Flash Medical

How to take revenge !!

2015-12-20T03:37:00.000-08:00

How to recognize a doctor in hospital?

2014-04-20T00:49:00.003-07:00

Ways to recognise a doctor in hospital.....

1. girl with apron pockets full of garbage.. restless, irritable ,
waddling gait.... shouting on phone... A GYNAECOLOGIST

2. steth in neck, hump at back, or sometimes belly try to come
out of shirt, silent, tired walk with masked facial
appearance..... no response to stimuli to smile... A MEDICINE
DOCTOR

3. snoozing on chair... but loud voice... few abuses...
dominating personality..

like DON of the hospital, everybody
talk to him politely including Dean or Medical superintendent
.. A SURGEON

4. brisk gait, white paste on pant nd boots.... loud voice...
lots of attitude... talking of self... arrogant, under influence
an ORTHOPEDICIAN
5. neeras attitude... tired body... always frustrated, response
to stimuli... red stetho...
A PEDIATRICIAN
6. Mostly female. ...gossiping...always eating
something. ..shouting on someone
ANAESTHETIST

7. Calm, neatly dressed, rarely seen by pts, blurring of vision
RADIOLOGIST

8. In dirty White coat, confused, always in hurry, everybody
shouting on him/ her including sister/ Mama
:INTERN

9. a cool, calm, polite, smart, soft spoken with always a smile
on face..sweet by nature.....These types of doctors only seen in toothpaste ads

Comparison between Decerebrate and Decorticate postures

2014-04-19T11:07:00.002-07:00

Medical Students in afternoon...

2014-04-19T10:59:00.000-07:00

Meanwhile a final year student at UHS

2014-04-19T10:50:00.002-07:00

Medicine Sendups 2013- Topic wise sorted out

2013-11-26T08:06:00.001-08:00

Medicine Cases and scenarios
UHS Medicine Sendups 2013

INFECTIOUS DISEASES

-A 26 year old male presented in OPD with C/O malaise, generalized body aches, headache, sore throat. Now he also has difficulty in swallowing. On examination pulse 96/min, BP=130/80 mm HG, Temp 103 F, with congestive sore throat, cervical lymph nodes were enlarged and tender, No clubbing, anemia, jaundice or dependent edema. On systemic examination spleen was 2cm enlarged with no other anomaly. Investigations showed Hb:14gm/dl, TLC 14000 with predominant atypical lymphocytes. Urine C/E and serum electrolytes were normal.

What’s the probable diagnosis?

What r Differentials

2 investigations to confirm? Give treatment (IMC)

A pt. having a 2 day H/O high grade fever, with rigors developed altered consciousness. O/E temperature is 105 F, He’s comatose, neck stiffness is absent.

What is the most likely diagnosis (cerebral malaria)? How will u confirm diagnosis? Give management(SZMC)

--A 50 yrs. old sewage worker is admitted with high fever, anorexia and severe myalgia. Examination revealed conjunctival hemorrhage, and suffusion and mild hepatomegaly. Few days later his urine output dropped to 200ml/day. There was no history of alcohol or drug intake or accidental ingestion of any topic substances.

Investigations= Hb=11.8gm/dl, TLC=38000cells/mm3 with 95%polyps, bilirubin=24mg/dl, ALT=445 IU/L, Alkaline Phosphatase=543IU/dl, blood urea=285mg/dl, serum creatinine=6.9 mg/dl, hepatitis serology is negative, malarial parasites thick and thin films were negative.

What is the most likely diagnosis(Weil's disease.. icteric leptospirosis.)?give 3 investigations to confirm it? How will u treat the pt(CPMC)

-A 20 yrs. old male presents with fever for last 10 days .examination reveals splenomegaly.

U r asked to defend the point that its spleen not kidney, what explanation will u give? Give 3 d/Ds and how will you differentiate them from one another? How will you treat brucellosis? Give drug, dose and duration of treatment (QMC)

-A 19 yrs. old NGO worker returned to Pakistan 2 weeks after working in a refugee camp in sub-Saharan Africa, he was febrile, dyspneic, and widespread inspiratory crackles were present. He had extensive macula papular rash, conjunctivitis, generalized stomatitis and bluish grey spots on buccal mucosa, Give diagnosis, investigations and treatment(PMC)

-A 15 yr old boy presented with 2 week H/O malaise, fatigue and pharyngitis. He has multiple palpable lymph nodes in axilla, groin and neck along with rashes on the body. He gave H/O taking amoxicillin 2 days ago. Hb=12.8, WBC=16000, platelets=160000, lymphocytosis on peripheral film.

Give diagnosis? Investigations and treatment (PMC)

-A 30 yrs. old man with H/O fever, tiredness, night sweats, weight loss, dyspnea for 1 month. On examination there’s pallor and skin lesions on tips of fingers, splenomegaly, and pan systolic murmur over the pericardium.

What’s the diagnosis(infectious mononucleosis)?Give investigations, treatment and prophylaxis of this disease(PMC)

-A 15 year old girl presented in OPD with C/O rash over her face, trunk, and both upper and lower limbs for last 2 days..2 days earlier she had high grade fever. She took paracetamol for that, it subsided a little bit followed by irritation of both eyes and non-productive cough. She also told that one of her younger brothers also had the same rash 3 weeks ago. On examination she’s pale pulse=100/mim, BP 110/70,temp=101 F, Her conjunctiva were congested with maculopapular rash with reddish in color over her face, neck, trunk and forearm, Other systemic examinations were normal. Lab tests TLC=4500, DLC P=76% ,M=4%, L=18%, E2%, ESR=18mm/1st hour with normal platelet count,

What’s the diagnosis, pathognomonic lesion and give 3 complications?(IMC)

-Herpes zoster aetiopathogenesis and treatment?(FMH)

-A 30 yr old female presents to u in OPD with complaints of insidious onset of malaise,headache,mild cough,high grade fever with rigors and chills.thers mild jaundice and hepatosplenomegaly.U r suspecting malaria.

Give investigations to diagnose malaria?Enlist 6 complications to diagnosis malaria?How wil u treat complicated falciparum malaria(CPMC)

-A boy presented with severe watery diarhoe and vomiting for last 2 days.There no fever or rectal bleed.He ahs not passed urine in the past 12 hours.Examination revals dry tongue and sunken eyes.BP was 50/30.ABdomen was non-tender with intact bowel sound.Bladder wasnt palpable.urea78mg/dl, creatinine=2.6 mg.dl, Na=124mmol/l, K=2.8mmol/l blood sugar=80mg/dl

Whats the complete diagnosis?whats the manegement(CPMC)

-TB(CMH)

-A 34 yr old female was admitted with complaint of alteed bowel habit,low grade fever with evening rise,weight loss for 3 monnths,ultrasound showed iliocecal mass and ascitis.

Give diagnosis(tb),investigations and treatent?(PMC)

SKIN

-A 70 yr old male presented in opd with chnge in shape and colour of existing mole.(IMC

How will u examine the lesion and what investigations wil b done to calculate the severity of this lesion.IMC)

-Scabies confirmation test and management?(FMH)

-Psoriasis(CMH)

-A 16 yr old girl is seen in clinic as shes concerned abt an area of hairloss on scalp,past medical history includes atopic eczema,and she has a number of de pigmentedaead on her hand.Give diagnosis and treatment(PMC)

-A 30 yr old female presented with papules in finger webs,breasts and abdomen and a H/O severe itching all over the body especially at night.

What is the probable diagnosis?What important questions wil u ask in history to confirm the diagnosis?(SZMC)

ENDO

-A 28 yr old male presents with complaint of change in facial apearance and increase in size in hands a ring and shoe that dont fit anymore

What other clinical features u wil find in this pt?How wil u investigate this condition?Describe most specific non-radiological test to diagnose this condition.Give treatment.(QMC)

-A 70 yr old male presented with abdominal pain,muscle cramps,nausea,vomit,diarhoea with fever and night sweats for last 6 months.On examination he was a dark looking male with dark coloured pigmentation of elbow,knee,palmar creases and knuckles.Theres n H/O fluid loss.His BP is 95/60 mmm HG, with postural hypotensionn.Hb=10,platelets=300000, WBC=8000, Na=128, K=4.5

Whats the diagnosis?how will u investigate?give treatment/(IMC)

-A 55yr old female presents with episodic sweating and tremors which r relieved by glucose.she gained 6kg weight of late and drinks 10 units of alcohol weekly.CBC,LFT,urea electrolytes r normal.FBS=4mmol/l(N=3-6mmol/l)

Give diagnosis(insulinoma0,investigations and management(PMC)

-30 yr old female presents with polyurea and passing 4litre urine per day.She has recently started new medication.Na=144mmol/l, plasma osmololity=299mmol/l, urine osmolality=230 mmol/l(N=350-1000mmol/l)

Give diagnosis(nephrogenic diabetes insipidus),drug causing it(lithium),treatment?(PMC)

-A 34 years old man presents with tiredness,headache,sweating and increase in size of feet.

Whats iagnosis?Give 3 investigations to reach diagnosis?Give 3 management steps?(IMC)

-A 25 yr old lady has attacks of headache,nervousness,palpitation,sweating and apprehension.Her BP in these attacks is170-180/110-120mmHg .examination shows black pigmented spots on the skin.

What is the most likely diagnosis?What investigations wud u like to do?AWhat wil b the menagement?(CPMC)

-Drug innduced hyperthyroidism(CMH)

-A 40 yr old male presented with C/O muscle weaknes and fatigue,He also has H/O polyuria and polydipsia.he has family history of hypertension.O/E his BP is 140/106, no pallor,jaundice or pedal edema.labs show metabolic alkalosis, blood sugar is 95mg/dl.

Give the most likely diagnosis?Give 3 d/Ds?Enlist specific investigation to diagnose?Give treatment?(AIMC)

DIABETES MELITUS

-A 38 year old male presented with polyuria and polydipsia.Examination showed weight 80kg and height 150 cm

Give 3 DDs and how will u confirm diagnosis?(IMC)

-DKA management(FMH)

-How wil u treat a drowsy pt with type 1 DM whose serum sugar=375 mg/dl, arterial ph=7.5, and urinary ketones are positve.(QMC)

PSYCHIATRY

How wil u treat patient of schizophrenia(QMC)

-Define schizophrenia?Give its etiology?How will u diagnose it?Give its management/(IMC)

-A 26yr old known psychiatric pt was brought to ER.He is raising slogans,talking excessively,has torn his clothes and wants to talk to the pesident immediately.on physical examination he has excessive salivation.torticollis and cogwheel rigidity in all limbs.

What is the likely psychiatric disorder and D/D?What could b the cause of neuroloical sign in this case?List the drug treatment in this case(CPMC)

-Bipolar(CMH)

-How wil u manage an acutely aggressive and disturbed patient in a medical emergency ward(PMC)

-A 30 yr old banker presented with recurrent,intrusive and ego dystonic thoughts regarding PAAKI and NAPAAKI(cleanliness and filth)

Whats the most likely diagnosis?Enumerate the 3 most common psychological intervention techniques for managing this condition?(SZMC)

KIDNEY

-A 20 yr old male,diagnosed case of nephrotic presented in ER with history of abdominal pain and hematuria for 2 hours.His urinanalysis shows RBC=15-20/hpf,Blood urea=2omg/dl,serum creatinine=0.5mg/dl

What is diagnosis?How wil u investigate?briefly discuss management?(IMC)

A 25yr old man developed bilatersal loin pain and frank hematuria,His symptoms started 24 hours afer deelopment of sorethroat,Bp=140/90, Urine R/E blood(4+) protein(2+)

Give diagnosis(IgA nephropathy),how wil u confirm diagnosis?What r the chances of developing end satge renal failure in this aptient(PMC)

-A 40 yr old male presented with dyspnea,cough and hemoptysis of 10 days.o/E temp=98, pulse=110, BP=170/110, pitting ankle edema,JVP not raised,b/l basal crepitations,cvs normal,hb=10 WBC=16000, ESR=85mm/1st hour, urea 230mg/dl creatinine=8.8 mg/dl, urine examination showed albumin, RBC and granular casts, Xray shows widespread interstitial shadowing of both lungs. Give d/Ds(ARF,wegeners),investigations(PMC)

-A 20 yr old boy presenter in ER with complaint of abdominal pain and vomit.O/E he was dehydrated and tachypneic.On investigations his oxygen saturation was 98% on ABGs,he had metabolic acidosis.His blood urea was 60mg/dl,and creatinine was 1.2mg?dl.

Whats D/D?What 3 tests wil u do?Give 3 steps of management?(SZMC)

-Nephrotic syndrome(CMH)

-A young pt with C/O facial puffiness in early hours of morning on getting out of bed,He aloso has C/O smoky urine.On examination his BP is 150/95,He has puffiness of eyes and pedal edema.Urine output is reduced with proteins ++ and RBCs.

What is likely diagnosis?What investigations wil u advise?Enlist 5 complications of this disease(AIMC)

-What do u mean by polyrea?list common causes of polyuria?give list of investigations to reach final diagnosis?(SMDC)

-A 24 yr old farmer developed high grade fever with rigors and chills which occur on alternative day,He took medication.2 days later he developed red coloured urine along with decreased urine output.he also developed nausea,vomit and drowsiness.Urine complete examination,colour=red, protein=1+, RBC=3+, RBC cast=+ve, CBC..Hb=10.6 gm/dl, TLC=5700/mm3, platelets=350000/mm3, urea=102 mg/dl, creatinine=3.2 mg/dl,

Whats the most likely diagnosis?How wil u investigate?Give steps of management?(SZMC)

-A 45 yr old man s shifted to ER from police custody after developing anorexia,nausea,vomiting,intelectua clouding leading to drowsiness over 3 days.Accompanying guard informs tht he as not passed urine since the previous day.Physical examination reveals a drowsy unwell looking person with facial puffiness,and swollen hands and feet.Skin of extremeties is studded with large ecchymosis,llimbs r tender as well, and neck veins r distended..His serum K=6.8 mEq/l and CPK 1432IU/L.

What is diagnosis(Rhabdomyolysis.. leading to renal shutdown.?2 investigations to confirm diagnosis?2 therapeutic measures for his serum potassium?(CPMC)

ACID BASE:

A 30 yr old male presented with H/O loose mtion and vomit for 3 days and oliguria for 1 day.On investigation blood urea 170 mg/dl,serum vreatinine=6mg/dl,serum K7mmol/l

Give diagnsis,manageement and 3 differences b/w heamodialysis and peritonela dialysis?(IMC)

-A 35yr old man who was a chronic alcoholic was found unconscious over the weekend.His lab reports were as follows.Serum glucose random=90mg/dl,ph:7.16, HCO3=10mEq/l , PCO2=25mmhg, Cl=102mEq/l, Serum Na=147mEq/l, serum potassium=4.5 mEq/l

What is the acid base idturbance?What is diagnosis?Give 4 causes of same acid base disturbance?How do u calculate anion gap(CPMC)

GIT

-Ulcerative colitis management and investigations(FMH)

-a 52 yr old man is admited with 10 hour h/o vomiting coffee ground material and passing black tarry stools,hes anxious,pale,pulse+100,BP=105/75, Spider nevi r seen on neck and chest and spleenomegaly is there.

Give reason of vomitus being coffee ground in this pt?After initial resusitation what 2 drugs maybe helpful?Give 2 endoscopic options likely to b helpful(CMC)

-ZPeptic ulcer(CMH)

-A 24 yr old female presents with diarhoea mixed with mucus and blood for 3 months.

How wil u diferentiate small and large bowel diarhoa?how wil u asses severity of ulcerative colitis and treat a severe case of UC ? What r extra intestinal manifestations of UC not associated with disease severity.(QMC)

-A 45 yr old male presents with multiple episodes of hematemesis.His pulse i thready120/min and extrmities r cold and clammy,BP=50/30.

Give imediate management?Give clinical features that wil help u ake a diagnosis of esophageal varices and not bleeding due to peptic ulceration.How wil u investigate this pt to make a diagnosis?(QMC)

-A final yr medical student is repeatedly visiting a gastroenterologist with complain of increased stool frequency over the past 4 months,he feels colicky abdominal pain relieved by defecation,He has past H/O similar complaints wen he had to prepare for professinal exams.

Give diagnosis(IBD),investigations,treatment(PMC)

-A 60 yr old lady presents to Er with 12 hour history of severe abdominal pain associated witth vomoiting.Shes sitting in bedand leaning forward.O/E she loooks in agony,bp 90/60,Abdomen is soft with mild tenderness,and nosigns of perotinitis,she has H/O cholilithiasis,her labs after admsiion show normal Cp,slightly deranges LFts,U/S abdomen shows cholilithiasis, with no evidnece of cholysystitis.

what is the likely diagnosis?what other investigations u wil ask for?give treatment?(WMC)

-A pt presented with H/O diarhoea,sometimes steatorhoea and weight loss.He has H/O some abdominal surgery.Investigations show hb=9.3 g/dl, MCV=107, normal folate,low b12,anti endo mysial antibodies r negative,normal pancreas on CT,duodenal biopsy showed sub total villous atrophy.

What is the likely diagnosis?Enlist 6 predisposing factors?Which investigations r required for diagnosis?(SZMC)

-A 40 yr old known case of type 1 DM presented with dirhoea without mucus or blood for 2 years and progressive fatigue and pallor for 1 yr.She has difficulty in getting up from sitting position.O/E BP 110/70,afebrile,edema legs.No lymphadenopathy,abdominal examination unremarkable,HB=8.4, TLC=7000, platelets 185000, MCV=66, RBS=120mg/dl, Albumin=3gm/dl, bilirubin=0.8mg/dl, ALT=83 IU/l, ALP=850 IU/L, LDH=normal, Stool R/e=normal, abdominal sonography=normal.

Whats the most likely diagnosis?Give 2 D/ds?Write 2 investigations for underlying disease?Outline management plan(WMC)

-A 34 yr old man with H/O ulcerative pancolitis for 10years presents with left knee swellinf and pain for 3 weeks,He also relates that he has had mildly increased stool frequency over past 5 days,Hes healthy and afebrile,Knee aspiration reveals sterile fluid with no crystals,Sigmoidoscopy shows acute exacerbation of UC.Give management?cause of knee swelling?what complicattions likely to occur when disease progresses.(CMC)

CVS

-Heart failure management(FMH)

-A 69yr old man with new orthopnea and edema is found to have a non-ischemic,dilated cardiomyopathy,ejection fraction is 20%, treatment includes IV furosemide,lisinopril and carvedilol.BP 95/60, pulse=70,He has jugular venous distension,clear lungs and displaced apex beat with s3 but no murmurs,and mid lower extremity piting edema.Give treatment?and complications likely to occur(CMC)

-A 68yr old male pesents with STEMI with changes noted in anterior chest leads.thrombolytic therapy was administered imediately.

What complications r likely to develop durng this.Give longterm mnagement plan(CMC)

-A 50 yr old man presents with chest pain in CCU.

What r the characteristics of pain to b cardiac in origin?give absolute contraindications to thrombolysis?Give dose,route and rate of streptokinase?Give early complications of acute MI?(QMC)

-A 24 year old male presents with low grade fever and malaise for 4 weeks and now develops SO on exertion.On auscultation u hear amurmur on apex.How wil u diferentiate mitral stenosis and mitral regurg?Which clinical findings point to heart failure in this aptient.How wil u diagnose this patient to have infective endo?give treatment?(QMC)

-Infective endo(CMH)

-ST elevated MI(CMH)

-A 40 yr old man with diseminated tb presented with dyspnea.O/E he has rapid low volume pulse,elevated JVP,hepatomegaly,ascitis and peripheral edema.Give diagnosis(constrictive pericarditis),D/Ds?How wil u confirm the diagnosis?give treatment?(PMC)

-A 22 yr old female who suffered from joint pain in her childhood.Heart was mentiones at that time.She started developing low grade fever which partially responds to antibiotics.How do u co relate joint pain with heart in this case?Enumerate other features of this disease?Give diagnosis?how wil u confirm the diagnosis?SMDC)

- A 30 yr old man presented in ER with H/O chest pain for the past 2 days.Chest pain is sharp in character and more on lying down.CBC+RFTs r normal.ECG shows generalised ST elevation in all leads.

Give 2 D/Ds?How wil u investigate and treat the most likely cause in this patient(SZMC)

-A 50 yr ols man was admitted with acute central chest pain.Clinical examination revealed normotensive(134/84) individual with normaly heard s1 and s2 and faint s3,ECG showed clasical features of acute anterior wal MI,and he was infused with injection streptokinase without any complications along with supportive treatment.After 1 week he was readmitted with sudden onset of breathlesnes,apprehension and couldnt lie straight in bed.clinical examination reveals BP 96/60, cyanosis,sweating, respiratory rate 34/min, basal crepitations, and 3-4/6 pansystoic murmur at mid left sternal border, which doesnt radiate to apex with gallop.ECG shows sinus tachycardia with signs of settling acute anterior MI

Give diagnosis?D/Ds?management?(WMC).

-Cardiac temponade management options and what wil b change in mangement if pt develops jaundice in few weeks of treatment.(FMH)

-O/E of chest of a young male pt,u find on left side that movements of chest r reduced,trachea is shifted to right side,percussion note is stony dull,on left side and breath sounds r absent on lest side.

Whats the diagnosis(left sided pleural effusion.. shift of mediastinum to the right.)?What radiological test wil u order?What invasive procedures u wil prefer and which tests u wil ask for?(SZMC)

-A 45yr old man presents in ER with complaints of severe headache and vomiting.His pupils were equal and reactive to light,neck stiffness was present.His BP was 160/110.CVS examination reveals ejection systolic murmur best heard at mitral area.Git examination reveals bilateral abdominal fulness.His father died of renal failure 3 months ago.

Whats the cause of headache(upture of Berry aneurysm leading to SUB ARACHNOID HEMORRHAGE. bilateral abdominal fullness is most likely secondary to polycystic kidneys.)?What is the diagnosis?How wil u manage this patient(CPMC)

RHEUMATOLOGY

-A 28 yr old woman with past history of butterfly rash and polyarthralgia is reffererd by the obstetric dept.Aged 21 she has ad DVT whilst on OCP and since then has had 3 miscarriages at 16-18 weeks and a recent IUD at 30 week.Following IUD she developed an extensive femoral vein thrombosis.

Hb11gm/dl, WBC=6*10 raised to power 9/l,normal differentiated, platelets=40*10 raised to power 9/l ,creatinine clearance=120ml/min, ANA 1 in 40, ENA=negative, DNApositive 1 in 10, VDRL=positive 1 in 1, plasma sodium 140mmol/l, potassium=4.5 mmol/l, Urea=4mmol/l

Give diagnosis?what further tests should b done?What precautions shal b taken in subsewuent pregnancies?(CPMC)

-RA flare management,pulmonary complications and significance of CCP antibodies(FMH)

-Rheumatoid arthritis(CMH)

-A 38yr old pashtoon lady admitted with 3 day H/O increasing pain and sweling of left leg.Over past 24 hours she has also developed low grade fever,no H/O trauma,immobilization,or prolonged air or land travel.

She was admited 2 years ago with a similar episode of pain and swelling in rt calf.DVT was confirmed on doppler scanning.Shes otherwise fit and well,married and lives with her husband,shes a non smoker.Her only medication is antidepresant prescribed by GP after she had a miscarriage 6 months ago,Her relationship with previous husband ended after this.Hb=10.5, MCV=53, WBC=2.5*10 raised to power 9/l, platelets=130*10 raised to power 9, and normal activity of protein c and s.

What is cause of her recurrent problems?what tests wil u do to confirm diagnosis?(CMC)

-30 yr old woman complains of stiffness of hands in morning along with swelling of small joints of both hands.Whats the most likely diagnosis?How wil u investigate to reach a diagnosis?Give list of drugs used for treatment with mechanism of achtion(SMDC)

-A young male complained of low backache(chronic),generally worse in the morning with multiple joint pain nad swelling.On examination spine is tender over sacral area.Crepitations r there on upper part of chest on auscultation.Xray lumbosacral supine shows fused vertebral bodies vertically.ESR raised.ANA and RA negative.

Give diagnosis(ankylosing spndylitis).investigations and management plan?(PMC)

-A 70 yr old lady comes with C/O joint and muscle pain for the last 4 weeks.daily self care activities like changing clothes,picking up items like cups and feeeding erself r getting diifficult.Symptoms r progressive.she feels feverish and turning in bed is difficult.She feels stiff in the morning.now shes unable to even get up from toilet seat.Examination reveals normal vital signs and minimal swelling of interphalangeal and metacarpophalengeal joints.Difficulty in raising arms above head and getting up from chair.CBC reveals normocytic normochromic anaemia,ESR 98, urea 34mg/dl, creatinine 0.8, ALT 30, ALP 101 bilirubin=0.8, Urine RE=no RBC casts or proteinurea.

Give diagnosis(Rheumatoid arthris)?3 D/Ds?and management?(WMC)

-A 23 yr old femalle presented with C/O fever for last 2 months.She has H/O recurrent oral ulcers,and arthritis,Examination showed temperature 100 F,mild jaundice,pallor,and right sided pleural effusion,hb=8, biliirubin=2mg/dl,urine examination showed proteinuria,

Give likely diagnosis?whats the caue of elevated bilirubin?What other investigations wil u advise in this patients?List 4 investigations of steroids in this patient(AIMC)

-A 40 yr old male patient presented with pain in small joints of hands(both) for the past 4 months.Theres H/O morning sickness lasting more than 1 hour.O/E joints of both hands r swollen and tender.CBC shows Hb=8mg/dl,TLC=10,500, platelets=1,50,000.RA factor=+ve

Which is the most common type of anemia in RA?What wil b the X-ray findings in an RA pts joint?List 4 DMARDS in treatment of RA with atleast 1 important side efect of each.(SZMC)

-A 48yr old lady with longstanding seropositive rheumatoid arthritis contacted her GP complainiong of 2 day H/O increasing shortness of breath.Her medication at the time was indomethacin 75mg BD annd methotraxate 7.g mg once weekly commenced one weeek previously.Prior to this she hadbeen receiving IM gold 50mg six weekly.This hadbeen discontinued due to lack of effect 1 month earlier.On examination her temperature was 36.6 C,BP 110/70 mm Hg,JVP not leevated,mild bilateral ankle edema.There was tachypnea with mild bilateral fine crepitations,An active synovitis of wrists and knee was noted.ECG unremarkable.

-Give 3 possible diagnosis(complications of RA.. pleural efffusion, osteoporosis, CCF)?What further investigations wil u advice?(CPMC)

CNS

-A patient presenting with bilateral lower limb weakness for last 3 days which traveled upwards and is now involving the forearms,Theres no involvement of sesory syster,bladder or bowel,however reflexes r absent with bilateral flexor plantar response,Theres H/O bloody diarrhoea 3 weeks ago.Give treatment(QMC)

-A 25 yr old man presented with rapidly progressive paralysis of all 4 limbs over days.Examination reveals hypotonia,grade 0/5 power,and absent reflexes in all 4 limbs,sensations were normal,CSF reveals opening pressure=13cm of water, cell count=7(all lymphocytes), protein=175mg/dl, sugar=70mg/dl, gram stain and Zn stain=negative, blood glucose=105mg/dl.

Give diagnosis,how wil u confirm diagnosis?give management?(CMC)

-Meningitis investigations and steps of management(FMH)

-A 17 yr old students from boarding presented with high grade fever for 1 day.Signs of meningeal irritation r positive.He also complains of severe headache and intolerance to light.(QMC)

How wil u diferentiate pyogenic,viral and tuberculous meningitis on CSF examination?How wil u treat this pt empiricaly?Gram stain reeals gram negative diplococi,what 3 options of prophylaxis can b offered to room mates.

-A 37 yr old male is brought to ER in a drowsy state.examination reveals signs off cholinergic toxidrome.later his attendents find a canister of malathhion in his room.

Give possible clinical findings in this patient?treatent?how wil u monitor response to treatment?(QMC)

-A middle aged man has difficulty in walking over a period of 2 years,He has stiffness of muscles and walks with stooping posture.O/E he has coarse tremors of hands which improve when he attempts to use his hand.

Give diagnosis?common causes of this disease and list of drugs used to treat it(SMDC)

-Myasthenia Gravis(CMh

-Subdural hemorrhage(CMH)

-Write short notes on chorea,raised intracranial pressure and FEV1(SMDC)

-A 16yr old girl presented with severe headache and vomiting for 2 weeks.O/E temp 100 F, bp 100/70 dehydrated, she has diplopia on left lateral gaze,and marked neck stiffnes with no weakness of any limb.

what is most likely diagnosis?why has she developed diplopia?Name 4 investigations and their expected findings which wil help in diagnosis?Outline treatment plan?(WMC)

A 24 year old lady recently diagnosed as a case of Rheumatoid Arthriris developed weakness,tiredness and double vision.bilateral ptosis found on examination.Give diagnosis?investigations and treatment(PMC)

-A 20 yr old lady is admitted with 1 day H/O sudden onset of left sided weakness.She was fairly well and only complained of SOB in exertion in the past.O/E her BP was 125/75, pulse 98/min irregular.CNS examination shows left sided dense hemiplegia, with brisk jerks and upgoing plantars on left side.Her chest is clear and CVs examination reveals loud S1 and prominent parasternal heave,

What is the composite diagnosis?(stroke due to AF) what investigation wil u ask for?write atleast 5.What management wil u give to avoid further strokes in the future.(WMC)

-A 15 yr old boy is brought tot u with progreessive weakness of both lower limbs over a period of 7days.He was previously normal except mild flu prior to present condition.O?E he is alert and afebrileGPE doesnt reveal any abnormality except undescended testes on 1 side.power in upper limd is 5/5 whereas 2/5 in lowr limb.Deep tendon reflexes were absent in both lowr limbs..

Give most likely diagnosis,investigations to confirm it and tel which investigations can prove fatal and their management(CPMC)

-A young pt was brought to ER with unconsciousness.He has H/O fever for last 3 days.

List 6 D/Ds?How wil u examine this pt?Enlist in points with expected abnormality?Enlist investigations u wil advise to diagnose?(AIMC)

-A middle aged man of village background has presented with sudden loss of consciousness.He is reported to b in perfect health before going to fields after a visit to the bank to conduct his routine.Theres no past history of similar such episodes.On examination he is deeply comatosed ,temperature 96.5 F,shallow slow breathing,pinpoint pupils.No signs of meningeal iritation andplanters are bilateraly extensor.

Give diagnosis and an outline of management plan (CPMC)

-A 30 yr old male prested to ER with C/O numbness and weakness in lower limb followed by upper limbs.He has a H/O diarhoea 2 weeks ago..O/E he ahs tachycardia and tachypnea.Bulk in upper and lower limbs is normal with reduced power and tone and absent reflexes.Plantars r downgoing.

What is likely diagnosis?Give 2 d/Ds?What investigations wil u advise?give management(AIMC)

-A 27 yr old male came to ER with 3 day H/O high grade fever,headache,vomiting and generalized tonic clonic seizures.O?E hes running high fever of 102 f,drowsy,and has neck stiffness,Thers no focal neurological defecit.

Give 3 D/Ds?outline management plan?Which neurological complications can occur(SZMC)

-A 28 yr old female presents with weakness of both lower limbs for the past 3 weeks.Shes unable to stand and walk without support.Examination reveals upper motor neuron type weakness of lower limbs with sensory loss at xiphistenum.

Give 3 D/Ds?whats the spinal cord and vertebral sensory level in this case?What tests wil u do to reach the diagnosis?(SZMC)

BLOOD

-Microcytic anaemia(CMH)

-A 25 yr old unmarried lady presents with mild SOB for 1 month,Shes pale nad hb is 9.

Give 10 clinical findings u need to proceed for further labs?give investigations in a schematic manner to reach diagnosis(CMC)

-A young man from a remote rural village of punjab gradually developed SOB.He loooks pale and has Hb of 5gm/l,What further investigations u wil ask for to reach a diagnosis?how wil u manage to cure him permanently(SMDC)

- A 35 yr old male presented with C/O shortness of breath,numbness,tingling in limbs and memory loss for the past 6 months.O?E he is pale,has angular chelosis,smooth tongue,and ocasional generalized bruises over the body.JVP is normal,normal vesicular breathing with no sound in chest.He also has loss of vibration and joint position sense with reduced ankle reflexes and upgoing plantars.CBC shows Hb=7,WBC 5500,and platelets 65000.What is the likely diagnosis?What r investigations to manage this patient?list 5 causes of this disease?Whats treatment(AIMC)

-A 25yr old female pesented in ER with complaint of bleeding from multiple sites 2 days after delivery,investigations showed prolonged PT and APTT and low platelets.

Whats the diagnosis?what r the different causes of this in this kind of pt?Outline management?(SZMC)

-A 56 yr old female presented with 3 month H/O malaise,sweat,weight loss,cough and hemoptysis.She also has H/O left sided facial palsy of lower motor neuron type in the past.she was treated with antibiotics for pneumonia recently but responded poorly and she remained unwell with low grade fever.Shes mildly anemic ESR=120, urine RE shows numerous RBCs, and proteins ++, urea 72mg/dl creatinine=2.2 mg/dl.

Whats the most likely diagnosis(wegeners granulomatosis)?Give atleast 2 D/ds?How wud u investigate?treatment plan?(WMC)

-A 60 yr old smoker has presented with sudden onset blindness in left eye which recovered in next 6 hours.he also gives H/O dragging sensation on left side of abdomen,He has no H/O previous CVS or respitatory disease.Clinically he has congested face and a mass palpable in left upper abdomen.CVS and Respiratory examinations r normal. Hb=16.9gm/l, MC=68 fl, WBC=16*10 raised to power 9/l, platelet cpunt=450*10 raised to power 9 and increased serum uric acid and normal biochemical profile,

Whats ur composite diagnosis?What r other diseases which can result in similar hematological picture?What investigations wud u order?(WMC)

RESPIRATORY

-A 55yr old man presented with cough,fever and hemoptysis of 2 months duration.he has lost 10kg weight.He left smoking 6months ago.He had pulmonaary tb 5 months ago which was treated with ATT for 9 months.His chest Xray shows opacity in right upper zone with blunting of right costophrenic angle.

Give 4 D/Ds and enumerate 6 investigations(CPMC)

-A 55 yr old smoker presents with high grade fever,cough and pleuritic chest pain for the past 2 days.he has now developes scanty rusty sputum and SOB,He looks distressed with an RR of 38/min.How wil u diferentiate b/w right pnemothorax and pneumonia?How wil u treat pneumonia in this aptient?give indications for tranfer to ICU in this pt.(QMC)

-A42 yr old smoker presents in clinic with productive cough,and foul smelling sputum,patient feels unwell, and feels that he is able to cough out more sputum in a particular posture,Hes febrile,has bilateral clubbing and b/l chest crepitations.

Give diagnosis?investigations and treatment(CMC)

-A 49 yr old male presented with green coloured sputum in cough for last 5 days.He has passed large volume of urine in the past 2 days..Now he presented with altereed consciousnes,O/E hes drowsy,has upgoing plantars,Hb=10, WBC=13000, urea=88mmol/l (N=20-40), RBS=31mmol/l, xray chest opacity in left upper lobe of chest.

give diagnosis(klebsiella pneuoniae infection.. pulmonary and urinary tract involvement, plus signs of meningitis)?treatment?(PMC)

-40 yr old male is admited with altered conscious level,fever and cough for last 4 days.On clinical examination theers pyrexia,tachycardia and tachypnea,Chest examinations reveal crepitations in mid and lower zones.investigations show serum urea=3.5mmol/l, Na=120mmol/l, k=3mmol/l.

Give diagnosis(atypical pneumonia),what complication has occured,how wil u diagnose and steps of management.(PMC)

-A young man of 25yr old has had cough in sputum for the past 5 years.Name physical signs u wil look for to reach the diagnosis?Name 2 key investigations.Name drugs used in tb treatment with their sideefects and dosages(SMDC)

-Interstitial lung disease(CMH)

-A 45 yr old ale farmer by ocupation,was brought to ER with complaint of shortness of breath,fever,dry cough,myalgia for last 12 hrs,he is tachypneic,has tachycardia,cyanosis.On auscultation he has bilateral bibasilar crepitus.HE HAS h/o SUCH EPISODES before.

What is the most likely diagnosis?Give 2 D/Ds?What investigations wil u advise?Give treatment(AIMC)

-A medical registrar hasbeen calledto c a 30yr old lady who was operated for acute apendicitis.She has developed marked breathlessness.and cannot lie straight in bed since last night.On exam BP 160/90, pulse 126/min regular, cyanosis,loud S1, respiratory rate 28/min, and bi-basal crepitus, X-ray shows cardiomegaly with prominent pulmonary conus,and double shadow of atria,

Whats the composite diagnosis?(pulmonary embolism) what r the D/Ds?Give 4 inveestigations u wil do and what do u expect to find?(WMC)

-A 70 yr old male complained of low back pain,fatigue,dyspnea,and blurring of vision.O?e he had pain over several vertebrae and his hb was 8,ESR=100mm/1st hr.

Give diagnosis(multiple myeloma).Give 3 investigations and management?(PMC)

LIVER

-A middle aged lady has prestented with pain RUQ/right uper quadrant),fever and jaundice,On examination shes healthy looking with yellownes of eyebals.there r marks of itching on her trunk.Liver is 3cm enlarged with sharp and regular edgeUSG shows dilated biliary channels.

Give 4 D/Ds in order of likelikhoood,Enlist 3 specific tests u wil do to confirm diagnosis(CPMC)

-A middle aged lady over a period of 2 weeks has developed yellowness of eyes and pain in right hypochondrium(rt)..O/E theres globular mass in right hypochondrium which moves with respiration and also side to side.

Give a list od D/Ds?how wil u investigate this case?(SMDC)

-A 35 yr old woman presented in ER with abdominal distension.What r possible causes?how wil u investigate?How wil u differentiate b/w ascitis and a large ovarian cyst(SMDC)

-A 22 yr olf female was admited with complaint of tiredness,anorexia,nausea,jaundice,On examination deep jaundice.palmar erythema,spider nevi,hepatosplenomegaly.labs show markedly elevated AST+ALT,high imunoglobulins,viral seerology for hepatitis b n C is negative.

what is the likely diagnosis?what investigations wil u advise to reach the diagnsis?Give management(AIMC)

-A cirrhotic pt whose ascitis was well controlled with diuretics,presented with progressive abdominal distension,On examination shifting dullness and fluid thrill r present.

What causes could b responsible for his worsening ascitis?How wud u investigate him?(SZMC)

-A 20 yr old presented in ER with gradual deterioratin of consciousness.His mother gave past H/O jaundice,abdominal distension and tremors for the past 2 years.Give provisional diagnosis(wilsons)?steps of management and investigations to reach the diagnosis?(PMC)

-A middle aged overweight man has 2 finger enlarged liver.His ALT is 66 IU/L.with negative serology for hepititis markers.BSF is 124mg/dl.Theres strong famly history of type 2 diabetes mellitus and early coronary artery disease.

Give diagnosis(NAFLD.. non alcoholic fatty liver disease.)?3 investigations to confirm the diagnosis?give management in this case(CPMC)

-Liver abcess(CMH)

-A 60 yr old man is admited to ICU via ER with acute GIT bleed due to esophageal varices,his BP on arrival 80/45 and hb has decreased from 11 to 6 gm/dl,he has receives 3 units of RBCs in Er,he appears to b chronicaly ill with icteric sclere and marked asccitis, His past medical history is significant for chronic liver disease with cirrhosis, patients urine output since admission is less than 30ml/h. Na=128, K=3.7, creatinine=2.8, urine analysis was rare except for rare epithelia cells.

what complications have developed? Give management and prognosis? (CMC)

Supplification! - By Maham Tariq (Final Year RMC)

2013-03-29T08:57:00.000-07:00

DISCLAIMER= This article,by no means, is not meant to motivate u to get a supply,but to stay away from it =p
“If you don’t flunk in any of the professional exams atleast once in your medical school….30 years from now,your grandchildren are going to make fun of you for being uncool” is a famous quotation of my own.

