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Internal Medicine XVI ‘A’

2068/10
rd
Bachelor Level/ MBBS/ 3 Phase (Final year)/ IOM Time: 3 hours
Internal Medicine XVI ‘A’ Full Marks: 80
Candidates are required to give answers in their own words as far as practicable.
The figure in the margin indicates full marks.
Attempt all the questions.

1. Write short notes on: 4X4=16


a. H.Pylori eradication
b. Hepatic encephalopathy
c. Investigations for case of jaundice
d. Drug treatment of ulcerative colitis
2. Write short notes on: 4X4=16
a. Chronic renal failure (CRF)
b. Hyperkalemia
c. Causes of nephritic syndrome
d. Indications of hemodialysis
3. Discuss briefly: 4X2=8
a. Diagnostic criteria of acute rheumatic fever
b. Thrombolysis for acute myocardial infarction
4. Describe the presentation, clinical features, investigation and management of pulmonary
thromboembolism. 8
5.
a. Write down the etiopathogenesis, diagnosis and management of myasthenia gravis.8
b. How will you diagnose clinically the following conditions? 4X2=8
i. Guillain- Barre syndrome
ii. Bell’s palsy
6. A 65 years old female attended MOPD with complaints of gradual progressive, breathlessness.
What are the possibilities? Write down the clinical features of COPD. How will you investigate
and manage a case of COPD? 4+4+4+4=16

2067-8

1. Define Bronchial Asthma. Describe clinical features and management of bronchial asthma.
2+6=8
2. Discuss the presentation of HIV associated tuberculosis. What are the different methods to
diagnosed tuberculosis? 4+4=8
3. Define Guillain Barre Syndrome. Discuss its clinical manifestations and treatment. 2+3+3=8
4. Define stroke. How will you differentiate ischemic from hemorrhagic stroke? How will you
manage a case of ischemic stroke? 2+2+4=8
5. Define acute myocardial infarction. Outline the investigation tools used to diagnose acute
myocardial infarction. What are the complications and how do you manage a case of acute
myocardial infarction? 4+4+4+4=16
6. Describe the management of : 4X4=16
a. Ulcerative colitis
b. Celiac disease
c. Variceal bleeding
d. Hepatic Encephalopathy
7. Write short notes on: 4X2=8
a. Hypokalemia
b. Adult polycystic kidney disease
8.
a. What are the guideline indications of renal replacement therapy (DIALYSIS) in acute
renal failure? 4
b. Discuss the management of Nephrotic Syndrome. 4

2066-8

1. A 30 years young man complaint of progressive weakness of limbs orating from lower limbs.
From second day his single breath count was significantly decreased. On interrogation he gave
the history of common cold few weeks back. 2+4+2+8=16
a. What is your diagnosis in this case?
b. What other clinical signs you will get in this case?
c. What are the diagnostic modalities?
d. How would you manage such case?
2.
a. How will you classify jaundice? How will you differentiate them from each other> How
will you treat a case of viral hepatitis? 8+4+4=16
b. Write short notes on:
i. Complications of duodenal ulcer
ii. Crohn’s disease
3. Describe the management of : 4X4=16
a. MDR Tuberculosis
b. Bronchiectasis
c. Pulmonary embolism
d. Pneumothorax
4. Write short notes on: 4X4=16
a. Chronic kidney disease
b. Erythropoietin
c. Haematuria
d. Hyperkalemia
5. How will you diagnose clinically the following conditions: 4X4=16
a. Infective endocarditis
b. Mitral stenosis
c. Myocardial infection
d. Aortic regurgitation
Internal Medicine XVI ‘B’
2068/10
rd
Bachelor Level/ MBBS/ 3 Phase (Final year)/ IOM Time: 3 hours
Internal Medicine XVI ‘B’ Full Marks: 80
Candidates are required to give answers in their own words as far as practicable.
The figure in the margin indicates full marks.
Attempt all the questions.
Group “A” (Medicine)
1. Discuss briefly: 4X4=16
a. Indications for drainage of amebic liver abscess
b. Management of cerebral malaria
c. Acute gout
d. Oral Hypoglycemic drugs
2. Write short notes on: 4X4=16
a. Diagnosis and treatment of typhoid fever
b. Slow-acting anti-rheumatic drugs
c. Thyrotoxicosis crisis (thyroid storm)
d. Causes of clubbing
3. Write down the etiology, diagnosis and management of Addison’s disease. 16
Group “B” (Dermatology)
4. Name five papulosquamous disorders? What is the etiopathogenesis of psoriasis? Nam e
treatment options in psoriasis. 1+1+2=4
5. List the causes of urethral discharge. How do you confirm its diagnosis? List the drugs with their
doses to treat urethral discharge syndrome. 1+1+2=4
6. Answer in short:
a. Define the condylomata lata? Mention how so they differ from condylomata acuminate.
1+1=2
b. How would you define single lesion pauci-bacillary Hansen’s disease? What is the
treatment? 1+1=2
7. Write short notes on: 1X4=4
a. Triple response of Lewis
b. Levocetrizine
c. Primary chancre
d. Tzanck smear
Group “C” (Psychiatry)s
8. Discuss the etiology, clinical features and management of depression. 4
9. Discuss the symptoms, signs and management of catatonic schizophrenia. 4
10. Write short notes on: 4X2=8
a. Clinical features of conversion disorder
b. Attention deftest hyperactivity disorder
2067-9
Group “A” (Medicine)
1. Describe the clinical manifestations of: 4X4=16
a. Rheumatoid arthritis
b. Hypothyroidism
c. Visceral Leishmaniasis
d. Severe anemia
2. Write short notes on: 4X4=16
a. Hypercalcemia
b. Oral hypoglycemic agents
c. HIV infection
d. Causes of lymphocytosis
3. Describe in brief the management of : 4X4=16
a. Diabetic peripheral neuropathy
b. Acute myeloid leukemia
c. Wilson’s disease
d. Paracetamol- poisoning
Group “B” (Dermatology)
4. Define Impetigo. List the common types and their causative organism. Mention the treatment of
impetigo contagiosa in a 4 year old child. 1+1+2=4
5. Mention in brief the cardinal clinical features of multi-bacillary Hansen’s disease. Explain how do
you confirm its diagnosis? 2+2=4
6. List the causes of vaginal discharge in a woman. Mention how you treat a woman with vaginal
discharge syndrome. 2+2=4
7. Write short notes on: 1X4=4
a. Acne vulgaris
b. Whitfield ointment
c. Gram Stain
d. Steven Johnson Syndrome
Group “C” (Psychiatry)
8. Discuss etiology, clinical features and the treatment of possessive compulsive disorder. 4
9. Classify anxiety disorders. What are the clinical features and management of generalized anxiety
disorders? 4
10. Discuss etiology, clinical features and treatment of Depressive disorders. 4
11. Write short notes on: 2X2=4
a. Delusions
b. Insight

