.

68. Lab evaluation-Hemolytic Anaemia.

69. Draw a neatly labelled diagram of Circle of Willis.

70. 8) Management of chronic kidney distace

71. Acute severe Asthma.

72. Investigations and treatment of Leptos insis

73. Myredama

74. Teirakagy of fafiot (TOF).

75. Lacunar infarct syndromes-neuroanatomy, clinical presentations, and management

76. . Status epilepticus-definition, clinical features, and management

77. . Acute Kidney Injury-definition, criteria, and investigations

78. Hyponatremia-definition, classification, clinical features, investigations, and

management
79. Alzheimer's disease

80. Complications of Acute Myocardial Infarction

81. . Management of hyperthyroidism

82. Indications for dialysis in Chronic Kidney Disease

83. Celiac disease

84. Investigations in covid 19
85. Decontamination in poisoning

86. Clinical features of portal hypertension

87. Treatment of hyperkalemia

88. Statins
89. ) Complications of Acute pancreatitis

90. areflexia

91. asconding prodire

92. ) Adult Vaccination 2

93. . Thrombocytopenia
94. Hepatic
Encephalopathy 95. Rights
of a patient
96. Clinical examination findings in (L) lateral medullary syndrome

97. ITP (Immune thrombocytopenia)-Diagnosis and management

98. Symptoms, signs and evaluation of hypocortisolism

99. Draw and label the cardiac conduction system (IM 1.8)

100. .DescribetheetiologyofupperGlbleeding.(IM15.1)

101.
ComparisonofCrohn'sdiseaseandUlcerativeColitisbasedonclinicalfeatures(IM
16.15)

102. Describeinvestigationsforirondeficiencyanemia(IM9.8)
103.
104. .DescribetheclinicalfeaturesofInfectiveendocarditis(IM1.3,IM1.21)

105. ClinicalfeaturesofVitaminB12deficiency.(IM123.3)1wboateseg.elok

106. Describethemanagementofhepaticencephalopathy(IM5.16)

107.
Enumeratethebloodcomponentsandmentiontheirindicationsforuse(IM9.17)

108. ClinicalfeaturesofAlcoholrelatedliverdisease(IM5.5)

109. .Causesofsecondaryhypertension(IM8.1)
110. CriteriaforSepsisandSepticshock(IM4.7)

111. Clinicalfeaturesofsnakeenvenomation(IM20.4)

112. .Managementofparacetamolpoisoning(IM21.4)

113. Clinicalfeaturesofplasmodiumfalciparuminfection(IM4.6)

114. .Shareddecisionmakinginhealthcare(IM26.12)

115. .ManagementofOrganophosphoruspoisoning(1M21.3)

116. ModesoftransmissionofHIV(IM6.19)

117. Organdonation(IM26.8)

118. DescribeclinicalfeaturesofLeptospirosis(IM25.2)

119. .EnumerateetiologyofFeverofUnknownOrigin(IM4.8)
Paper 2-Medicine

1.ESSAY

(15x2-30 Marks)

1. A 65 year old diabetic on insulin stopped medications for last one week brought to the
casualty unconscious He had abdominal pain and vomiting two days back.O/E drowsy,
dehydrated PR 112/mt BP 90/60mmHg GRBS 685 mg%

a. what are your differential diagnosis

b. describe the pathogenesis of any one of your diagnosis
c. discuss the clinical features of your diagnosis
d. How will you manage the case?
e. What are the complications of the primary diagnosis

(2+3+3+5+2-15 Marks)

2. A 16 year student was brought with h/o fever one week back, she was found to have
purpuric spots over both shins. Abdomen examination no organomegaly made out.
Investigation
revealed PLC:30000.

a. what are the differential diagnosis

b. How will you approach a case of bleeding?
c. Mention the investigations this patient further required.
d. How will you treat the probable diagnosis?
e. What are the possible complications

(2+3+3+4+3= 15 Marks)

3.A 30 year old woman presented with 7-8 episodes of bloody diarrhea, abdominal pain and
tenesmus in 6 weeks. On examination, she was pale & febrile, with a pulse rate of 104 per
minute. As she was not responding to broad spectrum antibiotics, a colonoscopy was planned.

a) What is your diagnosis (2)

b) Investigations(3)
c) Management(3)
d) complications of above disease (2)

4. Pneumothorax
a) Classification (2)
b) Clinical features(2)
c) Investigations(3)
d) Management(3)

5. A 35 year old nurse presented with complaints of significant weight loss , anorexia and slowly
progressive breathing difficulty for one month. On examination she is cachexic and trachea is
shifted to the left . breath sounds are diminished/ absent over right mammary, infraxillary ,
infrascapular and inter scapular areas with stony dullness over these area
a. Whatisyourprobablediagnosis(2)
b. Enumeratesixcommoncausesofthiscondition(3)
c. Howdoyouexaminethispatient(4)
d. Howdoyoutreatthispatient(4)
e. Whatarethecomplicationsofthiscondition(2)
6. A 60 year old farmer is brought unconscious to the emergency department . On examination ,
he was drowsy , with bronchorrhea , hypersalivation and miosis. A distinct garlic odor was
smelled
a. Whatisyourprobablediagnosis(1)
b. Whataretheetiologicalagentsresponsibleforsuchacondition(2)
c. Whatisthepathogenesisofthiscondition,withmechanism(4)
d. Describetheclinicalfeaturesofthiscondition(4)
e. Discussmanagementofthiscondition(4)
7. A 65 year old male presented with a history of fatigability, malaise, early satiety and
abdominal fullness for the last 1 month . no prior co morbidities . On examination pallor + P/A
massive splenomegaly + CBC shows TC-30,000 platelets -7.2 lakhs Hb-8.2 peripheral blood
smear- shift to left with predominant neutrophils and presence of bands , myelocytes,
metamyelocytes pro myelocytes and 2% blasts
a. Whatisyourprobablediagnosis(2)
b. Whatisdifferentialsformassivesplenomegaly(3)
c. Whatarethephasesinthenaturalhistoryofgivendisease(3)
d. Whatisthecytogeneticandmolecularabnormalitiesseeninthispatients(3)
e. Whatarethedrugsandtreatmentoptionsavailableforthispatient(4)
8. A 50 year old male patient was undergoing evaluation for his symptoms of increased thirst,
increased appetite and increased frequency of urination for the last 2 months. His RBS= 360
HbA1c=9.6 height=165cm weight=90kg BP - 120/80 mmHg.
a. Whatistheprobablediagnosis(1)
b. Diagnosticcriteriaforgivencondition(2)
c. Whatarethepossiblelongtermcomplicationsofthisdisease(3)
d. Describethenonpharmacologicalmanagementofthiscondition(3)
e. Whatarepharmacologicalmanagementoptionsavailable(3)
f. Howwillyouassessthe“targetorgandamages”occurringinthispatient(3)
9. The 19 year old boy presented with a two day history of high grade fever , retro orbital pain
and severe arthralgia, particularly over low back . On examination he is febrile , conjunctiva
sufficed and has generalized erythematous blanching skin rash
a. Whatisthemostprobablediagnosisandrighttherelevanttesttoconfirmthe
diagnosis(5)
b. Whatarethelikelycomplicationsyouanticipate(5)
c. Whatarethedifferentialdiagnosisforthemaculopapularskinrash(5)
d. Discussthephysiologyofbodytemperatureregulation(5)
10. A 35 year old woman presented with fever, malaise and weight loss O/E Pt has oral ulcers
with alopecia pallor present . Symmetrical arthritis of large and small joints . Deformities H/o
one abortion in the past
a. Whatistheprobablediagnosis(2)
b. Whataretheneurologicalmanifestationsinthiscase(3)
c. Investigationstobedone(3)
d. Treatmenttobestarted(4)
e. Twodrugswhichcanproducethiscondition(3)
11. 52 year old male who is chronic smoker has cough with expectoration and comes to
emergency department with weakness and swelling in legs since last one week
O/E tachypnoeic JVP is elevated and Pt has a Rt ventricular third heart sound with tender
hepatomegaly
a. Whatisyourdiagnosis?(2)
b. Howareyougoingtoinvestigate(3)
c. Discussthemanagement(3)
d. Whatthearecomplications(4)
e. Give2causesforunilateralnonpittingpedaloedema(3)
12. A 25 year old woman presented with an insidious onset of gait ataxia of 6 months duration.
She is a strict vegetarian . On examination she had bilateral loss of ankle reflexes
a. Whatcouldbeaprobablediagnosis(3)
b. Whatotherneurologicalmanifestationsmaybepresentinthisexamination(3)
c. Namefeatureyoucanexpectingeneralexamination(3)
d. Drawandlabelaperipheralsmearofthislady(3)
e. Mentionsstepsinevaluatingthispatient(3)
13. 34 year old male agricultural worker presented to casualty with history of dyspnea of one
day duration . he had fever of 5 days with myalgia and oliguria
a. Whatisrelevanceofadetailedhistorytakinginthispatient(2)
b. What clinical examination findings will you look for in this patient (2)
c. Explainthereasonsfordyspneainthispatient(2)
d. Howwillyouinvestigatethispatient(4)
e. Outlinethemanagement(5)
14. A 42 year old male was brought to casualty in an unconscious state . A clinical
examination showed PR: 50/mt . pinpoint pupil and fasciculations
a. Whatisyourclinicaldiagnosis?why?(2)
b. Whatotherclinicalexaminationfindingsyouwilllookforinthispatient(2)
c. Whatarethenecessaryinvestigationsinthispatient(2)
d. Howwillyoutreatandmonitorthispatient(6)
e. Thispatientontheseconddayofillnessdevelopedneckmuscleweaknessand
weakness of all 4 limbs. What complications is this patient developing and how will you
treat it?(3)
15. A 72 year old gentleman presented with complaints of lower back aches for months .
skeletal survey revealed multiple punched out lesions on the skull and lab investigations
revealed Hb= 6g/dl ESr= 150 mm/hr creatinine= 24mg/dl
a. Whatistheprobablediagnosis(2)
b. Clinicalfeatures(4)
c. Pathophysiology(4)
d. Management(5)
16. A 38 year old lady was brought to the emergency department with decreased mental status .
On examination she was hypothermic with pulse rate 52 bpm and BP- 76/40mmhg Also there
was loss of lateral third of eyebrows puffiness of hands and face
a. Whatisyourprobablediagnosis(2)
b. Clinicalfeatures(4)
c. Investigations(4)
d. Treatment(5)
17. A 38 year old male admitted with fever , tiredness and joint pains of 2 weeks . He had a
dental procedure three weeks prior to this . Had polyarthralgia following sore throat in childhood
. he has palpitations dyspnoea and syncope for many years he is not on any medications from
childhood
a. Discussthediagnosisordifferentialdiagnosisforhiscurrentillnessandadmission(3)
b. Mention2signsinhishandoneinabdomenandoneincvsinthemostprobable
diagnosis you thought of (2)
c. Whatinvestigationsyouwilldointhispatientandmentiontheexpectedabnormalitiesin
those (3)
d. Howwillyoutreatthecurrentclinicalcondition(3)
e. Do you feel that he has received optimum medical care from childhood till dental
extraction what measures or treatment you would have adopted if he was under your
care all these times (4)
18. 35 year old woman multipara vegetarian with menorrhagia is admitted with exertional
breathlessness and tiredness. She has pica, perianal itching and numbness feet. Husband is
alcoholic and not taking care of the family
a. Fromthehistorydiscusstheprobableclinicalproblemsinthispatient(3)
b. Whatclinicalsignswithyoulookfortoconfirmyourhistorydiagnosis(3)
c. Whatinvestigationswillyoudoandmentiontheexpectedabnormalities inthispatient(3)
d. Howwillyoutreather(3)
e. Communicateandcounselthefamilymembersinviewofthecurrentproblemsinthe
family (3)

19. A 22 year old bodybuilder on long term steroids presents to the emergency room with
profound weakness, dizziness, and nausea after the workout . on examination he appears
drowsy markedly dehydrated PR- 110 BP- 86/60mmhg RBS- 60mg/dL skin hyperpigmentation
a. Mostprobablediagnosis
b. Etiologyofprimaryandsecondarycauses
c. Howdoyoudifferentiatebetweenprimaryandsecondary?
d.Emergencytreatmentsteps? Totalmarks-15
20. A 40 year old female who is on long term OCP arrives at the emergency department
complaining of sudden onset chest pain and difficulty breathing . She recently had surgery for a
fractured neck of left femur after a RTA. On examination she is obese tachypnoeic , tachycardia,
and displays signs of respiratory distress in the form of an inability to complete a sentence in
single breath PR- 120/ BP- 90/40mmHg SpO2- 88%
a. Mostprobablediagnosis
b. X-rayECGandechofindings?
c. Emergencymanagementofthiscondition
d.ClassificationofPAH totalmarks-15
21. A 30 year old male with a history of gradually progressive generalized edema initially
noticed facial puffiness later developing into anasarca. The patient gave a history of fronting of
urine but no history of haematuria . On examination he has bilateral pitting pedal edema
BP-130/80mmHg and on urine routine examination showed 3+ protein .
a. Whatisthemostprobablediagnosis(1)
b. Howwillyouinvestigatethepatient(3)
c. Whatarethetypesofglomerulardiseasesthatcanhavesuchapresentation(2)
d. Describetheplanoftreatmentforsuchpatients(4)
22. 65 year old smoker presented with sudden onset breathlessness preceded with cough and
mucoid sputum . On examination he was seen to using accessory muscles of respiration with
barrel shaped and on auscultations had bilateral wheeze
a. Whatisthemost probablediagnosis(1)
b. Howwillyouinvestigatethepatient(3)
c. Describethemanagementofthepatient(4)
d. Whatarethecomplicationsthatcanoccurinsuchapatient?(2)
23. A 57 year old man came with a history of sudden onset of retrosternal pain of one day
duration. There was radiation of the chest pain to the left shoulder and left arm . There was
profuse sweating too. On examination he was restless, anxious, and afraid of death PR-112/min
BP- 90/70mmHg heart sounds were a muffled pulse occasionally turned irregular and unusually
fast which aggravated the hypotension . Thus he went into cardiogenic shock
a. Whatwasthemostprobablediagnosis?Whataretheriskfactorsforits
development?(2)
b. Whataretheunderlyingpathologicalprocesses?Whatarethedifferentstagesof
coronary artery heart diseases? (3)
c. Whicharetheimmediatechangesinheartsoundsandmurmursinthissituation?(1)
d. Whatinvestigationswillyoudotodisproveorprovethediagnosis?Mentiontheresults
also (3)
e. Whatarethefourimportantcomplicationsofthisacutepotentiallyfatal illness?(2)
f. Whicharethe4importantconditionsfromwhichthisillnesshastodifferentiate?(2)
g. Whatisthetreatmentthedrugdoseandcomplicationsoftreatment?(2)
24. A 45 year old man presented with a sudden onset of vomiting of a large quantity of blood on
several occasions . He was a chronic alcoholic patient consuming 500ml of rum everyday. On
examination he was pale and having moderate jaundice . Abdomen was distended and showed
moderate hepato-splenomegaly and presence of free fluid in the abdomen. He was also
confused and disoriented and stuporous.
a. What is the most likely medical emergency ? What precipitated it ?(2)
b. What is the primary liver disease in the patient ? What are its causes other than
alcoholism?(3)
c. How will you investigate the case? Mention the details of finding expected?(2)
d. Whataretheapproachesformanagement?Whatistheemergencytreatmentforupper
GI bleeding?(3)
e. Whataretheapproachesfortheemergencytreatmentavailablenow?Whatarethe
precautions to prevent coma?(2)
f. Whatarethecomplicationsyoumayexpectwhiletreatingthispatient?(3)
25. A 50 year old lady presented to OP with h/o slurring of speech and generalized weakness
for the past few weeks. Her symptoms increased after intake of macrolide for respiratory
infection. She also noticed drooping of her eye lid towards evening time . O/E her reflexes and
sensations are normal . What is the diagnosis? Differential diagnosis, pathophysiology of this
condition , clinical features , laboratory evaluations and management of this condition.
(2+2+2+3+2+4=15)

26. A 45 year old male from Nedumangad presented to casualty with C/ O fever and headache
for 1 week. He also noticed flushing of skin during initial days of fever and now noticed bleeding
from gums . O/E relative bradycardia , conjunctiva congestion and rash present. What is your
diagnosis ? DD of this condition WHO case definition of this condition , investigations,
management of this condition , complications.(2+2+3+2+4+2=15)

27.A 28 year old man recently returned from New Delhi presents with a history of fevers with
rigor only in the late evening hours. On examination, he has pallor and tender
hepatosplenomegaly . Answer the following questions
a. Whatistheprobablediagnosis?(1)
b. Whicharethemainspeciescausingthisillness?(1)
c. Drawandlabelthelifecycleofthisorganism(3)
d. Howwillyouconfirmthediagnosis?(3)
e. Howwillyoutreatthispatient?(4)
f. Writeabouttheprophylaxis(3)
28. Discuss the pathophysiology , clinical features , investigations and management of systemic
sclerosis. How will you advise a female patient on getting married and starting a
family(2+4+3+4+2=15)

29. 30 year old lady with a history of low grade fever and left sided chest pain for 3 weeks .
On examination she has mid pallor + no clubbing + tracheal shift to right side , decreased
respiratory movements ,stony dullness and absent breath sounds in the left axillary and
infrascapular region
a. Whatislikelydiagnosis-justify(2)
b. Howdoyouinvestigateandconfirmthediagnosis(5)
c. Explainthefeaturesseenineachoftheinvestigations(3)
d. Howtotreatthepatient(5)
30. A 60 year old male farmer was brought to the emergency room after taking an unknown
substance. On arrival he was sweating , salivation, urinary, fecal incontinence and constricted
pupil
a. Whatisyourprobablediagnosis(1+2+2+5+5)
b. Describethemechanismofactionofthetoxin
c. Discussregardingtheothersymptomsandsigns
d. Discussregardingintermediatesyndrome
31. A 30 year old lady diagnosed to have systemic lupus erythematosus
a. Discusstheinvestigationstoconfirmthediagnosis(5)
b. Differentiatebetweeninflammatoryandmechanicalcausesofjointpain(5)
c. Discuss2nonrheumatologicalmanifestationsofthiscondition(5)
32. A 30 year old man suffering with fever myalgia decreased output yellow discolouration of
his eyes and blood tinged sputum for the past three days
a. Discusstheinvestigationstoconfirmthediagnosis(5)
b. Discusstherelevantserologicalinvestigationsneededforthispatient(5)
c. Discussthepharmacologicaltreatmentforthiscondition(5)
33. A 25 year old patient comes with a fever of four days. . on examination he has BP = 100/70
mmHg PR=48/min rashes over the body. No lymphadenopathy no hepatosplenomegaly
platelet count= 90,000/m3. Hb =16gm% PCV= 50 SGOT/SGPT 116 and 92 respectively . SBd
1.1mg% US abdomen showed ascites . (2+2+4+4+3)
a. Whatisthemostprobablediagnosis?explainwithreasons
b. Nametwodifferentialdiagnosis
c. Howwillyouinvestigatethispatient
d. Whatarethecomplications
e. Howwillyoumanagethispatient?