Well,I admit all the phonecalls,condolence txtx ,friends coming over from every clan of the class and asking me how i am doing plus me getting complimented on my looks all the time,irrespective of whether or not I was looking good made me feel very much like a celebrity.Not to mention the cards n gifts I received,which btw I never did when I passed.And how can I forget all the birthday wishes,since my birthday was a few days before supply.These r all the perks that come ONLY when u flunk.
Writing about supply is very much like being in love “so many thoughts but u cant express
For me it encompassed not just two months of grinding hardwork but also,not missing out on the winter trip as well as election fervour,along with all the tests and attendances(these being less important ofcourse.lol)
On a serious note,it helps very much if you remember that it happened for a reason(read my nalaiqi), would be over soon and for good,wil make you a better student and after this you will most certainly be able to count your blessings,like not sulking or ranting when you ‘just pass’.One thing is for sure it would bring you closer to God,to people and most importantly to yourself,It would help u understand how blessed you are.In multiple ways,Suppli teaches and redefines for you what matters in life.
Those who flunk dont want to be pitied upon or sympathised with,because people suffer major setbacks in life.Its not a good feeling that friends seem depressed that u flunked.Dont take it too hard on yourself,stop trying to find the reason, just wait a little and have faith.You would,for sure,be paid back in full.
The most challenging part of supply is not the exhausting study involved or the fear of detention,but probably pulling yourself together.This might have been the part where I scored the most alhamdulilah.The culprits for this are my family(present family,not future family,incase you get any wrong ideas ),and the entire batch 36.Through this article I would like to acknowledge and thank each and everyone in batch 36,and MOST IMPORTANTLY warn you all never to flunk,because I don’t think I wil be able to be as big as a support as you ppl were,and for all your kindness and help,I truly am grateful!

How Diabetes symptoms can be reversed

2012-12-18T05:55:00.003-08:00

Trouble begins when over indulgence in food (requiring an over-production of insulin) either leads to failure of the pancreas or cell damage (caused by over-production of insulin) in-turn leading to insulin becoming ineffective. Unfortunately, once the process of converting food into energy breaks down, there is no way to repair it. However, diabetes symptoms can be reversed by keeping our blood sugar levels under control and adopting a healthier lifestyle.

How diabetes symptoms can be reversed

1. First off, you need to consult a diabetic specialist so that you can be properly diagnosed as to the type of diabetes (Type I or Type II) and also the progress of the disease. Where required, the physician or specialist will also prescribe medicines that may or may not include insulin.

2. If you are an adult, given that diabetes is categorized as a ‘lifestyle disease’ (meaning triggered by unhealthy lifestyle of the person), you would probably have to make drastic changes to your lifestyle. These changes would have to include incorporating adequate exercises, eating regular healthy meals, getting adequate sleep and if you were previously overeating, then, incorporating portion control plates, cups and glasses into your dinnerware.

3. You would also have to get yourself acquainted with the U.S.D.A approved concept of ‘MyPlate’ diet. Briefly, Myplate refers to a plate theoretically divided into four parts in the ratios of 3:3:2:2. The larger parts are one each for vegetables and wholegrain (including pulses). The two smaller parts are one each for proteins and fruit. To this, include a small 6 oz glass of low-fat milk or non-fat, non-sweetened yoghurt.

4. You also need to understand the energy formulae: Food to consume = Total energy requirement. An average adult requires approximately 2,100 calories of food every day (because we need roughly 2,100 calories of energy each day). If you need to reduce your weight, you should incorporate physical activity equivalent to not less than 200 calories per day. Since you are drawing 200 calories worth of additional energy than that provided by food, your body makes up the deficit by breaking down 200 calories worth of stored fat. Over time, you will reduce your body fat.

5. You also need to understand that some foods are digested immediately and therefore release glucose immediately into the blood stream. Other foods (e.g. proteins) take some time to digest. If you have been prescribed medication, you need to time the medication so it coincides with the glucose release in the blood stream. This is vital as mismatch will lead to your medication becoming ineffective and your diabetes progressing further despite the medication.

6. Conduct regular blood sugar tests at home by using diabetes test strips. The only way you know the efficacy of your medication as well as your efforts is by conducting regular blood sugar tests at home. If your medication is matched with the release of glucose in the blood, then even at peak times your blood sugar should have a normal reading. This is the sign that you have got it right.

If you incorporate all six actionable points mentioned above, then your diabetes symptoms can be reversed.

Check out also for sugar free gift baskets for diabetes

Patho sendups-sorted out Seqs 2012

2012-10-20T21:52:00.000-07:00

CNS

---Enlist 4 major classes of brain tumors,Enlist tumors derived from glial cells and which 1 has best prognoisis among them?Enlist 4 hstological features of hemangioms and how psammoma bodies r formed(WMC)

young blood transfusion officer presented with headache, photophobia, imitability, fever, clouding of conscious neurological impairment & neck stiffness. CSF is frankly purulent. Ct Sean showed no mass or tumor

a. What is your diagnosis?
b. Describe different types of suspected disease & dynastic approach

(CMC)

A 15 year old boy presented with painful swelling above left knee joint from lastfew months. On examination swelling is warm and tender. There is no h/o of trauma.Lab report shows raised ESR and leukocytosis. X-rays shows destructive lytic lesion inthe distal diaphysis of femur.

1. Give two provisional differential diagnoses. 2

2. Biopsy report shows sheets of uniform small round cells having hyperchromatic nuclei and scanty cytoplasm. Homer-Wright rosettes are present. Areas of tumor necrosis are also seen. What is your definite diagnosis? 1

3. Enlist four benign chondrogenic neoplasms. 2 (RMC)

A 66 yrs old male patient, hypertensive for the last 20 yrs, reports in the emergency department with severe headache and vomiting. He is confused. His wife tells that he has not taken antihypertensive medication for 3 weeks because it is not possible for them to buy expensive medicines.

1. What are the effects of hypertension on brain? 3

2. What are different types of brain aneurysms? (RMC) 2

---(a) Give the CSF laboratory findings of Acute Pyogenic Meningitis.

(b) Enumerate the Brain Tumors and give the morphology of Astrocytoma.(SZMC)

---A 50 years old male with history of severe headache & seizures presents with SOL (space occupying lesion) in white matter of temporal lobe of left cerebral hemisphere. Histological examination reveals sheets of cells with regular nuclel & clear halo of cytoplasm along with calcification & delicate network of anastomosing capillaries.

a. What is your diagnosis? (1)

b. Give molecular genetics of this neoplasm. (2)

a. Classify other glial tumors. (2)(SMC)

---A 29 year old female suffering from episodes of headach throughout her pregnancy. Her B.P Was….. but on CT-Scan planed after delivery shows a well circumscribed dural based tumour …. In diameter the left cerebral hemisphere.

a) Write most likely morphological type of tumour in the above patient. 02

b) Classify brain tumours (PMC)

---. a) classify brain tumors. (2.5)

a) Give Macroscopic and microscopic picture of Astrocytoma. (2.5)(SIMS)

a. Give the CSF findings in tabulated from in (3)

Acute phylogenic meningitis,Viral meningitis and Tuberculous meningitis.

b. Give briefly the histological picture of acute meningitis. (MMDC)

---A 10 year old architectural student a admitted from university halls of residence with a 24 hours history of headache. Nausea vomiting and tastelessness. There is neck stiffness on physical examination

i. What is the probable diagnosis

i. Which investigations would u pattern to confirm the diagnosis 1

ii. What is the most probable causative organism 1

iii. Tabulate 2 differences between purulent and aseptic meningitis 2(NSMC)

GIT

Q2) A 23 year old years old female resents with recurrent episodes of blood diarrhea lasting for 3-d times at a time accompanied by severe abdominal pain & cramps. She remains alright for 1-2 min in between. These episodes. Left hemicolectomy revealed pancolitis

a. What is the diagnosis?

b. Give the etiology & pathogenesis of this disease

c. Give histological findings of this condition(CMC)

----Define leukoplakia?4 risk factors for development of squamous cell esophageal carcinoma?enlist gross and microscopic features of diffuse gastric cancer?Classify gastric carcinoma according to their location in stomach and according to gross and microscopic features(WMC)

A 20 year old female presented, in the OPD with mass in the parotid region. She told that swelling is from last 10 years. Initially it was of almond size and gradually it has acquired the size of walnut. On clinical examination the swelling is painless, mobile, firm and discrete.

1. Give two most likely differential diagnoses. 2

2. Name the test you will request for its immediate diagnosis. 1

3. What is the relationship of salivary gland tumor being malignant with the anatomical size of the salivary gland?1

4. Name the most common primary malignant tumor of the salivary gland. 1 (RMC)

Q3) A 35 years old comes to the hospital with pain epigastrium relieved on drinking cup of milk

a. Give pathogenesis & morphology

b. Enumerate the gastric tumors with morphology of any one of them(CMC)

---A 30 years male smoker, presents in emergency with hematermesis. He gives history of progressive dysphagia for the last 3 months and anorexia for 1 month. History of marked weight loss is also given. Physical examination revealed non specific findings. ultrasound examination of abdomen shows "leather bottle stomach" with enlarged pyloric lymph node.

a) What is your diagnosis? (1)

b) Give the etiological risk factors of this disease? (2)

c) What are the modes of spread? (1)

d) What is Krukenberg tumour? (2)(SIMS)

---A 50 years female resented in OPD clinic with history of altered bowel habits, abdominal pain and blood stools. Her colonoscopy shows pseudopolyps and hyperemic mucosa.

a) What is the diagnosis? (1)

b) Enumerate the difference between ulcerative colitis and Crohns disease? (3)

c) What are the extra intestinal manifestations of this disease? (1)(SIMS)

---A 26 years old male has recurrent attacks of bloody mucoid diarrhea with abdominal ceramics which are relieved on defecation. Each episode lasts for 5-6 days followed by symptom free periods of 4-5 months Colonoscopy shows pan colitis extending from rectum to the splenic flexure.

a) What is the diagnosis 01

b) What features will a colonoscopy biopsy show 03

c) What is the role of intestinal flora in the pathogenesis 01(PMC)

---a) Define the term leukoplakia 01

b) List the possible predisposing factor of leukopiakia 01

describe the morphological features of pleomorphic adenoma 02(PMC)

---a. Write a note on pleomorphic adenoma giving its morphology as well. Why is it necessary to take special care in its resection? (2)

b. Write a note on etiophathogenesis of peptic ulcer with special emphasis on the role of pylori. (3)(SMC)

---a. Discuss the morphology of Crohn disease. (3)

b. Enumerate five differences between Crohn disease & ulcerative colitis. (2)(SMC)

--- 4 Microscopic picture of stomach showed an ulcer base containing a superficial thin layer of necrotic fibrinoid debris overlying a zone of inflammatory infiltrate with neutrophils predominating. Under which was a lower thick zone of granulation tissue with dilated blood vessels and lymphocytes.

(a) What is the relationship between chronic gastritis, Helicobacter pylori, and chronic peptic ulcer? (03)

(b) What are the complications of chronic peptic ulcers? (02)(SZMC)

---on gross examination the rectum showed a diffusely inflamed mucosal surface. This causes chronic diarrhea with grossly bloody, mucus filled stools. The disease begins in the rectum and proceeds proximally and is usually evident on proctoscopic examination, where pseudo polyps and ulcers and be seen.

(a) What are inflammatory bowel diseases? (01)

(b) Summarize the differences comparisons of inflammatory bowel diseases (04)(SZMC)

---A 30 years old lady presented to her doctor with history of dyspepsia. On gastro copy, she was having gastric uteer. Her gastric biopsy revealed heavy colonization by small curved spiral organisms in the surface mucus.

a) Name the causative organisms. (01)

b) Describe the role of this micro-orgamnism in producing this gastric pathology (04)(MMDC)

---A 27 years old female presented with a 9 month history of bloody diarrhea crampy abdominal pain 3 weeks ago she noticed that her left knee was swollen. Red and painful. Her temperature 38 C (10-11) RR is 32/min & B P is 130/90mmHg. Abdominal palpation showed lower quadrant tenderness. Laboratory / studies showed no 9.3 gm/dl Microscopy of stools reveals numerous white and read blood calls. Colonoscopy showed pseodopoype….. mucosa

i) What is most likely diagnosis? 1

ii) Write 1 extra intestinal manifestation associated with the disease? 1

iii) Name 2 complications 2

iv) Give 1 differential diagnosis of the disease mentioned (NSMC) 1

---A 25 yr old man presents with low grade fever,wt loss,fatigue,crampy abdominal pain,episodic diarrhoea and post prandial bloating,Rt lower quadrant tenderness is elicited on palpation of abdomen,on capsule endoscopy=thickening of terminal ileum,edema,markd luminal narrowing and cobblestone appearance of mucosa,Write 2 clincal conditions considered in DD?6 miicroscopic differences b/w them?4 dietry factors associated with colorectal carcinoma(WMC)

---:

RENAL

---a) Name the various types of giomerulonephnritis 02

b) Give the features of membrane proliferative glomerulonephritis 03(PMC)

---A 5 year child comes to the physician with generalized oedema and proteinuria. He is disguised as nephritic syndrome.

i- What type of nephritic syndrome is found in this age group? (01)

ii. What is its pathogenesis? (02)

iii. Write down two other primary and two secondary causes of nephritic syndrome. (02)(SZMC)

A 38 yrs old female patient of SLE develops progressive renal failure with very high level of BUN and creatinine. Renal biopsy is performed and the lesion comes out to be rapidly progressive glomerulonephritis.

1. What are the different types of Primary glomerulopathies? 3

2. What are the features of glomerular syndrome associated with rapidly progressiveglomerulonephritis? 2 (RMC)

---69 years old industrial worker & chian smoker presented with cost vertebral pain, palpable mass & hematuria. MRI showed metastasis to lungs & bones. This man died after 5 years of initial treatment

a. What is your diagnosis?
b. Describe gross & microscopic findings of this lesion(CMC)

. an old lady presents with generalized body edema. Her laboratory investigations show hypoalhaminemia and macroulbuminuria. Her fasting glucose levels are more than 200 mg/dl on three consecutive day. Her urine analysis reveals few red blood eels.

a) What diagnosis comes in your mind? (01)

b) What characteristic features would you expect to find in her …. Biopsy specimen?

---8 year old boy with poor socioeconomic status presented in nephrology OPD with complaints of fever, malaise, nausea, olliguria and coca-coloured urine 1 to 2 weeks after recovery from sore throat.

(a) What is the most likely diagnosis?
(b) What is the most likely cause?
(c) Write down the laboratory diagnostic tool? (SZMC)

---a. Write down causes of nephritic syndrome. (2)

b. Describe morphology of crescentic glomerulonephritis (3)(SMC)

---A 60yr old man comes to clinician with complaint of coco coloured urine n flank pain.man has had low grade fever and lost 10 pounds over the past month.hes chronic smoker.large mass can b palpated in lt.kidney,lab findings=secondary polycythemia.risk factors?2microscopic features of clear cell carcinoma?4 common locations of metastasis?(WMC)

Give in a tabular from the clinical presentation, eight microscopy and election microscopy immured eurescence features of acute past streptococcal and membranous glomerulo nephritis. (MMDC)

---….: A 12 years old girls complains of swelling of her eyelids abdomen & ankles she has been a good health until overal months ago, when she gained weight & also noted swelling of her lower logs An x-ray … of the chest shows bilateral postural effusions without evidence of lung disease Un analysis reveals heavy ……………. (8 g per 24 hrs)

Without hematuria a per coetaneous needle biopsy of kidney discloses no morphological abnormalities by light microscopy

i. What is most likely diagnosis? 1

ii. Give two probable causes? 2

iii. Enlist the differences between nephritic & nephritic syndrome? 2 (NSMC)

---A 6 years old-boy presented in OPD with generalized odema and proteinuria of 8.5g/day. His condition who wed marked improvement with corticosteroid therapy.

a) What is your diagnosis? Name two other biochemical investigations which could assist in the diagnosis? (2)

b) Give the light microscopic and ultra structural changes seen in the glomeruli in a renal biopsy obtained from such a case. (3)(SIMS)

MUSCULOSKELETAL

a. Enumerate the bone forming tumors. Give morphology of giant cell tumor of bone

b. Compare & contrast the morphology of Osteoarthritis & Rheumatoid arthritis(CMC)

---A 60 years old female presented with deep, achy pain in her legs and back haberden nodes were also present at distal interphalangeal joints.

(a) What is the most likely diagnosis? (01)

b) What is hone eburnation? (02)

A year old male presented with increasing pain in the left leg near knee joint, of approximately 3 months duration and a recent onset of low-grade fever. On physical examination, there was some local tenderness and soft tissue swelling over the lower end of left femur. Radiological examination revealed mixed tytic and ectoblastic lesions with peri-osteal elevation in the metaphy seal region.

a. What is your diagnosis? (2)

b. What will be the histomorphological findings? (3)(MMDC)

--- a. What is Rheumatoid arthritis? Describe its morphological features (3)

b. What are the X-ray findings of following two tumors…….? (2)

i. Osteosarcoma

ii. Chondrosarcoma (SMC)

---12 a) Give histological features of chondrosarcoma 02

b) Enlist the complications of Rheumatoid Arthritis 03(PMC)

---A boy presented in surgical opd,hes 20.and has sweeling(painful) in lower part of thigh just above knee and difficulty in walking,radiogram shows destructive mixed lytic and blastic lesion and codman triangle.Diagnosis?Whats codman triangle and how is it formed?Give histological variants of chondrosarcoma?Describe histological features of dysplasia(fibrous)Name commonest organisms causing pyogenic osteomyelitis,define involucrum(WMC)

---A-

---…: A…..A 53 year old male presents to his CP with an acutely painful right big toe. on examination the toe is swollen erythematous with red and shiny overlying skin and is extremely tender to touch.

i) What is the most probable diagnosis

ii) Which investigation will be the most helpful for the diagnosis (only one) 1

iii) Name two causes of the underlying abnormality 1

8….. Name four Prognostic Factors for melanoma of skin(NSMC)

HEART

A 40 years male presents with chest pain with associated dyspnoea and profuse sweating. Physical examination reveals pulse 130/min and B.P 160/100mm Hg. His ECG shows ST-Segment elevation.

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

b) Enlist them complications associated with it. (2)

Which cardiac enzymes will you advise in such a patient to reach a definite diagnosis? (SIMS)

A 58 year old man with ACUTE MYOCARDIAL INFARCTION after he collapsed on his office. Desk. He is known hypertensive and smokes. Serum cholesterol level is elevated. His father died of myocardial infarctions and his mother has stable angina.

a. identify the major risk factors for atherosclerosis in this patient. (2)

b. Microscopic structure of Atheroma. (3)(MMDC)

A 40 year old male chronic smoker with sudden on set of severe chest pain was brought to cardiac institute. The ECG showed left ventricular infarction and Lab investigation showed raised cardiac enzymes.

1. What will be the morphologic changes in the myocardium after 2 days of attack? 3

2. What pathologies are seen in the reperfusion injury after thrombolytic therapy? 2 (RMC)

---A-A 34 year old I/V drug abuser presents to ER with a 24 hrs history of fever & shaking……His murmurs Echocardiography shows vegetations on heart valves The patient develops headache & right arm paralysis. CT scan on bran demonstrates an infarct of right frontal lobe.

i) What is the most likely diagnosis of heart? 1

ii) What is the most likely causative agent? 1

iii) What is cause of brain infarct in this case? 1

B—What are 4 major Jones criteria for rheumatic heart disease? 2(NSMC)

A ten-year-old child had history of a mild sore throat. Three weeks later, the child suffered from fever and painful swelling of the knee joints, followed by pain and a murmur suggestive of mitral regurgitation. The antistreptolysin O titer was elevated. In her thirties, the patient began to to have dyspnea on exertion, which slowly increased in severity in her forties and had coughed up some blood-tinged sputum.

(a) What is significance of the history of rheumatic fever as a child? (01)

(b) What are the primary symptoms of acute rheumatic fever? (02)

A 30 year old man presents to the emergency room with sudden high fever and shaking chills. A new murmur localized to the mitral valve is hear. Patient has bilateral nail-bed hemorrhages, painful nodules on tips of finger and toes. Blood culture and echocardiogram is ordered and broad spectrum antibiotics are immediately started.

A. what is the most likely diagnosis in this case?

B. Compare the vegetations of infective endocarditis and rheumatic heart disease.

C. Describe characteristic histologic features of myocardium in hypertrophic cardiomyopathy.

D. describe the gross and microscopic appearances of myocardial infarction of 1-3 days duration.(WMC)

---A15 years old girls has sore throat with fever & three weeks later she developed pain in knee & hip joints. Systolic murmur with hypotension

a. Give the pathogenesis & morphology

a. Name the lab tests to diagnose the disease(CMC)

A…why HDL cholesterol is called Good cholesterol”? (NSMC) 1

B….describe morphologic features of atherosclerosis (NSMC) 4

---a. Give the evolution of morphological changes in myocardial infarction in relation to interval of time since original injury. (3)

b. Which form of cardiomyopathy is associated with systolic dysfunction? Give its gross & microscopic appearance. (2)(SMC)

--- A 14 years old boy presented in the OPD with shortness of breath for one month and swelling of were joint’s for 2 weeks. He suffer’s from Sore Throat Off & On. His ASO titer is 800….. Echccardegnactry shows valvular vegetations.

a) What is most likely diagnosis 01

b) What is pattern of joint involvement in this condition. 02

c) What is pathogenesis of this disease & name two complication which he develops. 02(PMC)

LIVER

LIVER+Pancreas

Q1) A healthy looking volunteer blood on labeled as Hepatitis B carrier on screening & was not allowed to donate blood.

a. What is serological diagnosis of Hepatitis B virus carrier?

b. Define & classify Hepatitis B virus carrier.

c. Enumerate the routes of transmission of Hepatitis B virus(CMC)

----. 55 years old male presented in OPD department with progressive weight loss & indigestion with yellow discoloration of skin. Physical examination reveals marked scieral itchiness. The lab investigations reversal was diagnosed to have mass on head of pancreas on CT scan.

---Describe the gross and microscopic features of alcoholic cirrhosis (5)(SMC)

---Define pancreatitis. Give etiology and pathogenesis of chronic pancreatitis. (5)(SMC)

A 45years old female came in the OPD. She gave h/o off and on pruritic, jaundice, dark urine with light stool from last 6 months. MRI showed extra hepatic bile duct obstruction by stone.

1. What are the important pathological findings in the liver before secondary biliary cirrhosis develops? 3

2. How you will differentiate histologically this lesion from primary biliary cirrhosis? (RMC) 2

---a) Tabulate the difference between obstructive and non obstructive jaundice 01

b) Give the salient histological features of Carcinoma Pancreas 02(PMC)

---. A sixteen year old girl, who has been feeling unwell for a week, presents with nausea and pain in the right upper quadrant of the abdomen. Her liver function tests show:

U/I (<40), ALP 98 u/l (50-120), and Urine is positive for Bilirubin.

a) What is your diagnosis? (1)

b) What is the reasons or increase in ALT and positive Urinary bilirubin. (2)

c) Give four causes of conjugated hyperbilirubinaemia. (2)(SIMS)

A 60 year old chronic alcoholic male presented in the medical emergency with sudden onset of abdominal pain radiating to back and left shoulder followed by nausea and vomiting. A diagnosis of acute pancreatitis is suspected.

1. What findings in the plasma of the patient help in diagnosis? 1

2. Why hypocalcemia occurs in these patients? 1

3. Enlist three important complications associated with this condition. 3

(RMC)

---A 57 yr old man with H/o blood transfusion presents with jaundica n ascitis,along with mildly elevated transaminases,as well as impaired hepatic synthetic function(coagulopathy,hypoalbuminemia),Give diagnosis?4 etiologies?Enlist central pathogenic processes in cirhosis?describe briefly mechanism of activation and proliferation of stellate cellsin cirhosis(WMC)

---A 55 years old man presented in the emergency with heamatemesis. He was transfused four pints of blood. His LFTs were moderately disturbed. His PT and APTT were prolonged. His abdominal ultrasound revealed coarse hepatic architecture and splenomegaly. Clinical examination showed palamer erythema. He had a past H/O jaundice after blood transfusion.

a) What is the likely diagnosis? What is the probable cause of heamatemesis?(2)

b) Give important features you expect to see in the liver biopsy? (1.5)

Classify this disorder on the basis of etiology. (SIMS)

Q6) A70 years old man is brought to the hospital with h/o cough, chest pain & dyspnea, hoarseness of voice & repeated chest infections

a. Give Who classification of lungs tumors

b. What is the role of tobacco smoking in pathogenesis of this condition

c. What are the three commonest causes of mortality in such conditions(CMC)

---known patient of chronic hepatitis is presented with jaundice blotting from as cites easy bruising from blood clotting abnormalities, loss of appetite, un intentional weight loss and abdominal pain especially in upper right quadrant, also nausea, emesis and fatigue.

(a) What is the most likely tumor? (01)
(b) Write down is marker? (02)
(c) Write down other investigations. (03)
(SZMC)

---Describe pathogenesis of cholesterol stones (Gull Bladder) (NSMC) 5

---. A 50 year-old lady presents with H/O dull right upper quadrant pain and flatulence for the past one year. Plain X-ray revealed no stone in the gall bladder. Ultrasound was advised. Following that cholecystectomy was performed. The lumen of Gall bladder was found to be full of stones.

(a) Enlist various types of gall stones.

(b) What are the expected microscopic features of removed Gall bladder? (01)

Performed)? (02) (SZMC)

MALE

) A 57 years old man developed frequency of maturation, urgency, overflow, incontinence & nocturia. PR exam showed nodular prostatic enlargement. PSA level is less than 4 ng/dl

a. What is your diagnosis?

b. Give gross & microscopic findings of this prostate(CMC)

80 years old man develops urinary symptoms with low backache. His prostatic Specific Antigen (PSA) level was 15ng/ml (Normal cut off value =4ng/ml). Bone scan revealed metastatic deposits in the lumbar spine.

a) What is the likely diagnosis? (1)

b) What would be the gross and microscopic picture of disorder? (4)(SIMS)

---An 80 yr old man comes with complaint of hesitancy and nocturia for past 1 yr,increasing backpain for 6 months,On digital rectal examination he ahs hard irregular prostate.boe scan shows increaed areas of uptake in thoracic n lubar vertebrae,serum alkaline posphatase=350U/L,serum prostatic acid phosphatase level=8ng/ml,PSA=72ng/ml,BUN=44mg/dl,serum creatinine 3.8 mg/dl,diagnosis?2 microscopic findings?What do u understand by term pin?diagnostic and prognostic significance of PSA?Describe briefly gleason grading system?(WMC)

---A – An 8 years old ….. is brought to the physician because his parents noticed a mass in his left testing physical examination revealed a solid mass that could not be trans illuminated. This testicle was removed ……….. & H/P revealed a haphazard arrangement of benign differentiated tissues including s testicle was removed ……….. & H/P revealed a haphazard arrangement of benign differentiated tissues including squamous epithelium. Glandular epithelium cartilage & neural tissue The patient is symptom free 5 years later

i. a) What is most likely diagnosis? 1

ii. b) is it a germ cell turner or non germ cell tumor? 1

B----- Classify testicular germ cell turner (NSMC)

--- A male patient presented in the OPD with Right Testicular Mass.

a) Name three testicular germ cell tumors 02

b) What is the value of serum tumour marker’s in the context of testicular tumours (PMC)

---a. describe microscopic appearance of carcinoma prostate. (2.5)

b. how do you stage the tumor? (2.5)(SMC)

. A 70 year old man has increasing difficulty with urination. He also has a feeling of urgency, but each time the urine volume is small. He has difficulty in starting and stopping urination. His problem has progressed over the last few years. His prostatic specifien antigen (PSA) level is slightly increased but has been stable overy this time.

a. What is the likely diagnosis? (2)

b. Give the microscopic appearance of the prostate in this condition. (MMDC) (3)

---A 35-years-old healthy male with a past history of crytorchidism repaired at age 5 presented with painless enlargement of the left testis. Laboratory data included serum HCG of 90 mU/mL (Ref.>5) and AFP of 7 ng/ml (Ref. 0.44).

a) How is Seminoma different from the usual gross appearance of a nonseminomatous germ cell tumor? (02)

(b) Are seminomas associated with increases in serum levels of HCG or a Fetoprotein? (01)

Left orchidectomy specimen of a 45 years old male was received in pathology lab. On cut section circumscribed grayish white fleshy homogenous mass devoid of hemorrhage and necrosis is seen. Microscopic examination of the representative sections shows sheets of large polygonal cells having clear cytoplasm. Nuclei are large having central 1to2 distinct nucleoli. Sparse lymphocytic infiltration is also present.

1. What is your diagnosis? 1

2. Why neoplastic cells have clear cytoplasm? Name special stain for it demonstration. 2

3. Name one immunohistochemistry marker for tumor cell. 1

4. Name the germ cell tumor seen usually above 65 years of age. (RMC) 1

Prostatic chips obtained after TURP of 70 years old male with urinary obstruction were submitted for histological examination which shows prostatic adenocarcinoma.

1. Name the precursor lesion of prostatic cancer. 1

2. How many grades are given in Gleason system? 1

3. Why there is a chance that early malignancy can be missed in TURP specimen. 1

4. What is the importance of serum PSA levels? (RMC) 2

FEMALE

Classify the ovarian tumors & describe any one benign epithelial lesion(RMC)

---A 65 years old female presented with right adenexal mass. Gross examination showed multiloculated cystic mass filled with mucoid gelatinous material. His pathological examination revealed a tumour composed of papillae and glands lined by pleomorphic stratified mucin secreting epithelium with atypical mitosis and stromal invasion.

a) What is the likely diagnosis? (1)

b) Classify ovarian surface epithelial tumors. (2)

c) Name nay two serological tumors markers for ovarian tumors. (2)(SIMS)

---A massively obese, 55 year-old, sexually active woman, nulligravida, presented to her gynecologist because of vaginal spotting for 1 year. An endometrial biopsy yielded abundant tissue. Following the biopsy, the patient was lost to follow up for 8 years. Endometrial biopsy is repeated, followed by a simple hysterectomy with bilateral satpingo-oophorectomy.

(a) What is a major risk factor for endometrial hyperplasia? (02)

(b) What are risk factors for the development of endometrial adenocarcinoma? (03)(SZMC)

A 60 yrs old obese, diabetic, post menopausal woman develops irregular vaginal spotting for the last three months. Her Pap smear report is within normal limits. Ultrasound of the uterus shows marked endometrial thickening. The endometrial biopsy diagnosis is complex atypical hyperplasia. Hysterectomy with bilateral salpingo-oophorectomy was done. The histopathology report shows endometrial carcinoma.

1. Name the type of endometrial carcinoma in this case. 1

2. What is endometrial hyperplasia and what are its types? 3

3. Which gene mutation is associated with endometrial hyperplasia andendometrial carcinoma? 1 (RMC)

---Write short notes on.

a. Molar pregnancy (1.5)

b. CIN (1.5)

c. Teratoma (2)(SMC)

---A 45 years old woman has raised CA-125 level in her blood and USG shows mass abdomen.

a. The mass belongs to which organ? (2)

b. describe microscopic features of Granulose cell tumor. (3)(MMDC)

---- a) Name six tumours of female genital tract 03

b) Describe briefly the microscopic picture of CIN-111 02(PMC)

---A 39 year old women reported to gynecologist with irregular spotting / vaginal bleeding for the last 3 months. She gave history of abortion 4 months back. Vaginal examination revealed hemorrhagic necrotic module in vagina. B HCG level was markedly elevated in excess of 50000 m IU/ml, and X-Ray chest revealed metastatic deposits.

A. What is the most likely diagnosis in this case?

B. Describe characteristic histological features of complex endometrial hyperplasia without atypia. (WMC)

---….: a 24 year old woman presents to clinic complaining of increased pain and bleeding during menstruation her last three menstruations have been accompanied by increasing intensity of cramping and large amount of blood. She talls you her menstrual cycle has been regular for last 6 months. After taking a complete history you earn that she has been having increased pelvic pain with intercourse. On pelvic examination you palpate fixed bioteral overrun masses and an MRI shows cohobate cysts and overy

i. What is the diagnosis? 1

ii. Name two other sites/tissues of body which may get involved 1

iii. Define adenomyosis? 1.5

iv. How chocolate cysts are formed? 1.5 (NSMC)

BREAST

A 62 years old female presented with 5 cm breast lump attached to skin & underlying tissues with enlargement of axillary lymph nodes. Microscopy showed pleomorphic epithelial calls with hyperchromatic nuclei & prominent nucleoli arranged in glandular pattern with invasion to stroma

a. What is your diagnosis?

b. Name breast tumors

c. Enumerate risk factor of above lesion(CMC)

---An 18 years old female complained of a nodule in the right breast. Clinical examination revealed a non-tender mobile, well eircummseribed tumor with positive slipping test.

a. What is your probable diagnosis? (2)

b. What will be the gross and microscopic findings after excision of this lesion? (3)(MMDC)

--A 50yr old lady presented to dr with history of lump in rt.breast since 6 months.lump was firm,with irregular margins,4cm and immmobile,uon histology it was foud that lump was ER and PR postive and HER2/NEU negative.Give 2 histological features?Whats the significace of ER+PR positive and HER2NEU negative in treatment?Enumerate architectural subtypes of DCIS?enlist 3 principal morphological features occuring in fibrocystic changes of breat?(WMC)

--- A 50 year old female presented with lump in her right breast. She was diagnosed as a case of carcinoma breast on histological examination of incised limp present in her beast.

(a) Classify carcinoma beast. (02)

(b) Give histological features of Medullar Carcinoma. (03)(SZMC)

A 45 yrs old female develops a painless lump in the upper outer quadrant of right breast. The mass is 5 cm in diameter and the right axillary lymph nodes are palpable. FNA reveals malignant cells. Modified radical mastectomy with axillary clearance is performed.

1. What are the different histological types of breast cancer? 2

2. What are the major prognostic factors of breast carcinoma? 2

3. What is Sentinel node? How it is detected and what is its importance? (RMC)

---A 50 years old female presented OPD with lump in the upper outer quadrant of left breast. On physical examination, the lump is firm and poorly circumscribed. FNAC showed malignant cells.

a) What is the likely diagnosis? Classify carcinoma female breast (2)

b) Give microscopic features of Invasive Ductal Carcinoma. (2)

c) Enumerate the major prognostic factors of carcinoma breast (1)(SIMS)

---a) Classify tumours of breast. 03

b) Describe role of tumour marker in the prognosis of Carcinoma Breast 02(PMC)

---A 60 year old women comes to your office for evaluation of a breast “lump” About 4 months age she noticed a “hard” but painless area along the lateral aspect of her left breast She has previously had minor chest tragus cm firm area in the upper outer quadrant which seems firmly attached to the chest wall. The overlying skin is dampest but the mass is painless There is a firm 2 cm nodule in the left…. And her left arms is swollen

i. 1 What is the most likely (Specify histological type) diagnosis 1

2 What are the risk factors (name 4 factors) (NSMC)

ENDO

) A 29 years old female presented with solitary nodule in front of need moving with swallowing. Cut surface of specimen showed papillary cocci.MRI showed metastasis to cervical lymph nodes. Later on she developed hoarseness, dysphagla, cough & dyspnea with metastasis to lungs also

a. What is your diagnosis?

b. Give the morphology & pathogenesis of suspected lesion(CMC)

---A 28 yr old woman has difficulty in concentrating at her job at work for past 1 yr,She is constantly getting up and walking to visiting co-workers.She complains work area is too hot,she seems nervous and spills her coffee alot,hasbeen eating more but lost 5kg in past month.temperature=37.5C,pulse 101/min,respiratry rate=18/min,BP=145/85,diffuse thyroid enlargement.diagnosis?4 lab findings for confirmation,2 characteristic microscopic features of this lesion.(WMC)

----briefly the metabolic complications of diabetes? (CMC)

---A 25 years old male radiographer presents with cervical lymphadenopthy, selling in front to neck and hoarseness of voice. FNAC of thyroid nodule proves it to be malignant.

(a) What type of thyroid cancer is common in this group? (01)

(b) What cellular morphology is diagnostic for it? (01)

A 20 year old female presented with exophthalmoses, tremors, menstrual irregularities and heat intolerance.

1. Give 4 causes of hyperthyroidism. 1

2. What tests you would perform to diagnose Grave’s disease. 2

3. What is thyroid storm? Why it is considered as a medical emergency? 2 (RMC)

---A 40 year old school teacher went to her general practitioner with complaints tiredness, weight gain and a feeling of discomfort tin neck. On clinical examination she had goiter and her laboratory tests revealed a raised serum TSH and low free T4 levels. Thyroid peroxides (TPO) antibodies were present in high concentrations.

a) What is the most likely diagnosis (1)

b) Give the mechanism of injury in this case (3)

c) Name two autoimmune endocrine diseases that this patient is at increased risk to develop. (1)(SIMS)

---A 40 years old lady c/o perfuse swatting and loss of weight. On examination Tachycardia and are noted.

a) Name the lab investigations which are indicated for diagnosis of this disease 03

b) Describe the microscopic features of papillary carcinoma thyroid 02

(PMC)

---….: A—A 50 years old man complains of muscle weakness & dizziness of 3 months in duration. His BP is 185/100 mmHg. Laboratory studies shows hypernatemia endocrine studies reveal elevated 50/um aldesterone & low rennin & angiotensin. BUN is 24mg/dl Creatinine is 1.2mg/dl. Entomological studies rule out Cushing syndrome

i) What is most appropnate diagnosis? 1

ii) Name two commonest causes of this condition? 2

B---Give two causes of adrenal crisis? 2(NSMC)

A 15 years old female presented with a swelling on left side of neek, which moves on swallowing. Her thyroid scan reveals a solitary cold module in left lobe of thyroid.

a) Considering the scenario, write down the differential diagnosis. (04)

b) Which further rest would help the best in finding the provisional diagnosis (01)(MMDC)

-------Name four retinal lesions/finding found in of diabetes mellitus 2(NSMC)

---A biopsy from a soft tissue mass in the illac fossa revealed metastatic carcinoma most consistent with a diagnosis of metastatic follicular carcinoma of thyroid gland. A cold thyroid nodulectomy for a 2 cm cold thyroid nodule 8 years back. The lesion was reported follicular adenoma.

a. If you were to re-examine the slides form the thyroid nodule which part of the lesion would you examine most carefully and why? (2)

b. What is the common mode of metastasis for follicular thyroid cancer and what are the commonest sites for metastasis. (3)(SMC)

A 28 years old male show shrinkage of liver on ultrasound.

a. what is the most likely diagnosis. (2)

b. Name three morphologic features of cirrhosis liver. (MMDC) (3)

BLOOD/HEMATOPEITIC

a. A 22 years lady belonging from minorities of Pakistan and strict vegetarian presented in medical OPD with generalized weakness, pailor and numbness of hand. On CBC his H6 g/dl and MCV is 115 fl. Patient had which type of anemia? What peripheral film findings are expected from a hematologist?

b. Enumerate the causes of decreased survival of Platelets?

c. How the morphological features of lymphoblast are different in comparison with the meloblast?

How the histochemical stains are helpful distinguishing ALL from AML?

(CMC)

A one year old male baby presented with complaints of progressive pallor and abdominal distention for the last three months. There is also H/O of blood transfusion once. On clinical examination hepatosplenomegaly was found. He was diagnosed as a case of Thalassaemia major on Hb Electrophoresis.

1. Describe peripheral film morphology in β thalassaemia major? 2

2. Describe the major morphological alterations seen in the bone marrow and spleen in thalassaemia major. 2

3. Mention the curative treatment available for thalassaemia major. (RMC) 1

---a. Enumerate the causes of hypochromic microcytic anemia. (2)

b. Explain the pathogenesis of beta thaiassemia major. (3)(SMC)

---A patient living in tropical area is diagnosed as case of Kala-zar. Aabdominal examination reveals massive splenomegaly.

a) Enlist six other infectious causes of splenomegaly. (03)

b) Describe pathogenesis of congestive splenomegaly. (02)(SZMC)

---. A 13 years old male presented with serve anaemia, and frontal bossing. X-ray skull showed crew cut appearance labs showed: MCV-65 fl, MCH: 18gm/dl, MCHC: 28%, HB: 6gm/dl

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

b) What is Hb H disease? (2)

c) How would you confirm a case of B Thalassaemia in the Laboratory, both homozygous and heterozygous (2)(SIMS)

---

Q.No. 12 Give features of FAB classification for AML (MMDC) (5)

Q.No. 13 List the investigations for bleeding diathesis (MMDC)

Draw a diagram to illustrate the DIAGNOSTIC usefulness of PROTHROMBIN TIME [PTT] and ACTIVATED PARTIAL THROBOPLASTIN TIME [APTT] in the diagnosis of coagulation disorders. (5) (MMDC)

---a) Classify Hemolytic Anemias 02

b) How will you screen a case of bleeding diathesis 03(PMC)

----A 24 years old woman presents to your office for a checkup. She states that her pregnancy has been proceeding smoothly. Although she has been feeling more tired than she expected she expected. Her physical examination is target unremarkable except for marked pallor. You order serum studies and find decreased hematocnt decreased fern tin and increased iron binding capacity

i. What is the diagnosis? 1

ii. Name two common causes? 1

iii. What are the findings on peripheral blood than? 1

iv. What other clinical signs and symptoms you would expect? 1

v. What is Plummer Vinson syndrome? NSMC)

2…..4…..: Give WHO classification of the Lymphoid Nepotisms(NSMC)

---Define anemia?classify anemia according to etiology and morphology?how will u manage a suspected case of megaloblastic anemia in the laboratory(WMC)

---A child 6 years old is suffering from fever for last one month. On examination there is anemia and pattern haemorrage. There is cervical and auxiliary hymphadenopathy. Peripheral film shows blast cells.

a) What is your diagnosis and enlist good prognostic features of ALL 03

b) Name the various phases of CML (PMC)

LUNG

Tabulate differences between Tuberculosis and saracidosis(NSMC)

A 65 yrs old male smoker is suffering from persistent cough with sputum production throughout the winter with intermittent low grade fever. He gave history of a similar attack last year, treated by antibiotics, bronchodilators and expectorant therapy. He develops dyspnea on exertion and sometimes becomes blue.

