Download DNB 2019 Dec 2019 Dec EMERGENCY MEDICINE PAPER III Question Paper

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FINAL EXAM

DECEMBER 2019

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NATIONAL BOARD OF EXAMINATIONS

EMERGENCY MEDICINE

PAPER-III

Time: 3 hours EM/D/19/52/111 Max. Marks:100

Important Instructions:

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

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

Write short notes on:

1. a) Compare the various scoring systems to predict outcome in acute onset chest pain. (3+2+3+2)
   

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   b) Describe ECG findings requiring immediate coronary intervention. Enumerate other causes of ST elevations.
   c) Utility of cardiac biomarkers in Emergency department.
   d) Classify acute myocardial infarction.
2. a) Describe etiopathogenesis, clinical feature and management of acute kidney injury. (4+2+4+2)
   b) Bicarbonate therapy - indications and complications.
   

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   c) Urinalysis in Emergency department.
   d) Indications for RRT in ED.
3. a) Describe the clinical features and management of meningitis in a pediatric age group. (5+3+2)
   b) Approach and management of coma in a young adult.
   c) Antiepileptic therapy in Emergency department.

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4. a) Enumerate the causes of acute onset dyspnea in adult patient, based on severity. Discuss the investigations performed to establish the diagnosis. (4+3+3)
   b) Non-invasive ventilation in ED - weaning protocol.
   c) Suggest, with justification the initial ventilator settings for invasive mechanical ventilation for a COPD patient.
5. a) Tricyclic antidepressant poisoning (4+3+3)
   b) Describe differences between Neuroleptic Malignant Syndrome and Serotonin Syndrome.
   

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   c) Organophosphorus poisoning - drug therapies for treatment.
6. a) Approach to the management of a young adult with fever and jaundice. Discuss the diagnostic algorithm. (4+3+3)
   b) Malignant Hyperthermia - clinical features and treatment pearls.
   c) Post-exposure prophylaxis for needle stick injury from HIV positive patient for emergency care providers.
7. a) Describe clinical features and management of Sickle cell crisis. (4+3+3)
   

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   b) ED physician role in management of febrile neutropenia.
   c) Blood component therapy in anticoagulant induced upper GI bleeding in ED.
8. a) Discuss various pain assessment scores in children. (4+4+2)
   b) Procedural sedation and analgesia for reduction of hip dislocation in a known hypertensive adult on regular antihypertensive.
   c) Femoral nerve block and intercostal nerve block.

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9. a) Approach to acute onset diffuse bullous lesions. (3+2+2+3)
   b) Approach to acute onset erythematous rash in children.
   c) Panic disorder - presentation and treatment.
10. a) Approach to a patient with narrow-complex tachycardia. (3+3+2+2)
    b) Describe Delta Gap and its clinical implications.
    

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    c) Metabolic alkalosis - causes, clinical presentations and management.
    d) Briefly discuss the clinical features and management of hypercalcemia.
    e) Briefly discuss the clinical importance of Osmolal gap for emergency physician.

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