Some of the helpful well created Mnemonics Submitted in our Facebook page .

Easy Pharmacology Mnemonics

ST elevation causes in ECG:- remember “ELEVATION”: -

• E:Electrolytes,
• L:-LBBB,
• E:-Early repolarization,
• V:-Ventricular hypertrophy,
• A:- Aneurysm,
• T:- Treatment (eg pericardiocentesis)
• I:- Injury (AMI, contusion),
• O:-Osborne waves (hypothermia),
• N:-Non-occlusive vasospasm

Morphine: side-effects MORPHINE:

• M:-Myosis,
• O:-Out of it (sedation),
• R:- Respiratory depression,
• P:- Pneumonia (aspiration),
• H:- Hypotension,
• I:- Infrequency (constipation, urinary retention) ,
• N:-Nausea,
• E:- Emesis

The simple way to read a “CHEST FILM”:- remember the phrase “ABCDEFGHI”

• A:(airway):- see the position of trachea(is it in centre or shifted either side)..!!.
• B:(bony skeleton):-see the clavicles,sternum,ribs(normal or any # line and presence of cervical rib)..!!
• C:cardiac silhouetee):-see the borders of heart n large blood vessels..!!
• D:-(diaphragm):compare left n rt one/air bubbles under lt diaphragm n presence of hemidiaphragm).
• E:-(effusion and/or empty space):-see the costophrenic n costocardiac margins…!!
• F:-(fields..i.e. lung fields):-small airways n vascular margins..,cavity,air bronchogram,local or descrete lesion,consolidation,etc…!!
• G:(gass bubbles):-presence or absence under left diaphragm..!!
• H:(hilar reason):-see any lymphadenopathy n all..!!
• I:(inspiratory effort):-look for either patient has inspired enough.normaly incase of normal quite respiration 1o anterior ribs should be visible.look also for the position of patient..i.e. either patient is rotated?? coz incase of rotation usualy mediastinum n hilar shadows r altered….!!

SUBMITTED BY: Dr. Santosh Kumar Bhagat

On Our Face Book Page

Streptoccaceae and Micrococcacea both are family of gram positive cocci.
1. Streptococcacea : Catalase negative
2. Micrococcacea : Catalase positive
Based on coagulase production, micrococcacea are:
a. Coagulase positive: S.aureus
b. Coagulase negative: S.epidermidis, S.saprophyticus

Micrococcus is strictly anaerobic, form irregular clusters or tetrads and do not ferment glucose whereas staphylococcus is normally facultative anaerobe and ferments glucose.

STAPHYLOCOCCUS AUREUS:
Morphology: Gram positive, non-sporing, non-motile, usually non-capsulate, aerobic and normally facultative anaerobic cocci (1micrometer in diameter) arranged in grape-like clusters.

Morphology

Colony characteristics: large, round, smooth, raised, shiny, opaque and are often pigmented with deep yellow pigment.

Culture and colony study

VIRULENCE FACTORS:
a. Strucutural components:
i. Capusle: Present in some strains lacking bound coagulase
- inhibits chemotaxis and phagocytosis
- inhibits proliferation of mononuclear cells
- facilitates adherence to foreign bodies

ii. Peptidogycan:
- Evokes production of IL-1 (endogenous pyrogen having endotoxin like activity) and opsonic antibodies by monocytes
- Leukocyte chemoattractant

iii. Protein A: It is a surface protein covalently bound to the peptidoglycan layer
- Inhibits antibody mediated clearance by binding with IgG1, IgG2 and IgG4 Fc receptors
- Leukocyte chemoattractant
- Anticomplementary

b. Toxins:
i. Exotoxins:
a. Enterotoxins (A to F) : staphylococcal food poisoning
b. Toxic shock syndrome toxin-1 (TSST-1): produce leakage or cellular destruction of endothelial cells

ii. Leukocidins (P-V) : kills polymorphonuclear leukocytes and macrophages
iii. Hemolysins (alpha, beta, gamma, delta): lyse erythrocytes
iv. Exfoliative toxins (ETA, ETB): split the stratum corneum leading to separation and loss of most superficial layers of the epidermis

c. Enzymes:
i. Catalase: catalyzes removal of hydrogen peroxide
ii. Coagulase: converts fibrinogen to fibrin
iii. Hyalurinidase: hydrolyzes hyaluronic acid in tissue, promoting the spread of staphylococci
iv. Fibrinolysin: dissolve fibrin clots
v. Lipases
vi. Nucleases
vii. Penicillinases
viii. Phosphatases
ix. Proteases