1. Define chronic bronchitis. 1

2. What are the complications of chronic bronchitis? 2

3. What other conditions come under the heading of COPD? 2 (RMC)

---A 25 years old man went to pulmonologist at the peak of spring season. Having severe disperse ….. wheez. His pulmonary function tests showed decrease FEV-I, Serum IGE level was elevated and ….. reveals absolute eosinophilla.

a) What is most likely diagnosis 01

b) Give four histological finding of this disorder and name three interleukin secreted in this diseases. 02

c) Name four chronic restrictive air way diseases. 02(PMC)

---A 44 yr old male presents to ur office complaining of persistent cough,which produces copious sputum,,hes a heavy smoker and has suffered such coughs for several years,his physical examination reveals diffuse wheexing and crackles,u suspect he will hav decreased fev1?fvc ratio,and strongly recommend that he stops smoking,diagnosis?define obstructive an ddestructive lung diseases and give 4 examples of each,name major etiological factors for malignant mesotheliomas.(WMC)

---A 30 years old man presented to his doctor of episodes of wheezing and normally in the period between the episodes. His physical examination and …… X ray are unremarkable. Scrum IgE level and complete blood count are normal. There is no family history of asthma or other allergies.

a. What is the most likely diagnosis in this case? (1)
b. What are the main abnormalities in this case? (2)
c. List the etiological factors of the condition?
(MMDC)

---. A 64 years old man, how has been smoker since the age of 18 presents with two months history of cough, SOB, hemoptysis and weighe loss. His serum sodium level was low. A 3cm mass was detected in the right lung MCT. Histopathologist reports this mass to be small cell lung cancer.

a. Give morphology of small call lung cancer. (2)

b. Explain hyponatremia in this patient. (2)

c. What would be most suitable treatment option for this patient? (1)(SMC)

---. X-Ray of a patient showed the hyperlucent lung fields and depressed diaphragm. On gross the external surfaces of the upper lobes of both the right and left lungs have large bullae.

a) What is the definition of emphysema? (1.5)

b) is this a clinical or an anatomic term? (0.5)

c) What are the major forms of emphysema? Can they always be distinguished from each other? (03)(SZMC)

---A 35 year-old lady c/o morning stiffness of small joints of hand. The joints are swollen and painful for last two weeks. Complete blood examination reveals leukocytosis. She has raised CRP level and is seroreactive for RA (Rheumatoid arthritis) factor.

a) What is the likely diagnosis? Give the pathogenesis of this disease. (3)

b) Give the clinical findings and pathogenesis of REITER’S syndrome. (2)

c) How can you do differentiate between Chronic Bronchitis and Emphysema.

(1.5)(SIMS)

---a) Enumerate the chronic obstructive diseases (COPD). (2)

b) What are the different anatomical types of EMPHYSEMA? (1.5)

c) How can you do differentiate between chronic Bronchitis and Emphysema. (1.5)(SIMS)

BLOOD VESSELS

a. Write down the composition of atherosclerotic plaque and briefly describe the clinically significant pathological changes which can occur in the plaques. (2)

b. What is the difference between rule & false aneurysm. Give pathogenesis of abdominal aortic aneurysm. (3)(SMC)

Enlist three principal components of atherosclerotic plaque. (wmC)

Eye solved sendup Seqz

2012-10-18T06:47:00.001-07:00

Thanks to Ramla Farooq for solving.

EYE
EYELID:
A boy of 10 yrs presented with severe drooping of eyelid since birth with poor levator excursion,causes?how wil u evaluate this problem?What wil b the best surgical ption to treat this case.
Since birth means congenital, so it could be either of Blepharophimosis,jaw winking ptosis, horner's syndrome, nerve paresis or tumors like neurofibroma, rhabdomyaosarcoma. Poor function requires BROW SUSPENSION procedures.

A young man working in chemical factory presented in eye OPD with installation of some chemical in both eyes.emergency treatment?Give medical treatment of grade 2 and 3 injury,complications which can develop if he is not treated?
Normal saline irrigation, irrigation with suitable acid or alkali, removal of particulate matter, double eversion of lid, removal of devitalized tissue.
Complications and treatment same as in book.

A 70 yr old man presented with persistent irritation andwatering R/E for the last 3 months,On examination there was inward rolling of lower lid and rubbing of conjunctiva by lashes.
Whats diagnosis and D/D?
Pathophysiology?
Complications?(RMC)
Senile entropion. dd is trichiasis.
over riding of preseptal over pretarsal part of orbicularis oculi.
complications can be conjunctivitis, corneal ulcer,epithelial defects in cornea.

ERRORS OF RERRACTION
A 14 yr old boy presented with rt.eye vision of 6/36 and left eye vision of 6/6 after maximum correction retinoscopy,shows fundus and anterior chamber is normal,Rt eye=+5D in both axis and lt.eye=+1.5D in both axis.
Whats ur diagnosis
What r different types of this condition.
Classify squint types.
What r different refractive errors types(NSMC)
hypermetropia.
axial, positional, index, curvature-- types.
eso/exotropias, eso/exophorias, paralytic, non paralytic,incyclo/excyclotropia, hypo/hypertropia.
myopia, hypermetropia, astigmatism, presbiopia.

A 25yr old male presented with gradual decrease in vision,On examination visual acuity was 6/12 ib rt.eye and 6/36 in left eye which increased on pinhole test.D/Ds,How will u evaluate refractive error,What r themost modern methods of myopia correction.MMDC
astigmatism, may be hypermetropia too.
evaluate any type of ref.error by by KERAOMETRY, A scan, fundus examination,and DIAGNOSE it by retinoscopy.
Most modern methods can be LASIK ans LASEK.

A 14yr old boy presented withrt.eye vision of 6/36 and lt.eye vision of 6/6 after simple correction retinoscopy,shows fundus and ant.chambers normal.Rt eye=+5D in both axes and lt.eye=+1.5 D in both axes
Whats diagnosis?what r different types of this condition?What r different refractive errors,classify types of squint?(SZMC)

---Whats ametropia?types?treatment?(SIMS)
REPEATING.. a-metropia is other word for refractive errors.

Write short notes on use of laser in ophthamology?Surgical management of myopia?(UMDC)
LASERS used in:
glaucoma treatment (ALT/DLT)
NdYag laser
Lasek and Lasik for refractive errors
laser thermotherapy for retinobalstoma
surgical man.of myopia is:
radial keratotomy, photorefractive keratometry, LASEK or LASIK

--A 25 yr old lady using concave glasses of -6 diopters
what is this condition called?
What r possible complications?
what other treatment modilities can benefit her
Myopia, prone to develop POAG and posterior staphyloma, retinal detachment, macular hemorrhage.
mentioned in above quest,..just add concave lens

CONJUNCTIVA
A young girl presented with itchy red eyes with mucoid discharge following exposure to dust
diagnosis?
drugs used to treat?
complications and their treatment?(CPMC)
Allergic conjunctivitis (same as in book)

-A 6 months old baby presented with purulent discharge since birth.
disgnosis?
which mechanism may cause the same?
treatment?(CPMC)
ophthalmia neonatorum i think.

A 45 yr old presented with burning and redness of eye of both eeyes for last 3 days.On examination theres watery discharge,follicular conjunctival reaction,and painful preauricular lymph nodes
Whats most likely diagnosis
How will u manage this case
What complications can occur(UMDC)
Epidemic keratoconjunctivitis. (same as in book)

--A 50 yr old man presents with fleshy red fibrovascular encroachment onto cornea from nasal side in exposed palpebral conjuctive,
Probabale diagnosis?what do u think this phenomenon is due to?Name atleast 3 surgical procedures.(WMC)
Ptrerygium, dry dusty environment etc, surgery by:
sclera base technique
conjunctival autograft
amniotic membrane grafting.

--A mother presented her 8 yr old child having red and watrey eyes,boy was having alot of itching and perilimbal conjunctiva was swollen with white dots upon it.
Diagnosis?
treatment?
Complications of this disease?(RMC)
Spring catarrah (vernal catarrah) white dots are TRANTA's dots.
(rest same as in book)

A pt with defecctive night vision visits OPd,diagnosis?typical signs in fundus?(WMC)
Vitamin A deficiency, retinitis pigmentosa, POAG, peripheral cortical cataract. Fundal findings i think Ret.Pig.ki honi chahyen.

Ayoung lady belonging to a low socio-economic background presented with mild mucopurulent discharge from both eyes from the last 2 weeks.Ordinary antibiotic drops didnot relieve it.On examination there was diffuse papillary reaction with a line of follicles in the upper tarsal conjunctiva.
Diagnosis?
Lab Investigations?
Treatment?(RMC)
Arlt's line.. TRACHOMA. (book)

A 15yr old boy presented with severe watering and itching of both eyes in spring season.Diagnosis?clinical features?treatment?
Spring catarrh.

A 10yr old boy presented in OPD with complaints of itcjing,watering and photophobia and these syptoms r more marked in spring each yr,By everting the upper E,tarsal conjunctiva shows flat topped polygonal shaped raised lesions,Diagnosis?corneal complications which can develop?how will u treat him?
Vernal/spring catarrah. They are cobble stone papillae so yes.

A young boy complains of redness of both eyes associated with mucopurulent discharge of both eyes for 4 days.
diagnosis
treatment(CMC)
Its mild bacterial conjuctivitis. Mucoprulent in chlamydial as well, but since koe specific feature nae uska so thats possibly a no.

-A young boy is known asthmatic since childhood,He gets recurrent attacks of irrittation,photophobia and redness since long.
Give diagnosis and all possible signs of diagnosis(FMH)
Vernal cKerato conjunctivitis or simply allergic speaking broadly.

An area hasbeen declared 'endemic'for trachoma by health authorirties,Nam emeasures which can b taken 4 its prevention.(CMC)
Maintenance of ocular and genital hygiene, protection from flies, destroy breeding places of flies, over crowding should be avoided.

CORNEA
A 40 yr old male presented with watering and photophobia of lt.eye.on examination visual acuity was 6/60 and corneal haze and circumcorneal congestion with corneal ulcer.How wil u examine case on slit lamp?diagnosis?
flouresein staining. Keratitis

-A young farmer sustained eye injury by a plant shot which he took as trivial,However lacrimation and pain went on increasing in the subsequent days.
Which necessary test is done on slit lamp to confirm the diagnosis of corneal ulcer.
Name atleast 2 culture media of interest in such a case?
What r complications of corneal ulcer?(RMC)
Agricultural products cause Fungal keratitis. Fluorescein again.
Sabourad's agar, KOH, red cell agar
(book)

A young man comes to clinic with history of forign body sensation,watering,photophobia in rt.eye,he consulted a local physician who gave some topical drops,On slit light examination there was dendritic lesion on cornea which stained with florescein dye.
probable diagnosis?
what ohter features do u expect to notice in such type of corneal lesion
management(CPMC)
HSV- dendritic ulcer.(book)

--An 85 year old male comes to u with the complaints of redness,watering an dpain of right eye,On examination there is dendritic and punctuate lesions in the right cornea staining with florescein,
What is ur diagnosis,
d/d,
classify corneal ulcer?(NSMC)
same dendritic ulcer..HSV
dd could be herpes zoster, acathemoba keratitis etc.
classify be etiology mainly (book)

A male pt of 35 yrs complaind of lacrimation,photophobia and redness in his rt eye for last 1 wk.Examination shows branch like corneal lesion.He has H/O fever 2 weeks ago.provisional diagnosis?How will u confirm the diagnosis?Name 2 drugs used to treat this condition.PMC
That seems to be geographical corneal ulcer.

Give management of unilateral cornela ulcer in2 yr old( UMDC)
It should be herpes simplex keratitis, UNILATERAL SCARRING.

Write notes on(UMDC)
management of keratoconus
indications of keratoplasty
(book)

-A 16 yr old boy with the history of allergic conjunctivitis for about 6 yrs,presented with gradual deterioration of vision in both eyes,Hes already using high minus glasses,but not satisfied bcs theres rapid change in glasses prescription,On torch light examination both corneas look clear but conical.
Probable diagnosis?Name 2 ocular and 2 systemic associations of this condition?what r steps of management?(WMC)
keraotoconus; allergic conjunctivitis, aniridia, ret.pig associated ocular
atopic dermatitis, Marfan's, osteogenesis imferfacta systemic.
(book)

An 85 yr old male comes to u with redness,pain,watering of rt.eye.On examination theres puctate and dedndritic lesions on rt cornea,staining with florescein.
Diagnosis?D/D?classification of corneal ulcer(SZMC)
HSV-keratitis, (rest is repetition)

-A midddle aged man presented with photophobia,lacrimation and pain and dimness in rt.eye.On examination of cornea there was central corneal geographical ulcer
diagnosis
complication
Dendritic ulcer again.

---A young girl is contact lens user,She accidently slept with them on and later complained of redness,photophbia,lacrimation blurred vision.Corneal ulcer is sspected.
Give treatment and complications if left untreated.(FMH)
Under the heading of bacterial corneal ulcer, same as in book.

OPTIC NERVE
A 30 yr old female presented in eye OPD preesnted with sudden decrease in vision and impaired colour vision in rt.eye.On examination rt.eye shows Rapid afferent pupillary defect and vision of lt.eye is normal.Diagnosis(optic neuritis),What will b the investigations to reach the diagnosis?treatment?SMC
perimetry, VEP's, MRI brain, blood cp n esr, serological tests for multiple sclerosis etc. Rest as in book.

-A 55 yr old lady presented in eye OPD with h/o severe early morning headache and projectile vomiting.On ophthalmoscopy,optic discs sof both eyes are swollen and congested
D/D
Most imp investigation
Diff b/w papillitis and pappiledema(CMC)
Diag..papilloedema
dd is papillitis, neuroretinitis, retrobulbar neuritis.
(book)

A 90 yr old male comes to u with sudden loss of vision of lt.eye.extraocular movements r painful.RAPD is positive in lt.eye and fundus is normal.
Diagnosis?
Causes of Papilledema?
management?(SZMC)
Optic neuritis.
(book)

CATARACT
---An old lady of 70 yrs is admitted for cataract surgery.
What r pre-operative investigations to b done?
Nmae surgical procedures available?
What r early-post operative complications?(RMC)
Ocular exam, Visual function tests, systemic examination and then specific investigations like blood cp or esr, blood sugar, urine re,CXR, B scan, (book)

--A 65yr old male presented in eye OPD with H/O gradual painless deterioration of vision in both eyes for the past 2 years
D/Ds
post operative complications of cataract surgery
(theres another question but its not really visible in the pic)(CMC)
cataract keratoconus, corneal degeneration, optic atrophy, ARMD, diabetic retinopathy.
(book)

-A middle aged pt of chronic uveitis has rt eye vision 6/24 and lt.eye vision 6/9.Slit light experiment shows that rt.eye has post.subcapsular lenticular opacities.It is decided that catract surgery wud b done and with IOL implant.What surgical technique u will use and y?What ocular measurements will u record to calculate IOL power.Mention 4 intraocular complications that cud develor during surgery.(ICCE)SMC Why icce?? why not phaco?
axial length by A scan, calculation of power of lens by biometry. Rest as in book.

A 1 yr old child brought to u in OPD with bilateral white pupils,on examination with B-scan ant and post chamber r normal.
Diagnosis?causes of leucocoria?causes of congenital cataract?(SZMC)
Congenital cataract.
(book--both)

PMC_______
---A male normotensive non diabetic 65 yrs of age complains of gradual painless blurring of vision,On examinations both pupils r white,His vision is reduced to counting fingers on both sides and his IOP is normal and both pupils react to light.
Provisional diagnosis?
complications occuring if left untreated?
different surgical methods to treat?
Enumerate 4 problems during surgical procedure
Senile cataract. If left untreated, gradual painless loss of vision is occuring and total blindness will be there. If it has completely matured or hyper mature, then phacolytic glaucoma.
(book--both)

A 65 yr old lady gives history of cataract surgery 2 yrs ago,She ahs preented with marked blurring and redness for 12 hours,On examination theres hypopyon in the ant.chamber and ant.vitreous is full of cells.
diagnosis?
management?
enumerate 4 most common intraoperative cataract surgery complications.(CPMC)
Auto immune mediated acute iridocyclitis.
manage by pain relief, treat underlying cause and prevent complications (rest as in book)

-A 50 yr male presentde in OPD eye for routine examination,Onexamination vision was 6/6 in both eyes and IOP was 36mmHG,On examination ant.chambers were deep and both pupils were slow in reacting to light.provisional diagnosis.What wil b the fundus changes in this case?Name 1 investigation to confirm this diagnosis.Classify drugs used to treat this condition.PMC
Im not sure but CHRONIC IRIDOCYCLITIS may be,, no other condition fulfills all the parameters.

--A 4 week old baby is brought to u with white pipillary reflex in both eyes,Fundus details r hazy.Ocular ultrasound reveals vitreoretinal echography,
diagnosis?risk involved if left untreated and how can u prevent it?
treatment.(CPMC)
I think baby has HEREDITARY BILATERAL RETINOBLASTOMA or cong.cataract.. Can't be sure coz part of the quest is missing.

---A 3yr old boy presented in OPD with rt.leucocorir,D/D(SIMS)
Book.

1 yr old boy brought to u in OPD with bilatereal white pupils,On examination,ant and post chambers r normal with B-scan.
Whats ur diagnosis?
What r the causes of leucocoria
What r the causes of congenital cataract(NSMC)
(BOOK)

A male normotensive non diabetic 65 yrs of age complains of gradual painless blurring of vision,On examinations both pupils r white,His vision is reduced to counting fingers on both sides and his IOP is normal and both pupils react to light.
Provisional diagnosis?
complications occuring if left untreated?
different surgical methods to treat?
Enumerate 4 problems during surgical procedurePMC
REPEATING

---Enlist pre-operative complications of cataract Extraction
Write down advantages of phacoemulsifictaion over ECCE(UMDC)
(book) pre op complications mein anesthesia and operative complications.

A 4 yr old boy presents with defective vision,on slit lamp bimicroscopy with dilated pupils revealed bilateral moderate opacification of inner lamellae of lens surrounded by clear lamellae with riders at the margins of the opacity,whats the name given to this type of cataract?Name 4 other types of cataract in small babies?management?(WMC)
Characteristic Congenital LAMELLER (zonular) cataract.
Rest from book.

PUPIL
----Horners syndrome definition or causes(FMH)
neurological syndrome caused by lesion in sympathetic pathway in head and neck. Causes are central , pre ganglionic and post ganglionic

OCULAR INJURIES
i---A young man working in chemical factory presented in eye OPD with installation of some chemical in both eyes.emergency treatment?Give medical treatment of grade 2 and 3 injury,complications which can develop if he is not treated?SMC
chemical injury...emergency treatment wash eye immediately with plenty of clean water. Acid and alkalies neutralised. Lime particles pcked up with forceps and EDTA applied as neutralising agent. For grade 2 and 3.. treat corneal ulcer, steriod, antibiotics, cycloplegic, ascorbate, tetracyclic ointment.
Complication are acute and long term mostly symplephron and corneal ulcer
---A pt was doing whitewash in a house,he got a splash of wash in his eye
What is the immediate measure to b taken
What type os chmical injury has occured
What r the delayed effects of chemical injury in this(FMH)
(chemical injury)

-------A 15 yr old girl received trauma on lt.eye with sulphuric acid,On examination there was severe conjunctival congestion and corneal haze
HOW WILL U MANAGE THIS PATIENT?
What complications will occur if these pts r not managed properly?(UMDC)
(chemical injury) emergency and medical treatment

-A young pt working in stone crushing factory presented to u with acute pain.lacrimation and marked decreased vision of rt.eye.History reveals fall of dust in affected eye during work,On examination conjunctiva is congested,corneal haze and infiltrate against pupillary area,Give spot diagnosis?treatment of this case?4 complications if pt is neglected?(Foreign body)
SMC
-An 18 yr old boy received tennis ball injury presented in ER with severe pain and
-- loss of vision,How will u investigate?Give clinical features?MMDC
(blunt trauma)

SQUINT
-A 5 yr old school boy presented in OPD with rt.eye convergent squint.History reveals that the misalignment is more marked while reading.How wil u evaluate this pt?treatment options?
.SMC non paralytic
A 70yr old male presented with drooping of lt.eyelid and diplopia,On examination eye was deviated downward and outward with normal pupillary reaction,How will u evaluate the case?investigations?diagnosis?(3rd nerve)MMDC

---A 9yr old boy presesnts with lazy eye(amblyopia),causes of amblyopia?treatment?(WMC)

----A patient 35 years of age complains of H/O blurring of vision at near.He doesnot have refractive error.He has also noticed misalignment of eyes sometimes which is outward
Give examination and probable diagnosis(FMH)
paralytic squint

-A female of 55 yrs complains of severe drooping of left upper eyelid since the past 1 week,On lifting eyelid was found to b diverted temporally and pt reported diplopia.provisionl diagnosis?Describe the abnormal extraocular movements in this case,Name 2 causes of this problem.PMC
paralytic squint....diplopia causes are paralytic squint, myesthenia gravis, tyhroid ophtalmopathy
-A male child of 5 yr presented with inward deviation of lt.eye since early childhood.Examination shows left esotropia of 30 degree.His vision was 6/6 in rt eye,and 6/60 in lt.eye.Cycloplegic refraction revelealed no refractive error,Why vision in lt.eye is poor?How vision can b improved?Which type of muscle surgery will correct this deviation.
PMC
due to convergent squint.. lateral rectus muscle surgery required. Treatment includes optical correction, occlusion, orthoptic and operative
----regarding squint
whats the difference b/w accomodative and non-accomodative?
Mention two tests to measure squint?
How will u manage a 2 yr old child with accomodative esotropia?(CPMC)
paralytic and non paralytc
---What r different types esotropia?Write down management of accomodative esotropia?(UMDC)

VITREOUS (hemmorhage)
---A young boy is known myopic having 10DS myopia.He has noticed floaters in his rt.eye with painless sussen decreased vision.
Give investigations and possible diagnosis(FMH)

UVEAL TRACT
---An 85 yr old male comes to u H/O red eye,watering,severe pain,He also gives history of joint pain and neck pain.
Diagnosis?D/D?Management?(SZMC) acute iridocyclitis

A 55 yr old diabetic pt complains of severe pain and decreased vision in hs rt eye,He was operated for cataract extraction with IOL implant 3 days ago,Examination shows ciliary congestion and hypopyon with absent fundal glow.Provisional diagnosis?Give 4 measures to prevent this complication,How will u traet this acse?PMC
endophthalmitis
---A 30 yr old man with history of backache presented wth mild eyeache,photophobia and visual disturbane,his best corrected V/A R/E was 6/12 and 6/6 L/E.IOP was 10mmHg R/E and 14mmHg L/E.Slip lamp examination shows a reaction in ant.chamber(cells(+2,Flare+2) in RT Eye.L/E ant.chamber was normal.Diagnosis?anatomical classification of disease?treatment of this case?(RMC)
acute iridocyclitis
---Discus clinical features of acute ant.uveitis?(SIMS)
--60 yr old man presents with pain,redness and photophobia of both eyes.On examination theres circumcorneal congestion,and dull ant.segment details,Greyish white deposits r noted on back surface of cornea.
Tabulate 2 clinical methods to perform with expected clinical findings in each.
diagnosis?
what r the most imp investigations in this case?(CPMC)
acute iridocyclitis

-----An 85 yr old male comes to u with red eye,watering and severe pain,He also give shistory of joint and neck pain.
gv diagnossis
D/D
Management?(NSMC)
acute iridocyclitis

---A 35 yr old female presented with ocular discomfort,photophobia and circumcorneal congestion?(UMDC)
Give D/Ds
Give management of ant,uveitis?(UMDC)
anterior uveitis

---A 55 yr old male operated in District hospital for rt.cataract extraction with IOL implantation 3 days back,He presented in eye emergency with decreased vision,severe pain.redness and swelling of rt.upper eyelid,On examination there was a severe reaction and hypopyon in ant.chamber,fundus view wasnt cleay due to ahze in vitreous,he was diagnosed as rt.endophthalmitis,discuss treatment(medical and surgical of this patient(SIMS)
GLAUCOMA
--A 65 yr old lady complains of headache,vomiting painful red eye with decreased vision for past 12 days,she gives H?O coloured halos around light in past,On examination she as corneal edema,shallow ant chamber and hypermature cataract,IOP=50 mm Hg,diagnosis?emergency treatment?surgical treatment?(WMC)
acute congestive glaucoma
A 70yr old patient(female) presented with severe ocular pain in lt.eye.History revealed decreased vision for last 1 yr,and rt.eye cataract surgery 2 yrs back.Examination of lt.eye shows shallow ant.cjamber,fixed and mid dilated pupil with an opaque lens.provisional diagnosis?Write emergency prescription for management of this patient.?What is definite treatment option for this patient.PMC
glaucoma and cataract.

A middle aged lady presented with painful red eye and gross decerase n vision for the past 1 day,she complained of seeing halos in both eyes on and off for the past 2 months,On examination visual acuity was hand movement and circumcorneal congestion and dilated vertically oval pupil shallow anterior chamber was present.Diagnosis?treatment options?MMDC
acute congestive glaucoma

5 causes of ectopic lentisSMC
-A 50 yr male presentde in OPD eye for routine examination,Onexamination vision was 6/6 in both eyes and IOP was 36mmHG,On examination ant.chambers were deep and both pupils were slow in reacting to light.provisional diagnosis.What wil b the fundus changes in this case?Name 1 investigation to confirm this diagnosis.Classify drugs used to treat this condition. PMC
Primary angle closure glaucoma suspect

55yr old hypertensive lady presented with acute pain in rt.eye and theres also profound loss of vision.Cornea is hazy,IOP pressure is 60mmHg with mid dilated pupil and shallow anterior chamber.diagnsis>treatment? Angle closure glaucoma
SMC

----An old lady was having visual deficit since long but not seeking medical advice due to family inattention,She suddenly developed pain in lt,eye with watering and redness,Her vision was light perception only,pupil wasnot recating to light and lens was white and opaque,she was diagnosed as lens induced glaucoma.
Whats the pathogenesis of lens induced glaucoma?
Whats emergency treatment of this case?
What r surgical problems of such cases?(RMC)

-Wat is normal peripheral field of vision and by which methods can v check it
Write down different field defects in optic nerve lesions(FMH

---A 45 yr old male comes to u with H/O headache,vomiting and pain in rt.eye,Examination shows corneal edema and shallow ant.chamber and IOP 50mmHg.
Diagnosis?D/D?Management?(SZMC)
congestive glaucoma

-A 2 yr old child presents in OPD with small pupil,ptosis of small degree and iris hypopigmenation
Most likely diagnosis?What ohter signs wud u look for?what advice will b given as ergards the time of surgery?(WMC) horner syndrome

---A middle aged male previously healthy and ahving no visual compplaints presented to eye dept for routine checkup.His best corrected vision was 6/6 for distant N6 for reading glasses,However his iop was 25mmHg in Rt.eye and 22mmHg.
Clinical features of POAG?
Name the visual field defects in POAG?
treatment(RMC)
---Discuss clinical featutes of acute congestive glaucoma?(SIMS)
---A 45 yr old male comes to u with H/O headache,vomiting and pain in rt.eye,Examination shows corneal edema and shallow ant.chamber and IOP 50mmHg.
Diagnosis?D/D?Management?(SZMC+NSMC) acute congestive glaucoma

---a 55 yr old patient with severe ocular pain,in his rt.eye and vomiting,on examination theres marked decrease in vision,hypermature cataract,raised IOP and shallow ant.chamber
What is D/D
Whats most likely diagnosis
How will u manage this case(UMDC)
Acute cngestive glaucoma

---A 61yr old lady comes for routine eye examination,her vison becomes 6/6 after refraction,On distant direct ophthalmoscopy her media was clear,fundoscopy showd relatively thinned but pink neuro-retinal rim,cup:disc ratio was 0.9 in both eyes.
What is the most probabale diagnosis
Name 3 tests to support the diagnosis
Briefly describe treatment and follow up plan(CPMC) open angle glaucoma
VISUAL PATHWAY
A middle aged lady comes to eye opd with H/O rt.eyeball protrusion in 10days duration she has swollen eyelids with incomplete closure of palpebral fissure with decreased vison
give D/Ds and investigations u will do to raech a possible diagnosis(FMH)
proptosis

RETINA
-Parents of a 1 yr old boy presented with lt.white pupil for 2 weeks.On examinattion a white mass was projecting feom retina inward along with blood vessels..DDs?how wil u council the parents?treatment options?MMDC
retinoblastoma

---A 70 yr old male presented to u with sudden painless loss of vision in rt.eye,Hes a known diabetic and hypertensive from the last 20yrs,On examination theres no fundal reflex.
Diagnosis?D/D?Risk factors for diabetic retinopathy?Classify diabetic retonopathy with treatment?

A 30yr old male presesnted with sudden painless loss of vision in rt eye,he has type 1 DM since childhood.Examination shows absent red reflex in rt eye and neovascularization of optic nerve head of lt.eye.diagnosis of both eyes?4 possibles signs in lt.eye?How will u treat lt.eye of the patient?PMC

---A poorly controlled diabetic pt developed gross loss of vision of rt.eye.On examination theres no view of fundus.Left fundus shows microanurysms,hard exudates and neovascularization of optic disc.diagnosis?how will u evaluate?treatment?
SMC
--A young diabetic lady presented with gradual decrease in vission in lt.eye which is worse on exposure to sunlight.Give clinical signs on slit lamp experiment.How will u examine retina?treatment options?MMDC
---A 50 yr old diabetic lady with 20 yrs of duration of diabetes presents with gradual painless decreased vision of both eyes.
Give 4 causes of gradual loss of vision?
Diabetic retinopathy, ARMD, cataract, optic atrophy

---What r different risk factors for the development of Rhegmatogenous retinal detachment?Write down different methods of management?(UMDC)
What r treatment madalities of diabetic retinopathy?
what is the cause of raised IOP in terminal stage of proliferative diabetic retinopathy?
(WMC)
--A 65yr old lady presented with slowly deteriorating painless visual loss in L/E for last 1 yr,Shes normo-tensive and normo-glycemic,Best corrected V/A R/E is 6/12 and L/E is 6/60,IOP and pupillary reactions to light were both normal.
name 2 most probable causes of this type of visual loss?
Investigations?
surgical options(RMC) Age related macular degeneration(ARMD) , cataract

----A young myopic pt is diagnosed as a case of retinal detachment
explain clinical features
Whats the expected of detachment in this case and the surgical plan
What is the prognosis and y
what wil u choose b/w urgent/late/delayed intervention in this case and y?(CPMC)

A 50 yr old known NDIIM lady for the past 10 years was undergoing routine oculat check up.
classify diabetic retinopathy
How will investigate such a case
What r the diffrent treatment options 4 diabetic retinopathy(RMC)
---Classify diabetic retinopathy with its treatment madalities?(SIMS)

ORBIT
---A 70 yr old banker developed foreign body sensation and tearing in both eyes,ocular examination revealed retraction of rt.upper eyelid.Past history revealed treatment of GRaves for past 1 yr,
List 6 other ocular features of this disease?treatment?(WMC)
graves ophthalmopathy

LACRIMAL SYSTEM
A 4 month old baby boy os brught to OPD and mother complains of rt,eye full of tears,small palpabral fissure and lashes matted together,diagnosis?treatment options?(WMC)
congenital nasolacrimal duct obstruction
-A 4 months old child presented with epiphora from rt.eye since birth.Diagnosis?management?at what age intervention shud b don.MMDC
congenital nasolacrimal duct obstruction

ENT Sendup solved Seqz- part 2

2012-10-18T06:45:00.003-07:00

>> A 50 years old diabetic male for last 10 years is admitted in the medical ward for management of diabetic ketoacidosis. Black necrotic turbinate is noted in the right nostril along with right eye proptosis by the medical resident on call. The patient is sent to ENT department for consultation.
a. Diagnosis?(mucormycosis)
b. How will you prove your diagnosis?
c. Manage? (CPMC)

>> A young man has peculiar nasal obstruction that he can breathe in but cannot breathe out. On examination he has a mass in left nostril.
a. Diagnosis?(Antrochoanal poly)
b. Investigate?
c. treatment? (CPMC)

>> A 30 years old female complains of proptosis of the right eye, diminution of vision in the right eye, rhinorrhea and cough.
a. differential diagnosis?(C.A sinus,Orbital cellulitis)
b. what investigations will you prefer to confer or negate each of your diagnosis? (CPMC)

>> A 55 years old lady presents with right sided nasal obstruction, foul smelling blood stained discharge, right sided proptosis and pain in face. Examinsation aslso reveals a loose right upper molar tooth. How will you manage? (CMC)

>> Causes of unilateral nasal discharge. How will you treat rhinolith? (CMC)

>> Classify nasal polyp. How will you diagnose and treat case of Antrochoanal polyp. (CMC)

>> A 14 year old boy presented in ENT OPD with his mothers with compaints of bleeding from nose off and on for the last 8 months. His mother tells you that he is having nasal obstruction and his voice quality has also changed.
a. Diagnosis and which single examination procedure would you like to carry out to reach to a provisional diagnosis?Juvenile angiofibroma
b. manage? (AIMC)

>> A 40 year old diabetic, immunocompromised woman presented with nasal obstruction, headache and swelling of left eye. CT scan shows double density sign in paranasal sinuses.
a. Diagnosis?(fungal sinusitis,needs to b confirmed)
b. management plan? (AIMC)

>> A 40 years old patient has presented with history of attacks of profuse clear watery nasal discharge with transient obstruction. Laboratory finding show normal IgE levels
a. Diagnosis?VMR
b. what other important condition is to be excluded?
c. differentiating features in respect of cause, age of onset, complaints and lab findings in each? (WMC)

>> A 30 year old diabetic developed boil nose. He was seen by general physician and was given antibiotics and anti inflammatory drugs. 3 days later he developed high grade fever, swelling of eyes, prostration, headache and diplopia.
a. Diagnosis?COmplication of boil=cavernous sinus thrombosis
b. Investigate?
c. Manage? (WMC)

>> A man gets feeling of tightness in the face and cheeks followed by blood stained nasal discharge after air travel. Also complains of headache of dull nature.
a. diagnosis?Epistaxis due to decompression sickness
b. definition, etiology, pathology clinical features and management in this case
c. How can you prevent this condition? (WMC)

>> Enumerate tumors of nasopharynx. Discuss treatment of nasopharyngeal carcinoma. (QAMC)

A young boy presented history of nose trauma 244 hours back. On examination nose is blocked with blood clots, nasal bridge is swollen with deviation of nose. How will you manage the case? What complications can be associated? (QAMC)

>> A 35 years old diabetic male presented with fever headache and nasal obstruction since last night. On examination, there is tenderness over cheeks, vision is alright, nasal mucosa is congested with purulent discharge coming through middle meatus. What is the most probable diagnosis?(C.A.Max sinus,but not confirm) What complications can occur? (QAMC)

>> patients with red spot on her lips suffers from regular nose bleeds, she is also under treatment for gut lesions.
a. possibility?Hereditary Telangectesia
b. investigate?
c. treatment (FMH)

>> 14 year old boy has right side nasal obstruction that is progressive in nature and massive nasal bleeding off and on. On examination, a mass is present in right nostril and there is also swelling of right check.
a. diagnosis?Angiofibroma
b. Confirm your diagnosis?
c. if same mass extending into cheek, mention its route. (NSMC)

>> 47 yr male with bilateral nasal obstruction, headache and postnasal discharge. On examination his nasal cavities are filled with multiple whitish looking masses that are insensitive to touch.
a. diagnosis.Ethmoidal poly
b. surgical approaches and which one is best and why?
c. complications of surgery? (NSMC)

>> 27 years old school teacher with h/o nasal obstruction, watery nasal secretions and occasional sneezing specially at morning timings. She is in the habit of using a decongestant nasal spray. Her inferior turbinates were swollen and wet.
a. diagnosisVMR
b. how this differs from nasal allergy?
c. manage(NSMC)

>> 60 years old diabetic woman develops fever with b/l nasal congestion, orbital swelling of right side of face and facial pain for the last 6 days, endoscopy shows areas of congestion of nasal mucosa with black necrotic mucous on both sides
a. diagnosis.mucormycosis
b. investigation
c. treat? (RMC)

>> 15 year young girl with severe watery rhinorrhea bilaterally alongwith occasional nasal congestion. Dark circles under the eyes and pale boggy inferior turbinates.
a. diagnosis.Allergic Rhinitis
b. investigate
c. treatment(RMC)

>> 20 year old woman was using vasoconstrictor nasal drops on and off for reducing rhinosinusitis for 6 years. She gets attacks of nasal discharge sneezing and permanent nasal obstruction. She has grape like masses hanging in the nasal cavity.
a. diagnosis.Bilateral etmoidal polps
b. medical treatment options?
c. best surgical procedure, enumerate complications also. (RMC)

>> various non traumatic causes of CSF rhinorhoea?
b. imp radiological investigations?
c. management? (SIMS)

>> Male child 14 years with recurrent epistaxis and right sided nasal obstruction for last 6 months. Mass in right nasal cavity and nasopharynx which is lobulated and pinkish in colour.
a.diagnosis?Anjiofibroma
b. investigations?
c. manage? (SIMS)

>> Management of a 20 years old motorcyclist who has sustained injuries on his facein a road traffic accident. (SIMS)

>> 22 years female with right sided nasal obstruction and foul smeling rhinorrhea for last 2 months. X-rays of paranasal sinuses showed opacity of right nasal cavity and maxillary sinus.
a. diagnosis.chronic max.sinusitis
b. treat? (SZMC)

>> 4 years old child with b/l nasal obstruction. h/o nasal trauma 2 days back. Anterior rhinoscopy revealed bilateral cystic swelling of septum.
a. diagnosis.septal hematoma
b. treat
c. complications(SZMC)

>> 30 years old female with c/o intermittent attacks of sneezing, nasal blockage and watery nasal discharge for last 5years. For the last 1 yeear, she states that her left sided nasal blockage has increased in intensity. Her nasal examnination showed septal deviation to right side with pearly white glistening multiple masses in left nasal cavity.
a. diagnosis.ethmoidal polyp
b. investigate and treat? (SZMC)

>> 3 year old female baby with mouth breathing, exclusive watering from mouth at right, nocturnal cough and occasional epistaxis. On anterior rhinoscopy, nothing abnormal is visible.
a. diagnosis?Adenoids
b. radiological investigations?
c. Treat? (IMC)

>> Boxer got sever injury to nose on day before and presented with epistaxis and almost complete blockage of nose. No external deformity of nose. Anterior rhinoscopy shows bilateral smooth reddish swellings. X-ray nasal bone shows no fracture.
a. diagnosis?Septal hematoma
b. treat?
c. complication? (IMC)

ENT sendup solved Seqz part-1

2012-10-18T06:44:00.001-07:00

Thanks to Asma Tamizuddin and Khadija Iftikhar (RMC) , for solving.