2066-8
Group “A” (Medicine)
1. Describe the clinical manifestations of: 4x4=16
a. Organophosphorus poisoning
b. Addison’s disease
c. Falciparum malaria in various s form
d. Diabetes mellitus with complication
2. Write short notes on: 4x4=16
a. ARV therapy in HIV/ AIDS
b. Gouty arthritis
c. Hypothyroidism
d. Phaeochromocytoma
3. Describe in brief the management of: 4x4=16
a. Snake-bite
b. Hyperthermia
c. ITP
d. Megaloblastic anemia
Group “B” (Dermatology)
4. List the causes of generalized pruritus. Mention the clinical features and management of
Scabies. 1.5+1+1.5=4
5. List the causative organism responsible for urethral discharge syndrome in a male. Manage how
you manage a 30 years old truck driver presenting to you with complaints of urethral discharge.
1+3=4
6. Write the clinical features and mention the treatment of lepromatous leprosy. 1+3=4
7. Write short notes on: 1x4=4
a. PCR
b. Albinism
c. Polymorphic light eruption
d. Clobestol Diproprionate
Group “C” (Psychiatry)
8. Write short notes on: 2X8=16
a. Fluoxetine
b. Clozapine
c. Anti-Parkinsonian drugs in psychiatry
d. Delusion
e. Clinical features of panic disorder
f. Hallucination
g. Management of Possession Syndrome
h. Types and indication of Electro Convulsive Therapy
General Surgery ‘A’
2068/10
rd
Bachelor Level/ MBBS/ 3 Phase (Final year)/ IOM Time: 3 hours
General Surgery XVII ‘A’ Full Marks: 80
Candidates are required to give answers in their own words as far as practicable.
The figure in the margin indicates full marks.
Attempt all the questions.

1. Describe the course and content of Femoral Hernia. Enumerate the clinical differences between
femoral and inguinal hernia. List the surgical approaches for repair of femoral hernia.
3+3+4=10
2. Enumerate the various thyroid swellings. List the difference between papillary carcinoma
follicular carcinoma. How will you manage a case of unilateral thyroid nodule? 4+3+3=10
3. Enumerate premalignant conditions of esophageal carcinoma. How do you investigate a patient
with dysphagia? 5+5=10
4. Describe dynamic and adynamic small bowel obstruction with their causes. How will you
manage a case of dynamic small bowel obstruction of six hours duration? 4+6=10
5. Classify surgical wounds with examples and describe in brief stages of wound healing. 4+6=10
6. Describe in brief types of colostomy and their indications. Mention complications of colostomy
and their management. 3+3+4=10
7. Write short notes ON: 5X4=20
a. Types of imperforated anus and its management
b. Intercostal tube drainage
c. Callot’ Triangle
d. Testicular torsion

