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Integrated Block Exam –V

Endocrine and Reproductive Block
PAHS

Complied by:
Sundram Mahaseth (962)
9th Batch (2018/2019)

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Integrated Block Exam –V

Endocrine and Reproductive Block
PAHS

Multiple Choice Questions (MCQs)

1. A 31 years old lady presented to Gynecology OPD with chief complaint of menorrhagia since 4 months.
On per vaginal examination, the doctor noticed a bulky uterus in abnormal axis. What is the normal axis
of the uterus? (=B)
a. Retroverted and antiflexion
b. Anteverted and antiflexion
c. Anteverted
d. Retroverted

2. A 25 years old primi, was admitted to Obstetric ward of Patan Hospital with complaint of severe left
hypochondrium pain with abrupt onset since 6 hours. The treating doctor made the diagnosis of Ectopic
pregnancy. Which is the most common site for the fertilized ovum to get implanted? (=C)
a. Ovary
b. Round ligament
c. Ampulla of fallopian tube
d. Internal os of cervix

3. A 45 years old male presented to surgery OPD with complaint of a lump in his scrotum along with
sensation of heaviness since 7 months. he also noticed lumps on his abdomen since 2 months. he is
utterly horrified thinking he has cancer. The doctor suspected it to be testicular tumor and the swellings
on his abdomen are enlarged lymph nodes due to metastasis of tumor. What are the draining lymph
nodes of testes? (=D)
a. Inguinal lymph nodes
b. Sister Mary Joseph lymph node
c. Virchow’s node
d. Para-aortic lymph nodes

4. A 28 years old man with history of Road traffic accident has findings of pelvic bone fracture with internal
organ damage. On examination, the muscles of pelvic diaphragm were torn in the levatorani. Which of
following muscle is not a part of levatorani?(=C)
a. Pucococcygeus
b. Ileococcygeus
c. Coccygeus
d. Puborectalis

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5. A 61 years old gentleman diagnosed with Parkinson’s disease is under Metoclopramide since many
years. Recently, he was brought to the hospital by his son with symptoms of increasing size of breast.
The doctor counseled the patient’s son that this is because of the long-term use of Metoclopramide and
that a particular hormone is responsible for causing the increase in breast size. Which organ is
responsible for secretion of this hormone?(=C)
a. Adrenal gland
b. Thyroid gland
c. Anterior pituitary
d. Posterior pituitary

6. A 2nd year medical student who is appearing for his Basic Science End exam is having palpitations, cold
extremities, anxiety and nervousness. He knows that he has these symptoms because the
catecholamines are on action. Which layer of adrenal gland secretes this hormone?(=D)
a. Zonaglomerulosa
b. Zona fasciculate
c. Zonareticularis
d. Adrenal medulla

7. A medical student studies the function of pituitary gland and realized that the hypothalamus is also
equally important in controlling the feedback system of many hormones in the body. Which structure is
responsible for relaying the information from the hypothalamus to the pituitary?(=D)
a. Superior hypophyseal artery
b. Supra-otic nucleus
c. Posterior lobe of pituitary
d. Hypothalamic hypophyseal portal system

8. Thyroid gland is lined by simple cuboidal follicular epithelium and that the lining epithelium and
follicular size depend on the state of activity of gland. What happens to the epithelial lines of thyroid
when they are not actively secreting?(=C)
a. Small follicles lined by tall cuboidal/ columnar cells
b. Small follicles with flattened epithelial cells
c. Larger follicles lined by flattened epithelial cells containing large amount of stored colloid
d. Larger follicles with empty cells

9. A 3 year old boy was brought by his mother due to a swelling on abdomen and a empty scrotum. This
condition was explained by the doctor as cryptoorchidism. The doctor explained the mother the normal
route of testes, where the testes herniate through a fold of peritoneum to reach up to scrotum. This fold
also contributes in formation of inner layer of testes. What is this fold?(=A)
a. Processusvaginalis
b. Tunica albuginea

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c. Internal spermatic cord

d. Hasselbach’s triangle

10. The anterior lobe of pituitary gland secretes many essential hormones. During the embryological
development, it originates from a source, which is called??(=A)
a. Rathke’s pouch
b. Wolffian duct
c. Pharyngeal hypophysis
d. Mullerian duct
11. What substance does aldosterone directly regulate the concentration of?
a. Potassium
b. Phosphorus
c. Sodium
d. Calcium
12. What hormone does the pancreatic alpha cell secrete?
a. Insulin
b. Somatostatin
c. Glucagon
d. Somatotropin

13. What stimulates the release of ADH from the posterior pituitary gland?
a. Increased blood levels of Sodium
b. Decreased blood levels of sodium
c. Increased blood levels of glucose
d. Decreased blood levels of glucose

14. Sperms are produced at a temperature that is:

a. Higher than body temperature
b. Immaterial
c. Lower than body temperature
d. The same at the body temperature