A 5 year old child has progressive decreased hearing loss and mild earache off and on. There is H/O nasal obstruction, both tympanic membranes are dull with loss of light reflex.CPMC
a. Diagnosis..GLUE EAR(SEROUS OTITIS MEDIA)

A 35 year old female presented with pain left ear for last 4 days. The pain is aggravated o chewing movements. There is no history of ear discharge. On examination movements of pinna are painful, meatus is occluded by swelling and there is some forward displacement of pinna.CPMC
a. Diagnosis...FURUNCLE
b. Differential diagnosis..FURUNCLE,DIFFUSE OTITIS XTRNA,MALIGNANT OTITIS ECTRNA

>> A seven year old child who had chronically discharging left ear, developed otalgia, retroauricular tender swelling with pinna protruded outwards and forwards. How will you manage..CMC

DIAGNOSIS..ACUTE MASTOIDITIS DUE TO CSOM

A female 45 years develops episodic vertigo. Each episode of vertigo being intense, accompanied with nausea and sweating, fullness in the ear, tinnitus and decreased hearing during the attack. She is having such episodes for last 6 months.CMC
DIAGNOSIS..MENIERE’S DISEASE

A 7 year old boy presented with mild otalgia and his mother was worried about his progress in school. Since last 6 months he has on and off attacks of sore throat. He also c/o difficulty in hearing.CMC
DIAGNOSIS..GLUE EAR

A 28 years old female was brought to emergency with history of headache, fever and neck stiffness. There is history of long standing left ear discharge, for which she was taking medications on & off. On examination she had attic perforation.AIMC

DIAGNOSIS..Atticoantral CSOM LEADNG TO MENINGITIS

>> A 40 years old female presented with history of episodic vertigo, right sided tinnitus and hearing loss for last 5 years. Frequency of attacks is increasing and now she has developed decreased hearing from right ear.AIMC

DIAGNOSIS..MENIERE’S DISEASE

40 year old male had surgery for cholesteatoma on left side. On recovery from anaesthesia he noticed that he cannot close his left eye and angle of mouth is pulled to the right without any taste disturbance.WMC
DIAGNOSIS..INFRACHORDAL(BELOW CHORDA TYMPANI) LESION OF FACIAL NERVE/paralysis of infratemporal part of facial nerve due to mastoidectomy

>> A 10 years old child presented to OPD with history of scanty purulent foul smelling ear discharge for last 2 year..attic prforation wd granulationzQAMC

DIAGNOSIS..CSOM(ATTICOANTRAL TYPE)

A 40 years old male presented with episodic vertigo and fluctuating sensorineural hearing loss and tinnitus for last 2 months.QAMC
DIAGNOSZ..MENIERE’S DISEASE

>> A 15 years old boy presented in emergency with sudden facial asymmetry on left side after herpes zoster infection.QAMC
RAMSAY HUNT SYNDROME(FACIAL PALSY DUE TO HERPES)

9 years old boy presented with complaints of watching and listening tv with loud voice and poor performance in class and no response to conversational voices.FMH
DIAGNOSZ..GLUE EAR

>> 45 years old patient with sudden vertigo on changing the position of head which is of few seconds associated with nausea only.FMH

DIAGNOSZ..BPPV(BENIGN PROXYSMAL POSITIONAL VERTIGO).

>> 25 years old developed loss of hearing and facial palsy after getting injury on the scalp.FMH
DIAGNOSZ..TRANSVERSE FRCTRE F TMPORL BONE/

>> 30 year old female receptionist with episodic vertigo, tinnitus and reduced hearing. Ears normal. Her pure tone audiograms show bilateral low frequency sensorineural hearing loss.NSMC

DIAGNOSZ..MENEIRE’S DISEASE

>> 26 years old pregnant lady with right sided complete lower motor neuron lesion facial nerve paralysis.NSMC

DIAGNOSZ..BELL’S PALSY

>> A 3years old child with his mother who complains that his child could not speak intelligently. Ears normal in shape.NSMC

GLUE EAR...(i thnk isme deaf child k causz b aane chayen bt do cnfrm it)

>> Young man having motor cycle accident with right ear bleeding with sight hearing impairment. Vitals, Glasgow coma scale and neck movements are normal but there is some blood in the right external auditory canal with conductive hearing loss.RMC

DIAGNOSZ..LONGITUDNAL FRACTURE F TEMPORAL BONE( LEADING TO TYMPANIC MEMBRANE PERFORATION, OSSICULAR DISRUPTION)

>> Female 22 years with right ear pain for 3 days which has gradually increased in intensity. The pain aggravated on chewing movements. There is no history of ear discharge. Movements of pinna are painful, meatus is occluded by swelling and forward displacement of pinna.SIMS
DIAGNOSZ..FURUNCLE

>> Female 25 years with decreased hearing in both ears for last 4 years which is gradually worsening. Hearing is better in noisy surroundings. Tympanic membrane intact but pinkish in colour.SIMS

DIAHNOSZ..OTOSCLEROSZ

>> 55 years old female with recurrent attacks of tinnitus with vertigo and fluctuating hearing loss. Normal

tympanic membranes.SZMC
a. investigate?
DIAGNOSZ..MENEIRE’S DISEASE

>> 2 years child with fever and severe pain right ear. Respiratory infection 3 days back. Bulging and hyperemic right tympanic membrane.SZMC
DIAGNOSZ..ACUTE SUPPURATVE OTITIS MEDIA

>> 45 years old lady got an attack of severe vertigo while delivering a lecture which lasted for about 30 minutes after which she was normal. h/o few such attacks in the past. Ear looks normal. Tuning fork test shows mild sensorineural deafness in the right ear.IMC
DIAGNOSIS..MENEIR’S DISEASE(DO CNFRM IT)

Community Medicine Sendups 2012- Sorted out SEQs

2012-10-15T09:56:00.000-07:00

v FOOD & NUTRITION

>>A researcher wants to find out the nutritional status of medical students. Describe how he should take a sample of 30 students from a class of 200 by using the “ Simple Radom sampling technique” (MMDC)

>>Define “protein energy malnutrition”. Tabulate five major differences between “marasmus” and “Kwashiorkor”. (MMDC

>>(a) define malnutrition? (1)

(b) Briefly described the control of “Protein Energy Malnutrition” (4) (NSMC)

>>District health management wants to initiate a program evaluation of nutritional status of the school children in schools.

a) Enlist 05 methods she would employ to serve this purpose.

b) Enumerate 06 the Socio-cultural factors that affect the nutritional status of people.

c) Name public health measures that can be used to prevent malnutrition in the rural community. (RMC)

>>In a BHU, a mother brings her one year old child to you for growth monitoring. His reported birth weight is 3 kg and his present weight is 6 kg.

a. what is your opinion about the weight of this baby?

b. what advice will you give to his mother keeping the current status of the baby in mind? (SIMS)

>>a) What is Nutritional anaemia? 2

b) Discuss different strategies to prevent nutritional anaemia in a community. (SMC) 3

>>A mother reports to you with her two years old child with the complaints of skin pigmentation, cracks & Changes in hair color. Examination showed weight slightly below the standard for age but it was masked by generalized body edema. (UMDC)

>>A research was conducted in obstetrics department regarding the effects of nutritional status of pregnant women on their deliveries and outcomes. It was observed that 60% of women who presented during pregnancy with pallor, palpitations and dyspnoea on exertion: developed complications at the time of delivery and their babies were below 2.5 Kg of weight at birth:

a. Which nutritional condition is hinted by the signs in these pregnant women? 1

b. Suggest measures to decrease the prevalence of this condition among pregnant Women? (UMDC)

v MCH+REPRODUCTIVE HEALTH+FAMILY PLANNING

>>A 28 years old prinigravida came to a MCH centre at 36 weeks of pregnancy for ante-natal cheek-up and advice:

a) What specific examination will you perform at this stage of pregnancy

b) What specific advice you will give hee in relation to micronutrients

e) Write down complications of anemia(NMC)

>>Enlist the components of antenatal service? (NSMC) (5)

>>(a) Define low birth weight? (1)

(b) What prenatal advice should be given to a pregnant Woman seeking antenatal care?(NSMC) (4)

(a) Classify Contraceptives? (2)

(b) How would you screen a patent for oral

Contraceptive pills?(NSMC)

>>Inspite of so many efforts infant mortality rate is still high in our country.

a..Asincharge of rural health centre, how will you reduce it in your area?

b.. what is child survival index. Enlist five causes of under five mortality.(QAMC)

>>Population growth rate in Pakistan is still very high, which reflects upon the great need of promoting family planning services.

a) What are the objectives of family planning?

b) Classify contraceptive methods and discuss the oral contraceptives in particular.

c) Enlist the absolute contraindications of hormonal contraceptives. (RMC)

>>Mother with normal obstetric history may be advised to have home delivery by health worker or a trained dai.

a) Give the advantages and disadvantages of domiciliary midwifery services.

b) What do you understand by risk approach in antenatal care?

c) What are the basic parameters to measure the growth of a new born baby? (RMC)

>>In a village of 5000 population crude birth rate is 40 per 1000 population and 20 infants die every year.

a. Calculate infant mortality rate. (2.5)

b. Enlist 4 main causes of infant mortality. (2.5)(SIMS)

>>A married couple with 2 children comes to you for advice of contraception for 4 to 5 years. The man is not motivated for using any contraceptive method. The wife aged 35 has been a known hypertensive for many years.

a. Which type of contraceptive method would you advise for the lady?

b. How would you counsel the woman regarding the use of this method? (SIMS)

>>A baby was delivered by an untrained birth attendant in a village, She cut the timed of the baby with an unsterilized dusty blade; baby died within seven days after developing serve muscular spasm, arching of the back and respiratory failure:

a) What do you think was the possible cause of death? 1

b) Could this death be prevented? If yes; How? (SMC) 4

>>A 4 months pregnant mother visited an RHC for the first time for antenatal check up. LHV checked her and gave her schedule for rest of the antenatal visits.

a. What are essential Lab investigations at first visit?

b. What is the schedule for rest of antenatal visits?

c. What is the nutritional and other important advise given to her during antenatal visits?(SZMC)

>>A 30 year old mother died during child birth due to hemorrhage. Despite he efforts Pakistan has not achieved the desired level of fertility and maternal mortality.

a. Define maternal mortality ratio. What is MMR in Pakistan?

b. Enlist 6 factors responsible for high fertility in Pakistan?(SZMC)

>>A mother brought her 3-year-old child to the Paeds OPD with complaints of on and off dairrhoea. On examination the child was irritable and his weight was 70% of the standard weight for age.

a) Categorize condition of the baby. (1)

b) List EIGHT contributory factor responsible for the above condition. (WMC) (4)

vENVIRONMENT

>>Name important “AIR POLLUTANTS”. What measures should be adopted to prevent and control AIR POLLUTION? (MMDC)

(a) What is super chlorination? (1)

(b) Name two sources of outdoor air pollution (1)

(d) Enumerate two characteristics of waste suitable For incineration (NSMC)

>>Rainy Season Often results in floods causing displacement of large population every ear. In such circumstances water born diseases are likely to spread which is a great concern for Public Health authorities.

a) Name five methods to purify water on small scale.

b) Name hazards of exposure to extreme hot and cold weather

c) How can you prevent such hazards(RMC)

>>You are working as medical officer in-charge of BHU Maraka. In the village one of the hand pump water having bad taste and odor. There was heap of garbage with lots of flies present within 20 feet distance.

a. How will you take sample from this band pump for bacteriological examination and send it to laboratory. (2.5)

b. How will you interpret the report of water testing lab in light of WHO standards for safe drinking water? (2.5)(SIMS)

>>The century has been declared “century of noise”. Noise is resulting in many ill effects on health. Suggest measures to control this menace? (5)(SIMS)

>>According to a research carried out by the students of Environment sciences department, concentration of certain harmful gases was increasing in atmosphere owing to which the surface of earth had become hotter than it was before:

a) What is this effect called? 1

b) What are the harmful effects of rising temperature of earth? (SMC) 4

>>A villager reports about the dirty linen and utensils being washed in the area around the well.

a. List THREE disadvantage of the practice. (1.5)

b. What measures can be taken to make the well water safe for drinking. (WMC) (3.5)

v OCCUPATIONAL HEALTH

>>A man 40 years of age is working in sugar cane industry for 20 years. He is suffering from whistling and buzzing in the ears.

a.. Name the immediate effects due to noise.

b.. What is the acceptable level of noise in hospital wards.(QAMC)

>>a) Define “Ergonomics”

b) What particular engineering measures would you recommend for prevention of “Bagasossi” in industrial workers.

c) Enlist important problems of industrialization. (RMC)

>>A pottery industry worker reported to you with the complaints of cough, dyspnoea on exertion and pain in chest. His x-ray chest showed snow storm appearance:

a) What is the likely diagnosis? 1

b) What is the role of pre-placement examination in the prevention of the above disorder? (SMC)

>>A person aged 40, who had been working as a laborer in the grain market for the last 25 years presented with history of repeated attacks of respiratory infections in the last 1 year. X-ray showed pulmonary fibrosis.

a. Give the likely diagnosis? 1

b. What is the role of occupational health service in the prevention of the given problem? (UMDC) 4

>>During screening of the workers of glass industry two were found to have “snow storm appearance” on chest X-ray.

a) What actions would you take for the above patients on the basis of social security service? (3)

b) List FOUR broad strategies to prevent the condition? (WMC) (2)

vPARASITES+ENTOMOLOGY+SNAKEBITE

>>(a) Enumerate mosquito control measures?(NSMC) (4)

(b) Give two sequel of snake bites(NSMC)

>>An 18 year old farmer how works barefooted for 10-12 hours on his fields daily, complains of weakness, breathlessness on exertion and diminished capacity for sustained hard work. On examination he looks pale:

a) What is the likely diagnosis? 1

b) How would you prevent and control this problem? (SMC) 4

>>A farmer in month of July working in his filed was bitten by a snake. He suddenly developed ptosis, slurred speech, weakness, and numbness in body and difficulty in breathing.

a. What type of poisonous snake might have bitten him? 1

b. Outline plan of management. 2

c. How can SNAKE BITES be prevented? (UMDC) 2

>>A farmer form Gilgit reported to a health facility with history of Intermittent fever and generalized pigmentation of the body. Clinical examination showed anemia and hepatosplenomegaly. Liver biopsy showed leishmianiaDonovani bodies.

a) Name the vector that transmits the above disease. (1)

b) Give FOUR broad strategies to control the problem. (WMC) (4)

vMENTAL HEALTH+BS

a) How the drug dependence is different from Addiction.

b) Name the six drugs/substances which produce dependence.

c) What public health measures can be taken to prevent and control drug abuse in the community(RMC)

>>A man is brought to you with history of inadequate dietary intake and signs of Thiamine deficiency. On further interviewing, he is found to be taking 30 units of Alcohol weekly (1 unit = 9 gms):

a) What is your opinion about he quantity of Alcohol intake in this person? 1

b) What SOCIAL and PSYCHOLOGICAL EFFECTS are likely in this person? (SMC) 4

>>Inflation and terrorism are outrageous in Pakistan which is expected to have bearing on mental health of the future generation.

a) List SIX possible problems that the future generation can have in the situation. (3) (WMC)

v DENTAL HEALTH+SCHOOL HEALTH+ HEALTH EDUCATION

>>In order to find the mean height of the school children, we took the sample of 625 students. The results a were as follow:

The mean height = 165 cm, The Standard Deviation = 10

Find the true (population) mean height, with 95 % confidence. (MMDC)

>>a) Enlist all types of communication(NMC)

b) Which one is the best, justify your answer (NMC)

>>Smoking is highly prevalent among students of Islamia University Bahawalpur. You health educate against smoking to these university students.

a.. Which type of barriers may affect communication?

b.. Enlist three communication method for these student and purpose. (QAMC)

>>(a) Describe the benefits of “Minus Desk”?

(b) Describe dental flourosis’

>>A 40 years old man came to a hospital with complains of gastritis. He also has dependence on a substance. On examination he had sings of peripheral neuropathy and cirrhosis of liver. His gait was ataxic and speech slurred.

a. Name the likely abused substance.

b. List the factors responsible for substance use disorders(SIMS)

>>How will you control the common diseases and health problems in school children? 5(SMC)

a. Define Health Promotion.

b. Describe in brief, different well known interventions in Health Promotion.(SZMC)

>>b) Give the role of a teacher in the school health service. (WMC)

vACCIDENTS+DISASTER

>>For a person wounded in a road side accident with loss of font,

a) Apply the following terms in order of occurrence Disease-Handleap-Disability-Impairment

b) Write down preventive measures for accidents(NMC)

>>District DG Khan is facing a problem of flood. What type of disaster it is

· How will you manage this situation? (5)(SIMS)

>>A school purchased furniture for a new section of class. Four After 6 month the school medical officer noticed that many pupils of this section had complaints of backache and eye strain.

a. what type of desk has been there in this class. (1)

b. list 4 objectives of school health services. (SIMS) (4)

>>on accidental fire in a factory numerous lives have suffered.

a. categorize the type of casualty.

b. what are the engineering measures to prevent occupational hazards. (SIMS)

>>Vast area in Pakistan was Striken by FLOODS this year, disrupting lives of many people

a) Give the type of disaster and the health problems that occurred in those areas?

b) What do you understand by DISASTER PREPAREDNESS? (SMC)

>>Recently massive fire broke out in factory at Karachi, leading to more than 300 death number of casualties:

a. Is it Disaster or an Accident?

b. Write the plan to manage this type of incidents.

c. Define Triage. (UMDC)

>>Heavy rains have affected large areas of Southern Punjab and upper Sindh. Scores of families are either forced to stay in open or take shelter in camps.

a) Identify FIVE health hazards that they face under the prevailing situation. (2.5)

b) Suggest measures for prevention of the identified health risks. (WMC) (2.5)

>>Last month, a fire broke out in factory claiming 289 deaths.

a) Categorize the incident. (1)

b) what health education should be provided to the related stakeholders for avoidance of such incident. (WMC) (4)

vIMMUNOLOGY

>>Suppose you are in charge of EPI centre. Describe how you would keep the vaccine in different compartments of refrigerator?(MMDC)

>>Give the schedule of vaccination both pre-exposure and post exposure for Rabies Vaccine (NMC)

>>(a) Name the diseases against which universal immunization

Is offered in Pakistan free of cost (3)

(b) What do you understand by the primary response

In immunity? (NSMC) (2)

>>A mother brought her 1 year old child to3 the vaccination centre BVH for Vaccination. She gave history of only one injection given to this baby at 2 and_{½
months of age. How will you proceed for vaccination}of this child. Give schedule, dose and site of administration.(QAMC)

>>Dr. Samina is working as programme associate in an NGO working in neonatal health. She has to deliver lecture to pregnant women on mother & child immunization.

a) What schedule of EPI vaccines would tell the audience.

b) What immunization should she recommend to women of child-bearing age. (RMC)

>>A child, 6 years old, who received only a single dose of vaccine in the past and his parents are not aware about name of that vaccine, reports to you for vaccination, how will you proceed With the vaccination in this child? (SMC) 5

>>A woman has brought her 4-week-old son to you for vaccination. He was born at home and no vaccination had been given so far.

a) Which vaccines should be given at once? (1)

b) Give the schedule along with does and routes of administration for the remaining diseases of EPI(WMC) (4)

vBIOSTATICS

>>a) What in the type of graphical presentation of data in the Diagram gram below?

b) What is the type of the skewed distribution of data?

c) Name manures of central tendency for A,B and C. (NMC)

->> (a) what is meant by standard error? (1)

(b) Enlist 12 method of presentation of data?(NSMC)

>>(a) What is normal distribution curve? (2)

(b) In nine families surveyed, the number of children per family

Were 4,6,2,2,4,3,2,,1 and 7. Calculate the mean, median & mode from this data (NSMC) (3)

>>Weight in kilogram for ten students of 4^th year MBBS class was taken which was as under:

48, 49, 85, 39, 48, 60, 70, 72, 30, 65

>>a.. Calculate standard Deviation

b.. Median.

c… Mean(QAMC)

>>Cholesterol level of patients in OPD of SZH were recorded as following. 175, 180,

190, 250, 220, 195, 160, 150, 170, 245, 200, 220, 230, 235, 240, 270, 295, 250 and >250.

a. Calculate mean, mean, median and mode.

b. Give frequency and percentage distribution of this data at cut off values, >200, 201 to 250 and > 250.

c. Draw histogram for the above data?(SZMC)

>>a) Name and interprets the given graph. (refer to sendup pic) (3)

b)Which sampling technique had most

probably been used to collect the data

shown in the given graph? (WMC) (2)

vDEMOGRAPHY+POPULATION CONTROL

>>With the help of a “line graph” (line diagram), describe the “Demographic Transition” of a developed country. (MMDC)

>>) Briefly explain “Population Pyramid?

Describe the Demographic Cycle (Transition)?(NSMC)

>>Human Development index (value 0 to 1) has three important components as 1. Life expectancy index 2. Education index 3. GDP per capita index. The minimum and maximum value of life expectancy at birth has been fixed/constant 25 and 85 years. If life expectancy in Pakistan is 65 years, then calculate life expectancy index for Pakistan.(QAMC)

>>Pakistan is in late expanding stage of demographic transition.

a..What consequences may occur if it is not passed speedily.

b.. What opportunity may be availed at this stage of proper policy is formed.(QAMC)

>>In Pakistan during recent years decline in death rate and birth rate has been

observed. Productions of agricultural and industrial products are increased and life style is improved.

a. Name the phase of demographic transition though which Pakistan is passing (2.5)

b. Name other phases of demographic transition. (2.5)(SIMS)

>>The population of Pakistan is growing at the rate of 1.8% annually and the total fertility rate is 5.2 per woman:

a) What do you think; given figures indicate about the trend of population growth? 2

b) What short and long term measures do you recommend to control this rate of population growth? (SMC) 3

>>a) What are the health problems of the aging population in Pakistan? 2.5

(b)What preventive measures will you take to deal with such problems? (SMC) 2.5

>>Major bulk of population is residing in rural areas of Pakistan. Each year large number of people migrate to urban areas for better living and other reasons.

a. Name the process of migration to urban areas.

b. Name different hazard that arise due to mass movement of rural population to urban areas?(SZMC)

>>Population of Pakistan is growing at an explosive rate, giving rise to many problems relating health, education and available resources:

a. How will you differentiation between GROWTH RATE & NATURAL INCREASE RATE in population?

b. Draw & label process of demographic transition. (UMDC)

>>Population in Pakistan grows at a rate of 1.8%

a) What measures would the government take to address the population issued arising due to the current Growth Rate? (3)

b) List FOUR components of Reproductive Health. (WMC) (2)

vPUBLIC HEALTH+PHC+ HEALTH AGENCIES

>>Enumerate the components of primary health care. Describe briefly the constraints in achieving these components. (MMDC)

What functions are being carried out by “UNICEF” in Pakistan? (MMDC

Write a note on health related “Millennium Development Goals”. (MMDC)

>>a) Name First Level Care Facilities (FLCF) OF Pakistan.

b) List the preventive and curative services provided at FLCF. (NMC)

>>Define Health Care System &What do you mean by

Input and output in health care delivery system?(NSMC)

>> a) Define planning in health

b) Draw and label ”Planning Cycle”

c) Differentiate between “Cost-benefit analysis and Cost-effectiveness analysis techniques of health

management. (RMC)

>>As COMPREHENSIVE PRIMARY HEALTH CARE is said to be beyond the reach of must developing countries, UNICEF proposes a selective approach with emphasis on mother and Child health called GOBI-FFF:

a) What is meant by GOBI-FFF? 2

b) Write the constraints for comprehensive Primary Health care in Pakistan. 3(SMC)

>>In a remote village, a Basic Health Unit (BHU) is present but it is not functional on account of non-availability of staff, so the village people go to a Tertiary Care Hospital if the need arises:

a. Dose this situation indicate integration of Health system? 1

b. >>List the services that should be provided at a BHU. (UMDC) 4

>>A family traveled all the way from a remote village to Benazir Bhutto Hospital for their child who had acute diarrhea.

a) What relevant question should you ask to prove the deficiency in the PHC service in their village? (3)

b) List FOUR uses of HMIS in Pakistan. (WMC) (2)

vHEALTH AND DISEASE+GEN. EPIDEMIOLOGY+ RESEARCH + DISEASE TRANSMISSION

>>Describe the stamps of a “Case Control Study”. (MMDC)

>>In a primary school there are 1,000 students. Out of those only 80% have been measles. From this child 40 children get measles ……….. short period of time. Calculate “secondary attack rate” of measles. (MMDC)

in a study 100 blood recipients and 100 non blood recipients were followed for one year for HCV, Out of 100 blood recipient 10 developed HCV while out of 100 non blood recipient only 2 develop HCV.

Groups	HCV +ve	HCV-ve	Total
Blood recipient	10	90	100
Not blood recipient	2	98	100
Total	12	198	200

>>What is disease risk index in this study? Calculate it and comments on result. (NMC)

>>Give two differences between case control & Cohort studies (1)

(b) Define secondary attack rate (NSMC)

>>Keeping in view adult hypertension disease, answer the following:-

a.. Define “ paradoxical effect of Prevalence” ?

b.. Give two uses of prevalence?(QAMC)

>>Ten people live in a house (8children, father and one mother). Two children suffered from chicken pox last years. From the remaining 8 family members, one child suffered from chicken pox from last 7 days, within incubation period, two more children are also suffering from the same disrease.

a..Calculate Secondary Attack Rate of this disease from the above mentioned data.

b..Interpret your results.(QAMC)

>>The investigators want to establish an evidence for association between intake of oral contraceptives and risk of cardio vascular diseases (CVDs) in women. One sub-Objective of the study is to know incidence of CVD in the exposed.

a) Name the epidemiological study design that can best used for the purpose.

b) Describe 03 measures of strength of association that can be calculated from the study design usned.

c) What are the disadvantages of the study design used.(RMC)

>>In a union council of Rawalpindi having population 100,000 50 new eases of chronic liver diseases (CLD) werer registered during 2010, where as 30 cases were on record since last year. At the end of Dec 2010, 20 of new cases and 5 of the older eases were treated but unfortunately 3 of the older group and 7 of the new cases died in September 2010.

a) Find out incidence-rate and Prevalence-rate of CLD for this union council for year 2010.

b) What was point prevalence of CLD on 1 Jan 2011.

c) Calculate case fatality for CLD IN this scenario. (RMC)

>> a) Define “Null Hypothesis”

b) Explain type-I and Type-II errors in Hypothesis testing.

c) Write down 04 objectives of “Literature review” in research. (RMC)

>>Death rate in emergency dept. of Punjab Institute of Cardiology is higher than the death rate in the emergency dept of services Hospital.

a. What type association it (explain) (2)

b. Enlist the criteria for association (3) (SIMS)

>>A researcher wanted to verify the statement that working in bank increases the risk of blood pressure.

a. What type of study he will conduct to verity the statement (2)

b. He steps for conducing this study (3)(SIMS)

>>A group of 20 students, after the school, went to the nearest fast food outlet and had burgers. Within 3 hours of eating, 10 students developed vomiting and diarrhea one hour later 7 more were affected, sparing only3:

a) The distribution of the cases in time suggests which kind of epidemic 1

Outline the steps taken to Investigate the epidemic. (SMC)

>>in a village with 20,000 populations, 60% are Muslims, 20% Christians, 10% pasies and 11% Hindus. A researcher in interested to take a 20% sample of the population for a study;

a) Name the best method of selecting true representative sample? 1

b) How will he draw this sample? (SMC) 4

>>. A public health physician plans to conduct a research to study the risk of lung cancer with smoking. He selects the patients with lung cancer and without lung cancer and evaluate the status of smoking.

a. What could be the study design?

b. Enlist different steps for conduction of study?

c. What is the formula to estimate risk? How would you interpret the inference?(SZMC)

>>A medical student determined the level of 100 pregnant women during pregnancy and after delivery, he took weight of the newborn. Out of 110 women, 60 were anemic and 40 had normal Hb. Out of 60 anemic, 30 had low birth rate babies and 30 had normal weight babies. Out of 40 with normal hb, 10 had low birth weight babies and 30 had normal weight. For this scenario,

a. what is the study design?

b. construct 2x2 table to determine association between maternal anemia and low birth weight?

c. calculate appropriate measure of association and interpret results.(SZMC)

>>A researcher wanted to study the risk of Peri-natal Mortality (PNM for 100,000 births) caused by maternal anemia during pregnancy and found the following observations:

Incidence of PNM / 100,000 Births

Among Anemic Pregnant Women	4000
Among Non-Anemic Pregnant Women	200

a. Calculate the ATTRIBUTABLE RISK (risk difference) and ATTRIBUTABLE FRACTION (percent). 3

b. Interpret the result. 2 PTO

a. Interpret the diagram 2

b. Define FREQUENCY DISTRIBUTION TABLE (FDT). (UMDC) 3

>>A worker applied 2 vaccines A & B on randomized mass group and observed the incidence of disease in them. The following table summarizes the result.

Vaccine	Study Group	Developed disease	Incidence Rate
A	100	20	20%
B	100	10	10%
Total	200	30	15&

The worker wishes to apply chi square test of significance as a research worker of this study. What will be:

a. The NULL & ALTERNATE HYPOTHESIS. 2

b. The DEGREE OF FREEDOM (d_f). 1.5

c. Define CONFIDENCE INTERVAL. (UMDC) 1.5

(SCREENING & SAMPLING)

>>) Enumerate the measures used to evaluate a “Screening test? (3)(NSMC)

You want to launch a screening programme for a disease in Bahawalpur city.

>>a.. What will be the criteria of a disease for which you want to launch a screening programme.

b.. What criteria you will select for decision of a screening programme.(QAMC)

>>Screening for Hepatitis C is to be done on the employees of a garment history.

a) What criterion for the screening test is required for this purpose.

b) How the problem of false positive and false negative is dealt with.

c) What lead time of screening. (RMC)

>>You want to launch a screening programme for a disease in Bahawalpur city.

a.. What will be the criteria of a disease for which you want to launch a screening programme.

b.. What criteria you will select for decision of a screening programme.(QAMC)

v COMMUNICABLE & NON-COMMUNICABLE DISEASES+CONTROL AND PREVENTION

>>What were the reasons of failure of “malaria eradication program”? (MMDC)

>>Hepatitis C is spreading very rapidly in an urban community. How would you educate the people about this health hazard? (MMDC)

>>) Enumerate 4 criteria for assessment of severity of

Diarrhea in Children under 5 year of age: (NSMC) (2)

>>A patient came to you with high grade fever, pallor, flushing and headache. He is living in a area where mosquito density is adequate. On blood complete examination there is raised haematocritValue and moderate thrombocytopenia.

a.. What is the most probable diagnosis. Name three mosquito born infections.

b..What personal protective measures can be adopted against mosquito bite.(QAMC)

>>Cancers are associated with multiple risk factors. In developing countries, almost 25% of all the cancers are attributed to chronic infections.

a.. Enlist the three prevalent infections leading to cancers.

b.. How will prevent cancers due to chronic infections. (QAMC)

a) >>Differentiate between MDR-TB and XDR TB.

b) What are the most common reason for the development of drug resistance?

c) What is the congenital rubella syndrome?(RMC)

>>Asad, a grade 5 student, was brought to Family ER department with history of dog bite. On examination minor abrasions on lower extremities were noticed by the doctor. His father, who was Professor in science college, told the doctor that Asad had been en by a dog six months earlier, and had undergone a full course of anti-rabies treatment.

a) What vaccination schedule should the doctor recommend for Asad 3

b) What is the standard intramuscular regimen of rabies anti-serum, recommended by WHO in previously unvaccinated persons. (RMC)

>>What is roll back malaria? What are the causes of failure of this program in Pakistan? (5)(SIMS)

>>A 2 year old boy who was partially vaccinated presented with high grade fever, red eyes, runny nose and a maculopapular rash on whole body

a. diagnosis?

b. complications? (SIMS)

>>For the last many years Pakistan in trying to eradicate Polio but as such there is no much success. Many cases of Polio have been reported from different provinces.

a. What are the reasons of these new cases from given areas?

b. Describe current strategies to eradicate Polio from Pakistan as recommended by WHO?(SZMC)

>>for the preventive options for TB, developed countries have controlled this before the advent of BCG and chemotherapy. BCG vaccine not seems to be very effective and there are limitations in improvement of socioeconomic conditions of Pakistan.

a. What is the strategy being implemented in Pakistan to control TB?

b. What are specific measures being taken to control TB by national tuberculosis Program?

c. What are five indicators that are used to measure the impact of TB control Program.(SZMC)

>>a. what are risk factors for breast cancer?

b. what are the primary and secondary preventive measures that can be taken to control cancer in Pakistan?(SZMC)

>>A4” Class student of a school was seen by a school health medical officer with low grade fever and maculo-papular rash behind the ears and on the face.

a. What is the probable diagnosis? 1

b. What measures will you recommend for this class mates and the child himself? 4(UMDC)

>>A 25 years old boy was admitted in Mayo Hospital Lahore with fever 103F. his tourniquet test positive. Lab investigation showed increased value of Heamatocrit and mark thrombocytopenia.

a. What is the likely diagnosis? 1

b. What immune prophylaxis is available against this disease? 1

c. Enlist preventive strategies against this disease. (UMDC) 3

>>a. Ahmad is a medical student wants to know about anti rabies vaccines. Can you write to name of available anti rabies vaccines? Which is the best and why? 2

b. he further enquires: Why RIG & Rabies vaccine is given simultaneously in PEP of Rabies he asked about importance of initial wound management and rationale of injecting for in to the wound? He likes to be explained the logic of giving RIG & vaccine simultaneously in the form of graphic presentation. (UMDC)

>>A young boy of 14 years is brought in the emergency department of POF hospital with history of dog bite on the left leg.

a) Outline the steps of management. (3)

b) Give measures to control urban rabies. (WMC) (2)

>>There is a progressive increase in the incidence of Dengue Fever as per diagram in Lahore over the last couple of years.

a) Which name can be given to the rising incidence of the disease? (1)

b) Give FOUR control strategies for Pakistan in the given situation. (WMC) (4)

RMC patho sendup 2012- Solved MCQs+SEQs

2012-10-15T03:28:00.001-07:00

DEPARTMENT OF PATHOLOGY,   RAWALPINDI MEDICAL COLLEGE RAWALPINDI Send Up 17/09/2012

MCQ`S Paper       Time allowed: 65 minutes                                                                       Total Marks: 65

Attempt all questions.   Mark the appropriate square on the response sheet

A 29 years old women presents with heat intolerance, nervousness, weight loss, protruded eyes & diffuse enlargement of thyroid. On Lab examination, TSH is decreased. Histologic sections from thyroid reveal increased cellularity with scalloping of the colloid at the margins of the follicles. Which of the following antibodies are more specific for this individual disease:

a. Antimicrosomal antibodies
b. Antithyroglobulin antibodies
c. TSH – receptor – stimulating antibodies
d. Antithyroid peroxidase antibodies
e.TSH – receptor – blocking antibodies

A 45 year old female diagnosed case of follicular variant of papillary carcinoma of thyroid presented with mass in the abdomen. CT scan shows left adrenal mass. Excision biopsy shows metastatic thyroid carcinoma on the basis of microscopic features which includes colloid follicles, nuclear grooves , optically clear nuclei and the presence of:
Russell’s bodies
b. Psammoma bodies
Apoptotic bodies
Myelin figures
Mallory bodies
1. Most common form of Cushing’s Syndrome is :
2. Due to pituitary tumors
3. Due to adrenal lesions
4. Due to Ectopic production of Cortisol
5. d. Iatrogenic(drug induced)
6. Due to renal insufficiency.
  1. A patient of Cushing’ssyndrome was given high doses of Dexamethasone. It can suppress hyper cortisolism is due to:
  2. a. Pituitary or hypothalamic lesions
  3. Adrenal carcinoma
  4. Ectopic Cortisol production
  5. Exogenous glucocorticoids intake
  6. Loading effect
    1. An old lady 58 years of age c/o gradual on set of bone pain, anorexia, constipation, polyuria, polydipsia and muscular weakness. Her serum Ca and Alk phosphatase were raisedand PO4 was low. She was probably suffering from:
    2. Hypercalcemia
    3. Hypophosphatemia
    4. Bone tumor
    5. d. Hyperparathyroidism
    6. Hypoparathyroidism
      1. An old-man living alone was found comatosed inhis home in the suburbs of Newyork city on sunday morning. He was shifted to hospital. His LFT showed SBilirubin 150mg/dl, ALT 400 iu, AST 1600 iu, Alk Phosphatase 300iu. What further test would you like to perform to look for the cause of his unconciousness?
      2. PT & APTT
      3. HBsAG
      4. AntiHCVab
      5. d. GTT
      6. S Albumin
        
        A 58yrs old man presented to his family doctor with weight loss, generalized weakness, and lethargy of 6 months’ duration. He c/o Polyuria especially at night. He had become impotent. On examination, pt found tobe slightly anemic, BP was 185/115. His urine contained protein but no glucose. His serum Na was 130, K 5.2,HCO3 16 mmol/L, Urea 65mg/dl, creatinine 5.3 mg/dl, Glucose R 135mg/dl, Alk phosphatase 205 U/L, &Hb 9.1 g/dl. Patient was suffering from,
        
        Diabetes mellitus
        
        Diabetes insipidus
        
        Nephrotic syndrome
        
        Renal osteodystrophy
        
        e. Chronic renal failure

An 8 yrs old girl was admitted to hospitalwith generalized oedema. Her urine became frothy and family doctor had found proteinuria. Results of other investigations showed serum is lipemic with raised total cholesterol and triglyceride levels. Her Na, K, Urea, Creatinine levels were low. Total proteins and serum albumin were also low. Urinary protein excretion in 24 hrs was 12g/L. In your opinion what is the diagnosis?
Hyperlipidemia
Hypoproteinemia
Ac. renal failure
Ac. fluid overload
e. Nephrotic syndrome
1. Bulla is fluid filled raised lesion 5mm or less in diameter. Which skin lesion is associated with bulla formation?
2. Erythema multiforme
3. Lichen planus
4. Psoriasis
5. d. Pemphigus
6. Panniculitis
  1. In most laboratories a serum PSA level of 4ng/mL is taken as cutoff point between normal and abnormal. Serial measurements of PSA are of great value in;
  2. a. Assessing response to radiotherapy
  3. Diagnosing prostatic cancer
  4. Chronic prostatitis
  5. Benign prostatic hyperplasia
  6. Prostatic Infarction
    1. In prostatic adenocarcinoma fatal outcome is associated with;
    2. Gleason score
    3. Gleason grade
    4. Raised PSA levels
    5. Associated chronic prostatitis
    6. e. Lymph node Metastases
      1. Following serum tumor markers are helpful in supporting testicular neoplasm. In yolk sac tumour of testis which marker is raised?
      2. Beta HCG
      3. b. Alpha Fetoprotein
      4. LDH
      5. Placental Alkaline phosphate
      6. Placental lactogen
        
        Alzheimer disease is the most common cause of dementia in the elderly. Autopsy of the patient died of this disease shows characteristic histological features in the brain which of the following is not a feature of this disease.
        
        Neuritic plaques
        
        Neurofibrillary tangles
        
        Cerebral amyloid angiopathy
        
        Granulovacuolar degeneration
        
        e.       Lewy body
        
        A 40 year old male is diagnosed to have gout. The different pathological lesions associated with gout do not includes.
        
        Acute arthritis
        
        Chronic tophaceous arthritis
        
        Tophi
        
        Gouty nephropathy
        
        e.       Gouty retinopathy
        
        A 5 year old child presented with a mass in the nasal cavity. A biopsy was taken from the mass. Morphology shows hyperchromatic round tumor cells forming submucosalzone of hypercellularity called cambium layer. This feature is seen in which type of sarcoma?
        
        Alveolar Rhabdomyosarcoma
        
        Ewing sarcoma
        
        c.        Embryonal Rhabdomyosarcoma
        
        Ostesarcoma
        
        PNET

Malignant melanoma is a very aggressive neoplasm. Its common site is skin. Other primary sites are oral and anogenital mucosal surfaces, esophagus and meninges. Identify one more primary site where this lesion can occur.
Breast
Brain
c. Eye
Liver
Testis
1. X-ray skull of a 60 year old male showed multiple punched out lytic lesions. Identify the neoplasm which produces such lesions.
2. Ewing sarcoma
3. Giant cell tumor
4. Lymphoma
5. d. Multiple myeloma
6. Metastatic prostatic carcinoma
  1. A 50 year old female presented with bilateral breast lumps. Mammography showed densities with irregular borders. FNA of both lumps shows malignant cells. Which histological type of malignancy usually presents with this clinical picture.
  2. Invasive ductal carcinoma
  3. b. Invasive lobular carcinoma
  4. Medullary carcinoma
  5. Mucinous carcinoma
  6. Tubular carcinoma
    1. In a 30 year old female breast lump of 2cm is excised having irregular borders. Histopathology report shows sclerosing adenosis. Which lesion is not a part of benign proliferative breast disease?
    2. Complex sclerosing lesion
    3. Duct ectasia
    4. Epithelial hyperplasia
    5. d. Fibrocystic change
    6. Papilloma
      1. Which one is the most important prognostic factor in the carcinoma of breast?
      2. Age
      3. b. Axillary lymph node metastases
      4. Involvement of resection margin
      5. Tumor grade
      6. Tumor necrosis
        
        Mammographic report of 40 year old female shows linear branching pattern of calcification. This type of calcification is characteristic of;
        
        a.       Ductal carcinoma in Situ
        
        Fibrocystic change
        
        Fibroadenoma
        
        Invasive ductal carcinoma
        
        Phyllodes tumor
        
        Liver biopsy of thalassemic patient was submitted to look for Iron pigment load. Which stain can be helpful in the demonstration of iron in liver tissue?
        
