(9 Edition ‘XN x PAST MO/WMO SOLVED INTERVIEW QUESTIONS 2015-2021 Authors eDr. Muhammad Naeem Akhtar Joyi via Nadeem Akhtar Toy; Akhtar Joyia Joyiaay : ; : Copyright -'2021-All rights reserved : Title; SECRETS OF PPSC 2015-2021 BY DR M NADEEM AKHTAR JOYIA. No pat ofthis Publication may be reproduced, distributed, or ransmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical or mechanical methods, without the prior written permission ofthe author, except inthe case of brief quotations embodied in evtical reviews and certain other non commercial uses permitted by copyright law. Every effort has been made in preparing this book to provide accurate and upto-date information, ‘which is in accord with accepted standards and practice at the time of publication, Nevertheless, the author can make no warranties thatthe information contained herein is (otally free from error, not least because clinical standards are constantly changing through research and regulation, The Edition: 1* Edition 2021 for PPSC MO/WMO. INTERVIEW. Font: Calibri & Times New Roman Compiler: Dr. M. Nadeem Akhtar Joyia & Dr. Sumera Akhtar Joyia & Dr. M.Naeem Akhtar Publication: Joyia Publications Composer: Saifal & Muzaffar Ahmad Joyia For Book > Contact Jeyia Publications Whats app No. 9345-7211700 ‘Scanned with CamScannerSecrets of PPSC By Dr M Nadeem Akhtar Joyia Sections Secrets of PPSC (Surgery Questions 2015-2021) Imp Tables of GIT S.Surgery for PPSC MO/WMO Interview Imp Tables of S.Surgery Mix for PPSC MO/WMO Interview Imp Tables of Urogenital S.Surgery for PPSC MO/WMO Interview Imp Tables of G.Surgery for PPSC MO/WMO Interview Secrets of PPSC (Medicine Questions 2015-2021) Secrets of Signs and Symptoms Secrets of PPSC (Anesthesia 2015-2021) Secrets of PPSC (Gyny & Obs Questions 2015-2021) Secrets of PPSC (Community Medicine & Paeds 2015-2021) |. Secrets of Psychiatry Secrets of Dermatology Secrets of Community Medicine Rabies Vaceine/Dog Bite Management Job Description of MO/Staff Working in BHU SOP for Blood Transfusion Covid 19 Pneumonia Management EPI ‘Snake Bite Management Kalapathar Poisoning, ‘Scanned with CamScanner ‘Page # 29 56 108 171 181 188 215 247 256 268 310 315 SESECRETS OF PPSC 1st Edition BY DR NADEEM JOY ‘or Book whats app at 0345-7211700 1: SURGERY cosrinerescrninn 1. What is MANTRELS Scoring System and describe it? Ans: (Multan, LHR, D G Khan, Rawalpindi, Faisalabad) MANTRELS Scoring System: Characteristics Points Migration of Pain to Right Lower Quadrant 1 Anorexia 1 Nausea and Vomiting 1 ‘Tenderness in Right Lower Quadrant 2 Rebound Pain 1 Elevated Temperature 1 Leukocytosis 2 Shift of White blood cell count to left 1 Total 10 RECOMMENDATIONS: SCORE <5 Appendicitis unlikely Score 5 or 6 Appendicitis Possible Score 7 or 8 Appendicitis Likely Score 9 or 10 Appendicitis Highly Likely (Source: Alvarado A.A Practical score for the early diagnosis of acute appem 2. What is the difference b/w Acute & Chronic Appendicitis? ‘Ans: (Multan, LHR, D G Khan, Rawalpindi) ‘Acute Appendicitis: Inflammation of inner lining of vermiform appendix, has more severe symptoms that appear suddenly within 24 to 48 hours, requies immediate treatment. symptoms commonly include right lower abdominal pain (RIF), nausea, Vomiting and decreased appetite. Typical appendicitis includes several hours of generalized abdominal pain that begins inthe region of the umbilicus with associated eorexia, nausea or vomiting. The pain then localizes into the right lower quadrant where the tenderness increases in intensity. It is possible the pain could localize to the left lower quadrant in people with situs inversus totais. The combination of pain, anorexia, leukocytosis and fever is classic. Chronic Appendicitis: It has milder symptoms that last for a long time and that disappear and reppear. It can go undiagnosed for several weeks, months or years. 3. What is Courvoisier’s Law? (D G Khan, Multan, LHR, Bahawalpur) Ans: ‘Courvoiser’s Law: It states that a painless palpable enlarged gallbladder (known as Courvoiser’s sign or Courvoiser-Terrier’s sign or Courvoiser Sundrome) accompanied with mild jaundice is unlikely to be caused by gallstones. Usually, the term is used to SS ae ‘Scanned with CamScannerloskeletal system chondral cyst id cyst ‘Baker's Cyst F Aneurysmal bone cyst > Stafne static bone cyst Female Reproductive System > Nabothian Cyst > Ovarian Cyst > Urethral diverticulum > Ectopic Ureterocele > Bartholin’s Cyst > Skene’s duct Cyst > Gartner’s Cyst > Paratubal Cyst > Dermoid Cyst > Complex Cyst > Benign Cystadenoma Male Reproductive System > Epididymal Cyst > Hydrocele cyst ® Spermatocele Rete tubular ectasis _ Seen In Various Locations Cyst (seen in ovaries, testes and many other locations from head to ion Cyst (Hand and foot joi d joints, and tendons -Yst (Ganglion cysts of the digits) 4 Cysts ce: {Gn infection due to the larval stage of Taenia sp. (crain’s back) the liver or oth al sae se abaya) other parts of the body due to the larve 4 ‘tumor a uncial ‘Scanned with CamScannerSECRETS OF PPSC Ist Edition BY DR NADEEM JOYIA; For Book whats app at 0345-7211700 5: 7. What is treatment of acute cholecystitis? (LHR, Multan, D G Khan, Rawalpindi) Ans: > Acute Cholecystitis requires analgesics, intravenous support & antibiotics. It usually settles with these measures. > Subsequent cholecystectomy may then be performed when the acute episode has resolved. > Careful selection of patients with chronic cholecystitis is important as not all patients are pain free when the gallbladder is removed; symptoms may abate spontaneously and not recur. There is an increasing association with operative mortality with advancing age. > Laparoscopic cholecystectomy has increased the acceptability of the procedure for patients & has consequently become widely available. 8. Define Appendicular Mass and its management? Ans: (LHR, D GKHAN, MULTAN, RAWALPINDI, BAHAWALPUR, PINDI) Appendiceal Mass: is an inflammatory tumor consisting of the inflamed appendix, its adjacent viscera and the greater omentum & caecal wall. Management: > NPO > IV FLUIDS > IV ANTIBIOTICS 9. What is Compartment Syndrome and its management? (Multan, LHR, Pindi) Ans: Compartment Syndrome: it occurs when the pressure within a compartment increases, restricting the blood flow to the area and potentially damaging the muscles and nearby nerves. It usually occurs in the legs, feet, arms or hands but can occur wherever there is an enclosed compartment inside the body. Management: > Fasciotomy > Physiotherapy > Anti-inflammtory drugs (Brufen etc) > Antibiotics ‘Scanned with CamScanner\: For Book whats app at 0345-7211700 6, 2 (DG khan, Multan, LHR, Pindi, Sargodha) clinical prediction rule for predicting the prognosis and pancreatitis. not secondary to gall stones: cose > 11.11 mmol/L (>200mg/dL) rum AST > 250 TU/100 ml um Calcium < 2,0 mmoV/L (<8.0 mg/dL) ‘decreased by > 10% (hypoxemia with PaO2 <60 mmtig) increased by 1.8 or more mmol/L. (5 or mo base excess) > 4 mEq/L on of fluids > 6 L re mg/dL) after IV fluid hydration to gall stones ‘Scanned with CamScannerSECRETS OF PPSC 1st Edition BY DR NADEEM JOYIA; For Book whats app at 0345-7211700 vi INTERPRETATION: 1. 