15. Of the following male organs which one is considered primary sex organ:
a. The ejaculatory ducts
b. The penis
c. The prostate gland
d. The testes

16. Which one of the following is one of the major targets of parathyroid hormone?
a. Intestines

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b. Brain
c. Heart
d. Liver

17. In females the effect of follicle stimulating hormone is:

a. The final maturation of the ovarian follicles and the release of oestrogen
b. The early maturation of the ovarian follicles and the release of oestrogen
c. The final maturation of the ovarian follicles and the release of progesterone
d. The early maturation of the ovarian follicles and the release of progesterone

18. The secretion of aldosterone is caused by :

a. angiotensin II
b. ACTH
c. epinephrine
d. insulin

19. Which hormone causes increased BSL, increased protein anabolism & increased plasma FFA?
a. Cortisol
b. Parathyroid hormone
c. Growth hormone
d. Insulin

20. How does insulin act?

a. Voltage gated ion channels
b. Tyrosine kinase membrane receptor
c. Nuclear receptor
d. G protein

21. A young age female who has history of diabetes mellitus came with complain of pruritus, erythema,
dysuria and odorless, thick curdy white discharge. What is your diagnosis?
a. Vulvovaginal candidiasis
b. Trichomoniasis
c. Bacterial Vaginosis
d. Cervicitis

22. A young age female who has history of diabetes mellitus came with complaint of pruritus, erythema,
dysuria and odorless thick curdy white discharge.In which medium do you culture vagianal discharge?
a. Blood
b. SDA

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c. Kupferberg medium
d. Mcconkey agar

23. Which herpes simplex virus causes oral and ocular lesion?
a. Type -1
b. Type-2
c. Type-3
d. Type-4

24. Which herpes simplex virus cause genital lesion?

a. Type -1
b. Type-2
c. Type-3
d. Type-4

25. A female was diagnosed to have Bacterial vaginosis. On microscopic examination multiple clue cells
were seen. What is clue cell?
a. Gram positive and gram negative rods
b. Vaginal epithelial cells and gram positive rods
c. Vaginal epithelial cells, gram positive, gram negative and gram variable rods
d. Candida species

26. 25yrs old primi on her first ANC checkup found to be positive for VDRL. What is the next test done to
confirm the diagnosis?
a. ELISA
b. MHA-TP
c. FTA-ABS
d. TPHA-abs

27. CMV is transmitted through urine, saliva, tears, blood, semen, cervical secretion and breast milk. What is
the lab finding of this case?
a. Enlarged intra nuclear inclusion bodies with Owl’s eye appearance
b. Orphan anne eye appearance
c. Meatball and spaghetti
d. Hyphae

28. What is the normal vaginal flora?

a. E.coli
b. Gardenerellavaginalis
c. Mycoplasma
d. Lactobacillus

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29. A 30 years old lady on oral contraceptives came to the gynecology OPD with the complaint of itching,
irritation and erythema. On further enquiry she also had frothy purulent discharge which is grey to
green yellow color. What is the most likely diagnosis?
a. Vulvovaginal candidiasis
b. Trichomoniasis
c. Bacterial Vaginosis
d. Cervicitis

30. What is the confirmatory test for HIV AIDS?

a. PCR
b. Enzyme Immuno Assay (EIA)
c. ELISA
d. Western blot

31. An uncircumcised 49-year-old male presents with the sudden onset of severe pain in the distal portion
of his penis. The emergency room physician examines the patient and finds that the foreskin is retracted
but cannot berolled back over the glans penis. The ER physician calls the urologist, who performs an
emergency resection of this patient’s foreskin. What is the correct diagnosis for this individual’s
condition?
a. Balanoposthitis
b. Omphalocele
c. Paraphimosis
d. Phimosis

32. Which of the following testicular tumors is most radiosensitive?

a. Seminoma
b. Embryonal carcinoma
c. Choriocarcinoma
d. Immature teratoma

33. A 27-year-old male presents with a testicular mass, which is resected and diagnosed as being a yolk sac
tumor. Which one of the listed substances is most likely to be increased in this patient’s serum as a
result of being secreted from the cells of this tumor?
a. b. fetoprotein (AFP)
b. Alkaline phosphatase
c. human chorionic gonadotropin
d. Prostate-specific antigen (PSA)

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34. Multiple small mucinous cysts of the endocervix that result from blockage of endocervical glands by
overlying squamous metaplastic epithelium are called
a. Bartholin’s cysts
b. Chocolate cysts
c. Gartner’s duct cysts
d. Nabothian cysts

35. Which one of the listed endometrial abnormalities has the greatest risk of developing into endometrial
cancer?
a. Simple hyperplasia
b. Complexhyperplasia
c. Atypicalhyperplasia
d. Cystichyperplasia

36. A 25-year-old woman in her fifteenth week of pregnancy presents with uterine bleeding and passage of
a small amount of watery fluid and tissue. She is found to have a uterus that is much larger than
estimated by her gestational dates. Her uterus is found to be filled with cystic, avascular, grapelike
structures that do not penetrate the uterine wall. No fetal parts are found. The most likely diagnosis for
this abnormality is
a. Partial hydatidiform mole
b. Complete hydatidiform mole
c. Invasive mole
d. Choriocarcinoma

