Download Diplomate of National Board (DNB) 2016 Dec FAMILY MEDICINE PAPER 1 Previous Question Paper
DECEMBER 2016
-1-
POSSESSION / USE OF CELL PHONES OR ANY SUCH ELECTRONIC GADGETS IS NOT PERMITTED INSIDE THE
EXAMINATION HALL.
FAMILY MEDICINE
PAPER ? I
FLM/D/16/08/I
Time : 3 hours
Max. Marks : 100
Important instructions:
? 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.
? 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.
1. A 1 year old child presents with itching of face and hands for 3
months, preventing sleep and feeding.
a) What is the most likely diagnosis? Mention the differentials.
b) How will you manage the child?
c) When will you consider specialist referral?
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.
a) What points in the history will suggest three other possible
diagnoses?
b) How will you attempt to establish these diagnoses?
5+5
3. A 75 year old man with chronic heart failure recently worsens, despite
compliance with medications.
a) List 5 possible reasons for this and how they can be corrected?
b) State the roles of spironolactone & beta blockers in heart failure
management.
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.
a) List 3 possible diagnoses, giving differentiating clinical features.
b) Management principles of each in brief.
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.
a) What is the pathophysiology?
b) What is the best management at this stage and when should
referral be made?
c) Pros and cons of routine PSA testing.
3+4+3
P.T.O.
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FINAL EXAM NATIONAL BOARD OF EXAMINATIONS
DECEMBER 2016
-1-
POSSESSION / USE OF CELL PHONES OR ANY SUCH ELECTRONIC GADGETS IS NOT PERMITTED INSIDE THE
EXAMINATION HALL.
FAMILY MEDICINE
PAPER ? I
FLM/D/16/08/I
Time : 3 hours
Max. Marks : 100
Important instructions:
? 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.
? 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.
1. A 1 year old child presents with itching of face and hands for 3
months, preventing sleep and feeding.
a) What is the most likely diagnosis? Mention the differentials.
b) How will you manage the child?
c) When will you consider specialist referral?
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.
a) What points in the history will suggest three other possible
diagnoses?
b) How will you attempt to establish these diagnoses?
5+5
3. A 75 year old man with chronic heart failure recently worsens, despite
compliance with medications.
a) List 5 possible reasons for this and how they can be corrected?
b) State the roles of spironolactone & beta blockers in heart failure
management.
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.
a) List 3 possible diagnoses, giving differentiating clinical features.
b) Management principles of each in brief.
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.
a) What is the pathophysiology?
b) What is the best management at this stage and when should
referral be made?
c) Pros and cons of routine PSA testing.
3+4+3
P.T.O.
FINAL EXAM NATIONAL BOARD OF EXAMINATIONS
DECEMBER 2016
-2-
POSSESSION / USE OF CELL PHONES OR ANY SUCH ELECTRONIC GADGETS IS NOT PERMITTED INSIDE THE
EXAMINATION HALL.
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.
a) List 3 management stragegies which can be taken using oral drug
in step-wise manner to improve glycemic control.
b) How will you start insulin, if above are not successful? What
advice will you give to this patient if started on insulin?
c) 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.
a) What is the differential diagnosis for the cause of his jaundice?
b) How would you proceed with history and physical examination to
assess him?
c) Investigations you would ask for with justification for each.
d) What are the characteristics of liver function tests in hepatocellular
and obstructive jaundice?
2+3+3+2
8. Give briefly the interpretation of the following values in research
studies.
a) Comparision of heights in same age groups in school children
rural Vs urban p<0.01, 95% CI 0.1 ? 1.8
b) Number needed to treat (NNT) 20/1000 in a trial of new lipid
lowering agent.
c) Odds ratio of 1 (one) in a Randomized Control Trial (RCT) of
mortality in sepsis patients receiving a new antibiotic.
4+4+2
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.
a) List the adverse effects of smoking that you would discuss with
him.
b) What practical advice will you give him to quit smoking?
c) List the withdrawal effects of quitting smoking.
d) 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.
a) List the differential diagnosis for this symptom in her.
b) Write the relevant history and physical examination features you
would elicit. List the investigations you would ask for with
justification for each.
c) Medical management of Grave?s disease.
2+4+4
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This post was last modified on 17 April 2020