Medicine II Solved SEQ

Final Year MBBS
Medicine-II
Solved SEQ Papers
Collected & Solved By:
Dr. Faheem Abbas Bhatti
(KMC Batch-01)
Note: Errors & Omissions are highly appreciated.
9 th Semester 2015
➢ A 35 years old brought in OPD with history of asymmetrical
pain of small and large joints off and on since 1.5 years; low
grade fever. Since last 3 months she has fallen face and
oedematous feet and also complaints of red itchy Patch on her
cheeks and nose.
a) What is your diagnosis?
➢ SLE (Systematic Lupus Erythematosus)
b) What investigations will you perform?
➢ CBC = leukopenia, lymphopenia thrombocytopenia
➢ ESR raised but CRP normal
➢ Urea and creatinine and urine analysis – proteinuria
➢ Complement levels c3 and C4 decreased
➢ Autoantibodies: (ANA - anti neutrophilic antibody best
screening test, anti double stranded DNA - elevated highly
specific test, Anti smith antibodies - elevated)
c) What is your management plan?
➢ There is no cure of SLE so control the symptoms
➢ General measures: Avoid Sun Exposure, Wear Protective
Clotting Sunglasses and Sun Screen
➢ Specific measures: NSAIDs and analgesics for arthritis,
Corticosteroid cream for skin rashes, Antimalarial drugs
(hydroxychloroquine), Cytotoxic drugs (Azathioprine and
Cyclophosphamide), Mycophenolate to treat lupus nephritis
w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
9 th Semester 2015
➢ A young boy 20 years of age brought in emergency room with
history of your for 3 days headache and unconsciousness. On
examination signs of meningeal irritation are positive.
a) What are the differential diagnosis?
➢ Encephalitis meningitis brain abscess cerebral Malaria
b) What investigations will you perform?
➢ CT scan, MRI, lumbar puncture, PCR, CSF culture, Antigen
antibody titre
c) How will you manage this patient?
➢ If bacterial meningitis is suspected then empirical therapy
• Vancomycin and ceftriaxone
• If immune defect is present then add ampicillin
• Dexamethasone to reduce mortality and morbidity
➢ If encephalitis is suspected
• IV acyclovir, Famciclovir and Valacyclovir for HSV
• Ganciclovir and Foscarnet for CMV
➢ If brain abscess is suspected
• Stereotactic aspiration and surgical excision of abscess
• Pencillin metronidazole and ceftazidime
➢ If cerebral Malaria is suspected
• Artesunate drug of choice
• Flouroqunine
• Doxycycline
• Tetracycline/Clindamycin
9 th Semester 2015
➢ A 30 years old woman presented with
complain of weakness in her thighs. Her
blood pressure is 160/100 mm hg. There
is facial plethora, cervical fat pad, purple
striae abdomen and centripetal obesity.
Random blood glucose is 234mg/dl.
a) What is your likely diagnosis?
➢Cushing syndrome
b) How will you investigate to establish your
diagnosis?
➢Dexamethasone Suppression test
➢24 hour urinary free cortisol
➢Salivary cortisol
c) Name drugs for her medical
management?
➢Ketoconazole and metyrapone
9 th Semester 2015
➢ 15 years old boy complaining of
progressive numbness and weakness of all
four Limbs for last 3 days. Symptoms
initially started from feet and then
ascending pattern with involvement of
hands. Alert bilateral lower motor neurone
type facial palsy, power is 4/5 in upper
Limbs and 3/5 in lower Limbs, reflexes are
absent in upper and lower Limbs. Planters
are down going and mild sensory loss to
vibration.
➢Guillain barre syndrome (GBS)
b) Name two investigations to confirm your
diagnosis?
➢Lumbar puncture - best initial test
➢Electromyography - most accurate test
c) Name single treatment option?
➢IV immunoglobulin and plasmapheresiss
9 th Semester 2015
➢ A 50 years old male developed fatigability,
dyspnea and loss of appetite gradually. On
examination, patient is anemic with massive
splenomegaly. On lab investigations,
haemoglobin is 8g/dL, WBC count is
150,000/cumm and ESR 100mm in 1st hour.
a) What is the most probable diagnosis?
➢ Chronic myeloid leukaemia
b) Give differential diagnosis of this condition?
➢ Chronic lymphocytic leukaemia
➢ Polycythaemia vera
➢ Essential thrombocytopenia
➢ Primary myelofibrosis
➢ Leukemoid reactions
c) How will you treat the case?
➢ Imatinib best initial therapy
➢ If imatinib fails, then therapy is bone
marrow transplant
9 th Semester 2015
➢ A female of 20 years age complaining of polyarthritis, hair loss
and skin rash on the face for more than 3 years, recently is
complaining of right sided chest pain. On examination she is
anemic, has mouth ulcers, edema on feet is positive and
spleen is palpable. There is pleural rub on the right
hemithorax on chest examination.
a) What is the most likely diagnosis?
b) Name 5 investigations helpful in the diagnosis and
management?
➢ CBC = leukopenia, lymphopenia thrombocytopenia
➢ ESR raised but CRP normal
➢ Urea and creatinine and urine analysis proteinuria
➢ Complement levels c3 and C4 decreased
➢ Autoantibodies
➢ ANA (anti neutrophilic antibody) → best screening test
➢ Anti double stranded DNA elevated → highly specific test
➢ Anti smith antibodies → elevated
c) Name 5 drugs used in this condition?
1) NSAIDs and analgesics for arthritis
2) Corticosteroid cream for skin rashes
3) Antimalarial drugs → Hydroxychloroquine
4) Cytotoxic drugs (Azathioprine and Cyclophosphamide) for
Lupus Nephritis, CNS, Heart And Lung Involvement
Hemolytic Anaemia
5) Mycophenolate to treat lupus nephritis
9 th Semester 2015
➢ A young male of 30 years age, working in factory
at Karachi is brought in emergency with history of
fever, epistaxis, purpuric spots all over the body
and hematemesis. His BP is 90/70 mmHg. He
gives history of severe headache, fever body ache
1 year back lost for one week from which he
recovered. His blood CP shows pancytopenia and
his MP is negative.
➢ Dengue fever
b) Name three important investigations to help
diagnosis?
➢ CBC → leukopenia & thrombocytopenia
➢ IgG antibody titre → fourfold rise
➢ PCR → detection of dengue virus RNA
c) Name steps in the management?
➢ Treatment is symptomatic - no existing antiviral
are effective
➢ Aspirin should be avoided due to building
➢ IV fluid volume replacement
➢ Blood transfusion - patient in shock
➢ Preventive measures should be taken
9 th Semester 2015
➢ A young male of 20 years age presented with
ataxia, spasticity dystonic posture associated with
dysarthria. On examination, there is mild
jaundice, spleen is palpable. His lab shows altered
LFTs with AST to ALT ratio > 2.2. Blood CP shows
pancytopenia and viral markers are negative.
➢ Wilson disease
b) What is the reason for pancytopenia?
➢ Splenomegaly is the reason for pancytopenia
c) Name two important investigation for diagnosis?
➢ Decreased serum ceruloplasmin - best single clue
➢ Increased urinary excretion of copper
➢ Liver biopsy - increased hepatic copper content
d) Write the name of drugs used for this condition?
➢ Copper chelating agent - Penicillamine and
Trientine
➢ Oral Zinc
➢ Liver transplant
9 th Semester 2015
➢ A 40 years of age known case of DM 10 years,
now she complains of oedema office in feet with
the Ganesh and tingling in both feet. she also
complaints of reduced vision. Her blood sugar is
300 mg is on maximum dosage of oral
hypoglycemic drugs.
a) What is the diagnosis of complication she has
developed?
➢ Peripheral neuropathy along diabetic retinopathy
b) Name the investigation in this case?
➢ HbA1c, OGTT, Slit Lamp Examination, Sensory