37. An 8-month-old infant is being evaluated for growth and mental retardation. Physical examination
reveals a small infant with dry, rough skin; a protuberant abdomen; periorbital edema; a flattened,
broad nose; and a large, protuberant tongue. Which one of the listed disorders is the most likely cause
of this infant’s signs and symptoms?
a. Graves’ disease
b. Cretinism
c. Toxic multinodular goiter
d. Toxic adenoma

38. A 52-year-old female presents with nausea, fatigue, muscle weakness, and intermittent pain in her left
flank. Laboratory examination reveals an increasedserum calcium and a decreased serum phosphorus.
The patient’s plasma parathyroid hormone levels are increased, but parathyroid hormone–related
peptide levels are within normal limits. Urinary calcium is increased, and microhematuria is present. The
patient’s abnormality is most likely caused by
a. Primary hyperparathyroidism
b. Primary hypoparathyroidism

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c. Pseudohypoparathyroidism
d. Secondary hyperparathyroidism

39. Histologic sections of the thymus that reveal reactive follicles with germinal centers are diagnostic of
a. Chronic inflammation
b. Thymic hyperplasia
c. Thymic hypoplasia
d. Thymoma

40. A low TSH, high T4, and high T3 suggests

a. Hyperthyroidism
b. Nonthyroidal illness (sick euthyroidism)
c. Estrogen therapy
d. Subclinical hypothyroidism

41. A 20 old man comes to his physician for health check up. On examination, left testis cannot be palpated
in the scrotum. The patient has no major illnesses and has normal sexual function.
Which statement regarding counseling of his condition is most appropriate? (k=d)
a. This is an outcome of childhood mumps infection
b. This is a common finding in more than half of all men
c. You will be unable to father children
d. You are at increased risk of developing testicular tumour

42. A patient was recently diagnosed as a case of Type II diabetes mellitus.

Which laboratory test is best to monitor long term disease control in this patient? (k=c)
a. Fasting blood glucose
b. Glycosylated albumin
c. Glycosylated haemoglobin
d. Random blood glucose

43. A 35 year old woman has had dull, constant abdominal pain for 6 months. On ultrasonographic
examination, right ovarian mass measuring 7x5cm is noted. Ovarian cystectomy was done. Microscopic
examinatation showed cyst wall lined by keratinized stratified squamous epithelium with underlying
adnexa along with thyroid tissue and cartilage.
What is your diagnosis? (k=c)
a. Choriocarcinoma
b. Dysgerminoma
c. Mature cystic teratoma
d. Mucinous cystadenoma

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VIVA Questions
1. Name the structures which form the outlet of perineum.
2. Name the layers of scrotum
3. Name the parts of male urethra
4. Name the parts of fallopian tube
5. What are the hormones secreted by the anterior and posterior pituitary gland?
6. what are the roles of progesterone and estrogen in female menstrual cycle?
7. Iodine metabolism?
8. Thyroid hormone synthesis?

1. What are the clinical features of Bacterial Vaginosis?

: At least three of the four following characteristics
 Discharge: homogenous, adherent, white-grey, foul smelling
 Vaginal fluid pH:>4.5
 Postive whiff Test (Amine test): Release of fishy amine odour from the vaginal fluid when mixed
with 10% KOH solution.
 Presence of clue cells: visible microscopy

2. What are the testes done for syphills?
: Nonspecific – VDRL and RPR
Specific – TPHA, FTA-Abs

3. A 45 year old obese male presented with polyphagia, polydipsia and polyuria. Lab studies showed
fasting blood glucose level of 145mg/dl (NV: 60-110 mg/dl). Urine analysis showed glycosuria and
proteinuria but no ketonuria.
1. Which cell type would you expect to be depleted in the islets of Langerhans? (1)
2. What is the pathogenesis of this condition? (2)
3. What are the three long term complications of this condition? (0.5x3=1.5)
4. What are the renal lesions that this patient may develop in future? (0.5x3=1.5)

Problem Based Questions (PBQs)

PBQ: AIDS
1. Mechanism of the replication, investigation and Its management.

PBQ -1
You plan to the understand the current early marriage in current VDC of Nawalparashi. The demographic
composition is given in the table below.
(table: age, midyear population, married population male and female separate. Slide ma ni cha tei table ho)
1. Calculate the age sex specific ratio for male and female between the age group 10-14. Interpret the
result.

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2. On further analysis , you found out that the girl with early marriage had poorer nutrition status. You
decided to speard awareness among those with early marriage. What are two communication channels
through mass media which you would like to use. ( TV, radio)
3. Components of nutrition by UNICEF- GOBIFFF
4. State any three condition for legal abortion according to the law of Nepal

PBQ 2
As a district health office posted in rural district, you would like assess health management system.
1. What are the various functions of health management system ( tyo 10 points corbid haru)
2. Mention any five temporary contraceptives devices.
3. Mentions three conditions when breach of confidentiality may be justifiable.

