PMDC Step II Exam SEQs : 13th May, 2012 by DOW university

xavier

Forum Moderator
Forum Moderator
PMDC Step II Exam SEQs : 13th May, 2012
Each question contains 10 Marks.


1. i. What are some common psychiatric problems in Pakistan?
ii. How would you manage them?

2. i. What is the effect of stress on physical and psycosocial health of a person?
ii. Give non-pharmacological interventions for reducing stress.


3. A 25 years obese lady has come to you with blood sugar of 160mg/dl.
i. What further lab tests would you advice her?
ii. What advice will you give her about diet and exercise?
iii. What drugs can be prescribed according to the priority?


4. A 14 years old boy has come to you from Lahore with history of fever, malaise, generalized weakness and body ache. He has a purple rash on the shoulder. Anemia and Jaundice are negative. No hepatosplenomegaly. Platelets: 80000/ul. TLC: 23000/ul.
i. What are the differential diagnosis?
ii. What further investigation would you advice?
iii. How would you manage the patient?


5. A lady has come to you with history of a breast lump, which is 1.5 cm. The lump is movable and not fixed.
i. Write two differential diagnosis.
ii. How will you manage her?
[likelocker]

6. A 55 years old man with history of anuria for 16 hours, has come to you. On examination, the bladder is palpable.
i. What is the diagnosis?
ii. What further clinical examinations will you do?
iii. What are the drugs prescribed to him for this condition.


7. A 25 years old girl has come with history of papules and comedones on her face and back of shoulder. There is no telangiectasia.
i. What is the diagnosis.
ii. What is the pathogenesis and precipitating factors for this disease?
iii. How will you treat this condition?


8. A 6 years old child has come with history of pain and redness in his left eye. There is also stickness in the eye.
i. What are the differential diagnosis for this condition.
ii. What is the diagnosis?
iii. How will you give treatment?


9. A young boy has come to you with 3 years history of alternating nasal obstruction, itching in the nose, watery discharge from nose and sneezing, specially in the winters. Give a detail management for the patient.


10. i. Write the schedule of immunization programme in Pakistan according to EPI, in a chart form.
ii. How can you prevent poliomyelitis in our country according to latest interventions?


11. A 4 years old female child has come with vomiting and diarrhea for 3 days. There is also mucus and blood in the stool.
i. What is the diagnosis?
ii. What futher questions will you ask in the history?
iii. Name the organism involved.
iv. What is the best antibiotic to treat her?


12. A 25 years old lady has come with her husband to your clinic. She has not been ableto achieve pregnancy.
i. Write 3 common causes of infertility.
ii. Name 3 investigations useful to know the cause.
iii. What drugs can be prescribed to her to help conception?


13. A young lady with 8 weeks pregnancy has come with lower abdominal pain and bleeding per vaginum.
i. How will you investigate a case of ectopic pregnancy?
ii. What are the methods to deal with it?


14. A man has come with a history of stab on left chest. His BP is 100/70, RR 30/min, tachycardia and silent left sided chest. Neck veins are ******.
i. What is the diagnosis?
ii. What immediate investigation will you perform?
iii. Give the management plan.


15. A boy has come to you with severe dyspnea and wheezing. He is cyanosed and have history of dyspnea and wheezing in the past. He is also having tacchycardia.
i. Write down the immediate management of this patient.
ii. What lab investigations will you perform?
iii. Give the management plan for the future.
[/likelocker]
 
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can anyone tell what was the answer of q no 14....it is cardiac tamponade or pneumothorax?? ....and also what was the answer of q no 6??
 

s.s

New Member
dr_zartasha said:
can anyone tell what was the answer of q no 14....it is cardiac tamponade or pneumothorax?? ....and also what was the answer of q no 6??
i think its pneumothorax
 

drjawad61

Member
8. A 6 years old child has come with history of pain and redness in his left eye. There is also stickness in the eye.
i. What are the differential diagnosis for this condition.
ii. What is the diagnosis?
iii. How will you give treatment?