        Crystal violet
        
        Fontana Masson
        
        c.        Perl stain
        
        Reticulin stain
        
        Von Kossa
        
        A liver biopsy of a 45year old obese female shows hepatic steatosis .Which condition is not associated with Hepatic steatosis?
        
        Alcoholic hepatitis
        
        Aspirin toxicity
        
        HCV positive Hepatitis
        
        NASH
        
        e.       Rotor’s syndrome

A 45 year old female gives h/o off and on RHC pain from the last 1 year . Her U/S shows multiple gall stones. Patient is not willing for the surgery. The clinician explains the complication of cholelithiasis to the patient. Which one is not associated with it?
Biliary obstruction
b. Hepatic abscess
Intestinal obstruction
Malignancy
Pancreatitis
1. 25. A 35 year old married female having multiple gallstones is waiting for the surgery. One day she presented in the emergency with acute abdomen. Pain is continuous and also referred to the upper back. Lab investigation shows elevated Serum amylase and lipase levels. What is your diagnosis?
2. a. Acute pancreatitis
3. Acute gastritis
4. Chronic pancreatitis
5. Ruptured tubal pregnancy
6. Perforated duodenal ulcer
  1. A healthy medical student has completed the course of HBV vaccination. To check his immunization status which serological test should be positive?
  2. HBsAg
  3. Anti-HBC IgM
  4. Anti-HBC IgG
  5. d. Anti HBS
  6. Raised serum ALT levels
    1. Liver biopsy of a 35 year old female suffering from jaundice and pruritus showsperiductal onion skin fibrosis a characteristic feature of;
    2. Chronic hepatitis
    3. Cirrhosis
    4. c. Primary sclerosing cholangitis
    5. Primary biliary cirrhosis
    6. Secondary biliary cirrhosis
      1. After few months of modified radical mastectomy and axillary lymph node dissection for carcinoma of left breast patient develops swelling and puffiness of left arm. On examination the swelling was generalized painless and non- pitting in nature .What could be the reason of this swelling?
      2. a. Lymph edema due to lymphatic obstruction
      3. Subclavian artery thrombosis
      4. Thrombophlebitis
      5. Tumour embolization
      6. Vasculitis
        
        Autopsy of a 50 year old male with sudden death showed 80 % narrowing of left coronary artery due to atherosclerosis. Which of the following cells is least involved in the pathogenesis of this type of coronary lesion?
        
        Endothelial cells
        
        Monocytes
        
        c.        Neutrophils
        
        Platelets
        
        Smooth muscle cells
        
        A 55 year old male with severe attack of acute myocardial infarction dies within half hour. Which complication is the cause of his death?
        
        Myocardial rupture
        
        Pericarditis
        
        Thromboembolism
        
        Ventricular aneurysm
        
        e.       Ventricular fibrillation
        
        A patient of Non Hodgkin lymphoma is receiving cytotoxic antitumour drugs. Which type of cystitis is suspected in these patients?
        
        Chronic cystitis
        
        Eosinophilic cystitis
        
        Follicular cystitis
        
        d.       Hemorrhagic cystitis
        
        Suppurative cystitis
        
        A 40 year old male presented with right testicular enlargement. Orchidectomy was performed and histological diagnosis of Seminoma was given. An identical tumour arises in the ovary is called as;
        
        Choriocarcinoma
        
        b.       Dysgerminoma
        
        Embryonal carcinoma
        
        Endodermal sinus tumour
        
        Granulosa cell tumour
        
        The skin lesion which is not associated with disorders of pigmentation is;
        
        Freckles
        
        Melasma
        
        Leucoderma
        
        d.       Psoriasis
        
        Vitiligo
        
        The disease associated with reduced osteoclasts bone resorption results in brittle and fragile bone called as;
        
        Osteomas
        
        Osteomalacia
        
        Osteoporosis
        
        d.      Osteopetrosis
        
        e.      Osteodystrophy
        
        35.    A 50 yrs old alcoholic male develops bilateral enlargement of breasts resembling adolescent female breast. The lesion is termed
        
        Fibroadenoma
        
        Fibrocystic disease
        
        c.       Gynaecomastia
        
        Phyllodes tumor
        
        Mastitis
        
        A 65 yrs old female reports with recurrence of a mass in her left breast. She gives history of lumpectomy two years back but has lost her medical record. Biopsy of the lesion shows increased stromal cellularity and cytologicatypia giving rise to the typical leaf like architecture. The diagnosis is
        
        Fibroadenoma
        
        Lactational adenoma
        
        Myofibroblastoma
        
        d.      Phyllodes tumor
        
        Gynaecomastia
        
        A 20 yrs old lady with a family history of breast carcinoma is very apprehensive. The hereditary susceptibility to breast cancer is associated most strongly with the following gene/genes mutation
        
        APC
        
        BRCA 1
        
        P53
        
        CHEK 2
        
        e.      BRCA 1 & BRCA 2
        
        The screening test used for the early detection of breast cancer in elderly is called
        
        Ultrasonography
        
        Fine needle aspiration
        
        c.       Mammography
        
        CT scan
        
        MRI

A 23 yrs old female patient presents in the outpatient department two weeks after delivery with red, swollen, very painful left breast. The nipples of both breasts are cracked and she is running high grade fever. The most likely diagnosis is
a. Acute mastitis
Periductal mastitis
Mammary duct ectasia
Fat necrosis
Pagets disease

A 20 yrs old male presents in the surgical OPD with multiple slightly painful slowly growing swellings on his back. Biopsy of one of the swellings reveals fibrousstroma and interspersed short fascicles of spindle cells having wavy nuclei. The lesion is
Schwannoma
b. Neurofibroma
Meningioma
Fibroma
Metastatic carcinoma
1. Transtentorial herniation of the temporal lobe of the brain is most commonly a consequence of which of the following
2. Intracranial hemorrhage
3. b. Increased intracranial pressure
4. Cerebral edema
5. Hydrocephalus
6. Meningitis
  1. A 14 yrs old boy in a village died after being bitten by a stray dog, which was diagnosed to be suffering from Rabies. On autopsy the pathognomic microscopic findings are bullet shaped cytoplasmic inclusion in pyramidal neurons of the hippocampus and Purkinje cells of cerebellum. These inclusions are called
  2. Lofra bodies
  3. b. Negri bodies
  4. Corpora amylacea
  5. Polyglucason bodies
  6. Lewybodles
    1. An 8 yrs old boy complains of severe headache and vomiting. On examination his gait is also disturbed. On suspicion of brain tumor, CT scan was ordered which showed a tumor located in the mid line of cerebellum. The tumor is removed by surgery. Grossly it is gray and friable. On microscopic examination extremely cellular neoplasm composed of sheets of small round cells having hyperchromatic nuclei. The tumor is
    2. Astrocytoma
    3. Ependymoma
    4. Meningioma
    5. d. Medulloblastoma
    6. Lymphoma
      1. Glioblastomamultiforme a variant of infiltrating astrocytoma belongs to which of the following WHO tumor grade
      2. Grade 0/IV
      3. Grade I/IV
      4. Grade II/IV
      5. Grade III/IV
      6. e.       Grade IV/IV
        
        A 50 yrs old diabetic female patient visits the gynecology OPD with complaints of marked vulvoviginalpruritis and curd like vaginal discharge. On PAP smear there are benign squamous cells, endocervical cell groups, neutrophils and filamentous hyphae. The causative agent of this infection is
        
        Trichomonas
        
        Gardenerella
        
        c.        Candida
        
        Chlamydia
        
        Mycoplasma
        
        A 40 yrs old female went to her gynaecologist for PAP screening after reading an article about cervical cancer in a magazine. She gave history of having sex with multiple partners. The report of the PAP smear showed severe dysplasia of exfoliated squamous cells. Colposcopy was performed. Cervical biopsy was taken and was reported as carcinoma in situ. This means
        
        Low grade SIL
        
        b.       High grade SIL
        
        Microinvasive carcinoma
        
        Invasive carcinoma
        
        Inflammatory lesion
        
        Endometriosis is the presence of endometrial tissue outside the uterus. The most common site includes;
        
        a.       Ovaries
        
        Uterine ligaments
        
        Retrovaginal septum
        
        Cul de sac
        
        Pelvic peritoneum

A 54 yrs old post menopausal female suffering from irregular vaginal bleeding for last two months undergoes ultrasound examination. A mass 9 cm in diameter, invading the uterine wall is reported. Hysterectomy is performed. On gross examination the mass is bulky and fleshy. Histopathologist reports it as leiomyosarcoma. Which microscopic features distinguish it from leiomyoma?
Nuclear atypia
Mitotic index
Anaplasia
Nuclear atypia and mitotic index
e. Nuclear atypia, mitotic index and zonal necrosis.
1. A 19 yrs old female presents in the OPD with a gradually enlarging mass in the lower abdomen. She is having regular menstrual cycles. Ultrasound shows a cystic mass 10cm in diameter in the right ovary. The mass is removed. On cut opening unilocularcyst filled with cheesy material,tufts of hair and tooth is seen. Which of the following tumors shows these features?
2. a. Benign mature cystic Teratoma
3. Dysgerminoma
4. Endodermal sinus tumor
5. Teratoma
6. Sertoli-Leydig cell tumor
  1. A 32 yrs old female married for 7 yrs is seeking treatment for primary infertility. She gives history of irregular menstrual cycles, dysmennorhea and pelvic pain. Ultrasound pelvis shows distortion of both ovaries by cystic masses 3-5 cm in diameter, filled with reddish brown thick fluid. The most probable diagnosis in this lady is
  2. Dysfunctional uterine bleeding
  3. b. Endometriosis
  4. Adenomyosis
  5. Ovarian tumors
  6. Pelvic inflammatory disease
    1. A teenage boy presented with orbital odema and proteinuria. The commonest cause of nephrotic syndrome in children is
    2. Membranous glomerulonephritis
    3. b. Minimal change disease
    4. Focal segment glomeruloseclerosis
    5. Membranoproliferative glomerulonephritis.
    6. IgA nephropathy
      1. A 6 yrs old child is brought to the paeds department. He is suffering from generalized edema. Serum albumin level is 2g/dl and there is massive proteinuria. Which other feature is required for a diagnosis of nephrotic syndrome.
      2. Hyperbilirubinemia
      3. Azotemia
      4. Glycosuria
      5. d. Hyperlipidemia &lipiduria
      6. Lipiduria
        
        Acute kidney injury (AKI) is a clinicopathological entity characterize byacute diminution of renal function. The renal tissue shows morphologic evidence of
        
        Glomerular injury
        
        Interstitial inflammation
        
        c. Tubular injury
        
        Arteritis
        
        Medullary injury
        
        A 50 yrs old female suffering from fever and painless hematuria. On palpation there is mass in the left flank. Ultrasound confirms a tumor 7 cm in diameter on the upper pole of left kidney. These findings suggest diagnosis of
        
        Adrenocortical carcinoma
        
        b. Renal cell carcinoma
        
        Renal cyst
        
        Renal adenoma
        
        Pheochromocytoma

A 70 yrs old male has developed swelling in the left parotid gland. It is 6cm in diameter and has gradually reached the present size over a period of 4 yrs. FNA of the lesion shows chondromyxoidstroma and groups of epithelial and myoepithelial cells. The tumor is
a. Pleomorphic adenoma
Mucoepidermoid carcinoma
Warthin tumor
Sialadentis
Acinar cell tumor
1. A 53 year old female cardiac patient underwent unremarkable hysterectomy but suddenly collapsed on the second post operative day after becoming breathless. This is a presentation of
2. Pulmonary hemorrhage
3. b. Pulmonary embolism
4. Pulmonary infarction
5. Pulmonary hypertension
6. Pulmonary odema
  1. A lung condition characterized by enlargement of air spaces distal to the terminal bronchiole accompanied by destruction of walls and without obvious fibrosis is labeled as:
  2. Chronic bronchitis
  3. Bronchiectasis
  4. Asthma
  5. d. Emphysema
  6. Pneumonia
    1. A lung condition characterized by formation of non-caseating granulomas and asteroid bodies is known as
    2. a. Sarcoidosis
    3. Tuberculosis
    4. Idiopathic pulmonary fibrosis
    5. Pneumoconiosis
    6. Silicosis
      1. A 53 year old male having chronic cough develops hemoptysis. He is a heavy smoker for the last 30 years. X-ray chest shows an opacity 3cm in diameter on the left side. Sputum examination is positive for malignant cells. The most common lung tumor correlated with a history of smoking is
      2. Large cell carcinoma
      3. Small cell carcinoma
      4. c. Squamous cell carcinoma
      5. Adenocarcinoma
      6. Carcinoid tumour
        
        Persons with heavy exposure to asbestos are at risk of developing
        
        Pleuritis
        
        Hydrothorax
        
        c.        Malignant mesothelioma
        
        Pneumothorax
        
        Pleural effusion
        
        A 4 years old boy presented with history of fluctuating jaundice .On examination the patient was pale, jaundiced with splenomegaly .Initial laboratory evaluation revealed Hb 6g/dl, MCV 99fl, MCH 27pg, WBC 6x 109/l, platelet count 250x109/l. Reticulocyte count is increased .What is the most probable diagnosis.
        
        Iron deficiency anaemia
        
        Aplastic anaemia
        
        Leukaemia
        
        d.       Haemolyticanaemia
        
        Haemophilia
        
        A 60 years old male presented with complaints of abdominal pain and fever for last 1 month.On examination there is massive splenomegaly. Laboratory evaluation shows leucocytosis 50x109/l. Hb 9g/dl with normal platelet count. Bone marrow examination showed myeloid hyperplasia with bimodal peak of neutrophils and myelocytes .What is the most probable diagnosis:
        
        Infection/sepsis
        
        Chronic neutrophilic leukemia
        
        Chronic lymphocytic leukemia
        
        d.       Chronic myeloid leukemia
        
        Acute myeloid leukemia

Autosomal Dominant pattern of inheritance is seen in
Pyruvate kinase deficiency
b. Hereditary spherocytosis
Sickle cell anaemia
Gauchers disease
G6PD Defeciency
1. A 34 years old multigravida pregnant lady presented with complaints of shortness of breath on mild exertion and fatigue. Complete blood picture showed Hb 7.8g/dl , MCV 62fl , MCH 17pg ,WBC 5x109/l and platelet count 300x109/l.Peripheral film showed microcytic hypochromic picture with pencil cells .Laboratory investigation will reveal :
2. a. Serum Iron ↓ , TIBC ↑ ,Serum ferritin↓.
3. Serum Iron ↓ , TIBC ↓ ,Serum Ferritin Normal
4. Serum Iron ,TIBC ,Serum ferritin all normal
5. Serum Iron ↑ , TIBC Normal, Serum Ferritin ↑
6. Serum Iron ↓, TIBC ↓,Serum Ferritin ↓
  1. A 14 years old boy presented with complaints of high grade fever, fatigue ,anorexia and gum bleed for last 1 week .Complete blood picture showed pancytopenia with increased WBC count. Peripheral film showed blasts.Bone marrow aspiration showed hyper cellular marrow with 98% blasts.
  2. Chronic lymphocytic leukemia
  3. Lymphoma
  4. c. Acute leukemia
  5. Multiple myeloma
  6. Chronic myeloid leukemia

Paper setters: Prof. Abbas Hayat . Asst. Prof. Dr Erum Nadeen Rana , Asst. Prof. Dr. Imtiaz Qureshi

DEPARTMENT OF PATHOLOGY

RAWALPINDI MEDICAL COLLEGE RAWALPINDI Send Up

MCQ`S Paper           Time allowed: 65 minutes                                                                                                Total Marks: 65

Attempt all questions. 

Attempt all Questions

Q1. Left orchidectomy specimen of a 45 years old male was received in pathology lab. On cut section circumscribed grayish white fleshy homogenous mass devoid of hemorrhage and necrosis is seen. Microscopic examination of the representative sections shows sheets of large polygonal cells having clear cytoplasm. Nuclei are large having central 1to2 distinct nucleoli. Sparse lymphocytic infiltration is also present.

What is your diagnosis? 1
Why neoplastic cells have clear cytoplasm? Name special stain for it demonstration. 2
Name one immunohistochemistry marker for tumor cell. 1
Name the germ cell tumor seen usually above 65 years of age. 1

Q2. Prostatic chips obtained after TURP of 70 years old male with urinary obstruction were submitted for histological examination which shows prostatic adenocarcinoma.

Name the precursor lesion of prostatic cancer. 1
How many grades are given in Gleason system? 1
Why there is a chance that early malignancy can be missed in TURP specimen. 1
What is the importance of serum PSA levels? 2

Q3. A 60 year old chronic alcoholic male presented in the medical emergency with sudden onset of abdominal pain radiating to back and left shoulder followed by nausea and vomiting. A diagnosis of acute pancreatitis is suspected.                                    

What findings in the plasma of the patient help in diagnosis? 1
Why hypocalcemia occurs in these patients? 1
Enlist three important complications associated with this condition. 3

Q4. A 15 year old boy presented with painful swelling above left knee joint from lastfew months. On examination swelling is warm and tender. There is no h/o of trauma.Lab report shows raised ESR and leukocytosis. X-rays shows destructive lytic lesion inthe distal diaphysis of femur.

Give two provisional differential diagnoses. 2
Biopsy report shows sheets of uniform small round cells having hyperchromatic nuclei and scanty cytoplasm. Homer-Wright rosettes are present. Areas of tumor necrosis are also seen. What is your definite diagnosis? 1
Enlist four benign chondrogenic neoplasms. 2

Q5.  A 40 year old male chronic smoker with sudden on set of severe chest pain was brought to cardiac institute. The ECG showed left ventricular infarction and Lab investigation showed raised cardiac enzymes.

What will be the morphologic changes in the myocardium after 2 days of attack? 3
What pathologies are seen in the reperfusion injury after thrombolytic therapy? 2

Q6. A 60 yrs old obese, diabetic, post menopausal woman develops irregular vaginal spotting for the last three months. Her Pap smear report is within normal limits. Ultrasound of the uterus shows marked endometrial thickening. The endometrial biopsy diagnosis is complex atypical hyperplasia. Hysterectomy with bilateral salpingo-oophorectomy was done. The histopathology report shows endometrial carcinoma.

Name the type of endometrial carcinoma in this case. 1
What is endometrial hyperplasia and what are its types? 3
Which gene mutation is associated with endometrial hyperplasia andendometrial carcinoma? 1

Q7. A 45 yrs old female develops a painless lump in the upper outer quadrant of right breast. The mass is 5 cm in diameter and the right axillary lymph nodes are palpable. FNA reveals malignant cells. Modified radical mastectomy with axillary clearance is performed.

What are the different histological types of breast cancer? 2
What are the major prognostic factors of breast carcinoma? 2
What is Sentinel node? How it is detected and what is its importance?

Q8.A 66 yrs old male patient, hypertensive for the last 20 yrs, reports in the emergency department with severe headache and vomiting. He is confused. His wife tells that he has not taken antihypertensive medication for 3 weeks because it is not possible for them to buy expensive medicines.

What are the effects of hypertension on brain? 3
What are different types of brain aneurysms? 2

Q9. A 65 yrs old male smoker is suffering from persistent cough with sputum production throughout the winter with intermittent low grade fever. He gave history of a similar attack last year, treated by antibiotics, bronchodilators and expectorant therapy. He develops dyspnea on exertion and sometimes becomes blue.

Define chronic bronchitis. 1
What are the complications of chronic bronchitis? 2
What other conditions come under the heading of COPD? 2

Q10. A 38 yrs old female patient of SLE develops progressive renal failure with very high level of BUN and creatinine. Renal biopsy is performed and the lesion comes out to be rapidly progressive glomerulonephritis.

What are the different types of Primary glomerulopathies? 3
What are the features of glomerular syndrome associated with rapidly progressiveglomerulonephritis? 2

Q11.A 20 year old female presented,  in the OPD with mass in the parotid region. She told that swelling is from last 10 years. Initially it was of almond size and gradually it has acquired the size of walnut. On clinical examination the swelling is painless, mobile, firm and discrete.

Give two most likely differential diagnoses. 2
Name the test you will request for its immediate diagnosis. 1
What is the relationship of salivary gland tumor being malignant with the anatomical size of the salivary gland?1
Name the most common primary malignant tumor of the salivary gland. 1

Q12. A 45years old female came in the OPD. She gave h/o off and on pruritic, jaundice, dark urine with light stool from last 6 months. MRI showed extra hepatic bile duct obstruction by stone.

What are the important pathological findings in the liver before secondary biliary cirrhosis develops? 3
How you will differentiate histologically this lesion from primary biliary cirrhosis? 2

Q13. A 20 year old female presented with exophthalmoses, tremors, menstrual irregularities and heat intolerance.

Give 4 causes of hyperthyroidism. 1
What tests you would perform to diagnose Grave’s disease. 2
What is thyroid storm? Why it is considered as a medical emergency? 2

Q14. A one year old male baby presented with complaints of progressive pallor and abdominal distention for the last three months. There is also H/O of blood transfusion once. On clinical examination hepatosplenomegaly was found. He was diagnosed as a case of Thalassaemia major on Hb Electrophoresis.

Describe peripheral film morphology in β thalassaemia major? 2
Describe the major morphological alterations seen in the bone marrow and spleen in thalassaemia major. 2
Mention the curative treatment available for thalassaemia major. 1

Paper setters: Prof. Abbas Hayat . Asst. Prof. Dr Erum Nadeen Rana , Asst. Prof. Dr. Imtiaz Qureshi

KEY TO SEQs

1.A     Seminoma                                                                                                              

       B     Glycogen which is PAS positive                                                                                                    

       C     c-KIT and PLAP                                                                                                     

       D   spermatocytic  seminoma

2    A  Prostatic intraepithelial neoplasia PIN                                                                

        B  Graded from I to V                                                                                                                           

        C  Because neoplasm develops in the peripheral region and TURP removes only  

              Para urethral tissue which is involved late by the malignancy                                                           

D)     Increased levels help in diagnosis and decreased levels help in assessing the

management response.

3.    A   Increased plasma amylase in first 24hrs and increased lipase levels followed

Within 72 to 96 hrs.

B)        Precipitate of calcium soaps in the necrotic fat                                              

C)        DIC,ARDS ,Shock and Acute renal tubular necrosis

4.     a Ewing sarcoma and PNET

        b. PNET

        c. Ostechondroma, Chondroma, Chondroblastoma, Chondromyxoid fibroma

5. a. Gross: Mottling with yellow-tan infarct center

        Microscopy:Coagulation necrosis, with loss of nuclei and striations; interstitial infiltrate of

neutrophils

b.Reperfusion-associated pathologies, includes  reperfusion-induced arrhythmias, myocardial

hemorrhage with contraction bands, irreversible cell damage distinct from and additional to

the injury associated with the original ischemic event (reperfusion injury), microvascular

injury, and prolonged ischemic dysfunction.

6.  a. Endometrioid carcinoma or type I

      b. It is defined as an increased proliferation of endometrial glands relative to stroma     resulting in an increased gland to stroma ratio when compared with normal proliferative endometrium Its types are simple hyperplasia without atypia, simple hyperplasia with atypia, complex hyperplasia without atypia, compex hyperplasia with atypia.

c. Inactivation of  PTEN Tumour suppressor gene

7. a. DCIS, LCIS, Invasive ductal ca, Invasive lobular ca , Tubular ca, Medullary ca,

        Papillary and Metaplasticca

    b. Invasive ca or In-Situ disease, Distant metastases, lymph node metastases, Tumour

size, locally advanced disease and inflammatory ca.

    c. The lymph node where breast carcinoma drain first identified with radiotracer or

        Colored dyes injected into the tumour followed by its drainage to the lymph node

which take up the dye first. This lymph node is biopsied to look for the metastases if

lymph node is negative for metastasis patient can be spared the morbidity of a

complete axillary dissection

8.   a. Effects are; Lacunar infarcts, Slit haemorrhages, Hypertensive encephalopathy,

       Massive hypertensive intracerebralhaemorrhage

     b. Different types of brain ANEURYSMS are;

Saccular, atherosclerotic, mycotic, dissecting traumatic

9. A. definition ;Chronic bronchitis is defined as persistent cough with sputum production  for at least 3 mont6hs in at least 2 consecutive years in the absence of any identifiable cause.

B. Complications of chronic bronchitis

1-       progress to COPD

2-       leads to Corpulmonale and heart failure

3 -Atypical metaplasia + dysplasia .respiratory epithelium provides rich soil for cancerous

transformation.

 C. Bronchiectasis, Asthma, Emphysema, Bronchiolitis

10. a.

Primary Glomerulopathies

Acute diffuse proliferative glomerulonephritis

  Poststreptococcal

  Non-poststreptococcal

Rapidly progressive (crescentic) glomerulonephritis

Membranous glomerulopathy

Minimal change disease

Focal segmental glomerulosclerosis

Membranoproliferative glomerulonephritis

IgA nephropathy

Chronic glomerulonephritis

Acute nephritis, proteinuria, and acute renal failure

11.     a. Benign salivary gland tumour (pleomorphic adenoma)  2. Lymphadenopathy

FNA
Larger the size of gland less likely to be malignant and vice versa
Mucoepidermoid carcinoma

12.    a. Prominent bile stasis in the bile ducts                                                          

               Bile ductular perforation with surrounding neutrophils                                

               Portal tract oedema

               Parenchyma shows cholestasis, feathery degeneration and bile lakes                   

Dense lymphocytic infiltrate in portal tract and granulomatous destruction of

Bile ducts

.

13.         a.    Grave’s disease, toxic MN goiter, solitary toxic adenoma, thyroiditis, etc

              b. fT3, fT4, TSH, TSH receptor Ab

c. Abrupt on set of severe hyperthyroidism seen in  Graves disease due to increase levels

ofcatecholamines under stress like infection surgery cessation of antithyroid

medication. Considered as medical emergency because significant number of patient

die of cardiac arrythemias  if not treated.

14. a.  The peripheral blood smear shows severe red cell morphologic abnormalities, including marked anisocytosis and poikilocytosis (variation in size and shape, respectively), microcytosis (small size), and hypochromia (poor hemoglobinization). Target cells (so called because hemoglobin collects in the center of the cells), basophilic stippling, and fragmented red cells are also common. The reticulocyte count is elevated, but because of ineffective erythropoiesis is lower than expected for the severity of anemia. Variable numbers of poorly hemoglobinizednormoblasts are seen in the peripheral blood due to "stress" erythropoiesis

b. The major morphologic alterations seen in the bone marrow and spleen. In the untransfused patient, there is striking expansion of hematopoietically active marrow, particularly in facial bones. This erodes existing cortical bone and induces new bone formation, giving rise to a "crew-cut" appearance on X-rays Both mononuclear phagocytic cell hyperplasia and extramedullary hematopoiesis contribute to enlargement of the spleen, which can weigh up to 1500 gm.

c. Bone marrow transplantation from an HLA-identical sibling is currently the only therapy offering a cure

EYE Sendups- SORTED OUT SEQz UHS 2012

2012-10-13T08:08:00.000-07:00

Copyrights All Rights reserved by Flash Medical

you are requested to remember in prayers someone who holds the credit of sorting out Eye Seqz but doesn't want name to be mentioned

Kindly do mention in comments if you find any SEQ that is not in the proper section.
For a detailed discussion and to get answers to the diagnosis, join this group on facebookhttp://www.facebook.com/groups/mbbsbatchof2013/

EYELID-A boy of 10 yrs presented with severe drooping of eyelid since birth with poor levator excursion,causes?how wil u evaluate this problem?What wil b the best surgical ption to treat this case.PMC

A young man working in chemical factory presented in eye OPD with installation of some chemical in both eyes.emergency treatment?Give medical treatment of grade 2 and 3 injury,complications which can develop if he is not treated?

SMC

--A 70 yr old man presented with persistent irritation andwatering R/E for the last 3 months,On examination there was inward rolling of lower lid and rubbing of conjunctiva by lashes.
Whats diagnosis and D/D?
Pathophysiology?
Complications?(RMC)

ERRORS OF REFRACTION
-A 14 yr old boy presented with rt.eye vision of 6/36 and left eye vision of 6/6 after maximum correction retinoscopy,shows fundus and anterior chamber is normal,Rt eye=+5D in both axis and lt.eye=+1.5D in both axis.
Whats ur diagnosis
What r different types of this condition.
Classify squint types.
What r different refractive errors types(NSMC)

-A 25yr old male presented with gradual decrease in vision,On examination visual acuity was 6/12 ib rt.eye and 6/36 in left eye which increased on pinhole test.D/Ds,How will u evaluate refractive error,What r themost modern methods of myopia correction.MMDC

-A 14yr old boy presented withrt.eye vision of 6/36 and lt.eye vision of 6/6 after simple correction retinoscopy,shows fundus and ant.chambers normal.Rt eye=+5D in both axes and lt.eye=+1.5 D in both axes

Whats diagnosis?what r different types of this condition?What r different refractive errors,classify types of squint?(SZMC)

---Whats ametropia?types?treatment?(SIMS)

---Write short notes on use of laser in ophthamology?Surgical management of myopia?(UMDC)

CMC

---A 25 yr old lady using concave glasses of -6 diopters

what is this condition called?

What r possible complications?

what other treatment modilities can benefit her

CONJUNCTIVA---A young girl presented with itchy red eyes with mucoid discharge following exposure to dust
diagnosis?
drugs used to treat?
complications and their treatment?(CPMC)

---A 6 months old baby presented with purulent discharge since birth.
disgnosis?
which mechanism may cause the same?
treatment?(CPMC)

-A 45 yr old presented with burning and redness of eye of both eeyes for last 3 days.On examination theres watery discharge,follicular conjunctival reaction,and painful preauricular lymph nodes
Whats most likely diagnosis
How will u manage this case
What complications can occur(UMDC)

---A 50 yr old man presents with fleshy red fibrovascular encroachment onto cornea from nasal side in exposed palpebral conjuctive,
Probabale diagnosis?what do u think this phenomenon is due to?Name atleast 3 surgical procedures.(WMC)

---A mother presented her 8 yr old child having red and watrey eyes,boy was having alot of itching and perilimbal conjunctiva was swollen with white dots upon it.
Diagnosis?
treatment?

Complications of this disease?(RMC)

A pt with defecctive night vision visits OPd,diagnosis?typical signs in fundus?(WMC)

---Ayoung lady belonging to a low socio-economic background presented with mild mucopurulent discharge from both eyes from the last 2 weeks.Ordinary antibiotic drops didnot relieve it.On examination there was diffuse papillary reaction with a line of follicles in the upper tarsal conjunctiva.
Diagnosis?
Lab Investigations?
Treatment?(RMC)

A 15yr old boy presented with severe watering and itching of both eyes in spring season.Diagnosis?clinical features?treatment?

MMDC

---Discuss clinical features and pathophysiology of allergic conjunctivitis?(SIMS)

A 10yr old boy presented in OPD with complaints of itcjing,watering and photophobia and these syptoms r more marked in spring each yr,By everting the upper E,tarsal conjunctiva shows flat topped polygonal shaped raised lesions,Diagnosis?corneal complications which can develop?how will u treat him?(vernal/spring.SMC

---A young boy complains of redness of both eyes associated with mucopurulent discharge of both eyes for 4 days.

diagnosis

treatment(CMC)

--A young boy is known asthmatic since childhood,He gets recurrent attacks of irrittation,photophobia and redness since long.

Give diagnosis and all possible signs of diagnosis(FMH)

---An area hasbeen declared 'endemic'for trachoma by health authorirties,Nam emeasures which can b taken 4 its prevention.(CMC)

CORNEAA 40 yr old male presented with watering and photophobia of lt.eye.on examination visual acuity was 6/60 and corneal haze and circumcorneal congestion with corneal ulcer.How wil u examine case on slit lamp?diagnosis?MMDC

---A young farmer sustained eye injury by a plant shot which he took as trivial,However lacrimation and pain went on increasing in the subsequent days.
Which necessary test is done on slit lamp to confirm the diagnosis of corneal ulcer.
Name atleast 2 culture media of interest in such a case?
What r complications of corneal ulcer?(RMC)

----A young man comes to clinic with history of forign body sensation,watering,photophobia in rt.eye,he consulted a local physician who gave some topical drops,On slit light examination there was dendritic lesion on cornea which stained with florescein dye.
probable diagnosis?
what ohter features do u expect to notice in such type of corneal lesion
management(CPMC)

---An 85 year old male comes to u with the complaints of redness,watering an dpain of right eye,On examination there is dendritic and punctuate lesions in the right cornea staining with florescein,
What is ur diagnosis,
d/d,
classify corneal ulcer?(NSMC)

-A male pt of 35 yrs complaind of lacrimation,photophobia and redness in his rt eye for last 1 wk.Examination shows branch like corneal lesion.He has H/O fever 2 weeks ago.provisional diagnosis?How will u confirm the diagnosis?Name 2 drugs used to treat this condition.PMC

---Give management of unilateral cornela ulcer in2 yr old( UMDC)

---Write notes on(UMDC)
management of keratoconus
indications of keratoplasty

---A 16 yr old boy with the history of allergic conjunctivitis for about 6 yrs,presented with gradual deterioration of vision in both eyes,Hes already using high minus glasses,but not satisfied bcs theres rapid change in glasses prescription,On torch light examination both corneas look clear but conical.
Probable diagnosis?Name 2 ocular and 2 systemic associations of this condition?what r steps of management?(WMC)

---What r clinical features of bacterial keratitis?(SIMS)

An 85 yr old male comes to u with redness,pain,watering of rt.eye.On examination theres puctate and dedndritic lesions on rt cornea,staining with florescein.
Diagnosis?D/D?classification of corneal ulcer(SZMC)

---A midddle aged man presented with photophobia,lacrimation and pain and dimness in rt.eye.On examination of cornea there was central corneal geographical ulcer

diagnosis

complications

(CMC)

----A young girl is contact lens user,She accidently slept with them on and later complained of redness,photophbia,lacrimation blurred vision.Corneal ulcer is sspected.

Give treatment and complications if left untreated.(FMH)

OPTIC NERVE

-A 30 yr old female presented in eye OPD preesnted with sudden decrease in vision and impaired colour vision in rt.eye.On examination rt.eye shows Rapid afferent pupillary defect and vision of lt.eye is normal.Diagnosis(optic neuritis),What will b the investigations to reach the diagnosis?treatment?SMC

---A 55 yr old lady presented in eye OPD with h/o severe early morning headache and projectile vomiting.On ophthalmoscopy,optic discs sof both eyes are swollen and congested

D/D

Most imp investigation

Diff b/w papillitis and pappiledema(CMC)

---A 90 yr old male comes to u with sudden loss of vision of lt.eye.extraocular movements r painful.RAPD is positive in lt.eye and fundus is normal.
Diagnosis?
Causes of Papilledema?
management?(SZMC)

----A 70 yr old male presented to u with sudden loss of vision in lt.eye,He shows painful extraocular movements,RAPD is positive in lt.eye and fundus oof that eye is normal.
Whats ur diagnosis
what r the causes of Papilledema
How will u manage this case(NSMC)

CATARACT---An old lady of 70 yrs is admitted for cataract surgery.
What r pre-operative investigations to b done?
Nmae surgical procedures available?
What r early-post operative complications?(RMC)

--A 65yr old male presented in eye OPD with H/O gradual painless deterioration of vision in both eyes for the past 2 years

D/Ds

post operative complications of cataract surgery

(theres another question but its not really visible in the pic)(CMC)

-A middle aged pt of chronic uveitis has rt eye vision 6/24 and lt.eye vision 6/9.Slit light experiment shows that rt.eye has post.subcapsular lenticular opacities.It is decided that catract surgery wud b done and with IOL implant.What surgical technique u will use and y?What ocular measurements will u record to calculate IOL power.Mention 4 intraocular complications that cud develor during surgery.(ICCE)SMC

---A 1 yr old child brought to u in OPD with bilateral white pupils,on examination with B-scan ant and post chamber r normal.
Diagnosis?causes of leucocoria?causes of congenital cataract?(SZMC)

PMC_______

---A male normotensive non diabetic 65 yrs of age complains of gradual painless blurring of vision,On examinations both pupils r white,His vision is reduced to counting fingers on both sides and his IOP is normal and both pupils react to light.

Provisional diagnosis?

complications occuring if left untreated?

different surgical methods to treat?

Enumerate 4 problems during surgical procedure

---A 65 yr old lady gives history of cataract surgery 2 yrs ago,She ahs preented with marked blurring and redness for 12 hours,On examination theres hypopyon in the ant.chamber and ant.vitreous is full of cells.
diagnosis?
management?
enumerate 4 most common intraoperative cataract surgery complications.(CPMC)

-A 50 yr male presentde in OPD eye for routine examination,Onexamination vision was 6/6 in both eyes and IOP was 36mmHG,On examination ant.chambers were deep and both pupils were slow in reacting to light.provisional diagnosis.What wil b the fundus changes in this case?Name 1 investigation to confirm this diagnosis.Classify drugs used to treat this condition.PMC

--A 4 week old baby is brought to u with white pipillary reflex in both eyes,Fundus details r hazy.Ocular ultrasound reveals vitreoretinal echography,
diagnosis?
risk involved if left untreated and how can u prevent it?
treatment.(CPMC)

---A 3yr old boy presented in OPD with rt.leucocorir,D/D(SIMS)

----A2 yr old child was brought to Ophthamologist with history of white pupil?
Whats D/D(UMDC)

----1 yr old boy brought to u in OPD with bilatereal white pupils,On examination,ant and post chambers r normal with B-scan.
Whats ur diagnosis?
What r the causes of leucocoria
What r the causes of congenital cataract(NSMC)

A male normotensive non diabetic 65 yrs of age complains of gradual painless blurring of vision,On examinations both pupils r white,His vision is reduced to counting fingers on both sides and his IOP is normal and both pupils react to light.

Provisional diagnosis?

complications occuring if left untreated?

different surgical methods to treat?

Enumerate 4 problems during surgical procedurePMC

---Enlist pre-operative complications of cataract Extraction
Write down advantages of phacoemulsifictaion over ECCE(UMDC)

--A 4 yr old boy presents with defective vision,on slit lamp bimicroscopy with dilated pupils revealed bilateral moderate opacification of inner lamellae of lens surrounded by clear lamellae with riders at the margins of the opacity,whats the name given to this type of cataract?Name 4 other types of cataract in small babies?management?(WMC)

PUPIL
----Horners syndrome definition or causes(FMH)

OCULAR INJURIES
---A young man working in chemical factory presented in eye OPD with installation of some chemical in both eyes.emergency treatment?Give medical treatment of grade 2 and 3 injury,complications which can develop if he is not treated?SMC

---A pt was doing whitewash in a house,he got a splash of ehitewash in his eye

What is the immediate measure to b taken

What type os chmical injury has occured

What r the delayed effects of chemical injury in this(FMH)

-------A 15 yr old girl received trauma on lt.eye with sulphuric acid,On examination there was severe conjunctival congestion and corneal haze
HOW WILL U MANAGE THIS PATIENT?
What complications will occur if these pts r not managed properly?(UMDC)

-A young pt working in stone crushing factory presented to u with acute pain.lacrimation and marked decreased vision of rt.eye.History reveals fall of dust in affected eye during work,On examination conjunctiva is congested,corneal haze and infiltrate against pupillary area,Give spot diagnosis?treatment of this case?4 complications if pt is neglected?(Foreign body)

SMC

-An 18 yr old boy received tennis ball injury presented in ER with severe pain and

-- loss of vision,How will u investigate?Give clinical features?MMDC

SQUINT

-A 5 yr old school boy presented in OPD with rt.eye convergent squint.History reveals that the misalignment is more marked while reading.How wil u evaluate this pt?treatment options?

.SMC

A 70yr old male presented with drooping of lt.eyelid and diplopia,On examination eye was deviated downward and outward with normal pupillary reaction,How will u evaluate the case?investigations?diagnosis?(3rd nerve)MMDC

---A 9yr old boy presesnts with lazy eye(amblyopia),causes of amblyopia?treatment?(WMC)

----A patient 35 years of age complains of H/O blurring of vision at near.He doesnot have refractive error.He has also noticed misalignment of eyes sometimes which is outward

Give examination and probable diagnosis(FMH)

-A female of 55 yrs complains of severe drooping of left upper eyelid since the past 1 week,On lifting eyelid was found to b diverted temporally and pt reported diplopia.provisionl diagnosis?Describe the abnormal extraocular movements in this case,Name 2 causes of this problem.PMC

-A male child of 5 yr presented with inward deviation of lt.eye since early childhood.Examination shows left esotropia of 30 degree.His vision was 6/6 in rt eye,and 6/60 in lt.eye.Cycloplegic refraction revelealed no refractive error,Why vision in lt.eye is poor?How vision can b improved?Which type of muscle surgery will correct this deviation.