System Examination, Urine Analysis, Urine
Albumin Creatinine Ratio
c) Name the steps in management.
➢ Strict glycaemic control
➢ Control Blood Sugar, Lipids, B.P, Stop Smoking
➢ For peripheral neuropathy - Tricyclic
Antidepressants, Anti Convulsant and Opioids
➢ For background retinopathy - refer to an
ophthalmologist for check-up and annual
screening
10 th Semester 2015
➢ A young lady of 23 years age having history of high
grade fever with rigors since last 3 days. Since
morning she become unconscious and passing little
amount of black urine. On examination she is
anemic jaundice, her liver and spleen are palpable.
She is in grade 2, and planters are bilateral upgoing.
➢ Cerebral Malaria with Black Water urine
b) Write two other differential?
➢ Q fever, Rocky Mountain spotted fever
➢ Enteric fever
c) What investigations you will carry to conclude your
diagnosis?
➢ CBC→ leukopenia & thrombocytopenia
➢ IgG antibody titre → fourfold rise
➢ PCR → detection of dengue virus RNA
d) How will you manage this patient.
➢ Treatment is symptomatic - no existing antiviral are
effective
➢ aspirin should be avoided due to building
➢ Volume replacement and blood transfusion -
patient in shock
➢ Preventive measures should be taken
10 th Semester 2015
➢ An obese male of 60 years age became unconscious early
in the morning with no movements on the right side of the
body with painful stimulus. On examination Babinskis sign
is positive on right side. He is known case of diabetes
mellitus and hypertension for more than 10 years, he has
history of Angioplasty three years back, his serum
cholesterol level is 250mg/dL.
➢ Stroke
b) What are the factors in this case?
➢ Non-modifiable: Age, gender, race, previous vascular event
➢ Modifiable: Hypertension, DM, Hyperlipidemia, Heart
disease, Smoking, Alcohol, Polycythaemia, Oestrogen
containing drugs
c) Discuss the management.
➢ Investigation: Non contrast CT scan, MRI, duplex
ultrasound of carotids, magnetic resonance angiography,
CT angiography, ECG, Echocardiogram, CBC, Lipid profile,
Blood Glucose, ESR, Serum Protein Electrophoresis
➢ Treatment: Perform ABCD, Maintain IV line, Tissue
plasmogen activators within 3hours, Aspirin, adequate
nutrition and hydration. Secondary prevention control BP,
Antiplatelets, Statin to lower cholesterol, Anticoagulant for
patient with atrial fibrillation, carotid endarterectomy if
carotid artery stenosis is >70
10 th Semester 2015
➢ 20 years old male come to neurology OPD with
complaints of tremor in both ends for last 7 months
and stiffness in Limbs for last 2 days. On
examination he is jaundice, hepatomegaly is
present. Neurological examination reveals
expressionless face, resting tremor of both hands,
cogwheel rigidity in upper Limbs and get is short
stepping. Patient brother also has same problem.
His LFTs shows total bilirubin 4.6mg/dL, SGPT 110,
HbS Ag-ve, anti HCV -ve.
a) What is the diagnosis?
➢ Parkinson's disease
b) List three investigation?
➢ CT scan, MRI, EEG
c) Name at least three drugs used in the management
of this disease?
➢ Pramipexole/Ropinirole - direct acting dopamine
agonists
➢ Carbidopa/levodopa - dopamine agonist
➢ Selegiline and Amantadine - COMT inhibitors
➢ Benztropine and Trihexyphenidyl - Ach stimulation
blocker
10 th Semester 2015
➢ A 30 years pregnant female is suffering from
continuous fever for the last 7 days. He has not
responded to chloroquine. On examination tongue
is centrally coated and spleen is just palpable.
Temperature 101F, pulse 90 beat/minute.
➢ Typhoid fever
b) Give three differential diagnosis?
➢ Malaria
➢ Acute gastroenteritis's
➢ Dengue fever
c) What investigations will you advise?
➢ CBC - leukopenia & thrombocytopenia
➢ Blood culture - most accurate test
➢ Stool culture - contain organism during 2nd and 3rd
week
➢ Widal test & PCR
➢ IgM dipstick test
d) How will you manage the case?
➢ Fluoroquinolones - drug of choice
➢ Cephalosporin & azithromycin - resistant cases
➢ Chronic carriers - Ciprofloxacin for 4 weeks +/-
cholecystectomy
10 th Semester 2015
➢ A 60 years old male developed polyuria with
polydipsia. After a few days he developed severe
bone pain, vertigo and spontaneous bone fractures.
His investigative shows, Hb 10, serum calcium 12 mg.
➢ Multiple myeloma
b) How will confirm the diagnosis?
➢ CBC - normochromic normocytic anaemia
➢ Protein electrophoresis - raised monoclonal
immunoglobulins spike
➢ BUN & creatinine - raised
➢ X-ray - for lytic lesion in bones
➢ Acidified urine analysis - raised Bence Jones Protein
➢ Bone marrow biopsy - > 10 plasma cells (diagnostic)
c) What is the treatment?
➢ Autologous bone marrow transplant - patients
(age<70)
➢ Melphalan & Prednisone - older patient
➢ Thalidomide & dexamethasone - for transplant
candidates
➢ Melphalan, Prednisone & Thalidomide - for non-
transplant candidates
➢ Loop diuretics - for hypercalcemia
➢ Bortezomib - for relapse myeloma
10 th Semester 2015
➢ A 40 years old lady diagnosed case of rheumatoid
arthritis is on anti inflammatory drugs since long
duration, now developed puffiness of body with
haemorrhagic spots on extensor aspects of upper
limb. She is complaining of generalized bone pain
difficulty in standing from squatting position.
a) What is your clinical suspicion for her condition?
➢ Cushing syndrome
b) What is the reason for her body ache and
difficulty in standing?
➢ Due to Myopathy & Osteoporosis
c) How will you manage her?
➢ Trans-sphenoidal surgical removal of tumor
➢ Pituitary radiotherapy
➢ Bilateral surgical adrenalectomy
➢ Glucocorticsteroid replacement therapy after
trans-sphenoidal surgery
➢ Lifelong glucocorticoid + mineralocorticoid
replacement if adrenalectomy performed
10 th Semester 2015
➢ A middle aged Lady complaining of difficulty in swallowing
and difficulty in continuous speech with sandy feeling in
her eyes. On examination her mouth is dry, erythematous
tongue with dental caries. Her eye is red with thick strands
at inner canthi.
a) What is the possible diagnosis?
➢ Myasthenia gravis
b) Name four conditions associated with it.
1) Limbo weakness
2) Ptosis
3) Facial weakness
4) Nasal quality speech
c) What tests are perform to diagnosis?
➢ Acetylcholine receptor antibody test → best initial test
➢ Tensilon (edrophonium) test → sensitive but not specific
➢ Chest X Ray & CT scan → to rule out thymoma/ thymic
hyperplasia
➢ Electromyography → single most accurate test
d) What is your management plan?
➢ Pyridostigmine/Neostigmine - initial therapy
➢ Thymectomy - no response to therapy & patients below 60
years
➢ If still no response then use immunosuppressive therapy:
➢ Steroids - initially if fails then add azathioprine,
cyclosporine & cyclophosphamide alternative
10 th Semester 2015
➢ A 45years old teacher in medical OPD with
complain of loss of weight despite increasing
appetite, his stool frequency has increased, while
during writing on blackboard he develops tremors
of hands. On examination he looks very anxious, is
pulse is 104 beats/min, BP: 150/80 mmHg.
a) What is most likely diagnosis?
➢ Hyperthyroidism
b) How will you investigate this patient?
➢ Thyroid profile: Decreased TSH but elevated serum
free T4 and T3
➢ RAIU → elevated
➢ Elevated TSI, Antithyroglobulin's & Antimicrosomal
antibodies
c) Describe treatment of this patient?
a) Immediate therapy