According to the question, if the answer is CONJUCTIVITS, it may be wrong, because in CONJUNCTIVITS involves both eyes. Plus the redness is unilateral. So I want to ask what is the correct diagnosis of this question. Will be thankful to you.
 

drjawad61

Member
ANY ONE PLEASE UPLOAD ALL THE DIAGNOSIS OF THE CASE SCENARIOS, IT WILL BE HIGHLY APPRECIATED FOR THOSE WHO ARE APPEARING IN STEP II.
IT IS A REQUEST FOR EVERYONE WHO KNOWS THE DIAGNOSIS OF ALL THE CASE SCENARIOS.
YOUR EARLY RESPONSE IS REQUIRED & WILL BE APPRECIATED.
THANKS.
 

xavier

Forum Moderator
Forum Moderator
drjawad61 said:
8. A 6 years old child has come with history of pain and redness in his left eye. There is also stickness in the eye.
i. What are the differential diagnosis for this condition.
ii. What is the diagnosis?
iii. How will you give treatment?

According to the question, if the answer is CONJUCTIVITS, it may be wrong, because in CONJUNCTIVITS involves both eyes. Plus the redness is unilateral. So I want to ask what is the correct diagnosis of this question. Will be thankful to you.

the answer is Bacterial Conjuctivitis. It usually involves both eyes but not always. Sometimes it starts in one eye and then infect the other eye after 1~2 days. Plus there is stickness in the eye which gives a clue about bac. conjuctivitis.
Kindly let us know what u think should be the answer...and then we can have a little chit chat which will definitely be helpful for other students.
 

xavier

Forum Moderator
Forum Moderator
drjawad61 said:
ANY ONE PLEASE UPLOAD ALL THE DIAGNOSIS OF THE CASE SCENARIOS, IT WILL BE HIGHLY APPRECIATED FOR THOSE WHO ARE APPEARING IN STEP II.
IT IS A REQUEST FOR EVERYONE WHO KNOWS THE DIAGNOSIS OF ALL THE CASE SCENARIOS.
YOUR EARLY RESPONSE IS REQUIRED & WILL BE APPRECIATED.
THANKS.
1. Common psychiatric problems in Pakistan: Depression, Generalized Anxiety, Schizophrenia, Post-traumatic stress disorder, Psychotic disorders due to substance abuse.

4. Dengue Fever
Malaria
Typhoid Fever

6. Benign Prostatic Hyperplasia

7. Acne Vulgaris

8. Bacterial Conjuctivitis

9. Allergic Rhinitis (Just to answer the questions)

11. Bacillary dysentery

14. Pneumothorax

15. Status Asthmaticus (Just to answer the questions)
 

drjawad61

Member
thanks xavier for the answer ,i also thought the same answer ,but in OXford hand book of clinical specialites and from other book and also from PLAB Digest ,i studied that conjuntivits is only one that has involves both eyes,but in case there is mentioning of only one eye ,so that confused me alot ,,

my second opinion is that there is also red eye in bacterial keratitis, and blepharospasm that mean closing of eyelid,
so that also cover STICKness of eye,

one more thing this is also possible that the scenario was missing e.g instead of unilateral there might be b/L ,that remove the dought completely, may be, but you know ,all i know was according to my knowledge,plz if iam wrong ,ifrom me ,your early response is highly appreciated
 

drjawad61

Member
xavier said:
drjawad61 said:
ANY ONE PLEASE UPLOAD ALL THE DIAGNOSIS OF THE CASE SCENARIOS, IT WILL BE HIGHLY APPRECIATED FOR THOSE WHO ARE APPEARING IN STEP II.
IT IS A REQUEST FOR EVERYONE WHO KNOWS THE DIAGNOSIS OF ALL THE CASE SCENARIOS.
YOUR EARLY RESPONSE IS REQUIRED & WILL BE APPRECIATED.
THANKS.
1. Common psychiatric problems in Pakistan: Depression, Generalized Anxiety, Schizophrenia, Post-traumatic stress disorder, Psychotic disorders due to substance abuse.