PMC

----regarding squint

whats the difference b/w accomodative and non-accomodative?
Mention two tests to measure squint?
How will u manage a 2 yr old child with accomodative esotropia?(CPMC)

---What r different types esotropia?Write down management of accomodative esotropia?(UMDC)

VITREOUS

---A young boy is known myopic having 10DS myopia.He has noticed floaters in his rt.eye with painless sussen decreased vision.

Give investigations and possible diagnosis(FMH)

UVEAL TRACT
---An 85 yr old male comes to u H/O red eye,watering,severe pain,He also gives history of joint pain and neck pain.
Diagnosis?D/D?Management?(SZMC)

A 55 yr old diabetic pt complains of severe pain and decreased vision in hs rt eye,He was operated for cataract extraction with IOL implant 3 days ago,Examination shows ciliary congestion and hypopyon with absent fundal glow.Provisional diagnosis?Give 4 measures to prevent this complication,How will u traet this acse?PMC

---A 30 yr old man with history of backache presented wth mild eyeache,photophobia and visual disturbane,his best corrected V/A R/E was 6/12 and 6/6 L/E.IOP was 10mmHg R/E and 14mmHg L/E.Slip lamp examination shows a reaction in ant.chamber(cells(+2,Flare+2) in RT Eye.L/E ant.chamber was normal.Diagnosis?anatomical classification of disease?treatment of this case?(RMC)

---Discus clinical features of acute ant.uveitis?(SIMS)

--60 yr old man presents with pain,redness and photophobia of both eyes.On examination theres circumcorneal congestion,and dull ant.segment details,Greyish white deposits r noted on back surface of cornea.
Tabulate 2 clinical methods to perform with expected clinical findings in each.
diagnosis?
what r the most imp investigations in this case?(CPMC)

-----An 85 yr old male comes to u with red eye,watering and severe pain,He also give shistory of joint and neck pain.
gv diagnossis
D/D
Management?(NSMC)

---A 35 yr old female presented with ocular discomfort,photophobia and circumcorneal congestion?(UMDC)
Give D/Ds
Give management of ant,uveitis?(UMDC)

---A 55 yr old male operated in District hospital for rt.cataract extraction with IOL implantation 3 days back,He presented in eye emergency with decreased vision,severe pain.redness and swelling of rt.upper eyelid,On examination there was a severe reaction and hypopyon in ant.chamber,fundus view wasnt cleay due to ahze in vitreous,he was diagnosed as rt.endophthalmitis,discuss treatment(medical and surgical of this patient(SIMS)

GLAUCOMA

--A 65 yr old lady complains of headache,vomiting painful red eye with decreased vision for past 12 days,she gives H?O coloured halos around light in past,On examination she as corneal edema,shallow ant chamber and hypermature cataract,IOP=50 mm Hg,diagnosis?emergency treatment?surgical treatment?(WMC)

A 70yr old patient(female) presented with severe ocular pain in lt.eye.History revealed decreased vision for last 1 yr,and rt.eye cataract surgery 2 yrs back.Examination of lt.eye shows shallow ant.cjamber,fixed and mid dilated pupil with an opaque lens.provisional diagnosis?Write emergency prescription for management of this patient.?What is definite treatment option for this patient.PMC

A middle aged lady presented with painful red eye and gross decerase n vision for the past 1 day,she complained of seeing halos in both eyes on and off for the past 2 months,On examination visual acuity was hand movement and circumcorneal congestion and dilated vertically oval pupil shallow anterior chamber was present.Diagnosis?treatment options?MMDC

5 causes of ectopic lentisSMC
-A 50 yr male presentde in OPD eye for routine examination,Onexamination vision was 6/6 in both eyes and IOP was 36mmHG,On examination ant.chambers were deep and both pupils were slow in reacting to light.provisional diagnosis.What wil b the fundus changes in this case?Name 1 investigation to confirm this diagnosis.Classify drugs used to treat this condition.

PMC

55yr old hypertensive lady presented with acute pain in rt.eye and theres also profound loss of vision.Cornea is hazy,IOP pressure is 60mmHg with mid dilated pupil and shallow anterior chamber.diagnsis>treatment?(open angle glaucoma)

SMC

----An old lady was having visual deficit since long but not seeking medical advice due to family inattention,She suddenly developed pain in lt,eye with watering and redness,Her vision was light perception only,pupil wasnot recating to light and lens was white and opaque,she was diagnosed as lens induced glaucoma.
Whats the pathogenesis of lens induced glaucoma?
Whats emergency treatment of this case?
What r surgical problems of such cases?(RMC)

-Wat is normal peripheral field of vision and by which methods can v check it
Write down different field defects in optic nerve lesions(FMH

---A 45 yr old male comes to u with H/O headache,vomiting and pain in rt.eye,Examination shows corneal edema and shallow ant.chamber and IOP 50mmHg.
Diagnosis?D/D?Management?(SZMC)

-A 2 yr old child presents in OPD with small pupil,ptosis of small degree and iris hypopigmenation
Most likely diagnosis?What ohter signs wud u look for?what advice will b given as ergards the time of surgery?(WMC)

---A middle aged male previously healthy and ahving no visual compplaints presented to eye dept for routine checkup.His best corrected vision was 6/6 for distant N6 for reading glasses,However his iop was 25mmHg in Rt.eye and 22mmHg.
Clinical features of POAG?
Name the visual field defects in POAG?
treatment(RMC)

---Discuss clinical featutes of acute congestive glaucoma?(SIMS)

---A 45 yr old male comes to u with H/O headache,vomiting and pain in rt.eye,Examination shows corneal edema and shallow ant.chamber and IOP 50mmHg.
Diagnosis?D/D?Management?(SZMC+NSMC)

---a 55 yr old patient with severe ocular pain,in his rt.eye and vomiting,on examination theres marked decrease in vision,hypermature cataract,raised IOP and shallow ant.chamber
What is D/D
Whats most likely diagnosis
How will u manage this case(UMDC)

---A 61yr old lady comes for routine eye examination,her vison becomes 6/6 after refraction,On distant direct ophthalmoscopy her media was clear,fundoscopy showd relatively thinned but pink neuro-retinal rim,cup:disc ratio was 0.9 in both eyes.
What is the most probabale diagnosis
Name 3 tests to support the diagnosis
Briefly describe treatment and follow up plan(CPMC)

VISUAL PATHWAY

A middle aged lady comes to eye opd with H/O rt.eyeball protrusion in 10days duration she has swollen eyelids with incomplete closure of palpebral fissure with decreased vison

give D/Ds and investigations u will do to raech a possible diagnosis(FMH)

RETINA

-Parents of a 1 yr old boy presented with lt.white pupil for 2 weeks.On examinattion a white mass was projecting feom retina inward along with blood vessels..DDs?how wil u council the parents?treatment options?MMDC

---A 70 yr old male presented to u with sudden painless loss of vision in rt.eye,Hes a known diabetic and hypertensive from the last 20yrs,On examination theres no fundal reflex.
Diagnosis?D/D?Risk factors for diabetic retinopathy?Classify diabetic retonopathy with treatment?

A 30yr old male presesnted with sudden painless loss of vision in rt eye,he has type 1 DM since childhood.Examination shows absent red reflex in rt eye and neovascularization of optic nerve head of lt.eye.diagnosis of both eyes?4 possibles signs in lt.eye?How will u treat lt.eye of the patient?PMC

---A poorly controlled diabetic pt developed gross loss of vision of rt.eye.On examination theres no view of fundus.Left fundus shows microanurysms,hard exudates and neovascularization of optic disc.diagnosis?how will u evaluate?treatment?

SMC

--A young diabetic lady presented with gradual decrease in vission in lt.eye which is worse on exposure to sunlight.Give clinical signs on slit lamp experiment.How will u examine retina?treatment options?MMDC

---A 50 yr old diabetic lady with 20 yrs of duration of diabetes presents with gradual painless decreased vision of both eyes.
Give 4 causes of gradual loss of vision?

---What r different risk factors for the development of Rhegmatogenous retinal detachment?Write down different methods of management?(UMDC)
What r treatment madalities of diabetic retinopathy?
what is the cause of raised IOP in terminal stage of proliferative diabetic retinopathy?
(WMC)

--A 65yr old lady presented with slowly deteriorating painless visual loss in L/E for last 1 yr,Shes normo-tensive and normo-glycemic,Best corrected V/A R/E is 6/12 and L/E is 6/60,IOP and pupillary reactions to light were both normal.
name 2 most probable causes of this type of visual loss?
Investigations?
surgical options(RMC)

----A young myopic pt is diagnosed as a case of retinal detachment
explain clinical features
Whats the expected of detachment in this case and the surgical plan
What is the prognosis and y
what wil u choose b/w urgent/late/delayed intervention in this case and y?(CPMC)

A 50 yr old known NDIIM lady for the past 10 years was undergoing routine oculat check up.
classify diabetic retinopathy
How will investigate such a case
What r the diffrent treatment options 4 diabetic retinopathy(RMC)

---Classify diabetic retinopathy with its treatment madalities?(SIMS)

ORBIT

---A 70 yr old banker developed foreign body sensation and tearing in both eyes,ocular examination revealed retraction of rt.upper eyelid.Past history revealed treatment of GRaves for past 1 yr,
List 6 other ocular features of this disease?treatment?(WMC)

LACRIMAL SYSTEM

A 4 month old baby boy os brught to OPD and mother complains of rt,eye full of tears,small palpabral fissure and lashes matted together,diagnosis?treatment options?(WMC)

-A 4 months old child presented with epiphora from rt.eye since birth.Diagnosis?management?at what age intervention shud b don.MMDC

ENT sendups- sorted out SEQz 2012

2012-10-11T14:05:00.001-07:00

"Fear Less, hope more
eat less, chew more
whine less, breathe more
talk less, say more
hate less, love more
and good things will be yours"
- Swedish Proverb

Due to possible human error, if you find any SEQ in the wrong section, kindly feel free to tell.for answers and detailed discussion on scenarios and their diagnosis, important prof questions, pastpapers, and lot more, join our group on

facebook:http://www.facebook.com/groups/mbbsbatchof2013/

Remember in Prayers

Ear

>> A 5 year old child has progressive decreased hearing loss and mild earache off and on. There is H/O nasal obstruction, both tympanic membranes are dull with loss of light reflex.
a. diagnosis?
b. investigations?
c. Management? (CPMC)

>> A 35 year old female presented with pain left ear for last 4 days. The pain is aggravated o chewing movements. There is no history of ear discharge. On examination movements of pinna are painful, meatus is occluded by swelling and there is some forward displacement of pinna.
a. diagnosis?
b. Differential diagnosis?
c. Management? (CPMC)

>> A seven year old child who had chronically discharging left ear, developed otalgia, retroauricular tender swelling with pinna protruded outwards and forwards. How will you manage? (CMC)

>> A female 45 years develops episodic vertigo. Each episode of vertigo being intense, accompanied with nausea and sweating, fullness in the ear, tinnitus and decreased hearing during the attack. She is having such episodes for last 6 months.
a. diagnosis?
b. D/D?
c. medical management? (CMC)

>> A 7 year old boy presented with mild otalgia and his mother was worried about his progress in school. Since last 6 months he has on and off attacks of sore throat. He also c/o difficulty in hearing.
a. diagnosis?
b. audiometric tests?
c. treatment? (CMC)

>> A 28 years old female was brought to emergency with history of headache, fever and neck stiffness. There is history of long standing left ear discharge, for which she was taking medications on & off. On examination she had attic perforation.
a. Diagnosis?
b. Investigations?
c. Treatment? (AIMC)

>> 40 year old male had surgery for cholesteatoma on left side. On recovery from anaesthesia he noticed that he cannot close his left eye and angle of mouth is pulled to the right without any taste disturbance.
a. what is the cause with probable site of lesion?
b. commonest condition you have to differentiate it from?
c. manage? (WMC)

>> Note on a. Exostosis? B. Haematoma auris(WMC)

>> A 10 years old child presented to OPD with history of scanty purulent foul smelling ear discharge for last 2 years. Ottoscopic examination reveals attic perforation with granulations.
a. diagnosis?
b. Complications?
c. manage? (QAMC)

>> A 40 years old male presented with episodic vertigo and fluctuating sensorineural hearing loss and tinnitus for last 2 months.
a. diagnosis?
b. investigations? (QAMC)

>> A 15 years old boy presented in emergency with sudden facial asymmetry on left side after herpes zoster infection.
a. Diagnosis?
b. differential diagnosis? (QAMC)

>> 9 years old boy presented with complaints of watching and listening tv with loud voice and poor performance in class and no response to conversational voices.
a. possible diagnosis?
b. manage?
c. complications? (FMH)

>> 45 years old patient with sudden vertigo on changing the position of head which is of few seconds associated with nausea only.
a. diagnosis?
b. pathophysiology?
c. describe Two maneuvers to treat? (FMH)

>> describe briefly. A. internal auditory canal. B. subperiosteal abscess of orbit. C. holman’s sign and tumor brush(FMH)

>> 25 years old developed loss of hearing and facial palsy after getting injury on the scalp.
a. describe possible line of fracture
b. manage? (FMH)

>> short notes on
a. plummer vinson syndrome
b. posterior wall of tympanic cavity
c. acoustic reflex(FMH)

>> 30 year old female receptionist with episodic vertigo, tinnitus and reduced hearing. Ears normal. Her pure tone audiograms show bilateral low frequency sensorineural hearing loss.
a. diagnosis
b. further sudiological tests?
c. surgical options? (NSMC)

>> 26 years old pregnant lady with right sided complete lower motor neuron lesion facial nerve paralysis
a. diagnosis
b. manage?
c. differences bw upper and lower motor neuron lesions causing facial paralysis(NSMC)

>> A 3years old child with his mother who complains that his child could not speak intelligently. Ears normal in shape.
a. audiological investigations
b. causes leading to this problem?
c. manage? (NSMC)

>> Female 25 years with decreased hearing in both ears for last 4 years which is gradually worsening. Hearing is better in noisy surroundings. Tympanic membrane intact but pinkish in colour.
a. diagnosis
b. findings on tuning fork tests and on pure tone audiometry
c. manage? (SIMS)

Short notes on.
a. cholesteatoma
b. cochlear implant(SIMS)

>> 55 years old female with recurrent attacks of tinnitus with vertigo and fluctuating hearing loss. Normal tympanic membranes.
a. investigate?
b. D/D? (SZMC)

>> 2 years child with fever and severe pain right ear. Respiratory infection 3 days back. Bulging and hyperemic right tympanic membrane.
a. diagnosis
b. treatment(SZMC)

>> Short notes on
a. otomycosis
b. otitic barotrauma(SZMC)

>> A 17 years old girl is diagnosed as a case of secretory otitis media.
a. describe clinical presentation of the case?
b. treat? (IMC)

>> describe surgical treatments of a case of chronic maxillary sinusitis not responding to medical treatment?(IMC)

Nose

>> A 50 years old diabetic male for last 10 years is admitted in the medical ward for management of diabetic ketoacidosis. Black necrotic turbinate is noted in the right nostril along with right eye proptosis by the medical resident on call. The patient is sent to ENT department for consultation.
a. Diagnosis?
b. How will you prove your diagnosis?
c. Manage? (CPMC)

>> A young man has peculiar nasal obstruction that he can breathe in but cannot breathe out. On examination he has a mass in left nostril.
a. Diagnosis?
b. Investigate?
c. treatment? (CPMC)

>> A 30 years old female complains of proptosis of the right eye, diminution of vision in the right eye, rhinorrhea and cough.
a. differential diagnosis?
b. what investigations will you prefer to confer or negate each of your diagnosis? (CPMC)

>> Causes of unilateral nasal discharge. How will you treat rhinolith? (CMC)

>> Classify nasal polyp. How will you diagnose and treat case of Antrochoanal polyp. (CMC)

>> A 40 years old patient has presented with history of attacks of profuse clear watery nasal discharge with transient obstruction. Laboratory finding show normal IgE levels
a. Diagnosis?
b. what other important condition is to be excluded?
c. differentiating features in respect of cause, age of onset, complaints and lab findings in each? (WMC)

>> A man gets feeling of tightness in the face and cheeks followed by blood stained nasal discharge after air travel. Also complains of headache of dull nature.
a. diagnosis?
b. definition, etiology, pathology clinical features and management in this case
c. How can you prevent this condition? (WMC)

>> Enumerate tumors of nasopharynx. Discuss treatment of nasopharyngeal carcinoma. (QAMC)

>> patients with red spot on her lips suffers from regular nose bleeds, she is also under treatment for gut lesions.
a. possibility?
b. investigate?
c. treatment (FMH)

>> 14 year old boy has right side nasal obstruction that is progressive in nature and massive nasal bleeding off and on. On examination, a mass is present in right nostril and there is also swelling of right check.
a. diagnosis?
b. Confirm your diagnosis?
c. if same mass extending into cheek, mention its route. (NSMC)

>> 47 yr male with bilateral nasal obstruction, headache and postnasal discharge. On examination his nasal cavities are filled with multiple whitish looking masses that are insensitive to touch.
a. diagnosis
b. surgical approaches and which one is best and why?
c. complications of surgery? (NSMC)

>> 27 years old school teacher with h/o nasal obstruction, watery nasal secretions and occasional sneezing specially at morning timings. She is in the habit of using a decongestant nasal spray. Her inferior turbinates were swollen and wet.
a. diagnosis
b. how this differs from nasal allergy?
c. manage(NSMC)

>> 20 year old woman was using vasoconstrictor nasal drops on and off for reducing rhinosinusitis for 6 years. She gets attacks of nasal discharge sneezing and permanent nasal obstruction. She has grape like masses hanging in the nasal cavity.
a. diagnosis
b. medical treatment options?
c. best surgical procedure, enumerate complications also. (RMC)

>> various non traumatic causes of CSF rhinorhoea?
b. imp radiological investigations?
c. management? (SIMS)

>> Management of a 20 years old motorcyclist who has sustained injuries on his facein a road traffic accident. (SIMS)

>> 4 years old child with b/l nasal obstruction. h/o nasal trauma 2 days back. Anterior rhinoscopy revealed bilateral cystic swelling of septum.
a. diagnosis
b. treat
c. complications(SZMC)

>> 3 year old female baby with mouth breathing, exclusive watering from mouth at right, nocturnal cough and occasional epistaxis. On anterior rhinoscopy, nothing abnormal is visible.
a. diagnosis?
b. radiological investigations?
c. Treat? (IMC)

Pharynx & Oral cavity

>> a. How will you diagnose a case of diphtheria?
b. Complications?
c. Treatment? (CMC)

>> A 9 years old boy comes with history of fever and painful swallowing. On examination there is greyish white membrane over the right tonsil which also extends to the soft palate.
a. Diagnosis?
b. Treatment?
c. Complications? (AIMC)

>> A 50 year old diabetic lady comes to OPD with complaints of boil in right tonsil. The next day she is brought to the emergency with headache, fever, vomiting and drowsiness.
a. diagnosis?
b. Management? (AIMC)

>> A 62 years old overweight retired businessman comes to you in ENT OPD with complaints of pain on right side of throat for last 3 days alongwith fever and difficulty in opening the mouth.
a. diagnosis and how will you treat?
b. Complications? (AIMC)

>> 25 year old male presented with 3 days history of sore throat for which he was getting treatment from a GP. He is unable to open mouth, having high grade fever and enlarged lymph nodes in jugulodigastric region. There is marked oedema of right side of palate, enlarged tonsil and uvula pushed to right:
a. diagnosis?
b. Manage? (WMC)

>> 6 years old child with fever 38C and sore throat, there is greyish membrane over the tonsil and his pulse is 160/min
a, diagnois?
b. investigations?
c. Treatment? (FMH)

>> 7 year old boy is having h/o recurrent attacks of acute tonsillitis with high grade fever (more than 102 degrees) and child was unable to attend school during attacks which were 5 in number per year for last 3 years.
a. diagnosis
b. treat?
c. mention different sorts of hemorrhages associated with surgical treatment of disease? (NSMC)

>> 20 years old male presented with sore throat and fever for last 3 days. Gray membrane on right tonsil which is extending to the soft palate.
a. diagnosis
b. investigate
c. complications
d. significance of early presentation regarding dosage of drug of choice. (RMC)

>> A. D/D of whitish membrane on tonsils
b. characteristic features of a diphteric membrane?
c. systemic manifestations of this condition and causes of mortality? (SIMS)

>> 35 years old female presented with fever and swelling in submental and right submandibular region for 4 days. Skin over the swelling is red and swelling is tender. First molar tooth of right lower jaw is carious.
a. diagnosis?
b. causative organisms?
c. manage? (SIMS)

>> 35 years old lady having h/o pan chewing for last 15 years, now for the last six months, she has developed slowly progressive dysphagia with trismus. Oral examination reveals whitish soft palate with contractures.
a. diagnosis?
b. management? (SZMC)

>> A. indications of tonsillectomy?
b. how will you treat reactionary hemorrhage 24 hours post-op? (IMC)

Larynx

>> A 4 years old child was playing. Suddenly he developed difficulty in breathing, stridor and low grade fever. No H/O foreign body inhalation. H/O running nose and cough for the last three days. How will you manage? (CPMC)

>> A 50 years old male complains of hoarseness of voice for the last 8 months.
a. How will you arrive at the diagnosis?
b. causes of vocal cord paralysis? (CPMC)

>> 55 years old male, known smoker for last 30 years presents with hoarseness of voice of two years duration. Indirect laryngoscopy shows an irregular mass involving both vocal cords anteriorly with impaired mobility. Examination of neck is unremarkable. Histopathology of the mass reveal well differentiated sq cell carcinoma.
Give TNM classification and staging of glottis tumors. (WMC)

>> what are the causes of left recurrent laryngeal nerve paralysis. How will you treat a case of B/L vocal cord paralysis? (CMC)

>> A 4 years old child presented in emergency with high grade fever and rapidly progressive dysphagia after an attack of sore throat. Child looks toxic, sitting in prop up position.
a. what is your diagnosis?
b. How will you manage this case?

>> A 55 years male, chain smoker developed change in voice for last one year. Now she developed extreme difficulty in breathing for last 15 days.
a. Diagnosis?
b. investigations
c. Different treatment modalities? (AIMC)

>> 11 years old boy learning hifz e Quran in a madrassa is seen with hoarseness of voice and at times aphonia especially in morning since he started his classes a year ago.
a. Diagnosis?
b. Differential diagnosis?
c. Management? (WMC)

>> A 60 years old smoker man developed hoarseness of voice for three months and respiratory distress for last 2 weeks. On examination there is mass on left vocal cord, what is diagnosis? Differential diagnosis? Investigations? How will you treat? (QAMC)

>> A 7 years old child has history of sore throat for last one year. He developed s3evere deep seated pain in throat. On examination he has drooling of saliva and mouth opening is painful. His oropharynx is totally normal. X- ray soft tissue neck lateral view shows thumb sign. What is diagnosis. How will you manage? (QAMC)

>> anatomical differences in children which may make management of airway more difficult than in adults (FMH)

>> classify the causes of laryngeal paralysis and briefly give the management of each variety.
(FMH)

>> 4 year old child brought with severe stridor and drooling of saliva from angle of mouth. High grade fever with ill looks.
a. diagnosis
b. name the organism responsible for this disease.
c. manage? (NSMC)

>> 65 year old male heavy smoker was having changed voice for last three months presented with respiratory difficulty.
a. diagnosis
b. manage the respiratory problem
c. treatment plan(NSMC)

>> 60 years old smoker male having progressive hoarseness of voice for last 6 months has now presented with respiratory distress for last 5 days.
a. diagnosis
b. immediate management?
c. treatment plan?(SIMS)

>> 45 years old male with h/o smoking 20 cigarettes daily for the last 30 years presented with c/o slowly progressive hoarseness of voice, now for the last 2 months developed dyspnea and right otalgia. Indirect laryngoscopy reveals fungating growth of right vocal cord with impaired mobility.
a. diagnosis?
b. manage? (SZMC)

>> 30 year old male with severe sore throat, odynophagia, high grade temperature for last 2 days. Saliva is drooling down the angle of mouth, anxious looking face and trismus.
a. diagnosis?
b. treat? (IMC)

>> Describe clinical features and treatment of vocal nodules. (IMC)

Oesophagus

>> 70 years edentulous male came with sudden onset complete dysphagia. He is spitting saliva and getting bouts of chocking
a. Diagnosis?
b. Why is he getting cough?
c. how will you investigate a patient of dysphagia? (WMC)

>> A 40 years old landlord presented with difficulty in swallowing for last 9 months which has progressively increased over this period. Now he is only able to take liquids orally.
a. differential diagnosis?
b. Investigate? (AIMC)

>> A 25 yaers old lady complains of progressive dysphagia for last one year. On examination she has pallor, angular stomatitis and koilonychias. What is the diagnosis? How will you manage? (QAMC)

>> 30 years old female with history of difficulty in swallowing for last 6 months. Indirect laryngoscopy is normal. Hb is 6 gm/dl. Barium swallow reported esophageal web.
a. diagnosis
b.findings which can be expected during ENT and systemic examination?
c. what other investigations are likely to be abnormal in her case?
d. medical treatment?(RMC)

>> A. esophageal causes of dysphagia(SZMC)
b. enumerate complications of rigid esophagoscopy(SZMC)

Surgical procedures

>> What is CALDWELL-LUC operation?
Indication and contra indication? (CMC)

>> Adult patient has undergone tracheotomy operation
a. post op nursing care. Discuss with reasoning. (IMC)

4th year Patho MCQs Sendup RMC- 2011

2012-09-14T13:02:00.001-07:00

MBBS III PROFESSIONAL -- SPECIAL PATHOLOGY MCQs SEND UP

2011 DEPARTMENT OF PATHOLOGY, RMC

TOTAL MARKS: 65

TIME ALLOWED: 65 minutes.

INSTRUCTIONSFor the multiple-choice items, fill in your answers on the answer sheet provided. We have tried to write a fair test, but there will surely be problems with certain items. If you have a question, raise your hand and we'll talk about it QUIETLY (don't phonate!)during the exam.In case you forget to write your Name and Roll No on the response sheet, then we will not be responsible and you will get zero.

Attempt all questions. All questions carry equal Marks. Mark ONE BEST option for each question.

CARDIOVASCULAR SYSTEM:

Q1. The most common cause of death immediately following the onset of acute myocardial infarction is:

A) Arrhythmia

B) Left ventricular rupture

C) Congestive heart failure

D) Shock

E) Pulmonary edema

Q2. Which of the two valves listed below is least commonly associated with rheumatic heart disease?

A) Aortic and pulmonary

B) Mitral and tricuspid

C) Aortic and mitral

D) Pulmonary and tricuspid

E) Aortic and tricuspid

Q3. Nonbacterial thrombotic endocarditis is most frequently associated with which of the following conditions?

A) Terminal neoplastic disease

B) Systemic Lupus erythematosus (SLE)

C) Old rheumatic endocarditis

D) Sub diaphragmatic abscess

E) Congenital Heart disease.

Q4. The most frequent cause of corpumonale with right-sided heart failure is:

A) Constrictive pericarditis

B) Disease of the lungs or pulmonary vessel

C) Left-sided heart failure

D) Pulmonary infundibular or valvular stenosis

E) Systemic Hypertension

Q5. Which of the following is not associated with Dissecting aortic aneurysm?

A) Death from hemopericardium

B) Degenerative changes of aortic media.

C) Hypertension.

D) Severe, tearing chest pain.

E) Severe atherosclerosis.

Q6. A 30 year old female has splenomegaly and anemia with spherocytosis. The circulating RBCs demonstrate an increased osmotic fragility on laboratory testing. An inherited abnormality in which of the following RBC components best explains these findings:

A) Glucose-6-phosphate dehydrogenase.

B) A membrane cytoskeletal protein.

C) Α-globin chain

D) Heme

E) Β-globin chain

Q7. A 60 year old man with H/O joint pains and is on NSAIDs, is becoming increasingly tired and listless. He occasionally passes dark stools. A CBC indicates a hemoglobin concentration of 9.7g/dl, hematocrit of 29.9%, MCV of 69.7fL/red cell, RBC count of 4.8x106/uL, and WBC count of 5500/uL. The most probable explanation of these findings is:

A) Iron deficiency.

B) Autoimmune hemolytic anemia.

C) Β-thalassemia major.

D) Chronic alcoholism.

E) Vitamin B12 deficiency.

Q8. A 9 year-old-boy has less than 1% factor VIII activity measured in plasma. If he is not given transfusions of factor VIII concentrate, which of the following manifestations of this deficiency is most likely to occur?

A) Hemolysis.

B) Splenomegaly.

C) Conjunctival petechiae.

D) Hemochromatosis.

E) Hemarthroses.

Q9. A 20 year old female present with fever of two weeks duration. A CBC shows a Hb concentration 14g/dL, hematocrit of 42.0%,MCV of 89fL,platelet differential count shows 60 segmented neutrophils,16 band cells, 6 metamyelocytes, 1blast,8 lymphocytes, 2 monocytes, and 2 eosinophils per100 WBCs. The pheripheral blood leukocyte alkaline phosphatase score is increased. The most likely diagnosis is:

A) Chronic myeloid leukemia (CML).

B) Hairy cell leukemia.

C) Hodgkin disease, lymphocyte depletion type.

D) Leukemoid reaction.

E) Acute lymphoblastic leukemia (ALL).

Q10. A new born baby is suspected to be suffering from neonatal sepsis. Which of the following abnormality in peripheral blood picture is most helpful in reaching the diagnosis?

A) Microcytosis.

B) Reticulocytoses.

C) Thrombocytosis.

D) High percentage of band cells.

E) Hypochromia.

RESPIRATORY SYSTEM:

Q11. The most common source of pulmonary thrombo-embolism is:

A) Femoral vein

B) Popliteal vein

C) Deep veins of calf

D) Sephaneous vein

E) Anti cubital veins

Q12. Over several decades which of the following inhaled pollutants is most likely to produce extensive pulmonary fibrosis?

A) Silica

B) Tobacco smoke

C) Wood dust

D) Carbon monoxide

E) Ozone

Q13. An 18year old female student before entry into a medical college had to undergo medial tests. She developed a 10mm area of induration on her forearm 3 days after intracutaneous injection of 0.1 ml of purified protein derivative (PPD). She appeared healthy. A chest radiograph would most likely demonstrate:

A) Marked hilar lymphadenopathy

B) Upper lobe calcification

C) Extenive opacification

D) Cavitary change

E) No abnormal findings

Q14. An 85 years old female had left eye problems including enophthalmos, meiosis, anhidrosis and ptosis. A chest X-Ray showed right upper lobe opacification. Which of the following conditions she is most likely to have?

A) Bronchopneumomia

B) bronchiectasis

C) Bronchogenic carcinoma

D) Sarcoidosis

E) Tuberculosis

Q15. A 35 year old male has flushing and diarrhoeal episodes. Bronchoscopsy reveals an obstructing mass filling the bronchus to the right upper lobe. Biopsy showed neuroendocarine nature of the tumor cells on immunostaining. The diagnosis is:

A) Hamartoma

B) Adenocarcinoma

C) Large cell carcinoma

D) Kaposi sarcoma

E) Carcinoid tumor

GASTROINTESTINAL TRACT:

Q16. A 39 year old male presented with on and off epigastric pain, provisional diagnosis of peptic ulcer disease was made. For confirmation of diagnosis on edoscopy, from where one should take the biopsy?

A) Gastric antrum

B) Gastric ulcer

C) Gastroesophageal junction

D) Duodenal ulcer

E) Greater curvature

Q17. The most frequent esophageal malignancy is:

A) Adenocarcinoma

B) Fibrosarcoma

C) Leimyosarcoma

D) Rhabdomyosarcoma

E) Squamous Cell Carcinoma

Q18. A 68 year old female has suffered from burning substernal pain for many years. This pain occurs after meal. She now has dysphagia. Endoscopy reveals a lower esophageal mass that nearly occludes the esophageal lumen. Biopsy of the mass is most likely to reveal which of the following neoplasm?

A) Adenocarcinoma.

B) Leiomyosarcoma.

C) Squamous cell carcinoma.

D) Non-Hodgkins lymphoma

E) Carcinoid tumor.

Q19. A 73 year old female has iron deficiency anemia. She has no vaginal bleeding, hematemesis, hemoptysis or melana.. However a stool Guaiac test result is positive. A colonoscopy reveals an obstructive lesion that is most likely to be a:

A) Malignant Lymphoma.

B) Adenocarcinoma.

C) Leiomyosarcoma.

D) Tubular adenoma.

E) Carciniod tumor.

Q20. A 59-Years old male presents with 2 month history of intermittent burning substernal and retrosternal pain radiating to his neck. The burning is usually relieved quickly with antacids. There is no relationship of these symptoms to exercise or exertion. Which of the following must be considered in the differential diagnosis of this patient’s problem?

A) Acid reflux disease.

B) Myocardial ischemia.

C) Peptic ulcer disease.

D) Panic disorder.

E) Carcinoma stomach.

Q21. A 10 year old boy comes to emergency with H/O nausea, vomiting, right iliac fossa pain and mild fever. On physical examination there is tenderness in paraumblical region and right iliac fossa. The provisional diagnosis is:

A) Intestinal obstruction.

B) Acute appendicitis.

C) Acute pancreatitis.

D) Acute peptic ulcer disease.

E) Ischemia Bowel Disease.

Q22. Which salivary gland is the most frequent site for tumor involvement?

A) Parotid gland.

B) Sub maxillary gland

C) Sublingual gland

D) Minor salivary gland

E) Parathyroid gland.

Q23. A 60-year-old man with H/O cigarette smoking and alcohol abuse develops a protruding centrally ulcerated mass in the oral cavity. The lesion is suspected to be carcinoma. Which of the following locations is most commonly the primary site of oral squamous cell carcinoma?

A) Base of the tongue.

B) Buccal mucosa

C) Floor of mouth

D) Palate

E) Tip of the tongue

Q24. A 40 year old man has severe abdominal pain for 03 days. Physical examination reveals board like rigidity of abdominal muscles. His pancreas shows chalky white fat necrosis. What is the most likely predisposing factor in the development of this disorder?

A) Cytomegalovirus (CMV) infection.

B) Hyperlipidemia.

C) Ischemia.

D) Peptic ulcer disease.

E) Chronic alcoholism.

HEPATOBILIARY SYSTEM:

Q25. Chronic Hepatitis is most likely to occur after acute infection with which of the following virus?

A) Hepatitis A virus

B) Hepatitis C virus

C) Hepatitis E virus

D) Hepatitis G virus

E) Hepatitis D virus

Q26. Three weeks after a meal at road site restaurant a 20 years old male presents with loss of appetite, malaise, fatigue and mild yellowness of sclera. Which of the following laboratory test findings is he most likely to have?

A) Hepatitis A IgM antibody

B) Hepatitis D IgM antibody

C) Hepatitis C antibody

D) Hepatitis B core antibody

E) Hepatitis B surface antigen

Q27. A 45 year female presents with ascites. Liver biopsy reveals diffuse portal tract bridging fibrosis and nodular regeneration of liver cells without hepatocyte necrosis and cholestasis. The findings are characteristic for:

A) Alcoholic hepatitis

B) Viral hepatitis

C) Drug toxicity

D) Cirrhosis

E) Chronic congestion

Q28. At autopsy, the liver of a 40 years old male shows irregular nodular mass. On cut surface the lesion is grey white with extensive fibrotic bands. What is the most likely diagnosis?

A) Hepatocellular carcinoma

B) Hepatitis

C) Cirrhosis

D) Primary Sclerosing Cholangitis

E) Hematochromatosis

Q29. A 25 years old male notices mild degree of scleral yellowness after her examination. Her liver function profile shows total bilirubin 4.9 mg/dl and direct bilirubin 0.8 mg/dl. Her other liver function tests are unremarkable. The condition is most likely to be:

A) Choledochal cyst

B) Primary biliary cirrhosis

C) Gilbert’s syndrome

D) Dubin-Johnson syndrome

E) Hepatitis C

URINARY SYSTEM:

Q30. Which of the following is most likely cause of the clinical combination of generalized edema, hypoalbuminemia and hypercholesterolemia in an adult whose urinalysis demonstrated marked proteinuria with fatty casts and oval fat bodies?

A) Nephritic syndrome

B) Nephrotic syndrome

C) Acute renal failure

D) Renal tubular acidosis

E) Urinary tract infection

Q31. After an acute myocardial infarction, a 50 years old male is in stable condition. However 2 days later, his urine output drops and his serum urea nitrogen increases to 33mg/dl. This oliguria persists for a few days and is followed by polyuria for 2 more days. His is then discharged from the hospital. What lesion best explains his renal abnormalities?

A) Acute tubular necrosis

B) Benign nephrosclerosis.

C) Acute renal infarction.

D) Hemolytic uremic syndrome.

E) Rapidly progressive glomerulonephritis.

Q32. A 28 years old female presents with a 2 days history of dysuria with frequency and urgency. A urine culture grows more than 100.000 colonies/ml of E.Coli. She is treated with antibiotic therapy. However, if she continues to suffer recurrences of this problem she is at great risk for development of:

A) Diffuse glomerulosclerosis.

B) Chronic glomerulonephritis.

C) Amyloidosis.

D) Membranous glomerulonephritis.

E) Chronic pyelonephritis

Q33. A 60 year old male presents with painless haematuria. On physical there is no significant finding. IVP shows a filling defect in the urinary bladder. What is the most likely diagnosis?

A) Stone in urinary bladder.

B) Schistosomiasis

C) Acute hemolysis.

D) Stone in urethra

E) Bladder carcinoma.

Q34. A 24 year old male is suffering from painless haematuria. What is the most probable diagnosis?

A) Stone in renal pelvis.

B) Stone in ureter.

C) Renal cell carcinoma

D) Acute glomerulonephritis.

E) Chronic pyelonephritis.

MALE GENITAL SYSTEM:

Q35. CA prostate most commonly involves:

A) Transitional zone of prostate.

B) Outer (Peripheral) zone of prostate.

C) Central zone of prostate.

D) Periurethral zone of prostate.

E) Capsule of the prostate.

Q36. The right testis of a 33 years old male is enlarged to twice normal size. The testis is removed, and the epididymis and the upper aspect of the right testis are involved with extensive granulomatous inflammation with epithelioid cells, Langhans giant cells, and caseous necrosis. The most common cause for these findings is:

A) Mumps

B) Syphilis

C) Tuberculosis

D) Gonorrhea

E) Sarcoidosis

Q37. Which of the following tumor marker is routinely performed in patients suspected of having carcinoma prostate?

A) PAP

B) AFP

C) PSA

D) CEA

E) CA-19-9

Q38. Which of the following tumor is most radiosensitive?

A) Breast carcinoma.

B) Prostate carcinoma.

C) Astrocytoma.

D) Colorectal adenocarcinoma.

E) Seminoma

Q39. Histology of a testicular tumor in a 24 year old man revealed syncitial sheet of polymorphic cells with vesicular nuclei, prominent nucleoli and prominent lymphocytic infiltrate in the stroma. The most likely diagnosis is:

A) Yolk sac tumor.

B) Seminoma

C) Teratoma.

D) Choriocarcinoma.

E) Embryonal carcinoma.

FEMALE GENITAL SYSTEM:

Q40. 54 year old woman with an abdominal mass undergoes exploration laparoscopy. Both ovaries are enlarged and hence resected. Pathology report is Krukenberg tumor, indicating which of the following:

A) Ectopic pregnancy.

B) Endometriosis.

C) Hyperestrogenic state.

D) Immunosuppression.

E) Metastatic carcinoma

Q41. You obtain a routine Pap smear while performing a physical examination on a 28-year old female. Gross inspection of the vulva, vagina, and cervix reveals no apparent lesions. The results of the Pap smear are consistent with cervical intraepithelial neoplasia (CIN) II. What is the major significance of this finding?

A) A cervicitis needs to be treated.

B) She has an increased risk for cervical carcinoma

C) Condyloma acuminata are probably present.

D) An endocervical polyp needs to be excised.

E) She needs to discontinue oral contraceptives.

Q42. A 58-year old female has had dull pain in the lower abdomen for the past 6 months, along with some minimal vaginal bleeding on three occasions. An abdominal ultrasound reveals a solid, 8-cm right adnexal mass. A total abdominal hysterectomy is performed, and the mass is diagnosed as an ovarian granulose-theca cell tumour. Which of the following additional lesions is most likely to be seen in the surgical specimen?

A) Condyloma acuminata of the cervix

B) Endometrial hyperplasia

C) Metastases to the uterine serosa

D) Bilateral chronic salpingitis

E) Partial mole of the uterus

Q43. A 20-year old female has had a bloody, brownish vaginal discharge for the past day. She now presents with shortness of breath. A chest radiograph demonstrates numerous 2- to 5- cm. nodules in both lungs. A red brown 3 cm mass is seen on the lateral wall of the vagina, and a biopsy of this mass reveals malignant cells resembling syncytiotrophoblasts. Serum level of which the following proteins, is likely to be elevated in this patient?