•Beta blocker: Propanol
•Antithyroid drugs: Propylthiouracil &
Methimazole
b) Long-term management:
•RAI ablation
•Thyroidectomy
10 th Semester 2015
➢ A 58 years old lady with history of diabetes
and is on Oral hypoglycemic drugs. No
complaining of edema feet with decreased
urine output and frequent hypoglycemic
spells. Alexa Nation pale looking and her BP
is 160/100mmHg, is HB is 6g% & creatinine
level is 4mg/dL, urine albumin is 4+.
➢ Chronic Renal Failure due to diabetic
nephropathy
b) Give atleast 2 reasons of anaemia in this
case?
➢ Loss of erythropoietin
➢ Peripheral neuropathy
➢ Metformin complications
c) Give three steps in management.
➢ General measures
➢ Control BP and Sugar
➢ Oral phosphate binders
9 th Semester 2016
➢ A 18 years old boy complaints of weakness of
all four Limbs for last two weeks, weakness is
progressive and of ascending pattern there is
numbness of both hands and feet. On
examination there is bilateral facial weakness,
on motor examination power is 4/5 in muscles
of both upper and lower Limbs. Reflexes are
absent plantar down going.
➢ Guillain barre syndrome (GBS)
b) Give differential diagnosis?
➢ Myasthenia Gravis, Amyotrophic Lateral
Sclerosis, Diphtheria, Acute Myelopathy,
Vasculitis Neuropathy
c) Discuss the management?
➢ Regular monitoring of respiratory function
➢ Ventilation is needed if vital capacity falls
below 1 liter
➢ Plasmapheresis within first 14 days or
➢ IV immunoglobulin within first 14 days
9 th Semester 2016
➢ A 48 years old smoker known case of
diabetic since last 5 years and is on Oral
hypoglycemic agents gilbenclamide and
metformin. Complaining of exertional
dyspnea feeling on face and feet.
Examination reveal pulse rate of 110
beat/min regular but feeble. Blood pressure
is 140/90 mmHg. Pedal edema pitting in
type is present. Chest examination shows
bilateral basal crepts. Precordial
auscultation reveals audible third heart
sound with soft systolic Murmur at mitral
area. Investigation show random blood
sugar of 276mg, albuminuria 2+, s creatinine
of 1.1 mg (normal).
a) What other investigation will you request
for diagnosis and why?
b) What will be your aim in management and
how will you plan to achieve target?
9 th Semester 2016
➢ A 22 years old girl complaining of drooping of
upper eyelid of right eye and generalized
weakness for last one year. Fluctuating course,
symptoms of worse in evening time. On
examination ptosis of right eye more worse on
sustained upward gaze, power of muscles of
upper and lower Limb is 5/5. Reflexes is normal,
plantar down going.
a) What is diagnosis?
b) Name two investigations?
➢ Acetylcholine receptor antibody test
➢ Tensilon (edrophonium) test
➢ Chest X Ray
➢ Electromyography
c) Name three drugs of choice?
➢ Pyridostigmine
➢ Neostigmine
➢ Prednisolone
➢ Plasmapheresis or IV immunoglobulins
9 th Semester 2016
➢ A 50 year old lady school teacher medical OPD
complaining of joint pain especially joints of both
hands for last 6 months which gradually has
increased, now she can't perform her routine work
due to pain at morning stiffness. She is also
complaining of weakness, lethargy and low grade
fever. She also gives history of similar attacks 3
years back and with treatment she was symptom
free. On examination joints of both hands are
tender and swollen.
➢ Rheumatoid arthritis
b) What are investigations for diagnosis of disease?
➢ CBC - anaemia, ESR and CRP raised
➢ Positive ANA (antinuclear antibodies)
➢ Anti CCP
➢ X-ray of hands and wrist
c) Write steps of Management?
➢ NSAIDs → Celecoxib
➢ Glucocorticoid steroids
➢ Disease modifying antirheumatic drugs:
Antimalarial, Gold, Sulfasalazine, Methotrexate
and Tumor necrosis factor receptor inhibitors
9 th Semester 2016
➢ A 20 years old male patient with history of high
grade fever for 2 days brought unconscious in
OPD. He is deeply comatose and Babinskis sign is
positive bilaterally. Signs of meningeal irritation
negative, jaundice negative.
a) Give two probable diagnosis?
➢ Encephalitis
➢ Meningitis
➢ Brain abscess
➢ Meningitis
b) Name investigation helpful in management?
➢ CT scan, MRI, Lumbar Puncture, PCR, EEG, Serum
& CSF antigen/antibody titer
c) Name steps in management?
➢ Perform ABCD
➢ Maintain IV line
➢ IV fluids
➢ Monitor Ventilation, Pulse, Blood pressure
➢ Use empirical therapy
➢ Vancomycin, Ceftriaxone, Ampicillin, Acyclovir,
Foscarnet
9 th Semester 2016
➢ A 30 years female patient residing in rural areas
complaining of continuous fever, for 10 days
and now she has developed diarrhea. Abdomen
distended mildly tender, tongue is centrally
coated, pulse 100/min, temperature 103F,
spleen is just palpable.
➢ Typhoid fever
b) Name investigations helpful in diagnosis?
➢ Stool culture - contain organism during 2nd and
3rd week
➢ Widal test
➢ PCR
c) Name five drugs used in this disease?
➢ Cephalosporin & Azithromycin - resistant case
cholecystectomy
9 th Semester 2016
➢ A female of 20 years age suddenly developed
purpuric rashes all over body epistaxis, there is no
history of fever, no history of drug intake.
Abdominal examination no hepatosplenomegaly,
her Hb is 6gm.
➢ Idiopathic thrombocytopenic purpura
b) Name investigations helpful in diagnosis?
➢ CBC - thrombocytopenia
➢ Bleeding time - prolong
➢ PT and APTT - normal
➢ Ultrasound - normal spleen
➢ Coombs test - positive
➢ Bone marrow biopsy - increased megakaryocytes
c) How will you manage the patient?
➢ Prednisone - initial therapy (mild bleeding)
➢ Severe bleeding - glucocorticoid steroid + IV
immunoglobulin
➢ Splenectomy - for remission
➢ Thrombopoietic agents - persistent disease after
splenectomy
9 th Semester 2016
➢ A female married 30 years age known case of
Pulmonary Koch's, she is an anti TB therapy for
6months. She is non compliant patient weakness,
weight loss, diarrhea, amenorrhea along with
hair loss and increased skin pigmentation. BP is
90/70 mmHg, x-ray chest shows small heart size,
with fibro calcious foci in both lungs.
➢ Addison's disease
b) Name investigations in relation to the disease?
➢ ACTH stimulation test
➢ CBC → WBC count with moderate neutropenia,
lymphocytosis and eosinophilia
➢ Serum potassium and urea nitrogen → elevated
➢ Sodium and blood glucose → low
➢ Morning low plasma cortisol
c) Name steps in management?
➢ Educate the patient about the disease
➢ Glucocorticoids
➢ Mineralocorticoids
➢ Sodium chloride replacement therapy
9 th Semester 2016
➢ A young girl 12 years of age having history of
polyuria and polydipsia brought unconscious in
causality. She has some fruity breath odor, with
acidotic breathing.
a) What investigations will you advise this
patient?
➢ Blood glucose → Elevated
➢ Ketosis → Positive urine & serum ketones
➢ Urea, creatinine, electrolytes → Increased
BUN:Cr ratio, Low K, Pseudohyponatremia
➢ Arterial blood gases → Increased anion gap
metabolic acidosis
➢ CBC → Leukocytosis
➢ ECG
b) What is your probable diagnosis?
➢ Diabetic ketoacidosis
c) Name steps in the management of a case?
➢ Short acting IV insulin
➢ Fluid replacement (normal saline and dextrose)
➢ Potassium replacement antibiotics
➢ Catheterization if no urine passed after 3 hours
10 th Semester 2016
➢ A 20 years female patient is brought in emergency
room with history of polyuria, polydipsia for 2
months, now for 2 day's patient is breathless with