2067-9

1. A 40-year female presented in the emergency with history of right upper quadrant pain and
fever for 24 hours. Pain was radiating to the back. What is the most likely diagnosis? Give the
differential diagnosis and discuss in detail the management. 1+3+6=10
2. Classify thyroid swelling and describe the natural history of simple goiter. 5+5=10
3. Enlist the causes of hematuria. Outline the management of renal stone. 5+5=10
4. Outline the investigation of a breast lump. How will you mange a case of fibro adenoma in a 20-
year-old female? 5+5=10
5. Define hernia and describe its etiology, composition and classification. 1+3+3+3=10
6. Write short notes on: 5X6=30
a. Epidural hematoma
b. Fournier’s gangrene
c. Full thickness skin graft
d. Retrograde appendectomy
e. Hirschsprung’s disease
f. Perianal abscess

2066-8

1. Describe Alvarado’s and Tzancki’s scores. What is atypical target sign in ultrasound of acute
appendicitis? Enumerate the complications of appendectomy. 4+2+4=10
2. An eighteen-year-old boy presents with hematemesis and malena. He has no previous medical
history. What are the possible causes of GI bleeding? Define upper GI bleed. Enlist the
investigations for the diagnosis. 5+2+3=10
3. What do you understand by pseudo pancreatic cyst? Describe its clinical features and enlist the
diagnostic modalities. Outline its management. 2+3+2+3=10
4. What are the types of hemorrhoids? Describe its clinical presentation and enlist various options
for its management. 2+4+4=10
5. Enlist various causes of dysphagia. Outline its investigations. How will you manage a case of
achalasia cardia? 3+3+4=10
6. Describe different types of renal stones. Outline investigations for renal stone. What are the
management options for 1 cm solitary stone inside the renal pelvis? 3+3+4=10
7. Describe the pathophysiology of chronic subdural hematoma. Discuss the clinical features and
its management? 3+3+4=10
8. What are the risk factors for breast carcinoma? Describe the TNM staging. Enlist the
investigation modalities for breast cancer. 2+5+3=10
General Surgery ‘B’
2068/11
rd
Bachelor Level/ MBBS/ 3 Phase (Final year)/ IOM Time: 3 hours
General Surgery XVII ‘B’ Full Marks: 80
Candidates are required to give answers in their own words as far as practicable.
The figure in the margin indicates full marks.
Use separate answer copies for each group.
Attempt all the questions.
Group ‘A’ (General Surgery)
1. Classify hemorrhage. Enlist clinical features of acute blood loss and its management. 2+3=5
2. Enlist the biochemical complication during parenteral nutrition and their correction. 2+3=5
3. Classify cysts. Describe the clinical features of epidermoid cyst. 2+3=5
4. What is universal precaution? Write down steps to prevent transmission of disease during
operation on a serology positive patient. 2+3=5
5. Write short notes on: 3X4=12
a. Crush syndrome
b. Post operative analgesic
c. Metabolic acidosis
d. Marjolin’s Ulcer

Group ‘B’ (Anesthesiology)


6. Write short notes on: 2X2=4
a. Ten golden rules of anesthesia
b. ASA grading
7. Illustrate the mechanism of action of local anesthetic agents. How do you manage toxicity of
local anesthetic agents? 1+3=4
8. Define hemorrhagic shock. How do you mange hypotension intraoperatively? 1+3=4
9. What do you understand by acute and chronic pain? How do you explain the role of epidural
analgesia to manage acute and chronic pain? 2+2=4

Group ‘C’ (Dental)


10. What is Acidogenic Theory? Discuss the role of oral hygiene in prevention of dental caries.2+3=5
11. Draw a diagram of mandible and label it. Discuss the salient features of mandible fracture.3+2=5
12. Write short notes on: 3X2=6
a. Relative and absolute contraindications of tooth extraction
b. Dentine

Group ‘D’ (Orthopedics)


13. Classify traumatic dislocation of the hip. How do you diagnose clinically the posterior dislocation
of the hip? Mention three complications. 1+2+1=4
14. What are the clinical features of nutritional rickets? 4
15. Write short notes on: 2X4=8
a. Frozen shoulder
b. Skeletal traction
c. Ewing’s sarcoma
d. Complications of untreated displaced fracture of lateral condyle of humerus in children

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Group ‘A’ (General Surgery)
1. A 30 year old was brought to the emergency with history of road traffic accident and ENT bleed
and severe right chest pain. What are the likely diagnosis and how will you manage them?
2+6=8
2. What are the phases of wound healing? Enumerate the factors influencing wound healing.
4+4=8
3. What do you understand by universal precaution? Mention briefly precautions that one has to
take while operating on a HIV positive patient. 2+6=8
4. Write short notes on: 4X2=8
a. Dermoid cyst
b. Blood fractions

Group ‘B’ (Anesthiology)