34. A 60 year old patient is brought to the casualty with a history of having been found lying
unconscious with sweating o/e he has bradycardia , frothing from the mouth, constricted
pupils and fasciculations . On the way to the hospital he had repeated seizures (1+2+4+4+4)
a. Whatisthemostprobablediagnosis?
b. Name4causesfortheconstrictedpupil
c. Howwillyouinvestigatethepatient
d. Howwillyoumanagethepatient
35. A 70 year old man having hyperlipidemia present with inability to move his left hand and
leg for one day . He said that his left hand was weak in the morning and in the evening he
developed weakness of left leg. o/e vital signs were stable . No wasting of muscles. Spasticity
of the left upper and lower limb . Power grade IV on side. Brisk deep tendon reflexes on the
left side and up going planar on the left side. Other systems were normal
a. Whatisyourprobablediagnosis
b. Whereisthelesion
c. Howwillyouconfirmthediagnosis
d. Howwillyoutreatthiscondition

36. A 45 year old man presented with a history of coughing with productive mucoid sputum for
the last three months . He had similar problems during the last winter. o/e patients are
tachyopenic , have mild cyanosis , barrel shaped chast and liver dullness in the 8th intercoastal
space. Patient has bilateral polyphonic bronchi and scattered crepitations all over the lung field
a. Whatisyourprobablediagnosis
b. Whataretheprobablecausesforthiscondition
c. Howwillyouconfirmthediagnosis
d. Howwillyoutreatthiscondition
37. A 16 year old male came with complaints of fever , joint pain and swelling of the right knee
which started 7 days ago, after a few days knee pain subsided and the elbow was affected .
There is a history of sore throat 2 weeks ago . o/e there is relative tachycardia pansystolic
murmur in mitral area and ECG shows prolongation of PR interval
a. Whatisyourprobablediagnosis
b. Enumeratethediagnosticcriteriaforthiscondition
c. Howdoyouinvestigatethispatient
d. Whatarethecomplications
e. Howdoyoumanagethepatient
38. A 65 year old man who was a chronic smoker having a cough with expectoration and
breathlessness for most days for the last 10 years came to casualty with demand on both legs
for the last week . o/e JVP elevated left parastrenal heave bilateral rhonchi and crepitations and
tender hepatomegaly
a. Whatistheprobablediagnosis
b. Howwillyouinvestigatethispatient
c. Whatarethepossiblecomplications
d. Discussthemanagement
39. A 65 year old diabetic on insulin stopped medications from last one week and brought the
casualty unconscious . he had abdominal pain and vomiting two days back o/e drowsy ,
dehydrated PR=112/min BP 90/60 mmHg GRBS 685mg%
a. Whatisyourdifferentialdiagnosis
b. Describethepathogenesisofanyoneofyourdiagnosis
c. Discusstheclinicalfeaturesofyourdiagnosis
d. Howwillyoumanagethecase
e. Whatarethecomplicationsofprimarydiagnosis(2+3++3+5+2)
40. A 16 year old student was brought with h/o fever one week back she was found to have
purpuric spots over the shins Abdomen examinations no organomegaly made out Investigations
revealed PLC: 30000
a. Whatarethedifferentialdiagnosis
b. Howwillyouapproachacaseofbleeding
c. Mentiontheinvestigationsthispatientfurtherrequires
d. Howwillyoutreattheprobablediagnosis
e. Whatarethepossiblecomplications(2+3+3+4+3)
41. A 45 year old farmer was admitted for high grade fever for 5 days associated with headache
and bodyache. o/e he has icterus , conjunctival congestion and severe tenderness of calf
muscle
a. Whatisthemostprobablediagnosis
b. Listfourcausesoffeverandjaundiceinthetropics
c. Describethepathophysiologyofthisdisease
d. Outlinethelaboratoryteststobedoneandtheabnormalitiesexpected
e. Discussthemanagementofthisdisease
f. Outlinethecomplications
42. A 30 year old man is brought to Er with shortness of breath and dry cough for 15 days. On
examination he is tachypneic with diminished movements of chest wall on the right side and
stony dull percussion note on right infrascapular area
a. Whatisyourprobablediagnosis
b. Listthecommoncausesofthiscondition
c. Whataretheteststobedoneinthispatient
d. Explainthetreatmentmodalitiesbasedonthecommoncauses
e. Discussthecomplication
f. Describetheclinicalexaminationsfindingsexceptedinthispatient
43.a 36 year old truck driver presented with irregular fever of one month duration and weight
loss. Clinical examination showed generalized lymph node enlargements and oral thrush . he
gives h/o multiple sexual
a. Whatisyourprobablediagnosis?(2)
b. Listouteightsexuallytransmitteddiseases?(4)
c. What are the specific tests done in this patient to arrive at a diagnosis?(6)
d. Whataretheotheroralconditionsassociatedwiththisdiseaseotherthanoral
candidiasis? (3)
44. A 20 year old college student presented with menorrhagia and bleeding from gums. She
does not have any other constitutional symptoms or weight loss. Clinical examinations were
unremarkable. Her routine blood investigations showed Hb= 12.g/dl . TC 7800 DC P70 L26 M4
platelet count 36,000/cumm ESR 10mm/Hr . Her LFT/RFT were within normal limits peripheral
smear showed thrombocytopenia without any other abnormal cells
a. Whatisthemostprobablediagnosis(2)
b. List4conditionscausingthrombocytopeniaand4conditionscausingthrombocytosis(4)
c. Whatarethetreatmentoptionsforthiscondition(5)
45. A 46 year old male comes to OPD with complaints of white patch over his cheeks. o/e
hypopigmented lesions with absence of sensation and sweating over the lesion were noted . on
further examination patient had thickened peripheral nerves including facial and ulnar
nerves(1+2+4+4+4)
a. Whatistheprobablediagnosis
b. 4differentialdiagnosisforwhitepatchesoverface
c. Howwillyouinvestigatethispatient
d. Treatmentforabovecondition
e. Whatarethecomplicationsthispatientmaydevelop
46. A 38 year old man comes to ER with high fever chills and rigger vomiting headache and
altered sensorium neck stiffness for 2 days he is admitted with provisional diagnosis of acute
bacterial meningitis (3+3+3+3+3)
a. Whataretheclinicalsignsyoulookforinthispatient
b. Etiologyofmeningitis
c. Howwill[youevaluatethispatient
d. Howwillyoutreatthispatient
e. Possiblecomplications

47. A 19 year old boy presented with a two day history of high grade fever, retro orbital pain
and severe arthralgia particularly over low back. On examination he is febrile , conjunctiva
sufficed
and has generalized erythematous bleaching skin rash
a. Whatisthemostprobablediagnosisandrighttherelevanttesttoconfirmthe
diagnosis(5)
b. Whatarethelikelycomplicationsyouanticipate(5)
c. Whatarethedifferentialdiagnosisforthemaculopapularskinrash(5)
d. Discussthephysiologyofbodytemperatureregulation(5)
48. A 70 year male with a history of smoking for more than 20 years and type 2 DM since 30
years develops progressive cough and exertional dyspnoea over the 6 months . presently he is
dyspoeic even at rest . He also has intermittent cough , low grade fever , and blood stained
sputum for two weeks . History of weight loss of 7kgs also noted
a. Mentiontwoimportantdifferentialdiagnosis(1)
b. Whataretheclinicalfeatureswillyoulookforonexamination(2)
c. Howwillyouevaluatethispatient(2)
d. Discussthepathogenesis(2)
e. Outlinetreatmentandfollowup(3)
49. A young female of 28 years presents with multiple joint pains. Sha has a facial rash and
hair loss
a. Whatisyourprovisionaldiagnosis(3)
b. Enumeratethediagnosticcriteria(3)
c. Howwillyouinvestigatethepatient(3)
d. Mentionthedrugsusedinitstreatment(3)
50. A 25 year old woman presented with an insidious onset of gait ataxia of 6 months duration.
She is a strict vegetarian . o;e she had bilateral loss of ankle reflex(3+3+3+3+3)
a. Whatcouldbetheprobablediagnosis
b. Whatotherneurologicalmanifestationmaybepresentinthiscondition
c. Namethefeatureyoucanexpectingeneralexamination
d. Drawandlabelaperipheralsmearofthislady
e. Mentionstepsevaluatingthispatient

51. A 22 year old female presented with complaints of generalized tiredness and oral ulcers.
o/e she appeared pale was jaundiced febrile (99.67) spleen was palpable 2cmLCM
Hb;6.5 TLC:3200 PLC:96,000 T-Bilirubin-3.6 DCT-+++ urine albumin 2+ RBC - 15 -20
a. Completeclinicaldiagnosis(3)
b. Howdoyouapproachanemia(3)
c. Give4causesforanemiawithsplenomegaly(2)
d. Relevantinvestigations(4)
e. Howwillyoutreather(3)
52. 56 year old male k/c/ o T2DM and SHTN presented with complaints of fever , cough, and
breathing difficulty of one week duration . o/e was febrile looking toxic withHR 110/min BP
-90/mmhg SpO2 90%, ra ,RR32/min . air entry was decreased over the infra axillary and
infrascapular areas and stony dullness note on percussion over the areas
a. Completeclinicaldiagnosis(2)
b. Commonetiologicalagents(2)
c. Howwillyouassesstheseverityandhiscondition(2)
d. Relevantinvestigationsandapproach(4)
e. Howwillyoutreatthepatient(3)
f. Howcanyoupreventfutureepisodes(2)
53. 30 year old lady with a history of low grade fever and left sided chest pain for 3 weeks . on
examination she had mild pallor+ no clubbing, tracheal shift to right side decreased respiratory
movements stony dullness and absent breath sounds in left axillary and infra scapular
region(2+5+3+5)
a. Whatisthelikelydiagnosisjustify
b. Howdoyouinvestigateandconfirmthediagnosis
c. Explainfeaturesseenineachoftheinvestigations
d. Howtotreatthepatient
54. A 30 year old patient manual laborer presents with a history of fever and body pain for 7
days. He also has yellowish discoloration of urine and eyes andoliguria for 2 days . o/e ;the
patient is febrile , jaundiced and has petechiae, sub conjunctival hemorrhage and elevated JVP
a. Whatisthemost likelycompletediagnosis
b. Discusstheaetio-pathologensisofthiscondition
c. Whatarethecomplications
d. Whataretheinvestigationsfindingsexceptedinthispatient
e.Howwillyoumanagethispatient (2+3+2+3+5)
55. A 72 year male presented with complaints of lower back ache since months skeletal survey
revealed multiple punched out lesions on the skull and lab investigations revealed Hb 6g/dl EST
150mm/hr creatinine- 24mg/dl
a. Whatistheprobablediagnosis(2)
b. Clinicalfeatures(4)
c. Pathophysiological(4)
d. Management(5)

56. A 38 year old lady was brought to the emergency department with decreased mental status .
o/e she was hypothermic with pulse rate 52 bpm and BP- 76/40mmHg also, there was loss of
lateral third of eyebrows puffiness of hands and face
a. Whatistheprobablediagnosis(2)
b. Clinicalfeatures(4)
c. Investigations(4)
d. Treatment(5)
57.a 65 year old male presented with a history of fatigability, malaise , early satiety and
abdominal fullness for the last 1 month . no prior co morbidities . o/e pallor+ P/A massive
splenomegaly + CBC shows Tc-30,000 platelets - 7.2 lakhs Hb-8.2 peripheral blood smear-
shift to left with predominant neutrophils and presence of bands myelocytes metamyelocytes
promyelocytes and 2% blasts.
a. Whatistheprobablediagnosis
b. Whatarethedifferentialsforamassivesplenomegaly
c. Whatarethephasesinthenaturalhistoryofgivendisease
d. Whatarethecytogeneticandmolecularabnormalitiesseeninthispatient
e. What are the drugs and treatment options available for this patient (2+3+3+3+4)
58. A 42 year old man was brought to the casualty with high fever, chills and a rigor headache
altered sensorium for two days. o/e the patient was febrile irritable pulse rate :44
BP:170/100mmHg with signs of meningeal infections
a. Whatisyourprobablediagnosis(2)
b. Whatareyourdifferentialdiagnosis(2)
c. Whatotherphysicalfindingsyouwilllookinthispatienttosupportyourdiagnosis(3)
d. Brieflyoutlinetheethiopathogenesisofcondition(4)
e. Brieflyoutlinethemanagement(1)

59. What is acute coronary syndrome? How will you classify ACS ? describe the clinical
features , diagnosis , management and complication of STEMI (15)

60. A 64 year old woman diabetic and hypertensive came with fever, lower abdominal pain and
vomiting for the last 2days skipped the usual dose of insulin because of tiredness. Present
blood sugar is 516mg and bystander tells patient is breathless
a. Whatisyourprobablediagnosisanddescribethediabetesrelatedcomplications?
b. Whataretherelevantinvestigationstoconfirmthecondition
c. Howwillyoumanagethispatient
d. Whatarethediseasesprecipitatingthiscondition (3+4+5+3)

61. A 60 year old male presented with right side chest pain , cough and shortness of breath of
2 days duration o/e patient febrile tachycardia and tachypnoea with signs of consolidation on
right lower areas with stony dullness on percussion
a. Whatisyourprobablediagnosis
b. Howwillyouinvestigatethispatient
c. Howwillyoumanageandwhatarethecomplications
d. Whatarethedifferentialdiagnosiswhichmayleadtothiscondition(2+6+3+2)
62. A 20 year old male from Assam presented with high grade fever for the past 3 days.
Fever was associated with chills and rigors . There was a history of passing black
coloured urine. o/e there was pallor , icterus and hepatosplenomegaly . the total WBC
COUNT WAS 13,000/m3 urine analysis showed presence of hemoglobin
a. whatistheprobablediagnosis
b. Whatisthecausativeorganism?
c. Whataretheinvestigationstobedone
d. Howwillyoutreatthispatient
e. Whatarethecomplicationsofthiscondition(2+2+4+4+3)

63. A 32 year old female patient presented with rashes over the face , pain in the wrist and
ankle joints. She also had breathlessness from exertion on examination. There were
erythematous malar rashes ,pallor bilateral pedal edema . The breath sounds were absent in
the infrascapular areas. Her hemoglobin was 9gm/dl . urine routine examination showed
presence of albumin and 10-12 RBCS. serum creatinin was 2.4mg/dl and blood urea was
68mg/dl
a. Whatisthemostprobablediagnosis
b. Whatisthediagnosticcriteriaforthisdisease
c. Mentiontheinvestigationsforestablishingthediagnosis
d. Howwillyoutreatthispatient
e. Mentiontwoneurologicalmanifestationsofthisdisease(2+3+4+4+2)

64. A 35 year old female presented with fever malaise and weight loss o/e PT has oral ulcers
with alopecia pallor present. Symmetrical arthritis of large and small joints. No deformities
h/o abortion in the past
a. Whataretheprobablediagnosis
b. Whataretheneurologicalmanifestationsinthiscase
c. Investigationstobedone
d. Treatmenttobestarted
e. Twodrugswhichcanproducethisconditions(2+3+3+4+3)

65. A 52 year old male who is a chronic smoker has a cough with expectancy and comes to
the emergency dept . with weakness and swelling of legs since last one week
o/e tachypnoeic JVP is elevated andPt has a Rt ventricular third heart sound with tender
hepatomegaly
a. Whatisyourdiagnosis
b. Howareyougoingtoinvestigate
c. Discussthemanagement
d. Whatarethecomplications
e. Give 2 causes for unilateral non pitting pedal oedema (2+3+3+4+3)
Short essays

3. 19 year old unmarried girl is brought to casualty with history of suicidal ingestion of
around 20 paracetamol 500 mg tablets. C/E she looks very anxious, pulse 100 / m * t and
BP 100/6
* C mm of Hg. How will you manage her? If she seeks medial help too late, what
complications can she develop? How you will explain the gravity of the situation to her
parents?

4. 85 year old lonely widow is brought with history of chronic diarrhoea, memory less and
delirious behavicur. O/E she looks ill-nourished, has red scaly lesions around her neck and
spongy bleeding gums. What is your impression and mention the rationale. How will you
manage her problems. What is Hartnup's disease?

Discuss the etiology, clinical features and management of acute meningitis.

Discuss pathophysiology and management of chronic plaque psoriasis.

Write about the pathophysiology of bronchial asthma. Discuss the stepwise management.
approach to its (3 + 5 = 8)

5. Diagnosis and management of SLE

4. Causes and evaluation of exudative pleural effusion

5. Diagnosis and management of Dengue hemorrhagic feve

6. Paracetamoi poisoning

7. Evaluation ci acute dyspnea in casualty

1. Poly arteritis nodosa

2. Dengue fever

3. Pancytopenia

4. Addisons disease

5. Lichen planus

Short Essays

1. Acute Respiratory Distress Syndrome.

2. Lyme Disease

3. Nervous System and Eye involvement in HIV

4. Lung Abscess

5. Paracetamol Poisoning.

Short Essays (5x8=40)

3. Organophosphate poisoning

4. Neurological Manifestations of

HIV 5. Oral Anticoagulants

6. Lepra Reactions

7. Thyrotoxic Crisis

3 Non oral hormonal contraception

4 Surgical options for fibroid uterus

5. Tests of Ovulation

6 Abnormal Vaginal discharge - Causes, Describe any two &

management 7 Hysterosalpingography

3. Hydatid cyst liver

4. Chronic pancreatitis

5. Acute cholecystitis

6. Chronic duodenal ulcer

3. Acute complications of diabetes mellitus

4: Hodgkin lymphoma

5. Opportunistic infections in HIV

6. Rheumatoid Arthritis - clinical features, criteria and

management 7. Psoriasis
Precise Answers

12. NYHA classification of Dyspnoea.

13. Bell's phenomenon

14.2 clinical features of Sarcoidosis

15. Enumerate five symptoms of Hand Eczema

16. Two uses of Erythropoietin

17. Three causes of milky pleural fluid

18. Drugs used in MDR TB

19. Three Causes of hypopigmentation

20. Salient Features of Bulimia nervosa

21. Enumerate three Metabolic side effects of psychotropic

drugs. a) Angio neurotic edema

b) Larva migrans

c) Chlordiazepoxide

d) Gene therapy

e) Frothy urine

f) Constricted pupils and toxicology

g) Eschar

h) Hypertrophic pulmonary osteoarthropathy

i) Red cell cast

j) Bitot's Spot

Write briefly on (1x10)

a) Fixed drug eruption

b) Reversible

c) Scrub typhus

d) Leptospira ictero-hemorrhagica

e) Massive splenomegaly

f) Wet beriberi

g) Papillary Necrosis

Precise Answers

12. NYHA classification of Dyspnoea.

13. Bell's phenomenon

14.2 clinical features of Sarcoidosis

15. Enumerate five symptoms of Hand Eczema

16. Two uses of Erythropoietin

17. Three causes of milky pleural fluid

18. Drugs used in MDR TB

19. Three Causes of hypopigmentation

20. Salient Features of Bulimia nervosa

21. Enumerate three Metabolic side effects of psychotropic drugs.

Precise Answers

1 Choose two appropriate drues for management of obesity

(6x1-6)

2 Choose 2 blood investigations to exclude secondary causes for obesity

3 Choose the most specific test for diagnosing rheumatoid arthritis

4 Enumerate 4 causes for fever of Inknown Origin in an immune competent

person 5 Choose 2 drugs which are used in the prophylasts for opportunistic

infection in
Precise answers:

(1x10

12) Benzodiazepine poisoning

13) Anxiety disorder

14 Insulin analogue

5)Herpes zoster

16) Hypertrophic cardiomyopathy

17) Zollinger Ellison syndrome

18) Radiological features of mitral stenosis in chest x-

ray Modes of transmission of HIV

20) Management of psoriasis 21) Causes of delirium

IV PRECISE ANSWERS

1.Alcohol dependent syndrome management -

2. Hypopigmented anaesthetic patch 4 causes

3. Four causes of Hypoglycemia

4. Four causes of high anion gap metabolic acidosis 1

5. Lab findings in acute adrenal crisis-1

6. Four uses of PET Scan

7. Types of Psoriasis -1
8. Opportunistic infection in HIV with CD4<2501

9. Mood stabilizing agents-Name 4 with their side effects

10. Adult immunization- 4 diseases covered by it with vaccination

schedules 11. Drug of choice in anaphylaxis

12. Deline pyrvola of unknown origin [PLUO

13. Any four skin manifestations in lupus

14. What is WHO stage-1 HIV dicesse.

15. Clinical features of latent letary.

16. Fiest rank symptoms of acute schizophrenia

17.Mechanism of action of Rosuvastatin

18. Name four HLA-By, associated arthropathies.

19. List four endocrine manifestations of lung malignancy.

20.Which all serpent venom, doos ASV availatila in India neutralise?