Most human strains produce coagulase A. The coagulase exists in 2 forms: free and bound
a. Free coagulase:
- Extracellular
- Heat labile
- Requires CRF(coagulase reacting factor- present in rabbit and human plasma but absent in guinea pigs) for clotting
- Tube test
b. Bound coagulase:
- Constituent of cell wall
- Heat stable
- Independent of CRF for reacting with fibrinogen
- Slide test
Production of bacteriocins by staphylococci is controlled by gene in plasmid.

LABORATORY DIAGNOSIS:
Specimens: Pus/discharge from supparative lesions, CSF from meningitis, blood from septicaemia, sputum from respiratory infection, and suspected food, vomit or faeces from food poisoning, needle aspiration
Culture:
i. Nutrient agar (non diffusible golden yellow pigment)
ii. Blood agar (usually beta hemolysis)
iii. Selective media like Ludlam’s media containing 8 to 10% NaCl (inhibits growth of most organisms other than staphylococci)
iv. Mannitol salt agar (fermented by S.aureus but not most of other staphylococci)
Biochemical tests:
a. Catalaste positive (helps to differentiate between Staphylococcus and Streptococcus)
b. Mannitol fermentation test (acid production without gas – usually by Staphylococcus aureus)
c. Phosphatase test (S. aureus positive, S epidermidis negative)
d. Coagulase test (differentiate coagulase positive and negative) – tube test and slide test
e. Most strain hydrolyse urea, reduce nitrates to nitrites, liquefy gelatin and MR, VP positive but indole negative.
f. Bacteriophage typing (a set of over 28 bacteriophage usied in typing)
g. PCR
h. Antibiogram pattern and Antibiotic sensitivity test (Penicillin-Cloxacillin-Vancomycin-Teicoplanin)
Identification:
a. Coagulase positive
b. Protein A formed by more than 95% strains
c. Phosphatase enzyme produced which is detected by culturing on nutrient agar containing phenolphthalein diphosphate.
d. DNA hydrolyzing deoxyribonuclease
e. Mannitol formation with acid production
f. Reduction of potassium tellurite to tellurium when grown in medium containing potassium tellurite.

PATHOGENESIS:
About 20-30% of healthy people carry the organisms in anterior nares; less often in skin, axilla and perineum; and mucous membrane of throat. Staphylococci are also found regularly on clothing, bed linens and other fomites in human environment.
The pathogenic capacity of a given strain of S.aureus is the combined effect of extracellular factors, virulence factors(as discussed earlier) together with invasive properties of the strain.

Virulence factors and pathogenesis

Patient will come with either:
• Pain and swelling in the infected area, painful movement ,discharge and abscess
• Accompanied by other complaints and symptoms

ANTIBIOTIC SENSITIVITY:
Sensitive to: flucloxacillin, erythromycin, lincomycin, vancomycin and cephalosporins
Resistance to:
a. Penicillin: Developed resistance due to beta-lactamase production, change in MRSA
b. Multi drug resistance (MDR): due to drug resistance genes present in plasmids

Assign the names of these amino acids to 20 different alphabets.

20 amino acids and their structures. Click to enlarge.