5. What are the indications of endotracheal intubation? Make a list of equipments and accessories
required for airway management. 2+2=4
6. What is defibrillation? Write two indications of defibrillation. List the drugs used advance
cardiac life support. 1+1+2=4
7. What are basic monitoring requirements during anesthesia? Calculate perioperative fluid
requirements for a 60 kg patient undergoing cholecystectomy. 1+3=4
8. What is regional anesthesia? Mention the indications of Epidural Analgesia? How do you
manage cardiovascular toxicity of local anesthetics? 1+1+2=4

Group ‘C’ (Dental)


9. How do you differentiate between chronic gingivitis and chronic periodontitis? Describe
etiology, types, clinical features and treatment of chronic periodontitis. 2+3=5
10. Write indications and contraindications of tooth extraction. What antibiotic prophylaxis would
you follow for prevention of infective endocarditis? 4+1=5
11. Write short notes on: 2X3=6
a. Eruption dates of permanent dentition.
b. LeFort’s I fracture
c. Course and area of innervations of inferior alveolar nerve

Group ‘D’ (Orthopedics)


12. What is acute compartment syndrome? In what conditions it develops in the forearm? How you
will diagnose and treat it? 4
13. What are the diagnostic criteria for rheumatoid arthritis? Mention common deformities in
rheumatoid hand. 4
14. Briefly describe how d you manage a case of fracture shaft of femur, in different age groups. 4
15. Write short notes on: 1X4=4
a. Osteosarcoma
b. Clinical features of tuberculosis of hip joint
c. Treatment of fracture neck of femur
d. Congenital talipes equinavarus

2066-8

Group ‘A’ (General Surgery)


1. A young individual sustained high voltage electric burns in the right upper limb. Outline
emergency management of electric burns and what precaution wills you take to prevent acute
renal failure. 4+4=8
2. Classify hemorrhage and describe each of them briefly. Enlist different types of blood products
and their use. 4+4=8
3. Define sterilization and disinfection. Describe various methods of sterilization in detail. How will
you sterilize optical instruments used in surgery? 2+4+2=8
4. Write short notes on: 2X4=8
a. Cellulitis
b. Basal cell carcinoma
c. Pott’s puffy tumor
d. Hilton’s method of drainage of abscess

Group ‘B’ (Anesthesiology)


5. What are IV inducing anesthetic agents commonly used? Give the adverse effects of sodium
thiopentone. 2+2=4
6. List the causes of hypoxia during anesthesia. Enumerate the methods of oxygen therapy.2+2=4
7. Enumerate the different local anesthetic agents and their does. Enlist the different local
anesthetic agents and their doses. Enlist the adverse effects of local anesthetics. 2+2=4
8. Writhe short notes on: 2X2=4
a. Halothane
b. Ketamine

Group ‘C’ (Dental)


9. Discuss deciduous, mixed and permanent dentition in brief. What are the teeth present at the
age of 8 months, 16 months and 12 years? 4
10. What are the factors involved in dental caries? How do you prevent dental caries? 4
11. Write short notes on: 2X4=8
a. Dentigerous cyst
b. Bass method of tooth brushing
c. FDI clinical notation
d. Indications of tooth extraction

Group ‘D’ (Orthopedics)


12. How will you treat intracapsular fracture neck of femur in different age groups? What are its
complications? 2+2=4
13. What are the X-ray pictures of osteosarcoma? 2
14. Give five clinical features of Rickets? 2
15. Briefly describe the causes of low back pain. How do you reach the diagnosis? 2+2=4
16. Describe in short the pathophysiology of acute hematogenous osteomyelitis. 4
Pediatrics XVIII
2068/10
rd
Bachelor Level/ MBBS/ 3 Phase (Final year)/ IOM Time: 3 hours
Pediatrics XVIII Full Marks: 80
Candidates are required to give answers in their own words as far as practicable.
The figure in the margin indicates full marks.
Use separate answer copies for each group.
Attempt all the questions.

Group ‘A’

1. A Newborn weighing 2.8 kg develops respiratory distress noticed at 30 minutes of live. What are
the causes of respiratory distress? Mention the broad headings of management of respiratory
distress according to the cause in such babes. 2+6=8
2. A 5 days newborn was brought by his mother with history of yellow discoloration of skin and
sclera for the last 3 days. He was full term normal delivery with normal sucking. Mother blood
group was A +ve. On examination the baby was active with yellowish discoloration of face and
sclera. 1+4+3=8
a. What is the most likely diagnosis?
b. What are the causes of unconjugated hyperbilirubinemia?
c. List the differences between physiological and pathological jaundice.
3. A 3 years old boy was brought to Pediatric OPD by her grand mother with complaint of five
episodes of vomiting since this morning and two episodes of loose stool. You examine him and
found some signs of dehydration. List the causes of vomiting. How will manage him? Mention
the physiological basis prescribing ORS. 2+3+3=8
4. You see a girl aged 7 years brought by her mother in OPD with complains of rashes in her body
which she noticed two days back. This girl has maculopapular rashes. What are the conditions in
which you get such rashes List the complications of measles. 4+4=8
5. What are the common opportunistic infections in children with HIV infection? What are the
indications of staring antiretroviral therapy in infants and children? What drug regimen will you
use? 3+3+2=8