21. What is aniphoric breathing? Give one condition as example

precise answer

1. Scrub typhus is caused by

2. In CURB65 scoring for pneumonia severity the alphabet C stands for

3. Causative organism of melioidosis is

4. Erythena chronicum migrans is a skin manifestation of

5. Pneumatocele is characteristically seen in pneumonia caused by

6. Malar rash is one of the diagnostic criteria for

7. Pre tibial myxedema is a feature of

8. Drug of choice for leptospirosis is

9. Multiple punched out lytic lesions in skull X-ray is a feature

of 10. Kaposi sarcoma is caused by virus.

Short Answers:

1. Lacunar infarct syndromes - neuroanatomy, clinical presentations, and

management.

2.Status epilepticus - definition, clinical features, and managernent

3.Acute Kidney Injury - definition, criteria, and investigations

4 .Hyponatremia - definition, classification, clinical features, investigations,

and management

5.ERCP

6. Dental Abscess

7. Umbilical fistula

8. How will you communicate the relative for the patient having gangrene big
toe (right)

9. Chocolate cyst ovary

10. Crypto menorrhoea

11. Postpartum sterilization

12. Vesicular mole diagnosed at 8 weeks of gestation- Management and follow

up

13. Non contraceptive benefits of combined oral contraceptive pills

14. Precocious puberty - definition

15. Define menopause

16. Two most common organisms causing acute PID

17. Method of insertion of CuT

18. Drugs used for medical abortion

19 . Drug used for medical management of ectopic

pregnancy 20. VIA expansion

21. Clinical features of Vitamin B-12 deficiency

22. .Cutaneous markers of Internal malignancy

23. Adjustment disorders

24. Method of Communicating Bad News to patient's

Relatives 25. PUVA therapy

26. Lung Abscess

27. Paracetamol Poisoning.

28. Dermatitis herpetiformis

29 . X-ray findings in Mitral Stenosis

30 . Risk factors for falls in an elderly

31. Primary Sjogren's Syndrome

32. Schizophrenia

33. Obsessive compulsive disorder

34. Hand X-ray findings in rheumatoid arthritis

35. Bronchiectasis

36. Multiple organ dysfunction syndrome

37. Extra articular manifestations of rheumatoid arthritis

38. Diagnosis and managerment of psoriasis

39. Evaluation of acute delirium

40 .Cutaneous manifestations of nutritional
deficiencies

41 . Risk factors and diagnosis of delirium.

42. Aetio-pathogenesis and management of sepsis.

43 . Clinical features and management in

organophosphate poisoning.

5. Extra-articular rnanifestations in rheumatoid

arthritis.
LONG ESSAYS : ob-gyn

1.Mrs. X 28 year old presented with fever after having delivered 5 days ago at local
hospital, shows feeling ill had lower abdominal pain with foul smelling lochia
a. Whatisyourdiagnosis(2)
b. Howwillyouascertainthecauseofthefever(4)
c. Whatisthemostlikelycause.why?(2)
d. Whatisthemanagement(3)
a. Whatarethedifferentialdiagnosis(3)
b. Whatarethesupportsofuterus(3)
c. Differentclassificationofprolapse(3)
d. Describethemajorstepsofvaginalhysterectomyandlist4complicationsofvaginal
hysterectomy (6)

8. A 45 year old lady P2L2 LCB=15 reported to OPD with complains of heavy menstrual
bleeding since 1 year. She complains of fatigue and excessive tiredness (GMC KOTTAYAM)
a. Whatisyourdifferentialdiagnosis(3)
b. DescribetheFIGOclassificationofAUB(3)
c. Mentionfewmechanismbywhichfibridcausesinfertility(3)
d. Outline the investigations and management of 18 weeks fibriod uterus (6)

9. A 24 year primi at 10 weeks gestation coming with bleeding per vagium (GMC
KOTTAYAM) a. Whatarethedifferentialdiagnosis(3)
b. Relevantinvestigationsofthecase(3)
c. Whatarethedifferenttreatmentoptionsforectopicpregnancy(3)
d. What are the indications and drugs and monitoring in medica management of ectopic
pregnancy (6)

10. A second gravida at 34 weeks of gestation came to the OPD with increased fatigability
and palpitation(GMC KOTTAYAM)
a. Whatidyourdifferentialdiagnosis(3)
b. Howdoyouevaluatethiscase(4)
c. Whatarecausesofanemiainpregnancy(3)
d. How do you manage a case of iron deficiency anemia at 34 weeks of gestations (5)

11. 22 year old primigravida at 39 weeks gestation admitted for safe confinement o/e for
height is 140cm(KMCT)
PA- abdomen pendulous and head is mobile
a. Whatisyourdiagnosis(1)
b. Whatisthebishop’sscoreanditssignificance(3)
c. DiscussthemethodsofdiagnosisofCPD(4)
d. Discusstheanatomyoffemalepelvis(3)
e. Discussthetrialoflabour(4)

12. 30 year old G4P3L3 with previous 3 FTND admitted at 36 weeks of gestation with
bleeding PV o/e uterus 34-36 weeks non tense and non tender head mobile FHR- present
(KMCT)
a. Whatisyourdiagnosis(1)
b. DiscussthecauseofAPH(4)
c. Howwillyouevaluatethepatient(4)
d. Explainthecomplications(2)
e. Discussthemanagement(4)

13. 36 year old P1L1 lady presented with heavy menstrual bleeding of 3 months duration
o/e pallor + p/a firm mass of 20 weeks gravid uterus (KMCT)
a. Whatistheprobablediagnosis(1)
b. Discusstheexaminationfindingsindetail(3)
c. Whataretheinvestigationsyousuggest(3)
d. WhatistheFIGOclassification(3)
e. Discussthemodalitiesofmanagement(5)

14. 60 year old obese hypertensive and diabetic lady presented with postmenopausal
bleeding.(KMCT)
a. Whatisyourprovisionaldiagnosis(1)
b. Riskfactorsforabovecondition(2)
c. Whatarethecausesofpostmenopausalbleeding(4)
d. Howwillyouevaluatethepatient(4)
e. Discussthemanagement(4)

15.A 26 years old G2P1L1 with 34 weeks of gestation presenting with painless bleeding
PV. Answer the following:
What is the diagnosis.
What are the maternal complications
Mention the investigation to be done
Describe the management (1+2+3+4=10)

16.Define induction of labour. Enumerate the pre-induction criteria, indications and

complications. (1+3+3+3=1)

17.Define normal delivery. Draw partogram to depict the events of normal labour and its
significance. (1+4+5=10)

18. A 25 years primigravida with 34 week gestation with H/O easy fatiguability, giddiness,
breathlessness, swelling of limbs. O/ E severe pallor, pedal oedema, raised JVP. Answer
the following.
What is the diagnosis What are the maternal complications.
Investigations to be done Describe the management. (1+2+3+4=10)

19.A 35 years old parous sterilized woman comes with profuse bleeding per vaginum
during periods for the past six months and on examination uterus is 14 weak size. Answer
the following :
• What is the most probable diagnosis.
• What are the differential diagnosis
• How do you evaluate
• What are the different management options (1+3+3+3=10)

20.A 62 years old woman comes with post-menopausal spotting and whitish discharge pv.
Answer the following:
• What is the differential diagnosis
• What are the investigations
• Management options (3+3+4=10)

21.What is fibroid uterus. Discuss its etiology, clinical features and management
(1+3+3+3=10)

22.Define and classify AUB and mention brief pathology of AUB. Differential diagnosis for
pubertal AUB and outline its management. (1+3+3+3=10)

23. 25-year-old primigravida at 36 weeks reported to casualty with generalised tonic

clonic seizures. O/E, patient is disoriented, BP-180/110 mm Hg. No previous h/o seizures.

A) What can be the diagnosis?

B] How will you investigate and manage this patient?
C) HELLP syndrome.(1+4+6+4)Mt. Zion

24. 30-year-old G5P4L4 at 36 weeks presented to casualty in labour. O/E, pallor +++,
P/A- uterus 34 weeks, 2-3 contractions are present in 10 minutes. Her Hb was 5 g%.

A] Classify anaemia in pregnancy.

B) How will you manage this case? What are the relevant investigations to be sent?
C) Maternal and foetal complications of anaemia.
D] Name 2 parenteral iron preparations.
E) Formula for calculating total iron dose required for correction in anaemia.
(1+4+6+4+3+6+3+1+2)Mt. Zion

25.A 75-year-old P2L2 presents with post-menopausal bleeding. Per speculum

examination reveals a cauliflower growth on her cervix.
A) Lymphatic drainage of cervix.
B) Risk factors of Ca cervix,
C) Screening of Ca cervix.
D) Staging of Ca cervix.
(2+3+5+5)Mt. Zion

26. 28-year-old P2L2 comes to you with C/O heavy menstrual bleeding and heaviness in
lower abdomen. O/E, P/A-uterus irregularly enlarged to 20 weeks, with USG confirming
diagnosis of leiomyoma.
A) FIGO classification of fibroids
B] Prerequisites for myomectomy.
C) Complications of hysterectomy.
D) Medical management of AUB-L.
(3+5+3+4) Mt. Zion

27.Mrs. M, para1 living1 referred from primary health centre for PPH following full term
vaginal delivery.
a) Define PPH
b) Enumerate causes for PPH
c) Diagnosis and management of atonic PPH (2+3+5)

28.27 years old pregnant woman has NYHA class II cardiac disease. Answer the following:
NYHA classification of cardiac disease in pregnancy and what is class II.
What is the antenatal management
How will you conduct the delivery
What contraceptive advice to be given

29.Define and classify postpartum hemorrhage. Mention the causes of the same. Discuss
the
diagnosis and management of a 6th gravida profusely bleeding after a normal delivery.
(3+3+4)

30.Mention the indications for caesarean section. How to select women for vaginal
delivery after caesarian section. How to monitor women with previous caesarian in
labour. Management of labour including complications in Vaginal Birth After Caesarian
sections
(2+3+2+3)

31.. 20 years old primigravida with newly detected hypertension at 35 weeks of gestation
complains of headache and epigastric pain. Answer the following:
What is the classification of hypertensive disorders in pregnancy
What are the investigations to be done
Describe the management of eclampsia. (3+3+4)

32.A 28 years old multiparous woman comes with three months of amenorrhea with
history of previous three abortions in first trimester. Answer the following:
What is the diagnosis.
What are the causes of first trimester abortions
Mention the investigations to be done
Describe the management (1+2+3+4)

33. 30 years old G4 P3 L3 at 20 weeks of gestation at regular antenatal care found to

have HB:6 gm%. Answer the following:
What is the most common cause for the anemia
List the types of anemia
Diagnosis of causes of anemia in pregnancy
Management of this patient (1+3+2+4)

34.Define normal delivery. Enumerate the abnormalities that can occur in each stage of
labour.

35.Define postpartum hemorrhage and mention its causes. What are the pre-existing risk
factors for PPH. Discuss the management of PPH after vaginal delivery. Mention the
active management of 3rd stage of labour. (2+2+4+2)

36.A 30 years old G5 P4 L4 with history of 8 months amenorrhea with bleeding PV with
pain abdomen. On examination, BP-150/100mm Hg, Uterus is tense & tender, FHR
absent. Answer the following:
• What is the diagnosis • Mention investigations to be done
• Maternal complications • Management in detail (1+2+3+4)
37.. 28 years multigravida comes with severe pallor, weakness and easy fatiguability.
Answer
the following:
What is the differential diagnosis
What are the investigations to be done
Describe the line of management. (3+3+4)

38.. A 26 years old primigravida woman comes with the antepartum hemorrhage at 33
weeks
of gestation. Answer the following:
What are differential diagnosis
What are investigations to be done
Describe the mode of management of one of them. (3+3+4=10)

39. A 25 years primigravida with 34 week gestation with H/O easy fatiguability, giddiness,
breathlessness, swelling of limbs. O/ E severe pallor, pedal oedema, raised JVP. Answer
the following.
What is the diagnosis What are the maternal complications.
Investigations to be done Describe the management. (1+2+3+4=1)

40. A 35 years old woman presents with mass abdomen. Answer the following
a) What are the differential diagnosis
b) Classify ovarian tumours
c) Complications of ovarian tumours
d) Management of ovarian cyst in a young nulliparous woman (3+2+2+3)

41.A 60 years old woman presents with mass per vagina which comes out on straining and
also difficulty in micturition. Answer the following:
What is the most probable diagnosis
What are the complications.
Investigations to be done
Describe the management. (1+2+3+4)

42.A 42 years old woman presents with heavy menstrual bleeding with pallor. Answer the
following:
What are the differential diagnosis.
Classification of abnormal uterine bleeding
Management of Dysfunctional Uterine Bleeding
Complications of abdominal hysterectomy (2+3+3+2)

43.30 years old married for 5 years with primary infertility and menstrual cycles every 2-3
months. Answer the following:
What is the main cause for her infertility
Mention female factors causing infertility
Evaluation and management of anovulation (1+4+5)

44.Discuss the stages of carcinoma cervix, its symptoms, signs and its differential
diagnosis. Add a note on its treatment options. (3+3+2+2)
45.What are the clinical features of polycystic ovarian syndrome. What are the
investigations useful for the diagnosis of PCOD. Treatment options for anovulatory
infertility in PCOD.
(3+4+3)

46.45 years old P1 L1 with prolonged bleeding was diagnosed as abnormal uterine
bleeding by her gynecologist. Answer the following:
Define and classify abnormal uterine bleeding (AUB)
Differential diagnosis for heavy menstrual bleeding and management of the same.(4+6)

47.A 45 years old woman presents with history of menorrhagia since 2 years and on
examination there is 20 weeks size uterus. Answer the following:
What is the diagnosis
What are the complications.
Investigations to be done
Describe the management. (1+2+3+4)

48. A 52 years female, Para 4 living 4 with all vaginal deliveries, came with complaints of
something coming out of vagina for 8 months and increased frequency of micturition for
two months. Answer the following:
What is the etiology of it
Describe supports of uterus.
Management of the condition. (3+3+4)

49.A 68 years old woman presents with mass per vagina. Answer the following:
What are the differential diagnosis.
Classification of prolapse
Describe the method of mayo ward repair
List the complications of vaginal hysterectomy (2+2+3+3)

50. A 40 years old woman presents with menorrhagia and heaviness in lower abdomen for
one year with USG suggestive of fundal fibroid. Answer the following:
What are the investigations to be done
Describe the mode of management of fundal fibroid.
What are the complications of fibroids (3+4+3)

51.75 years old woman presents with abdominal distension and on examination there is a
mass in the abdomen and shifting dullness. Answer the following:
• What are the differential diagnosis.
• What are the investigations.
• What is the management.
• What are the prognostic factors. (3+3+3+1)

52. A 28 years old woman is found to have a haemoglobin level of 8 grams % in her second
trimester of pregnancy. Answer the following
a) What are the investigations you would do
b) How do you treat iron deficiency anemia in second trimester of pregnancy
c) Management of labour in severe anemia
d) Rationale of routine iron supplementation in pregnancy (2+3+3+2)

53.A 15year old girl c/o continuous bleeding P/V x 15 days following amenorrhoea for
4 months. Menarche 12 years. Previous cycles regular

a. What is your diagnosis (1)

b. Write down aetiological classification of abnormal uterine bleeding (3)

c. What investigations you will do to confirm your diagnosis(3)

d. How will you manage this case(3)

54.A 38 year parous woman presents with secondary dysmenorrhoea and dyspareunia. O/E
There is a mass of size 14 weeks pregnant uterus. P/V examination shows tender fornices
and forniceal fullness

a) Write 4 differential diagnosis?(4)

b)How will you investigate? (2)
c)How will you manage a case of endometriosis medically(4)

55. A 40 year old lady c/o blood stained purulent discharge P/V, Irregular foul smelling
bleeding and post coital bleeding p/v
a) What is your first diagnosis(1)
b) How will you stage this disease(2)
c) How will you manage early stage of this disease (3)
SHORT ESSAYS

1) Investigational management of endometrial hyperplasia.

2)Causes of female infertility

3)Define menopause.Briefly explainfew menopausal

symptoms 4)Screening methods in cervical cancer

5) Clinical features and management of acute PID

6)24yr old primi with strong family h/o diabetes came to OP. How will you investigate for
GDM? What are the maternal & fetal complications in uncontrolled GDM

7) 20 yr old primi gravida at 32 weeks of Gestation came to OP with c/o head ache. O/E her BP
is 140/92 mmHg. What is your provisional diagnosis? What are the investigation to be done
How will you manage?

8) Primi gravida at 8 weeks of pregnancy coming to OPD for the 1" time. What are the
investigations you advice? What are the minor ailments in pregnancy? How will you counsel
her?

9)30yr old Primi at 20 weeks of pregnancy. She is a known case of RHD, What is NYHA
classification? How will you manage a case of critical MS in pregnancy?