A : Alanine
B:

C: Cysteine
D: Aspartate
E: Glutamate
F: Phenylalanine
G: Glycine
H: Histidine
I: Isoleucine
J:
K: Lysine
L: Leucine
M: Methionine
N: Aspargine
O:
P: Proline
Q: Glutamine
R: Arginine
S: Serine
T: Threonine
U:
V: Valine
W: Tryptophan
X:
Y: Tyrosine
Z:

How to remember:

1. Unique 1st letter:
a. Cysteine
b. Histidine
c. Isoleucine
d. Methionine
e. Valine
f: Serine

2. More than 1 leter but still 1st letter:
a. Alanine
b. Glycine
c. Leucine
d. Proline
e. Threonine

3. Phonetically suggestive:
a. Arginine (R-ginine)
b. Phenylalanine (F-enylalanine)
c. Tyrosine (tYrosine)
d. Tryptophan (W-structure of tryptophan)

4. Others:
a. Aspartate or Aspartic acid (asparDic)
b. Asparagine (aspargiN)
c. Glutamate or Glutamic acid (gluE-tamate)
d. Glutamine (Q-tamine)
e. Lysine (K is near L)

CLASSIFICATION OF AMINO ACIDS:
On the basis of:

A. Structure:
1. Aliphatic side chains: GAVLI
Glycine, Alanine, Valine, Leucine, Isoleucine
2. With OH group: STY
Serine, Threonine, Tyrosine
3. Acidic: AAGG
Aspartate, Aspargine, Glutamate, Glutamine
4. Sulphur containing: CM
Cysteine, Methionine
5. Basic: HIstory of ARGentina was Lie
Histidine, Arginine, Lysine
6. Aromatic: HTTP
Histidine, Tryptophan, Tyrosine, Phenylalanine
7. Imide:
Proline

B. Essential and Non-essential:
1. Essential: PVT TIM HALL
Phenylalanine, Valine, Threonine, Tryptophan, Isoleucine, Methionine, Histidine, Arginine, Lysine, Leucine
Semi-essential are Histidine and Arginine

2. Non-essential: Rest of the 10 amino acids

C. Metabolic Fate:
1. Ketogenic: Lysine, Leucine
2. Partially Ketogenic/Glucogenic: Isoleucine and other 3 aromatic amino acids (Tyrosine, Tryptophan, Phenylalanine)
3. Glucogenic: Rest

D. Polarity:
1. Polar with no charge on R: STY: glutamine, aspargine, cysteine, glycine
2. Polar with +ve R: Arginine, Histidine, Lysine (Basic)
3. Polar with -ve R: Aspartate, Glutamate (Acidic)
4. Non-polar: Rest

Tackling MCQs

These tips for tackling Multiple Choice Questions (MCQs) was provided in OrbitMBBS to help students preparing for MBBS entrance exam preparation (Institute of Medicine, Ministry of Education, BPKIHS).  However, the tips provided may be equally helpful for others facing MCQs.

Introduction:
 Multiple choice questions consists of 3 parts: the stem(the question), distracters( the wrong choices) and the correct choices.

 Multiple choice exams ask a student to recognize to correct choice among a set of options rather than asking the student to produce a correct answer entirely his\her own mind.

Preparation:
 The preparation required for an MCQ paper is different from that for an essay paper. For an essay paper, it is often possible to spot commonly recurring topics and to plan your revision accordingly. But this is often not possible for MCQ examinations, in which a large number of questions can be made from the broader range of syllabus.

 One of the best ways of revising for MCQs is to read as widely around a subject as possible, concentrating less on memorizing hard facts and more on understanding basic principles and concepts.

 Remember, rote learning will stick up the matter in your tongue temporarily but if you understand what you read, it will stay as an imprint in your grey matter for ever.

 If you can, try to work through previous MCQ papers as these will give you the best indication of the style of each particular examination. If there is limited pool of questions, they may even be repeated in the exam as in the case of Maharajgunj Medical College entrance examination.

 1\3 rd of your study hour’s everyday to practice the old questions and the model MCQs.

 Don’t worry even if you make any mistakes in the beginning. In this level, you have a potential to
improve yourself.

 Try to find out your loopholes, and the reasons for choosing wrong answers. Also, try to correct the
mistakes you have made in your next practice session.

 Whatever you read, try to convert it to MCQ pattern. In other words, try to concentrate in other
part which can be made into MCQs.

