Example:
3. THEME-COMMON PSYCHIATRIC PROBLEMS [Questions (Total: 6 marks)
From options to given below, choose the best answer for the questions
Options:
A. Inj. Haloperidol E. Tab. Diazepam
B. Amitriptyline counseling F. Tab. Lithium
C. Tab. Chlorpromazine G. Inj. Fluphenazine deconoate
D. Tab. Trihexyphenidyl
Questions: What is your treatment option in the following scenarios?
Mr. P feels sad all the time and he has lost interest in meeting with friends…
3(ii). Mr. A has a fluctuating mood. Sometimes he is very enthusiastic and sometimes he is …
(LO 0219) M.MED. FAMILY MEDICINE (Sub Code: 4012)
SECOND YEAR THEORY EXAM FEBRUARY 2019
PAPER II SURGERY AND ALLIED SCIENCES
QP .CODE: 434012
Time: Three Hours Maximum Marks: 100
INSTRUCTIONS
The paper is for a total of 100 Marks.
All questions are mandatory. Answer ALL the questions.
The Paper has 2 parts Part A Part B.
Part A has Descriptive Type Questions (40 Marks).
o There are 2 questions in this part.
Part B has Objective type Extended Matching Questions- EMQs (60 Marks).
o There are 10 sets of these questions.
o Each set has 6 questions.
o Each question carries 1 mark.
o The theme of each set is mentioned at the beginning.
o In each set there are options followed by some questions.
o The options are lettered using the English Alphabets D and so on.
• Match each question to a single best option and write it in your
answer paper like this:
• Each option may be used more than once. Some options
may not be used at all.
B
C
3(iii) B
D
A
G
Page 2 of 8
PART A
DESCRIPTIVE QUESTIONS
(ANSWER ALL QUESTIONS)
1. 32-year-old Mr. Suresh has an inguinoscrotal swelling since one year. (Total:20 Marks)
A. As a primary care physician, what are the differential diagnoses you will consider for a
inguinoscrotal swelling? Marks)
B. What are the salient points you will ask in history for a patient with an inguinoscrotal
swelling? Marks)
C. What are the inspection findings you would look for in a inguinoscrotal swelling?
Marks)
D. What are the four important questions you will ask to arrive at the diagnosis of an
inguino scrotal swelling? Draw an algorithm for diagnosis of inguinoscrotal swelling
based on these questions. Marks)
2. You are a family physician with an office practice in a semi urban area. You had to
perform minor surgical procedures in your practice time to time. (Total 20 Marks)
A. What are the types of anesthesia? Marks)
B. What are the commonly used local anesthetic agents? Discuss briefly. Marks)
C.What are the common sedative agents we use in office practice for procedures? Discuss
briefly. Marks)
D. Mrs. Tina as come with paronychia right index finger and need to rain it. How will you
give digital anesthesia? Marks)
PART B
EXTENDED MATCHING QUESTIONS
(ANSWER ALL QUESTIONS)
1. THEME: HEAD INJURY [Questions (Total: 6 Marks)
From the options to given below, choose the best answer for questions
Options:
A. Inadequate cerebral perfusion
B. Pontine injury
C. Traumatic optic nerve injury
D. Inadequate cerebral perfusion
E. Acute subdural hematoma
F. Acute extradural hematoma
G. Chronic subdural hematoma
H. Chronic extra dural hematoma
I. Transtentorial herniation
J. Horner's syndrome
Questions: What is the clinical diagnosis?
Mahesh is a 17-year-old college student who is brought to the hospital after an accident.
While examining him, you find that one of his pupils does not constrict when light is directed at
it but constricts when light is directed into the contralateral pupil.
Page 3 of 8
1(ii). Mr. Mohan was riding his bike without a helmet. He was hit by a lorry and was
resuscitated and intubated in the site because there was a hospital near the accident site. Now he
is on a ventilator. Examination now shows bilateral dilated pupil that does not react to light.
1(iii). 68-year-old Mr. Sultan, who is on regular medications for his unstable angina had a fall in
the bathroom. He was unconscious for several minutes and then when there was no sign of him,
his wife pushed open the bathroom door and found him sitting dazed. The history is that he was
confused for about 10 minutes and then was his normal self again. However, after about 4 hours,
he began to feel drowsy and confused again. He is brought to you and you find his GCS is 12.
1(iv). Mr. Anand was hit by a vehicle from the back when he was riding a bike without a
helmet. In the casualty, he was resuscitated and intubated because his GCS was 6/15. Now, after
2 hours, he is hyperpyrexic and pupils are pin point.