Group ‘B’

6. A 5-year-old child came in emergency with history of fever and pain on the right side of the
chest. On examination, he was in respiratory distress with normal position of trachea and
bronchial breath sound on right side of the chest. 1+4+3=8
a. What is the most likely clinical diagnosis?
b. List the causes of pleural effusion.
c. List the complications of pneumonia in children.
7. You examine a one-year-old girl and found moderate pallor and liver of 4 cm and palpable
spleen tip. There is history of blood transfusion once. List the causes of anemia. How will you
investigate suspected case of thalassemia? Describe the management of thalassemia major.
2+3+3=8
8. A 4 years old child was brought by his care-giver with history of swelling of the whole body for
the last 10 days with passage of scanty urine. On examination, he looks puffy with pedal edema
and ascites. His urine shows Albumin++++ without RBCs in urine. 1+3+4=8
a. The most likely diagnosis is.
b. List 5 common causes of hematuria in children.
c. List complications of prednisolone.
9. Ten years old boy was rushed to ER and found him having generalized tonic clinic convulsion.
How will you manage him now? List the causes of such events and how will you investigate.
2+3+3=8
10. A 2 year old child came in emergency with tachypnea, tachycardia. On examination, he was
stunted, cyanosed with clubbing. There was history of cyanotic spells in the past.
1+4+3=8
i. What is the most likely diagnosis
ii. Outline the treatment of Congestive Cardiac Failure (CCF).
iii. List the causes of cyanotic heart disease in children.

2067-9

Group A
1. A two year old child presented in the ER because of difficulty in breathing and high fever for two
days. List four important key signs that you will look for respiratory distress. What are the World
health Organization age related definitions for tachypnoea? List the medicines you will use for
complicated pneumonia. 3+1+2=6
2. Enumerate the clinical pointers for inborn errors of metabolism. A 9 months old child has history
o f hypoglycemia and has hepatosplenomegaly with hypotonia and cardiomegaly. What type of
metabolic disease this child is likely to have? 3+2=5
3. List the signs seen in skull, GI system and palm of a child whose karyotyping shows three 21st
chromosome. What it s the risk of having another child? 3+1=4
4. Enumerate problems that can occur in an adolescent? List programs associated with adolescent
health in Nepal. 4+3=7
5. List cardiac disease that may present as congestive cardiac failure without cyanosis. Enumerate
key points that you will consider in treating congestive cardiac failure. 3+5=8
6. List the findings that suggest lower motor neuron in a floppy child. How will you diagnose child
who is floppy and has degeneration of anterior horn cells? 3+2=5
7. Which investigation can diagnose hypothyroidism during neonatal period? List important signs
that will make suspicious of this disease during neonatal period? 1+4=5
Group B
8. List the five causes that may lead to chronic and persistent diarrhea. How will you differentiate
chronic diarrhea from persistent, dysentery and acute water diarrhea? 2+5=7
9. How will you classify a dehydration based on sodium content of plasma? How will you manage a
child whose serum sodium is 160 mmol/L? 2+5=7
10. List three hypothesis that heave been postulated for the pathogenesis of Post-Streptococcal
Glomerulonephritis? Enumerate the five differential diagnosis. Which investigations are done
when follow-up is required? 2+2+2=6
11. What do you understand by preventive chemotherapy in Tuberculosis? List the features that
suggest neuro-tuberculosis. Which specific investigations help to make the diagnosis?
2+3+3=8
12. How will you prevent mother to child transmission of HIV? How will you make a definitive
diagnosis of HIV in an infant who is two month old? What are the indications of anti-retroviral
therapy in children? 3+2+3=8
13. How does the WHO define Protein Energy Malnutrition (PEM)? List important points for initial
assessment of sever malnutrition. 1+3=4