acidotic breathing, reduced urine output,
dehydrated with some fruity smell from mouth.
a) Diabetic ketoacidosis
b) How will you manage the patient?
Investigations:
➢ Blood glucose → Elevated
➢ Ketosis → Positive urine & serum ketones
➢ Urea, creatinine, electrolytes → Increased BUN:Cr
ratio, Low K, Pseudohyponatremia
➢ Arterial blood gases → Increased anion gap
metabolic acidosis
➢ CBC → Leukocytosis
➢ ECG
Treatment:
➢ Fluid replacement (normal saline and dextrose)
➢ Potassium replacement antibiotics
➢ Catheterization if no urine passed after 3 hours
10 th Semester 2016
➢ A female 40 years age complaining of morning
stiffness along with arthritis, specially proximal
interphalangeal joints of both arms for the last
one year. Recently patient has developed
nodules on the extensor surface of both
forearms.
a) What is the most probable clinical diagnosis?
b) What investigations you will advise for the
diagnosis?
➢ CBC → Anaemia, ESR and CRP raised
➢ Anti CCP
10 th Semester 2016
➢ A young lady of 24 years having
perverted diet for clay (multani mitti).
She is complaining of early fatigue,
palpitation and dyspnea on activity. Hb
is 6.4g.
a) What is the cause of her symptoms?
b) What are the mechanism/reason for
her low hemoglobin?
c) What investigations will you ask for?
d) What will be the management?
10 th Semester 2016
➢ A 42 years old lady present to
emergency department, she is flushed
and sweaty, her blood pressure is
185/110mmHg. She admit episodes of
headache, feeling stressed, anxious
and episodes of high blood pressure.
Her urine examination is normal,
abdominal ultrasound reveal a positive
adrenal mass.
b) Write one syndrome associated with
this?
c) Name two investigations to confirm
your diagnosis?
d) How will you treat?
10 th Semester 2016
➢ A 28 years pregnant lady had a severe
postpartum hemorrhage and recovered from
shock after couple of hours. She had an
involution of breast and failure of lactation. She
also complaining of lethargy, fatigue. With the
passage of time she remain ammonerhgic, ankle
tendon reflex was slow to return but no weight
gain.
a) What is the likely diagnosis?
➢ Sheehan syndrome
b) Name two other causes of the same?
➢ Large Pituitary tumor or cyst
➢ Hypothalamic tumors (craniopharyngioma,
meningioma, glioma)
c) How will confirm your diagnosis?
➢ Measure GH, TSH LH and IGF-1
➢ Insulin tolerance test
➢ For GnRH, measure FSH and LH
➢ Treat the cause
➢ Multiple hormone replacement therapy specially
cortisol
10 th Semester 2016
➢ A 48 years old patient complaining of
headache, dizziness and pruritis for
the last 2 months. He has a weight
loss. On examination, he is cyanosed,
plethoric face and congested
conjunctiva. Liver spleen are
moderately enlarged, blood pressure is
170/100 mmHg, Hb level 10g/dl,
platelets are increased.
b) What investigations will you perform
to confirm diagnosis?
c) What will be the treatment option?
10 th Semester 2016
➢ A 50 years always diabetic lady is on oral
hypoglycemic agents is brought to your clinic
for follow up.
a) What necessary clinical examination will you
perform?
➢ General Physical examination
➢ Sensory system
➢ Eye, abdominal and cardiovascular examination
b) List investigations which will request and why?
➢ HbA1c
➢ Urea creatinine
➢ Random blood sugar
➢ Urine D/R
10 th Semester 2016
➢ A 30 years old male patient brought in OPD with history
of continuous fever for 10 days. He looks toxic. On
examination his pulse is 90/min, temperature 103F.
Connect dongle examination pink papules 2-3mm in
diameter detected, chest is clear. No any other
remarkable finding detected. Patient has received
antimalarial drugs 5 days back.
➢ Typhoid fever
b) What investigations you will advise?
week
c) What complications you expect if left untreated?
➢ Acute Bronchitis, Toxic Myocarditis, Hemolytic Anaemia,
Parotitis, Typhoid Meningitis, Peripheral Neuritis
d) Name five drugs used in the treatment of this disease?
➢ Cephalosporin & azithromycin - resistant cases
cholecystectomy
10 th Semester 2016
➢ A 24 years old male game in emergency
department complaining of weakness of all for
limbs far lot of one week, weakness started
initially from legs and then after few days involve
both arms, he is bedridden, no history of fever,
sphincter involvement. On examination vitally
stable well oriented time place and person, facial
weakness, bulk normal, tone decreased. Power
1/5 in legs and 3/5 in upper limb. Reflexes absent
plantar down going.
➢ Guillain barre syndrome (GBS)
b) Name investigations?
➢ Lumbar puncture - best initial test
➢ Electromyography - most accurate test
c) Specific treatment options?
➢ Regular monitoring of respiratory function
➢ Ventilation is needed if vital capacity falls below 1
liter
➢ Plasmapheresis within first 14 days or
➢ IV immunoglobulin within first 14 days
9 th Semester 2017
➢ Discuss the management of
diabetic ketoacidosis?
9 th Semester 2017
➢ Classify anaemia? Discuss the management of iron
deficiency?
Anaemia means decrease in RBC mass. Marked by:
i. Haematocrit: <41% in men or <36% in women OR
ii. Haemoglobin: <13.5g/dl in men or <12g/dl in women
Classification: Based on Mean Corpuscular Volume
a) Microcytic Anaemia - MCV <80
1) Iron Deficiency Anaemia
2) Thalassemia
3) Anaemia Of Chronic Disease
4) Sideroblastic Anaemia
b) Macrocytic Anaemia - MCV >100
1) Megaloblastic Anaemia
2) Alcoholic Liver Disease
3) Hypothyroidism
4) Chemotherapeutic Agents
5) Myelodysplastic Syndrome
c) Normocytic Anaemia - MCV 80-100
1) Low Reticulocyte Count (<2%)
2) High Reticulocyte Count (>2%)
➢ Management of iron deficiency anaemia
➢Ferrous Sulphate & Ferrous Gluconate
➢Blood Transfusion - severe symptoms
9 th Semester 2017
➢ A 32 years old female came in neurology OPD with
complaining of generalized weakness for last 6
months, which is worse during work and evening.
On examination she is bilateral ptosis which is
worse on sustained upgazed and bilateral facial
weakness. Other neurological examination is
unremarkable.
b) What is pathophysiology of this disorder?
➢ Autoimmune disorder caused by antibodies against
postsynaptic acetylcholine receptors. Acetylcholine
receptors antibodies leads to decrease number of
active and functional acetylcholine receptors at the
postsynaptic membrane.
c) Name investigation for confirmation of diagnosis?
➢ Acetylcholine receptor antibody test - best initial
test
➢ Tensilon (edrophonium) test - sensitive not specific
➢ Chest X Ray & CT scan - to rule out thymoma/
thymic hyperplasia
➢ Electromyography - single most accurate test
9 th Semester 2017
➢ A 35 year old teacher presents in medical OPD
complaining of weakness, lethargy hand tremors of
hands. He also complains of weight loss despite
increased in appetite. He also complaining of heat
intolerance. On examination pulse is 102 beats/min
and BP is 150/85 mmHg.
➢ Hyperthyroidism
b) Name the investigations?
➢ Thyroid profile
➢ Thyroid binding globulin
➢ Antimicrosomal ABs
➢ Radioactive iodine uptake scan
c) Name the steps in treatment?
i. Immediate therapy
Methimazole
ii. Long-term management:
•RAI ablation
•Thyroidectomy
9 th Semester 2017
➢ A 50 years old farmer was brought
unconscious in emergency department. On
examination pulse was 88 beats/minute, BP
was 110/70 mmHg. Chest was clear, pupils
were reacting with light and planters were
