Download DNB 2019 June FAMILY MEDICINE FAMILY MEDICINE PAPER 1 Question Paper

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FINAL EXAM

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Time: 3 hours FLM/J/19/08/I 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 50-year-old patient comes to you with shortness of breath for the past 5 days. He is a diabetic and a hypertensive but has not been regular in his visits to the doctor. He has a history of smoking for the past 25 years and has been coughing on and off for the past 2 months. (2+4+2+2)
   1. What are the possible causes of his shortness of breath?

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   2. The clinical approach to this patient including history and physical examination.
   3. Investigations to assess this patient with justification for each.
   4. Describe the pharmacological management of each of the causes of symptoms you have listed.
2. A 24-year-old bus driver is brought to you by his family with history of episodes of sudden and unexplained behaviour lasting for a few hours after which he is normal. (2+4+4)
   1. State the likely differential diagnosis you would consider.

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   2. What historical points will you elicit to substantiate your diagnosis?
   3. Discuss the role of investigations to establish the diagnosis.
3. A 25-year-old lady presents to you with history of hemi-cranial headache for the past 2 days. She has been having similar symptoms since the age of 15 years. (2+2+2+4)
   1. List the common causes of headache in family practice.
   2. What clinical features will you look for in this patient to arrive at a diagnosis?

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   3. How will you manage the current symptoms?
   4. How will you counsel her to prevent further attacks?
4. Etiology, clinical features, investigations and management of post streptococcal glomerulonephritis. (1+2+2+5)
5. A 40-year-old labourer in the local market presents to you with history of generalised pruritus for the past 1 week. Discuss the approach to this patient including significant history, physical examination, investigations and management. (3+2+2+3)

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6. A 40-year-old businessman with a busy work schedule visits you as he has a family history of diabetes mellitus, heart disease and high cholesterol and is concerned about his health. He has a BMI of 35. (5+5)
   1. Comment on the significance of BMI and how reducing it will affect other co-morbidities.
   2. Discuss the various methods of weight reduction you will advise.
7. 1. Clinical features, investigations and management of depression in family practice. (3+2+3)
   2. List the indications for referral to a psychiatrist. (2)

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8. Describe the common symptoms and their management in a terminally ill patient suffering from breast cancer. (10)
9. A 55-year-old woman presents to you with history of fatigue, weight gain and day-time drowsiness for the past 3 months. (5+5)
   1. List 3 possible causes for her symptoms giving reasons.
   2. Describe in detail the clinical approach to this patient in the light of the above possibilities.

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10. A 55-year-old lady who has been a diabetic for the past 8 years, complaints of burning and pricking sensation of her feet. Her standing systolic blood pressure is 30 mm Hg lower than when she is sitting. (4+2+4)
    1. What specific physical examination points will establish the likely diagnosis?
    2. Discuss the mechanism of low standing blood pressure.
    3. List other abnormalities she is likely to have in the light of the blood pressure abnormality.

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