12. 13. If the score >-3, Severe pancreatitis likely If the Score <3, severe pancreatitis is unlikely OR Score 0 to 2: 2% mortality Score 3 to 4: 15% mortality Score 5 to 6 : 40 % mortality Score 7 to 8: 100% mortality vvvv vv What are different Types of Joint? (Sargodha, Multan, D G khan, LHR) ‘Ans: A Joint is a point where two or more bones meet, Types: > Fibrous (immovable) > Cartilaginous (partially moveable) > Synovial (freely moveable) TYPES OF SYNOVIAL JOINTS > Gliding Joint (Acromioclavicular and sternoclavicular joints, intercarpal and intertarsal joints, vertebrocostal joints, sacro-iliac joints) > Hinge Joint (Elbow joints, knee joints, ankle joints, interphalangeal joints) > Pivot Joint (Atlas/Axis, Proximal radio-ulnar joints) > Fllipsoid Joints (Radiocarpal joints, metacarpophalangeal joints 2-5, ‘metatarsophalangeal joints) > Saddle Joint (First carpometacarpal joints) > Ball and Socket Joint (Shoulder Joints, Hip Joints) Mention INDICATIONS OF Tracheostomy? (MULTAN, LHR, PINDI) Ans: Indications: > Airway obstruction > Long-term ventilatory support > Prevention of aspiration by allowing suctioning of excessive airway secretions Mention Indic Ans: Indications: > A nodule associated with signs suggestive of malignancy inducing recurrent nerve paralysis, palpable nodes in the neck, extreme hardness or extension into adjacent tissues > Anormal thyroid gland in a patient with proven metastatic thyroid cancer > Asolitary nodule > Any thyroid abnormality ions of Thyroidectomy? (D G KHAN, LHR, MULTAN) ‘Scanned with CamScanner-__ sECRETS OF PP! ; For Book whats app at 0345-7211709 g ¥ DR NADEEM JOYIA; a 16C 1st Edition B inal Pain? Eaeette pee LHR, D ROMAN, FAISALABAD, RAWALPIND}) Seer isver Abdominal Pain: ‘Acute appendicitis Diverticulitis Ectopic Pregnancy (Females) Ovarian Cyst (Females) Intestinal obstruction Acute Cholecystitis PID IBD > Urinary Tract Infection > Cystitis vVvvvvvvy 15. Mention Indications of NG tube? Ans: (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI) Indications: > To decompress the gastrointestinal tract in case of intestinal obstruction and in paralytic ileus > Gastric lavage in organophosphorus Poisoning and gastric haemorrhage > Itisused to feed unconscious patient or who is unable to take orally 16-Define Fracture and mention Its Types? =e ee aa DG KHAN, FAISALABAD, RAWALPINDI) break in the contineigs ns 2 medical condition in which there is a partial or complet ae BED a bone. In more severe cases, the bone may be broken into Eorea ae ne fracture may be the result of high force impact or stress or a Beets a, 8 a result of certain medical conditions that weaken the bones fracureis thee eho eeopenie, bone Cancer or osteogenesis imperfect where the A fracture isa trope 2t™e4 a pathological fracture. OR en bone, the same as a crack or break, A bone may be completely froeined or o artic * pieces) Pally fractured in any number of ways (crosswise, lengthwise, in multiple Ty > Trang comPound fracture) racture (Non-D (Diggs X™ Dspace) ture ‘Scanned with CamScanner‘SECRETS OF PPSC Ist Edition BY DR NADEEM JOYIA; For Book whats app at 0345-7211700 9: —————————————————— Greenstick fracture Hairline fracture Impacted fracture Intra-articular fracture Pathological fracture Spiral fracture Stress fracture VVVVVVV 17. What is Comminuted Fracture? Ans: (Multan, LHR, D G KHAN, BAHAWALPUR, SARGODHA) ‘A comminated fracture is a break or splinter of the bone into more than two fragments. Since considerable force and energy is required to fragment bone, fractures of this degree occur after high-impact trauma such as in vehicular accidents. 18. Define Hernia and Mention Its Types & Complications? ‘Ans: (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Hernia: A Hernia is the abnormal exit of tissue or an organ such as the bowel through the wall of the cavity in which it normally resides. Hernias come in a number of types. Most commonly they involve the abdomen, specifically the groin. OR Hernia happens when an internal organ pushes through a weak spot in your muscle or tissue. ‘Types: Inguinal Femoral Umbilical Incisional Diaphragmatic Hiatal Hernia Epigastric Hernia Lumbar hernia ‘Obturator hernia Paraumbilical hernia Perineal hernia VVVVVVVVVVY. Complications: > Inflammation > Obstruction of any lumen, such as bowel obstruction in intestinal hernias > Strangulation > Hydrocele of the hernia sac > Haemorrhage ‘Scanned with CamScannerSECRETS OF PPSC 1st Edition BY DR NADEEM JOYIA; For Book whats app at 034: 11700 19, > Imeducibility or incarceration, in which it can’t be reduced or at least not without very much external effort. In intestinal substantially increases the risk of bowel obstruction and st Pushed back i hernias, this also rangulation, tO Place, 19. What is Acute Abdomen? Ans: (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Any sudden onset, spontaneous non-traumatic disorder in the abdominal area that requites urgent surgery (most of them), unstable and will go into shock, should be initiated first. Analgesic and Painkillers are not preferably giv diagnosis is made. ‘Acute appendicitis Acute Peptic Ulcer & its complications Acute Cholecystitis Acute Pancreatitis Acute Intestinal Ischemia Acute diverticulitis Ectopic Pregnancy with tubal rupture Ovarian Torsion resuscitation en until a VVVVVVVY 20. What are the number of cervical vertebrae and nerve? Ans: (Bahawalpur, Sargodha, Rawalpindi) Cervical vertebrae: 7 Nerves: 8 21. A Person Came in Peripher: manage it? : (Multan, SARGODHA) Ans: > Proper History Examination (local) > Check Vitals PR, RR, BP Any signs of Shock (treat accordingly) > Any signs of Sepsis (teat accordingly) 2 paral You manage RTA in PERIPHERY? ( Multan, UHR, D G KHAN, FAISALABAD, RAWALPINDI, ALPUR, SARGODHA) ine 'y with trauma mark on the left flank, how will you LHR, D G KHAN, RAWALPINDI, BAHAWALPUR, In TT IM stay Inj Dyclo IM stay Pee fs a bleeding, the area should be covered and pressed fal plate or board tnden ttte/deformity, the area should be supported