4. Dengue Fever
Malaria
Typhoid Fever

6. Benign Prostatic Hyperplasia

7. Acne Vulgaris

8. Bacterial Conjuctivitis

9. Allergic Rhinitis (Just to answer the questions)

11. Bacillary dysentery

14. Pneumothorax

15. Status Asthmaticus (Just to answer the questions)

THANKS A LOT FOR THE DIAGNOSIS ,ANSWERS ,THATS A GREAT JOB ,
 

xavier

Forum Moderator
Forum Moderator
drjawad61 said:
thanks xavier for the answer ,i also thought the same answer ,but in OXford hand book of clinical specialites and from other book and also from PLAB Digest ,i studied that conjuntivits is only one that has involves both eyes,but in case there is mentioning of only one eye ,so that confused me alot ,,

my second opinion is that there is also red eye in bacterial keratitis, and blepharospasm that mean closing of eyelid,
so that also cover STICKness of eye,

one more thing this is also possible that the scenario was missing e.g instead of unilateral there might be b/L ,that remove the dought completely, may be, but you know ,all i know was according to my knowledge,plz if iam wrong ,ifrom me ,your early response is highly appreciated

This page is from Oxford handbook of Opthalmology....see the line underlined in red. Usually bilateral but may be sequential, means can involve one eye in the begining and the other one later.




However, the point here is PAINFUL red eye. There is no pain in conjuuctivitis, but discomfort or burning is present. As the patient is 6 years old boy, he can not differentiate 'discomfort' from 'pain' ... so he will give history of pain instead of discomfort. (The scenario is totally correct and there was painful red eye plus stickness in left eye)

Blepharospasm is totally a different thing. There is twitching of eyelid and then dryness of eyes in blepharospasm.
 

drjawad61

Member
CAN ANY ONE PLEASE WRITE THE DIAGNOSIS OF THESE PAST PAPERS

CASE HISTORY
4. A 20 years old girl has come with one day history of right lower abdominal pain, loss of appetite, nausea and vomiting. Surgeon has decided to do appendectomy.
What are the findings observed by the surgeon in the removed appendix?
What would be the findings on microscopic studies of the removed appendix?


18. a) A baby girl has born with Sacrococcygeal swelling. What is the embryonic explanation of this teratoma?
b) What are the derivatives of Neural crest cells?

19. a) What are the blood schizonticidic antimalarial drugs?
b) What are the adverse affects seen by chloroquine use?

20. A 64 years old women fall on ground 2 hours back and brought to emergency with clinical feature of severe pain on movement of leg. When the leg abducted and externally rotated ,a pain slight relieved.
What is the possible diagnosis regarding damage? What could be other possible diagnosis of injury? Why leg was laterally rotated?

20 SEQs from the last PMDC exam 12th June, 2011
An old lady presents with history of fall, pain in pelvic region and cannot externally rotate her leg.
a) What is the most likely diagnosis?
b) Why can't she rotate her leg?
c) What is the supply to that area?
d) What tests will you perform to confirm your diagnosis?

2) a) What is the fate of RBCs?
b) How would you classify anemias?

3) a)What are the predisposing factors of cancer?
b) Write down the chemical carcinogens.



5) A 25 years old female has come to you with the history of oligomenorrhoea, weight gain and hirsutism.
a) What is the diagnosis?
b) How would you investigate her?
c) Give the treatment plan.

6) a) Why is there high maternal mortality rate in Pakistan?
b) How can you reduce the mortality rate?


7) A primigravida has come to you in 10th week gestation with blood group B -ve. How would you give antenatal care to her?

8) A 41 years old lady has come to you with severe joint pain. X-ray shows bony erosions.
a) What is the diagnosis?
b) Which vitamin and minerals deficiency can lead to this condition?
c) Write down the role of parathormone in human body.

9) A 27 years old man after the death of his father 1 month back, suffered from lack of sleep and interest, crying spells and loss of energy.
a) What is the most likely diagnosis?
b) What are the differential diagnoses?
c) What would be the drug choices to start the treatment?

10) A 30 years old sportsman has come with ring shaped lesions on his back with well defined margins.
a) What is the diagnosis?
b) How would you confirm the diagnosis on clinic and lab?
c) How will you treat him?

11) a) What are the Non-pharmacological interventions of behavioral changes?
b) Write down the DON'Ts of communication skills.

12) A 3 days old child presents with high grade fever, irritability and reluctant to feed.
a) What are the risk factors of neonatal sepsis?
b) How would you investigate a case of neonatal sepsis?

