PART II SEQS PAPPER ; 15 X 10 =150

Q;1.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?

Q;2A 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?

Q;315. A boy has come to you with severe dyspnea and wheezing. He is cyanosed and have history of dyspnea and wheezing in the past.on examination chest is silent. He is also having tacchycardia.i. Write down the immediate management of this patient.?ii. What investigations will you perform immediately?iii. Give long term mx plan for future?

Q;4A 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?

Q;5i. 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?

Q;6A man has come with a history of stabwound on left chest. His BP is 100/70, RR 30/min, tachycardia and on exam breath sounds are dec . Neck veins are distended.i. What is the diagnosis?ii. What immediate measure will you perform?iii. Give definitet management?

Q;7A young 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.what investigation you will offer?

ii. How will you manage her?

Q;8A 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

Q;9A young lady with 8 weeks pregnancy has come with lower abdominal pain and bleeding per vaginum.i.give D/D?i. How will you investigate a case of ectopic pregnancy?ii. What is management?

Q;10A 25 years old lady has come with her husband to your clinic. She has not been conceived from last two yrs .i. Write 3 common causes of infertility?ii. Name 3 investigations useful to know the cause?iii. Name drug used for ovulation induciton?

Q;11A 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.

I-Give a detail management for the patient?

Q;12A 6 years old child has come with history of mild 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 investigate and manage ?

Q;13A 25 years old girl has come with history of papules and nodules 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?

Q;14i.write common psychiatric problems in Pakistan?ii. How would you manage them?

Q;15i. What is the effect of stress on physical and psycosocial health of a person?ii. Give non-pharmacological interventions for reducing stress.

PART II; MCQS PAPPER ; 150 X 1 =150

1-CASE:ASCENDING PARALYSIS OF LIMBS FOLLOWINGG.I INFECTION IN 13 YRS OLD BOY;OCCUR INA-G.B SYNDROMEB-LMN LESIONC-UMN LESIOND-TRANSVERSE MYLITISE-MYASTHENIA GRAVIS

2-COMMON COMPLICATION OF NASAL BONE FX IS A-SEPTAL HAEMATOMAB-SEPTAL ABCESSC-SEPTAL PERFORATIOND-SADDLE NOSE DEFORMITYE-NEOPLASIA

3-CASE:TITHTENESS OF FORHEAD SKIN+INTERSTIAL FIBROSIS OCCUR IN A-SYSTEMIC SCLEROSISB-RHANAUDE DZC-RAD-REITERS SYNDE-UMN LESION

4-CASE;CSF SHOW INC NEUTROPHILS,PROTEIN AND GLUCOSE >70 OF SERUM GLUCOSE SHOWA-ENCEPHLITISB-PYOGENIC MENINGITISC-VIRAL –D-TB—E-FUNGAL --

5-DRUR OF CHOICE IN ACUTE MX IF SBP ISA-CEFITAXIMEB-CEFTRIAXONEC-CIPROFLOXACIND-TETRACYCLINE-PENICILLIN

6-CASE;-- -- -ON EXAMINATION SUCCESSION SPALSH IS FOUND IN EPIGASTRIC AREAA-C.PYLORIC STENOSISB-HYDROPNEMOTHRAXC-NECROTIZING ENTEROCOLITIS

D-INT.OBSTRUCTIONE.IMPERFORATE ANUS

7-MOST COMMON COMPOSTION OF U.BLADDER STONE ISA-MIXEDB-CA OXALATEC-URIC ACIDD-STRUVITE CALCULIE-PHOSPHATE

8-IN DABETIC PT—WET GANGRENE IS DUE TO—A-NEUROPATHIC ULCER WITH INFCTIONB-ISCHEMIAC-NEUROPATHYD-INFCTIONE--------

9-CASE:---HAPATOSPLENOMEGALY AND DEC GLUCOCEREBROCIDASE FOUND INA-GAUCHER DZB-GILBERT SYNDC-

10—IN PREGNANT LADY;EPIDURAL ANESTHESIA ACT—AS—TOA-PRONG ANESTHESIA AFFECT IN POST OPERATIVE PERIDEB-0NLY DURING DELIVRYC-D-

11-BEST INVESTIGATIN OF CHOICE FOR ANGIOFIBROMA ISA-CT SCANB-MRIC-X-RAY LAT VIEWD---- ----- WATERS VIEWE-

12-CASE;PT PRESENT WITH FITS AFTER MIDDLLE EAR INFCTION INVEST OF CHOICE WILL BEA-CT SCAN OF HEAD B-MRIC-X-RAYD-

13-WHICH HERNIAL REPAIR IS GOOD TO PREVENTITS RECURRANCEA-SHOULDICE REPAIRB-BASSINI REPAIRC-LYTE,S REPAIRD-MESH REPAIRE---