70-year-old Mrs. Radha comes to you with a history of acute onset of headache, confusion
and some gait disturbances for the last one week. She is not a known diabetic or a hypertensive.
On examination, she is afebrile, power in the right lower limb is 3/5 and in the right upper limb
is 4/5. In the left eye, there is papilledema and the pupil is unreactive and dilated.
1(vi). The CT scan of Mrs. Tina who sustained a head injury before 6 hours, shows a hypo dense
area which is convex toward the brain.
2. THEME: SITES FOR ANAESTHESIA [Questions (Total: 6 Marks)
From options to given below, choose the best answer for questions
Options:
A. Web space at the base of the finger,
just distal to the MCP joint
B. At the junction of proximal and
middle phalanx, in the lateral aspect
C. At the junction of proximal and
middle phalanx, in the dorsal crease
D. Lateral to the Palmaris tendon, in
proximal wrist crease.
E. clock and 12 clock position
F. clock and 11 clock position
G. Between the medial malleolus and
the calcaneum just behind the
posterior tibial artery
H. Between the medial malleolus and
the calcaneum, 2 cm lateral to the
posterior tibial artery
I. Between the lateral malleolus and
the calcaneum, 2 cm medial to the
posterior tibial artery
J. Medial to the Palmaris tendon, in
distal wrist crease.
K. Medial to the Palmaris tendon, in
proximal wrist crease.
L. Intervertebral space between L L
5
M. Intervertebral space between L 2
L3
Questions: What is the site of the anaesthesia?
Mr. Sam has come with a paraphimosis and you need to reduce it. The sites for penile block
are-
2(ii). You want to give a wrist block for a procedure. The site is-
2(iii). Mrs. Kala, a diabetic for 10 years needs an amputation of right big toe and the second toe.
The sites for block are-
2(iv). Mr. Dayalan has come with a felon in the right index finger. The site for block is-
The site for anaesthesia for Mrs. Geetha who is posted for emergency LSCS isPage
4 of 8
2(vi). Mr. Kumar has come with an injury in the proximal phalanx of the right second finger.
You need to do suturing.
3. THEME DIAGNOSIS OF RED EYE [Questions (Total: 6 Marks)
From options to given below, choose the best answer for the questions
Options:
A. Endophthalmitis
B. Hordeolum externum
C. Acute bacterial conjunctivitis
D. Uveitis
E. Seborrhoeic blepharitis
F. Viral conjunctivitis
G. Ulcerative blepharitis
H. Keratitis
I. Episcleritis
J. Pterygium
K. Vernal conjunctivitis
L. Seborrhoeic blepharitis
M. Scleritis
Questions: What is the clinical diagnosis?
27-year-old Mr. Samuel has come with painful eyes and photophobia for the past 2 weeks.
On questioning further, you realize there is pain in the brow and continuous ocular pain which is
worse on eye movements. There is no relief with analgesics. On examination there is a scleral
nodule with bluish discoloration.
3(ii). 33-year-old Mrs. Lakshmi has a nodule in the right eye with sectoral congestion. The
lesion is triangular, fleshy and asymptomatic.
3(iii). 10-year-old Meena has come with complaints of itchy eyes. On examination, there is
bilateral redness of eye and watery discharge. There are no red flags. Preauricular lymph nodes
are palpable bilaterally.
3(iv). 21-year-old Faizal has come with red eye. On examination, there is gelatinous thickened
accumulation of tissue around limbus and presence of discrete whitish raised dots along the
limbus.
24-year-old Ms. Swati has come with complaints of itching of both eyes. On examination,
both the eyes are red and there is crusting in the lid margin. On removing the crusts, there is
bleeding.
3(vi). 5 0-year-old Mrs. Kanaka has come with sudden onset of severe photophobia, head ache,
pain and diminished vision. There is ciliary congestion and pupil is constricted and irregular.
4. THEME: TREATMENT FOR RED EYE [Questions 4 (Total: 6 Marks)
From options to given below, choose the best answer for the questions
Options:
A. Tab. Doxycycline 100 mg od for 6
weeks
B. Tarsal injection of gentamicin OD
for a week
C. Ketorolac drops
D. Excision
E. Tab. Ciprofloxacin 500 mg OD for
six weeks
F. Ciprofloxacin ointment bd for 6
weeks
Page 5 of 8
G. Taping the lateral canthal skin
supero-temporally with adhesive
plaster
H. Tape the lid to the skin of the cheek
with adhesive plaster
I. Topical steroids
Questions: What is the management in the following conditions?
10-year-old Kavitha has simple allergic conjunctivitis of moderate severity.