13) A patient with history of proteinurea ++, BP 130/90, TLC 25000, Glycocylated Hb 9.
a) What is the most likely diagnosis?
b) What is the treatment to reduce the proteinurea?

14) A young female presents with swelling in-front of the neck with history of palpitations and perspiration.
a) What other clinical signs would you look for?
b) How would you investigate her?
c) How would you treat her?

15) A child presents with to you with itchy eyes. He has a family history of atopy.
a) Write down the differential diagnosis.
b) How would you treat the child?

16) a) What are the causes of haematemesis?
b) Give management of acute case of haematemesis.

17) An 11 years old boy has come to you with severe earache.
a) What are the causes of earache?
b) How would you treat the child?

18) A young boy got fever with rigors and chills. On examination, there is splenomegaly. Lab investigations show anemia, thrombocytopaenia. Blood smear shows Plasmodium Falciparum.
a) How would you further investigate him?
b) What are the complications of malaria?
c) How will you teat a case of falciparum malaria?

19) A 42 years old lady has come to you with neck swelling.
a) How will you classify the goiters?
b) Write down the investigations for goiter.

20) A 42 years old lady has presented with fever of 101 °F, anorexia, nausea and pain in right mid abdomen. On examination, there is guarding and tenderness in the right mid abdomen.
a) What is the most likely diagnosis?
b) Write down FOUR differential diagnoses.
c) Give the steps of management.
1) A man of 40 years with drooping of eyelids presented to Medical OPD with complains of difficulty in swallowing towards the end of the meal intake and severe musde weakness few minutes after the start of exercise.
a)from which disorder the man is suffering? b) what is the course of this disorder? C) Which drug is effective In this disorder?

2) A young man sustained injury to the chest in a road accident.Effective ventilation was compromised by a large flail segment of the thoracic wall. His investigations showed: Arterial PCO2~ 60 mmHg (40 mmHg) Arterial PO2~ 65 mmHg (95 mmHg) Arterial pH 7.25 (7.4) Arterial bicarbonate 25 mmol/L (24 mmol/L) •) a)Which disorder the young man developed7 b)explain the compensatory mechanisms initiated in the man to correct the disorder?

3) Enlist SIX clinical uses of sympathomimetic drugs with one drug example for each use.



4) An 8 year old school going chlid had severe bacterial pharyngitis, which was treated by the familv physician. Alter 3 weeks, he developed fever, migratory polyarthritis and carditis.

a) Name the condition and the causative organism. b) Name ONE other sequel of this type of pharyngis and the type of hypersensitivity involved.

5)A woman of 35 years old was diagnosed to have Carpal Tunnel Syndrome. Give Its anatomical basis. Which factors predispose to this condition?what are the symptoms of this disease?

6)A 2 year old girl who has cough and difficulty in breathing is brought to a basic Health Unit. On examination her respiratory rate is 65 breaths / min and she has chest In-drawing.

a) What question would you ask from the mother? b) What examination would you perform in this patient according to IMCI Guidelines?c) If the child does not have any danger sign how would you classify and treat her?

7)A 1 year old boy has high grade fever and sore throat for one day, He develops generalized tonic clonic seizure which last for five minutes. His elder brother also has similar episode when he was 9 months old.. a)what is the most likely diagnosis? B)how would you manage this child? C)what is the prognosis of this condition? .


8)A 37 year old man presents with four months history of having loose motions with blood and mucous. He has not responded to repeated courses of antibiotics and metronidazole. He has also developed backache and polyarthralgia. There is no history of significant weight loss..

a) What is the most likely diagnosis? B) list TWO relevant investigations with likely abnormalities c) briefly outline the treatment.

9)A 52 year old clerk Who had myocardial infarction two months earlier presents with shortness of breath on exertion.. He is also woken up at night with severe shortness of breath and bouts of cough. a) What is the most likely diagnosis b) list Five Important principal signs to be looked for c) list TWo most relevant Investigations to make the diagnosis
10)A 33 year old lady who is known to have mitral stenosis and regurgitation presents with sudden onset weakness of left half of body.her pulse is irregularly irregular.