14-IN HYPERTHYROIDISMA-DEC.TSH,INC T3 T4

B-INC.TSH----C-NORMAL---D-DEC.T3 T4E-INC.TSH

15-IN PANCREATIC INJURYA- INC AMYLASEB-INC TRYPSINOGENC-INC GASTRIND-INC CHYMOTRYPSINE-INC LIPASE

16-CASE:ASCENDING PARALYSIS OF LIMBS FOLLOWINGR.T.I INFECTION IN 9 YRS OLD BOY;OCCUR INA-G.B SYNDROMEB-LMN LESIONC-UMN LESIOND-TRANSVERSE MYLITISE-MYASTHENIA GRAVIS

17-CASE: IN A CHILD, BARKING COUGH AND HOARSENESS FOUND INA-CROUPB-EPIGLOTTITISC-ACUTE LARYNGITISD-R.LARANGEL N INJURYE-LUNG CA

18-F.BODY BELOW VOCAL CORDS I S SHOULD TAKEN OUT WITHA-BRONCHOSCOPEB-TRACHEAL---C-D-

19-CASE; ABSENT PERIPHERAL PULSES ACUTLY INDICATEA- ATHEROEMBOLISMB-ISCHEMIAC-RHANAUDE DZD-DRY GANGRENEE-VARICOSE VEINS

20-IN A YONG BOY.CAUSE OF POST RENAL FAILUER IS -----A-POST URETHRAL VALVEB-HAEMOLYTIC DZC-NEPHROTIC SYNDD-TOXINSE-HYPOSPADIAS

21-MOST COMMON CAUSE BOWL-OBSTRUCTION IN ADULTS ISA-HERNIAS

B-ADHESIONSC-FECAL IMPACTIOND-GI CAE-ING.HERNIA

22-MOST COMMONLY PERIANAL FISTULA FORMATION OCCUR --A-PERIANAL ABCESS BURSTB-IN RECTAL CAC-F.BODY –D-

23-LOW FISTULA IS A-BELOW ANORECTAL RINGB-BELOW DENTATE LINEC-ABOVE DENTATE LINE D-BELOW PECTINATE LINEE-ABOVE ANO-RECTAL RING

24-MOST COMMON CAUSE OF ANAL FISTULA IN PAK IS A-T.BB.CROHNS DZC-U/COLITISD-HPVE-RECTAL CA

25-TRANSIENT ERYTHEMATAUS RASH SHOW --A-WHEALB-PARAKERATOSISC-MACULED-PAPULEE-ACANTHOSIS

26- ACANTHOLYSIS IS A FEATUER OF –A-PEMPHIGUSB-B.PHEMPHIGUS C-SUPPURATIVE HIDRANITISD-PSORIASISE-S-JOJNSAN-SYND

27-CASE;MACULOPAPULAR RASH AFTER 1 DAY TX OF R.T.I OCCUR –A-EBVB-MEASLESC-HERPESD-CHICKENPOSE-LYME DZ

28-ULCERATED ,EVERTED EDGE IS A FINDING OF A-MALIGNANT MELANOMAB-BCCC-TROPHIC ULCERD-TB ULCERE-SCC

29-LEAST COMMON CAUSE OF TESTICULAR CA ISA-INTERSTIAL TETRATOMAB.SEMINOMAC.TERATOMAD-LYMPHOMAE.—

30-USUALLY DX OF CONGENITAL DISORDER IS DONE WITHA-U/SB-CVSC-AMINOCENTESISD-TRIPLE SCANE- NUCHAL TRANSLUCENCY

31-PRANGNANT LADY PRESENT AT 8 WKS WITH PREVIOUS HISTORY O F CONGENITAL ANOMLY WHAT INVST-- -A- CVSB-AMINOCENTESISC-TRIPLE SCAND-NUCHAL TRANLUCENCYE----

32-TRIPLE SCAN DURING PREGNANCY INCLUDE—EXCEPTA-AFPB- ESTRIOLC-FSH&LHD---

33-CASE;YOUNG FEMALE PRESENT WITH DYSMENOREA ,DYSPAREUNIA AND HAVE IRREGULAR M/C.A-ENDOMETRIOSISB-ADENOMYOSISC-FIBROIDSD-CERVICAL CAE----

34-PAINLESS WHITISH PLAQUE ON BUCCAL MUCOSA—A-CANDIDA ALBICANSB-MUCORC-HPVD-INF.MONONUCLEOSISE-ASPERGILLOSIS

35-IN HOGJKIN LYMPHOMA--- IS A-PAINLESS SUPRACLAVICULAR L.AB.PAINFUL-----C-PAINFUL MEDIASTINAL L.AD-PAINLESS -----E-VIRCHOWS NODE

36-PHAKOLYTIC GLAUCOMA –A-DEVELOPMENTALB-DUE TO CHANGE IN SHAPE OF LENSC- ---------D- ---------E. 