10)G4P1L1A2 with 6 weeks amenorrhoea, abdominal pain, bleeding p/v and h/o fainting
attack. What is the differential diagnosis
How will you confirm the diagnosis?
How will you manage an unruptured ectopic.

11)Non oral hormonal contraception

12)Tests of Ovulation

13)Abnormal Vaginal discharge - Causes, Describe any two &

management 14)Hysterosalpingography

PROBLEM SOLVING
15)A 26 years G,PL, with a previous normal vaginal delivery, currently at 34 weeks, presents
to the casualty with C/O bleeding per vaginum. O/E, pallor +, BP-120/78 mm Hg. P/A-uterus
34 weeks, relaxed and fetal heart sound is regular and around 140 bpm.
A] How will you manage this patient?
B]Enumerate the differences between placenta previa and abruption.

16)A 35-year primigravida at 28 weeks comes to you with diagnosed polyhydramnios. O/E-
P/A - uterus 32 weeks, relaxed and fetal heart sound is regular and around 148 bpm. Her
OGTT reports are 108/240/160 mg/dl at fasting, 1 hour and 2 hours respectively.
A] How will you counsel this patient?
B]How will you manage this case?

17)34 year G,P,L,A, at 38 weeks and 5 days presented to the labour room in active labour.
After you conduct her delivery, you notice excessive bleeding per vaginum and that the uterus
is
flabby on per abdominal palpation. O/E-pallor ++, PR-110 bpm and BP-100/60 mm Hg.
A] What are the predisposing factors for atonic PPH.
B] How will you manage this case?

18)Mrs X', P₁L, presents on postnatal day 5 with C/O fever and foul-smelling discharge per
vaginum. (2)
A] Define puerperal pyrexia.
B]What relevant investigation will you do? How will you manage this case?

19)A 32 years G,P,L, with previous two cesarean deliveries, currently at 36 weeks, presents
to the casualty with C/O severe lower abdominal pain. O/E, PR-120 bpm. P/A-uterus 36
weeks, cephalic and foetal heart sound is around 180 bpm, scar tenderness +.
A]What are the signs of scar rupture?
B] Enumerate common indications for cesarean delivery.
C] Enumerate some complications of LSCS.

PROBLEM SOLVING

20)A 65 years P_{2}L_{2} presents to the OPD with C/O mass descending per vagina, O/E, she
is found to have grade 3 UV prolapse with cystocele and a decubitus ulcer.
A]Delancey's levels of support.
B] Urinary and bowel symptoms associated with prolapse.
C]Management of decubitus ulcer.

21)A newly married couple comes to the family planning OPD for contraceptive advice. How
will you counsel the couple regarding the available options? (8)

22)An 18-year unmarried girl presents to the OPD with C/O irregular cycles and facial hair
growth.
A]Diagnostic criteria of PCOS.
B]How will you counsel and manage the patient?

23)26-year married woman with h/o 2 months amenorrhoea presents to the OPD with
complaints of passage of grape like vesicles and bleeding per vaginum.
A] Signs and symptoms of hydatidiform mole.
B] Differentiate between complete and partial mole?

24)A 52 years P₁L, presents to you with C/O dyspepsia, abdominal distension and loss of weight
since the last three months. O/E,P/A, abdomen distended with an abdominopelvic mass with
heterogenous consistency and size of about 28 weeks. Ascites is present.
A]Tumour markers of Ca ovary.
B]Steps of staging laparotomy.

25)30 yr G3P212 at 28 weeks with a 2hr GTT (75gm glucose) of 200mg/dl. How will you
counsel and manage the patient?

26)19 year old primi gravida presented at 36 week with seizure. On examination her BP
is 160/110mmHg. How will you manage her?

27) 34 yr old G4P313 at 34 weeks gestation present with tiredness, easy fatigability,
breathlessness. On Examination severe pallor +. How will you investigate & manage her?

28)What is induction of labour? What are the methods of induction of labour? Write the
indications & complications of the same?

29)Write the management of post partum hemorrhage?

30.POP-Q classification of prolapse

31. Bacterial vaginosis
32. Female sterilization techniques
33. Hyperemesisgravidarum
34. Secondary post partum hemorrhage
35. Down's syndrome

36. Methods of termination of pregnancy in second trimester.

37. Cord prolapse.

38. Management of HIV positive women in pregnancy and labour

39.Management of accidental hemorrhage.

40. Parentral iron therapy in moderate degree anemia in early third

trimester 41. Management of Hbsag positive women in labour.

42. What are the obstetric factors leading to prolapse

43. What are the indications for IVF

44. What are the causes of genitourinary fistula

45. Polycystic ovarian syndrome

46. Medical management of endometriosis

47.Intra uterine insemination

48. Anatomy and physiology of fallopian tube with its surgical

application. 49. Turner's syndrome.

50. Theories of endometriosis.

51. Deep Transverse Arrest

52. Diagnosis and management of cervical incompetence

53. HELLP Syndrome

54.VBAC

55.USG in Obstetrics

56.Induction of labour

57.IUCD

58.Medical termination of pregnancy

59 Hysteroscopy

60.PROM and It's management.

61.Third stage Complications.

62.Diagnosis and Management of GDM

63.Bacterial vaginosis

64. Vaginal elongation of cervix

65. Choclate cyst

66.21 year old primi at 32 weeks of gestation on routine investigations, her Hb was found to
be 8gm%

a. How do you evaluate her?

b. How do you manage a case of Iron deficiency anemia in pregnancy?

67. Shoulder dystocia drill

68. Define GDM. How do you screen for GDM? Antepartum management of case of GDM.

69. Cardio vascular changes in pregnancy

70. Prenatal screening

71.Abruptio placenta

72.Hyperemesis gravidarum

73. Neonatal resuscitation

74. Causes of Acute pain abdomen in pregnancy

75. A 30 year old Primigravida with 26 weeks presents with OGTT level of 160ing / d * L

How will you caunsel and manage this patient a case of Grade II NYHA

76. A Primigravida with 28 weeks of pregnancy Comes with c / O Breathlessness on slight

activity, nocturnal cough. How will you manage this patient

77. A Primigravida weeks of pregnancy comes to OPD with 1 episode high recording of BP *
150/90 mmHg
How will you manage this patient

78. What is hyperemesis gravidarum. What are the causes. How will you manage this condition

79. Pelvic floor

80. Methods of prenatal Diagnosis

81. What are the complications of preeclampsia? How do you manage a case of eclampsia?.

82. What is CPD? Diagnosis and Management.

83. Caesarian Section- Types, indication and procedure

84. Primi gravida at 37 weeks of pregnancy coming with a BP of 150/100mm Hg and

convulsion of tonic clonic nature. Diagnosis and management of the same.

85. Define GDM. Why is pregnancy called a diabeteogenic state? Describe the complications of
diabetes in pregnancy.

86. What is IUGR and how is it classified. What are the causes? How do you make a diagnosis
of the same and write the management of severe IUGR at 36weeks pregnancy.

87. Define caesarean section. What are the types. What are the indications for CS. What is the
management of a second gravida at term with a previous C S done for fetal distress?

88. A primi gravida with gestational age 38 weeks 5 days has a mobile head or grip. She is 142
cm of Height. What are the causes. How will you manage a case of first degree CPD.

89 .A 26 year old primi gravida with 2 months amenorrhoea coming to casualty with bleeding
per vagium. Her urine pregnancy test is positive. Write about the differential diagnosis?How
will you investigate and manage a case of missed

abortion?(8)
90. A 32 year old G2P1L1 presenting with 28 weeks pregnancy with 75 gm GTT value of
150mg / d * l Outline the management of gestational diabetes. (8)

91.How do you select cases for TOLAC(trial of labour after caesarean) What are the risks
involved in TOLAC?(8)

92.A 24 year old G2P1L1 presenting with USS findings at 11 weeks showing
monochorionic twins? What are the foetal complications anticipated in this

pregnancy.(8)
93.What is the management of a primigravida at 32 weeks of gestation presenting with
preterm premature rupture of memberanes? (8)

94. Distinguish between caput succedaneum& cephal haematoma

Screening for GDM

95. Now stress test(NST)

96. Physiology of lactation

97. Missed Abortion

98Anemia with pregnancy-

a) causes

b) Evaluation and management at 32 weeks

c) Screening and management of GDM 32 weeks 4

99.Types of Maternal pelvis and common presentation in each.

100.Ante partum fetal surveillance

101.Define complications of 3 ^ prime4 stage of labour

102.Enumerate the important objectives of good ANC care. what do you understand by high
risk pregnancy and what are the clinical methods / by which you will recognize them during
ANC?

103. What are common causes of Anemia during pregnancy? How will you evaluate a pregnant
women for Iron deficiency Anemia and Enumerate the indications for blood transfusion/
PRBC?

104.What are the complications of Diabetes in pregnancy & during labour? What are the
precipitating factors for ketoacidosis and outline your management protocol.

105.. What is ASB? What are the predisposing factors for Pyelonephritis in pregnancy? Give an
outline of management of a case of pyelonephritis in pregnancy. Enumerate the complications.
106.What is RPL? Enumerate the causes of RPL? How will you manage a case of Cervical
Incompetance based on Obstetric History?

107. A 28 year old primigravida with critical mitral valve stenosis presents to the OPD with
shortness of breath at 8 wks of gestation. What is the possible line of management and how
will you counsel her?

108.A 34 year old G2P1L1 presents to the OPD with polyhydramnios. Her blood sugar fasting
is 146mg / d * l and post prandial 243mg / d * l How will you counsel and manage this patient?

109. 19 year old primigravida presents to the OPD at 34 wks pregnancy with BP 140/94
mmHg. She was normotensive previously. Her BP was rechecked and found to be the same.
What is you provisional diagnosis. How will you investigate and manage her?

110. What is hyper emesis gravidarum .Name any two causes? How do you manage this
condition?

111.What are the different types of twins? What are the complications specific monochorionic
twins? Explain in detail about TTTS
1.Causes for increased perinatal mortality in severe preeclampsia.

2. Caesarean hysterectomy.

3. Acute inversion of uterus.

4 Apgar score and its importance.

5. Vaccum extraction.

6.Carbohydrate metabolism in pregnancy

7. Anencephaly

8. Puerperal sepsis

9.Role of prostaglandins in obstetrics

10.Neonatal jaundice

11.Ressucitation of newborn.

12. Maternal mortality.

13.Sudden post partum collapse.

14.Misoprostol.

15. Techniques of delivering after coming head in breech

16.Complications of Ovarian cyst

17. Hysterosalpingogram

18. Emergency contraception

19. MTP act

20. Bacterial vaginosis

21.PPTCT-Expand

22. Chance of rupture of lower segment caesarean scar in labour

is 23. Extra calorie needed in pregnancy and Lactation is

24. Method used for delivery of placenta

25. Name 2 complications of abruptio placenta

26. Name 1 manoeuvre used in delivery of after coming head in breech

27. Name one condition where forceps is preferred over vacuum

28. Robisons classification used for the classification of

Befine maternal mortality ratio.

29. Pawlick's grip.

30.Degrees of moulding

31. What are the 4 characteristics of reactive Non Stress Test?

32. Expand TOLAC Define abortion,

33.Define preterm labour

34.Which drug used in treatment of atonic PPH is contraindicated in patients with

heart disease complicating pregnancy?

35.Retained placenta

36.Asymptomatic bacteruria

37. External cephalic version

38. Active management of third stage of labour

39. Prostaglandins in pregnancy-uses and contraindications

40. Mac Roberts Manoeuvre

41. Bishops score-components

42. Define inevitable abortion

43. Signs of placental separation

44. Diagonal conjugate

45. What is moulding

46. Jhonson's formula

47. What is CRL

48. Variable decceleration

49.Types of twins

50.Causes of foetal growth retardation

51.Differences between cephal hematoma and caput

succedaneum(4) 52.Causes of puerperal pyrexia(4)

53.Schedule of antenatal visits(4)

54) Non stress test (4)

55.The smallest diameter of true pelvis

56. The shortest transverse diameter of foetal skull

57. Four causes of oligohydramnios

58.NIPT-expand the term

59) Define grand multipara.

60. Define proteinuria in pregnancy

61.Name one compression suture put in the uterus in post partum hemorrhage.

62) Name one ultrasound feature suggestive of dichorionic

63.Functions of Placenta

64. Etiopathophysiology of pereclampsia

65. Screening for Gestational Diabetes Mellitus

66. Non invasive method of Prenatal testing

67. Physiology of lactation

Short Answers

68. Respectful maternity care

(5x4 20 marks)

69. Episiotomy
70. Meconium aspiration syndrome

71. Antenatal corticosteroids

72. What is medical negligence? How can effective communication between

healthcare providers and patients reduce the risk of medical negligence?
One word answers: 1 mark each

1.Maternal mortality ratio

2.Twin peak sign is characteristic US finding in
3.Manoeuvre to correct shoulder dystocia
4.Post term pregnancy

5.Frequent and painful contractions at 36 weeks.

6.Compression of head posteriorly on type II posterior placenta.
7.Routinely used method of delivery of placenta.
8.Type of delivery in occipito-posterior position.

9.One twin disappears in subsequent scan in second trimester.

10.In interlocking of twins first twin sacrificed to delivery of second twin.
11.Embryonic demise within 6 weeks of conception.
12.Death of fetus from 28 weeks to one week after delivery .

13.MMR(Maternal Mortality Rate)

14.Puerperium is upto ______ weeks
15.McDonald’s stitch is used in _____ condition
16.Implantation of placenta in lower uterine segment is ______

17.Drug of choice in post-menopausal woman with osteoporosis

18.Types of ectopic pregnancy
19.Meig’s syndrome
20.Wandering or parasitic fibroid

21.Malignant form of fibroid uterus

22.Commonest mode of spread of ca-cervix
23.Commonest tumor felt in the anterior fornix
24.Latest classification in degrees of prolapse uterus

25.Red degeneration of fibroid is common in

26.Corpus cancer syndrome
27.Drug of choice in a postmenopausal woman with osteoporosis
28.Strawberry appearance on cervix is the characteristic of

29.Ovulation of graffian follicle without rupture.

30.Decreased sperm count in a semen sample
31.Commonest cause of death in carcinoma cervix.
32.Characteristic microscopic finding in bacterial vaginosis.

33.Characteristic sonological feature of molar pregnancy

34.Pathological retraction ring seen in obstructed labour
35.Condition when chorionic villi of the placenta penetrates the myometrium up to the
serosal layer
36.-------------- denote types of placentation in twin pregnancy

37.Write any one indication for classical caesarean section

38.What is the indication for Antenatal Corticosteroid
39.Write the name of the outlet forceps
40.Name the antiretroviral drug used in the newborn of an HIV positive mother.
Draw and label:

41.USG, for calculation of gestational age is most accurate if done at ……………..

42.Which type of presentation with meconium stained liquor is not an indicator of fetal
distress.
43.Perinatal mortality rate in India is about .............
44.Pathological demarcation between upper segment and lower segment of uterus is called
………………..
45.Medication given to the mother for fetal lung maturity
46.Popular male contraceptive
47.Malignant form of hydatidiform mole
48.Common form of anemia in pregnancy according to peripheral smear
50.Name the depression between upper and lower halves of uterus in an obstructed labor
51.Expand – ‘TOLAC’
52.Name the type of deceleration seen with cord compression in labor
53.Name the drug used to prevent respiratory distress syndrome in preterm labor
54.Denominator in face presentation
55.Active management of labour will help to reduce ………………….
56.Use of forceps to cut short the second stage of labour in cardiac disease.
57.Infrequent painless contractions of uterus during pregnancy.
58.What is the full form of TOLAC.
59.Labor monitoring is done using ……………………
60.Forceps used for after coming head.
61.Most common technique for abdominal tubectomy.

62.Device for doing endometrial sampling

63.Expand SERM, SPRM
64. Two complication of ovarian cyst
65.Criteria for diagnosis of PCOS-name
66.Most common technique for abdominal tubectomy.

67.Labour process starting before 37 weeks of gestation

68.Total of last trimester fetal demises, intra partum fetal deaths and infant deaths up to 7
days postpartum
69.Pelvis compressed from three directions in rickets
70.Intermittent lower abdominal pain in pregnancy without cervical changes

71.Name the most common non-lethal aneuploidy resulting in significant mental disability in
children
72.Name the “uterine compression suture” used to control uterine atony after delivery
73.Name the correct place where the vacuum suction cup is applied for efficient delivery of
the fetal head
74.Normal dose of anti-D immunoglobin after a term delivery of a Rh positive new born to a
Rh negative mother.

75.Measurement of uterine contraction is -

76.Incidence of breech presentation at term is -
77.Diameter For Diagnosis Of Midpelvic Contraction.
78.Calorie intake for normal pregnancy.
79.USG measurement to diagnose IUGR
80.Perinatal mortality rate
81.NT scan is done at ____ weeks
82.Jacquemier’s sign
83. Post-partum uterus becomes a pelvic organ at how many weeks
84. Most common cause of abortion in first trimester of pregnancy
85. The compression sutures for atonic PPH is called ------------
86. Most common heart disease in pregnancy.
87. Age of elderly primi
88. Naegle formula is to calculate
89. Commonest indication for caesarean delivery is
90. What is the full form of ECV
91. MMR(Maternal Mortality Rate)
92. Peurperium is upto ______ weeks
93. McDonald’s stitch is used in _____ condition
94. Implantation of placenta in lower uterine segment is ______
95.Gold standard for diagnosing endometriosis
96.Area between old and new squamocolumnar junction in cervix
97.Image guided minimally invasive procedure in treatment of fibroid uterus
98.Triad of obesity, high blood pressure and diabetes with endometrial carcinoma

99.Procidentia
100.Drug of choice in atrophic vaginitis
101.Name the virus which causes cervical cancer
102.Name of injectable contraceptive

103.Name the 4th generation progestogen pill.

104. Health assistant or worker at village level -
105. Full form of POP-Q classification.
106. Most common cause of cryptomenorrhia

107.Most common cause for primary amenorrhea

108.Name of the operation to correct stress urinary incontinence, in present day practice.
109.Where is Rokitansky protuberance found.
110.Fixed reference point in the POPQ system

111.Genital malignancy with highest mortality.

112.Drug of choice in persistent trophoblastic disease.
113.Commonest mode of action of combined oral contraception pill.
114.The reference point in POP Q classification of prolapse.

115.First metastatic lymph node in malignancy.

116.Plication at bladder neck during anterior colporrhaphy for stress incontinence.
117.Ovary develops from........
118.Commonest site of genital tuberculosis.

119.Name the gas used for insufflation in laparoscopic surgeries

120.Commonest tumor marker in choriocarcinoma
121.Expand – “ICSI”
123.Fibroma of ovary is associated with what syndrome.