PBQ 3
A 37 yr old trunk driver brought to OPD with c/o of difficulty in passing urine . On further inquiry he said that
his father is diabetic and is on oral hypoglycemic drug.
1. What further history would you like to ask the patient. (polydysphagia, polyuria ask if there is pain during
micturation, oligouria, symptoms related to urine mainly)
2. What is the likely organism seen in gram stain. Mention its two important virulence factor (question ma
intracellular gram negative diplococci thiyo. So it is N. gonorrhea)
3. Mentions different zones of prostate with the percentage of their contents.
4. What criteria should be used for diagnosis of diabetes mellitus. ( mention 3)
5. Explain the role of insulin in carbohydrate and fat metabolism.
6. What are the newer analogues of insulin and their advantages.( greater stability, consistency, better
modified pharmacokinetics)
7. What are the three lesions encountered in renal complications seen in diabetes mellitus.

PBQ 4
A 45 yr old lady presented to opd with excessive increase in weight , increase mass in neck . on inquiry she
also gave history of heat intolerance.
1. What other features in history would you like to explore.
2. How will you confirm that the above mentioned mass is from thyroid? ( pre tracheal fascia)
3. What is the pathogenesis of development of exophthalmous in this condition.
4. What are the precursor of t3 and t4. How are they formed??
5. Mention four effects of t3 anf t4 in nervous system

Further investigation was done, ultrasound of neck. Diffuse bilateral thyroid gland noted.
6. Describe the development of above mentioned gland (thyroid). List four congenital anomaly related to this
gland.
7. What is the drug of choice for the treatment of this patient . Describe its mechanism of action. (
methimazole)
8. What is the imporantance of adjuvant therapy in this case. Which drug is added as adjuvant therapy in this
case. (propanolol)

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PBQ 5
A 30 yr old lady presented with the complain of no menstruation for 6 weeks along with nausea, vomiting and
breast discomfort. She wants confirmation for her pregnancy and has come to antenatal clinic.
Beta hcg test positive
1. What structure secrete above mention hormone at this stage of pregnancy. (synctiotrophoblast).
Mention the function of this hormone.
2. Mention one condition suggestive
a. If the hormone fails to rise at appropriate level
b. If the level of hormone is raised/ elevated marked
3. What are the two angles of uterus that determine its normal position . Mention two important
ligaments maintaining these angles.
4. Mention two histological changes seen in breast during pregnancy
5. What are the types of fibroid according to its location.
6. Mention three complications during pregnancy due to this pathology (fibroid).
7. What further history would you like to focus on while asking about the obstetric history?
TORCH panel test done which was reactive for toxoplasmosis gondii for which she was treated.
8. What other infections does this panel test help to diagnose?
9. Name the infective stage of this parasite. How will you diagnosis the congential abnormality due to this
parasite?
10. Mention four drug that can be used to delay labour in this case.

PBQ 6
Mr. karun khadka, 55 yr old retire soldier came to OPD with the complain of muscle ache and decreased
libido. Doctor suggested something is wrong with adrenal gland of this patient and provisional diagnosis of
cushing syndrome was made.
1. Name the right sided relation of above mentioned gland (ans-stomach). Mention its arterial supply
and venous drainage( adrenal gland).
2. How lab investigation had been sent to diagnose the above mentioned syndrome.
3. Regulation of aldosterone. Write down the preliminary precursor, biosynthesis and how does this
hormone mediate in target cells.
4. What are the valid investigation for HIV? Mention three confirmatory test to diagnose HIV.
5. Rational of tapering dose of prednisolone
6. What is importance of using prednisolone for backpain.
7. What further history do u need?

Community Health Sciences (CHS)

1. Wealthflow theory
2. Standardization
3. Fecundity
4. Which part of the body is norplant inserted?
5. Location for inserting intra uterine contraceptive
6. When should be the emergency contraceptive pill be taken? (soon after unprotected intercourse upto
120 hours)
7. Which part of female reproductive tract does the female condom protect?

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8. Which should be the minimum content of iodine in salt? (15ppm)

9. contempletation
10. quarantine was created in venice. How mand days it require for ship to wait? (40 days)
11. one of the PHC is health facility must be shared equally by all irrespective of their ablility to pay. Which
principle does this indicate? ( equitable distribution)
12. barefoot doctors in china. Likewise in Nepal? FCHV
13. mother and baby are provided with clothes by government of Nepal. What is that called? (nyano jhola)
14. sustainable development goal- which is the health related goal? 3
15. according to IHR, there are four disease which must be informed to WHO. Which one of these falls
under that? (wild type polio)
16. you have recently visited to Nepal from mexico. The officers at tribhuvan international airport limits ur
travel because of chance of u acquiring swine flu. What is the term called?( quarantine)
17. member countries of WHO has been categorized under various regions. How many regions are there? 5
18. UNICEF started program for maternal and child health, full supplementation of nutrition. What is that
program called? (GOBIFFF)
19. Health care model in cuba where government pays through taxes. What is the model called? Beveraidge
20. Which level is the program FCHV implemented? ward
21. Garphical representation in the form of flowcharts, diagrams. What is the method called?