37-CASE; LYTIC LESION ON X AND X-RAY AND BONE PAIN –A-MULTIPLE MYELOMAB-THALASSEMIAC-M.SCLEROSISD-PAGETS DZ OF BONEE-RA

38-MOSTLY TRACTIONAL RETINAL DETACHMENT OCCUR IN A- DIABETIC RETINOPATHYB-ROPC-RDD-GLAUCOMAE-----

39-RECENT MX OF CHOICE FOR SENILE CATARACT ISA-CATARACT EXTRACTIONB-PHAECOEMUSIFICATION WITH IOL IMPLATAIONC-IOLD-DON’T TXE-INTRA CAPSULAR EXTRACION

40-INDICATION OF VACUME—FOR DELIVRY ISA---CROWNINGB------C-----D-

41-20 YRS OLD PREG LADY UNDERGO OBSTRUCTED LABOUR----MX IS TO---A-PROSTAGLANDINS B-OXYTOICINC-C-SECTD--------E- -------

42-20 YRS OLD LADY PRESENT WITH MENORRHAGIA,MX WILL BE --A-MAFENAMIC ACID + TRANEXAMIC ACIDB-OCPC-TRANEXAMIC ACIDD-MAFENAMIC ACID E- GnRH ANALOG

43-STRABISMIUSA-MISALIGNMENT OF EYEB- ------C- ------

D- 

44-RATIO OF MAJOR DEPRESSION IN A POPULATION ISA-EQUALB-F:M 2:1C- -----1:3D------3:1E- 

45- IT IS RECOGNIZED REGARDING FOLLOWING -------- DZ TO HAVE CNS STRUCTURAL DEFECT,A- SHIZOPHRENIAB-DEPRESSIONC-ANXIETYD-PTSDE----

46-CLEFT LIP REPAIR IS DONE AT ---A- 3-MONTHSB-10 MONTHSC-I YR D-18 ME-2 YR

47-REGARDING 4 PILLARS OF MEDICAL ETHICS;JUSTICE ISA-FAIR/EQUAL DISTRIBUTION OF HEALTH RESOURCESB-TO GIVE COMPLETE INF REGADING DZC-NEVER HARMD-PT INTEREST AND HEALTH IS IMPTE---

48-COMMOM MISCONCEPTION REGARDING COUNSELLING ISA-INVOLVE GIVING DIRECT ADVICE TO PT B-----C----D-

49-BEST MX OF CONFLICT RESOLUTION IS ITS- --A-PREVENTIONB-C-D-

50- ----------MODEL IS WIDLEY DISCOURAGED BY MODERAN DAY DOCTORSA-NON-DISCLOSUR MODELB-FULL DISCLOUSUR MODELC-D-

51-COUNSELLING IS ---A-DEEP UNDERSTANDING,&TO HELP PEOPLE THEMSELVES

B---C-D-

52-PT CONCERN REGARDING MX AND ITS RISK IS ASK IN ---A-INFORMATIONAL CARE B-COUNSELLINGC-FULL DISCLOUSAR D-E-

53-FOLLOWING IS CRISIS SITUATION –A-ROLE CONFUSIONB- ---------------C- ---------------D-

54-CASE DX,-----------BUDD CHIARI SYD----

55-MX OF CALCIFIED HYDATID CYST IS A-NO TXB-EXCISEDC-DRAIND-LOBCTOMYE---------

56-MX OF SPLENIC ABSCESS –ISA- DRAIN IMMEDIATELYB-SPLENECTOMYC-IV ABXD-STEROIDSE----

57-CASE; BLOODY DIARRHEA OCCUR INA-CRHONS DZB-ULCERATIVE COLITISC- DIVERTICULITISD-ANAL FISSUERE---------

58-CASE;IN MENSTURATIN WOMEN—UNDERGO SHOCK AND ERYTHEMATOUS SKIN ERUPTION,S CAUSE IS A-BACTEROIDSB-STAPH AUREUSC-E COLID-PSEUDOMONASE- ------