 Do consult your seniors who have already achieved the success. What you gain this way is far much
significant than what you learn by reading text books alone.

In the day before exam:
 Revise and discuss in a group if possible. Discussing with others is a great way to reinforce your own
knowledge.

 Go through Short notes, quick literature review and tables. Do not waste your time going through
huge text books.

 Concentrate and revise what you know rather than what you don’t know. Otherwise, You will
uselessly get worried.

 Don’t intoxicate yourself with alcohol, hypnotics or sedatives. If you are not being able to sleep, take
bath and a natural tranquilizer like onion.

 Get an alarm clock for yourself. (Make sure that it has batteries and is functioning properly) or ask
someone to wake you up at the specified a time.

 Make sure you know how to get to your testing location and how long it will take you to get there.

 Be sure you are properly prepared mentally.

On the day of Exam:
The following tips may help you manage your stress level on the day of exam:
 The idea that to have forgotten everything might strike your mind, but it is just a mere psychology

 Remember you’re not the only one to have such kind of feeling, everyone would have be going
through same psychology.

 Double-check testing centre rules and be sure to have your admit card and essential stationeries
with you.

 A black gel pen will always be handy as the doesn’t fade the answer sheet

 Eat and drink wisely in the morning or day of the test. Make sure you don’t go into the test hungry. Hunger can interfere with your concentration, and so can the noise of rumbling stomach. Don’t create an unnecessary and unfortunate distraction!

 Don’t forget to wear a watch. You’ll need to keep eye on the minute hand while you’re testing.

 Remember and worship your god. Try to keep yourself cool.

 Arrive at the testing center early. Give yourself time to relax and reflect for several minutes before the test begins.

 Don’t scared seeing the huge crowd of examinee. Be aware of the fact that you are not competing with all of them; your competition is only with the few number of them.

 Take time to decompress by walking the halls. At the care of any bodily functions, like visit the bathroom if you have to.

 Take try to adjust your seat before you start the exam.

 Try to relax by taking several deep breaths in through your nose and exhaling slowly and completely through your mouth.

 Visualize you are passing the exam.

 Pay close attention to directions. Read them Twice, if possible. Don’t make assumptions.

General approach:
 Always calculate the time available for each question before the exam and stick to that time strictly.

 Remember…. Time management is key factor in any exam.

 Our recommendation is to answer the questions in three rounds.

 The first round includes answering those questions which are most confident about.

 In the second round, answer the questions which can be solved after recalling your theory and brainstorming.

 The third round involves solving the questions with the help of intellectual guessing technique that we have mentioned in the next session.

 When you finish answering all the questions, if the time permits, you can go through all of them once. If on a second reading you feel like changing too many answers’ relax for a few moments and try again. It is our observation that when a student change the answer, more often, the second answer is wrong! But, you can change the answer if you have a valid reason for doing so.

 Wrong answers are NOT given a negative mark. In other words, a correct answer gets full credit; a wrong answer neither gets nor loses anything. Select the answer you think is best. Aim to answer at 100% of MCQs in every paper. (But for the MOE exams, keep in mind the negative system.)

 Overall, remember that you are looking for the best answer, not only a correct one.

Making Intellectual guesses
When faced with an MCQ that you are unsure about, a number of points can help make an intellectual guess.

 An understanding and familiarity with key words and phrases that commonly feature in MCQs is vital to get the correct answer.

 Question which include absolute and sweeping statements such as “never”, “always”, or ‘exclusively “are generally false(because any rule can have exception).

 Question which include the keywords “could, possible, or may” are more often true.

Funny Response
 Some people who set the question want to play with the students’ mind. If there are funny responses as an option, it is generally wrong: like: “no where in the list”.

Long response
 It is often the correct one.
 The one who sets the question tries to lengthen the correct answer in order to justify.

Grammatical clues
 If the stem ends with an in definite article “an” for example then the correct response probably begins with the vowel. (Similarly, if it ends with “a” then the correct option begins with a consonant)

 Similarly, If the verb in the stem is singular, the correct answer will be singular. (Same case will apply in the plural stem and option)

All of the above
 Often a correct response
 If you can verify that more than one of other responses are correct, then choose” all the above”.