124.Culture media for candidiasis

125.Vaccine for cervical cancer
126.Precocious puberty
127.Failure of contraceptive method is expressed as

128.Clue cells are seen in …………

129.Most common virus implicated for cervical cancer
130.Condition where menstrual blood fails to come out of the genital tract due to
obstruction in the passage is called as ……………..
131.‘Call Exner bodies’ are seen in which ovarian tumor.

132.Failure rate of condoms.

133.Drug of choice for lactation suppression.
134.Criteria for ovarian pregnancy.
135.Anterior sling surgery.

136. Hobnail cells are seen in which ovarian carcinoma

137. Karyotype of Klinefelter’s syndrome is
138. Causative organism of strawberry vaginitis is
139. GnRH is secreted by

140. Most common cause of amenorrhea

141. Milk secretion in non -pregnant woman
142. Hormone given for flushing in post-menopausal women
143. Latest classification in prolapse uterus

144. Ovulation of graffian follicle without rupture.

145. Decreased sperm count in a semen sample
146. Commonest cause of death in carcinoma cervix.
147. Characteristic microscopic finding in bacterial vaginosis.

148. Drug of choice in post-menopausal woman with osteoporosis 11. Types of ectopic
pregnancy

149. Meig’s syndrome

150. Wandering or parasitic fibroid

151. Malignant form of fibroid uterus

152. Commonest mode of spread of ca-cervix

153. Commonest tumor felt in the anterior fornix

154. Latest classification in degrees of prolapse uterus

Twin peak sign

155. Fontanelles and Sutures of fetal skull

156. Red degeneration of fibroid is common in

157. Corpus cancer syndrome

158. Drug of choice in a postmenopausal woman with osteoporosis 13. Strawberry appearance
on cervix is the characteristic of Frequent and painful contractions at 36 weeks.

159. Compression of head posteriorly on type II posterior placenta.

160.Routinely used method of delivery of placenta.

161. Type of delivery in occipito-posterior position.

One twin disappears in subsequent scan in second trimester.

162. In interlocking of twins first twin sacrificed to delivery of

second twin.

163. Embryonic demise within 6 weeks of conception.

164. Death of fetus from 28 weeks to one week after delivery.

Chocolate cyst is diagnostic of.................

165. The Ideal Oral Contraception for lactating mothers?

166. Screening test for carcinoma Cx

167. Absence of semen

Lie of the foetus

168. 1st stage of labour

169. Oligohydramnios

170. Diagonal conjungate

171. Bandl's Ring

172. Deep Transverse Arrest

173. Oxytocics

174.Physiological Jaundice

175.Drug given to prevent Rh incompatabilty in the next

pregnancy

176.Twin peak sign is seen in which type of twin pregnancy

177. Drug of choice in eclampsia

178.Bimanual method to assess for CPD

179.Amniotic fluid index in polyhydramnios

180.Couvelaire uterus is seen in which condition
Define cephelhematoma

181.What is succenturiate placenta

182. What is HELLP syndrome

183.Deline missed miscarriage

184.What is Speloings sign

185.Twins cocur when cleavage of the emiryo occur after 12 days

of fertilization.

186. Define polyhydraminios

187. Define puerperal pyrexia

188.Average ph of vagina

189.Operation for 3º utero vaginal prolapsed in an old parous

lady

190.One intra operative complication of Hysterectomy

191.Drug of choice for Trechomonas vaginals mweu

 LONG ESSAYS

1)1year old child who is partially immunized, is brought to casualty with fever for 6 days, rash for 1 day,
associated with cough, rhinitis, and eye discharge.

Examination reveals the following: Weight: 7.5 kg (Birth weight wäs 3 kg)

Respiratory rate50/min, not able to suck at breast, subcostal retraction is present.

What is the complete diagnosis

Mention the relevant investigations you will advise

How will you manage this child

Mention 4 differential diagnosis

Mention four complications that can occur

How can this be prevented?(3 + 3 + 3+2 + 2 + 2 = 15)

2) 4 months old male baby is admitted in ward with history of highgrade fever of 7 days. Baby's weight gain is
not adequate and there is history of recent crying during micturition with an increased frequency. There is a
similar history about two months back which was managed by Homeo doctor
Most probable diagnosis

Mention the important clinical features you will look for, to support your diagnosis

List the investigations you order to help in diagnosis

What is the drug of choice with dose, route and duration

Mention 2 predisposing causes

How will you prevent this condition(1 + 4 + 4+2 + 2 + 2 = 15)

3)Define congestive cardiac failure(2).

Enumerate 4 causes of CCF in infants(2) .

Which are the symptoms and signs of CCF in infants(4)

Which are the differential diagnoses of respiratory distress in infants(2).

How do you manage infants with CCF including investigations(5).

4) A 5 year oid boy is brought to the OPD with history of reddish spots all over the body of 1 week duration.

O/E Afebrile, active child. No pallor or LNE.Multiple Petechlae, purpurae & small ecchymosis + over the trunk
and extremities. P/A No hepatosplenomegaly.
a)What is the most probable diagnosis? (1)

b) Give 4 reasons for considering that diagnosis (2)

C) Which are the other causes for bleeding manifestations in children.(3)

d) How do you differentiate between these conditions?(4)

e) How do you manage this patient?(5)

5) 10 year old Shubhman is brought to the CP with complaints of decreased urine output and cola-coloured
urine of 3 days duration. He has a history of sore throat 2weeks back. O/E: he has edema of eyelids and
pedal edema. BP: 148/90
a) Write the most likely diagnosis,

b) Write down 4 causes for hematuria in children

c) Write down the investigations with their interpretation that you will do for this child.

d) What are the complications expected in this child?

e) What is your treatment plan?

6)What are the components of Tetrology of Fallot (TOF)?

Describe the clinical features of TOF.

Enumerate the complications.

Outline the investigations and treatment of TOF including management of complications.

Name 2 congenital cyanotic heart diseases other than TOF.

7)A 5 year old boy came to OPD with gradual onset of generalized edema associated with decreased urine
output... There was no history of discoloration of urine. No history of cardiac or liver disorders and no past
history of similar episodes. Ole nutritional status is normal along with normal vitals including blood pressure.
There was pitting pedal edema and ascites on abdomen examination.
Other systems normal

a. What is the most probable diagnosis and mention one Differential Diagnosis

b. Justify your diagnosis with positive and negative points

c. Briefly describe the complications expected

d. How will you plan the management of this child with investigations and treatment

e. Mention the counselling points for prognosis and immunization plan for the child.

8)A 10 month old child presented with bil pedal edema. His mid arm circumference was 11 cm.

Define Severe Acute Malnutrition and mention the positive points for this diagnosis in above child

b) Mention the indications for supervised home and hospital based management in SAM

Enumerate the steps in the management of acute complications in SAM

d)

Briefly mention the steps to be taken to prevent undernutrition in community

9)Discuss the clinical features, diagnosis and management principles of severe acute malnutrition in children.
Discuss the preventive strategies. (3+3+6+3=15)

10) Define SAM, enumerate its complications and management of complicated SAM.

11) A 2 year old baby weighing 10 Kg brought to the emergency room with multiple episodes of loose stools
and vomiting for 1 day. On examination she is irritable with sunken eyes, poor thirst, skin punch going back
very slowly and other systemic examination within normal limits.
a) What is your diagnosis? (1)

b) Outline the management of this child (6)

c) Name etiological agents for diarrioca (3).

d) What are the indications of using antibiotics in diarrhea? (2)

c) Enumerate various complications associated with diarrhea (3)

12) One year old girl was brought to the outpatient clinic with complaints of poor appetite, fussy behavior and
geophagia. On examination she had prilor. There was no lymphadenopathy or hepatosplenomegaly.
a. What is the most probable diagnosis ?

b. Write 4 points favoring your diagnosis.

c. What ase the other relevant points in history you will ask?

d. How will you confim your diagnosis?

c. Discuss in detail about tie managemen: of this child.

13). An 18-month-old baby is brought to the emergency room with complaints of fever, cough and
breathlessness for 2 days. Mother complains thai he is not sucking at breast from today morning onwards. On
examination his pulse rate is 120/nt. respiratory rate is 58/mi, SpO2 89% in room air.

a. Classify the condition of this child as per ARI control program giving reasons.

b. What are the other important points in history you will ask?? cEnts" any two common etiological agents
responsibie for his condition.
d. Discuss : In detail about the management

e What are the measures to prevent this condition? (2-3- 244+4=15 marks)

14)A two-year-old brought with h/o of not gaining weight. She was born ter vaginaly * mon Sienificant
antenatal, natal and estatalinistory. She was started on formula from 3" month of life, Breast feeding was
stopped at 8 months. O/E wt 7 kg Ht 76 cm, MUAC - 10cm

a) What is the diagnosis and the criteria for the same?

b) Discuss the differential diagnosis

c) Describe the clinical features and expected complications

d) How will you manage this case?

e) What is the criteria for hospital discharge?

15) A 2 year old child is brought with history of poor feeding and recurrent episodes of diarrhea. His weight is
5kg: length is 70cm and head circumference 47 cm.He has bilateral pedal edema
1. What is the most probable diagnosis?

2. What complications you expect in this child?

3. List down the investigations to be done and the expected findings

4. Outline the immediate management

5. Age independent Anthropometric criteria for assessment of PEM

16). A 6yr old boy presented with fever and progressive pallor for one month.

examination,

he is toxic and has generalized lymphadenopathy and hepatosplenomegaly. Petechial patches present all over
the body.
1. What is the most probable diagnosis?

2. Name three important differential diagnosis and differentiating features

3. What are the investigations to confirm the diagnosis?

4. Write briefly about the management

5. Mention the prognostic indicators

17)Define Severe Acute Malnutrition . What as the etiological factor? Describe the clinical feature of SAM.

18)Baby Badra, 1year old girl is in brought to you with complaints of poor weight gain ; recurrent respiratory
infections since 3 much of age. On examination baby alert, Pulse rate - 160m, Respiratory Rate 40/min, CVS
examination revealed a systolic munier is the left normal border. The baby weighed 6 .5 kg

(m) What is the most probable diagnosis ?

(b) Give reasons for your diagnosis.

c) List 4 other clinical signs that you expect in this baby

(d) Give2 differential diagnosis

(e) Analyze and comment on the weight of the child

In What are the findings that you would expect to see in the ches Xray lmage of this

baby? (f) How will you manage this baby?

19) 1 Year old girl is brought to Pediatrics OPD with high grade fever of 5 days along with cough and
rhinorrhoea. On the day prior to presentation, she also developed a rash which mother noticed first over the
face which then extended to trunk and extremities.
O/E: She is febrile and fussy with a temperature of 101-degree F. There is a generalised erythmatous
maculopapular rash over the face, trunk and extremities. There are a few whitish spots opposite the lower 2"
molars. Systemic examination is unremarkable.

Mother says that she has received vaccination till 4 months of age.

What is the most likely diagnosis

List 4 other exanthematous fevers in children

List 4 complications of the above condition described in the question

What treatment would you offer for this child?

List any 4 live vaccines and write their detailed schedule

20) 7 year old boy presents to the ER with multiple areas of bluish discoloration over the trunk and extremities.
He had low grade fever and mild cough one week prior to this. There is no history of trauma. 0/E: multiple
petechiae and purpura are noted in the skin as well as on the hard palate.
There is no pallor, lymphadenopathy or organomegaly.

What is the most likely diagnosis? (1 mark)

b. List 4 differential diagnosis (2 marks)

Enumerate the investigations that you will do in this child (3 marks)

d. Enumerate the difference in bleeding patterns between platelet disorders and coagulation disorders (2
marks)
e. Discuss the management of the condition (2 marks)

21)3 year old Sanju is admitted for evaluation of development. At 6 months he attained head holding,by 10
months sitting with support. He does not stand or walk. He can scribble, feed with spilling. There is a postnatal
history suggesting birth asphyxia neonatal seizures, difficulty in changing diapers. His deep tendon reflexes are
all exaggerated. (2+2+2+5+4)
a) Comment on his development.

b) Probable diagnosis.

c) What is GDD?

d) Enumerate etiological factors causing developmental delay.

c) Define and classify CP.

22) 2 year old Shehzin has been presenting with fever and irritability since last 5 days. On examination he has
swelling of the hands and feet with red eyes,rash and cracked lips. No history of cough,allergies, and is
passing urine adequately. (2+5+3+3+2)
a) What is the probable diagnosis with reasons?

b) How do we diagnose this case,clinical and lab criteria?

c) Phases of this disease.

d) Treatment

e) Complications.

23). A 6 month old child weighing 7 kg. presented with complaints of 12 episodes of loose stools for 2 days,
3 episodes of vomiting for 1 day. On examination, child was lethargic with poor oral intake and on palpation
the skin pinch is delayed.
A. What is the diagnosis and its severity?

B. What are the common causes of diarrhoea?

C. Common complications of acute diarrhoea.

D. Compare between different types of dehydration

E. How will you manage this patient?

24). a 3 year old child presented with complaints of fever for 2 days, cough for 1 day and breathing difficulty
since last evening. On examination the child is febrile and grunting, has Respiratory rate of 48/ min with
intercostal retractions. The child is refusing to have

food. A. What is the diagnosis?

B. Comment on the danger signs you will watch for?

C. Etiology of the condition.

D. How will you evaluate and treat this patient?

E. Complications related to the condition

25) An eight year old female child is brought to the outpatient department with fever, pain and swelling over
major joints, which is migratory in nature. Her ESR is 66mm in the first hour. She gives a history of throat pain
20 days back.

What is the most probable diagnosis

Discuss the etiopathogenesis, clinical features and management

26) 2 year old male child came to the emergency room with a history of multiple episodes of loose stools
since 2 days, associated with fever. On examination child was irritable,dry mouth,skin pinch goes back slowly.

How will you assess the severity of discase

Discuss the etiopathogenesis and principles of management including nutritional management

27)Five year old child is brought with complaints of passing cola coloured urine since 1 week. He also has

headache for 2 days & reduced urine output since 2 days.

O/E : facial puffiness present. Pale

HR-80/m RR-38/mt BP- 150/92 mmHg.

distended. No shifting dullness/ fluid thrill. Scars present over lower limbs.

What is the most probable Diagnosis?

DD & Arguments in favour of the Diagnosis.

Investigations

Complications expected and its management

.Treatment
28)Two year old child was brought with ci/o fever since today morning Be one episode of generalized
tonic clonic seizure 6 hours back.
O/E: Alert, child febrile HR-120/mat

RR-32/mt

Chest clear. No meningeal signs. No HSM

What is the most probable Diagnosis ?

b. Differential Diagnosis

c/ Arguments in favour of the Diagnosis.

How will you classify this condition

How will you investigate this child?

How will you counsel the parents of the child

29). Define Severe Acute Malnutrition (SAM). What are the etiological factors? Describe the clinical features
of SAM? Enumerate the complications. Give a brief outline of the treatment protocol for SAM.

30), 2 months old, is brought to you with complaints of not gaining weight. His mother says that he cannot feed
at a stretch and needs to rest in between. On examination. he is alert, respiratory rate is 60 per min, heart rate
is 160 per min, afebrile. His peripheral pulses are well felt and bounding. There is no cyanosis. He has
increased sweating on the forehead.
What is the probable diagnosis?

Give reasons for your diagnosis.

List 4 other clinical signs that you would expect in this baby?

Give two differential diagnoses.

What are the findings that you would expect to see in the Chest X ray imar- - this baby?

List the steps in the management of this baby.

31)What is acute flaccid paralysis. Discuss the differential diagnosis of a case of acute flaccid paralysis and its
surveillance
b) When and where was last case of poliomyelitis reported in India

c) What is Bivalent OPV? (1)

d) What is VIPP? (1)

1) What is VDPP? (1)

32) Seven year old child was brought with fever and seizure. 0/E deeply comatose, pale and significant
hepato- splenomegaly. (2+2+3+3+5)
Answer the following

a) What are the possibilities?

b) What clinical signs will you look for this case

c) How will you investigate?

d) How will you manage?

e) Write 5 complications of any one of the differential diagnosis.

33) 3 year old Anoy has fever and tiredness fo* the Inst 4 weeks. On examination he is sick, severe pallor
present and has palatal purpura and tenderness over the sternum. Liver is palpable 4cm below the RT.costal
margin and spleen 3cm.
a) What is the most probable diagnosis? (l mark)

b) Write 2 differential diagnoses. (1 marks)

c) investigations to be done (Include the resait also) (4 marks)

d) Name 3 important complications of the discase. (3 marks)

c) Enumerate drugs any 4)used to treat the liscase. (2marks)

How will you counsel the parents regarding the above condition?(4 marks)

34) Describe various steps in the management of complicated Severe

Acute Mainutrition. (15 marks)

35)Define Acute Diarrheal disease. What are the etiological factors causing the condition .? What are the
clinical features and how do you assess and classify dehydration ?What are the steps in the management of
the condition? How can you prevent the condition
36)Alen 9 months old child is brought with complaints of fever of three days duration, with multiple episodes of
vomiting and three episodes of seizures. On examination he is febrile 102 degree F, drowsy and Anterior
Fontanelle is bulging
What is the most probable diagnosis?

What are the differential diagnosis?

How will you reach a diagnosis?

What are the complication you expect in the shore disease?

How will you manage the condition?

How will you prevent the condition?

37). A 3 year old child came with complaints of fever, since 3 days and 1 episode of convulsion by day 3.
On examination, child is drowsy febrile, neck stiffness positive, kernigs sign negative.

a)What is the provisional diagnosis

b)Enumerate differential diagnosis

c)What are the findings you looking for?

d) how will you plan the investigations and findings you expect?

e) treatment and complications

f) prevention of the above condition

38). A 6 year old male child came with History of snake bite. On examination, fang mark present, at bite site,
edera and bleeding from the site. CRT -4 sec BP. 80/60mmhg
HR: 120/min.

a. What is the complete diagnosis?

b. What are the findings you will look for in snake bite?

c. Name the investigations.

d. Treatment.

e. Complications.

39) 3 year old healthy boy presents with generalised petechiae and purpuric rashes since 5 days.
History of upper respiratory infection two weeks back. On examination petechiae and purpura present. No
pallor or organomegaly.
Answer the following:

a) What is the most probable diagnosis? (1)

b) Mention the most important differential diagnosis with explanation (2)

c) Briefly write down how you will investigate this child (4)

d) Mention any other 4 important causes of bleeding manifestations in a chüd(3)

e) Briefly outline the treatment plan for this current admission (3)

1) Mention the prognosis and outcome in the long term of the diagnosed condition (2)

40)9 month old baby boy presents with high fever, vomiting and convulsions. On examination baby is
drowsy, anterior fontanelle bulging and pulsatie

Answer the following

a) What is the probable diagnosis? (1)

b) What are the differential diagnosis? (3)

c) What are the necessary investigations and expected results (3+2)

d) Mention how you will the treat this child (3)

e) Mention briefly prevention of this condition (3)

41) A 4 year old girl child with a height of 80 cm is brought for evaluation.

a) Define short stature

b) Enumerate the types and give 2 examples for each

c) How will you investigate a child with short stature?

d) Management of short stature.