59-PTH---A-MAINTAIN OSTEOBLAST AND OSTEOCLAST ACTIVITYB-INC CA ABSORPTION FROM GIC-------D-----E-

60-AT WHICH MONTH CHILD ADOPT PRONE PROSITION AND START PLAY FROM HAND TO HANDA-3 MONTHB-6 MONTHC-9 MONTHD-12 ---E-18---

61-CASE;PARAMEDIAN VOCAL CORD PALSY,HORSENESS.IN A PT WITH HISTORY OF SMOKING –MOSTLYA-RECURRENT LARANGEAL NERVE PALSYB-CA BRONCHUSC-LEFT R LARANGEAL N PALSYD-CA STOMACHE------------

62-ASYMETRIC-OLIGO-INFLAMATORY ARTRITIS OCCUR IN ----A-PSORIASISB-RAC-------------D-----------E.

63-FOR CHEST TUBE DRAIN TUBE IS INSETED IN ----A-4TH ICSB-5TH ICSC-2ND ICSD—

64-CASE;ABORTION AT 14 WKS . MX WILL BEA-SURGICAL EVACUATIONB-INDUCTIONC-OXYTOCIND-C-SECTE-------

65-COMMON CAUSE OF IST TRIMESTER MISCARRIAGE ISA-CHROMOSOMAL ABNORMALITIESB- DRUGS C-HPT&GDMD----------E—

66-MOST COMMON CAUSE OF PPH IS A- RETAINED PLACENTA

B-MULTIPLE GESTAIONC- UTERINE ATONYD-E-

67-CASE;SUDDEN CATASTROPHIC CARDIOVASCULAR COLLPSE AND COAGULAPATHY AFTER ACCIDENTA-ATHEROEMBOLISMB-GAS EMBOLISMC-FAT EMBOLISMD---E—

68-DYSNEA ON 2ND POST OP DAY ---A-ATELACTASISB-PNEMONIAC-PNEUMOTHORAXD-MIE-PE

69-MX OF DVT INCLUDE---A-HEPARIN FOLLWED BY WARFARINBB-COMPRESSION STOCKINGC-WARFARIND-----E-----

70-FIXED SPLITTING OF 2ND HEART SOUND ---A-VSDB-PDAC-MSD-TOFE-ASD

71-CSOM;CENTRAL PERFORATION IS IN A-PARS TENSAB-PARS FLACCIDAC-ATTICO-ANTRALD-E-

72-PHYLLOIDS TUMOUR OF BREAST.MX ISA-WIDE EXCISIOMB.R.MASTECTOMYC.M.R.MASTECTOMYD-----------E.

73.PRECOUCIOUS PUBERTY---IN ----A-21 HYDROXLASE DEF

B-CONG ADRENAL HYPERPLASIAC-DOWN SYNDD-------E-------

74-CASE;TRAUMA TO BREAST ON EXAMINATION THERE IS THETHERING OF BREAST SKIN DX ISA-CA BREASTB-FAT NECROSISC-FIBROADENOMAD-----E—

75-CASE;PREGNANT LADY ---COAGULATION ABNORMALITY—---UNDERGO PARALYSIS OF –A-ANTI PHOSPHOLIPID SYNDB---------C---------D-

76-INVST OF CHOICE FOR IMMEDIATE DX OF I.E ISA-ECHOB-BLOOD CULTUERC------D—E.

77-CASE;RETROSTERNAL BURNING PAIN OCCUR IN –A-GERDB-MIC-GASTRITISD-OESOPHAGEAL SPASME.

