LA EXCELLENCE - IAS MEDICAL SCIENCE TEST – 7 DATE: 10-NOV- 2016 Medical sciences – Paper 2  1 and 5 are compulsory  Answer any of the 5 questions from below. SECTION-A Q1) A) A middle-aged man presents to the emergency department complaining of stiff, painful joints and dry, cracking finger nails. The nurse notes scaly leisonson his elbows. 1. What is the differential diagnosis in the above case 2. What are the investigations you will order for? 3. What is auspice sign and Koebnersphenomenan? 4. What is the treatment for the above case? B) A young boy is brought to the emergency room after visiting his primary care physician, who noted erythematous, desquamative lesions all over his body (well over 30% of body surface area) and ulcerations of the mucosal membranes of the mouth and eyes. He was recently treated with penicillin for an infection. 1. What is the differential diagnosis for the above condition? 2. What is Nikolsky sign? 3. How the case shall be managed? C) What is the principle of MRI and how it differs form CT scan. Discuss the role of the two in diagnosis of a stroke? D) An 8-month-old child, weighing 8 kg, is brought with loose motions 6 per day, mixed with blood, for last 2 days. There is no history of vomiting. i. Enumerate the 4 most important signs you will look/feel for to assess the severity of dehydration. ii. Assessment of dehydration reveals SOME dehydration. Write the initial prescription for appropriate management of this child. E) Patient is a 22-year-old female with no past medical history of psychiatric conditions who has been brought to the ER by her roommate. Her roommate explains the patient has slept in over a week and has redecorated their apartment twice over that time. She also has been talking much more than usual and has spent a great deal of money on online shopping. When asked, the patient describes her mood as "the best ever," and notes that she has been hearing voices that other people cannot hear all week. She denies a history of depressive symptoms and denies substance use. 1. What is the diagnosis in the above case. 2. Discuss the treatment for the same.

Q2) A) 1. what are the various pigmentation disorders.

www.laex.in Ph: 9052 29 29 29 / 9052 49 29 29 for our current affairs: www.civilsprep.com LA EXCELLENCE - IAS MEDICAL SCIENCE TEST – 7 DATE: 10-NOV- 2016 2. Discuss the differences between vitiligo and albinism 3. What is PUVA therapy?

B. A 2-year- old boy was brought to you with cough and feve r for 3 days. On examination, the respiratory rate was 46 per minute along with lower chest in drawing. i. Classify the illness of this child as per . IMNCI guidelines. ii. Outline the treatment for this child. iii. Enumerate the general danger signs you will ask or look for in this child to assess the severity of illness.

C. An elderly woman is bed-ridden for 4 weeks because of a fractured hip. She is brought to the casualty with sudden onset of breathlessness. i. Enumerate the possible causes of breathlessness in this case. ii. Describe the management of acute pulmonary embolism.

Q3) A. 49-year-old woman with chronic hepatitis C infection develops a very itchy rash on her forearms, calves, and buccal mucosa. On exam, multiple polygonal, purple papules are found on the skin. The buccal mucosa shows a lacy, reticulated pattern. She has taken antihistamines with some relief of pruritis. 1. What is the differential diagnosis in the above condition. 2. What can be the most likely diagnosis 3. What are the long term complications of above condition 4. What are wickham striae.

B. Healthy 2-week-old male presents with mild jaundice. He was born at term. Labs show a total billirubin of 18 mg/dl (normal <7 mg/dl), and a direct billirubin of 0.8 mg/dl (normal 0-0.4). 1. Discuss the pathological causes of neonatal Jaundice. 2. Discuss the differential diagnosis based on time line for neonatal Jaundice. 3. What are the treatment choices available . What are the indications for phototherapy.

C. 26-year-old man with multiple fractures and soft tissue injuries from a motorcycle accident has diffuse bleeding from all the needle puncture sites and open wounds on the second day of his hospitalization. His prothrombin time (PT) is 20 seconds (11-15), his partial thromboplastin time (PTT) is 100 seconds (60-85), and his platelet count is 45,000 (150K -450). His D-Dimer assay is positive. What is the probable diagnosis and how this case can be managed.

Q4) A 50-year-old male, chronic heavy alcoholic for 20 years, was administered aspirin for headache. Following which, he developed sudden massive hematemesis.

www.laex.in Ph: 9052 29 29 29 / 9052 49 29 29 for our current affairs: www.civilsprep.com LA EXCELLENCE - IAS MEDICAL SCIENCE TEST – 7 DATE: 10-NOV- 2016 i. Enumerate the causes of hematemesis in this case. ii. How will you manage this patient?

B.) i. Draw a flow diagram showing the pathophysiology of Respiratory Distress Syndrome in a newborn. ii. Outline the measures to prevent RDS in a pregnant woman at 30 weeks of gestation, with 'threatened preterm labour. iii. Enumerate the clinical factors predisposing to bilirubin toxicity in newborn infants.