normal. Sugar was 525 mg.
➢ Hyperosmolar nonketotic coma
b) What further investigations are required to
confirm diagnosis?
➢ Plasma Glucose level
➢ Plasma osmolality
➢ Serum electrolytes
➢ Urine dipstick test
c) Enlist the steps of Management?
➢ Fluid replacement
➢ K Replacement
➢ Antibiotics
9 th Semester 2017
➢ A young lady of 35 years of age complaining of pain in
small joints of both hands more market in the
morning with stiffness. On examination there are
nodules of variable size on extensor expect of arms.
Xray of hand shrivelled juxta-articular osteopenia and
bony erosions.
b) Write supporting criteria in above scenario?
➢ Morning with stiffness
➢ Symmetrical joint swelling
➢ Swelling of small joints
➢ Variable sized nodules
➢ X-ray showing bony erosions
c) Write most specific test for diagnosis?
➢ CBC → Anaemia
➢ Anti CCP positive
➢ ESR or C reactive raised
➢ Disease modifying antirheumatic drugs: Antimalarial,
Gold, Sulfasalazine, Methotrexate and Tumor
necrosis factor receptor inhibitors
9 th Semester 2017
➢ A young lady with polyarthritis and fixed erythematosus
rash over mallar eminences brought in emergency with fits
and psychotic behaviour. Her chest examination reveals
bilateral fine crackles at lung bases. Lab reveals ESR of 110
mm/1st hr. Urine DR microscopic haematuria and
proteinuria.
b) What investigations will you ask to confirm your diagnosis?
➢ ANA positive
➢ Complement levels decreased
➢ dsDNA antibodies elevated
c) What are the drugs prescribed to control the active
disease?
Cyclophosphamide), Mycophenolate to treat lupus
nephritis
d) Write possible cardiac manifestation in above case?
➢ Pleuritis, Pericarditis, Pleural rub
9 th Semester 2017
➢ A 30 year old female presented in OPD with
complain of difficulty in falling for solid
foods intermittently. On examination she
looks pallor, she is koilonychia. Her blood CP
shows Hb 7.5g/dl, MCV 47.4fl, MCH 27.8pg.
➢ Iron deficiency anaemia
b) How will you confirm your diagnosis?
➢ CBC: microcytic anaemia(MCV<80), low
reticulocyte count, increased platelet count,
red cell distribution width elevated
➢ Iron profile: Decrease ferritin, Decrease
serum iron, Decrease transferrin saturation,
Increased total iron binding capacity
➢ Ferrous sulphate
➢ Ferrous gluconate
➢ Blood transfusion - Severe symptoms
9 th Semester 2017
➢ A 40 years male patient is brought
unconscious in what with history of
high grade fever for 3 days. On
examination pupils are dilated not
reacting to light, Babinski's sign
bilaterally positive, test clear jaundice
negative, no other remarkable
findings.
a) What are the two main reasons for
this condition in our setup?
b) Give management of any one of them?
10 th Semester 2017
➢ Classify anaemia? Discuss the management of iron
deficiency?
Anaemia means decrease in RBC mass. Marked by:
i. Haematocrit: <41% in men or <36% in women OR
ii. Haemoglobin: <13.5g/dl in men or <12g/dl in women
Classification: Based on Mean Corpuscular Volume
a) Microcytic Anaemia - MCV <80
1) Iron Deficiency Anaemia
2) Thalassemia
3) Anaemia Of Chronic Disease
4) Sideroblastic Anaemia
b) Macrocytic Anaemia - MCV >100
1) Megaloblastic Anaemia
2) Alcoholic Liver Disease
3) Hypothyroidism
4) Chemotherapeutic Agents
5) Myelodysplastic Syndrome
c) Normocytic Anaemia - MCV 80-100
1) Low Reticulocyte Count (<2%)
2) High Reticulocyte Count (>2%)
➢ Management of iron deficiency anaemia
➢Ferrous Sulphate & Ferrous Gluconate
➢Blood Transfusion - severe symptoms
10 th Semester 2017
➢ What is diabetic ketoacidosis discuss
the clinical features, investigation and
management of diabetic ketoacidosis?
10 th Semester 2017
➢ A 32 years old female came in neurology OPD with
complaining of generalized weakness for last 6
months, which is worse during work and evening.
On examination she is bilateral ptosis which is
worse on sustained upgazed and bilateral facial
weakness. Other neurological examination is
unremarkable.
b) What is pathophysiology of this disorder?
➢ Autoimmune disorder caused by antibodies against
postsynaptic acetylcholine receptors. Acetylcholine
receptors antibodies leads to decrease number of
active and functional acetylcholine receptors at the
postsynaptic membrane.
c) Name investigation for confirmation of diagnosis?
➢ Acetylcholine receptor antibody test - best initial
test
➢ Tensilon (edrophonium) test - sensitive not specific
➢ Chest X Ray & CT scan - to rule out thymoma/
thymic hyperplasia
➢ Electromyography - single most accurate test
10 th Semester 2017
➢ A 35 year old teacher presents in medical OPD
complaining of weakness, lethargy hand tremors of
hands. He also complains of weight loss despite
increased in appetite. He also complaining of heat
intolerance. On examination pulse is 102 beats/min
and BP is 150/85 mmHg.
➢ Hyperthyroidism
b) Name the investigations?
➢ Thyroid profile
➢ Thyroid binding globulin
➢ Antimicrosomal ABs
➢ Radioactive iodine uptake scan
c) Name the steps in treatment?
i. Immediate therapy
Methimazole
ii. Long-term management:
•RAI ablation
•Thyroidectomy
10 th Semester 2017
confirm diagnosis?
➢ K Replacement
➢ Antibiotics
9 th Semester 2017
➢ A 30 year old female presented in OPD with
complain of difficulty in falling for solid
foods intermittently. On examination she
looks pallor, she is koilonychia. Her blood CP
shows Hb 7.5g/dl, MCV 47.4fl, MCH 27.8pg.
b) How will you confirm your diagnosis?
10 th Semester 2017
➢ A 15 years old boy complaining of
progressive numbness and weakness of all
four Limbs for last 3 days. Symptoms
initially started from feet and then
ascending pattern with involvement of
hands. Alert bilateral lower motor neurone
type facial palsy, power is 4/5 in upper
Limbs and 3/5 in lower Limbs, reflexes are
absent in upper and lower Limbs. Planters
are down going.
➢Guillain barre syndrome (GBS)
b) Write two investigations to confirm your
diagnosis?
➢Lumbar puncture - best initial test
➢Electromyography - most accurate test
c) Write treatment option?
➢IV immunoglobulin and Plasmapheresiss
10 th Semester 2017
➢ A 50 years old male developed fatigability,
dyspnea, loss of appetite and headache
gradually, he also complaints low grade fever.
On examination, patient is anemic with massive
splenomegaly. Blood CP shows, haemoglobin is
8g/dL, WBC count is 150,000/cumm with
myelocytes.
➢ Chronic Myeloid Leukaemia
b) What further investigations will be advised?
➢ Leukocyte Alkaline Phosphate (LAP) score →
Diminished
➢ Chromosome analysis → Philadelphia
chromosome is diagnostic
➢ Platelet count → Elevated
c) How will you treat the case?
➢ Imatinib best initial therapy
➢ If imatinib fails, then therapy is bone marrow
transplant
➢ Supportive care: Blood Transfusion (Anemia),
Give Platelets(Bleeding) & Antibiotic (infection)
10 th Semester 2017
➢ A 30 years female is suffering from remittent
fever for last 7 days. She has not responded
chloroquine. On examination tongue is
centrally coated and spleen is just palpable.
Temperature is 101F and pulse is 98/min.
➢ Typhoid fever
➢ Stool culture - contain organism during 2nd
and 3rd week
c) How will you treat the case. Name two drugs?
➢ Cephalosporin & azithromycin - resistant
cases
cholecystectomy
9 th Semester 2018
➢ What is Cerebral Malaria.
Describe its clinical features,
investigations treatment in
detail?
9 th Semester 2018