4(ii). 34-year-old Mr. Ayush has persistent posterior blepharitis.
4(iii). Mrs. Doulath has ectropion in both eyes due to post burns facial scarring. She is not
willing for surgery. This is the temporary method of treating her condition.
4(iv). 8-year-old Aby has chronic dacryocystitis. This is the definitive treatment for him.
Mrs. Gowri, a 70-year-old retired clerk has entropion in both the eyes. She is not willing
for surgery. This is the temporary method of treating her condition.
4(vi). 26-year-old Mr. Bhasker has chronic internal hordeolum. This is the definitive treatment
for him.
5. THEME: DIAGNOSIS OF ORTHOPAEDIC CONDITIONS [Questions
(Total:6 Marks)
From options to given below, choose the best answer for questions
Options:
A. Pulled elbow
B. Colles' fracture
C. Rib fracture
D. Fracture clavicle
E. Fracture humerus
F. Compartment syndrome
G. Carpal tunnel syndrome
H. Supracondylar fracture
I. Scaphoid fracture
J. Lunate fracture
Questions: What is the most probable diagnosis?
34-year-old Mrs. Geeta has come with restriction of right thumb movement and pain over
the area of anatomical snuffbox, after a fall.
5(ii). 5-year-old Felicita has come with severe pain in the left elbow after a fall. On examination,
there is significant swelling around the elbow with a shaped deformity, with ecchymosis in
the antecubital fossa. Radial pulse is absent.
5(iii). 62-year-old Mrs. Meena has come with pain in the left wrist following a fall. On
examination, there is swelling of wrist and there is a dinner fork deformity.
5(iv). 4-year-old Vignesh is brought by his mother with a history of not being able to move the
right arm. The child is holding the arm still at his side and refusing to bend the elbow. There is
no history of fall, but the pain started when his father was trying to leave him in his LKG class
despite of Vignesh's refusal to go inside.
45 years old Mr. Khanna has come with history of fall on outstretched hand. On
examination, there is severe pain in the upper arm and there is wrist drop.
5(vi). 23-year-old Mr. Rao is brought with very severe pain, by his relatives, 6 hours after
application of cast for right forearm fracture. On examination, right radial pulse is not palpable
and there is paraesthesia of the right hand.
Page 6 of 8
6. THEME: MANAGEMENT OF ORTHOPEDIC CONDITIONS [Questions
(Total: 6 Marks)
From options to given below, choose the best answer for the questions
Options:
A. Traction
B. Internal fixation
C. External fixation
D. Cast
E. Sling
F. Splint
Questions:
70-year-old Mr. Siva has a left acetabular fracture. The type of fracture management that
can be done in the primary management of his condition is
6(ii). 34-year-old Mr. David had injury of right shoulder 2 weeks ago. But he has come only
today because the shoulder pain is still persisting. His X-ray shows a mal-aligned fracture right
clavicle. The type of definitive fracture management for Mr. David is
6(iii). 30-year-old Mrs. Kamala has had an internal fixation for her fracture humerus. The
additional type of fracture management she needs is
6(iv). 44-year-old Mr. John has sustained fracture of right femur in a road traffic accident. The
type of fracture management that should be done in the primary management of his condition
during transfer is
Mr. Giri has a contaminated grade 3c fracture right humerus. The type of fracture
management he needs is-
6(vi). 9-year-old Munna has a simple fracture of right ulna. It happened yesterday and the right
forearm is badly swollen. The type of fracture management that should not be done in the
primary management of his condition is
7. THEME: DIAGNOSIS OF HERNIA [Questions (Total: 6 Marks)
From options to given below, choose the best answer for questions
Options:
A. Strangulated hernia
B. Richter's hernia
C. Epigastric hernia
D. Spigelian hernia
E. Incarcerated hernia
F. Diaphragmatic hernia
G. Para umbilical Hernia
H. Umbilical hernia
Questions: What is the diagnosis?
2-year-old Dinesh has features of hypothyroidism. This is the common hernia found in
children with hypothyroidism.
7(ii). 41-year-old Mrs. Kavitha has come with abdominal pain suggestive of acid peptic disease.
But on examination, you find a small button like swelling midway between the xiphisternum and
the umbilicus.
7(iii). Mr. Gowtham presented with irreducible hernia. On surgery, only antimesentric border of
the intestine was found to be strangulated through a small defect in the abdomen.
7(iv). Mrs. Devi has come with a swelling above the umbilicus with cough impulse positive.