A)what is the most likely cause of her paralysis? b) Name ONE deffinitive test to confirm the neurological problem c) Name ONE deffinitive Investigation to look for the likely cardiac problem d) How would YOU prevent further stroke In this lady

11)A 15 year old girl is brought to emergency with vomitting, shock and pain abdomen. She is having rapid breathing. She is afebrile, her chest is clinically clear and there Is no abdominal rigidity. Her laboratory results shows; Blood Glucose 18 mmol/L Sodlum 131 mmol/L Potassium 5.8. mmol/L Bicarbonate 08 mmol/L pH (Arterial Blood) 6.9

a)what is the most likely diagnosis ?b)what acid base abnormality is present? c) outline briefly the management

12)A 48 year old man under treatment for hypotension comes to the clinic for follow-up visit.Blood pressure is well controlled with diurerics.Examination shows bilaterally palpable kidneys.His urea and creatinine are slightly elevated.his elder brother is also being treated for hypertension and renal disease.
a)what is the most likely diagnosis? b)which investigation is required to confirm the diagnosis?c)list the likely renal complications
Hidden content: UNLOCKED
________________________________________
13)A 40 year old patient presents to you with grouped vesicles and blisters in a band like distribution on the right side of his chest.he has a history of pain in the same region,three days prior to eruption.
a)what is your diagnosis?justify your diagnosis. b)how will you treat this patient?

14)A boy 19 years of age comes to you with severe pain in the throat on right side with fever and dysphagia for one day.On examination his saliva is drooling from right angle of mouth.He is unable to open his mouth properly.throat examination shows swollen and congested right tonsil and anterior pillar.
a)what is the most probable diagnosis?
b)how will you treat the case?

15)A 9 years old boy presents with burning,itching and thick ropey discharge from the eyes.The symptoms get aggravated in summer season and respond well to medication.
a)what is the probable diagnosis?
b)what is the aetiology of the disease?
c)what are the treatment options?


16)A 26 years old P2+O presented with severe abdominal pain and attacks of faintness.Last menstrual period(LMP)was unsure.Her pulse was 110/minutes and blood pressure was 90/60 mmHG.
A)WHAT IS THE MOST LIKELY DIAGNOSIS?
B)HOW WILL YOU MANAGE HER?

17)A 40 year old lady has presented with pain in right hypochondrium with radiation to right shoulder and jaundice with temperature.
a)what is your appropriate investigation plan?
b)what are the treatment options for bile duct stones?

18)A young lady with multinodular goiter has been advised surgery for cosmetic reasons.Give the steps of operation for subtotal thyroidectomy?

19)A 25 year old man is planned for anorectal surgery under spinal anaesthesia.
a)what is the most appropriate site for injection and why?
b)Enlist the complications of spinal anaesthesia

20)A 36 year old primigravida is followed up at the health centre and referred to the hospital antenatal clinic at 37 weeks of gestation.On abdominal examination the size of the uterus corresponds to the dates and the head was not engaged but instead felt in the fundus with a longitudinal lie.
a)what is the most likely presentation in this case?
b)what would you like to do before you allow this patient to deliver vaginally?Mention Two.
c)Mention Three complications to this fetus that can occur during delivery.

21)A patient weighing 60 kg has sustained burn of face and scalp,upper chest front and both upper limbs
a)what is the percentage of burn area?
b)what is the calculation of fluid for first 24 hours?
c)what is the escharotomy?

22)A 45 year old lady with carcinoma of breast had undergone modified radical mastectomy on right side and has been advised chemotherapy treatment.
a)what is the broad classification of broad chemotherapeutic agents”?
b)what are the complication of chemotherapy?

23)Healthcare is at cross-roads,as regards the ideal model of healthcare
a)list the four the major differences between the conventional Medical model of healthcare and Engels biopsychosocial model of healthcare.
b)Which model of healthcare will you prefer to use in your clinical practice?Justify your choice by Highlighting briefly the advantages that your choice carries.

24)As a doctor working in a remote village of Pakistan with no reproductive Health facilities,You notice that a number of new borns delivered by traditional birth attendants are dying within a week after developing spasm of body ,jerks,arching of the back refusal to take mother feed and eventually difficulty in breathing.
a)what would be the most likely cause of these deaths?
b)what preventive steps would you put into place to stop these deaths?