➢ What is Diabetes mellitus.
Name the complication of
type-II. Name the drugs used
for the treatment of type-II?
9 th Semester 2018
➢ A young lady of 35 years of age complaining of pain in
small joints of both hands more market in the
morning with stiffness. On examination there are
nodules of variable size on extensor expect of arms.
Xray of hand revealed juxta-articular osteopenia and
bony erosions.
b) Write supporting criteria in above scenario?
➢ Morning with stiffness
➢ Symmetrical joint swelling
➢ Swelling of small joints
➢ Variable sized nodules
➢ X-ray showing bony erosions
c) Write most specific test for diagnosis?
➢ CBC → Anaemia
Gold, Sulfasalazine, Methotrexate and Tumor
necrosis factor receptor inhibitors
9 th Semester 2018
➢ A middle aged lady complaining of feeling of
cold, gradual weight gain, food intake, easy
fatigue and hyper somnolence. Her voice is
hoarse and having menorrhagia. She noticed
midline neck swelling.
a) What is the clinical diagnosis?
➢ Hypothyroidism
b) Write three clinical signs you will look for?
➢ Deep Tendon Reflex, Motor Activity, Periorbital
Puffiness, Hair Loss, Tongue Enlargement
c) How will you confirm your diagnosis?
➢ Thyroid profile
➢ Thyroid Binding globulin levels
➢ Antimicrosomal Abs
➢ Radioactive thyroid scan
➢ T4 for lifelong
➢ If strong suspicious of 2nd hypothyroidism give
hydrocortisone with thyroid hormones
➢ T4 should be taken on an empty stomach
9 th Semester 2018
rash over mallar eminences brought in emergency with fits
and psychotic behaviour. Her chest examination reveals
bilateral fine crackles at lung bases. Lab reveals ESR of 110
mm/1st hr. Urine DR microscopic haematuria and
proteinuria.
b) What investigations will you ask to confirm your diagnosis?
➢ ANA positive
disease?
nephritis
d) Write possible cardiac manifestation in above case?
➢ Pleuritis, Pericarditis, Pleural rub
9 th Semester 2018
➢ A 30 years female is suffering from remittent
fever for last 7 days. She has not responded
chloroquine. On examination tongue is
centrally coated and spleen is just palpable.
Temperature is 101F and pulse is 98/min.
➢ Typhoid fever
and 3rd week
cases
cholecystectomy
9 th Semester 2018
confirm diagnosis?
➢ K Replacement
➢ Antibiotics
9 th Semester 2018
➢ The mother of a 18 year old boy reported that her
son has frequent episodes of reduced
responsiveness/ disconnection from the
surroundings during with the ongoing activity stops,
he stares in space and has vacant look. These
episodes in abruptly with return to normal
alertness and resumption of previous activity. Each
last for 3-5 seconds. There is no fall jerky moment.
a) Name the types of epileptic seizure.
i. Partial seizure: Simple partial seizure, Complex
partial seizure, Partial seizure with secondary
generalization
ii. Complex seizures: Generalised tonic clonic seizure,
Absence seizures
b) Name the investigation of choice.
➢ Electroencephalography
c) Name the drug of choice.
➢ Carbamazepine - Partial seizure and Partial seizure
with secondary generalization
➢ Sodium valproate - Primary Generalised Tonic
Clonic Seizure
➢ Ethosuximide - Absence seizures
➢ Sodium valproate - Myoclonic
9 th Semester 2018
➢ A 20 year male presented with lethargy few
days after taking antimalarial drugs.
Examination he is pale, jaundice, spleen is 2
FB palpable. His mother gives history of
such episodes in past after taking anti-
malaria drugs.
➢ Haemolytic anaemia?
b) Name three investigations?
➢ CBC → Normal MCV, sometimes slightly
elevated
➢ Serum LDH → Elevated
➢ Serum indirect bilirubin → Elevated
➢ Urine D/R → Hemosiderin present in severe
haemolysis
c) What enzyme defect is responsible?
➢ Glucose 6 phosphate dehydrogenase
deficiency
10 th Semester 2018
➢ What is Cerebral Malaria?
Describe its clinical features,
investigations and treatment?
What are the other complication
of falciparum malaria?
10 th Semester 2018
➢ What are different types of
diabetes mellitus? What
investigations are used to
diagnose Diabetes mellitus?
Name the drugs used for the
treatment of type 2 diabetes.
10 th Semester 2018
➢ A young lady of 32 years of age complaining of
pain in small joints of both hands more marked
in the morning with stiffness, pain improves
with movement. Her mother is also suffering
from deforming arthritis.
b) Discuss different investigations used for
diagnosis?
➢ CBC → Anaemia
c) Name the drugs used to manage.
10 th Semester 2018
➢ A middle aged male complaining of
gradual weight gain, fatigue, lethargy and
increased sleep. His voice is hoarse.
a) What is the clinical diagnosis?
➢Hypothyroidism
b) Write three clinical signs you will look
for?
➢Deep Tendon Reflex, Motor Activity,
Periorbital Puffiness, Hair Loss, Tongue
Enlargement
c) How will you treat?
➢T4 for lifelong
➢If strong suspicious of 2nd hypothyroidism
give hydrocortisone with thyroid
hormones
➢T4 should be taken on an empty stomach
10 th Semester 2018
rash over mallar eminences brought in emergency with
fits and psychotic behaviour. Her chest examination
reveals bilateral fine crackles at lung bases. Lab reveals
ESR of 90 mm/1st hr. Urine DR shows microscopic
haematuria and proteinuria.
b) What investigations will you ask to confirm your
diagnosis?
➢ ANA positive
disease?
nephritis
10 th Semester 2018
➢ A 20 years old male is complaining of fever for
last 7 days. He has not responded to
chloroquine. On examination, temperature is
101F and pulse is 90beats/min and spleen is
just palpable.
➢ Typhoid fever
and 3rd week
cases
cholecystectomy
10 th Semester 2018
➢ A 60 years old hypertensive male
come in neurology OPD with
complaining of sudden onset right
sided limb weakness. On
examination, pulse is 90
beats/min, BP 200/100 mmHg,
tendon reflex increase on right
side and planter up going.
b) Name single investigation for
confirm your diagnosis.
c) Name five risk factors.
10 th Semester 2018
➢ A rheumatoid lady is on NSAIDS, DMARD
and Steroids. Since long duration she
noticed a gradual increase in her weight
body aches, purpuric spots on extensor
aspects and difficulty on standing from
squatting position.
a) What is the possible diagnosis?
➢ Cushing syndrome
b) What is the reason for her body ache and
difficulty in standing?
➢ Due to Myopathy & Osteoporosis
c) Write steps in management?
➢ Trans-sphenoidal surgical removal of tumor
➢ Pituitary radiotherapy
➢ Bilateral surgical adrenalectomy
➢ Glucocorticsteroid replacement therapy
after trans-sphenoidal surgery
➢ Lifelong glucocorticoid + mineralocorticoid
replacement if adrenalectomy performed
10 th Semester 2018
➢ A 20 year male presented with lethargy few
days after taking antimalarial drugs.
Examination he is pale, jaundice, spleen is 2
FB palpable. His mother gives history of
such episodes in past after taking anti-
malaria drugs.
➢ Haemolytic anaemia?
b) Name three investigations?
➢ CBC → Normal MCV, sometimes slightly
elevated
➢ Serum LDH → Elevated
➢ Serum indirect bilirubin → Elevated
➢ Urine D/R → Hemosiderin present in severe
haemolysis
c) What enzyme defect is responsible?
➢ Glucose 6 phosphate dehydrogenase
deficiency
9 th Semester 2019
➢ A female house officer presidents in the medical OPD with
complain of lethargy progressive weight gain and weakness. She
also complains of dry skin and hair loss. She is also complaining
