Download DNB 2017 Dec EMG MED EM PAPER III Question Paper

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EMERGENCY MEDICINE

PAPER - II

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NATIONAL BOARD OF EXAMINATIONS

DECEMBER 2017

Time : 3 hours

Max. Marks : 100

Important instructions:

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• Attempt all questions in order.
• Each question carries 10 marks.
• Read the question carefully and answer to the point neatly and legibly.
• Do not leave any blank pages between two answers.
• Indicate the question number correctly for the answer in the margin space.

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• Answer all the parts of a single question together.
• Start the answer to a question on a fresh page or leave adequate space between two answers.
• Draw table/diagrams/flowcharts wherever appropriate.

Write short notes on:

1. A 30-year patient presents to the emergency with fever and altered sensorium.

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   1. Enumerate differential diagnosis
   2. Approach to the patient in the ED

   4+6

2. A 68 year old male presents to ED with chest pain. His ECG shows ST- segment elevation in V2-V6.

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   1. Enumerate causes of ST segment elevation
   2. How will you manage this patient in the ED?
   3. Discuss HEART score and TIMI score in a patient with chest pain.
   4. How will you decide between percutaneous coronary intervention and fibrinolytic therapy?

   2+2+3+3

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3. A 30 year old presents to the emergency with an acute onset of breathlessness.

   1. Enumerate the causes of acute onset of breathlessness
   2. In a patient with acute asthma, how do you classify his asthma attack based on the peak expiratory flow rate (PEFR).
   3. What are the indications for assisted ventilation in a patient with acute asthma?

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   4. What are the initial ventilator settings for invasive positive pressure ventilation in acute asthma?

   3+2+2+3

4. A 42 year old male is brought to the ED with right arm and leg weakness with slurring of speech for past 2 hours. His vitals are PR 100/min, BP 200/130 mmHg and oxygen saturation 95%. He is fully conscious.

   1. Step-wise assessment and management of this patient in ED.

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   2. What are stroke-mimics?
   3. What are the absolute and relative contraindications to fibrinolytic therapy?

   5+2+3

5. 1. What are the causes acute onset of jaundice?

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   2. List the complications of cirrhosis of liver
   3. Discuss briefly spontaneous bacterial peritonitis
   4. Discuss briefly hepato-renal syndrome

   2+2+3+3

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6. 1. Pathophysiology of acute kidney injury
   2. RIFLE criteria for acute kidney injury
   3. Laboratory evaluation of acute kidney injury
   4. Radiocontrast-induced nephropathy

   3+3+2+2

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7. A patient has come with suspected tetanus. Discuss the following:

   1. Pathophysiology of tetanus
   2. Control of muscle spasms
   3. Control of autonomic dysfunction

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   4. Immunotherapy and immunization

   3+3+2+2

8. 1. Factors precipitating lithium toxicity
   2. Toxic effects of chronic lithium poisoning

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   3. Management of chronic lithium poisoning

   3+4+3

9. 1. Regulation of body temperature
   2. Cooling techniques in heat stroke

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   3. Complications of heat stroke

   3+4+3

10. 1. Clinical features of myxedema crisis
    2. List differential diagnosis of myxedema crisis

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    3. ED treatment of myxedema crisis

    3+2+5

POSSESSION / USE OF CELL PHONE IS NOT PERMITTED INSIDE THE EXAMINATION HALL.

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