ICM (Introduction to Clinical medicine)

1. 27.A 40 yr old diabetic for general checkup. His weight is 67 kg and his height is 104 cm. calculate his
BMI.
2. 28. a 16 yr child presented with cough. On rountine examination, the doctor fould that the child’s
length was less than -2 S.D. what does this suggest? Stunting
3. 29. 23 yr girl with DM referred to eye clinic for ocular evaluation. What can be seen in focus?
Retinopathy
4. 30. a 28 yr women present with slighty tender swelling infront of her neck. She also complaints of
feeling very hot and palpitations. Which condition? Graves disease
5. 31. a lady with goiter whose mother had hypothyroidism. She wants to check wheter she has the
same. what feature in the history would u like to ask? Cold Intolerance
6. 32. a 48 yr old women presented with goiter. Her mother died of thyroid cancer at the ag of 50 and she
was very anxious if she has the same condition. What features in the history would be most
concerning?- hoarseness of voice
7. 33. a 38 yr old women with overweight. The doctor checks her waist circumference. What is the cut off
value? 88 cm
8. 34. a 23 year old pregnant lady with three miscarriage in past but no living children. G4P0A3

Anatomy

1. a male child is found to have a anamoly of penis in which the external urethral orifice is in ventral aspect
of glans penis. What is the cause of this condition? Failure of fusal of urethral folds

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2. lining of fallopian tube- ciliated columnar epithelium

3. a man complaints of loss of sensation over right scrotum and medial right thigh. Which nerve is likely to
be affected? Genitofemoral

4. a 15 yr old boy found to have only one testis, the case of undestended testis. Which structure help this
to passage from abdomen to scrotum? Gubernaculums
5. after hysterectomy, 52 years old female presented with the pain in flank, abdominal distension, fever
and chills. Retrograde urethral… where must have been the urethra intentionally cut?- transverse
cervical ligament

1. what are the bony landmarks that lie in the same plane while holding pelvis in anatomical position.-
anterior superior iliac spine and anterior aspect of pubis
2. a 25 yr old pregnant for pelvic muscle floor examination. Which muscle lies there? Piriformis
3. posterior boundary of ovarian fossa- ureter
4. lady with enlarged superficial linguinal lymph node on left thigh and external genital. MRI shows mass in
uterus . which part of uterus is most likely to be involved with the mass? Cornu
5. which artery supplies paired erectile tissue of penis? Deep artery of penis

6. ejaculatory ducts open in which part of prostate?

7. puededal nerve block- vaginal examination. Landmark found. What is that landmark? Ischial spine
8. during su
9. development origin of non keratinized epithelium of vagina. Endoderm of urogenital sinus only
10. gubernaculum is a fibrous muscular band which extend from developing gonads to the labio scrotal
swellings. What are the derivatives of this in female? Round ligament of uterus and ligament of ovary

11. during the fetal life the adrenal corten lacks its typical trilayer morphology which is seen in adult gland.
Which layer is it to develop after birth? Zona reticularis
12. during pratical, you are asked to find structure beside recurrent laryngeal nerve. Which structure is
asked to locate? Parathyroid IV
13. during menstruation, which artery sheds? Spiral arteries
14. extavagination of urine due to injury to spongy urethra. What is the most common site where urine
extravaginates in this case. –scrotum
15. 62 yr old male with slow growing tumor in deep perineal space. Which structure is most likely to be
injured? Bulbourethral gland

16. benign tumor in gap between ……. Which structure is compressed due to this tumor? Dorsal vein of
penis
17. multiparpus women develops weakness of urogenital diaphragm. Which muscle is present in this
diaphragm?- sphincter urethrea

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Biochemistry

1. steroid hormones interacts with specific receptors – transcription for specific genes
2. estriol measurement is used in high risk pregnancy which is formed after metabolism of estradiol and
estrogen. It is most abundantly excreted in urine. Which metabolic pathway is involved in its
formation?- 16 alpha hydroxylase
3. primary characteristics of leydig cells.- excretion of testerone
4. the adrenal medulla secretes hormone known for fight of flight response. Which is this hormone?
Epinephrine
5. which hormone antagonizes action of insulin? Cortisol and epinephrine
6. Women with complaint of tiredness and weight gain. Doctor suspects hypothyroidism. What parameters
used to detect her condition? TSH
7. a 35 yr old man had not taken food for 5 days. On 6th day, he was brought to hospital. Blood sugar was
normal this may be due to glycogenesis. Which hormone takes part? Cortisol

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Intergrated Block Exam (IBE)-V