42)A 2 year old boy presented with high grade fever for 3 days with projectile vomiting, irritability and 2
episodes of seizures since 1 day.
a) Most probable diagnosis

b) Differential Diagnosis

c) Relevant clinical

examination d) How will you

investigate?

e) How will you manage?

43)9 month old baby weighing 5 kg is brought to the emergency room with poor activity and drowsines Birth
weight 2.7kg, breast feeding stopped and started on diluted cow's milk from 4 months onwards. 0/E sici
looking, lethargic, Pulse 110/mt. No pallor. Oedema on both legs. Liver 2 cms soft spleen not palpable.

Discuss your clinical diagnosis? (2)

b. List 4 acute complications in this child? (4)

c. Discuss the management of this baby? (6)

& Discuss causes of poor weight gain in an infant? (3)

2. Discuss the clinical features types, hemodynamics, medical management and complications of ventricular
septal defect

44) Discuss the clinical features, diagnosis and management principles of severe acute malnutrition in the
preventive strategies. (3+3+6+3=15) children

Three-year-old boy is brought to the emergency room with fever, cough and severe breathlessness of one day
duration. Child is very sick, drowsy and grunting. O/E- RR 68/min, HR-126/min, pyoderma present, Severe
dyspnoea with chest indrawing and retractions, Breath sounds decreased on both sides, bilateral crackles,
CVS-normal
Discuss the diagnosis (2)

List the etiological agents causing the disease in this child (2)

How will you manage this child (5)

Discuss the complications (3)

Discuss the preventive strategies (3)

1. Stages of TB lymphadenitis of the neck

2. Types of Modified Radical Neck Dissections

3. Premalignant oral lesions-types and management strategy

4. Complications after superficial parotidectomy

5. Arterial claudication - definition and classification

6.Medullary carcinoma of thyroid - aetiology and surgical management

7.Types of pneumothorax and principles of their management

8. Briefly discuss the aetiology and management of hydronephrosis

9.Basal cell carcinoma

10. Fissure in ano

11.Tuberculous cervical adenitis

12. Premalignant condition of oral malignancy

13.Discuss the causes of burns and management of 60 % burns

14.Enumerate all the different major and minor blood groups. Enumerate various blood
products. Describe the blood transfusion reactions and its management.

15.Discuss the assessment of surface area and fluid management of thermal burns .

16.Discuss the investigations and management of abnormal nipple discharge.

17.Briefly discuss the diagnosis and management of congenital diaphragmatic hernia in a child

18. What is Glasgow coma scale. Discuss its components and role in the management of
Head Injuries.

19.Management of differentiated thyroid cancers (DTC),

20. Basal cell carcinoma.

21.Chronic venous hypertension and CEAP classification.

22.Carcinoma of anterior two third of tongue. Mycetoma of foot.

23.Briefly describe the lifecycle of echinococcus granulosus. Discuss the management of

hyda- tid cyst of liver (1.5+1.5 Marks)

24.Define closed loop obstruction with a neat & labelled diagram. Briefly discuss the initial
management of a patient with intestinal obstruction presenting to the emergency depart-
ment
(1 + 2marks)

25.List 2 potential complications of cardiopulmonary bypass. List the 4 main indications for
Cor- onary artery bypass graft? (1+2 marks)

26.Briefly discuss the management of appendicular mass?

27.Discuss the preoperative preparation for a 50-year-old female with pheochromocytoma?

28.Briefly discuss the investigations and management of carcinoma of gall bladder?

29.Enumerate the types of mesenteric cyst and describe the characteristic clinical finding of
this condition? (1.5+1.5marks)

30.List the structures to be removed & structures not to be injured when doing a right hemi-
colectomy? (1.5+ 1.5marks)

31.Discuss the clinical presentation and management of femoral hernia? (1 + 2marks)

32. A 72-year-old came to OPD with complaints of bleeding per rectum of recent onset. List
and briefly discuss 3 differential diagnosis in this patient?

33.Complications of Acute pancreatitis and management of acute pancreatitis. (in brief)

34. Ulcerative Colitis

35. Fistula in Ano

36.Bariatric surgery

37.Chronic Duodenal ulcer

38.Pre-malignant lesions of oral cancer

39. Pleomorphic adenoma

40. Medullary carcinoma thyroid

41. Cystosarcomaphylloids

42. Treatment oflymphedema

43. Achalasia cardia

44. Local complications of acute pancreatitis

45. a. Indications for surgery in ulcerative colitis

b. Surgical management of ulcerative colitis

46. Colonic polyposis syndromes

47.Etiology Pathogenesis,clinical features,complications and management of hydatid cyst

of liver

48. Gastrointestinal stromal tumor(GIST)

49.Tracheo-oesophageal fistula

50.Hirschsprung's disease

51.Colorectal Carcinoma - Pathophysiology, investigations and management.

54.Inguinal hernia - Clinical Anatomy, investigations and management.

55.Portal Hypertension - Etiopathogenesis and management.

56.Upper Gl Bleed - Investigations and management.

57. Choledochal cyst

58. GERD Gagal ses done.

59. Sigmoid Volvulus.

60.Complications of varicose veins

61.Septic shock

62.Surgical site infection

63.Cervical rib
64.Tuberculous cervical lymphadenitis
Answer briefly: (10x2=20)

9. Thyroid scan
10. What are the types of nerve injuries.
11. Management of empyema thoracis
12. Management of breast abscess
13. Classify types of hydrocephalus
14. What is the rule of nines as applied to burns.
15. How do you manage paraphimosis
16. Classification dermoid cysts
17. What is the difference between undescended and retractile
testis. 18. How do you clinically stage Hodgkin’s lymphoma .
*******************

9. What is a ranula
10. Mention the indications of circumcision
11. What is “lucid interval” as applied to head Injuries
12. How will you clinically diagnose a thyroglossal cyst
13. What are the types of basal cell carcinoma
14. How do you treat acute paronychia
15. How do you diagnose and treat submandibular duct calculus.
16. What is trendelenburg test for varicose veins
17. How do you diagnose and treat Ludwig’s angina.
18. What are the grades of intermittent claudication of the lower
limb.

9.Contra indications for laparoscopic surgery

10. Clarke’s staging of malignant melanoma
11.Phimosis"
12. Glasgow coma scale
13. Sebaceous cyst
14. Dry gangrene
15. Staging of tubercular lymphadenitis
16. Thyroid function tests
17. Cystic hygroma
18. Thiersch graft

9. FNAC
10. Subdural hematoma
11. Cardiac tamponade
12. Cystic hygroma
13. Phimosis
14. Saphena varix
15. Tetany
16. Advantages of laparoscopic surgery
17. Warthin’s
tumour 18.
Marjolin’s ulcer

*******************
1. 46-year-old male patient presented with severe pain in epigastrium and then spreading to
whole abdomen since 1day, with 3-4 episodes of vomiting On examination there is
tachycardia, distended abdomen with guarding and rigidity, bowel sounds sluggish in nature
a) What is the most probable clinical diagnosis?
b) What are the relevant investigations?
c) Briefly describe about the management of the condition

2.50 year old male patient presented with abdominal pain, distension and constipation History
of significant weight loss and loss of appetite present. There is a history of altered bowel habits
and blood and mucus per rectum. On examination, abdomen is distended, mass left iliac fossa
a) What is the clinical diagnosis?
b) What are the relevant investigations?
c) Describe briefly about the management of the condition

3.A 56 yrs old man presented with bleeding PR-3 months H/o altered bowel habits 4 months
Associated left sided abdominal pain No significant family history. O/E pallor, P/A: vague
mass left iliac fossa, firm and does not indent to touch.
a)Probable diagnosis(2)
b)Relevant investigations(2)
c)Treatment options(3)
d)Complications and follow up of this patient(3)

4. A 29 yr old gentle man presented with H/o Haematuria on & off Associated left sided loin
pain. No previous urinary complaints. He is a painter by profession and chronic smoker O/E
No pallor .P/A mass felt in left lumbar region, moves with respiration, ballotable He has an
irreducible left sided varicocele.
a)Most probable diagnosis(2)
b)Common & atypical clinical presentations(3) c)Relevant investigations and treatment
options. (3)
d)Why is the varicocele irreducible?(2)

5.Discuss the causes, investigation, and management of upper il bleeding.

6.Acute appendicitis aetiology, pathophysiology, clinical features, investigations, and

management.

7.Define rheumatoid arthritis

a)Describe pathology of rheumatoid arthritis b. b)Describe hand deformities in rheumatoid
arthritis
c)Outline management of rheumatoid arthritis of knee.
8.46-year-old male patient presented with severe pain in epigastrium and then spreading to
whole abdomen since 1day, with 3-4 episodes of vomiting On examination there tachycardia,
distended abdomen with guarding and rigidity, bowel sounds sluggish in nature
a) What is the most probable clinical diagnosis?
b)What are the relevant investigations?
c)Briefly describe about the management of the condition

9. 50 Y old male patient presented with abdominal pain, distension and constipation History of
significant weight loss and loss of appetite present. There is a history of altered bowel habits
and blood and mucous per rectum. On examination, abdomen is distended, mass left iliac
fossa a)What is the clinical diagnosis?
b)What are the relevant investigations?
c)Describe briefly about the management of the condition.

10.Enumerate the cause of PVD what are the DD's for PVD. Discuss Clinical features,
Investigations & management of a case of Burgers disease

11.20years old male admitted with evisceration of bowel following a bull gore injury. How will
you manage this patients?

12.An obese female of 40 yrs presented with jaundice and itching all over body
a)What are the differential diagnosis of a case of obstructive jaundice?(2)
b)How will you investigate and reach the aetiological diagnosis?(4)
c)How will you treat the patient?(4)

13.A 60 year old male presented to OP with ulcer tongue anterior third. He gives history of pan
chewing and smoking
a)What is your Provisional diagnosis?(2)
b)How will you investigate the patient?(4)
c)How will you treat the patient?(4)

14.A 60 Year old female presented with a complaint of multiple episodes of vomiting
immediately after food intake. On examination she has an upper abdominal suss with visible
gastric peristalsis and succussion splash
a)Mention the probable diagnosis
b)How will you investigate
c)Briefly describe the management

15.A 56 Year old male presented to the casualty with painful swelling over the right groin with
multiple episodes of vomiting, abdominal distention and constipation. He had a swelling in the
right groin which increases in size on straining and disappears on lying down before the onset
of current complaints
a)Mention probable diagnosis.
b)what are the probable complications if this is left untreated.
c)Describe the management.

16.A 25yr male presented with acute abdominal pain, first felt in the periumbilical area later
shifted to right iliac fossa, associated with loss of appetite and two episodes of vomiting and
mild fever. O/E: PR: 90/mint. P/A: rebound tenderness and rigidity right iliac fossa. His brother
had a similar attack 2 months back.
a)What is the most probable diagnosis and mention the differential diagnosis?
b)What are the relevant investigation and its interpretation?
c)Briefly describe about the treatment?

17.60 yr old male patient presented with increasing constipation alternating diarrhea, loss of
appetite, blood and mucus P/R and feeling of incomplete evacuation and tenismus since 6
months. O/E Anaemic per abdomen NAD. P/R showed a mass at the finger tip found arising
from lateral wall of the bowel.
a)What is the clinical diagnosis and mention the differential diagnosis?
b)Describe the relevant investigation?
c)How will you manage this condition?

18.A 60 yr old post-menopausal lady came to the Surgery OPD with h/o a right sided breast
lump of 2 months duration. It was painless and rapidly progressing. O/E Irregular, firm to hard
mass of 5x6 cm with only breast tissue fixity. The right axilla showed multiple matted lymph
nodes.
a)What are the investigations needed to have a definite diagnosis? (5)
b)How will you stage the disease? And discuss the treatment (5)
c)What are the post-operative complications of MRM? (5)

19.A 32-year-old man was brought to casualty with h/o RTA. On examination he was
conscious, PR was 128/mt BP 90/60 mm of Hg. He had multiple long bone fractures on his
left leg and thigh also had multiple rib fractures on right side?
a)How will you manage this patient in Emergency Department based on ATLS guidelines?(4)
b)What is Glasgow Coma Scale (GCS)?(3)
c)What is flail chest?(2)
d)Write a short note on Extradural haematoma?(3)
e)What are the Complications of blood transfusion?(3)

20.A 23-year-old thin built female patient came to surgical OPD with swelling in front of neck
and palpitation for five months. She has tachycardia, tremors and protruded eyeballs. There is
diffuse enlargement of thyroid gland.
a)What is the most probable diagnosis in this case?(1)
b)How will you investigate?(4)
c)Discuss in detail about the various treatment options available for this patient? (6)
d)What are the complications of surgical management in this case?(4)
21.A 50 years old male patient with a history of Acid Peptic Disease presented to the
Emergency department with severe upper abdominal pain and vomiting of 1 day duration. On
examination Patient is conscious, Pulse-120/ minute BP100/60. Per Abdomen-Generalised
distension, rigidity and guarding is present, Liver dullness is obliterated, other systems are
normal.
a)What is the most probable clinical diagnosis
b)What are the relevant investigations you will do in this patient?
c)Briefly describe the management of this case

22.A 20 years old boy presented with severe right lower abdominal pain of 2 days duration. He
had nausea and vomiting, no altered bowel habits. He had similar symptoms 1 month ago and
was treated conservatively and responded well. On clinical examination, patient is afebrile,
there
is mild tenderness in the right iliac fossa and a vague mass, firm in consistency and smooth
surface is palpable. Other systems are normal
a)What is the most probable diagnosis?
b)What are the relevant investigations you will do in this patient?
c)Briefly describe the management of this patient.

23.35-year-old female presented in the OPD with a lump in the upper outer quadrant of left
breast for the last 9 months. On examination there is 3 cm lump in the left breast which is
mobile and not involving the skin and underlying muscles. Left axillary lymph nodes are also
palpable and freely mobile with no clinical evidence of spread of the disease to distant organs.
a)What is the stage of the disease?
b) Explain the investigations and management of this disease

24.Describe the etiopathogenesis, clinical features and management of carcinoma tongue.

25.A 65 year old male patient presented with painless, progressive jaundice of 1 month
duration. H/o itching and passing clay coloured stools. On examination, icterus present,
abdomen globular mass in right hypochondrium.
a)What is your diagnosis?
b)What are the relevant investigations
c)Describe management

26.50 year old male patient with vomiting about 15 hours after consuming food since 2
months. Tolerates only oral liquid. H/o significant weight loss & loss of appetite present II/o
melaena present O/E Abdomen distended, visible gastric peristalsis present.
a)What is the clinical diagnosis.
b)What are the relevant investigation.
c)Describe about the management.

27.54 year old lady came with complaints of yellowish discoloration of eyes and passage of
high colored urine for 1 month, associated with generalized itching which disturbs her sleep
and daily activities History revealed passage of clay-colored stools for 3 weeks with an episode
of silvery
stools and decreased appetite. Examination: Patient is icteric and scratch marks over torso,
vitals stable Abdomen Examination: Visible lump in right hypochondrium, 3 x 3cm in size,
moves with respiration
a)Enumerate the possible differential diagnosis.(2)
b)What are the investigations to be done in sequence to confirm your diagnosis.(6)
c)Explain with a diagram Enterohepatic circulation.(2)

28. 45 year old man came with complaints of a painless right testicular lump for 1 year, with
recent onset backpain for 2 weeks. Examination revealed a testicular lump of size 4 x 4cm with
secondary hydrocele.
a)Classify Testicular tumors(2)
b)What is the investigation of choice to confirm your diagnosis?(1)
c)What are the investigation that helps in staging the disease?(2)
d)Explain with a flowchart the management of testicular tumors.(2)
e) Explain in detail how you will counsel the patient regarding orchidectomy.(3)

29.A 47-year-old female patient came to the Surgery ORD with a history of noticing swelling in
front of the neck for 6 years. She is anxious and restless. She also has complaints of
palpitations, loss of weight, amenorrhea, increased sweating, restlessness since the past 6
months. On examination, both lobes of thyroid enlarged with multiple nodules, largest nodule
2x2cm palpable in the right lower pole thyroid, moving up with deglutition. The lower border is
not palpable. Pemberton's test positive.Pulse rate is 120/min.
a)Write the most probable complete diagnosis.
b)List the pre-operative investigations with a short note on the indication for each
investigation. c)Describe the management and possible complications.

30.A 25 yr old gentleman presented to the surgical or with a swelling front of neck at its right
side of 4x3 cms size moving well with deglutition having well defined borders and uniformly
hard consistency. Ipsilateral side level II and III hard lymphadenopathy of size 1,5 cm x 1cm
noted with restricted intrinsic mobility.
a) What is the most probable clinical diagnosis? Enumerate two points in favour of this
diagnosis. (2)
b)Mention one most probable differential diagnosis of the scenario with only little difference in
presentation, mentioning points in favour of this differential diagnosis. Enumerate 2 more
differential diagnosis of this scenario, contrasting in its presentation by the absence of
lymphadenopathy.(3)
c)Discuss the investigations and management.(5)
d)Briefly describe the complications of surgery and the protocol of follow up of this patient.(5)

31.
a) Define and classify shock.
b)Discuss the aetiopathogensis of septic shock and its clinical features
c) Enurserate the causes of haemorrhagic shock
d) Discuss the management of septic shock.
32.An 18 year old girl presented with b/o right sided lower abdominal pain, fever & vomiting of
1 week duration treated conservatively at local hospital, now presented with a mass in the
right iliac fossa, with low grade pain. Her vitals are stable only
a)Most probable diagnosis?
b)How will you investigate this case?
c)What is the management protocol & how will you treat this case

33.A 60 year old male, c/c Alcoholic, smoker presented with yellowish discoloration of
urine/sclera associated generalized body itching of 1 month duration. He passes clay coloured
stool and the entire body with scratch marks. Per abdomen a globular mass palpated in the
right hypochondrium. No associated fever or pain abdomen
a)What is your diagnosis?
b)Investigate him to reach your diagnosis for further management
c)How will you treat this case.

34.A 55 year old female comes to the opd with hard lump in the right breast of size 2x3 cm
with evidence of ulceration of skin over the lump. O/E Axilla-Mobile hard lymphadenopathy
a)What is the most probable diagnosis with staging?(2)
b)Discuss etiopathogenesis and classification.(4)
c)How will you investigate this case?(4)
d)Briefly discuss the management.(5)

35.Discuss WHO classification of Salivary gland tumors and clinical features, investigation and
management of pleomorphic adenoma.