25)A 29 Years old Housewife present with feeling fatigue and lethargy in the morning that improves as the day passes for the last three months.she feels that she can no longer cope with ‘Heavy-workload’ at home and that she is unable to enjoy her sex-life.Her appetite is reduced and tends to wake up repeatedly at night after fearful dreams.She feels that this could be a ;punishment ‘for the thousands of sins that she has committed.
She states that her symptoms started just after she recovered from a prolonged fever and that did not respond to antibiotics.and that she feels better after taking –rest.
a) List Four clinical conditions that you will consider in the differential diagnosis ;choosing also the most probable /likely diagnosis.
b) Name TWO drugs that she is likely to respond with their doses
c) What would you tell the patient and family about the nature of patients illness

) A man of 40 years with drooping of eyelids presented to Medical OPD with complains of difficulty in swallowing towards the end of the meal intake and severe musde weakness few minutes after the start of exercise.
a)from which disorder the man is suffering? b) what is the course of this disorder? C) Which drug is effective In this disorder?
Hidden content: UNLOCKED

2) A young man sustained injury to the chest in a road accident.Effective ventilation was compromised by a large flail segment of the thoracic wall. His investigations showed: Arterial PCO2~ 60 mmHg (40 mmHg) Arterial PO2~ 65 mmHg (95 mmHg) Arterial pH 7.25 (7.4) Arterial bicarbonate 25 mmol/L (24 mmol/L) •) a)Which disorder the young man developed7 b)explain the compensatory mechanisms initiated in the man to correct the disorder?

3) Enlist SIX clinical uses of sympathomimetic drugs with one drug example for each use.

4) An 8 year old school going chlid had severe bacterial pharyngitis, which was treated by the familv physician. Alter 3 weeks, he developed fever, migratory polyarthritis and carditis.

a) Name the condition and the causative organism. b) Name ONE other sequel of this type of pharyngis and the type of hypersensitivity involved.

5)A woman of 35 years old was diagnosed to have Carpal Tunnel Syndrome. Give Its anatomical basis. Which factors predispose to this condition?what are the symptoms of this disease?

6)A 2 year old girl who has cough and difficulty in breathing is brought to a basic Health Unit. On examination her respiratory rate is 65 breaths / min and she has chest In-drawing.

a) What question would you ask from the mother? b) What examination would you perform in this patient according to IMCI Guidelines?c) If the child does not have any danger sign how would you classify and treat her?

7)A 1 year old boy has high grade fever and sore throat for one day, He develops generalized tonic clonic seizure which last for five minutes. His elder brother also has similar episode when he was 9 months old.. a)what is the most likely diagnosis? B)how would you manage this child? C)what is the prognosis of this condition? .

8)A 37 year old man presents with four months history of having loose motions with blood and mucous. He has not responded to repeated courses of antibiotics and metronidazole. He has also developed backache and polyarthralgia. There is no history of significant weight loss..

a) What is the most likely diagnosis? B) list TWO relevant investigations with likely abnormalities c) briefly outline the treatment.

9)A 52 year old clerk Who had myocardial infarction two months earlier presents with shortness of breath on exertion.. He is also woken up at night with severe shortness of breath and bouts of cough. a) What is the most likely diagnosis b) list Five Important principal signs to be looked for c) list TWo most relevant Investigations to make the diagnosis

10)A 33 year old lady who is known to have mitral stenosis and regurgitation presents with sudden onset weakness of left half of body.her pulse is irregularly irregular.

A)what is the most likely cause of her paralysis? b) Name ONE deffinitive test to confirm the neurological problem c) Name ONE deffinitive Investigation to look for the likely cardiac problem d) How would YOU prevent further stroke In this lady

11)A 15 year old girl is brought to emergency with vomitting, shock and pain abdomen. She is having rapid breathing. She is afebrile, her chest is clinically clear and there Is no abdominal rigidity. Her laboratory results shows; Blood Glucose 18 mmol/L Sodlum 131 mmol/L Potassium 5.8. mmol/L Bicarbonate 08 mmol/L pH (Arterial Blood) 6.9

a)what is the most likely diagnosis ?b)what acid base abnormality is present? c) outline briefly the management


12)A 48 year old man under treatment for hypotension comes to the clinic for follow-up visit.Blood pressure is well controlled with diurerics.Examination shows bilaterally palpable kidneys.His urea and creatinine are slightly elevated.his elder brother is also being treated for hypertension and renal disease.
a)what is the most likely diagnosis? b)which investigation is required to confirm the diagnosis?c)list the likely renal complications
Hidden content: UNLOCKED
________________________________________
13)A 40 year old patient presents to you with grouped vesicles and blisters in a band like distribution on the right side of his chest.he has a history of pain in the same region,three days prior to eruption.
a)what is your diagnosis?justify your diagnosis. b)how will you treat this patient?