4th Batch, PAHS

Multiple Choice Questions

1. A 23 year old girl with 5 year history of DM 2 presented to opd for eye check up: what is you main
concern regarding the check up ans:retinopathy
2. which zone of Adrenal gland develops after birth?Ans: zonareticularis (Anatomy)
3. 62 year male presented with a slow growing tumor in the perineal space. Which structure is likely to get
injured? Bulbourethral Gland
4. OCP how long?.... 120 hour after intercourse
5. A boy comes to opd with weight of 67.5 and height of 150 cm calculate BMI
6. A female visits opd with complaints of amenorrhea then she was prescribed metformin whats is the
main adr of this drug?? GI effects
7. amenorrhea lai metformin prescribe??
8. there is urine evagination due to injury to spongy urethera.. What is the most likely site for
accumulation of evaginated urine?? Scrotum
9. By mother 13months child presented with absence of testis in scrotum condition called??
10. 26 yr old female neck swelling, palpitation, sweting...doc suspects graves disease. which clinical
presentation will make him sure ?? ANS >> PROPTOSIS

11. Pt with HIV willing to undergo antiretroviral theraphy for which he chooses Protease Inhibitor (PI)...so
which drug (which is a protease inhibitor itself) will act as booster i.e enhance other PIs) ?? ANS
RITONAVIR
12. Facility- shared equally by all the people irrespective of the ability to pay Ans: Equitable distribution
13. Mr pandit came to opd after unprotected sexual intercourse and asked for emergency contraception.
Doctor prescribed emergency OCP. What is the max time effectiveness of the drug? - 120 hrs
14. A 26yr old male smoker is trying to quit smoking. Which stage is he in? Contemplation stage
15. What antigen is detected first in HIV infection? -P24
16. During delivery, medain episiotomy was done but tearing occured furher ahead..which structure is
most probably damaged? External anal sphincter
17. Immediately after meal theres rise in insulin level in body..what is the moa of this hormone? Closure of
ATP dependant potassium channel
18. Mr.Pandit came 2 opd with poor libido. Which drug should be given.-sildenafil
19. Givernaculum derivative in female: round ligament of uterus and ligament of ovary
20. Which is the most imp. str involved in descent of testis?- Gubernaculum

21. Mr.karki injured his scrotum in a scooter accident n came to opd with complain of loss of sensation on
scrotum,which nerve supplies this scrotum: Genitofemoral nerve
22. A female visits opd with complaints of amenorrhea which was then diagnosed with polycystic ovary
disease then she was prescribed metformin whats is the main adr of this drug?? Gi effects
23. Ulipristil 30 mg single dose - the emergency ocp
24. A 48 yr old men came with goitre in patan hospital. She gave a history of her mother died of thyroid
cancer .She is concern of that what history differenciate this. :Horsness of voice.

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25. A person come to opd with complain of lacrimation and salivation when riding bike in dusty road. And
doctor suspect it as a allergy .which of the drug is drug of choice for that condition.
26. Ans :Dexomethacine
27. iodine fortification. ans.15 parts per million
28. toxoplasma gondi reservior ans. Pig/ cat
29. 24 YRS OLD PREGNAT LADY, 3 MISCARRIAGE in past, no living children..obstretic history??? :G4P0A3
30. Health insurance system in cuba- Beveridge model

31. Spiral artery sheds off- during induced abortion

32. biological ability to reproduce or remain by using highly effective means of contraception. which term? :
fecundity
33. a male came to opd wid inguinal lymoh node pus discharge, pus collected and giemsa stain was done
and inclusion bodies were found... what is likely organism??---chlamydia trachomatis
34. UNITED NATION CHILDREN EMERZENCY FUND (UNICEF) components are family health, family planning
.... What is initiative for this? Ans...GOBIFFF
35. Patient came to opd with complain of easily fatigue, hoarseness of voice, cold intolerance, weight gain.
What might be the cause of these symptoms? Ans. Hypothyroidism
36. Which cancer can be protected by OCP? -Ans. Ovairan
37. Quarantine period for ship -40 days
38. ans-primary chronic adrenocortical insufficiency Yesei ko character haru deko theoo question ma, ani
what is the condition called ???
39. Paid by government through tax....ans Biveridge
40. hypercholestermia and hypertriglycerdemia are side effect of?? Ans: Ritonavir

41. 30 y/f wid vaginal discharge n lower abdominal pain...concerned of cervical cancer...test?? ans...Pap
smear test
42. During your rotation to HP, you are planning to an organize an awareness program among married
women about the use of Norplant in a VDc of Makwanpur. What is the site of norplant implantation?
Ans: Medial side of arm
43. A 32 Year old male presented to the OPD of Patan Hospital with the complaint of suppurative Inguinal
lymphadenitis. Pus was collected and giemsa stain was ordered.The patient was later diagnosed with
lymphogranuloma venarum. Which serovar of the responsible organism causes the disease? Ans:
Serovar L1, L2 and L3
44. Structure found in the posterior border of thyroid gland and dorsal to recurrent laryngeal nerve? Ans-
Parathyroid IV
45. .....verumentum opens where? ans: ejakulatory duct
46. OCP - decreases risk of ovarian cancer
47. lining of vagina is derived from ? Ans : endoderm of urogenital sinus
48. Blood supply of penis( corpus cavernosum and corpus spongiosom) --- deep penile artery
49. Rupture of urthra extravasation of urine into –Scrotum
50. Where to place intra uterine device (IUD)? Ans )above the cervix inside uterus