2066-8

1. A three years old girl has presented to emergency of your hospital with complaints of fever and
cough of three days’ duration. What questions will ask the parents that will help you to decide
whether the child is suffering from a mild disease or from a life threatening condition requiring
hospitalization? 3
2. An 18 months old boy has been brought to you for consultation. The parents are worried about
his feeding. On examination, you find that the child weighs 11 kg and is able to walk and he
speaks a few words with meaning. What is your assessment of the child’s growth and
development? What advice will you give the parents about feeding of the child? 2+2=4
3. A 7 years old boy presents with edema. Enumerate the common causes of edema in children. He
also gives history of red colored urine. List the clinical signs you will see in this patient. How will
you manage this patient? 2+3+3=8
4. A two months old infant is brought to OPD born to a HIV positive mother. How will you counsel
the mother on infant feeding? What investigation will you order to confirm the diagnosis? Does
this infant need to be on any medication? 3+3+2=8
5. List the causes of respiratory distress in neonates. Enumerate the problems in preterm baby.
3+3=6
6. Define croup. How will you differentiate acute layngotracheobronchitis and epiglottitis? List
three drugs that are used for the treatment of severe acute laryngotracheobronchitis. 1+3+2=6
7. Which is the single most common cardiac defect in children? What special clinical sign will be
present in this defect? What is your advice to parent when this is diagnosed at 6 months of age?
1+2+2=5
8. Classify clinical types of diarrhea. Write one complication for each type of diarrhea. List three
constituents of RESOMAL that is not present in normal ORS. 1+2+2=5
9. List four pathophysical changes in gastrointestinal system during protein energy malnutrition.
List five important heading in which you treat a child with severe protein energy malnutrition.
List five causes of failure to gain weight in spite of adequate calorie intake in
malnutrition.2+2+2=6
10. List three salient features that diagnoses asthma clinically? Which plan of action is used for
children who cannot afford inhalers and other costly medicines for asthma? How will you
classify a child who has symptoms of asthma more than 2 times a week and less than 1 times a
day and exacerbations may affect activity and the FEV1 is more than 80% predicted? 3+1+1=5
11. List five important clinical signs that differentiate peripheral nervous system from central
nervous system lesion. List five signs of severely raised intracranial pressure. List two drugs for
the treatment of raised intracranial pressure. 2+2+1=5
12. Nine months old child who is on cows milk and rice lito presented with pallor. The peripheral
blood smear shows hypochromic microcytic red blood cells. List two conditions that can present
with this. What further two investigations differentiate between these two conditions. Write
one specific treatment for these conditions. 2+2+2=6
13. A male neonate is born with ambiguous genitalia. Further examination reveals signs of
dehydration. List two serum electrolyte abnormalities that are found in this condition. List two
investigations that confirms the diagnosis. Which two drugs are used for this condition?
2+2+2=6
14. List six different diagnoses for juvenile rheumatoid arthritis (JRA). List four investigations that
helps to diagnose JRA. List four disease modifying anitrheumatic drugs for this disease. 3+2+2=7
Gynecology and Obstetrics
Paper XIX
2068/11
rd
Bachelor Level/ MBBS/ (3 Phase) Final/ IOM Time: 3 hours
Gynecology and Obstetrics XIX Full Marks: 80
Candidates are required to give answers in their own words as far as practicable.
Use separate answer copies for each group.
The figure in the margin indicates full marks.
Attempt all the questions.
Group ‘A’ (Gynecology)
1. A 32 years regularly menstruating para 2 lady presented in emergency with sudden onset of
severe pain abdomen for 4 hrs. She is ill looking, vitals are within normal range. Rt iliac fossa and
suprapubic region are tender on palpation. Cervix is normal looking, uterus is normal in size,
with a tender 6X8 cm mass in the Rt fornix.
a. Give your provisional diagnosis. 2
b. What are the differential diagnosis? 3
c. List the investigations. 3
d. How will you treat this case? 2
2. Define screening. What are the different methods of screening for carcinoma of the cervix? How
do you treat cancer stage I. 2+4+4=10
3. Write short notes on: 5X4=20
a. Signs and symptoms of ovulation
b. Differences and common features between adenomyosis and fibroid uterus
c. List the progesterone containing temporary methods of contraception and their
advantages
d. Symptoms and signs of trichomonas vaginalis and its treatment
4. A 28 year lady on her 8th postpartum day delivered at home came to emergency with the c/o
pain lower abdomen, high grade fever and foul smelling discharge for two days. Examination
revealed temperature of 102°F and pulse 116 beats/ min. uterine height is 24 wks size tender
and has foul PV discharge.
a. What is your provisional diagnosis? 1
b. What investigations will you request? 4
c. How will you treat this case? 5

Group ‘B’ (Obstetrics)

5. A 53 years old primi gravida at 38 weeks comes with the c/o watery discharge P/V.
a. What is the probable and differential diagnosis? 2
b. What steps will you take during examination to confirm the diagnosis? 4
c. How will you manage her? 4
6. Write short notes on: 5X4=20
a. Use of oxytocics in the management of post-partum hemorrhage
b. Hematological changes during pregnancy
c. Neonatal problems of IUGR babies
d. Clinical significance of amniotic fluid