None of the above
 Usually the incorrect response
 However, it is reliable than “all of the above” rule.

Verbal association
 A response that repeats keywords that are in stem is likely to be correct.

Guessing in a group
 While guessing a lot of question at once, it is better to select the same option. According to the rule
of probability 255 of the guesses done in this manner will be correct.

Double Negative statements
 Translate double negative statements into positive ones which will reduce the confusion.
 Like “not lacking” or “not more” becomes “having” and “some”.

Source: http://orbitmbbs.com

(Use them Only as Resource)

PANCYTOPENIA:

“All Of My Blood Has Taken Some Poison”:
Aplastic anaemias
Overwhelming sepsis
Megaloblastic anaemias
Bone marrow infiltration
Hypersplenism
TB
SLE
Paroxysmal nocturnal haemoglobinuria

Extracted from SOMALIMED Association.

Medicine and Allied subjects I

Section�A�

1.A 50 year old man has been brought to the hospital complaining of central chest pain of 4 hours duration. List the possibilities. How will u diagnose a case of MI? outline the management of MI of four hours duration.3+3+5

2(a). enumerate the causes of haemoptysis . briefly describe the clinical manifestation and investigation to arrive at the diagnosis.2+4

(b).describe clinical features and management of a case of psoriasis.3+3

3. write briefly on-3×4=12

a) Steven Jhonson syndrome

b) management of acute severe bronchial asthma

c) diagnosis of rheumatic fever

section B

1a) describe clinical features of Grave�s disease.6

b) discuss management of nephrotic syndrome due to minimal change lesion.6

2a) describe� briefly articular and extra articular features of rheumatoid arthritis.3+3

b) describe briefly the management of diabetic keto acidosis.5

3. write briefly on:3×4=12

a) paracetamol overdose

b) addison�s disease

c) different types of high altitude sickness

Medicine and allied subjects II

section A

1. A 75 year old man is brought to emergency ward with six to seven hours history of weakness affecting the left upper and lower limbs and left side of the face.

a)�� What is the diagnosis and which blood vessels is most likely to be involved?2+1

b)�� List the clinical features you would use to differentiate an upper and lower motor neuron weakness.3

c)�� List the essential investigations you will perform and outline the treatment.3+3

2a) describe the clinical features of falciparum malaria. How would you manage a case of severe falciparum malaria? 3=3

b) what do you mean by depression? Outline the treatment of endogenous depression?3+3

3. write briefly on: 3×4

a) obsessive compulsive disorders

b) treatment of kalaazac

c) neurocysticercosis

section B

1a) define fulminant hepatic failure. Briefly describe its clinical features. Describe management of hepatic encephalopathy. 3+5+4

2a) list cause of microcytic hypochromic anaemia. Mention laboratory investigations that will help in the differential diagnosis of this condition.2+3+5

b) discuss the principles of management of septicaemic shock. 6

3. write briefly on:3×4=12

a) tobacco related diseases

b) aleukaemic leukaemia

c) organophosphorus poisoning

Surgery

section� A

1. What do you understand by systemic inflammatory response syndrome (SIRS)? How do you manage a case of septic shock? 5+5
2. Give the differential diagnosis of thyroid swelling and how will you investigate it? 5+5
3. Write short notes on:3×5

a)�� Necrotizing fasciitis

b)�� SSG

c)�� TPN

Section B

1. Enumerate the cause of� bleeding per rectum. Write the clinical features, classification and treatment of fistula per ano and Goodshall�s rule. 4+1+2+3+2
2. Discuss the differential diagnosis of a groin swelling in a 45 year old person. How will you treat a case of indirect inguinal hernia in this patient?
3. Write short notes:3×4
   1. Colostomy
   2. Paradoxical aciduria
   3. Tension pneumothorax
   
   