wil > affected part and immobilized using a cloth or taP®- Mf patient in Shock, treat Accordingly (IV Flnides : ‘Scanned with CamScannerSECRETS OF PPSC 1st Edition BY DR NADEEM JOYIA; For Book whats app at 0345-7211700 11: SS > If Vitally stable, Refer to DHQ Orthopedic Surgeon 23. How will you manage a patient with Femur Fracture? Ans: (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) > The First Priority in treatment is to rule out other life-threatening injuries and stabilize the patient. ATLS (Advanced Trauma Life Support) guidelines should be followed (ABCDE), made hemodinamically stable and resuscitated. > The emergent management of femur injuries in the sports setting is intended to restore alignment. If limb deformity is present, inline longitudinal traction is applied, realigning the extremity and maintaining limb perfusion. A splint is applied to maintain the alignment as the patient is transported to the hospital for definite treatament. > Treatment for acute trauma related femoral fractures and displaced femoralstress fractures is performed by an orthopedic surgeon and usually involves surgical stabilization (open reduction anad internal fixation, intramedullary nailing) > For non-displaced femoral shaft stress fractures, protected cruth-assisted weight bearaing is implemented for a minimum of 1-4 weeks, based on the resolution of symptoms and radiographic evidence of healing (callus formation) 24, Define Shock and mention its Types? Ans: (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Shock: State of cellular and tissue Hypoxia due to either reduced oxygen delivery and inadequate oxygen utilization or a combination of these processes. Types: > Cardiogenic Shock > Hypovolemic Shock > Septic Shock > Anaphylactic Shock > Neurogenic Shock 25, How to Calculate Fluid in Burn Cases? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) ‘Ans: The PARKLAND formula for the total fluid (Ringer Lactate) requirement in 24 hours is as follows > 4mlx BSA (%) x body weight (kg) > 50% given in first eight hours > 50% given in next 16 hours 26. What is Rule of Nines (9) in Burn Patients? Ans: (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) ‘Scanned with CamScannertion BY DR NADEEM JOYIA; For Book whats app at 0345-72170 19 ‘SECRETS OF PPSC Ist Edit ; i ents: The size of a burn can be quickly estimated b Rule ofNines Aeerecoirris method divides the body's surface area into percentage a a and back of the head and neck equal 9% of the body's surface area, The fron, ana back ofeach arm and hand equal 9% of the body’s surface area. OR ‘The Wallace rule of nines is a tool used in pre-hospital and ately medicine to estimate the total body surface area (BSA) affected by a burn. In addition to determinin, bum severity, the measurement of burn surface area is important for estimating patient's fluid requirements and determining hospital admission criteria. The rule of nines was devised by Pulaski and Tennison in 1947 and published by Alexander Bums Wallace in 1951. To estimate the body surface area of a burn, the rule of nines assigns BSA values to each ‘major body part. > The front and back of the head and neck equal 9% of the body surface area. > The front and back of each arm and hand equal 9% of the body surface area. > The chest equals 9% and stomacah equals 9% of the body surface area. > The upper back equals 9% and lower back equals 9% of the body surface area > The front and back of each leg and foot equal 18% of the body surface area > The genital area equals 1% of the body surface area. 27. Define Upper GI Bleed and mention its causes? Ans: (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Upper GI Bleed: Acute gastrointestinal (GI) bleeding is a potentially life-threatening abdominal emergency that remains a common cause of hospitalization. Upper GI ene (UGIB) is defined as bleeding derived from a source proximal to the ligament of Treitz. CAUSES: Arterial (Nonvariceal): Peptic Ulcer disease Mallory-Weiss tear Haemorthagic Gastritis Neoplasm. Inflammtory Pseudoaneurysms Aortoduodenal Fistula Tatrogenic Injury Trauma Hemobilia Hemosuccys VVVYVVVVVVVV Venous (Variceal) > Citthosis ‘Scanned with CamScanner‘or Book whats app at 0345-7211700 13: SECRETS OF PPSC 1st Edition BY DR NADEEM JOY > Budd-Chiari Syndrome > Splenic Vein Thrombosis Medications Nonsteroidal anti-inflammtory drugs Selective serotonin reuptake inhibitors Anticoagulants Antiplatlet drugs vvvv Note: > Hematemesis: Vomiting of fresh blood Coffee ground emesis-vomiting of dark, gastric acid-exposed blood > Melena: Black, tarry stools > Hematochezia: Passage of fresh blood in feces 28. Mention items required for Folleys Catheter? Ans: (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Folleys Catheter Surgial gloves/gloves Urine Bag Lignocaine Gel Distilled Water Syringe VVVVVV 29, Mention D/D of Lower Abdominal in females? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) D/D of Lower Abdomen Pain: Miscarriage PID Ruptured Ectopic Pregnancy Endometriosis Ruptured or Torsion of ovarian Cyst ‘Adenomyosis Menstrual Pain/Dysmenorthea VVVVVVV 30, Mention Types of Consent? (Multan, D G KHAN, RAWALPINDI, SARGODHA) Ans: > Implied Consent > Verbal Consent > Written Consent ‘Scanned with CamScannerSECRETS OF PPSC Ist Edition BY DR NADEEM JOYIA; For Book whats app at 0345-7211700 15: Infectious Process Inflammtory bowel disease Ulcer Anatomic: Diverticulosis Neoplastic: Polyp, Carcinoma VV YY Veo 35. Describe Counselling of Diabetic FOOT? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: Take care of your Diabetes/Sugar (Fasting & Random) Check your feet daily Be more active Wash your feet every day Keep your skin soft and smooth Keep your toenails immed Wear shoes and socks Protect your feet from hot and cold Keep the blood flowing to your feet VVVVVVVVYV 36. What is Green Stick Fracture? (D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: Green stick fracture is a crack or break on one side of a long bone in the arm or leg that does not extend all the way through the bone. Children are more likely to have greenstick fractures because their bones are softer and less brittle than an adult. 