Download DNB 2020 December Emergency MedIcIne Paper III Question Paper

FINAL EXAM

DECEMBER 2020

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EMERGENCY MEDICINE

PAPER-III

Time: 3 hours EM/D/20/52/III

Max. Marks: 100

Important Instructions:

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• You are provided with 5 answer sheet booklets. Each individual answer sheet booklet consists of 10 pages excluding the covering jackets.
• Answers to all the questions must be attempted within these 5 answer sheet booklets which must be later tagged together at the end of the exam.
• No additional supplementary answer sheet booklet will be provided.
• Attempt all questions in order.
• Each question carries 10 marks.

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• 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.

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• Draw table/diagrams/flowcharts wherever appropriate.

Write short notes on:

1. A 42-year-old male presents to the ER with fever and shortness of breath since 2 days. He is tachypneic, hypoxic and hypotensive. 3+3+4
   1. Enumerate differential diagnosis of non-infectious causes of fever.
   2. Echocardiography in pulmonary embolism.
   3. Approach to a patient with suspected PE and with hemodynamic instability.

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2. An 18-year-old female presents to the ER with history of ingestion of 20 tablets of paracetamol (each of 500 mg) about 3 hours back. She is hemodynamically stable and has no comorbidities. 1+1+2+2+4
   1. What are the minimal toxic doses of paracetamol in adults and children?
   2. Pathophysiology of paracetamol toxicity.
   3. Signs and symptoms of paracetamol overdose.
   4. Investigations for the above patient in the ER.

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   5. Treatment of the above patient in the ER.
3. A 70-year-old male comes to ER with history of giddiness and nausea since morning. He has a pulse rate of 48/min. His ECG shows irregular pacing. 2+2+2+2+2
   1. Indications for permanent pacing in adults.
   2. Five letter Pacemaker Code.
   3. Causes of pacemaker malfunction.

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   4. Pacemaker syndrome.
   5. Advanced Cardiac Life Support Interventions in patient with pacemaker.
4. A 27-year-old male presents to the ER with a high grade fever, headache and retro-orbital pain and joint pains since 2 days. He has a heart rate of 102/min, BP 100/76 mmHg and SpO2 96% on room air. He also complains of nausea and abdominal pain. You suspect dengue. Discuss: 2+2+2+4
   1. Phases in dengue.
   2. Severe dengue.

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   3. Laboratory investigations in dengue.
   4. Management of the above patient in the ER.
5. A 46-year-old male presents to the ER with uneasiness, severe headache and a blood pressure of 230/128 mmHg. 2+2+2+2+2
   1. Define hypertension and hypertensive emergency.
   2. Treatment (including therapy goals) of hypertensive emergency in acute ischemic stroke for thrombolysis.

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   3. Treatment (including therapy goals) of hypertensive emergency in aortic dissection.
   4. Treatment (including therapy goals) of hypertensive emergency in intracerebral bleed.
   5. Treatment (including therapy goals) of hypertensive emergency in eclampsia/pre-eclampsia.
6. A 20-year-old male presents to the ER with complaints of lower limb weakness since 2 days. 2+2+6
   1. Critical and emergent causes of neuromuscular weakness.

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   2. Non neurologic causes of weakness.
   3. How would you assess a hemodynamically stable patient for a neural/muscular cause of weakness?
7. A 46-year-old female presents to the ER with jaundice, fever with chills and right upper quadrant pain since 2 days. 3+7
   1. What could be the differential diagnosis in the above case?
   2. Management of the above patient on the ER. (Investigations and treatment).

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8. A 57-year-old patient, known case of chronic renal disease on regular dialysis thrice a week, presents to the ER from the dialysis unit with hypotension. 3+4+3
   1. Key elements of history of the hemodialysis patient in the ER.
   2. Differential diagnosis of peridialytic hypotension.
   3. Disequilibrium syndrome.

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9. A 42-year-old male was carrying out repair works on an electric pole when he suffered an electrical injury. He presented to the ER with burns on anterior abdominal wall. 5+5
   1. Clinical features of electrical injury.
   2. ED management of a patient with electrical injuries.
10. A 27-year-old is brought to the ER by his parents. He is very agitated and combative. 6+4
    1. Approach to a patient with acute agitation in the ER.
    2. Restraints in the ER.

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P.T.O.

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