Surgery II

Section A

1. 56 year old male presented with haematuria, left lumbar pain and palpable mass in the left lumbar area. How would you manage this case? 12
2. a) grades of renal trauma and their management. 6

b) bladder outlet obstruction.5

3. short notes on:3×4

a. thromboangitis obliterans

b. regional anaesthesia

c. ESWL

section� B

4.fracture healing and compression techniques in orthopaedics.12

5. discuss the etiology, Pathophysiology, clinical feature and management of CTEV.11

6. write short notes:3×4

a. dequervain�s disease

b. colle�s fracture

c. giant cell tumor

Gyane-obs

section A

1. how will you investigate a woman with normal early pregnancy, reported for 1^st visit? What various aspects will you emphasize during her counseling? 6+4
2. Write short notes:5+5
   1. Monitoring of labour in a woman with previous caeseran section.
   2. Complications of artificial rupture of membrane

Section B

1. Outline and discuss the management of labour in 20 years old primi at 38 weeks of pregnancy with rheumatic valvular heart disease. What are the possible complications which can occur in labour and 3^rd satge.7+3
2. Write short notes on: 5+5
   1. Episiotomy
   2. Neonatal sepsis

Section C

1. What is fibroid uterus? Discuss the management in detail, of fibroid uterus detected in a 35 year old woman. 1+5
2. Write short notes on:4+4
   1. Induction of ovulation
   2. Medical management of endometriosis

Section D

1. List the etiological factors or carcinoma cervix. How will you treat a case of invasive carcinoma cervix.2+5
2. Write short notes:4+4
   1. advantages of LNG- levonorgesterol device
   2. 2 swabs test in VVF
   
   

Paediatrics

Section A

1. Briefly outline the physiology of breast feeding. List the advantages. 3+4
2. Write short notes:3×3
   1. Cold chain
   2. BCG
   3. Rickets

Section B

1. Write short notes on:
   1. Turner syndrome
   2. Indications of exchange transfusion
   3. Trachea- esophageal fistula
   4. Kangaroo mother care

Section C

1. List the causes of haematuria. Describe the clinical feature of acute renal failure.3+3
2. Differential diagnosis of diphtheria. Discuss the complications of diphtheria.3+3
3. Write short notes on: 4×3
   1. Cretinism
   2. Management of acute liver failure
   3. Tof cyanotic spells
   4. Rheumatic fever- treatment with prophylaxis

Section D

1. A child of 3 years age comes to the ER with difficulty in breathing and wheeze.1+2+2
   1. Discuss the five most important differential diagnosis
   2. How do you proceed to investigation?
   3. Write down the steps of management.
   4. a. snake bite treatment 3×3

b.hypokalaemia

c. organophosphorus poisoning

�

Thanks to Dr. Anjali Subedi

USMLE ebooks downloads

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All the books are free to download. We have only searched and provided links for you.

Pharmacology

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Preventive Medicine

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Surgery

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Psychiatry

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Pediatrics

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Medicine

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Pathology

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Neuro Science

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Emergency Medicine

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Gyane & Obs

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PathoPhysiology

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Micro Biology

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Neruology

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Chest Radiology

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Physical Diagnosis

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Bio-chemistry and genetics

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7the Sem. Examination

Subject:- ENT

Section – �A�

1. A 30 years old female presented with chronic progressive hearing loss, tinnitus worsen during pregnancy.
   1. What is the Diagnosis ?
   2. Etiology and clinical features
   3. Audiological investigation and treatment
   4. Write short notes
      1. Impedance mechanism of middle ear
      2. Menier�s disease
      3. Lateral sinus thrombophlebitis
      4. Organ of corti
      5. Differentiate

CSOM Tubotympanic type and Atticoantral type

Section – �B�

1. Classify chronic specific rhinitis. Give etiopathogenesis, clinical features and treatment of Rhinoscleroma.
2. Write differences between
   1. Antrochoanal polyp and Ethmoidal polyp
   2. Acute frontal sinusitis and acute maxillary sinusitis
   3. A . Draw a labeled diagram of nasal septum.