2067-9
Group A (GYNECOLOGY)
1. A 25 years woman married for 4 years comes with history of overdue by 8 days, severe
abdominal pain for 6 hours and brownish discharge P/V for 2 hours. On examination patient was
pale, abdominal tenderness in lower abdomen, rebound tenderness present and on P/V
examination vague adnexal mass felt in right fornix which I very tender. 2+4+4=10
a. What is the most likely diagnosis?
b. What two investigations you would like to do for confirming your diagnosis.
c. How will you treat this case?
2. A 60 years old multi-parous female complains of a mass at the introitus, which enlarges on
coughing or straining for the past 5 years. However, it became irreducible 4 months ago and she
is bothered by it. 2+4+4=10
a. What is the most likely diagnosis?
b. What are the contributing factors to this condition?
c. How will you manage this patient?
3. A 20 years old female G1P0, presents at 12 weeks amenorrhea with excessive nausea/ vomiting
and PV bleeding for 1 week. On examination uterus size is of 20 weeks and per- speculum
examination grape like vesicles seen in the external os and vagina. 2+2+6=10
a. What 2 investigations would you like to do for diagnosis?
b. What is the surgical definitive treatment of this condition?
c. How would you monitor the patient post-treatment?
4. Write short notes on: 5X2=10
a. Oral contraceptives
b. What are the screening testes for carcinoma cervix?
5.
a. What is mild pre-eclampsia? 1
b. What physical evaluation of mother will you do daily? 3
c. What lab evaluation will you do and how frequently? 3
d. What fetal evaluation will you do and how frequently? 3
6. Define APH (ante-partum haemorrhage). What are the causes of abruption placenta? How do
you differentiate between abruption placenta and placenta previa? What are the complications
of abruption placentas? 1+2+4+3=10
7.
a. What are the risk factors of dizygotic twin? 2
b. What tare the risk associated with twin pregnancy on mother and fetus? 6
c. Indications of caesarean section in twin pregnancy? 2
8. Write short notes on: 5X2=10
a. Partograph
b. Magnesium Sulphate
2066-9

GYNECOLOGY:

1.
a. Enumerate the hormonal and non-humoral contraceptive methods. 5
b. Elaborate the advantages of combined oral contraceptive pills over injection
depomedroxy progesterone acetate. 5
2. A 25 year old woman married for 2 years is anxious to become pregnant. How do you establish
whether the woman is ovulating or not by
a. History and clinical examination 5
b. Investigation 5
3. A 16 year girl comes with ultrasonic diagnosis of 7 weeks pregnancy. She is unmarried.
a. How will you counsel her? 3
b. What are the options for managing this case 4
c. What contraceptive advise will you give her 3
4. Write short notes on: 5X2=10
a. Classification of ovarian tumors
b. Investigation of postmenopausal bleeding
OBSTETRICS
5. A 24 years old woman books for antenatal care in her first pregnancy.
a. What are the important history you will record? 3
b. What physical examination you will do on each antenatal visit? 3
c. What are the blood and urine test you will advice? 2
d. What is the purpose of routine ultrasound scan? 2
6.
a. Define preterm, term and post-term pregnancy. 1
b. What are the risk factors for preterm labor? 2
c. List the names of drugs used for managing preterm labor. 5
d. Describe the dose and role of steroid in preterm labor. 2
7.
a. Define ante partum hemorrhage (APH). 2
b. How ill you differentiate whether the APH is due to placenta previa or a abruption
placenta? 4
c. How will you manage a case of placenta prevail with bleeding P/V at 34 weeks of
pregnancy? 4
8. Write short notes on: 5X2=10
a. Active management of third stage of labor
b. Causes of puerperal pyrexia
Ophthalmology
Paper XX
2068/11
rd
Bachelor Level/ MBBS/ 3 Phase (Final year)/ IOM Time: 1 ½ hours
Ophthalmology XX Full Marks: 40
Candidates are required to give answers in their own words as far as practicable.
The figure in the margin indicates full marks.
Attempt all the questions.
1. How common are refractive errors in children? How would you manage Myopia? What are the
common complications of high myopia? 3+2.5+2.5=8
2. Describe the clinical features of orbital cellulitis. How would you differentiate this condition
from preseptal cellulitis? 4+4=8
3. List out common conditions of painless gradual diminution of vision. Describe the diagnostic
features of Proliferative diabetic retinopathy. 4+4=8
4. A 25 years old male presents to Eye OPD with redness and blurring of vision. He also gives
history of neck and low back pain. What could be possible diagnosis? How would you manage
the condition? 3+5=8
5. A 65 years old hyper metropic female presents with pain, redness and blurring of vision for 6
hours. What could be the possible cause or causes? How would you manage the condition?
3+5=8

2067/9
1.
a. Describe the clinical features of viral conjunctivitis. 4
b. Explain brief outline on the principles of management of Bacterial Corneal ulcer. 4
2. What are the differential diagnoses of Painful Red Eye? Discuss the management of Acute
Anterior Uveitis in a young male patient. 3+5=8
3. What tare the common causes of blindness of Blindness in people above 65 years? Discuss the
clinical features and management of Age related macular degeneration. 3+5=8
4. What ate the various causes of Proptosis? Describe the clinical features of Dysthyroid Eye
Disease. Explain how could this condition leads to visual deterioration. 3+3+2=8
5. Describe the etiopathogenesis and clinical features of Diabetic Retinopathy. Explain the role of
LASER therapy in this condition. 3+3+2=8