A) Human chorionic gonadotrophin

B) Alpha-fetoprotein

C) Estrogen

D) Androgen

E) Thyroxin

Q44. The malignant surface epithelial tumours of ovary include:

A) Mucinous cysadenoma

B) Stromal tumour

C) Sarcomatoid tumour of Ovary

D) Squamous cell carcinoma

E) Leiomyoma

DISEASE OF BREAST:

Q45. A 52 year old female presented with a lump in her breast . Biopsy of the lump showed invasive ductal carcinoma. The connective tissue adjacent to the tumour was densly collagenous. This is an example of:

A) Anaplasia

B) Dysplasia

C) Desmoplasia

D) Carcinoma

E) Metaplasia

Q46. A 20 years old female presents with lump in her right breast which is freely mobile and nontender. What is the most likely diagnosis?

A) Invasive ductal carcinoma

B) Fibroadenoma

C) Intaductal pappiloma

D) Fibrocystic disease

E) Abscess

Q47. Which of the following risk factors play the most important role in the development of male breast carcinoma?

A) Obesity

B) Age older than 70 years

C) Long term digoxin therapy

D) Klinefelter syndrome

E) Chronic alcoholism

Q48. A microbiology laboratory reports growth of staphylococcus aureus from pus drained from a breast abscess. What is the most likely predisposing condition for the development of a breast abscess?

A) Breast feeding

B) Endocarditis.

C) Inflammatory breast carcinoma.

D) Menopause.

E) Paget’s disease of breast.

Q49. Of the histological subtypes of breast carcinoma, which metastasizes most frequently to peritoneum, reteroperitoneum and leptomeninges?

A) Invasive ductal carcinoma

B) Lobular carcinoma

C) Mucinous carcinoma

D) Medullary carcinoma

E) Metaplastic carcinoma

ENDOCRINOLOGY:

Q50. A 2-year old child has had failure to thrive. The child is short, with coarse fascial features, a protruding tongue, and an umbilical hernia. Profound mental retardation is apparent as the child matures. These findings are best explained by a lack of:

A) Cortisol

B) Norepinephrine

C) Somatostatin

D) Thyroxine (T4)

E) Insulin

Q51. A 0.7-cm microadenoma of the adenohypophysis is seen by head MRI in a 25-year- old female. Which of the following complications is she most likely to have?

A) Amenorrhea with galactorrhea

B) Hyperthyroidism

C) Acromegaly

D) Cushing disease

E) Syndrome of inappropriate antidiuretic hormone (SIADH)

Q52. A 60-year-old woman has been feeling tired and sluggish for more than a year. Thyroid gland is not palpable. Serum T4 level is decreased but TSH is markedly increased. Which of the following factors is important in the pathogenesis of this condition?

A) Irradiation to neck during childhood.

B) Prolonged iodine deficiency

C) Anti-microsomal and anti-thyroglobulin antibodies

D) Mutations in the RET protooncogene

E) Recent viral upper respiratory tract infection.

Q53. A 59 year old woman with advanced metastatic lung cancer develops profound fatigue, weakness and alterning diarrhea and constipation. Physical examination demonstrates hyperpigmentation of skin even in areas protected from the sun. Tumor involvement of which endocrine organ is most strongly suggested by this patient’s presentation?

A) Adrenal gland.

B) Endocrine pancreas.

C) Ovaries.

D) Pituitary glands.

E) Thyroid gland.

Q54. During physical examination a 45 years old man is noted to have a 3 cm palpable nodule in one lobe of an otherwise normal size thyroid gland. Needle aspiration of the nodule demonstrates polygonal tumor cells and amyloid, but only very scanty colloid and normal follicular cells. Which of the following is the most likely diagnosis?

A) Follicular thyroid carcinoma.

B) Hashimotos disease.

C) Medullary thyroid carcinoma.

D) Papillary thyroid carcinoma.

E) Thyroid adenoma.

MUSCULOSKELETAL SYSTEM AND BONES AND JOINTS:

Q55. Most common pathogen responsible for acute osteomyelitis in a two year old child is:

A) Streptococcus pneumoniae.

B) Escherichia Coli

C) Candida albicans

D) Haemophilis influenzae

E) Salmonella typhi.

Q56. Most common malignant tumor seen in bone is:

A) Osteosarcoma

B) Chondrosarcoma

C) Secondaries(mets)

D) Lymphoma

E) Enchondromas

Q57. Histopathological features of Duchenne type muscular dystrophy include all of the following EXCEPT:

A) degeneration of muscle fibers

B) Infiltration of macrophages

C) Fibrosis

D) Granulation tissue

E) Regeneration of unaffected muscle fibers.

Q58. Reiter’s syndrome is not associated with:

A) Arthritis.

B) Urethritis.

C) Positivity for HLA-DRB1

D) History of some enteric infection

E) Positivity for HLA-B27

Q59. Main causes of peripheral neuropathies are:

A) Excessive physical work.

B) Deficiency of Vitamin D

C) Chondropplasia.

D) Hypertension

E) Diabetes mellitus

CENTRAL NERVOUS SYSTEM:

Q60. Which of the following is not a tumor of central nervous system?

A) Astrocytoma.

B) Oligodendroglioma.

C) Meningioma.

D) Ependymoma.

E) Retinoblastoma.

Q61. Which of the following CNS tumor has the best prognosis?

A) Anaplastic astrcytoma (WHO grade III)

B) Glioblastoma multiforme.

C) Pilocytic astrocytoma (WHO grade I)

D) Medulloblastoma.

E) Oligodendroglioma (WHO grade II)

CLINICAL CHEMISTRY:

Q62. A 60 year old male presents with acute retrosternal chest pain to emergency department. Lab investigations show total CK 360U/L (NV: upto 195U/L), CK MB 32 U/L (NV: upto 25U/L), SGOT 54U/L (NV: 5-40U/L), LDH 418U/L (NV: 230-460U/L). ECG was consistant with Acute Myocardial Infarction. What is the possible duration of his present attack?

A) 30 minutes

B) 2 hours

C) 12 hours

D) 36 hours

E) 5 days

Q63. A 15-year-old boy is brought to the emergency in coma. The doctor on duty notes that the patient’s breath smells like acetone. This would be most consistent with which of the following?

A) Alcohol intoxication.

B) Diabetic hyperosmolar coma.

C) Diabetic ketoacidosis

D) Heroin overdosage.

E) Profound hypoglycemia.

Q64. A 10-year-old boy sustains 25% burns over his body. Next day his serum urea nitrogen (BUN) is 30mg/dl and serum Creatinine is 0.8 mg/dl. I/V fluids are given continuously and there is no drop in blood pressure or urinary output. Which of the following most likely accounts for the BUN and Creatinine values:

A) Decreased renal perfusion.

B) Distal urinary tract obstruction.

C) Increased synthesis of urea

D) Renal glomerular disease.

MBBS III PROFESSIONAL -- SPECIAL PATHOLOGY MCQs SEND UP

2011 DEPARTMENT OF PATHOLOGY, RMC

TOTAL MARKS: 65

TIME ALLOWED: 65 minutes.

Attempt all questions. All questions carry equal Marks. Mark ONE BEST option for each question.

CARDIOVASCULAR SYSTEM:

Q1. The most common cause of death immediately following the onset of acute myocardial infarction is:

A) Arrhythmia

B) Left ventricular rupture

C) Congestive heart failure

D) Shock

E) Pulmonary edema

Q2. Which of the two valves listed below is least commonly associated with rheumatic heart disease?

A) Aortic and pulmonary

B) Mitral and tricuspid

C) Aortic and mitral

D) Pulmonary and tricuspid

E) Aortic and tricuspid

Q3. Nonbacterial thrombotic endocarditis is most frequently associated with which of the following conditions?

A) Terminal neoplastic disease

B) Systemic Lupus erythematosus (SLE)

C) Old rheumatic endocarditis

D) Sub diaphragmatic abscess

E) Congenital Heart disease.

Q4. The most frequent cause of corpumonale with right-sided heart failure is:

A) Constrictive pericarditis

B) Disease of the lungs or pulmonary vessel

C) Left-sided heart failure

D) Pulmonary infundibular or valvular stenosis

E) Systemic Hypertension

Q5. Which of the following is not associated with Dissecting aortic aneurysm?

A) Death from hemopericardium

B) Degenerative changes of aortic media.

C) Hypertension.

D) Severe, tearing chest pain.

E) Severe atherosclerosis.

A) Glucose-6-phosphate dehydrogenase.

B) A membrane cytoskeletal protein.

C) Α-globin chain

D) Heme

E) Β-globin chain

A) Iron deficiency.

B) Autoimmune hemolytic anemia.

C) Β-thalassemia major.

D) Chronic alcoholism.

E) Vitamin B12 deficiency.

A) Hemolysis.

B) Splenomegaly.

C) Conjunctival petechiae.

D) Hemochromatosis.

E) Hemarthroses.

A) Chronic myeloid leukemia (CML).

B) Hairy cell leukemia.

C) Hodgkin disease, lymphocyte depletion type.

D) Leukemoid reaction.

E) Acute lymphoblastic leukemia (ALL).

Q10. A new born baby is suspected to be suffering from neonatal sepsis. Which of the following abnormality in peripheral blood picture is most helpful in reaching the diagnosis?

A) Microcytosis.

B) Reticulocytoses.

C) Thrombocytosis.

D) High percentage of band cells.

E) Hypochromia.

RESPIRATORY SYSTEM:

Q11. The most common source of pulmonary thrombo-embolism is:

A) Femoral vein

B) Popliteal vein

C) Deep veins of calf

D) Sephaneous vein

E) Anti cubital veins

Q12. Over several decades which of the following inhaled pollutants is most likely to produce extensive pulmonary fibrosis?

A) Silica

B) Tobacco smoke

C) Wood dust

D) Carbon monoxide

E) Ozone

A) Marked hilar lymphadenopathy

B) Upper lobe calcification

C) Extenive opacification

D) Cavitary change

E) No abnormal findings

A) Bronchopneumomia

B) bronchiectasis

C) Bronchogenic carcinoma

D) Sarcoidosis

E) Tuberculosis

A) Hamartoma

B) Adenocarcinoma

C) Large cell carcinoma

D) Kaposi sarcoma

E) Carcinoid tumor

GASTROINTESTINAL TRACT:

A) Gastric antrum

B) Gastric ulcer

C) Gastroesophageal junction

D) Duodenal ulcer

E) Greater curvature

Q17. The most frequent esophageal malignancy is:

A) Adenocarcinoma

B) Fibrosarcoma

C) Leimyosarcoma

D) Rhabdomyosarcoma

E) Squamous Cell Carcinoma

A) Adenocarcinoma.

B) Leiomyosarcoma.

C) Squamous cell carcinoma.

D) Non-Hodgkins lymphoma

E) Carcinoid tumor.

A) Malignant Lymphoma.

B) Adenocarcinoma.

C) Leiomyosarcoma.

D) Tubular adenoma.

E) Carciniod tumor.

A) Acid reflux disease.

B) Myocardial ischemia.

C) Peptic ulcer disease.

D) Panic disorder.

E) Carcinoma stomach.

A) Intestinal obstruction.

B) Acute appendicitis.

C) Acute pancreatitis.

D) Acute peptic ulcer disease.

E) Ischemia Bowel Disease.

Q22. Which salivary gland is the most frequent site for tumor involvement?

A) Parotid gland.

B) Sub maxillary gland

C) Sublingual gland

D) Minor salivary gland

E) Parathyroid gland.

A) Base of the tongue.

B) Buccal mucosa

C) Floor of mouth

D) Palate

E) Tip of the tongue

A) Cytomegalovirus (CMV) infection.

B) Hyperlipidemia.

C) Ischemia.

D) Peptic ulcer disease.

E) Chronic alcoholism.

HEPATOBILIARY SYSTEM:

Q25. Chronic Hepatitis is most likely to occur after acute infection with which of the following virus?

A) Hepatitis A virus

B) Hepatitis C virus

C) Hepatitis E virus

D) Hepatitis G virus

E) Hepatitis D virus

A) Hepatitis A IgM antibody

B) Hepatitis D IgM antibody

C) Hepatitis C antibody

D) Hepatitis B core antibody

E) Hepatitis B surface antigen

A) Alcoholic hepatitis

B) Viral hepatitis

C) Drug toxicity

D) Cirrhosis

E) Chronic congestion

Q28. At autopsy, the liver of a 40 years old male shows irregular nodular mass. On cut surface the lesion is grey white with extensive fibrotic bands. What is the most likely diagnosis?

A) Hepatocellular carcinoma

B) Hepatitis

C) Cirrhosis

D) Primary Sclerosing Cholangitis

E) Hematochromatosis

A) Choledochal cyst

B) Primary biliary cirrhosis

C) Gilbert’s syndrome

D) Dubin-Johnson syndrome

E) Hepatitis C

URINARY SYSTEM:

A) Nephritic syndrome

B) Nephrotic syndrome

C) Acute renal failure

D) Renal tubular acidosis

E) Urinary tract infection

A) Acute tubular necrosis

B) Benign nephrosclerosis.

C) Acute renal infarction.

D) Hemolytic uremic syndrome.

E) Rapidly progressive glomerulonephritis.

A) Diffuse glomerulosclerosis.

B) Chronic glomerulonephritis.

C) Amyloidosis.

D) Membranous glomerulonephritis.

E) Chronic pyelonephritis

Q33. A 60 year old male presents with painless haematuria. On physical there is no significant finding. IVP shows a filling defect in the urinary bladder. What is the most likely diagnosis?

A) Stone in urinary bladder.

B) Schistosomiasis

C) Acute hemolysis.

D) Stone in urethra

E) Bladder carcinoma.

Q34. A 24 year old male is suffering from painless haematuria. What is the most probable diagnosis?

A) Stone in renal pelvis.

B) Stone in ureter.

C) Renal cell carcinoma

D) Acute glomerulonephritis.

E) Chronic pyelonephritis.

MALE GENITAL SYSTEM:

Q35. CA prostate most commonly involves:

A) Transitional zone of prostate.

B) Outer (Peripheral) zone of prostate.

C) Central zone of prostate.

D) Periurethral zone of prostate.

E) Capsule of the prostate.

A) Mumps

B) Syphilis

C) Tuberculosis

D) Gonorrhea

E) Sarcoidosis

Q37. Which of the following tumor marker is routinely performed in patients suspected of having carcinoma prostate?

A) PAP

B) AFP

C) PSA

D) CEA

E) CA-19-9

Q38. Which of the following tumor is most radiosensitive?

A) Breast carcinoma.

B) Prostate carcinoma.

C) Astrocytoma.

D) Colorectal adenocarcinoma.

E) Seminoma

A) Yolk sac tumor.

B) Seminoma

C) Teratoma.

D) Choriocarcinoma.

E) Embryonal carcinoma.

FEMALE GENITAL SYSTEM:

Q40. 54 year old woman with an abdominal mass undergoes exploration laparoscopy. Both ovaries are enlarged and hence resected. Pathology report is Krukenberg tumor, indicating which of the following:

A) Ectopic pregnancy.

B) Endometriosis.

C) Hyperestrogenic state.

D) Immunosuppression.

E) Metastatic carcinoma

A) A cervicitis needs to be treated.

B) She has an increased risk for cervical carcinoma

C) Condyloma acuminata are probably present.

D) An endocervical polyp needs to be excised.

E) She needs to discontinue oral contraceptives.

A) Condyloma acuminata of the cervix

B) Endometrial hyperplasia

C) Metastases to the uterine serosa

D) Bilateral chronic salpingitis

E) Partial mole of the uterus

A) Human chorionic gonadotrophin

B) Alpha-fetoprotein

C) Estrogen

D) Androgen

E) Thyroxin

Q44. The malignant surface epithelial tumours of ovary include:

A) Mucinous cysadenoma

B) Stromal tumour

C) Sarcomatoid tumour of Ovary

D) Squamous cell carcinoma

E) Leiomyoma

DISEASE OF BREAST:

A) Anaplasia

B) Dysplasia

C) Desmoplasia

D) Carcinoma

E) Metaplasia

Q46. A 20 years old female presents with lump in her right breast which is freely mobile and nontender. What is the most likely diagnosis?

A) Invasive ductal carcinoma

B) Fibroadenoma

C) Intaductal pappiloma

D) Fibrocystic disease

E) Abscess

Q47. Which of the following risk factors play the most important role in the development of male breast carcinoma?

A) Obesity

B) Age older than 70 years

C) Long term digoxin therapy

D) Klinefelter syndrome

E) Chronic alcoholism

Q48. A microbiology laboratory reports growth of staphylococcus aureus from pus drained from a breast abscess. What is the most likely predisposing condition for the development of a breast abscess?

A) Breast feeding

B) Endocarditis.

C) Inflammatory breast carcinoma.

D) Menopause.

E) Paget’s disease of breast.

Q49. Of the histological subtypes of breast carcinoma, which metastasizes most frequently to peritoneum, reteroperitoneum and leptomeninges?

A) Invasive ductal carcinoma

B) Lobular carcinoma

C) Mucinous carcinoma

D) Medullary carcinoma

E) Metaplastic carcinoma

ENDOCRINOLOGY:

A) Cortisol

B) Norepinephrine

C) Somatostatin

D) Thyroxine (T4)

E) Insulin

Q51. A 0.7-cm microadenoma of the adenohypophysis is seen by head MRI in a 25-year- old female. Which of the following complications is she most likely to have?

A) Amenorrhea with galactorrhea

B) Hyperthyroidism

C) Acromegaly

D) Cushing disease

E) Syndrome of inappropriate antidiuretic hormone (SIADH)

A) Irradiation to neck during childhood.

B) Prolonged iodine deficiency

C) Anti-microsomal and anti-thyroglobulin antibodies

D) Mutations in the RET protooncogene

E) Recent viral upper respiratory tract infection.

A) Adrenal gland.

B) Endocrine pancreas.

C) Ovaries.

D) Pituitary glands.

E) Thyroid gland.

A) Follicular thyroid carcinoma.

B) Hashimotos disease.

C) Medullary thyroid carcinoma.

D) Papillary thyroid carcinoma.

E) Thyroid adenoma.

MUSCULOSKELETAL SYSTEM AND BONES AND JOINTS:

Q55. Most common pathogen responsible for acute osteomyelitis in a two year old child is:

A) Streptococcus pneumoniae.

B) Escherichia Coli

C) Candida albicans

D) Haemophilis influenzae

E) Salmonella typhi.

Q56. Most common malignant tumor seen in bone is:

A) Osteosarcoma

B) Chondrosarcoma

C) Secondaries(mets)

D) Lymphoma

E) Enchondromas

Q57. Histopathological features of Duchenne type muscular dystrophy include all of the following EXCEPT:

A) degeneration of muscle fibers

B) Infiltration of macrophages

C) Fibrosis

D) Granulation tissue

E) Regeneration of unaffected muscle fibers.

Q58. Reiter’s syndrome is not associated with:

A) Arthritis.

B) Urethritis.

C) Positivity for HLA-DRB1

D) History of some enteric infection

E) Positivity for HLA-B27

Q59. Main causes of peripheral neuropathies are:

A) Excessive physical work.

B) Deficiency of Vitamin D

C) Chondropplasia.

D) Hypertension

E) Diabetes mellitus

CENTRAL NERVOUS SYSTEM:

Q60. Which of the following is not a tumor of central nervous system?

A) Astrocytoma.

B) Oligodendroglioma.

C) Meningioma.

D) Ependymoma.

E) Retinoblastoma.

Q61. Which of the following CNS tumor has the best prognosis?

A) Anaplastic astrcytoma (WHO grade III)

B) Glioblastoma multiforme.

C) Pilocytic astrocytoma (WHO grade I)

D) Medulloblastoma.

E) Oligodendroglioma (WHO grade II)

CLINICAL CHEMISTRY:

Special Patho-CVS Class test RMC 2011

2012-09-11T09:55:00.001-07:00

DEPARTMENT OF PATHOLOGY

RAWALPINDI MEDICAL COLLEGE RAWALPINDI 4^th year 2nd term test (23/5/2011)

SEQ`s Paper Time allowed: 50 minutes Total Marks: 50

  INSTRUCTIONS: 1.As usual.  Any questions?  Ask quietly.

  2.Attempt all questions. Mark the appropriate square on the response sheet 3. Be precise and answer in one word preferably what has been asked.

Be sure you hand in your answer and response sheets with your names and roll numbers. Failure to return both will result in a grade of zero. There are 10 SEQ`s and 25 MCQ`s. questions in total.

Q. No 1: A young 38 year old man presents in the emergency with history of paroxysmal recurrent sub sternal chest discomfort.

a. Enlist the types of Angina. 1.5

b. What is the mechanism underlying unstable angina? 3.

Q. N0 2: A young patient from Rawalpindi lands

in the emergency with chest pain, the patient

could not be managed properly due to deteriorating health care delivery system, and died..

a. Enumerate the specific biomarkers used for the diagnosis of myocardial infarction? 4

b. Which is the most useful and why? 1

Q. No 3. 12 year old boy develops migratory arthritis after an episode of Phryrangitis weeks earlier. He is having fever with tachycardia.

b. What is the most probable diagnosis? 1

b. Write the Jones diagnostic criteria for this condition. 4

Q. No 4: Tabulate the differences between acute and subacute infective endocarditis. 5

Q. No 5:a. Enumerate the complications of myocardial infarction. 2.5

b. Enlist the causes of Left sided heart failure. 2.5

Q. No 6. A fifty year old diagnosed patient of HIV develops red purple lesions on the skin of his feet. On investigation the lesions are found to be vascular tumor .

a. What is the diagnosis? 1.5

b. Name four different type of this tumor 2

3. Name the three different morphological appearances of the disease. 1.5

Q. No 7. A thirty year old women gas had coldness and numbness in her arms and decreased vision in her Eye for the past five months. On examination radial pulses are not palpable. Femoral pulses are strong with decreased sensation and cyanosis in her arms with no warmth or swelling.

a. Name the probable diagnosis? 0.5

b. List three morphological changes seen in this condition. 1.5

c. Enlist three major groups of vasculitis and give two examples of each 3

Q, No 8. . A woman brings her 2 yr child with a soft bluish swelling on her face, which was present at birth. She also told that it is expanding for last 2 year. Diagnosis of capillary hemangioma was made.

a. Give gross and microscopic picture of this condition? 2

b. Give classification of vascular tumors? 3

Q. No. 9 A 58-year-old male Principal of a Medical College reports having repeated and progressively prolonged and severe episodes of pericardial chest pain over the last 6 months. The episodes have become more frequent over the past 2 months and occur on minimal physical exertion. Angiography shows 50% stenosis of left anterior descending artery (LAD).

a. Given that this degree of stenosis in itself does not precipitate an acute myocardial event, what changes in the atherosclerotic plaque must have precipitated these attacks in this patient?

What do you understand by ‘vulnerable plaques’? (4+1)

Q. No 10 A 58-year old bureaucrat is diagnosed with acute myocardial infarction after he collapsed on his office desk. He is a known hypertensive and smokes 10 to 12 cigarettes per day and drinks socially. Serum cholesterol level is elevated and he confesses being fond of desserts and Gulab jamans. His BMI and waist circumference are increased for his height. His father died of myocardial infarction, and his mother has stable angina.

a. Enumerate the identified the major risk factors for atherosclerosis in this patient and categorize them as constitutive (non modifiable) and potentially controllable.

b. Also list the minor risk factors for atherosclerosis in this patient. (3+2)

The first person finishing gets bonus 5 marks if claimed. Also write your challenges on it.  You are also allowed to follow the standard procedure (see us for a challenge form) -- but why wait? If u have time jot down.

 This exam is not intended to be especially difficult.  Be prepared for somewhat more challenging exams in the future           GOOD LUCK!

Paper setters: Prof. Abbas Hayat Dr. Atifa Dr. Homera Niazi Dr. Aiman.Aijaz Dr. Fareeha Dr.Saad Amjad Dr. Azer Majeed Dr. Fahim Dr.M. Fateen Rashed

DEPARTMENT OF PATHOLOGY

RAWALPINDI MEDICAL COLLEGE RAWALPINDI 2^nd term test 3^rd Prof. 2011

MCQ`s Paper Time allowed: 25 minutes Total Marks: 2 x25= 50

  INSTRUCTIONS:

 1. As usual.  Any questions?  Ask quietly.

 2.Attempt all questions. Mark the appropriate square on the response sheet

1. Pressure overload is not associated with:

a. Ventricular hypertrophy

b. Concentric hypertrophy

c. Hypertension

d. Aortic stenosis

e. Aortic regurgitation

2. Which of the following is not a feature of Fallot’s tetrology?

a. Aortic stenosis

b. Pulmonary stenosis

c. Ventricular septal defect

d. Overriding of aorta

e. Right ventricular hypertrophy

3. An I/V drug abuser complains of high grade fever with shortness of breath and tachycardia. His blood CP shows leucocytosis and raised ESR.. What is the likely diagnosis?

a. Acute thrombophlebitis

b. Acute infective endocarditis

c. Acute urinary tract infection

d. Acute chest infection

e. Pyrexia of unknown origin

4. What is the likely causative organism for the above answer..

a. Streptococcus Viridans

b. B hemolytic streptococcus

c. Staphylococcus aureus

d. CMV

e. Salmonella

5. The earliest biochemical change developing after myocardial ischemia is:

a. ATP depletion to 10% of normal

b. Cessation of aerobic metabolism with onset of ATP depletion

c. ATP depletion to 50% normal

d. Loss of contractility

e. Irreversible cell injury

6. Irreversible cell injury develops in ischemic heart disease after:

a. 10 – 15 min

b. 20 – 30 min

c. One hour

d. 12 hours

e. One day

7. Granulation tissue begins to appear at the site of myocardial infarction on:

a. 1^st day

b. 3^rd day

c. 5^th day

d. 7^th day

e. 2 weeks

8. Myocardial infarction becomes grossly visible after:

a. 2 hours of ischemia

b. 12 hours of ischemia

c. 24 hours of ischemia

d. 48 hours of ischemia

e. 3 days of ischemia

9. A young boy is diagnosed to be suffering from acute Rheumatic fever. His heart will show all the following morphological changes except one, which?

a. Pancarditis

b. Aschoff bodies

c. Vegetations on mitral valve

d. Ring abscesses in myocardium

e. Mitral stenosis

10. A patient underwent cardiac valve replacement 6 months back. Now he develops PUO and is suspected to be suffering from infective endocarditis. Which organism is the most likely cause for his infection.

a. Staph Aureus

b. Streptococcus viridans

c. Hemolytic streptococcus

d. HACEK group of viruses

e. Staph epidermidis

11. Hypertrophy of heart seen in CCF is associated with:

a. Increased protein synthesis

b. Myocyte proliferation

c. Induction of fetal gene program

d. Abnormal proteins

e. Inadequate vasculature

12. Pulmonary congestion seen in left sided heart failure is not associated with:

a. Pulmonary edema

b. Widening of alveolar septa

c. Heart failure cells

d. Accumulation of edema fluid in alveoli

e. Shrunken collapsed lungs

13. The commonest tumor of the heart in children are:

a. Fibroma

b. Lipoma

c. Myxoma

d. Rhabdomyoma

e. Rhabdomyosarcoma

14. In Kawasaki's disease, you will probably NOT see

              A enlarged lymph nodes containing granulomas

              B.   erythema of the palms

               C.   fever

                               D.   reddening of the oral mucosa

               E.   reddening of the surfaces of the eyes

15. What's the major risk factor for Buerger's thromboangiitis obliterans?

              A.   alcohol abuse

              B.   cocaine use

              C.   old age

              D.   sexual promiscuity / multiple partners

              E.   smoking

16. Most "unstable angina" is probably due to

               A.   a thrombus forming and lysing

               B.   extreme hypercholesterolemia and rapid atherogenesis

               C.   multiple emboli to the coronaries

               D.   serial hemorrhages within a plaque

               E.   various rhythm disturbances developing and disappearing

17.  Listen carefully to your ankylosing spondylitis patients because they are much more likely than other folks to develop:

A.   aortic insufficiency

B.   aortic stenosis

C.   carotid bruits

D.   mitral insufficiency

E.   pulmonic stenosis

18. Primary site of involvement in AS is:

a. Intima

b. Media

c. Adventitia

d. Endothelium

e. ECM

19. Various factors influencing plaque change include all but:

a. Cholesterol content of plaque

b. Collagen metabolism

c. Emotional stress

d. Hypertension

e. Total triglyceride levels in blood

20. One of the following statements is not true, which one?

a. Myocardial infarction leading to severe pump failure is associated with 70% mortality.

b. Cardiac rupture leads to formation of true aneurysms.

c. Acute plaque change triggers Unstable Angina

d. Thromboembolism is an important complication of Myocardial infarction

e. Maximum granulation tissue formation occurs around 10 – 14 days after infarction.

21. Dilated Cardiomyopathy is associated with:

a. Conduction defect

b. Systolic dysfunction

c. Diastolic dysfunction

d. Vavular dysfunction

e. Myocardial ischaemia

22. All statements about Rheumatic Heart disease are true except:

a. Carditis is immune mediated

b. Aschoff Bodies are pathognomonic of RHD

c. Bread and Butter Pericarditis is a feature of RHD

d. Aortic valve is most commonly affected in RHD

e. Fibrosis in valvular leaflets leads to “Fishmouth” stenosis

23. An increased incidence of atherosclerosis has been correlated with all of the following except

a. HTN

b. Diabetes mellitus

c. Increased serum high density lipoprotein

d. Increased serum low density lipoprotein

e. Use of oral contraceptives

24. A child with fever, arthralgias, GIT and renal involvement and hemorrhagic urticaria like lesions of the skin – most likely diagnosis is:

a. Takayasu arteritis

b. Polyarteritis nodosa

c. Temporal arteritis

d. Henoch-Schonlein purpura

e. Wegener granulomatosis

25. A. 58 -year-old Principal of a medical college known hypertensive with a sedentary lifestyle experiences severe choking substernal chest pain that lasts for about 10 minutes. What degree of stenosis in his coronary arteries would have caused his symptoms?

a. 90%

b. 50%

c. 10%

d. 20%

e. <1%

KEY FOR SEQs:

Q. No 1: Stable Angina / Typical Unstable Angina / Crescendo Prinzmetal Angina / Variant

At rest Prolonged duration Disruption of stable atheroma à thrombosis Embolization, vasospasm

Q. No 2: CPK , CK MB AST LDH Troponins I & T II , CRP Homocysteine levels BNP

Troponin I & T is the best because it is the most sensitive and specific marker of myocardial damage. Their levels begin to rise after 2-4 hours and peak at 48 hours. Their levels remain elevated for 7-10 days

Q. No 3: a. rheumatic fever b.Major criteria: Migratory polyarthritis Carditis Subcutaneous nodules

Erythema marginatum Sydenham chorea

Minor criteria: Fever Pain right upper quadrant abdomen Raised ESR Raised CRP Elevated ASO titers EKG changes Presence of 2 major or 1 major + 2 minor criteria is diagnostic of RF

Q. No 4:

ACUTE IE	SUBACUTE IE
Develop on healthy valves	Develop on diseased valves / prosthesis
Caused by highly virulent organisms	By organisms of low virulence
Acute & severe	Insidious
50% mortality	Recovery common
Destructive necrotizing	Less destructive

Q. No 5: Complication of MI:

1. Contractile dysfunction à crdiogenic shock 2. Arrhythmias 3. MC rupture 4 cardiac rupture syndrome 5 Pericarditis 6. Right ventricular infarction 7. Extension 8. Mural thrombosis 9. Ventricular aneurysm 10 Papillary muscle dysfunction 11. Progressive late heart failure

Left sided heart failure:

Causes:IHDn HTN Aortic, mitral valvular disease Non ischemic MC disease (myocarditis, cardiomyopathy) Pericarditis Thyroid disease Pregnancy Septic shock

Q. No 6: a. kaposis sarcoma

b. chronic c. lymphadenopathci d transplant associated kaposis sarcom e. AIDS-associated Kaposi sarcoma

c.patch,plaque and nodule

Reference ROBINS page 535,chapter 12

Q. No 7: a. takayasu arteritis

b.irregular thickening of aortic or branch vessel wall with intimal wrinkling

adventitial mononuclear infiltration with perivascular cuffing

granulomatous changes with patchy necrosis and giant cells

c.large vessel vasculitis(giant cell arteritis,takayasu arteritis)

medium sized vasculitis(PAN,kawasaki)

small vessel vasculitis(wegeners granulomatosis,churg strauss)

Reference ROBBINS page 519,page 517-chapter 12

Q no 8

Pathologic Basis of Disease 6^th edition, Chapter 12, page 531,532

a. Gross----few mm to several cm, bright red to blue, slightly elevated intact covering epithelium. Microscopic-----lobulated, unencapusalted aggregates of closely packed thin walled capillaries, blood filled, lined by flattened endothelium, scant CT.

b. Benign Neoplasm----Hemangioma, Lymphangioma, glomus tumor, vascular ectasias, reactive vascular proliferations. Intermediate Grade Neoplasm----Kaposi sacrcoma, Hemangioendothelioma. Malignant neoplasm----Angiosarcoma, Hemangiopericytoma

Q.NO.9

a..haemorrhage into artheroma,rupture,fissuring,erosion,ulceration

b. which has a thin fibrous cap and is vulnerable to these changes.

Q.N.10 KEY Q 10 Robbins and Cotran Pathologic Basis of Disease 7^th Ed. 520, Table 11-2

Major Risk factors:

Non-modifiable: Increasing age, Male gender, Family history

Potentially controllable: Hyperlipidemia, Hypertension, cigarette smoking

Minor risk factors:

Obesity, Physical inactivity, High carbohydrate intake, alcohol

2011 UHS pastpapers 4th year (Annual and supplementary)

2012-09-01T08:30:00.000-07:00

RMC CLASS TEST FOURTH YEAR OPHTHALMOLOGY-2010

2012-08-30T12:59:00.005-07:00

RAWALPINDI MEDICAL COLLEGE, RAWALPINDI

CLASS TEST FOURTH YEAR OPHTHALMOLOGY 8^th SEPTEMBER 2011

Total marks: 30Marks Time allowed: 45 Minutes

Instructions: All questions carry equal marks, Attempt all questions

No 1 A child presents with esotropia at 2 years of age;

a. What clinical (not laboratory) tests will you perform?

Ocular examination especially

Ocular movements

Cover -uncover test

Hirshberg, krimsky test

Cycloplegic refraction

b. What is the treatment?

Prescription of glasses

If no improvement then surgery

No 2. A young man was struck by ball while playing cricket, complains of double vision

a. What are the causes of diplopia?

Muscle trauma

Muscle entrapment

Hematoma

Nerve trauma

Orbital cellulitis

b. Which other clinical signs may be positive in such a case?

Infra orbital nerve anaesthesia

Subcutraneous emphysema

Double diplopia

Echymossis

Proptosis/ enophthalmos

Nasal bleed

Subconjunctival hemorrhage

No 3. A middle aged lady complains of sudden decrease of vision in one eye after a history of flashes and floaters for 3 days

a. What is the likely cause?

Retinal detachment

b. What is the treatment?

Retinal detachment surgery

No 4. Answer the following questions briefly

a. What is the definition of Myopia?

It is refractive error in which parallel light rays coming from infinity come to focus in front of the retina when the accommodation is at rest

b. What are the treatment options of Myopia?

Glasses

Contact lense

Refractive surgery

No 5. An elderly person presents with redness, severe pain and gross decrease in vision in the eye, 2 days after routine Phacoemulsification;

a. What is the D/D and most likely cause?

Acute post operative endophthalmitis

b. Which other clinical signs may be positive in such a case?

Lid odema

Conjunctival chemosis and congestion

Subconj haemorrhage

Corneal haze/ odema

Hypopyon

Piosterior synechae

Loss of fundal glow

MCQS

RAWALPINDI MEDICAL COLLEGE, RAWALPINDI

CLASS TEST FOURTH YEAR OPHTHALMOLOGY 8^th SEPTEMBER 2011

Time allowed: 30 Minutes ROLL NO: _____________

Total marks: 30Marks

MCQs single best, please tick or encircle the correct option.

1. Sjogren syndrome is keratoconjunctivitis sicca associated with many systemic diseases like

A. Systemic hypertension

B. Acid peptic disease

C. Rhematoid arthritis

D. Ischemic heart disease

2. A mother presented her 8 year old baby with rapidly progressive lid swelling and proptosis for the last one week. She tried treatment at a nearby general practitioner’s centre but there was absolutely no improvement. On examination by ophthalmologist lids were swollen and red but not hot. First line of diagnosis should be

A. Retinoblastoma

B. Rhabdomyosarcoma

C. Orbital cellulitis

D. Ruptured dermoid cyst

3. A 65yr old lady complaining of burning and watering eyes for the last many months was being evaluated for dry eye syndrome. Her Schirmer 1 test will be declared as positive if the length of wet filter paper at the end of five minutes is

A. Less than 6mm

B. Less than 5 cm

C. Less than 15mm

D. Less than 15cm

4. A 45 year old lady known thyrotoxic for the last many years and having dysthyroid orbitopathy started feeling impaired central vision and defective red green color appreciation for the last few days. Her problem is the result of

A. Severe proptosis

B. Dry eye

C. Restrictive thyroid myopathy

D. Dysthyroid optic neuropathy

5. A 15 year old boy presented with frequent change of glasses number, increasing irregular astigmatism and a state of visual dissatisfaction. He is suffering from

A. Blepharitis

B. Trachoma

C. Wilson,s disease

D. Keratoconus

6. Of the drugs known for their optic nerve toxicity include

A. Atropine

B. Steroids

C. Erythrocin

D. Ethambutol

7. Photorefractive keratectomy is a modern way of treating myopia. It works by

A. Reducing the length of globe

B. Thickening the central part of cornea

C. By modulating the crystalline lens

D. By decreasing the thickness of central part of cornea.

8. Bacterial conjunctivitis and keratitis are frequently treated by the quinoilone group of drugs like moxifloxacin, etc. they help to eliminate infection by

A. Destroying the cell wall of microbes

B. Inhibiting the protein synthesis

C. By inhibiting the cell wall synthesis

D. By inhibiting DNA-gyrase and cell proliferation.

9. Eye is an organ capable of focusing the images of distant objects upon the retina. The refractive power is maximally contributed by

A. Cornea

B. Lens

C. Vitreous

D. Retina

10. The eyes prone to angle closure have

A. Small cornea, deep chamber, hypermetropia

B. Myopic eye, deep chamber, large corneas

C. Shallow chambers, thicker corneas, anteriorly placed lens, hypermetropes

D. Shallow chambers, thin cornea, posteriorly placed iris lens diaphragm

11. A 35 year old farmer sustained some eye injury by plant life which he felt trivial and a routine matter. However watering, irritation, etc started soon in the following days and he urged a medical advice for his worsening problem. His corneal perforation was impending because

A. There had developed a visible corneal opacity

B. Hypopyon formation had occured

C. Keratoconus and surface irregularities devoloped

D. there is descematocoele

12. While preparing for cataract surgery and doing his biometric calculations, the Keratometer gives

A. Horizontal and verticle diameters of cornea

B. Diaptoric power of the front of cornea

C. Power of back surface of cornea

D. Diaptoric power of the crystalline lens

13. The presence of Kayser-Fleischer ring is a sure feature of

A. Alkaptonuria

B. Keratoconus

C. Wilson’s disease

D. Albinism

Fossa for lacrimal sac is formed by lacrimal bone and

A. lodges in the medial orbital wall.

B. is present in the superotemporal wall of orbit anteriorly

C. is present in the inferotemporal part of the orbit posteriorly

D. in part by zygomatic bone

15. Regarding soft and hard exudates of retina

A. Soft exudates are reversible while hards exudates are not.

B. Soft exudates show lipid deposition while hards are calcium deposits

C. Soft exudates donot disturb vision while hard ones always disturb it

D. Soft exudates show retinal ischemia while hard exudates show leakage

A patient of retinal detachment usually comes with the complaints of

A. Sudden painful blindness

B. A veil or curtain falling in front with a shower of black spots

C. Pain, redness, watering

D. Colored haloes with severe headache.

17. A retinal detachment is a separation of

A. Retina from choroid

B. Retina and choroid from sclera

C. Neurosensory retina from retinal pigment epithelium

D. Separation of retina at inner plexiform layer

A young tennis player sustained injury on his right eye and there was a severe visual concern. The sign most consistent with a ruptured globe is

A. Cataract formation

B. Raised intraocular presurre

C. Hypotony and irregular anterior chamber

D. Subconjunctival haemorrhage

19. A young adult having complaints of backache and stiff joits presented to eye specialist for his ocular complaints. On examination he was found to have Iris bombe which is

A. A Nodule on iris surface

B. 360 degrees posterior synechiae

C. Effect of prolonged use of steroids

D. Effect of prolonged use of topical atropine

20. The following describes best the sympathetic ophthalmia

A. It is a condition when cancer from one eye spreads to the fellow eye

B. when a progressive corneal ulcer leads to perforation

C. An ocular wound with incarcination of uveal tissue in one eye leads to a granulomatous panuveitis in the fellow eye after a few weeks.