36.A 42 year old man is complains of pain and distension of abdomen and repeated hile stained
vomiting for 2 days duration. He gives history of laparotomy for acute appendicitis 1 year back.
On examination there is distension of abdomen and a nidline scar is visible. Also there is visible
bowel loops and peristalsis.

a)What are the diagnosis and the possible causes? (3)

b)How will you investigate this patient?(3)
c)Describe the management of this patient.(4)

37.A 62 year old man is having progressive jaundice weight loss, deep coloured urine and
itching for 3 months duration. On Examination, there is deep jaundice. Abdomen should a
globular mass in right hypochondrium which is moving down with respiration. No other mass are
palpable.
a)What is the diagnosis?(2)
b)Give two causes for this condition?(2)
c)How will you investigate?(3)
(d)Describe the management of the patient. (3)

38.A 45 years old female with complaints of dilated and tortuous veins along the medial aspect
of left Mower limb associated with dull aching pain with healing ulcer just above the medial
malleolus.
a)Name the complications of this condition.(3)
b)What investigations will you perform(4)
c)How will you treat this patient.(8)

39.What are the classes of Haemorrhagic shock and their management (15)

40.1.A 64-year-old male patient presents with the complaints of pain and lump in the left
lower abdomen for last 6 months. The patient has attacks of constipation followed by diarrhea
for last
5 months. He is passing blood with stool for the last 3 months. Along with lump he has
anorexia and loss of weight for the same period. On physical examination, on general survey he
has mild pallor. On abdominal examination,contour of abdomen and position of umbilicus are
normal. A lump is palpable in the left lumbar region extending into the left iliac fossa, surface
smooth, size 12 cm x 8 cm, margin rounded, consistency hard and mobile. No other mass is
palpable in the abdomen. Systemic examination is normal.
a)What is the most probable clinical diagnosis
b)What are the relevant investigations
c)Briefly describe about the management of the condition

41.A 36-year-old male with a history of alcohol abuse brought to the casualty department
complaining of epigastric abdominal pain for the past 36 hours. He describes the pain as
constant and radiating to his back. He also complains of nausea and has vomited several times
Physical exam reveals abdominal distension and diffuse tenderness to palpation, worse over
the epigastrium, with guarding. His vital signs are notable for a temperature of 101°F, sinus
tachycardia, and hypotension with a blood pressure of 90/60 mm Hg.
a)What is the most probable clinical diagnosis
b)What are the relevant investigations
c)Briefly describe about the management of the condition.

42.50 year old man presents to the casualty with abdominal distention and vomiting Had
history of irregular diet habit in his younger age and also he had history of one episode of
coffee ground vomitus. O/E pallor +, he is asthenic. P/A a mas of size 5X5 cm in the
epigastrium.
a)What is your diagnosis (3)
b)How will you confirm the diagnosis (3)
c)What is the treatment (4)
43.A 30 year old female presents to the OP with history of neck swelling in the midline of neck.
History of thyroxine in the past. She has difficulty in swallowing and sense of foreign body in
hypoxyoodism the throat
a)What is your diagnosis (2)
b)How will you confirm diagnosis (3)
c)What are the complication of thyroid swelling(3)
d)What is the management (2)

44.A 65 year old women was brought to casualty with history of fall on outstretched hand,
Complaints of pain and deformity right wrist.
a)What is the most probable diagnosis?(2)
b)Name four named distal end radius fractures(2)
c)How will you manage the case?(2)

45.60years old nulli parous female presented with painless progressive lump over RT breast of
6 months with recent rapid increase in size and reddish discolouration over the skin over the
swelling On examination 75 cm hard irregular lump over the upper outer quadrant of RT breast.
Skin shows peud orange appearance. 21 cm hard mobile lymph node palpable in art axilla. No
clinical evidence of metastasis
a)Write complete diagnosis with TNM staging(1)
b)How do you work up this patient?(7)
c) What are the treatment options?(7)

46.30 years old chronic beedi smoker presenting with progressive pain both calfs after walking
for some time since 6 months. He noticed recent blackish discolouration & ulcers of toes with
severe pain at night
a)What is the probable diagnosis, with differential diagnosis.(2)
b)How do you manage this patient?(7)
c)Write briefly on intermittent claudication & rest pain(6)

47.A 25 year-old male patient was admitted with fracture of right femur he was found to be
febrile with respiratory distress and altered mental status.
Based on this presentation:
a)What is the most probable clinical diagnosis and enumerate the reasons for arriving at this
diagnosis. (1)
b)Discuss the pathophysiology and symptomatology of this condition (2)
c)Describe the diagnostic criteria for this condition.(1)
d)Describe in detail the management of this condition. (2)

48.60 yr old man has presented with progressive jaundice -7 months duration.
on examination GB palpable & non tender
a)diagnosis &differential diagnosis (5)
b)investigations of choice & findings you expect in each (5)
c)describe medical management (5)
d)write on surgical treatment(5)

49.
a)causes & pathology of septic shock (10)
b)investigations in septic shock (10)
c)treamentof septic shock (10)

50.A 45-year-old man is brought to the casualty with history of fal from 20ft height. On
examination he is conscious, oriented, PR-110/min BP-80/60, Pallor+. He has surgical
emphysema on left side of chest with decreased air entry on the same side. He also has
alidominal guarding and rigidity.
a)Discuss the assessment and management of this patient. (10)
b)Classify Shock (3)
c) Complications of blood transfusion (2)

51.Describe gangrene. Define critical limb ischemia and discuss etiology, clinical features,
investigations and management of a patient with critical limb ischemia. Add a note on bypass
procedures of lower limb.

52.1. A 68 year old male presented with abdominal pain and distension of one week duration.
He had noticed blood in stool since 2 months. On arriving at emergency department he was
having vomiting and not passed stool since 4 days. On examination he had a tense abdomen
with gaseous distension and presence of a vague mass in left iliac fossa was noticed.
a)What are the possible clinical scenarios?(2)
b)How do you investigate this patient.(4)
c)Describe your plan of management.(4)

53.A 52 year old male who is a diabetic and hypertensive presented to emergency department
with history of abdominal pain and vomiting after an episode of binge dirnking. No
hemetamesis On examination he had a pulse rate of 108 beats per minute and BP
100/60mmHg. Tenderness of epigastrium was noted.
a)Possible diagnosis and differential diagnosis
b)How will you investigate this patient.
c)How do you manage this patient.

54.Mrs. XYZ, 60 years old female came to the Surgery OPD with complaints of recently
discovered Aump noticed in the left side breast. On examination, there is a lump of size 3x3
cm over the left upper quadrant of breast with a fi single mobile lymph node measuring 2cm in
the
left axilla.
a)What is the diagnosis and TNM staging?(1)
b)Describe management options for this patient.(2)
c) List 4 main structures preserved in modified radical mastectomy and mention 4
complications of modified radical mastectomy.(2)
55.A 47-year-old female patient came to the Surgery ORD with a history of noticing swelling in
front of the neck for 6 years. She is anxious and restless. She also has complaints of
palpitations, loss of weight, amenorrhea, increased sweating, restlessness since the past 6
months. On examination, both lobes of thyroid enlarged with multiple nodules, largest nodule
2x2cm palpable in the right lower pole thyroid, moving up with deglutition. The lower border is
not palpable. Pemberton's test positive. Pulse rate is 120/min.
a)Write the most probable complete diagnosis.(1)
b)List the pre-operative investigations with a short note on the indication for each
investigation.(2)
c)Describe the management and possible complications.(2)

56.1. A 15 yr old male patient came to the OPD with complaints of vague pain and swelling over
the lower femur of 5 months duration. There is no ho fever but the patient gave a history of
weight loss and loss of appetite the swelling was insidious onset and rapidly growing
a)What is the possible diagnosis?(1)
b)What are the clinical features and how will you classify this?(2)
c)What are the investigations for this clinical condition?(1)
d)What is the treatment for this case?(2)

57.45 years old male, smoker, alcohohe presented to ED with sudden onset abdominal
pain,associated with 1-4 episodes of bilious vomiting OF there is tachycardia, low BP. abdominal
distension guarding and rigidity. Bowel sounds are absent
a)What is most probable clinical diagnosts
b)What are the relevant investigations?
c)Describe about the management

58. 23 year old female patient brought to El with history of spillage of boiling water over chest,
abdomen and left upper lunb. OF Tachycardia ( BP normal, blebs present over chest, abdomen
& Left upper limb,GCS 15/5.
a) What is your diagnosis.
b)Describe relevant investigations and management with help of diagram.

59.46 year old male patient presented with diffuse pain in the abdomen since 3 days, with 3-4
episodes of vomiting, not passing flatus and stools since 2 days. On examination there is
tachycardia, distended abdomen with guarding and board like rigidity, bowel sounds absent.
a)What is the most probable clinical diagnosis
b)What are the relevant investigations
c)Briefly describe about the management of the condition

60.50 Y old male patient presented with non bilious vomiting about 1-1.5 hrs after consuming
food since 3 months. History of significant weight loss and loss of appetite present. He also has
history of peptic ulcer and is on treatment for the same since 2 years. History of malena, history
of altered bowel habits. On examination, abdomen is distended, visible gastric
peristalsis present.
a) What is the clinical diagnosis
b)What are the relevant investigations
c)Describe briefly about the management of the condition.

61.Potts Paraplegia Pathplogy Pathogenesis, Clinical features, stages & management.

(6)

Orthopedic Essay (6 mark)

1. A 25 years construction worker presents to the emergency department after having fallen
from the first floor. He complains of pain in both heels of his feet. Answer the following:
What are the likely injuries sustained. What other area of the body must be examined.
Describe initial management of this patient. Discuss treatment of the most probable
diagnosis (1+1+2+2=6)

2.. A 20 years old is brought to the emergency department following involvement in a

motorbike accident. He has an open wound on his right shin and his leg is deformed. He is
unable to
move his affected leg. Outline the first aid and its management (2+4=6)

3.An 18 years old girl presents with a 3 months history of painful swelling of the distal thigh.
She is ill looking and examination reveals a firm tender swelling localized to the distal
metaphysis of the femur. Discuss: Possible differential diagnosis. Diagnostic workup
Treatment of the likely cause (2+2+2=6)

4.One year old child is brought with inability to move right lower limb for one day. Child is
irritable and lethargic, refusing to feed. On examination, right lower limb is motionless and
hip area is tender. Discuss the differential diagnosis and management of most probable
diagnosis (2+4=6)

5.6 yr old child presented following a fall on outstretched hand with pain & deformity of right
elbow. On examination radial pulse was not palpable.
a)What is the most probable diagnosis?(1)
b)How will you manage the patient?(3)
c)Enumerate the complications that can occur due to the injury(2)

6.Define rheumatoid arthritis

a)Describe pathology of rheumatoid arthritis b. b)Describe hand deformities in rheumatoid
arthritis
c)Outline management of rheumatoid arthritis of knee.
7.A 70 years old female present to the emergency department with history of fall. Patient
complaints of hip pain. On examination ship Tenderness present & leg raising not able to do.
There is mild external rotation of lower limb. No shortening of limb
a)Diagnosis (1)
b)Differential diagnosis (1)
c)Classification (6)
b)Investigation (3)
e)Treatment (4)

8.A 14-year-old boy with swelling of distal thigh of 6 years duration presents with a 3 months
history of pain and swelling and a recent increase in size. There is no history of truma Patient
is moderately built. Examination reveals a firm to hard tender swelling localized to distal
metaphysis of femur.
a)Give the probable diagnosis?(1)
b)Mention the Radiological features?(2)
c)Outline its Treatment?(3)

9.A 7 year old boy had fallen on out stretched hand in their school ground while playing in a
swing. He had severe pain in the right elbow. On examination he has swelling and tenderness
around the elbow and 3 bony point relationship is maintained
a)What is your clinical diagnosis?
b)Outline investigations and treatment?
c)Enumerate the complications.

10.Define Osteoporosis. Discuss briefly about the investigation and management of

osteoporotic compression fracture of LS vertebra in a 70 year old lady.

11.22 year old male presented with history of RTA in ED. On examination he had a 10 cm long
lacerated wound over right leg with comminuted fracture both bone right leg and dorsalis
pedis pulsation present.
a)How will you manage this patient?
b)What is the type of injury and classification?
c)What are the complications?

12.65 year old housewife complains of pain in both knees for 2 years which has been
progressively worsening. Examination reveals bilateral genu varum and crepitus duri knee
movements. What radiological features help confirm the presence of knee osteoarthritis.
Discuss the treatment options available for this patient

13.A 7 yrs old female came to OPD with deformity at her Right elbow. Parents gave history of
some fracture at the elbow 3 yrs back which was treated conservatively with plaster. On
examination, carrying angle reduced no tenderness, no distal neurovascular deficits.
a)What is the most probable diagnosis? (1M)
b)What are the clinical features of this type of deformity (2M)
c)Management plan of this condition? (3M)

14.Classify feature neck of femur, Discuss clinical features, Diagnosis and management of
fracture neck of femur in 35 years old female.

15.How will you diagnose supracondylar fracture in children?

a)what are its immediate complications and its management?
b)What are the late complication and its management?

16.
a)Discuss pathophysiology of fracture healing(2)
b)Factors influencing it.(2)
c)Complication of fractures(2)

17.A 65 year old obese lady presented with bilateral knee pain with difficulty in climbing stairs
for the last 4 years which has been progressively worsening. There is no history of trauma or
fever. Examination revealed bilateral genu varum and painful limitation of flexion & crepitus
during knee movements.
a) What is the most probable clinical diagnosis? (1)
b) How will you detect minimal and moderate effusion in the knee joint? (2)
c) What radiological features help confirm the diagnosis in this case? (1)
d) Discuss the treatment options available for this patient. (2)

18.Define Osteoporosis, Describe etiology, pathology, clinical and radiological features and
management of Osteoporosis

19.Define colle's fracture. What are the displacements in colle's fracture? Management and
complications of colle's fracture
(1+2+1+2=6)

20.
a) A 65 year old women was brought to casualty with history of fall on outstretched hand,
Complaints of pain and deformity right wrist.
a)What is the most probable diagnosis?(2)
b)Name four named distal end radius fractures(2)
c)How will you manage the case?(2)
Short essays : GIT

1. Achalasia cardia
2. Complications of acute pancreatitis
3. Meckel’s diverticulum
4.Periampullary carcinoma
5. Hydatid cyst liver
6.Intussusception
7.Gastric outlet obstruction
8.Pseudocyst of pancreas

Short Essays: (8x5=40)

9. Haemorrhoids

10. Management of carcinoma colon

11. Intussusception

12. Local Anaesthesia

13. Gas gangrene

14. Papillary carcinoma thyroid

15. Flail chest

16. Submandibular sialadenitis

17. Prepare and get the informed consent for surgery for perforation peritonitis.

18. Stages of TB lymphadenitis of neck

18. Types of Modified radical neck dissections

Moufer imk

20. Premalignant oral lesions - types and management strategy

21. Complications after superficial parotidectomy

22. Arterial claudication - definition and classification

23. Fracture ribs - complications and management

24. Medullary carcinoma of thyroid - aetiology and surgical management

25. Ureteric colic - symptoms and immediate management

26. Tracheostomy

27. Complications of blood transfusion

28. TB cervical Lymphadenitis

29. ANDI

30. Thyroglossal cyst

31. Tuberculous cervical adenitis

32. Premalignant condition of oral malignancy

33. Basal cell carcinoma

34. Fissure in ano

35. Briefly discuss the diagnosis and management of congenital diaphragmatic hernia in a
child

36.What is Glasgow coma scale. Discuss its components and role in the management of Head
Injuries.

37.Gastrointestinal Stromal Tumor (GIST)

38.Mammography

39. Spinal anaesthsia

40. Gall Stones

41. OGD (Oesophago Gastro Duodenoscopy)

42. Congenital hyper trophic Pyloric stenosis (CHPS)

43. Splenic injury

44. Intestinal tuberculosis

45.Pre malignant lesions of penis (9)

46.Screening mammography (9)

47.Colorectal Carcinoma - Pathophysiology, investigations and management.

48. Inguinal hernia - Clinical Anatomy, investigations and management.

49.Portal Hypertension - Etiopathogenesis and management.

50. Upper GI Bleed - Investigations and management.

51. Briefly describe clinical presentation of a young girl diagnosed with intussuseption.

52. Acute and chronic presentations of Crohns Disease

53. ERCP-indications and relative contraindications

Theraputic uses of the procedure

54. Importance of taking an informed consent prior to performing surgery in a patient

who presented with intestinal obstruction.

55. Investigation in a case Peripheral Occlusive Arterial Disease

56. Classify malignant melanoma. Discuss the aetiology and surgical management.

57. Hydatid cyst liver

58. Chronic pancreatitis

59. Acute cholecystitis

60. Chronic duodenal ulcer

61.Fracture ribs-complications and management

62. Ureteric colic-symptoms and immediate management

Clinical Situation (3) -GIT

1.A ten year old boy is brought to the casualty with complaints of vomiting and colicky
abdominal pain of two days duration. On examination there is a sausage shaped mass
around the umbilicus . digital rectal examination shows red current jelly .
what is the diagnosis in this case .discuss the treatment options

2.A 20 years old man is admitted with evisceration of bowel following a bull gore injury. How
will you manage this patient

3.A 65 years old person is referred to you with abdominal pain of two days duration. He gives
history of intake of analgesies for a long time. His plain x-ray abdomen shows free gas under
right dome of diaphragam. What is your diagnosis. How will you investigate the case and
mention briefly the treatment

4.A 60 years old man with mass descending per rectum. Enlist the likely causes. Mention
briefly the management
Section A – Surgery (GIT)

5. Pseudomyxoma peritonei
6. Ranson’s criteria
7. Low fistula in ano
8. Splenic abscess
9. Meckel’s diverticulum

5. Perianal abscess
6. Visible gastric peristalsis
7. Femoral hernia
8. Amoebic liver abscess
9. Colonoscopy

5. Ischio-rectal abscess
6. Appendicular mass
7. Desmoid tumor
8. Complications of
splenectomy 9. Choledochal
cyst

5. Fissure in ano
6. Umbilical hernia
7. Charcot’s triad
8. Hydatid cyst of liver
9. Pigment stone

Section B – Orthopaedics

6. Thomas test for hip

7. Deformity in trochanteric fracture of femur
8. Aneurysmal bone cyst
9. Clinical and radiological features of osteoarthritis of
knee 10. Screening for congenital dislocation of hip
11. Name five tumor like conditions of bone

6. First aid in suspected cervical spine injury

7. Classification of peripheral nerve injuries
8. ‘Pointing’ index
9. Diagnosis of hip dysplasia in newborns
10. Congenital muscular torticollis
11. Complications of Colles fracture

6. Classification of nerve injuries

7. Grading of ligament injury
8. Chondrosarcoma
9. Types of fracture
10. Brodie’s abscess
11. Causes of bow legs

6. Nerve repair
7. Radiological features of rickets
8. Osgood-Schlatter disease
9. Fracture patella
10. Diagnosis of compartment
syndrome 11. Foot drop
FINAL YEAR SHORTCUTS:

Medicine

CNS common symptoms:

1. Neuropathy:
● Paraesthesia
● Sensory or motor or sensory motor loss
● Numbness
● Tingling sensation
● Cramping pain
● Wrist drop & foot drop
2. Visual symptoms:
● Blurring of vision
● Flashes
● Dark spots
● Uveitis
● Retinitis, chorioretinitis
● Retinal edema, blindness
● Papilledema
3. Neurocognitive disorders:
● Executive dysfunction
● Memory impairment
● Disruption of attention, multitasking, impulse control, judgment and memory encoding
and retrieval
4. Motorsymptoms:
Paraesthesia
● Paraparesis
● Hemiplegia
● Motor aphasia
● Cerebellar ataxia
●
5. SensoryPain
symptoms:
● Loss of sensations
● Unusual sensations
● Sensory aphasia
● Sensory ataxia
●
6. Signs ofHeadache
raised ICT:
● Seizure
●
 ● Projectile vomiting
● Papilledema
● Cranial nerve palsies
● Hypertonia
● Hyperreflexia
● Bulging anterior fontanelle (Peds)
7. Signs of meningeal irritation:
● Neck pain & neck stiffness
● Kernig’s sign positive
● Brudinski’s sign (leg & knee sign) positive
● Seizure, headache
● Bulging anterior fontanelle (Peds)

8.