B. Blood supply of nasal septum

Section � �C�

1. Classify Tonsillitis. Describe the various etiologies for membranous tonsillitis.
2. Describe the cause of hoarseness of voice. Describe etiology, clinical features and treatment of glottis carcinoma.
3. Write short notes on
   1. Juvenile nasopharyngeal angiofibroma
   2. Intrinsic muscles of larynx and their functions

Subject:- Ophthalmology

Section – �A�

1. Define refractive error. What are the different types of refractive errors ? Outline the management of MYOPIA.
2. A. Enumerate four causative organisms for membranous conjunctivitis. Describe the clinical feature and management of Acute membranous conjunctivitis.

B. Describe briefly the clinical features and treatment of Hypopyon corneal ulcer.

1. Describe briefly:
   1. Etiology and clinical features of Acute anterior uveitis (iridocyclites)
   2. Etiology and treatment of Senile cataract

Section – �B�

1. Describe the diagnostic triad of primary Open angle Glaucoma
2. A. Describe fundus changes of diabetic retinopathy.

B. Discuss Retinoblastoma

1. Enumerate the causes of uniocular proptosis. Describe the clinical features and management or orbital cellulitis.

Section � �C�

1. An epidemic or Red eye had just begun in a Primary School. What steps will you take to prevent the spread of the disease ?
2. What is Commitant Squint ? What are its adaptive mechanism ? How will you differentiate commitant squint from a non commitant squint ?
3. Draw and label normal Lacrimal drainage system. Describe lacrimal pump failure.

Subject � Com. Med.

Section � �A�

1. What is experimental epidemiology ? Describe methods and importance of randomization.
2. What is Tuberculosis Control Programme ? Describe the mechanism of multi drug resistant tuberculosis. What is DOTs Plus ? Give recommendation for drug therapy in Nepali DOTs Plus project.
3. Describe the approaches and strategies adopted under National Vector Borne Diseases Control Programme by MOH Nepal for
   1. Case detection
   2. Treatment
   3. Prevention and control of diseases concerned

Section � �B�

1. List nutritional disorders prevalent in Nepal. In this context how. Would you intervene for safe motherhood and better survival for infants as envisaged by MOH Nepal in its National Health Policy.
2. What is CB-IMCI according to MOH Nepal. What are the various preventive and control measures for reduction in high morbidity and mortality in children under five years of age.
3. Describe risk factors, preventive and rehabilitative measures for rheumatic heart disease.

Section � �C�

1. Describe the organization of Healty delivery system in Nepal from Ministry of Health to Sub Health Post and its staffing pattern.
2. Write short notes on:
   1. Planning cycle
   2. Epidemiology of road traffic accidents
   3. Measures for early detection of Cancer

Subject:- Forensic Medicine

Section – �A�

1. Define Rape. What are unnatural sexual offences ? Write about sexual perversions.
2. Write briefly on:
   1. Hallucination
   2. Examination in chief and cross examination
   3. Mediolegal importance of pregnancy

Section � �B�

1. Define injury. Classify mechanical injuries. Write the grievous injury of Indian and Nepal Separately.
2. Give the Differences between
   1. Wound of entrance and wound of exit in a fire arm wound
   2. Anti mortem hanging and post mortem hanging

Section � �C�

1. Describe mode of action of Organo phosphorous poison. Give the symptoms manifested in Organo Phosphorous toxicity and line of treatment also.
2. Write notes on:
   1. Hatters shake tremers
   2. Risus sardonicus
   3. Delirum tremens

Semester Examination June 2009

9^th Semester

Subject:- Medicine & Alide I

Section � �A�

1. A 50 year old man is admitted with central chest pain of few hrs duration. List possible causes. How will you arrive at diagnosis?
2. A. What are the diagnostic criteria of Acute Rheumatic fever ? What prophylactic treatment you will give and how long?

