M.B.B.S. DEGREE EXAMINATION
(For the candidates admitted upto the Academic Year 2018-2019)
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THIRD PROFESSIONAL PART II - SUPPLEMENTARY (CBME)
PAPER I - GENERAL MEDICINE -1
O.P. Code: 526081
Time: Three hours Maximum : 100 Marks (80 Theory + 20MCQs)
Answer all the Questions
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I. Elaborate on: (2x15=30)
1. A 75 year old man presents to the out-patient department with progressive weight loss for 3 months, fatigue and malaise. He had lost up to 10 kgs. On Examination patient was ill built and ill nourished. Otherwise general examination was uneventful. On systemic examination, patient had a palpable spleen measuring about 9cms. No other organomegaly. His Complete blood count showed the following :
Total Count -39,250 cells / cmm
Differential count -Neutrophils 67%, Lymphocytes 7%, Monocytes 2%, basophils 4%, Eosinophils 3%, Bands 3%, Metamyelocytes 5%, Myelocytes 9%
RBC 4.37 M /cmm
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Haemoglobin 13gm/dl
MCV 92 fl
MCH 29.7 pg
MCHC 32.5
Platelets 1,98,000/cmm
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RDW -13.1%
a) What is the probable diagnosis? (2)
b) What are the differential diagnosis for a patient presenting with palpable spleen of 9cms? (4)
c) What are the other investigations necessary for this patient for confirming the diagnosis? (4)
d) How can this patient be managed? (5)
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2. A 25 year old male patient is admitted with persistent fever for the past one month. Patient gives history of being diagnosed with Valvular heart disease during childhood and was advised to take prophylactic treatment for the same. The patient has been on irregular treatment for the past 3 years. Now the patient has high grade fever with joint pain, unusual tiredness, night sweats and weight loss. The patient also has orthopnoea and paroxysmal nocturnal dyspnoea which he is experiencing for the first time. On Examination, patient is febrile, pallor and icterus present, painful tender swelling present in the fingertips and petechial rashes are present. The pulse was irregularly irregular. On systemic examination, Pansystolic murmur was heard in the mitral area and he also had a mild Hepatosplenomegaly.
a) What is the probable diagnosis? (2)
b) What is the diagnostic criteria for the above condition? (3)
c) Enumerate the causative agents for this condition? (3)
d) What is the pathophysiology for the above condition? (2)
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e) How to manage the patient? (5)
II. Write notes on: (10 x 5=50)
1. Heat related illness
2. Treatment of Rheumatoid arthritis.
3. Clinical features and Management of Scorpion sting.
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4. Complications of Falciparum Malaria and their immediate management.
5. Enumerate the causes and diagnosis of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH).
6. Enumerate the causes of Hypertriglyceridemia.
7. IgA Nephropathy.
8. Thyrotoxicosis.
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9. Inflammatory Bowel disease.
10. A 50 year old man brought to the hospital with status epilepticus is critically ill and needs ventilatory care. As a treating physician how will you explain to the patient’s attendants regarding the condition and prognosis of the patient.
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