78-LIVER COND CAUSE PRURITIS DURING PREGNANCYA-CHOLESTASIS OF PREGNANCYB-CIRRHOSISC-LFD-BUDD CHIARI SYNDE------

79-FACTOR VIII DEF OCCUR IN A- HAEMPHILIA AB- HAEMOPHELIA BC-SC DZD-WV DZE.WARM AB HAEMOLYTIC ANEMIA

80-CASE-MX. INDICATION FOR HAEMODYLYSIS ISA-K>7,FLUID OVERLOADB---C—

D—

81-WILSON DZ AFFECT A-CORNEAB-BRAIN C-LIVERD-ALL ABOVEE- KIDNEY

82-CASE;PROXSMAL HPT------—DXA-PHAECHROMOCYTOMAB-CUSHING SYNDC-R A STENOSISD------E-------

83-TYPICAL FEATUER OF HYPOTHYROIDISM ISA-MENORRHAGIA IN FB-DRY SKINC-COLD INTOLERANCED-BRADYCARDIAE-

84-CASE;ACID BASE DISORDER—DX—A-COMPENSATED RESPT ALKALOSISB-C-

85-PYCHOLOGICAL COMPONENT OF ANXIETY IS A-TREMORB-SWEATINGC-PALPITAIONSD;TACHYCARDIAE---

86-MX OF A PT WITH COAGULATION DEFECT SHOULD—A- BLOOD TRANSFUSIONB-PCVC-PLATLETSD-FFPE----

87-A SUSPECTED CASE OSF RUPTER AAA MX SHOULD—A-TAKE PT IMMEDIATELY TO E/RB-U/SC-WAITD-CTE- -------

88-RICHTER HERNIA CONTAINA-CIRCUMFERANCE OF A BOWL

B-WHOLE BOWLC-PERITONIUMD-MESENTRYE---

89- BREAST ABCESS MX—A-ABX+I&D+---B-ABXC-I&DD-----E.

90-COMMON CAUSE OF EPISTAXIS IN ADULT IS A- TRAUMAB-HPTC-HUMIDITYD-NASAL DZE-----

91-OPTIC NEURUTIS AND HYPERURACEMIA IS A TOXIC AFFECT OF A-ETHAMBOTOL AND PYRAZINAMIDEB-P & ISONIAZIDC-I & STREPTOMYCIND-E & ISONIZIDE-E& RIFAMPIN

92-IN CASE OF A MENINGITIS IST STEP SHOULD-- --A-LPB-CTC-ABXD----E.

93- CASE;LYMPHOBLAST IN PERIPHERAL BLOOD—IN –A-CLLB-ALLC-CMLD-AMLE------

94-BS;SELECTICTIVE REFLECTION INDICATE---A-TO SUMMARIZE IMPT POINT AT END O F COMMUNICATIONB-REPEATING ---C--------D-------E-

95-COMMUNICATION IMPROVE BY---A-USING MINIMUM PROMPTSB-----C.D

96-M.IMPT DIAMETER OF PELVIS IS ---A- ANT-POST—B- -------------------C- -------------------D- -------------------E-

97-HYDATIDIFORM MOLE DEVELOP FROM—A- DECIDUAB-PLACENTAC-ENDOMETRIUMD------------E-

98-TEST TO DIAGNOSE GDM---A-GLUCOSE CHALLENGE TESTB-GLUCOSE TOLERANCE TESTC-RBSD-FBSE.------

99-FILARIASIS- --BY—A-WUCHERIA BANCROFTIB-AEDES AGYPTIC-SHISTOSOMIASIS MANSONID.SALMONELLAE---

100-MOST SPECIFIC TUMOUR MARKER FOR TERATOMA IS—A- B-HCGB- A-FETOPROTEINC- PSAD- CA 19-9E- ACID PHOSPHATASE

101- COMMONEST SITE OF EPISTAXIS IS ---A-KIESSLBACH,S PLEXUSB- ANT. ETH ARTRYC- POST- --D- POST ETH ARTRYE- -------

102-TWIN PREGNACY IS BEST DX WITH—A-U/SB-PHY.EXAMC-CTD-----E-----

103-COMMON CAUSE OF ACUTE CHOLECYSTITIS ISA-GALL STONE 

B- ALCOHOLC-----D—

104-RADIOTHRAPY IS TX OF CHOICE FOR –A-ADVANCED CERVICAL CAB-VAGINAL CAC-VULVAR CAD- OVARIAN CAE- ------------

105-DIC IS A CONDITION ASSOCATED WITH—A-PLACENTA PREVIA B-PLACENTA ABROPTIOC-PIHD----E-

106-INC FREQUENCY OF MULTIPLE GESTAION—CAUSE---A-MODERN MEDICAL TECHNQSB.-----C------D-

107-FOLLOWNIG IS NOT A RISK FACTOR FOR GAST.CA..A-GASTRIC POLYPB-H.PYLORIC-----D-----

108-CASE 8 YR OLD BOY PRESENT WITH C/F OF NEPHRITIC SYD-AFETER THROAT INFCTION--DX—A-POSPT STREPTOCCAL GLOMERULONEPHRITISB-IgA NEPHROPATHYC--------D--------

109- WERNCKOSAKOFF SNYD IN ALCHOLICS, DEF OCCUR OFA-VIT-B COMPLEXB-VIT CC-CA PANTOTHENATED-VIT AE- THIAMINE

110-GOLD STANDARD TX FOR BPH IS –A-TURPB-PROSTATECTOMYC-FINASTEROIDED-ALFA-BLOKERE-GnRH ANALOG