Download University of Jaffna MBBS 2021 July Medicine Paper II Question Paper

FACULTY OF MEDICINE

FINAL EXAMINATION FOR MEDICAL DEGREES -JULY 2021

MEDICINE PAPER II

Date: 26.07.2021 Time: 3 HOURS

--- Content provided by‌ FirstRanker.com ---

Answer All TEN (10) Questions

Medicine - Final MBBS -July 2021 Index Number:

1. A 30-year-female presents to accident and emergency department with shortness of breath of one day duration. She also has reduced urine output for last 3 days and no urine output for last 12 hours. Examination revealed bilateral pedal oedema, pulse 90bpm, BP 165/100mmHg, elevated JVP, bi- basal fine crepitations and tender hepatomegaly without palpable urinary bladder. Initial investigations show

   UFR - Albumin +, RBC- field full with few RBC cast. Blood urea - 70mg/dl(normal 6 -20mg/dl)

   1. What is the most likely diagnosis? (10 marks)

      --- Content provided by FirstRanker.com ---

   2. List 4 causes for above diagnosis? (10 marks)

   3. List the investigations that need to be performed on this patient? (30 marks)

   --- Content provided by‍ FirstRanker.com ---

   4. Discuss the management of this patient? (50 marks)




2. A 56-year old man presents with a history of right sided pleuritic chest pain of 3 days duration.

   --- Content provided by‍ FirstRanker.com ---

   1. List 4 causes of pleuritic chest pain? (10 marks)

   2. Examination reveals signs confined to right lower zone with reduced vocal fremitus and vocal resonance with stony dullness. List 3 important general examination findings those have aetiological significance? (10 marks)

      Physical findings Aetiological significance

   --- Content provided by FirstRanker.com ---

   3. What investigation you will perform to confirm the clinical diagnosis of 2.2 (10 marks)

   4. Discuss the investigations you will perform to arrive at an etiological diagnosis? (50 marks)

   5. Briefly outline the treatment of this patient? (20 marks)

      --- Content provided by​ FirstRanker.com ---




3. A 60-year-old male who has undergone coronary artery bypass graft 5 years back following an acute anterior myocardial infarction presents with exertional dyspnoea of NYHA II of one week duration. He is a diabetic for 20 years. His current medications are Aspirin 150 mg daily, Clopidogrel 75 mg daily, Metformin 500 mg tds, Gliclazide 80 mg bid and Atorvastatin 20 mg noct.

   On general examination he has bilateral pitting ankle oedema and pallor. His PR is 110/min irregularly irregular. BP is 140/70 mm Hg, has bilateral basal inspiratory fine crepitations. Initial investigations showed Sp02 92% on air

   --- Content provided by‌ FirstRanker.com ---

   RBS 321mg/dl, FBC 9.5g/dl, MO/ 7011, WBC 4800/mm3, N 70 L28, Platelet 155000/mm3

   UFR reveals protein ++ and a 12 lead ECG shows atrial fibrillation.

   1. What is the most probable clinical diagnosis for his exertional dyspnoea? (10 marks)

   2. Name two conditions that could have precipitated the above presentation. (10 marks)

      --- Content provided by⁠ FirstRanker.com ---

   3. Name two ECG abnormalities you would look for to confirm the diagnosis of atrial fibrillation. (20 marks)

   4. Name two possible causes for his pallor. (10 marks)

   --- Content provided by‌ FirstRanker.com ---

   5. Name two possible causes for the ankle oedema. (10 marks)

   6. What investigation you would request to confirm the diagnosis you mentioned in (10 marks)

   7. Name a medication you would administer to relieve his presenting symptoms (10 marks)

      --- Content provided by‍ FirstRanker.com ---

   8. 1. Name 02 medications that could be added to improve the prognosis of the condition you mentioned in 3.1 (10 marks)

      2. Name two blood investigations you would perform before initiating the treatment. (10 marks)

      --- Content provided by​ FirstRanker.com ---




4. A 32-year-old male presents with a history of fever, loss of appetite and weight of 1 month duration.

   1. Define Pyrexia of Unknown Origin (PUO)? (20 marks)

      --- Content provided by‌ FirstRanker.com ---

   2. On direct questioning he admits that he had an altered bowel habit and right sided lower abdominal pain of 3 months duration. Name 2 differential diagnosis for the above presentation (10 marks)

   3. How will you differentiate clinically the 2 conditions that you have mentioned in 4.2 (30 marks)

   --- Content provided by‍ FirstRanker.com ---

   4. Name an important initial imaging investigation you would request on this patient (10 marks)

   5. Name 2 specific investigations you would request to arrive at a definite diagnosis? (10 marks)

   6. Name 2 cardiac conditions that could present with PUO? (10 marks)

      --- Content provided by FirstRanker.com ---

   7. Name 2 non haematological malignancies presents with PUO? (10 marks)




--- Content provided by​ FirstRanker.com ---

5. A 35-year-old male presents with bilateral symmetrical distal interphalangeal joint pain and swelling and low backache of 3 months duration. He had seen a dermatologist for a rash involving both knees and lower legs six months back and is on topical ointments.