of on and off menstruation with heavy flow and constipation. On
examination, her pulse is 60 beats/min, blood pressure
110/90mmHg. Har CBC reveals normocytic normochromic
anaemia. Her lipid profile is elevated. A diagnosis of
hypothyroidism was established.
a) Enlist any five cardiovascular and neurological manifestation of
hypothyroidism?
➢ CVS: Angina, cardiac failure, hypertension, bradycardia,
hyperlipidemia, peripheral edema
➢ CNS: Poor memory, ataxia, muscle weakness, Depression,
psychosis, impaired hearing
b) Name any Three investigation of hypothyroidism?
➢ Thyroid profile, ECG, MRI
c) Name life threatening complication of hypothyroidism?
➢ Coronary heart disease, Cardiac failure, Angina, Goiter,
myxedema coma
d) How will you manage hypothyroidism?
➢ T4 lifelong
➢ Clinically and hormonal euthyroid
➢ If there is a strong suspicious of secondary hypothyroidism give
➢ If a patient has coronary heart disease then coronary artery
bypass graft or stent replacement before thyroid hormone
replacement is initiated
➢ Myxedema coma treated with high dose of T4 along with T3
9 th Semester 2019
a) Name most common organism causing bacterial
meningitis?
➢ Streptococcus pneumoniae - most common
cause except neonatal period
➢ Group B Streptococcus and E coli - most
common in neonatal period
➢ Nigeria meningitis - most common cause in
elderly patient
➢ Listeria monocytogenes - more common in
immune system defect patients
b) What are CSF findings bacterial meningitis?
➢ Pressure(9-18cm) - increased
➢ Appearance - cloudy
➢ WBC count(<5cells/mm3) - 1000- 20000
➢ Differential count - polymorphs
➢ Glucose(50-75mg/dl) - decreased
➢ Protein(15-45mg/dl) - increased
c) Discuss complication of acute bacterial
meningitis?
➢ Deafness, Cerebral Edema, Hydrocephalus,
Ventriculitis, Hyponatremia, Subdural Empyema
9 th Semester 2019
complain of weakness in her thighs.
Her blood pressure is 160/100 mm hg.
There is facial plethora, cervical fat
pad, purple striae abdomen and
centripetal obesity. Random blood
glucose is 234mg/dl.
➢Cushing syndrome
b) How will you investigate to confirm
your diagnosis?
c) Name drugs for treatment of this
disorder?
9 th Semester 2019
➢ A 50 years old obese female is taking oral
hypoglycemic agents. She also has upper
respiratory tract infection for which she is taking
antibiotics. During the course of treatment, she
develops lethargy and is brought to emergency
department in comatose state. On clinical
examination there is no focal deficit or neck
stiffness. Her laboratory report shows random
blood sugar 796 mg/DL, BUN 84 mg/DL, and serum
creatinine 3mg/dl. Whereas her electrolytes are
found normal.
b) What other parameters will you like to assess?
➢ Plasma Osmolality
➢ Serum Electrolytes
c) What are the principles of management?
➢ K Replacement
➢ Antibiotics
9 th Semester 2019
➢ A 30 year old female is admitted with the
complaints of weakness and dyspnea for 3
months. On examination pulse 120
beat/min, respiratory rate 20 breaths/min,
mucous membranes are pale with spoon
shaped nails. Hb 7gm/dl with microcytosis.
b) How will you investigate?
c) Give treatment.
9 th Semester 2019
➢ A 16 year old male known case of ischemic
heart disease comes in neurology emergency
with complain of left sided body weakness for
last one day. On examination pulse 90
beats/minute regular, blood pressure 170/100
mmHg, well oriented with time and place.
Power 0/5 on left arm and left leg. Brisk
reflexes in left arm and left leg and left
plantar upgoing.
➢ Stroke
b) Name single investigation for confirmation of
your diagnosis
➢ MRI or non contrast CT scan
c) Name three risk factor of this condition?
➢ Non-modifiable: Age, Gender, Race, Previous
Vascular Event
➢ Modifiable: Hypertension, Hyperlipidemia,
Heart Disease, DM, Smoking, Polycythemia,
Alcohol, Estrogen containing drugs
9 th Semester 2019
a) Name the extra-articular
manifestation of rheumatoid arthritis?
➢Damage to the ligaments and tendons
➢Rheumatoid Nodules
➢Felty syndrome
➢Caplan syndrome
b) What are goals of therapy of
rheumatoid arthritis?
➢Reduce joint pain and swelling
➢Improve joint function
➢Slow or stop the disease process
particularly joint image
c) Write the group of drugs used in the
management.
➢NSAIDs, DMARDs, Steroids, Anti Tumor
Necrosis Factor (TNF) therapy
9 th Semester 2019
➢ A 25 year old fair coloured female school teacher
presents in OPD with abdominal pain, fever and loss of
appetite. She recalls that she recently started drinking
tap water since many days at school because the filter
plant has malfunctioned. An examination pulse 60
beats/min, blood pressure 110/70 mmHg, spleen is just
palpable and Rose spots over her trunk.
a) Most likely diagnosis and which organism is responsible
for this condition?
➢ Typhoid fever caused by Salmonella
b) Which investigations will you order to confirm your
diagnosis?
➢ Typhi Dot
week
c) How will you treat this patient?
➢ Ceftriaxone & Azithromycin
➢ For drug resistance: Ampicillin, Chloramphenicol,
Ceftriaxone, Ciprofloxacin
9 th Semester 2019
➢ A 18 year young boy resident of Karachi presented
with high grade fever, headache, bilateral orbital
pain, bone breaking pain and vomiting. Blood CP
shows TLC 3200/mm3, haematocrit 55% in platelet
count <80000.
a) Give three differential diagnosis?
➢ Dengue fever
➢ Typhoid fever
➢ Scarlet fever
➢ Malaria
b) What is the most likely diagnosis?
➢ Dengue fever
c) Which further investigation will you order?
➢ CBC: Leukopenia and thrombocytopenia
➢ IgG antibody titre: rise fourfold
➢ PCR: detection of dengue RNA virus
➢ How will you treat this condition
➢ Treatment is symptomatic
➢ Bed rest & Fluid replacement
➢ Pain relievers
➢ Blood transfusion in patient with shock
➢ NSAIDS & aspirin avoided
10 th Semester 2019
a) What is stroke?
➢ Sudden onset of focal neurological deficit lasting
>24hrs or leading to death with no cause
apparent other than a vascular one
b) What are the types of stroke?
➢ Two types
a) Ischemic stroke (85): is due to inadequate blood
flow to the part of the brain due to occlusion of
cerebellar artery
➢ Subtypes: thrombotic and embolic
b) hemorrhagic stroke (15): Due to rupture of
vessels
➢ Subtypes: Intracerebral hemorrhage and
subarachnoid hemorrhage
c) What are the risk factors of stroke?
a) Non-modifiable: Age, gender, race, previous
vascular event
b) Modifiable: Hypertension, diabetes mellitus,
hyperlipidemia, heart disease, smoking, alcohol,
polycythemia, estrogen containing drugs
10 th Semester 2019
➢ A lady health worker present in the emergency department with
complain of lethargy and weakness. She informed that she has
gained weight in past few months and has dry skin and alopecia.
Moreover she is also complaining of irregular menstruation with
heavy flow and constipation. The lady also informs of somnolence
and feels cold during the night. On examination, her pulse is 59
beats/minute. Blood pressure 120/100 mmHg. Her CBC report is
unremarkable and lipid profile is deranged.
➢ Hypothyroidism
b) Enlist any five cardiovascular and neurological manifestation of this
condition?
➢ CVS: Angina, cardiac failure, hypertension, bradycardia,
hyperlipidemia, peripheral edema
➢ CNS: Poor memory, ataxia, muscle weakness, Depression, psychosis,
impaired hearing
c) Name any three investigation of this disease?
➢ Thyroid profile, ECG, MRI