51. A person age...came to OPD with complain of papular skin rashes, mucosal lesion in the oropharynx and
condylomata at the mucocutaneous junction.which type syphilis ? ...Ans secondary
52. Term for women have capacity to bearing children but can prevent by using contraceptives—nuptiality

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53. Biosynthesis of testosterone- leydig cells in testicles

54. confirm of thyriod cancer- ask patient to sallow saliva if it moves along then ....pbq....
55. Ciliated colmunar epithelium - fallopian tube
56. Infective stage of toxopasma gondii-- tachyzoites...bradyzoites..oocyst...
57. In developed country there is emerging of new concept of wealth transfer theory. Where wealth is
consider as information.what factor most describe it? Ans..transfer of wealth from children to parents
58. 35years old man hadn't eat for last 5 days. He was brought to hospital. His blood glucose level was quite
normal. It is supposed it is due to gluconeogenesis which involves many hormons. Among them
intracellularly acting hormone is
Ans...cortisol (steroids)

Problem Based Questions (PBQs)

1. What are the three conditions for Abortions?

2. Condition when the Breach of confidentiality is expected
3. History of DM.
4. History of Hyperthyroidism
5. Methods of Temporary contraception’s with types?
6. Write the developmental process of Thyroid gland and it’s congenital.
7. How do you confirm the inflammation is of Thyroid gland?
8. What is the rationale of Adjuvant therapy and name the drug?
9. Appropriate drug for Multinodular Goiter and it’s MOA.
10. Pathogenesis of Exophthalmos?
11. How are T3 and T4 are formed? Effects of T3 and T4 on Nervous system?
12. What are the actions of insulin on carbohydrates and fat metabolism.
13. What are newer analogues of insulin.
14. What are the Renal lesions occurring as the complication of DM?
15. Rationale of Tapering Prednisolone and its advantages?
16. What are the Angles of Uterus? Name two ligaments supporting position of uterus.
17. What histological changes occurs during pregnancy?
18. MOA of Ritodrine. Name other drugs related to it.
19. What produces HCG hormone? What is the function of HCG.
If HCG fails to rise appropriately?
If HCG markedly elevates?

20. Three pathologic complications during pregnancy?

21. What are the zones of prostate, their percentage and contents.
22. Patient is diagnosed as Cushing syndrome.
What is the arterial and venous blood supply of left sided of above gland?
Which hormone is Elevated?
Write the Regulation of that hormone.
23. What are the 3 types of confirmatory test for HIV?

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24. Except T. gondi, what other diseases are caused by TORCH panel?
25. Lab diagnosis of Neisseria gonorrhea?
Write it’s virulence factors.
What samples are sent to lab?
Culture media?

Practical/OSPE/OSCE

Station 1: PHARMACOLOGY VIVA

1: Gnrh agonist functions
2: insulin therapy complications
3: what is the rational of giving clomiphene citrate in PCOD?
4: classification of hypoclycemic drug
5: Tocolytics.
6: antiretroviral classification with examples.
7: Action of oxytocin on uterus...
8: antithyroid drugs
9: oral hypoglycemic drugs classification

Station 2: Prescribe for a 50 old male with DM type II.

Station 3: Council the patient came for OCP.

Station 4: Rest

Station 5: PHYSIOLOGY
1:Which hormone is responsible is for urine test positive in case of pregnant
2: Which structure secrete it.
3: what is the mechanism for ammonrrhoea in pregnant?
4: hormone secreted by placenta
5:

Station 6: PHYSIOLOGY VIVA

Station 7: leiomyoma gross

1: which organ is this.
2: 3 gross features
3: types according to location (intra mural, submucosal, sub serosal)
4: Diagnosis
5: malegnency form of this disease (leiomyo sarcoma)

Station 8: Gross Identification (hurthel Cell adenoma/ follicular adenoma)

1: Identify the given specimen.

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1: Write 3 gross features of the given specimen?