Clinical features: (Write system wise)

- GIT:

- CVS:
Stomach pain, burning sensation in stomach or throat, constipation, nausea, vomiting, (with
blood, mucus, describe contents), eructation, diarrhea, tenesmus, purging, etc.
Hypotension
- or hypertension, bradycardia or tachycardia, feeble or rapid pulse,
hyperdynamic
- precordium, wide pulse pressure, pedal edema, Orthoptera & PND, circulatory
collapse, shock, death (hypotension, arrhythmia, seizure, coma, death)
Hepatic: Jaundice, tender hepatomegaly, hepatic encephalopathy, fatty degeneration
RS: Breathlessness, cough, hemoptysis, tachypnea or bradypnea
a. SignsofConsolidation:
i. Diminishedrespiratorymovements
ii. Highpitchedtubularbronchialbreathing
iii. Dullnoteonpercussion
iv. Markedlyincreasedtactilevocalfremitus&vocalresonance
v. Nomediastinalshift
vi. Bronchophony,egophonyandwhisperingpectoriloquypresent
vii. Duringresolutionofconsolidation→Coarsecrepitationsheard
b. SignsofTuberculosis
● Significant,unintentionalweightloss
● Reductionofappetite,cachexia
● Hemoptysis
● Coughwithexpectoration
● Eveningriseintemperaturewithnightsweats(lowgradefever)
● Breathlessness
● Finecrepitations
● Bronchialbreathing
● Hard,matted,enlargedlymphnodes
● c.
Dischargingsinuses
● Consolidation
 - Renal: Oliguria, hematuria, albuminuria, uremia, nephrotic syndrome, renal failure
- CNS: Headache, drowsiness, projectile vomiting, anxiety, disorientation, convulsions, lethargy,
restlessness, confusion, insomnia, delusion, delirium, encephalopathy, tremor, insensibility,
irreversible coma, death
- Musculoskeletal: Cramps, spams, paralysis of muscles, rhabdomyolysis

Investigations:
● To confirm diagnosis
● To find the causative organism / etiology & to aid in antibiotic therapy (antibiotic
susceptibility testing)
● To check the prognosis of disease or response of patient to therapy
● Microbiological: Blood culture, stool & urine culture. Detection of causative organisms.
Detection of organism specific antibodies and antigens.
● Serological: CBC, LFT, RFT, S. Creatinine, BUN, lipid profile, coagulation profile, ABG &
serum electrolytes, etc.
●
Radiological: X Ray (chest, abdomen-pelvis, etc.), CT scan, MRI, contrast studies, radio
isoto scans etc.
●
Immune assay
●
Other: Electrocardiogram, Echocardiography, Electroencephalogram

Risk factors:

Can be classified into modifiable, non modifiable or host, genetic, environmental factors
● Immunocompromised:impairedhostdefensemechanism(HIV,cytotoxictherapy,
radiotherapy, chemotherapy, old age, pediatric age group, neutropenia), old age,
pediatrics , long term use of steroids, malignancies, chronic diseases
● Comorbidities:DM,HTN,Epilepsy,bronchialasthma,COPD,IHD,etc.(dyslipidemia+
obesity + hypertension + insulin resistance = all are interconnected, known as metabolic
syndrome)
● Senility
● Ethnicity,race&genderpreponderance/prevalence/predisposition
● Geneticpredisposition:HLAassociation,geneticmutations(polygenicormonogenic
mutations), family history (hereditary, familial), monozygotic twins
● Autoimmunedisorders(havehigherriskofgettingotherautoimmunedisorders)(Graves’
disease, Hashimoto’s thyroiditis, vitiligo, Addison’s disease, pernicious anemia, etc.)

Modifiable risk factors

● Addictions(smoking,alcoholism,drugabuse)
● Sedentarylifestyle&obesity(morecommonlyfornoncommunicablediseases)
● Diet
● Highpressure,stressjob(morecommonlyfornoncommunicablediseases)
● Irregularcircadianrhythm(morecommonlyfornoncommunicablediseases)
Spread:
● Hematogenous
● Lymphatic
 ● Direct spread

Routes:
● Feco Oral
● Inhalational
● Ingestible
● Sexual
● Perinatal/Verticaltransmission
● Inoculation

General Principles of Management:

● Hospitalization,starttreatmentasearlyaspossible.
● Monitorvitals(BP,pulse,RR,Temperature,JVP,spO2),stabilizethepatient.GCS
assessment.
● Putinrecoveryposition.
● Airway(patentairway,clearobstructionduetosecretionsortonguefallingback),
breathing (monitor spO2, mechanical ventilation) & circulation (pulse, by monitoring)
● SecureanIVline:fluidresuscitationtomaintainbloodpressure.Monitorvitals,fluid
intake & output.
● Ventilatorysupport:oxygenatetomaintainspO2.(Tracheostomyinemergency,
mechanical ventilation, endotracheal intubation)
● Correctionofhypoglycemiawithglucose.(DNS)
● Correctionofelectrolyteimbalances.
● Correctionofmetabolicdisturbances.
● Giverelevantmedication:testdosetoavoidanaphylaxis,monitorvitalsaftergivinga
bolus, modify dose according to the response.
● Antibioticcover/empiricalantibiotictherapy.(Ifyoudon’tremember:justputthird
generation cephalosporin, fluoroquinolones, penicillin, etc.)
● Lifestylemodifications,pharmacotherapy,psychotherapy,surgicalinterventions.
** How to correct alkalosis
- Salineinfusion.
- Potassiumreplacement.
- Magnesiumreplacement.
- Chlorideinfusion.
- Hydrochloricacidinfusion.

** How to correct acidosis

- IVsodiumbicarbonate,whichhelpsbalancetheacidsinyourblood.
- Fluidsdeliveredthroughaveininyourarm(IVfluids).
- Sodiumcitrateifyouhavekidneydiseaseorkidneyfailure.
- Insulinifyouhavediabetes-relatedacidosis.
Psychiatry

Psychiatry common symptoms:

● Body image issues
● Pathological guilt
● Hysteria
● Anxiety, panic
● Depressed mood or euphoria (acute mania)
● Actions triggered by stressors
● Substance abuse, alcohol abuse, smoking addiction
● Psychosis (loss of contact with reality): Schizophrenia, mania, bipolar disorder
● Specific psychotic symptoms include delusions, hallucinations, ideas of reference, and
disorders of thought
● Neurosis: Depression, phobia, anxiety
● General symptoms: inability to rest, irritability, sleep disturbances, bowel & bladder
disturbances, worrisome & fearsome thoughts

Psychiatry common treatment options: ( Pharmacotherapy & Psychotherapy)

● Pharmacotherapy: SSRIs, SNRIs, Benzodiazepines, atypical antipsychotics & atypical
antidepressants
● Psychotherapy: Cognitive behavioral therapy, interpersonal psychotherapy, psycho
education, electro convulsive therapy, counseling, mindfulness exercises, breath exercises
● Lifestyle modifications: Healthy diet, proper sleep wake cycle / circadian rhythm, regular
exercise, meditation

Pediatrics
For neonatal pathologies:

A. Etiologies
● TORCH infections
● Acquired infections (TB, Meningitis, etc.)
● Teratogens
● Maternal metabolic problems: DM, HTN, obesity, dyslipidemia, malnutrition
● Structural defects
● Genetic anomalies
● Seizures
● Drug induced
● Radiation exposure
● Perinatal trauma (instrumental delivery, prolonged labor)
● Preterm labor, PPROM, PROM
 B. Investigations:
● Xray
● USG
● CT scan
● MRI

C. Clinicalfeatures
● Mental retardation (can be progressive or nonprogressive)
● Growth retardation
● Impaired cognition

D. Jjj

Surgery
Any trauma question:
Initial resuscitation should be performed according to ATLS: ABCDE

Any procedure/test:
Name, process, indications, contraindications, principle and aim

Investigations:
● To confirm diagnosis
● To stage malignancy
● To check for fitness for surgery

Management:
● Constant monitoring
● Medical management
● Conservative management
● Surgical management

General principles of Management:

● Stabilize the patient & monitor the vitals.
● Cause should be found and treated.
● Correction of the anemia, deficiencies like protein and vitamins.
● Proper investigation as needed.
● Transfusion of the blood if required.
● Control the pain and infection.
 ● Rest, immobilization, elevation, avoidance of repeated trauma.

Description of any surgical procedure:

● Explain procedure to patient
● Take consent
● Inform about alternative procedures, indications, complications and failure
● rates Fitness for surgery
● Scrub, paint, drape
● Administer anesthesia
● Steps of surgery

Complications of any surgical procedure:

● Rupture of organ, perforation
● Injury to surrounding tissues, organs
● Rupture of blood vessel leading to excessive blood loss, hemorrhage, hypovolemic shock
● Infection: Iatrogenic spread or active infection direct spread leading to septicaemia

Contraindication to any surgical procedure:

● Active infection
● Drug allergy
● Lack of fitness for surgery
● Contraindications to anaesthesia

Any disease:
● Relevant anatomy
● Pathophysiology
● Clinical features
● Investigations
● Management

For any cancer:

● American Joint Committee on Cancer (AJCC) gives the tumor–node–metastasis (TNM)
staging for any carcinoma
● Etiopathogenesis of cancers: Activation of tumor growth-promoting genes and
proteins. Inactivation of tumor suppressor genes. Loss of contact inhibition.
Exposure to carcinogens. Inherited predisposition. Presence of other diseases
(other malignancies enhance the risk of metastasis). Alcohol consumption,
Smoking. Presence of precancerous lesions (metaplasia, dysplasia). Chemical
carcinogenesis (Radiation exposure, increased oxidative stress, reduced
antioxidants). Biological carcinogenesis. Idiopathic. (Note: hyperplasia →
metaplasia → dysplasia → carcinoma in situ → invasive carcinoma)
●
Orthopedics

Commonest site for most bone diseases: Lower end of

femur Risk factors:

a. Highlyvirulentorganisms
b. Malnourishment
c. VitaminDdeficiency
d. Hypocalcemia&Hyperparathyroidism
e. Immunocompromised:Oncorticosteroids,HIV,oldage
f. Senility
g. Osteoporosisduetomenopause-Postmenopausalagegroup h.
Wearandtearofbonesduetoheavyworkload

Clinical features:
● Pain
● Inability to move
● Swelling
● Redness
● Weakness
● Deformity
● Joint pain
● Fever, redness, swelling, pain (signs of inflammation)
● Discharging sinus (pieces of bone in the discharge)

Investigations:
a. Haematological:
● Complete blood count
● Culture: for discharging sinus (pus)
● ESR
● Calcium

b. Radiological:
● Xray
● USG
● Bone scans (Technetium 99, Indium 111,
● etc.) CT scan
● MRI

Treatment:
a. Conservativemanagement/Symptomaticrelief
 ● Bed rest
● Antibiotics
● Rehydration
● IV fluid resuscitation
● Immobilisation
● Restricted weight bearing and heavy exercise of affected bone
● Physiotherapy for later stages of recovery

b. Surgical management
● Open repair
● Excision
● Removal of dead bone, infected granulation tissue
● Amputation

Complications:
● Acute exacerbation
● Pyogenic arthritis
● Septicaemia
● Pathological fractures
● Growth deformities: Shortening, lengthening and deformation of bone
● Joint stiffness, tenderness
● Disability, restricted mobility

Obstetrics

Common risk factors for obstetric complications :

● Advanced maternal age
● Early maternity
● Immunocompromised: impaired host defense mechanism (HIV, cytotoxic therapy,
radiotherapy, chemotherapy, neutropenia), long term use of steroids, malignancies,
chronic diseases
● Family History
● Grand multipara
● Short stature
● Alcoholism, smoking, substance abuse & other addictions
● High risk pregnancy: PIH (per-eclampsia, eclampsia), GDM, Anemia, thyroid disorders,
heart disorders, multi fetal pregnancy
● Prolonged, obstructed labor, instrumental delivery, cephalopelvic disproportion, PPROM,
PROM
Common symptoms for obstetrics:
● Lochia
● PV spotting, PV bleeding, PV leaking
● Vaginal discharge: Foul smelling, white or bloody
● Lower abdominal pain
● Morning sickness (emetics gravidarum), hyperemesis gravidarum, nausea, vomiting
● Giddiness, headache, ataxia
● Seizure
● Orthostatic hypotension
● Weakness, lethargy, lassitude, easy fatigability
● Dyspnea, palpitations, chest pain

Common investigations for obstetrics:

● To confirm diagnosis
● To find the causative organism / etiology & to aid in antibiotic therapy (antibiotic
susceptibility testing)
● To check the prognosis of disease or response of patient to therapy
● Serological: CBC, LFT, RFT, S. Creatinine, BUN, lipid profile, coagulation profile, ABG &
serum electrolytes, etc.
● Hormonal assay: HCG, progesterone, estrogen, thyroid hormones
● Microbiological: Blood culture, stool & urine culture. Detection of causative organisms.
Detection of organism specific antibodies and antigens.
●
Fetal assessment: NST (non stress test), BPP (biophysical profile), CTG
● (cardiotocography)
Radiological: USG abdomen & pelvis, Doppler of umbilical vessels
●
Other: Electrocardiogram, Echocardiography

Important parameters to be monitored in obstetrics:

● Fetal movements
● Hb, blood glucose, bp monitoring
● Partograph during labor
● Vaginal discharge monitoring after / during pregnancy
● Lochia in puerperium

Principles of management in obstetrics:

● Hospitalization, start treatment as early as possible.
● Monitor vitals, stabilize the patient. GCS assessment.
● Put in recovery position.
● Airway (patent airway, clear obstruction due to secretions or tongue falling back),
breathing (monitor spO2, mechanical ventilation) & circulation (pulse, by monitoring)
● Secure an IV line: fluid resuscitation to maintain blood pressure. Monitor vitals, fluid
intake & output.
 ● Ventilatory support: oxygenate to maintain spO2. (Tracheostomy in emergency,
mechanical ventilation, endotracheal intubation)
● Correction of hypoglycemia with glucose. (DNS)
● Correction of electrolyte imbalances.
● Correction of metabolic disturbances.
● Give relevant medication: test dose to avoid anaphylaxis, monitor vitals after giving a
bolus, modify dose according to the response.
●
Antibiotic cover / empirical antibiotic therapy. (If you don’t remember: just put third
generation cephalosporin, fluoroquinolones, penicillin, etc.)
●
Lifestyle modifications, pharmacotherapy, psychotherapy, surgical interventions.

Gynaecology

Common risk factors for gynecological infections:

● Menstruating teenagers
● Multiple sexual partners
● Unprotected sexual intercourse
● IUD users
● Recurrence of previously existing disease
● Immunocompromised: impaired host defense mechanism (HIV, cytotoxic therapy,
radiotherapy, chemotherapy, neutropenia), long term use of steroids,
malignancies, chronic diseases
● Comorbidities: DM, HTN, Epilepsy, bronchial asthma, COPD, IHD, etc.

Common symptoms & signs in gynecological infections:

Symptoms
● Fever, lassitude
● Lower abdominal pain
● Vaginal discharge: white, purulent, foul smelling, bloody
● Dryness, itching/pruritus, leucorrhea
● Irritation & itching
● Infertility
● Menstrual abnormalities: Dysmenorrhea, Menorrhagia, Metrorrhagia or amenorrhea,
hypomenorrhea, oligomenorrhea
● Urinary symptoms: urgency, dysuria, recurrent urinary tract infection, stress urinary
incontinence, increased frequency of micturition
● Dyspareunia - painful sexual intercourse, dysuria - painful micturition
● Inflammation of organs: vaginitis, cervicitis, endometritis, vulvitis, urethritis,
epididymitis, prostatitis
●
Penile ulcerations
 Signs
● Adnexal tenderness
● Forniceal tenderness
● Thickening or mass present
● Congestion

Common preventive measures in Gyn :

● Community based approach to increase public health awareness.
● Prevention of sexually transmitted diseases with the knowledge of healthy and safer
● sex. Liberal use of contraceptives.
● Routine screening of high-risk populations.

Common complications in Gyn:

● Hematocolpos, hematometra, hematosalpinx, pyocolpos, pyometra, pyosalpinx
● Infertility
● Erosions
● In pregnancy: Genital infections can cause preterm labor, PROM, PPROM, LBW

Common principles of therapy in Gyn:

● To control the infection energetically.
● To prevent infertility and late sequelae.
● To prevent reinfection.
● Adequate rest, avoid sexual intercourse
● Analgesics
● Antibiotic cover: Syndromic management
● Metronidazole 200mg td
● Fluconazole 150mg od
● Ceftriaxone

Investigations:
● To confirm diagnosis
● To stage malignancy
● To check for fitness for surgery

Hematological investigations

Microbiological investigations

Radiological investigations & Imaging:

● Transvaginal ultrasound can accurately assess the myoma location, dimensions,
volume and also any adnexal pathology.
● 3D USG
 ● Hysteroscopy: to check for any pathology inside the uterus
● Hysterosalpingography: to check for tubal pathologies, blockage (filling defects), etc.
● MRI
● CT Scan

Other investigations:
● Laparoscopy
● Uterine curettage

Description of any surgical procedure:

● Explain procedure to patient
● Take consent
● Inform about alternative procedures, indications, complications and failure
● rates Fitness for surgery
● Scrub, paint, drape
● Administer anesthesia
● Steps of surgery

Complications of any surgical procedure:

● Rupture of organ, perforation
● Injury to surrounding tissues, organs
● Rupture of blood vessel leading to excessive blood loss, hemorrhage, hypovolemic shock
● Infection: Iatrogenic spread or active infection direct spread leading to septicaemia

Contraindication to any surgical procedure:

● Active infection
● Drug allergy
● Lack of fitness for surgery
● Contraindications to anesthesia