d) Name life threatening complication of this disorder?
➢ Coronary heart disease, Cardiac failure, Angina, Goiter, myxedema
coma
e) How will you manage this patient?
➢ T4 lifelong
➢ Clinically and hormonal euthyroid
➢ If there is a strong suspicious of secondary hypothyroidism give
➢ If a patient has coronary heart disease then coronary artery bypass
graft or stent replacement before thyroid hormone replacement is
initiated
➢ Myxedema coma treated with high dose of T4 along with T3
10 th Semester 2019
➢ A 20 years old female patient presents to
the OPD with high grade continuous
fever for the last six days. She also
reports pain in the abdomen and
vomiting. On examination, her BP is
110/60mmHg, pulse is 68 beats per
minute and temperature is 101.5F. Her
abdomen is soft but tender in tip of
spleen palpable.
➢Typhoid fever
b) What is the Single best investigation?
➢Blood culture, stool culture, Widal test
c) What is the treatment for multi drug
resistant typhoid fever?
➢Fluoroquinolones, Azithromycin,
Ampicillin, Ceftriaxone
10 th Semester 2019
➢ A 18 years male student at a University in
Karachi returns to his home in Nawabshah.
On returning home he is suffering from
severe fever, facial flushing and severe
headache with retro-orbital pain. There is
myalgia and joint pains. He also noticed
bleeding from his gums.
➢ Dengue fever
b) How will you investigate this case?
➢ CBC, PCR, IgG antibody titre, viral profile
c) How will you manage this case?
➢ Bed rest then symptomatic treatment
➢ Give IV fluid for replacement
➢ NSAIDs
➢ Paracetamol for fever
➢ Blood transfusion
➢ Safety measures for prevention
10 th Semester 2019
complain of weakness in her legs and
thighs. Her blood pressure is 160/100
mm hg. There is cervical fat pad,
purple striae abdomen, facial plethora
and centripetal obesity. Random blood
glucose is 234mg /dl.
➢Cushing syndrome
b) How will you investigate to confirm
your diagnosis?
c) Name drugs for treatment of this
disorder?
10 th Semester 2019
➢ A 50 years old obese female is taking oral
hypoglycemic agents. She also has upper respiratory
tract infection for which she is taking antibiotics.
During the course of treatment, she develops lethargy
and is brought to emergency department in comatose
state. On clinical examination there is no focal deficit
or neck stiffness. Her laboratory report shows random
blood sugar 796 mg/DL, BUN 84 mg/DL, and serum
creatinine 3mg/dl. Whereas her electrolytes are
found normal.
a) What is the cause of this comatose state?
➢ Hyperosmolar nonketotic acidosis
b) What other parameters will you like to assess?
c) What are the principles of management?
➢ K Replacement
➢ Antibiotics
10 th Semester 2019
➢ A 22 years old young female medical student reported to
OPD with the complain of bleeding gums and reddish
spots on body (legs, hands, neck) since past 2 months.
Past medical history revealed that patient was known
case of epilepsy for 7 years of age and was on
carbamazepine for past 12 years. Intraoral examination
revealed bleeding from gingiva in lower anterior region,
which was inflamed, reddish, tender on palpation, soft
in consistency. On further enquiry she also admits heavy
menstrual flow.
➢ Idiopathic Thrombocytopenic Purpura
b) Which investigations will help in diagnosis?
➢ CBC → Thrombocytopenia
➢ Bleeding time → Prolong
➢ PT and APTT → Normal
➢ Ultrasound → Normal spleen
➢ Coombs test → Positive
➢ Bone marrow biopsy - increased megakaryocytes
c) What are treatment options?
➢ Prednisone → initial therapy (mild bleeding)
➢ Severe bleeding → Steroid + IV Immunoglobulin
➢ Splenectomy - for remission
➢ Thrombopoietic agents → after splenectomy if disease
persists
10 th Semester 2019
➢ A 55 years old house lady came to medical OPD with
history of pain in the joint of her both hands for 5 years,
pain is more market early in the morning and partially
relieves after 1 hour as she starts working at her home.
On examination there is ulnar deviation of her hands
with swan neck and boutonniere deformities of fingers.
Her blood pressure is 130/80 mmHg, her spleen is
palpable to 2 finger breadth. Her HB is 9g/DL, leukocyte
count is 12000/cmm with 30% neutrophils and platelet
count is 625000.
b) Write any three investigation of this condition?
➢ CBC - anaemia, ESR and CRP raised
➢ Anti CCP
c) Write steps of Management?
d) How will you manage this case?
Gold, Sulfasalazine, Methotrexate and Tumor necrosis
factor receptor inhibitors
10 th Semester 2019
➢ A 16 years old girl came in neurology
emergency with complain of jerky
movements of left arm and leg with
loss of consciousness for the last 30
minutes associated with scrolling of
eyeballs and urinary incontinence. In
her pulse is 100 beats per min, BP
110/70 mmHg. GCS 9/15 with bilateral
upgoing plantar signs of meningeal
irritation are not present.
➢ Partial complex seizure with
generalized
b) Name single investigation for
confirmation of diagnosis?
c) Name five drugs used for their
treatment?
Final Year MBBS
Medicine-I
Solved SEQ Papers
Collected & Solved By:
Dr. Faheem Abbas Bhatti
(KMC Batch-01)
Note: Errors & Omissions are highly appreciated.
9 th Semester 2015
➢ A male patient 50 years of age
chronic smoker for many years
brought to emergency department
in drowsy state. On examination
cyanosis is positive, edema feet
positive, raised JVP, BP 110/60
mmHg, temperature 102F. Chest
examination reveals crepts +
rhonchi positive all over the chest.
a) What is the primary diagnosis?
b) Name the complications he has
developed?
9 th Semester 2015
➢ A 32 years old lady admitted with
history of progressive exertional
dyspnea and occasional episodes
of PND sudden loss of power of
left side of body reviews pulse of
130b/min regularly irregular, BP of
120/90mmHg having diastolic
rumble of mitral area, bilateral
basal crepts and left sided
weakness with signs of upper
motor neuron lesion.
➢ What is the complete diagnosis
and discuss the management?
9 th Semester 2015
➢ A known case of polycystic kidney
disease presents with nausea,
vomiting, pruritis, restless legs
and altered level of consciousness.
On examination he is anemic, his
BP is 160/110mmHg and on CVS
examination there is pericardial
rub.
a) What is the most probably
diagnosis?
b) What investigations you look
advice?
c) Name the steps to manage the
case?
“You get a strange feeling when you’re about to
leave a place. Like you’ll not only miss the
person you love but you’ll miss the person you’re
now, at this time and this place, because you’ll
never be this way ever again.”
KMC Batch-01

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Final Year MBBS

➢ Discuss the management of

➢ What is diabetic ketoacidosis discuss

the clinical features, investigation and

management of diabetic ketoacidosis?

➢ What is Cerebral Malaria.

Describe its clinical features,

➢ What is Diabetes mellitus.

Name the complication of

type-II. Name the drugs used

for the treatment of type-II?

➢ What is Cerebral Malaria?

Describe its clinical features,

investigations and treatment?

What are the other complication

➢ What are different types of

diabetes mellitus? What

investigations are used to

diagnose Diabetes mellitus?

Name the drugs used for the

treatment of type 2 diabetes.

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