   1. What is the likely clinical diagnosis? (10 marks)

   2. Mention three other characteristic patterns of joint involvement that can be seen in the diagnosis mentioned in 5.1? (10 marks)

   --- Content provided by‌ FirstRanker.com ---

   3. Mention 4 other sites of skin rashes you will look carefully in this patient? (10 marks)

   4. List the other clinical manifestations of the disease you mentioned in 5.1 (10 marks)

   5. What investigations will help in establishing the diagnosis? Write the expected findings (10 marks)

      --- Content provided by FirstRanker.com ---




6. A 50-year-old male with diagnosed Chronic Liver Cell Disease (CLCD) presents with abdominal pain and distension of one week duration. He is a febrile, icteric and confused on admission. He is a heavy alcohol consumer and had several similar admissions in the past. On examination he is very dark in complexion, GCS 13/15,PR 112bpm,BP 110/70mmhg,diffuse abdominal tenderness with fluid thrill elicited.

   His initial investigations are WBC 10500/mm3,N-85%,L-12%, Hb 10.3g/dl, MCV 102fl,PLT-85000/mm3, RBS 210mg/dl

   --- Content provided by‌ FirstRanker.com ---

   1. Give two acute medical problems you have identified in this patient? (10 marks)

   2. Write two likely underlying aetiology of CLCD you will consider in this patient (10 marks)

   3. Name other relevant physical signs you will elicit in this patient in view of the problems identified in 6.1 (15 marks)

      --- Content provided by FirstRanker.com ---

   4. List the investigations you will request in this patient to help in the management of the acute problems mentioned in 6.1 and Give reasons (15 marks)

   5. How will you manage this patient on presentation? (40 marks)

   --- Content provided by‍ FirstRanker.com ---

   6. List the other complications of CLCD and the relevant investigations you will perform to assess them. (10 marks)




7. A 25-year-old female patient presents to the ward with a history of progressive drooping of eyelids, and double vision for the past 8 months. She clearly states diurnal variation with worsening of symptoms towards the evening. Her medical history is otherwise unremarkable. On examination she has bilateral asymmetrical ptosis and ophthalmoplegia with variable diplopia not conforming to a particular ocular nerve palsy. She does not have any bulbar weakness or proximal muscle weakness. She has a small diffuse goitre. Remaining examination is unremarkable.

   --- Content provided by FirstRanker.com ---

   1. What is the diagnosis? (10 marks)

   2. Name a test and an examination technique that you can do immediately in the ward which might support your diagnosis? (10 marks)

   3. List a specific blood investigation and a neurophysiological investigation that would support your diagnosis. (10 marks)

      --- Content provided by⁠ FirstRanker.com ---

   4. What is the significance of goitre with respect to the diagnosis? (10 marks)

   5. Outline the management of this patient. (40 marks)

   --- Content provided by⁠ FirstRanker.com ---

   6. What advices you would give her on discharge? (20 marks)




8. What are the advises you would give this patient on discharge? (20 marks)

   --- Content provided by​ FirstRanker.com ---




9. A 30-year-old previously healthy farmer presents to A&E with a history of ingestion of organophosphate taken one hour prior to admission.

   1. List six important physical signs you will expect in this patient (20 marks)

   --- Content provided by⁠ FirstRanker.com ---

   2. Name the antidotes used in the treatment (10 marks)

   3. How do you manage this patient in the first one hour? (40 marks)

   4. List five clinical parameters and their targets that need to be achieved to confirm the adequacy of antidote treatment. (20 marks)

      --- Content provided by‍ FirstRanker.com ---

   5. List two long term complications of this poisoning (10 marks)




--- Content provided by‌ FirstRanker.com ---

10. A 60-year-old woman presents with excessive tiredness on mild exertion for last 3 months. She has no significant past medical history except taking thyroxine 100 micrograms mane daily for hypothyroidism due to Hashimoto's thyroiditis. On physical examination, she is pale, and having depigmented macules over limbs and trunk. Her vitals are normal.

    Investigations show

    Hb 8.1 g/dl

    MCV 116fL (80-96)

    WBC 8000/mm3

    --- Content provided by‌ FirstRanker.com ---

    Platelets — 170,000/mm3

    Bilirubin 1.00 mg/dl. (0.3-1.5)

    1. What nutritional deficiency that could cause her anemia? (10 marks)

    2. List three other important physical signs you will expect in this nutritional deficiency (15 marks)

       --- Content provided by⁠ FirstRanker.com ---

    3. List the findings you would expect in the blood picture (10 marks)

    4. What blood investigation you will perform to confirm the diagnosis mentioned in "10.1" (10 marks)

    --- Content provided by FirstRanker.com ---

    5. What is the etiological diagnosis for her deficiency mentioned in "10.1" (10 Marks)

    6. List four other medical conditions that could cause the nutritional deficiency mentioned in 10.1 (20 marks)

    7. List two blood investigation you will perform to confirm the diagnosis mentioned in "10.5" (10 marks)

       --- Content provided by⁠ FirstRanker.com ---

    8. Outline the management of her anemia (15 marks)

--- Content provided by FirstRanker.com ---