Page 7 of 8
3 hours old Monika's baby has presented with complaints of difficulty in breathing and
grunting. On examination, abdomen is scaphoid and bowel sounds are heard in the right
hemithorax.
7(vi). 43-year-old Mr. John has come with vomiting and abdominal pain. On examination, he is
febrile, toxic, his pulse rate is rapid, feeble, 128 minute and his BP is 90/70 mm of Hg. On
examination of abdomen, he has a tender, irreducible hernia; there is generalized distension and
tenderness.
8. Theme: ORAL HEALTH [(Questions (Total: 6 Marks)
From the options to given below, choose the best answer for questions 8 8
Options:
A. Malignant ulcer
B. Aphthous ulcer
C. Herpetic ulcer
D. Gum hypertrophy
E. Dental plaques
F. Dental abscess
G. Leukoplakia
H. Oral candidiasis
I. Oral hairy leukoplakia
Question: Choose the right diagnosis for the patients described below:
30-year-old Mr. Paul has come with repeated episodes of small, round painful ulcers inside
the mouth. He is otherwise healthy. On examination the ulcers are round, yellowish, elevated
spots surrounded by a red halo.
8(ii). Mr. Raghav has come with complaints of burning sensation of oral cavity. On
examination, there are white patches on gums, tongue and inside the mouth that can be peeled off
leaving a raw area.
8(iii). Mrs. Leela, an epileptic on phenytoin has come with these oral lesions.
8(iv). 45 year old Mr. Somnath has come with irregular non-painful white patches on the sides
of the tongue, with corrugated appearance. He is HIV positive.
Mr. Raju, a smoker for 20 years, has come with a slightly elevated, grey coloured, single
well-defined lesion inside the right cheek.
8(vi). Mrs. Kalpana has come with severe, continuous facial pain for the past 2 days. On
examination, right side of her face is swollen and there is severe pain in the left second upper
molar on tapping with a spatula.
9. THEME: HEAD INJURY [Questions (Total: 6 Marks)
From options to given below, choose the best answer for the questions
Options:
A. No need for CT scan
B. Protect his airway, CT scan.
C. Needs CT scan and observation
Questions: Does this patient need a CT scan?
34-year-old Mr. Vasu had a motor bike accident on his way home from work. He was not
wearing a helmet. After the accident he cannot remember leaving his office. His neurological
examination is normal.
Page 8 of 8
9(ii). 41-year-old Mr. Hari hit his head on a doorframe 20 minutes ago. He feels a bit dizzy He
is taking 'heart tablets', not sure what. On examination there is a big bruise on his forehead. His
neurological examination is normal.
9(iii). 23-year-old Mr. Farhan is hit by a car. He has a fractured tibia. He is making moaning
noises. When you press on the fingernail, he opens his eyes and pulls his hand away.
9(iv). 16-year-old Ratheesh fell backwards off a wall and hit his head. His friend said he was
'knocked out' for 2-3 seconds. He walked into the clinic and seems fine now after 2 hours.
32-year-old Mr. John is involved in a RTA. When you talk to him, he opens his eyes, but
he seems a bit confused when he talks. He does not lift his arms when you ask him. When you
pinch his skin on his chest he moves his arms but does not grab your hand. If you press his
fingernails he withdraws his arm.
9(vi). 7-year-old Harini fell off a tree and hit her head 3 hours ago. She has vomited 4 times,
including just now in the clinic.
10. THEME: DIMINISHED VISION [Questions [10 -10 (Total: 6 Marks)
From options to given below, choose the best answer for questions
Options:
A. Myopia
B. Cataract
C. Giant cell arteritis
D. Cerebrovascular accident
E. Presbyopia
F. Retinal detachment
G. Multiple sclerosis
H. Migraine
Questions: What is the diagnosis?
10(i). 80-year-old Mrs. Meera presents with sudden loss of vision on left side. She has been
troubled by unilateral left sided headache on and off for 1 week.
10(ii). 50-year-old Mr. Mani is not able to read the newspaper, but can see objects at a distance
without difficulty.
10(iii). 68-year-old Mr. Rajesh presents with gradual progressive loss of vision. Now he is only
able to count fingers in the left eye and tell light from dark in the right eye. Lenses seem cloudy.
10(iv). 8-year-old Chintu is not doing well at school and misbehaving in class. Snellen chart
shows 6/18 in left and 6/12 in right eye. Pin hole improves to 6/9 and 6/12.
10(v). 29-year-old Mrs. Neela presents with blurred vision in left eye on and off for a few
months.
10(vi). 47-year-old Mr. Manickam presents with sudden painless loss of vision in left eye. He
had complaints of some flashes and floaters.