2066/9
1. What is xeropthalmia? Describe the causes, clinical features and treatment of xeropthalmia. (10)
2. What are the different forms of conjunctivitis? How do we establish their diagnosis and treat
them? (10)
3. How would you manage a case of acute angle closure glaucoma? (8)
4. Write short notes on (any THREE): (4X3=12)
a. Chalazion
b. Iridocyelitis
c. Types of cataract surgery
d. Chronic dacryocystitis
ENT
Paper XXI
2068/11
Bachelor Level/ MBBS/ (3rd Phase) Final Year/ IOM Time: 1 ½ hours
ENT XXI Full Marks: 40
Candidates are required to give answers in their own words as far as practicable.
The figure in the margin indicates full marks.
Attempt all the questions.
1. An one year child was brought to you with high fever and inability to cry. On examination there
was swelling in posterior pharyngeal wall. What is your diagnosis? How will you manage the
case? 5
2. Write the differential diagnosis of unilateral nasal obstruction. How will you manage a case of
sino-nasal polyp? 5
3. What are the common presenting signs and symptoms of carcinoma of tongue? What are the
treatment options do you know to manage such a case? 2+1.5+1.5=5
4. What are the causes of granulations in external auditory canal? How do you approach such a
case to confirm the diagnosis? Which nerve is responsible for referred otaliga? 2+2+1=5
5. Describe the clinical presentation, investigations to be done and overall treatment of Meniere’s
disease. 2+1+2=5
6. How does a case of carcinoma larynx present? How do you confirm the diagnosis? List the
available treatment options of such a case. 2+2+1=5
7. How does a case of allergic rhinitis present? How will you investigate and treat a case of allergic
rhinitis? 2+1+2=5
8. Write short notes on: 2.5X2=5
a. Tracheostomy care
b. Vocal cord nodule

2067-9

1. How does a case of Otitis media with Effusion (OME) present in children? What are the specific
investigations do you advice to confirm your diagnosis? List the different complications of
ventilation tube (grommet) insertion. 2+1+2=5
2. How do you confirm the diagnosis of Sensory Neural Hearing Loss (SNHL)? What are the
indications doing Pure Tone Audigramme (PTA)? 2.5+2.5=5
3. How does a case of Carcinoma of Pyriform Sinus present? How do you confirm the diagnosis of
such a case? List the treatment options of a case of Carcinoma of Pyriform Siunses presented in
this early stage. 2+1.5+1.5=5
4. What are the clinical features of Acute Frontal Sinusitis? What treatment option do you advise
to manage such a case not responding to conservative treatment? 3+2=5
5. Outline the steps of management of a case of Active Epistaxis. What are the complications of
Posterior Nasal Packing? 2+3=5
6. What are the different methods do you know to remove wax from the External Auditory Canal?
What are the complications you may face during syringing the ear? 2.5+2.5=5
7. What are the different sites where foreign body gets impacted in the esophagus? Write down
the complications of rigid oesophagoscopy. 2+3=5
8. A 12 years old boy comes to OPD with complaint of progressive, unilateral nasal obstruction and
recurrent nasal bleeding. His hemoglobin is 6 gm% and he also complains of hearing loss of the
same side of his ear. 2+3=5
a. What is the most likely diagnosis of this case?
b. How will you manage this case?

2066-9
1. What are the different aims or advantages of myringoplasty surgery? What are the common
graft materials that are used for this surgery? Mention two important causes of graft uptake
failure after myringoplasty operation. 2.5+1.5+1
2. Define Meniere’s disease. How does a patient present to you clinically during acute stage of this
disease? List three important conditions that should be considered in its differential diagnosis.
1+2.5+1.5
3. Writhe down the pathophysiology of nasal polyps. How do nasal polyps appear on clinical
examination? What is the advantage of functional endoscopic sinus surgery over conventional
procedures surgical treatment of nasal polyps? 2+2+1
4. What are the various possible etiological factors of atrophic rhinitis? How will you treat a case of
atrophic rhinitis medically? 2+3
5. A 25 years old non-smoker lady, teacher by profession, visited to you with the complaints of
progressive hoarseness of last 2 weeks duration. During indirect laryngoscopy her vocal cords
could not be seen due to excessive gag. How do you investigate her to confirm the diagnosis?
What are the treatment options for such a case? 2+3
6. How will you take care of a patient with tracheostomy in the post-operative period? 5
7. How do you diagnose a child with enlarge adenoids? Enumerate three important complications
of adenoidectomy operation. 3.5+1.5
8. A seven years old school going male child brought to the hospital by his parents with the
compliant of mild hearing impairment with occasional pain in both the ears, especially at right.
This was preceded by a episode of common cold. What could be the most possible diagnosis of
this child? How do you confirm the diagnosis in such a case? What will be the consequences of
this condition if not properly treated in time? 1+2.5+1.5