Download DNB 2016 Dec FAMILY MEDICINE PAPER 1 Question Paper

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FINAL EXAM

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DECEMBER 2016

FAMILY MEDICINE

PAPER — I

Time : 3 hours

Max. Marks : 100

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Important instructions:

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.

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5. Indicate the question number correctly for the answer in the margin space.
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.

NATIONAL BOARD OF EXAMINATIONS

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FLM/D/16/08/1

1. A 1 year old child presents with itching of face and hands for 3 months, preventing sleep and feeding.

   1. What is the most likely diagnosis? Mention the differentials.
   2. How will you manage the child?
   3. When will you consider specialist referral?

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   4+4+2

2. A 40 year old man with chronic diarrhea for 5 years labeled as irritable bowel syndrome presents with increase in diarrhea.

   1. What points in the history will suggest three other possible diagnoses?
   2. How will you attempt to establish these diagnoses?

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   5+5

3. A 75 year old man with chronic heart failure recently worsens, despite compliance with medications.

   1. List 5 possible reasons for this and how they can be corrected?
   2. State the roles of spironolactone & beta blockers in heart failure management.

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   5+(2+3)

4. A 25 year old lady has episodes of pain unilateral face and temporal region lasting 12 to 24 hours for last 3 months.

   1. List 3 possible diagnoses, giving differentiating clinical features.
   2. Management principles of each in brief.

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   6+4

5. A 55 year old asymptomatic man was discovered to have gross prostatomegaly with post-void residue of 45ml on routine ultrasound abdomen at a master health check up.

   1. What is the pathophysiology?
   2. What is the best management at this stage and when should referral be made?

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   3. Pros and cons of routine PSA testing.

   3+4+3

P.T.O.

1-

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

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FINAL EXAM NATIONAL BOARD OF EXAMINATIONS

DECEMBER 2016

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FAMILY MEDICINE

PAPER - I

6. A 55 year old diabetic of 8 years duration has an HbA1c of 9.0% on Metformin 2gm/day & Glimeperide 4mg/day.

   1. List 3 management strategies which can be taken using oral drug in step-wise manner to improve glycemic control.
   2. How will you start insulin, if above are not successful? What advice will you give to this patient if started on insulin?

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   3. If HbA1c is 8% with all above treatments, what further can a diabetologist offer?

   4+4+2

7. Mr.Pratap is a 75 year old man who has come with a history of yellow discolouration of his eyes. You notice that he is jaundiced.

   1. What is the differential diagnosis for the cause of his jaundice?

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   2. How would you proceed with history and physical examination to assess him?
   3. Investigations you would ask for with justification for each.
   4. What are the characteristics of liver function tests in hepatocellular and obstructive jaundice?

   2+3+3+2

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8. Give briefly the interpretation of the following values in research studies.

   1. Comparision of heights in same age groups in school children rural Vs urban p<0.01, 95% Cl 0.1 -1.8
   2. Number needed to treat (NNT) 20/1000-in a trial of new lipid lowering agent.
   3. Odds ratio of 1 (one) in a Randomized Control Trial (RCT) of mortality in sepsis patients receiving a new antibiotic.

   4+4+2

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9. Sooraj is a 45 year old office worker who also has diabetes and hypertension. During the consultation for management of his health, you raise the issue of his smoking.

   1. List the adverse effects of smoking that you would discuss with him.
   2. What practical advice will you give him to quit smoking?
   3. List the withdrawal effects of quitting smoking.

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   4. Pharmacological treatment to help quit smoking.

   2+2+2+4

10. Rani is a 50 year old lady who has been getting episodes of palpitation.

    1. List the differential diagnosis for this symptom in her.

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    2. Write the relevant history and physical examination features you would elicit. List the investigations you would ask for with justification for each.
    3. Medical management of Grave’s disease.

    2+4+4

2.

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