3 xn What is type of haemorrhage in patient regarding surgery? (Multan, LHR) > Primary Haemorrhage: at the time of injury/surgery or continuously afterward > Reactionary Haemorrhage: restarts after period of 3 hours post-operatively > Secondary haemorrahge: restarts few days later after surgery 38. What are the total number of vertebrae and name them? (LHR, Multan) Ans: Total Vertebrae: 33 > Cervical :7 gp 212 > L:5 > SACRAL:5 > Cocegeal : 4 ‘Scanned with CamScannerSECRETS OF PPSC 1st Edition BY DR NADEEM JOYIA; For Book whats app at 0345-7211700 19: 48. Describe Blunt Abdominal Trauma and its management? (LHR, MULTAN) ‘Ans: Blunt abdominal usually results from motor vehicle collision, assaults, recreational accidents or falls. The most commonly injured organs are the spleen, liver, retroperitoneum, small bowel, kidneys, bladder, colorectum, diaphragm and pancreas. Management: Reassessment of the airway Protection of the cervical spine with in-line immobilization is absolutely mandatory Intubation if indicated Supplemental oxygen Volume resuscitation Neurological assessment (Glasgow Coma Scale) Head-to-toeexamination Nasogastric tube Folleys catheter Ultrasonography ‘Treatment of blunt abdominal trauma begins at the scene of the injury and is continued upon the patient’s arrival at the emergency department (ED) or trauma center, Management may involve non-operative measures or surgical treatment as appropriate. VVVVVVVVVVV Indications for Laparotomy in a patient with blunt abdominal injury include the following: Signs of peritonitis Shock or haeamorrhagae Clinical deterioration during observation Haemoperitoneum findings after focused assessment with sonography for trauma (FAST) or diagnostic peritoneal lavage (DPL) examinations. VVVV 49, What is Hydated Cyst? (FAISALABAD, MULTAN, D G KHAN) Ans: Hydatid Cyst: The Larval form of tapeworm (echinococcus granulous) infects various ody organs and forms fluid filled cysts that contain immature daughter cells and can increase in size from 5-10 cm or more, These fluid filled Cysts are hydatid cysts which fare most commonly formed in liver and lungs and can stay there for many years. 50. How many Layers are opened during Open Cholecystectomy? ‘Ans: ((Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI) ‘The First layer includes the peritoneum, transverses abdominis, internal oblique laterall and posterior rectus sheath medially. The second layer includes the external oblique 2 (ii: ea ‘Scanned with CamScannerSECRETS OF PPSC 1st Edition BY DR NADEEM JOYIA; For Book whats app at 0345-7211700 ai: 55. 56. Drain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. ATLS: Advanced Trauma LIFE Support (ATLS) is a training programe for medical providers in the management of acute trauma cases, developed by the American College of Surgeons. Similar programs exist for immediate care providers such as paramedics. Its goal is to teach a simplified and standardized approach to trauma patients. What is haemorrhoides and its treatment? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: Haemorrhoides: Haemorthoides are swollen, enlarged veins that form inside and outside the anus and rectum, They can be painful, uncomfortable and cause rectal bleeding. Treatment: > High Fiber diet > Laxatives > Topical anesthetics > Topical corticosteroids > Mild astringent > Analgesics > Surgery (Sclerotherapy or rubber band ligation) MENTION D/D OF PAIN AT RHC? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: Acute cholecystitis Peptic ulcer disease Ascending Cholangitis Hepatic Tumor Diverticulitis Crohns disease Primary Biliary Syndrome Abdomen Aortic aneurysm Right Renal Colic Pyelonephritis Nephrolithiasis Hepatitis VVVVVVVVVVVV ‘Scanned with CamScannerSECRETS OF PPSC Ist Edition BY DR NADEEM JOYI. 6: 6 a s ‘or Book whats app at 0345-7211700 25: Peritoneal Signs: Rebound tenderness, Involuntary guarding, abdominal rigidity (peritoneal irritation, rupture or impending rupture) ' Psoas Sign: RLQ pain with extension of right thigh (Retrocecal appendix or abscess adjacent to psoas) Rovsing’s Sign: RLQ pain with LLQ palpation & retropulsion of colonic contents (acute appendicitis) Obturator Sign: RLQ pain with internal rotation of right thigh (Pelvic appendix or abscess) Rectal Tenderness: Right pelvic pain during rectal examination, especially with pressure on right rectal wall. (pelvic appendix or abscess) VV VO Mention Grades of Haemorrhoides? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: > Grade I: No prolapsed. Just prominent blood vessels, only bleeds > Grade II: Prolapse upon bearing down but spontaneously reduce. > Grade II: Prolapse upon bearing down and requires manual reduction. > Grade IV: Permanent prolapsed and cant be manually reduced. Define Anal Fissure and its Treatment? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: Anal Fissure: The Person would feel pain on passing stool and his constipation may be secondary to the pain he experiences while passing stool. The blood will be at the edge of the stool. The fissure is visible easily without even performing the DRE/Proctoscopy. DRE is contraindicated in case of Fissure. Treatment: Sitz Bath 0.3 % GTN + Lignocain Gel Icepacks to reduce swelling Take Fiber Diet Increase Fluids Intake juices etcc Ispaghol Husk Syp Duphalac (Lactulose) for constipation Antibiotic if needed VVVVVVVV ‘Scanned with CamScannerSECRETS OF PPSC 1st Edition BY DR NADEEM JOYIA; For Book whats app at 0345-7211700 108: MEDICINE rss ineie ssi 1. What is D/D of 50 year old male with low GCS? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, Sargodha) Ans: D/D of Low GCS CVA Metabolic Encephalopathy (Hepatic, Uremic etc) > Hypoglycemia > DKA > > vv Head Injury/Head Trauma. Poisoning 2. What will be the management of patient with LOW GCS? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: Management of Patient with Low GCS: > Check/Secure Air way. > Check Breathing > Circulation Maintenance (Pass IV Line) > Pass NG > Pass Folleys > Check Vitals > Send all baseline > Check RBS > CT Scan of Brain > Specific Treatment According to cause > Manage the Precipitating cause Like Stress, Infection Dehydration 3. What is Thyroid Storm Management? (Multan, LHR, D G Khan, Pindi) Ans: ‘Thyroid Storm Management: ‘The main strategies for the management of thyroid storm are reducing production and release of thyroid hormone, reducing the effects of thyroid hormone on tissues, replacing fluid losses and controlling temperature. Thyroid storm requires prompt treatment and hospitalization. Often admission to intensive care unit is needed. sip tie . In high fever, temperature control is achieved with paracetamoV/acetaminophen and external cooling measures (ice packs). Dehydration, which occurs due to fluid loss from sweating, diarthea and vomiting, is treated with frequent fluid replacement. ‘Scanned with CamScannerSECRETS OF PPSC 1st Edition BY DR NADEEM JOYIA; For Book whats app at 0345-7211700 110: —————————————————————————— Malabsorptions syndromes are common in family medicine but may be overlooked because of a wide variation in presentation.Classic symptoms include diarrhea, steatorrhea, weight loss, flatulence, and postprandial abdominal pain. 6. What are the main features of Nephrotic Syndrome? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: Nephrotic Syndrome: Triad of Odema, Proteinuria (more than 3.5 gram/24 hr) And serum protein less than 30g/L... Hyperlipidemia is also associated with Nephrotic Syndrome. > Proteinuria > Edema > Hyperlidpidemia > Hyper coagulation 7. Define Acute Respiratory Distress Syndrome? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR) Ans: RDS: RDS occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. The fluid keeps your lungs from filling with enough air, which means less oxygen reaches your bloodstream. This deprives your organs of the oxygen they need to function. Symptoms: Shortness of breath 8. What is Surfactant? (LHR, PINDI, D G KHAN, Sargodha, Multan) Ans: Surfactant: The word "surfactant" is a blend of surface-active agent, coined c. 1950. Agents that increase surface tension are "surface active" in the literal sense but are not called surfactants since their effect is opposite to the common meaning. 9. What are the causes of Compliance of Fatty Liver? (LHR, Multan, D G Khan) Ans: Fatty liver causes > Obesity > Smoking > Hypertension > Hypertriglycridemia > Diabetes ‘Scanned with CamScanner16. 17. SECRETS OF PPSC Ist Edition BY DR NADEEM JOYIA; For Book whats app at 0345-7211700 112: er sebortheic dermatitis, irritant contact dermatitis, nummular eczema, dyshidrotic eczema, asteatotic eczema, venous stasis dermatitis, and lichen simplex chronicus (neurodermatitis). . What are ECG changes after 6 hours of MI? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: In the first hours and days after the onset of a myocardial infarction, several changes can be observed on the ECG. First, large peaked T waves (or hyperacute T waves) then ST elevation, then negative T waves and finally pathologic Q waves develop. Times FROM Onset of Symptoms ECG changes Changes In Heart > Minutes Hyperacute T waves (tall T waves), ST-elevation Reversible ischemic changes > Hours ST-elevation, with terminal negative T waves, negative T waves (these can last for days to months) Onset of myocardial necrosis > Days Pathologic Q waves Scar formation What are normal and random sugar levels? (Multan, LHR, D G Khan) Ans: > EBS : < 126mg/dl > RBS: <200 mg/dl > HbAIc: <6.5% How can you confirm a person is diabetic? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: Criteria for diagnosis of DM: 1.Classic Symptoms of DM +Random biood Random blood glucose is the result of exami time of the last meal slucose >-200 mg/dl (11.1 mmol/L) ination at any time in a day regardless of the OR 2.Classic Symptoms of DM + Fasting blood glucose level >-126mg/dl (7.0 mmol/L) Fasting is defined as the condition when patients do not obtain extra calori fo) calories a sfor at least 8 oR 3:The 2 hours post loading plasma glucose>-200 mg/dl (11.1 mm ‘ .L mmol/L) OGTT is performed according to WHO standard using 75, which is dissolved into the water 8 758 anhydrous glucose load ‘Scanned with CamScanner‘SECRETS OF PPSC 18, Deseribe dog bite manag gALABAD, RAW 20. 1A; For Book whats apP at 0345-72179. 1 dition BY DR NADEEMJO its vaccination? ite management and its va‘ rALPINDI, BAHAWALPU, (Multan, LHR, , SARGODHA) Ans: > Clean the wound r > Wash the wound with soap and water > Keep open the wound/don’t stitch the wound > Apply antibiotic ointment to the injury area every > Rabies Vaccine 0,3,7 OR 0,3,7,14,28 day to prevent infection, ‘What is stroke? Its Types? Risk factors? And Prevention? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPLR, SARGODHA) Ans: Stroke: A stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to de in minutes, A stroke is a medical emergency and prompt treatment is crucial. Early action can reduce brain damage and other complications. ‘Types: Ischemic Stroke Haemorthagic Stroke TIA (mini Stroke) Risk Factors: High Blood Pressure Diabetes Mellitus Smoking High Blood Cholesterol & lipids Prevention: Stay away from smoking Control DM Control Cholesterol Control BP VVVV vvvv vvy It 2 Malaga t@ you at your RHC with BP over 200/120 mmbig, What will 1, LP do? (Multan, LHR, D G KHA\ SARGODHA) N, FAISALABAD, RAWALPINDI, BAHAW”! Ans: Maintain Vv line, oak foley’s cathter, y.sodium nitroprusside (nipride) LV infusi cap.adalat ( nifidipi pride) IV infusion, 7 drops ace tiPine) 10mg sublingual.Check bp every 15-30 minutes and g® Pests (semi) 4omg x, Record Mannie 15-30 minutes, ‘Scanned with CamScannerhats app at 0345-7: ast Eation BY DR NADEEM JOYE a 0 ly SECRETS OF PPSC : onary embolism. The American ¢, with suspected puter ent standard of care fr the ee in of choice fr stable pa ost CTA (0 Radiology (ACR) considers of pulmonary embolism. ECG S1Q3T3 ‘Treatment: Depending on your medic anticoagulant (blood-thinner) medicati stockings, and sometimes surgery or in and reduce the risk of furure blood clots. ical condition, treatment options may include ions, thrombolytic therapy, compression terventional procedures to improve blood flow What is drug reaction and treatment of Anaphylactic Shock? (Multan, LHR) Ans: Drug Reaction: Anaphylactic Shock Anaphylactic Shock Treatment: > Epinephrine (adrenaline) to reduce your body's allergic response. > Oxygen, to help you breathe. > Intravenous (IV) antihistamines and cortisone to reduce inflammation of your air passages and improve breathing. > A beta-agonist (such as albuterol) to relieve breathing symptoms. 28. 29. What is ECG and EEG? (Multan, LHR, D G Khan, Pindi, Sargodha) Al ECG: An electrocardiogram (ECG) records the electrical signal from your heart to check for different heart conditions. EEG: An electroencephalogram (EEG) is a test that detects electrical activity in your bal using =a, metal ies Ghats) attached to your scalp. Your brain cells communicaté lectrical impulses and are active all the time, even wh: 7 is activity shows up as wavy lines on an EEG recording, er nate 30. What are Types of MI? (Multan, LHR, D , LHR, D G KHAN, RAWALPINDL BAHAWALPUR, SARGODHA) ae Types of MI: A heart attack i 2 ee also known as a Myocardial Infarction, » a mbpent elevation myocardial infarction (STEMI), *Sment elevation myocardial infarction (NSTEMI) 31, What are ECG i ae Sees MI(STEMI, NSTEMD (LEtR; Multan, D G Khan) ECG Changes in M1; : hoi he aft Ina myocardial infa ct 5 .. e 9 rhe onset ofa yee tansmural schema develops. 