D. When an eye becomes sensless i.e doesnot see , doesnot pain, etc.

21. The drug of choice for the treatment of uveitis is:

A. Moxifloxacin

B. Beta-methasone

C. Atropine

D. Tropicamide

22. Commonest cause of cicatricial entropion in Pakistan is

A. Pemphigus

B. SLE

C. Trachoma.

D. Acid/Alkali burns

23. A young auto-electrician was on follow up visits after sustaining a chemical eye burn from burst wet motor battery some two months ago. His lids were found to be adherent with the globe. the condition is called as

A. Blepharoptosis

B. Symblepharon

C. Ankyloblepharon

D. Blepharophimosis

24. An orbital surgeon working at the orbital apex will not find

A. Superior oblique

B. Inferior oblique

C. Superior rectus

D. Inferior rectus

Synaptophore is a device used for

A. Measuring angle of deviation

B. Measuring degree and range of fusion

C. Determination of retinal correspondence

D. All of the above

Secondary angle of deviation is larger than primary in

A. Concomitant esotropia

B. Concomitant exotropia

C. Paralytic heterotropia

D. A and V pattern deviations

A known diabetic and hypertensive 55 years male sustained ischemic extraocular paralysis of his right lateral rectuts muscle. To avoid diplopia he is advised to keep his face turned

A. To the right

B. To the left

C. To the right and chin down

D. To the left and ipsilateral head tilt.

28. Open angle glaucoma can occur in the following situations

A. Taking analgesics for a prolonged period

B. Habitual use of preparations containing vitamins and minerals

C. Raised intracranial pressure

D. Finding pigment dispersion in anterior chamber

29. A 50 year old man on polytherapy for glaucoma presented following drugs to his ophthalmologist. The one capable of lowering IOP by increasing out flow facility includes

A. Latanoprost

B. Timolol

C. Acetazolamide

D. Infusion mannitol

30. The most favorite drug of ophthalmologists for quick lowering of IOP in emergency room/ operation room is

A. A.Pilocarpine eye drops

B. Timolol maleate eye drops

C. Oral glycerine

D. Mannitol infusion 20%

RMC Solved SEND-UP EXAMINATION OF OPHTHALMOLOGY2010 (MCQs+SEQs)

2012-08-30T12:57:00.003-07:00

RAWALPINDI MEDICAL COLLEGE, RAWALPINDI
SEND-UP EXAMINATION OF OPHTHALMOLOGY2010

MCQs: 30
Single best                                   Marks: 30   Time: 30Mins

Optic disk oedema is seen in all except
Papilloedema
CRVO
Open angle glaucoma
Hypertensive retinopathy
Papilitis

The first line of treatment in chemical injury is
admission if severe
topical antibiotics
topical cycloplegia
neutralization of pH by irrigation
oral analgesia

The most common cause of proptosis is
orbital infection
orbital hemorrhage
orbital tumor
orbital pseudo-tumor
thyroid ophthalmopathy

Calculation of IOL power is called
Biometry
Pachymetry
Tonometry
Keratometry
Ophthalmoscopy

Aphakia can be corrected by following
Specticles
Contact lenses
Anterior chamber IOL
Posterior chamber IOL
All of above

A patient with sudden painless loss of vision and no fundal view was possible. Which of the investigation is helpful to see the retina.
Keratometry
Pachymetry
B-Scan
A-Scan
Indirect ophthmoscopy

Direct Ophthalmology is done for
Examination peripheral retina
Examination of central retina
Refractive power of eye
Axial length of eye
To find out the power of IOL

A patient presented with gross painful decrease of vision. On torch examination there was conjunctival congestion and pupil irregular miosed. Which is the probable diagnosis
Anterior uveitis
Acute congestive glaucoma
Conjunctivitis
Scleritis
Foreign body


Regarding Myopia
It is also called Far sightedness
Correction is with concave lens
Correction is with convex lens
Image formed behind the retina
Eye ball is small

A patient who was operated for cataract four years back comes to you with foggy vision. On examination there was posterior capsular thickening, which mode of treatment is most useful.
Excimer laser
YAG-Laser
Argon laser
Krypton laser
Diode laser

Esotropia is
Divergent squint
Latent convergent squint
Associated with accommodation reflex
Associated with accommodation and hypermetropia
None of above

Which of the following regarding atropine is true
Increases IOP
Used in neovasular glaucoma
Miosis
Atropine is weak cycloplegic
All of above

Pathognomic clinical signs of proliferative diabetic retinopathy is
Micro aneurysms
Hard exudates
Deep retinal hemorrhages
Neovascularization of retina
Vitreous hemorrhage

A child of one year old presented with watering in left eye and sticky discharge. On examination regurgitation test was positive. What is the    diagnosis?
Nasolacrimal duct block
Common canaliculus block
Punctal atresia
Buphthalmos
None of above

In Hypermetropia all are true except
Axial length of eye ball is small
Correction with convex lens
Image formed behind the retina
Refractive error can be diagnosed by retinoscopy
Rays of light converged behind the retina when accommodation reflex is active

Exophthalmos associated with thyroid ophthalmopathy have following clinical signs except
Proptosis
Ptosis
Lid retraction
Conjunctival chemosis
Extraocular muscle thickening

Nasolacrimal duct opens in
Superior meatus
Inferior meatus
Middle meatus
Nasopharynx
None of above

Trachoma is associated with except
Tranatas dots
Follicles
Papillae
Herbit pits
Corneal pannus

A patient presented with diplopia in primary position along with ptosis in left eye. The eye was deviated infrolaterally. The diagnosis will be
Fourth nerve palsy
Third nerve palsy
Sixth nerve palsy
Seventh nerve palsy
All above

A young boy presented in emergency with watering and photophobia in right eye. Which test is appropriate?
a.   Schirmer test
b.   Tear breakup time
c.   Rose Bengal staining
d.   Applanation tonometry
e.   Flouroscine staining

According to WHO a person is blind when
vision in better eye is less than 2/60 and/or visual field is less than 30 degrees in better eye
vision in better eye is less than 3/60 and/or visual field is less than 30 degrees in better eye
vision in better eye is less than 3/60 and/or visual field is less than 20 degrees in better eye
vision in better eye is less than 3/60 and/or visual field is less than 60 degrees in better eye
vision in better eye is less than 5/60 and/or visual field is less than 30 degrees in better eye

Complications of contact lenses include all of the following except
Allergy
Corneal infiltrates
Corneal ulcer
Permanent loss of vision
Corneal pigmentation

WHO grading of trachoma includes all except
TF follicles
TI inflammation
TS scarring
TT trichiasis
TP pannus

Least common cause of sudden loss of vision is
Vitreous hemorrhage
Optic neuritis
Central retinal venous occlusion
Central retina artery occlusion
Retinal detachment

Symptoms of cataract include all of the following except
Halos
Decreased vision in low illumination
Decreased vision in bright light
Glare
Sudden loss of vision

The best choice for a ten year child with unilateral traumatic cataract is:
Extra capsular surgery with contact lens
Intra/extra capsular surgery with spectacles
Extra capsular surgery with intraocular lens.
Intra capsular surgery with contact lens
Phacoemulsification with foldable IOL

Iridodonesis is seen in:
Intumescent cataract
Closed angle glaucoma
Subluxation of lens
Acute anterior Uveitis
High Myopia

Main cause of Dendritic corneal ulcer is:
Fungal
Bacterial
Parasitic
Viral.
Toxic

Dry eye is usually seen in:
Lowe’s syndrome
Sjogren’s syndrome.
Refsum’s syndrome
Marfan’s syndrome
Perinaud syndrome

Regarding probing and syringing test, which statement is true
Recommended for acute dacryocystitis
Regurgitation is positive
Congental nasolacrimal duct block
Chronic dacryocystitis in old age
None of above

RAWALPINDI MEDICAL COLLEGE, RAWALPINDI
SEND-UP EXAMINATION OF OPHTHALMOLOGY 2010

SEQs:
Marks: 40, Time: 1Hour, 30Mins

A middle aged female presented with right painful red eye and gross decrease of vision for last one day. She had complaint of seeing halos in both eyes off and on since two months. On examination visual acuity was hand movement and circumciliary congestion with dialated vertically oval pupil and shallow anterior chamber.
What are the causes of painful red eye? (02)

acute conjunctivitis
acute anterior uveitis

acute congestive glaucoma

acute bacterial keratitis/ ulcer

What is the diagnosis in this case? (02)

Acute congestive glaucoma

Briefly write the treatment? (04)

reduction of IOP first medically then surgically by iridotomy

I/v mannitol

oral glycerol

Pilocarpine ed

timolol ed

tab actazolamide

Anti inflammatory drops eg Steroids

analgesia

antiemetics

put fellow eye on pilocarpine or do prophylactic laser iridotomy

Write short notes on.
Trachoma (04)
Pterygium (04)

18 years old boy received tennis ball injury to the eye while playing cricket and presented in emergency with severe pain and loss of vision.
What are the effects of blunt trauma on the eye? (02)

lid laceration, tear, echymossis

conjunctival tear , sub conjunctival haemorrhage

corneal abrasion, tear, odema

hyphema

iridodialysis, traumatic mydriasis, sphincter tear

lens luxation, subluxation, cataract

vitreous haemorrhage

retinal haemorhages, commotio retinae

disc odema, avulsion of optic disc

muscle trauma

orbital floor fracture, medial wall fracture

orbital haemorrhage

etc

What special investigations will you perform? (02)

complete eye examination

plus visual fields,Bscan, Xray orbit, CT and MRI

What is the treatment of Hyphema? (04)

absolute bed rest for atleat 72 hours

analgesics (no asprin)

sedatives

Atropine ed

mild steriod ed

aminocaproic acid orally

Must take IOP regularly if raised then medically control IOP

If IOP more than 55mmhg for 5 days or 35 for 7 days or corneal staining then surgical drainage (paracentesis)

70 years old male presented with drooping of left eye lid and diplopia. On examination the eye was deviated to downward and outward with normal papillary reaction.

What are the causes of binocular diplopia? (02)

III nerve palsy
IV nerve palsy

Vi nerve palsy

nerve palsies are due to

idiopatic causes

vsacular causes DM HT

tumours

Trauma

Infections

myositis

myopathy (Myasthenia gravis)

muscle trauma

orbital floor fracture

thyropd ophthalmopathy

orbital cellulits

orbital pseudo tumor

raised ICP

etc

What is the diagnosis in this case? (02)

III nerve palsy

What is the significance of papillary reaction in this case? (02)

pupil sparing third nerve palsy signifies medical caused ie idiopathic, DM HT and CT scan is not indicated

What are the treatment options? (02)

consevative management

Treat the cause

treat diplopia with prisms

spontaneous recovery will occur in most cases

surgery after six months for any residual defect ie causing diplopia in primary position of gaze and for severe ptosis

5. Regarding Cataract

What are the causes? (02)

Senile

traumatic

endocrine

Secondary

Congenital

Hereditary

metabolic

What are the indications of Cataract Extraction? (02)

Visual
medical

diagnostic/therapeutic

cosmetic

Name the operations? (02)

Lensectomy

ICCE
ECCE

Phacoemulsification

What are the complications of Phacoemulsification? (02)

in addition to routine complication of cataract sugery

wound leakage, corneal burn, descmets membrane stripping, endothelial decompensation

Iris trauma, rhexis extending beyond equator, small rhexis leading to phimosis,

PC rent and all its sequlae

Dropping of nucleus or pieces

Increased chanc3e of endophthalmitis as compared to ECCE

Ophthalmology MCQs- 4th Year

2012-08-26T21:37:00.000-07:00

1. The first line of treatment in chemical injury is

admission if severe
topical antibiotics
topical cycloplegia
neutralization of pH by irrigation
oral analgesia

2. In blow out fracture the commonest bone to fracture is

maxillary (floor)
zygomatic (lateral wall)
lachrymal (medial wall)
frontal (roof)
ethmoidal (medial wall)

3. Following are the features of orbital floor fracture

diplopa on upgaze and downgaze
damage to supra-orbital nerve
haemoptysis
numbness of lateral canthus
haziness of ethmiodal sinus on x ray

4. The commonest painless lid swelling is

a. stye

b. cyst of moll

c. cyst of zeis

d. internal hordeolum

e. chalazion

5. The most commont cause of proptosis is

orbital infection
orbital hemorrhage
orbital tumor
orbital pseudo-tumor
thyroid ophthalmopathy

6. A patient presents with red eye, decreased visual acuity, raised Intraocular pressure & shallow anterior chamber. The likely diagnosis is

cataract
open angle glaucoma
retinal detachment
hyphema
acute angle closure glaucoma

7. Female with uncontrolled diabetes presents with painful red eye and visual acuity is also decreased. On examination there was raised Intraocular Pressure and new blood vessels on the iris. The treatment includes all except.

atropine
beta blockers
steriods
pain killers
pilocarpine

8. The commonest cause of cataract is

trauma
diabetes
hypo-parathyroidism
TORCH infections
old age

9. Regarding Phaco-Emulsification, better visual outcome is expected when

Operation is performed via superior clear corneal incision
Operation is performed via superior scleral tunnel incision
Operation is performed via supero-temperal clear corneal incision
Operation is performed via temporal clear corneal incision
Operation is performed via temporal scleral tunnel operation

10. Phaco-Emulsification is done except in

Immature cataract
Mature cataract
Hyper-mature cataract
Hype-mature morgagnian cataract
Dislocated cataract

11. On gonioscopy following structures are visible

Most anterior is bowmans layer
Next is trabecular meshwork
Next scleral spur
Next ciliary body
And lastly iris recess

12. In Addition to High IOP and High vertical cup-disc ratio, risk factors for POAG include all of the following except

a. Old age

b. Family history

c. Retinal nerve fibre defects

d. Parapapillary changes

e. Hypermetropia

13. The earliest visual field defect in POAG is

a. Isolated paracentral nasal scotoma

b. Bjerrums scotoma

c. Arcuate scotoma

d. Altitudinal Scotoma

e. Centrocecal scotoma

14. Chronic simple glaucoma, is a generally bilateral, but not always symmetrical disease, characterized by:

An IOP 21mmHg.
Angle grade II.
Glaucomatous optic nerve head damage.
Altitudinal field defects

15. Specific sign of glaucomatous damage is

Baring of circumlinear blood vessels
Bayoneting
The laminar dot sign
Disc haemorrhages
Superior or inferior polar notching of the cup

16. in myopia

Length of eye ball is short
Corneal radius of curvature is less
Lens is less spherical
Image forms in front of the retina when the patient accommodates
Patient can see far objects clearly when he exerts accommodation

17. Symptoms of cataract include all of the following except

Halos
Decreased vision in low illumination
Decreased vision in bright light
Glare
Sudden loss of vision

18. Treatment options in POAG may include all except

pilocarpine
beta blockers
prostaglandin analogues
carbonic anhydrase inhibitors
atropine

19. WHO grading of trachoma includes all except

TF follicles
TI inflammation
TS scarring
TT trichiasis
TP pannus

20. Least common cause of sudden loss of vision is

Vitreous hemorrhage
Optic neuritis
Central retinal venous occlusion
Central retina artery occlusion
Retinal detachment

21. Best vision in moderate myopia is achieved by

glasses
soft contact lenses
rigid gas permeable lenses
Laser vision correction procedures
kerato-melieusis

22. Complications of contact lenses include all of the following except

Allergy
Corneal infiltrates
Corneal ulcer
Permanent loss of vision
Corneal pigmentation

23. Pupil in acute anterior uveitis is

miosed and regular with poor reaction
miosed and irregular with poor reaction
dilated and irregular with good reaction
dilated and regular with poor reaction
mid-dilated and oval with poor reaction

24. According to WHO a person is blind when

vision in better eye is less than 2/60 and/or visual field is less than 30 degrees in better eye
vision in better eye is less than 3/60 and/or visual field is less than 30 degrees in better eye
vision in better eye is less than 3/60 and/or visual field is less than 20 degrees in better eye
vision in better eye is less than 3/60 and/or visual field is less than 60 degrees in better eye
vision in better eye is less than 5/60 and/or visual field is less than 30 degrees in better eye

25. The most common cause of reduced vision in the world is

trachoma
diabetic retinopathy
refractive errors
glaucoma
cataract

26. Ayoung male of 22years present with gradual decrease of visual acuity in both eyes and change of refractive error on examination with retinoscope there was high astigmatism. Give likely diagnosis?

a. keratoglobus

b. keratoconus

c. megalocornea

d. buphthalmos

e. keratitis

27. A young boy presented in emergency with watering and photophobia in right eye. Which test is appropriate?

a. Schirmer test

b. Tear breakup time

c. Rose Bengal staining

d. Applanation tonometry

e. Flouroscine staining

28.When the eye is medially rotated, the prime depressor muscle of eye ball

a. Inferior rectus

b. Inferior oblique

c. Superior oblique

d. Inferior rectus and inferior oblique

e. Lateral rectus

29. A patient on slit lamp examination shows hypopyeon in anterior chamber after trauma, which is due to

a. Pus in anterior chamber

b. Cells in anterior chamber

c. Protein in anterior chamber

d. Blood in anterior chamber

e. Foreign body in anterior chamber

30. A patient have blunt trauma with tennis ball and having hyphema, which is

a. Pus in anterior chamber

b. Foreign body in anterior chamber

c. Uveal tissue

d. Blood in anterior chamber

e. Cells in anterior chamber

31. Calculation of IOL power is called

Biometry
Pachymetry
Tonometry
Keratometry
Ophthalmoscopy

32. Benign tumors of eye except

a. Limbal dermoid

b. Chlazion

c. Orbital cyst

d. Dermoid cyst

e. Rhabdomyosarcoma

33. An infant presented with sticky discharge both eyes and extreme congestion of conjunctiva. Provisional diagnosis is the ophthalmia neonatroum which is caused by

Gonococcus
E.Coli
Staph.aureous
Streptococcus
Diphtheria

34. Timolol is

a. Beta blocker

b. Carbonic anhydrase inhibitor

c. Antibiotic

d. Alpha blocker

e. Calcium channel blocker

35. Aphakia can be corrected by following

Specticles
Contact lenses
Anterior chamber IOL
Posterior chamber IOL
All of above

36. A patient presented with diplopia in primary position along with ptosis in left eye. The eye was deviated infrolaterally. The diagnosis will be

Fourth nerve palsy
Third nerve palsy
Sixth nerve palsy
Seventh nerve palsy
All above

37. Retinoscopy is done for

Examination retina
Examination optic nerve
Refractive power of eye
Axial length of eye
To find out the power of IOL

38. A patient presented with sudden painless loss of vision in left eye. Patient is known diabetic. How you are going to examine the patient except

Retinoscopy
Direct ophthalmoscopy
Indirect ophthalmoscopy
Slit lamp examination
Examination with triple mirror

39. A young patient presented with Rosette shaped cataract which is characteristic of

Senile cataract
Complicated cataract
Secondary to diabetes
Radiation induced cataract
Traumatic cataract with blunt trauma

40. A patient presented with photophobia and watering in left eye. On examination with fluorescein staining revealed dendritic ulcer which is caused by

Staphylococci
Fungal
Herpes simplex virus
Herpes zoster virus
Mycobacterium

41. Distichiasis is

a. Misdirected eye lashes

b. Accessory row of lashes

c. Everted lid margin

d. Inverted lid margin

e. Drooping of upper lid

42. Traucoma is associated with except

Tranatas dots
Follicles
Papillae
Herbit pits
Corneal pannus

43. Nasolacrimal duct opens in

Superior meatus
Inferior meatus
Middle meatus
Nasopharynx
None of above

44. A patient of 45 years old presented with facial palsy. The epiphora in this patient was due to

a. Ectropion

b. Entropion

c. Lagophthalmos

d. Lacrimal pump failure

e. Hyper screction of tears

45. foreign body sensation can be produced by all except

a. Allergic conjunctivitis

b. Viral conjunctivitis

c. Cataract

d. Contact lens wear

e. Trichiasis

46. Exophthalmos associated with thyroid ophthalmopathy have following clinical signs except

a. Proptosis

b. Ptosis

c. Lid retraction

d. Conjunctival chemosis

e. Extraocular muscle thickening

47. A patient presented with gross decrease of vision. On torch examination there was conjunctival congestion and pupil miosed. Which is the probable diagnosis

a. Anterior uveitis

b. Acute congestive glaucoma

c. Conjunctivitis

d. Scleritis

e. Foreign body

48. A patient with sudden painless loss of vision and no fundal view was possible. Which of the investigation is helpful to see the retina.

a. Keratometry

b. Pachymetry

c. B-Scan

d. A-Scan

e. Indirect ophthmoscopy

49. A hypertensive and diabetic patient presented with sudden painless loss of vision. What are the possibilities except

a. CRAO

b. CRVO

c. Vitrous Hemorrhage

d. Retinal detachment

e. Neovascular glaucoma

50. Myopia is a condition which is

a. Farsightedness

b. Correction with concave lens

c. Correction with convex lens

d. Image formed behind the retina

e. Eye ball is small

51. Hypermetropia is a condition in which except

a. Axial length of eye ball is small

b. Correction with convex lens

c. Image formed behind the retina

d. Refractive error can be diagnosed by retinoscopy

e. Rays of light converged behind the retina when accommodation reflex is active

52. A patient who was operated for cataract four months back comes to you with foggy vision. On examination there was posterior capsular thickening, which mode of treatment is most useful.

a. Excimer laser

b. YAG-Laser

c. Argon laser

d. Krypton laser

e. Diode laser

53. In diabetic retinopathy the new vessel formation is due to following pathology

a. Retinal hemorrhage

b. Vitreous hemorrhage

c. Retinal oedema

d. Retinal ischemia

e. Retinal breaks

54. Esotropia is

a. Divergent squint

b. Latent convergent squint

c. Associated with accommodation reflex

d. Associated with accommodation and hypermetropia

e. None of above

55. Exophoria is

a. Latent convergent squint

b. Alternate divergent squint

c. Associated with accommodation reflex

d. Latent divergent squint

e. None of above

56. Which of the following regarding atropine is true

a. Increases IOP

b. Used in neovasular glaucoma

c. Miosis

d. Atropine is weak cycloplegic

e. All of above

57. Pathognomic clinical signs of proliferative diabetic retinopathy is

a. Micro aneurysms

b. Hard exudates

c. Deep retinal hemorrhages

d. Neovascularization of retina

e. Vitreous hemorrhage

58. A child of one year old presented with watering in left eye and sticky discharge. On examination regurgitation test was positive. What is the diagnosis?

a. Nasolacrimal duct block

b. Common canaliculus block

c. Punctal atresia

d. Buphthalmos

e. None of above

59. Regarding probing and syringing test, which statement is true

a. Recommended for acute dacryocystitis

b. Regurgitation is positive

c. Congental nasolacrimal duct block

d. Chronic dacryocystitis in old age

e. None of above

60. Optic disk oedema is seen in all except

a. Papilloedema

b. CRVO

c. Open angle glaucoma

d. Hypertensive retinopathy

e. Papilitis

4th year Patho RMC sendup- 2011

2012-08-25T05:17:00.005-07:00

MBBS III PROF. -- SPECIAL PATHOLOGY SEQs SEND UP

25th Oct 2011--CLASS OF 2009 DEPT. OF PATHOLOGY, RMC

If you have a question, raise your hand and I'll get with you.  Please do not phonate.

TOTAL MARKS: 70

TIME ALLOWED: 70 minutes.

Attempt all questions. All questions carry equal Marks.

CARDIOVASCULAR SYSTEM.

Q1. A 14 years old male presents in the OPD with shortness of breath for one month and swelling of right knee joint for two weeks. He suffers from sore throat off and on. His ASO Titre is 800 IU/ml. The doctor suspects that he is suffering from some sort of heart problem. (2+2+1)

a) What is the most likely diagnosis? What is the type of joint involvement in this condition?

b) What is the pathogenesis of his disease?

c) Name two complications which can occur in this boy.

Q1. KEY:

a) Rheumatic heart Disease.

A migratory polyarthritis of a large joint occurs. (1+1=2)

b) Pathogenesis of Rheumatic heart disease.

The antibodies directed against the M protein of Group A streptococci cross react with antigens of heart.

c) Complications:

Mitral stenosis.

Atrial stenosis.

Thromboembolism.

Heart failure.

Arrythmias. (0.5+0.5=1)

HAEMATOPOIETIC SYSTEM

Q2. Illustrate the pathogenesis of anemia, skeletal deformities and hemochromatosis in beta thalassemia major with the help of a flow chart.

(2+2+1)

Q2. KEY:

Normal b-thalassemia

Normal erythroblast Abnormal erythroblast

Normal red blood cell

Hypochromic red cells with alpha globin aggregates

Destruction of aggregate containing cells in spleen

RESPIRATORY SYSTEM:

Q3. A 25-year-old female went to a pulmonologist at the peak of spring season having severe dysponea and wheeze. Her pulmonary function tests showed decreased FEV1, serum IgE levels were elevated and blood revealed absolute eosinophilia. (1+2+2)

a) What is the most likely diagnosis?

b) Give four histologic findings of this disorder.

c) Name four chronic restrictive airway diseases.

Q3. KEY:

a) Bronchial asthma.

b) Histologic findings of bronchial asthma:

Occlusion of bronchi and bronchioles with mucus plugs that contain whorls of shed epithelium giving rise to Curschmann spirals.

Numerous eosinophils and Charcot-Leyden crystals.

Airway remodeling:

Thickening of basement membrane of bronchial epithelium.

Edema and inflammatory infiltrate in the bronchial walls with prominence of eosinophils and mast cells.’Increase in size of submucosal glands.

Hypertrophy of bronchial wall muscle.

(Any four 0.5 marks each= 2 marks)

c) Four chronic restrictive airways diseases:

i) Pneumoconiosis.

ii) Interstitial fibrosis.

iii) Radiation pneumonitis.

iv) Interstitial pneumonia.

v) Sarcoidosis.

vi) Hypersensetivity pneumonitis.

(Any four 0.5 marks each=2)

ORAL CAVITY AND GASTROINTESTINAL TRACT.

Q4. A 30-year-old villager presents in the gastroenterology ward with a three weeks H/O nausea, vomiting, abdominal pain and bloody stools. On sigmoidoscopy multiple polyps are distributed throughout the colon and a 2x2.5 cm mass is found in the descending colon. His liver is enlarged and nodular. X-ray chest reveals bilateral opacities. (1+2+2)

a) What is the likely diagnosis?

b) Classify neoplasia of large intestine(TNM classification).

c) Give four dietry factors predisposing to a higher incidence of this cancer.

Q4. KEY:

a) Colorectal carcinoma.

b) TNM classification of carcinoma of the colon and rectum.

Tumor (T).……………...………0=none evident

is=in situ

1=invasion of submucosa

2=invasion of muscularis propria

3=invasion of subserosa or nonperitonealized

pericolic fat

4=invasion of contagious structures

Lymph Nodes (N)………….…0=none evident

1=1 to 3 +ve pericolic nodes

2=4 or more +ve pericolic nodes

3=any +ve node along a named blood vessel

Distant Metastasis (M)……..0= none evident

1=any distant metastasis

c) i) Excess dietry caloric intake relative to requirements

ii) A low content of unabsorbable vegetable fiber.

iii) A corresponding high content of refined carbohydrates.

iv) Intake of red meat.

v) Decreased intake of protective micronutrients.

(0.5+0.5+0.5+0.5=2)

Q5. A 26 year old male has recurrent attacks of bloody mucoid diarrhea with abdominal cramps, which are relieved on defecation. Each episode lasts for 5-6 days followed by symptom free periods of 4-5 months. Colonoscopy shows pancolitis extending from rectum to the splenic flexure. (1+3+1)

a) What is the diagnosis?

b) What features will a colonoscopic biopsy show?

c) What is the role of intestinal flora in the pathogenesis?

Q5. KEY:

a) Diagnosis: Ulcerative colitis

b) Histologic features:

Ulceration of mucosa

Inflammation limited to mucosa

Pseudopolyps

Crypt abscesses: Neutrophil aggregates in lamina propria

Mild lymphoid reaction

Mild to severe fibrosis

Mild serositis

c) Role of intestinal flora:

IBD is caused by a strong immune response against gut flora.

Microbes may exacerbate immune reaction by providing antigens, inducing

costimulators and cytokines, all of which contribute to T cell activation.

Reducing intestinal flora has a beneficial role in IBD.

The hunt for a specific microbe has been fruitless.

HEPATOBILIARY SYSTEM.

Q6. A 1-month old infant presenting with jaundice is diagnosed with extraheptic biliary atresia. (3+2)

a) What are the major histological features on the liver biopsy?

b) Which two enzymes are likely to be raised in this condition?

Q6. KEY:

a) Liver biopsy:

Cholestasis is the key finding

Accumulation of bile pigment within hepatic parenchyma

Bile plugs form in bile canaliculi, rupture of canaliculi leads to extravasation of bile which is taken up by Kupffer cells

Accumulation of bile in hepatocytes leads to feathery degeneration and eventually to dissolution of hepatocytes

Ductular proliferation in portal areas

Portal tract edema, periductular neutrophil infiltrates

Unrelieved obstruction leads to portal tract fibrosis

b) Enzymes:

Serum alkaline phosphatase

g- glutamyl transpeptidase

URINARY SYSTEM.

Q7. Clinical pyelonephritis is most commonly caused by ‘ascending infection’. Give the five major steps in its pathogenesis. (5)

Q7. KEY:

· Colonization of distal urethra and introitus, role of bacterial adhesions and fimbriae

· From urethra to bladder, through urethral catheterization or instrumentation. Commoner in females in absence of these procedures. ? Shorter urethra, trauma during coitus, no antibacterial properties in vaginal fluid, hormonal changes

· Multiplication in bladder: Obstruction to urine outflow or bladder dysfunction promote stasis allows multiplication

· Vesicoureteral reflux: Incompetence of VU valve allows retrograde flow of urine, especially during micturition and permits bacteria to ascend into ureter. Congenitally absent or short intravesical portion of urethra

· Intrarenal reflux: VU reflux further propels the urine into renal pelvis and deep into renal parenchyma. Most common at poles.

MALE GENITAL SYSTEM

Q8. A male presented in OPD with a right testicular mass. (2+3)

a) What three serum markers would you order in a patient with a testicular

mass?

b) What is the value of serum markers in the context of testicular tumors?

Q8. KEY:

a) Serum markers for testicular germ cell tumors:

AFP

HCG

LDH

b) Value of markers:

In evaluation of testicular masses
In staging of testicular GCTs, a persistently raised AFP after orchidectomy indicates stage II disease, even if lymph nodes do not appear enlarged
In assessing tumor burden: LDH is related to tumor mass and is an independent prognostic marker for GCTs
In monitoring response to therapy: serial measurements of AFP and HCG, rapid fall indicates eradication. Recurrence can be predicted

FEMALE GENITAL SYSTEM:

Q9. A 45-year-old female patient develops a peanut sized nodule in an old midline laparotomy scar, which becomes painful during menstrual period. The excised nodule consists of normal-looking endometrial tissue with glands and stroma. (1+3+1)

a) What is the diagnosis?

b) Give three theories of pathogenesis of such lesions.

c) List two important sites for this process other than the abdominal wall.

Q9. KEY:

a) Diagnosis: Endometriosis

b) Theories:

Regurgitation/implantation theory: Retrograde menstruation through fallopian tubes common even in normal women, implantation in peritoneal cavity
The metaplastic theory: Endometrium could arise directly from coelomic epithelium
The vascular or lymphatic dissemination theory: Dissemination through pelvic veins or lymphatics can explain endometriosis in lungs and lymph nodes

c) Common sites of implantation:

Ovaries
Uterine ligaments
Rectovaginal septum
Pelvic peritoneum

Laparotomy scar

DISEASES OF BREAST:

Q10. A 68 year old lady has presented with a painless mass in upper outer quadrant of left breast. A pathologist is grading a breast tumor according to the Scarff-Bloom-Richardson system. (3+2)

a) Which three morphological features will he assess in this system?

b) What is the significance of ER/PR and Her 2-neu status in a breast CA?

Q10. KEY:

a) Nuclear grade

Tubule form

Mitotic rate

· ER/PR status: Positive tumors have a slightly better prognosis than negative ones. Most valuable in predicting response to therapy, if both positive 80% tumors respond, if one positive, 40% and if both negative less than 10%

· Her 2-neu: over-expressed in 20% of breast carcinomas. Positive tumors have poorer prognosis, targeted therapy to her 2 neu receptor is effective in these patients (1+1)

ENDOCRINOLOGY.

Q11. The patient presented with mass in front of neck, throidectomy was done and specimen was sent for histopathology. While examining H & E sections from the thyroidectomy specimen, a pathologist notices a lesion having a follicular pattern of growth. (3+2)

a) What is the differential diagnosis for such lesions?

b) List two nuclear features diagnostic for papillary carcinoma of

thyroid.

Q11. KEY:

a) Thyroid lesions with a follicular architecture

· Non neoplastic

o Hyperplastic nodule in goiter

· Neoplastic

o Follicular adenoma

o Follicular carcinoma

o Follicular variant of papillary carcinoma

· Optically clear, empty nuclei (orphan Annie)

· Intranucler inclusions (pseudo-inclusion)

· Nuclear grooves

MUSCULOSKELETAL SYSTEM AND BONES & JOINTS.

Q12. A 19 year old male presented in OPD with swelling in left knee for last 6 months which is associated with pain. He complaints of shortness of breath for the last one month. X-Ray of the knee shows ill-defined lesion in metaphyseal region of distal femur with elevated periosteum. X-Ray chest shows multiple coin-shaped opacities. (1+2+2)

a) What is the diagnosis?

b) Explain the classic radiologic finding associated with this condition.

c) Give its microscopic features.

Q12. KEY:

a) Osteosarcoma

b) Codman triangle

Tumor elevates the periosteum to form the codman’s triangle, which is formed by the angle between the elevated periosteum and the surface of the involved bone.

c) Hallmark is “formation of osteod” by malignant mesenchymal cells. This is seen in the form of islands of primitive bony trabeculae hugged by a rim of malignant osteoblasts.

CENTRAL NERVOUS SYSTEM.

Q13. A 60-year-old man presented to his primary care physician with complaints of headache and weakness in his left arm over the past several weeks. The day before his appointment, he experienced two episodes of uncontrollable shaking in his left arm and leg, accompanied by development of weakness in his left leg. On physical examination, he was found to have mild papilledema, decreased strength in his left arm and leg, and brisk deep tendon reflexes on the left side of his body compared to the right. A CT scan of his head revealed a ring-enhancing mass in the right frontal region. (2+2+1)

a) What is the most likely diagnosis?

b) Give any TWO histological patterns of the lesion.

c) What is the most common site of the lesion?

Q13. KEY:

a) Astrocytoma

b) i) Fibrillary Astrocytoma

ii) Pilocytic Astrocytoma

iii) Pleomorphic Astrocytoma

iv) Glioblastoma Multiforme

c) Cerebral Hemispheres

CLINICAL CHEMISTRY.

Q14. List 2 laboratory tests each for the evaluation of hepatocyte integrity, biliary excretory function and hepatocyte function. (2+1½+1½)

Q14. KEY:

hepatocyte integrity………………..AST

ALT

LDH

biliary excretory function………….serum bilirubin

urine bilirubin

serum bile acids

serum alkaline phosphatase

serum GGT

hepatocyte function………………….seum albumin

Serum ammonia

aminopyrine breath test

This exam is not intended to be especially difficult.  Be prepared for somewhat more challenging exams in the future.

Paper setters: Prof. Dr. Abbas Hayat, Dr.Aiman Aijaz

GOOD LUCK

Natural Acne Scars Remedies - Common Sense Prevails

2012-08-20T12:31:00.000-07:00

Natural Acne Scars Remedies - Common Sense Prevails

Acne is one of those things that everybody seems to get at one point or another, and yet nobody really likes it. While some cases are mild, other cases are quite severe and can lead to visible scarring. So, not only do these people have to suffer through a bad outbreak of acne, they then have to live with the scars for the rest of their lives. Or do they? The answer to that is no they don't, or at least they can try any number of acne scars remedies that will minimize the scars that are there. Not all of these treatments will work the same on everybody, but they are worth trying if it means you can feel better about yourself. One of the best known remedies for acne scars is citrus juice. You can apply
the juice of a lemon or lime directly to the problem areas. However, some people find that pure citrus juice irritates their skin, so you may want to try different dilutions until you find the one that's best for you. Apply it once or twice a day for several weeks and see how much lighter your scars look. It can take quite a while, but if it just doesn't seem to be working for you, then you can try other acne scars remedies. A lot of people swear by olive oil for making their acne scars less visible. In fact, there are any number of different oils that you can try. Simply massage the oil into the scar and the surrounding area, and let it sit. This helps to soften and moisturize the skin which can help diminish the visibility of acne scarring. Here's a natural remedy for acne that you may not be familiar with: tomatoes! That's right. Tomatoes are high in Vitamin A which keeps the body from producing too much sebum, which is the substance that is largely responsible for acne to begin with. Tomatoes are also rich in antioxidants which are beneficial for repairing the skin. One of the most soothing acne scars remedies is a mixture of rose water and sandalwood. Simply add a few drops of the rose water to the sandalwood until it is at a paste like consistency. Then put the resulting paste directly on the scars and let it sit for about an hour. This is generally very gentle on the skin, so you can even leave it on as you sleep. You have to be more careful if you are currently experiencing an acne outbreak, as you shouldn't let any foreign material (such as any of the above ingredients we've talked about) get into the sores. Not only can it be irritating, but it can also make the acne worse. However, if you need immediate comfort, you may want to try an icepack to help cool and temporarily tighten the skin. While a lot of people have found success with the above acne scars treatments, you should always consult with a qualified medical professional before doing anything that has to do with your health. About The Author you found this article of help then feel free to visit our site for further advice. http://StayingHealthy.fastprofitpages.com/?id=spellbob I am married to Georgina we live in a flat in Notting hill London. We like to travel , enjoy the theatre, cinema, photography, cycling, swimming. I write articles occasionally for the internet on various topics and themes. Article copyright@ Robert Taylor The author invites you to visit: http://www.my-net-biz.co.uk

10 Definite Don’ts Of Great Hair Care

2012-08-15T03:14:00.001-07:00

10 Definite Don’ts Of Great Hair Care

If the amount of money consumers spend on hair care products annually is any indication, most people are concerned about the appearance of their hair and strive to attain beautiful, healthy and stylish locks. In fact, most will go to any lengths to achieve their desired look. From professional salon treatments to over-the-counter serums, hair care is a big business. The only problem is that while many people are buying the right hair care products for their hair, they forget to follow basic hair care regimens that will guarantee the health and beauty of their tresses. Additionally, many are also causing needless damage to their hair by participating in unhealthy hair care behavior. So, what should you do to
make sure that your hair stays healthy, shiny and strong? To avoid all hair care disasters, follow these 10 absolute don'ts of great hair care.

Hair care don'ts

1. Avoid unprofessional and over-the-counter hair care products whenever you can. Many of these only offer false hopes and promises.

2. Do not cut your own bangs. Leave all of your cutting needs, even bangs, to your hair care professional.

3. Avoid excessive sun, chlorine and salt water during the summer months. Excessive exposure can cause severe damage that is irreversible even if you use the best hair care products.

4. Do not use clarifying hair care products on your tresses more than one time per week. They can strip hair of moisture and essential oils.

5. Do not visit a hair care salon without first getting a referral from someone you can trust. Choosing a salon based on an advertisement or sale alone is very risky.

6. Do not purchase hair color that comes in a box.

7. Never stick with an outdated look because you are afraid of looking different. Styles change for a reason. Ask your hair care professional to bring you into this decade with a new style.

8. Do not straighten your hair with a clothes iron. C'mon, this was so over in the 70s. We have straightening irons that won't damage your hair for this now. Look in the hair care isle.

9. Don't brush your hair or put too much tension on it while it is still wet. This will cause breakage. Also, do not wear tight styles such as corn rows for extended periods of time unless you have ethnic hair.

10. Never use sun-lightening products such as lemon juice or over-the-counter hair care products designed to lighten hair with the sun unless you want a very short hair cut in the future.

In the end, hair care is a very individualized and personal thing. Feel free to add your own flair and style to your hair care routine, but remember to include hair care principles that will benefit your hair and avoid those that damage it. Michael Barrows' website gives great advice for good hair. Get your free ebook packed with hair style and hair care tips and advice, visit http://www.great-hairstyles.com