2: Write 3 microscopic features?
3: What is your diagnosis?
5:

Station 9: PATHOLOGY VIVA

1: DM definition and classification
2: cryptorchidism defn
3: define carcinoma in situ. 2 virus responsible for cervix carcinoma
4: Test done in case of pheochromocytocroma
5: Endometrosis defn and difference from adenomyosis. complication
6: overian polyp
7: complete and partial mole
8: define graves disease
9: endometrial cyst
10:humanpalliloma virus 16 and 18, 1.teratoma 2.Dysgerminoma 3.hydratiform mole,types
and how will you manage, is it benign re malignant, chorionic carcinoma, Fibroids

Station 10: Microscopy (papillary carcinoma)

1: Write 4 microscopic features?
2: What is your diagnosis
3: what may be the causes?
4: Name other 3 types of papillary carcinoma.
5: 3 varients of papillary carcinoma
6: risk factors

Station 11: Rest

Station 12: Anatomy gross

1: fallopian tube identify and write it parts
2: identify which side testis and write 3 layers and venous drainage
3: vas defference its embryology
4: corpus spongiosum and its covering
5: sacro tuberous/ spinus ligament and coccygeous muscle

Station 13: ANATOMY VIVA

1: layers of scrotom?
2: lebel hip bone?
3: Broad ligament parts.
4:Pudendal canal
5: Deep n superficial canal n their contents
6: Embryological development of vagina
7: teratoma
8:pituitary embryology,

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Station 14: Microscopy

1: pituitary : 4 character
2: epidydimis 4 characters

Station 15: BIOSTATISTICS’

direct and indirect standardization

Station 16: Rest

Station 17: MICROBIOLOGY VIVA

1: How hiv evades the immune system?
2: Chlaymadia trachomatis,,,,CLUE cells,
3: Toxoplasma gondii nd infection in pregnancy
4: Chlamydia sp
5: Hiv ko coreceptor

Station 18: neisseria gonorrohoeae

Station 21: RPR

Station 22: Glucose tolerance test interpretation

Station 23: BIOCHEMISTRY VIVA

1: How goiter occur
2: posterior pituitary hormone and its action

Station 24: Perform colorimetry and interpret the result. find gkucose conc. using glucose peroxidase-
oxidase reaction

Station 25: Rest

Station 26: Take the history of patient came to hospital for Antenatal check up and lower abdominal
pain.

Station 27: Examine neack of a patient(thyroid examination)(don’t do general examination)

Station 28: growth chart. A boy came OPD ht. 50 cm. age:… wt….
1: plot ht and wt

Practical/OSPE/OSCE

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1. Prescribe in appropriate format for a 34 year old pregnant woman for hyperthyroidism.
2. Choose appropriate drug(s) from given strips and counsel the patient for Peptic Ulcer Disease.
3. Viva:
a. What is the rationale of combining Metronidazole and ……………………
b. What is the mechanism of action for different hormonal contraceptives? (more than one
mechanism)
c. What is the pharmacological basis of prescribing terlipressin in oesophageal varices.
d. Why should the long term use of corticosteroid therapy be terminated by tapering?
e. Hh
4. Identify the specimen : Kidney
a. What is your gross diagnosis? (2): Renal Cell Carcinoma
b. Write any two morphological features seen in the specimen
c. What are the 3 microscopic structures that are seen in this condition
d.
5. A 40 year old otherwise healthy female feels a small lump in the neck. Her physician palpates a firm,
painless 1.5 cm nodule in the right lobe of thyroid. Fine needle aspiration cytology is done and she
undergoes thyroidectomy. The slide is provided here.
a. What is your diagnosis? (2) (Papillary carcinoma thyroid)
b. Write three identifying features? (0.5x3=1.5) (papillae with fibrovascular cores, papillae lined
by tumour cells, nuclear clearing, grooving and intranuclear inclusions, psammoma bodies.)
c. Which gender is commonly affected by this condition? What is the risk factor for this condition?
(1+1.5=2.5) ( Female, exposure to ionizing radiation.)
d. What are three other carcinomas seen in this organ? (0.5x3=1.5) (Follicular carcinoma,
Medullary carcinoma, Anaplastic carcinoma.)
e. Which is the main route of metastasis in this condition? (1.5) (Lymphatic spread)
f. What will be the prognosis of this patient? (1) (Excellent prognosis.)

OSPE:

A 40 year old otherwise healthy female feels a small lump in the neck. Her physician palpates a firm, painless 1.5
cm nodule in the right lobe of thyroid. A fine needle aspiration cytology is done and she undergoes
thyroidectomy. The slide is provided here.
1. What is your diagnosis? (2)
Ans: Papillary carcinoma thyroid
2. Write three identifying features? (0.5x3=1.5)
Ans: papillae with fibrovascular cores, papillae lined by tumour cells, nuclear clearing, grooving and
intranuclear inclusions, psammoma bodies.
3. Which gender is commonly affected by this condition? What is the risk factor for this condition?
(1+1.5=2.5)
Ans: Female, exposure to ionizing radiation.

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4. What are three other carcinomas seen in this organ? (0.5x3=1.5)

Ans: Follicular carcinoma, Medullary carcinoma, Anaplastic carcinoma.
5. Which is the main route of metastasis in this condition? (1.5)
Ans: Lymphatic spread
6. What will be the prognosis of this patient? (1)
Ans: Excellent prognosis.

Integrated Block Exam (IBE)-V…………….. Sundram Mahaseth