1% . arction, several changes can be ot ‘Scanned with CamScannerSECRETS OF PPSC 1st Edition By py R NADEEM JOYI ‘or Book whats app at 0345-7211700 118: 32. 33. on the EGG. First, lars e Se peaked T waves (or hyperacute T waves), then ST elevation, then negative T waves and finally pathologic Q waves develop, i Describe criteria of SK? (Multan, LHR, D G KHA , LHR, N, FAISALABAD, ee nL, BAHAWALPUR, SARGODHA) ns: Reach Hospital Within 6 hours of MI Absolute Contraindications to thrombolysis: Haemorthagic stroke ot stroke of unknown origin at any time Ischaemic stroke in the preceding 6 months Central nervous system damage or neoplasms Recent major trauma/surgery/head injury. (within the preceding 3 weeks) Gastro-Intestinal bleeding within the last month Known bleeding disorder Aortic dissection Relative Contraindications to Thrombolysis: Transient ischaemic attack in the preceding 6 months Oral anticoagulant therapy Pregnancy or within 1 week post partum. Non-compressible punctures Traumatic resuscitation Refractory HTN (Systolic BP>180 mmHg) ‘Advanced liver disease Infective endocarditis ‘Active peptic Ulcer VVVVVVVVV VVVVVVV What are Contraindications of Thrombolytic Therapy (SK)? (LHR, MULTAN) Ans: as already solved above |. How will you prepare SK? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) ee ion of Streptokinase Infusio Protocol for preparation of . > Dilute el solution in 5 cc of Normal Saline (0.9%) 5 During the solution the saline should be transferred to the vial carefully through the sides of the walls of vial; thus avoiding the formation of air bubbles in the solution, > Please rotate the vial in between the palms slowly to dissolve the powder; avoid > i the vial. i é eae y and slowly remove the solution from the vial in a syringe and prepare a colon of solved medication by dilating wih 100ml noma saline in feds chamber (not in infusion pump) ea ae “olution preparation again the care should be taken to pour the solution along the walls of the peads chamber. ‘Scanned with CamScannerSECRETS OF PPSC 1st Ee 40. Define ICP? And hi 41. 42. 0345-72 For Book whats app at 11709 ADEEM JOYA: ly dition BY DR N Ste Multan, ww will you manage it? (Rawalpindi, Multan, LHR) 0" within the craniospin se i is defined as the pressure t inal pared a sa acme a fixed volume of neural tissue, blogg, a compartment, a clost cerebrospinal fluid (CSF). Normal 5-15mmhg ‘Treatment of High ICP: Head Elevation (30 degree) No Neck Compression . Mannitol for patients who have decreased LOC (or Furosemide) Steroids (Dexamethazone) for tumors Hyperventilation: Controlled to PCO 2 35-40 mmHg Sedation, Muscsle relaxants Hypothermia Barbiturates: Terminal Option What are the types of Shunt in ICP? (D G KHAN, MULTAN, LHR, PINDI) Ans: The most common shunt systems are: > Ventriculoperitoneal (VP) Shunts. This type of shunt diverts CSF from the ventricles o the brain into the peritoneal cavity, the space in the abdomen where the digestive organs are located > Ventriculoatrial (VA) Shunts > Ventriculopleural (VPL) Shunts > Lumboperitoneal (LP) Shunts VvYVVVVVV What are the duties of MO/WMO in RHC? (Multan, LHR, D G KHAN, parame RAWALPINDI, BAHAWALPUR, SARGODHA) Duties of MO/WMO in RHC: , MO is responsible for implementing all activities rou! under healtVfamily welfare delivery system in PHC area. He/She is responsible in hishe Be well as overall in charge. It is not possible to enumerate all his Fee Cor cepoen eee Fee theta be sole 4 j cretiilccetarrolonn ing of PHC and other national programme. 1.Curative Work: > Organize dis i > Organize ieee PD, Alllot duties to Staff < ae Provide guidance to health assistant/ health workers ‘Scanned with CamScanner= «TS OF PPSC 1st Edi SECRE! St Edition BY DR NADEEM JOYIA; For Book whats app at 0345-7211700 122: 2.Preventive Work (mmunization) > Universal Immunization Programme (UIP) > National Vector Born Disez eC ase Control Programme (NVBDCI > Control of Communicable Diseases ; ie 2 (Malaria, Filariasis, Leprosy, STDs > School Health ial 3.Promotive Work Services (MCH) Reproductive/Child Health OR Duties of MO/WMO in RHC: 43. Therapeutic Preventive Medicolegal Administrative Diagnostic Referral vVVVVVV How is TB treated? (D G KHAN, MULTAN, LHR, PINDI, SARGODHA) ‘Ans: If you have an active TB disease you will probably be treated with a combination of antibacterial medications for a period of six to 12 months. The most common treatment for active TB is isoniazid (INH) in combination with three other drugs—rifampin, pyrazinamide and ethambutol. |. What are the 2 line drugs of TB and their side effects? (LHR, MULTAN) Ans: > STREPTOMYCIN: Ototoxicity, Neurotoxicity, Nephrotoxicity > Amikacin/Kanamycin: Ototoxicity, Nephrotoxicity > Capreomycin: Nephrotoxicity, Ototoxicity What is the emergency treatment of dog bite and snake bite? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: ; Emergency Management of Dog Bite: > Clean the wound > Wash the wound with soap and water > Keep open the wound/don’t stitch the wound ; > aa "Pfibjotic ointment to the injury area every day to prevent infection, > Rabies Vaccine 0,3,7 OR 0,3,7,14,28 ‘Management of Snake Bite: ‘Scanned with CamScannerSECRETS OF PPS NADEEM JOYIA what: 0345-721 For Book whats aPP at : yR NADEE! ¢ 1st Edition BY D} x to use a pressure immobilization banda Coverthebite wi lean 2 bande guy rapped around te DHE Then, wap you an, pda aud the entre limb, so that it's immobilize Snake bite Treatment: f : i i with snake bite Confirmed coral/nom 1 ‘ Ere peniistet Coral snake specific Antivenom immediat ‘dmit ICU, Start IVF, IV abx ' 5 a Jabortary studies (CBC, Coags, UA with micro) > Administer CroFab ‘Wound Score: ‘Wound Score=1 Observe for 6 hours NO labs, Antivenom or antibiotics ‘Wound Score=2 Observe for 23 hours IVF as indicated NO labs, Antivenom ‘Antibiotics only if concern for wound infection Wound Score=3 Admit surgery IV abx if significant cellulitis/Induration Obtain labortary (CBC, Coags, UA with micro) tes CroFab if labs abnormal or wound advances ound Score=4 Admit ICU Start IVF, IV abx a Bere, aes (CBC, Coags. UA with micro) inon-coral snake bite or unknoy, ely, admit to Icy Vu VV VV VY 46. What is CPR? (Multan, LHR, D G KHAN, Sy |, FAISALAB: BARAWALPUR, SARCODIIS) AD, RAWALPINDI, CPR: Cardiopulmonary resuscitation (CPR) i PR) i ; : emergencies such aa heart tack or Ge coaie technique chats usefl in a It 4 Se e Tis a hand at the center of the person's chest. Make sure te CPR if a person is in bed or eee a loot. You cannot effectively Pom > Put your othe ae POsnon, doing CPR on eG dominant hand, and then interlock your fingers. 