14)A boy 19 years of age comes to you with severe pain in the throat on right side with fever and dysphagia for one day.On examination his saliva is drooling from right angle of mouth.He is unable to open his mouth properly.throat examination shows swollen and congested right tonsil and anterior pillar.
a)what is the most probable diagnosis?
b)how will you treat the case?

15)A 9 years old boy presents with burning,itching and thick ropey discharge from the eyes.The symptoms get aggravated in summer season and respond well to medication.
a)what is the probable diagnosis?
b)what is the aetiology of the disease?
c)what are the treatment options?

16)A 26 years old P2+O presented with severe abdominal pain and attacks of faintness.Last menstrual period(LMP)was unsure.Her pulse was 110/minutes and blood pressure was 90/60 mmHG.
A)WHAT IS THE MOST LIKELY DIAGNOSIS?
B)HOW WILL YOU MANAGE HER?

17)A 40 year old lady has presented with pain in right hypochondrium with radiation to right shoulder and jaundice with temperature.
a)what is your appropriate investigation plan?
b)what are the treatment options for bile duct stones?
18)A young lady with multinodular goiter has been advised surgery for cosmetic reasons.Give the steps of operation for subtotal thyroidectomy?

19)A 25 year old man is planned for anorectal surgery under spinal anaesthesia.
a)what is the most appropriate site for injection and why?
b)Enlist the complications of spinal aneasthesia

20)A 36 year old primigravida is followed up at the health centre and referred to the hospital antenatal clinic at 37 weeks of gestation.On abdominal examination the size of the uterus corresponds to the dates and the head was not engaged but instead felt in the fundus with a longitudinal lie.
a)what is the most likely presentation in this case?
b)what would you like to do before you allow this patient to deliver vaginally?Mention Two.
c)Mention Three complications to this fetus that can occur during delivery.

21)A patient weighing 60 kg has sustained burn of face and scalp,upper chest front and both upper limbs
a)what is the percentage of burn area?
b)what is the calculation of fluid for first 24 hours?
c)what is the escharotomy?

22)A 45 year old lady with carcinoma of breast had undergone modified radical mastectomy on right side and has been advised chemotherapy treatment.
a)what is the broad classification of broad chemotherapeutic agents”?
b)what are the complication of chemotherapy?

23)Healthcare is at cross-roads,as regards the ideal model of healthcare
a)list the four the major differences between the conventional Medical model of healthcare and Engels biopsychosocial model of healthcare.
b)Which model of healthcare will you prefer to use in your clinical practice?Justify your choice by Highlighting briefly the advantages that your choice carries.

24)As a doctor working in a remote village of Pakistan with no reproductive Health facilities,You notice that a number of new borns delivered by traditional birth attendants are dying within a week after developing spasm of body ,jerks,arching of the back refusal to take mother feed and eventually difficulty in breathing.
a)what would be the most likely cause of these deaths?
b)what preventive steps would you put into place to stop these deaths?

25)A 29 Years old Housewife present with feeling fatigue and lethargy in the morning that improves as the day passes for the last three months.she feels that she can no longer cope with ‘Heavy-workload’ at home and that she is unable to enjoy her sex-life.Her appetite is reduced and tends to wake up repeatedly at night after fearful dreams.She feels that this could be a ;punishment ‘for the thousands of sins that she has committed.
She states that her symptoms started just after she recovered from a prolonged fever and that did not respond to antibiotics.and that she feels better after taking –rest.
a) List Four clinical conditions that you will consider in the differential diagnosis ;choosing also the most probable /likely diagnosis.
b) Name TWO drugs that she is likely to respond with their doses
c) What would you tell the patient and family about the nature of patients illness
 
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