C.) A child in 2nd class of a public school had an itchy skin lesion. Within next 1 month, this lesion spread to 10 other students in the same class. Examination revealed multiple excoriated papulovesicular itchy lesions in finger-webs and flexural aspects of wrists. i. What is the most likely diagnosis? ii. Outline the prophylactic measures to be undertaken to prevent the spread to other iii. children. iv. Outline the management of individual children in this class

SECTION-B Q5) A. what do You understand by minimally invasive surgery? Where is it commonly practiced. What are its complications and advantages. B. List the causes of tongue ulcer. (i) . State the predisposing factors which may lead to the development of tongue carcinoma. (ii) What is the preferred modality of treatment in carcinoma of the tongue ? C. A 52-year-old complains of a feeling of heat beginning in the face, neck, and chest followed by profuse sweating in the upper body that lasts five minutes. These episodes are happening repetitively throughout the day. She was previously diagnosed with a lump in her left breast and has a history of DVT. 1. What is the differential diagnosis for the above case? 2M 2. How will you evaluate the case and what can be the treatment offered to the patient? 4M 3. Identify the possible contradictions for harmony replacement therapy for the above women? 4M D. What is Pap smear. Discuss the analysis of PA smear results and further management E) What are vector borne diseases. Discuss programmes to control the same.

Q6) A) A 7-year-old girl is brought with a history of dog-bite five minutes ago. She has abrasions on her hand, but no bleeding. (i) What category of bite would this injury fall under ? 5M

www.laex.in Ph: 9052 29 29 29 / 9052 49 29 29 for our current affairs: www.civilsprep.com LA EXCELLENCE - IAS MEDICAL SCIENCE TEST – 7 DATE: 10-NOV- 2016 (ii) What are the first-aid measures which need to be given to this child ? 5M (iii) What prophylactic steps would you take to prevent rabies in this child? 10M

B) 17-year-old girl is brought to her pediatrician . During the interview, she notes that she has not yet had a period, although she notes that she has been exercising more often during the past few months. On exam, she has a BMI of 22, breasts are Tanner stage I, and measured follicle stimulating hormone (FSH) level is 167 mIU/mL (normal 0.3-10 mIU/mL). 1. What is the possible diagnosis? Explain with reasons – 10M 2. What is the differential diagnosis for the above condition. - 5M

C) discuss the causes for secondary amennorhoea and its presentation? – 15M

Q7) A. Discuss the clinical features of intestinal Tuberculosis? How it can be managed surgically? 15M B. What are the most common cancers found in India. Discuss management of Lung cancer in initial stages. 20M C. A 60-year-old female presents to her obstetrician after having a 3 day history of increased pelvic pressure and a "bulge" that is felt in her vagina when she coughs. Additionally, she has had a recent worsening of lower back pain. 1. What can be the most probable diagnosis? 3M 2. How will you evaluate the case? 3M 3. What are the causes for above condition? 3M 4. How could it have been prevented? 3M 5. Why is this situation occurs mostly in post menopausal women. 3M

Q8) A) Write two contraindications for the following contraceptive methods – 1) OCP 15M 2) Progesterone only pills 3) Norplant 4) IUD 5) Post coital contraception

B) 1. What is Breech presentation? What are the risk factors? How it shall be managed? – 10M 2. A 25-year-old woman comes to the clinic at 28 weeks gestation complaining of headaches and abdominal pain. She states that these symptoms began 5 days ago and have been worsening. The patient's vitals are notable for a blood pressure of 175/95 mmHg. On physical exam pain is elicited upon palpation of all 4 quadrants, in particular the right upper quadrant. A urine dipstick demonstrates 3+ protein.

www.laex.in Ph: 9052 29 29 29 / 9052 49 29 29 for our current affairs: www.civilsprep.com LA EXCELLENCE - IAS MEDICAL SCIENCE TEST – 7 DATE: 10-NOV- 2016 The patient is admitted to the hospital and started on IV magnesium sulfate and labetalol. Five hours after this treatment has begun she has a seizure. 1. How you manage the case further? 10M 2. What is HELLP syndrome? 5M

C.) 1. What are the clinical symptoms of BPH?How it can be managed. – 15M

Q9) A) A 23 year old primigravida is pregnant with twins at 11 weeks gestation. She is experiencing nausea and vomiting of moderate intensity that is worse in the morning. She has tried nonpharmacologic therapies with limited success. She has also tried drinking and eating small amounts at a time, and staying away from odors that make her feel nausea. Labs reveal a hypochloremic alkalosis. Identify her condition and discuss management - 15M

B) Discuss the reasons for discharge form nipple. How it shall be investigated and managed. 20M C) What are health targets under SDGs? How India can achieve the same. Suggest the m,ensures. – 15M

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