1 ¥" oe aettyents old), you can use one hand. For@ Bieta cich coniprescons pe qoute old) you uss two fingers : : Lean . : Press down ints thelr cheer nc uectly over the person and keep your arms straight You shoul be tying torah ae oP, ts important to let the chest rise A608 a around 100 comy lown about two inches, or five centimeters. Aim © “° Ipressions i chest compressions, mute, oF to the beat of Staying Alive. Complete ‘Scanned with CamScanner‘TS OF PPSC 1st Edi Sea ition BY DR NADEEM JOYIA; For Book whats app at 0245-7211700 124: > itecn. 's mouth. Once you've done 30 chest compressions, stop; tilt ead back and open their mouth at the chin. Cover their face with a pocket mask or barrier device, Add a rescue breath. Breathe into the person's mouth, enough for their chest to begin to rise. If you can't see the chest starting to rise, reposition their head and ty again. » Watch the chest fall, then do another rescue breath, Once the person’s chest is settled, you can re-adjust the head if needed, then complete another rescue breath. Continue the 30 compressions, 2 breaths cycle. Do this until EMS arrives, the scene becomes unsafe, or if the person wakes up. If you can, switch out with another trained person, every two minutes, > 47. What does AED stands for? (LHR, MULTAN, D G KHAN, PINDI) Ans: An automated external defibrillator (AED) is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation (VF) and pulseless ventricular tachycardia and is able to treat them through defibrillation, the application of electricity which stops the arrhythmia, allowing the heart to re-establish an effective rhythm, 48. What are the types of Malaria? (Multan, LHR, D G Khan, Sargodha, Pindi) Ans: > PLASMODIUM VIVAX > PLASMODIUM FALCIPARUM > PALSMODIUM MALARIAE > PLASMODIUM OVALE 49, Describe amanagement of DKA? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: DKA: : State of Insulin deficiency (absolute or relative) causing dehydration, acidosis and metabolic derangement. ; > Anion gap metabolic acidosis . BHOB > SmEq/L “Blood glucose > 250 mg/dl .Ph<7.3 HCO3 < 18mEq/L History: Thirst Polyuria Abdominal Pain Nausea and vomiting Profound weakness VVVVV ‘Scanned with CamScannerSECRETS OF PPSC Ist Edition By p R NADE| EM JOYIA; For Book whats app at 0345-7211700 12: 50. 51. 52. - Add 1 ampule (25 mmol) to each liter of fl si - If K <2.5 THEN add 2 ampules to a ie luid after 1* liter When patient becom i ee les stable infuse 2 U of Humulin R/HOUR or 4 U IM x every Adjust insulin dose onc e oral Cedus nsulin dose once oral intake has stared Inj Ceftriaxone 1 g 1V BD Counsel the pati F e patient and educate the patient how to use Insulin in case of emergency VVVV Vv What is Obesity and its risk factors? (LHR, FAISALABAD, BAHAWALPUR) is a complex disease involving an excessive amount of body fat. Obesity is not just a cosmetic concern. It a medical problem that increases the risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers. BMI >30 Risk Factors: > Lack of physical activity > Unhealthy eating patterns > Not enough sleep > High amounts of stress can increase your risk for overweight and obesity Childhood obesity remains a serious problem in the United States, and some populations are more at risk for childhood obesity than others. What is triphasic CT Scan? Why we do triphasic CT Scan in HCC complications of liver Cirrhosis? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) ‘Ans: ‘Triple-phase CT (including an arterial phase, a portal venous phase, and a late be highly accurate in the diagnosis and characterization ‘washout phase) has been found t y ’ act Of HCCs but like US, may miss smaller lesions. Pooled estimates reveal a sensitivity of Gas and a specificity of 93%. Disadvantages of CT include cost, radiation exposure, and the need for iodinated contrast. ndings of HCC include a hypervascular patter with arterial enhancement and ic CT fi Cae the portal venous phase. rapid washout during i jent of Cerebral Malaria? (Multan, LHR, D G KHAN, How wil yo AWALPINDS ‘BAHAWALPUR, SARGODHA) ‘Scanned with CamScannerSECRETS OF PPSC 1st Edition BY DR NADEEM JOYIA; For Book whats app at 034! 211700 12: Ans: eee are a family of toxins produced by certain fungi that are found on agricultural crop: as maize (corn), peanuts, cottonseed, and tree nuts, The main fungi that produce aflatoxins are Aspergillus flavus and Aspergillus parasiticus, which are abundant in warm and humid regions of the world. Describe Asthma and its management? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: Asthma is a condition in which your airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when you breathe out and shortness of breath. Symptoms: SOB, Cough; Wheeze To confirm asthma, your doctor may have you take one or more breathing tests known as lung function tests. These tests measure your breathing. Lung function tests are often done before and after inhaling a medicine known as a bronchodilator which opens your airways. Management: > Intermitent: Step 1: Preferred SABA > Mild Persistent: Step 2: Preferred: Low dose ICS Alternative: Cromolyn, LTRA or Theophylline > Moderate Persistent: Step 3: Preferred: Low dose ICS+LABA or medium Dose ICS Alternative: low-dose ICS+either LTRA, Thephylline or Zileuton > Severe Persistent: Step 4: Preferred: Medium dose ICS+LABA ‘Alternative: Medium dose ICS+either LTRA, Theophylline or Zileuton > Severe Persistent: Step 5: Preferred: High dose ICS+ LABA and Consider Omalizumab for patients who have allergies > Severe Persistent: Step 6: Preferred: High dose ICS +LABA+ Oral Corticosteroid AND Omalizumab for patients who have allergies ions and treatment of Migraine? (Multan, LHR, D G KHAN, 59, hee are the pre VALPINDI, BAHAWALPUR, SARGODHA) : a drome (1-2 days): Itabilty, Fatigue, increased or decreased appetite ee ‘Scanned with CamScannerSECRETS OF PPS 61 62. BY DR NADEEM JOYIA: For Book whats app at 0345-7211799 125, 3C Ist Edition ity to light, tingli bness, speech disorders min): Sensitivity to light, tingling, num! Aura (up oa 24: Fatigue problems concentrating Headache (Upto 74 hours): Severe throbbing p Common treatments for Migraine: Pain Releivers ‘Targeted Meds ‘Triptans BOTOX SHOTS VVVV vvv How Diabetes management is done? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: > Keep your blood glucose levels as near to normal as possible by following a diet plan, taking prescribed medication and increasing your activity level > Maintain your blood cholesterol (HDL and LDL levels) and triglyceride levels as nea the normal ranges as possible. Medications: > Sulfonylureas: First Generatior cetohexamide, Chlorpropamide, Tolbutamide, Tolzamide Second Generation: Glibenclamide, Glyburide, Glimepride, Glipizide Biguanides: Metformin Meglitinides: Repaglinide, Nataglinide Thiazolidinediones: Pioglitazone, Rosiglitazone Alpha-glucosidase Inhibitors: Acorbose, Miglitol Glucagon like peptide-1-agonist: Exenatide, Liraglutide Amylinomimetics: Pramlinitide acetate VVVVVV - Describe different ECG findings of MI? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) eee ILL Inferior aVL: Lateral aVF: Inferior V1: Septal V2: Septal V3: Anterior V4: Anterior V5: Lateral V6: Lateral VVVVVVVVYV Describe investigations and mana, j pee ae 'gement of Meningitis? (Multan, LHR, D G Ka oe LAB) INDI, BAHAWALPUR, SARGODHA) i ‘Scanned with CamScannerTS OF PPSC 1st Edit 63. 65. For a definitive diagnosis of meningit rc ingitis, fluid (CSF). In people with meningitis, along with an increased white blood call you'll need a spinal tap to collect cerebrospinal the CSF often shows a low sugar (glucose) level | count and increased protein. Ste enetts ist be weated immediately with nravenous anodes and sometimes corticosteroids. This helps to ensure recovery an reduce the risk of mplications, such as brain swelling and seizures. The antibiotic or combination of antibiotics depends on the type of bacteria causing the infection. Describe Management of Bronchial Asthma? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: already solved above Which model is used for breaking the bad news? (Multan, LHR, D G KHAN, ce RAWALPINDI, BAHAWALPUR, SARGODHA) ns: SPIKES model: The SPIKES model was first published in The Oncologist in 2000 as a protocol for delivering bad news to cancer patients. Model For Breaking Bad News: SPIKES PROTOCOAL > S: setting and listening skills > P: patient’s perception > I: invitation from patient to give information > K: knowledge-giving medical facts > E: explore emotions and empathise as patient responds > Si: strategy and summary ‘What are the causes of IDA? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: Causes of IDA: > Chronic Blood Loss: i Gastrointestinal-esophagitis, peptic ulcer, malignancy, IBD, hookworm infestation Genitourinary heavy menstrual bleeding, postpartum haemorrhage, intravascular haemolysis Systemic: hereditary haemo schistosomiasis , ; > Decreased Iron Uptake: improperly balanced vegan or vegetarian diet, iron poor diet, eating disorder ; Decreased Iron Absorption: celiac disease, atrophic gastritis, gastric and/or intestinal bypass, IBD, helicobactor pylori colonization, concomitant drug use e.g proton pump inhibitors > Increased Demand: preg! rhagic telangiectasia, eating disorder, chronic nancy, menstrual loss, blood donation, endurance sports Scanned with CamScannervia; For Book whats app at 0345-7211700 135 MJ" SECRETS OF PSC Ist Edition BY DR NADEEMJ| emities “ia sconing? (Multan, LHR, D G KHAN, FATSALApap is Organophosphatae Poison , a RAWALPINDI, BAHAWALPUR, SAROOT OT) organophosphates (OPs). 3 isonins rare iS. Se Sauer aeued ‘as insecticides, medications, and ding excess acetylch Organophosphates af Mptocks the effects of acetylcholine, including ylcholing Aropine compete or ring at muscarinic cholinergic receptors on smooth mus, Btn png i eo c , nervous system. Symptoms: Muscarinic Symptoms: Diarrhoea Urination Miosis Bronchospasm Emesis Lacrimation Salivation Sweating Nicotinic Symtoms: Muscle weakness Muscle fasciculation Muscle paralysis Hypertension Tachycardia (CNS Features: Fatigue Confusion Unconsciousness Seizures Ataxia Respiratory: Resp. depression VY VVVYVVY VYVVVY VvYVVVVVV 80. What is Kala Pathar Poisonin, 8? (Multan, LHR, Raya » LHR, D G KHAN, FAISALABAD, may BAHAWALPUR, SARGODHA) pcan es of Paraphenylene Diamine Ps Assessment of ABGs | Ste Breathing: Assure Oxygen supply & assis > Perform Tracheostomy (if auton (Kala Pathar) Intake: ‘Scanned with CamScanner= ‘SECRETS OF PPSC 1st Edition BYD) R NADEEM JOYIA: For Book whats app at 0345-7211700 141 Pathophysiology: 91 > > > » VVVVVV . What are Types of Shock? (Multan, (a) Increased hydrostat oc ‘atic pressure edema ty @dema with diffuse alveolar damage (DAD) (Mina nlty edema without DAD and €d' edema due to simultaneous increased hydrostatic pressure and permeability. Symptoms: Walking up at night with a breathi eee ee reathless feeling that goes away when you sit up Shortness of breath, Orthpnea Swelling in the lower part of the body Rapid weight gain especially in the legs Fatigue LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: VVVVVVVVV VVVVVVV VVVVVV Hypovolemic Shock: Hypotension Tachycardia Weak thread pulse Cool, pale, moist skin U/O Decreased Decreased CO Increased SVR Cardiogenic: Hypotension Tachycardia Weak thread pulse Cool, pale, moist skin U/0 < 30mI/h Crackles Tachypnea Decreased CO Increased SVR Neurogenic: Hypotension Bradycardia Warm Dry Skin Decreased CO Venous & Arterial vasodilation Loss Sympathetic tone Anaphylactic: ‘Scanned with CamScannerJOYIA; For Book whats app at 0345-7211799 139 SECRETS OF PPSC 1st Edition BY DR NADEEM Mild skin rashes/Hives Moderate Reactions: Severe Skin rashes/Hives Wheezing Abnormal Heart Rhythms High or Low Blood Pressure : Shortness of breath or Difficulty in breathing Severe Reactions: Difficulty in breathing Cardiac arrest Swelling of the throat or other parts of the body Convulsions Profound low blood pressure VVVVV VVVVV V 88. What are the side effects of Steroids? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Ans: Side Effects of Steroids: Cataracts/ Glaucoma /Ulcers /Gastritis /Skin (Striae, thinning, bruising)/ Hypertension’ Hirusitism/ Hyperglycemia/ Increase Infections/ Avascular necrosis of the femoral head Glycosuria/ Osteoporosis/ Obesity/ Immunosuppression/ Diabetes/ Behavioral changes! Tatrogenic Cushing syndrome/ Delay wound Healing/ Increase mental dysfunction/ Vocal | cord changes/ Pharangeal candidiasis 89. What are the different types of bleeding disorder? (Multan, LHR, D G KHAN, FAISALABAD, RAWALPINDI, BAHAWALPUR, SARGODHA) Hereditary: > Haemophilia A (Factor VIII deficiency) > Haemophilia B (Factor IX deficiency) > Von Will brand disease > Disorders of Fibrinogen (Hereditary afibrinogenaemia, Hypofibrinogenaemia, Dysfibrinogenaemia) ‘Acquired: Disseminated Intravascular Coagulation (DIC) Liver disease Vit K deficiency Massive transfusion of stored blood Acquired inhibitors of coagulation Heparin or oral anticoagulant therapy Renal Disease VVVVVVYV 90. What is Pulmonary Edema? (Multan, L! , LHR, D G KHAN, FAISALABAD; BAY AUEIND!, BAHAWALPUR, SARGODHA) # Pulmonary edema is a condition caused by excess fluid in the lungs. / ‘Scanned with CamScanner