B. Describe high altitude sickness. What advice you will give to trekker?

1. Write briefly:
   1. Pellagra
   2. Atrial fibrillation
   3. Erythema Nodosum

Section � �B�

1. Describe the classification and diagnostic criteria of Diabetes mellitus. Outline treatment for type II diabetes mellitus.
2. A. Enumerate the causes of Acute Renal failure. Outline its management

B. What are Nosocomial Pneumonias. List the management.

1. Write note on:
   1. Cutaneous lesions of SLE
   2. Hypokalemia
   3. Disease modifying drugs used for Rheumatoid arthritis

Subject- Medicine & Alide II

Section � �A�

1. Describe the pathogenesis, clinical features of tubercular meningitis. Outline its management
2. A. Enumerate the clinical features of Psoriasis. How will you manage a young adult Presenting you as case of Psoriasis.

B. Describe clinical manifestation of infection with HIV

1. Write brief notes on:
   1. Management of Status epilepticus
   2. Anti ameobic drugs
   3. Obsessive compulsive neurosis

Section � �B�

1. Enumerate Myeloproliferative syndromes. Describe the clinical features and management of any one of them.
2. A. List the signs of portal hypertension. What are pharmacological and non pharmacological means to stop bleeding from ruptured oesophageal varices?

B. Describe the pathogenesis and treatment of H. pyloric infection

1. Write notes on:
   1. Clinical features and treatment of organo phosphorus poisoning
   2. X-Linked inheritance with example
   3. Cerebral malaria

Subject:- Surgery & Alide I

Section � �A�

1. Discuss the clinical features and investigations of a case of Carcinoma head of Pancreas. Describe the surgical treatment of such a case.
2. A. Discuss the differential diagnosis of lump in the right iliac fossa.

B. What is Crush syndrome and how do you manage it?

1. Write short notes on:
   1. Electrolytes imbalance in GOO
   2. 1^st 24 hrs fluid requirement of 70% burns in a 70 kg man.
   3. Mismatched blood transfusion

Section � �B�

1. A 55 yra old lady resented with a solitary thyroid nodule
   1. A what could be the causes
   2. What investigations are to be done
   3. Write down the treatment of the Papillary Carcinoma of the thyroid

1. A. Discuss the complications of a gall stone.

B. Enumerate the differences between the Carcinoma of the left and the right side of the Colon.

1. Write short notes on:
   1. Hutchinson�s pupil (Head injury)
   2. Tumour Markers
   3. Indications of Surgery in Coronary Artery disease

Subject � Surgery & Alide II

Section � �A�

1. A Patient, 60 yrs old presents with haematuria
   1. What could be the cause ?
   2. What investigations are required ?
   3. What is the treatment of Wilm�s tumour ?
   4. A. How don you manage a case of injury of anterior urethra

B. Describe the X-Ray findings of :

i. Intestinal obstruction

ii. Barium swallow in ca oesophagus

iii. Pneumo thorax

1. Write short notes on:
   1. Complications of General Anaesthesia
   2. Mammography
   3. Sub mucous fibrosis

Section � �B�

1. Describe the pathology, clinical features and treatment �of the Septic arthritis of hop
2. A. Describe the radiological signs in
   1. i.����� Rickets
   2. ii.����� Tuberculosis spine
   3. iii.����� Ewings Sarcoma

B. Classify fracture femoral neck (Intra capsular) an mention the problems associated with it.

1. Write short notes on:
   1. Wrist drop
   2. Compartment syndrome
   3. Colle�s fracture

Subject:- Paediatrics

Section � �A�

1. Discuss the etiology, clinical features & management of a case of nutritional rickets.
2. Discuss the milestones at 9 months of age in a healthy child.
3. Enumerate the live attenuated vaccines & mention their contra indications.

Section � �B�

1. Write short notes on:
   1. Prevention of Hypothermia
   2. Handicaps of a pre term baby
   3. Hypoglycemia in a new born baby
   4. Perinatal mortality

Section � �C�

1. A 4 yrs old girl presented with low grade fever, intermittent cramping, abdominal pain with vomiting & swelling of knees of 3 days duration. There is multiple raised petechial rash over extremities & trunk.
   1. What is the most likely diagnosis
   2. Mention investigations to diagnose it
   3. How will you mange the child & what is the prognosis

1. What is modified Jones criteria of diagnosis of acute Rheumatic fever. How will you investigate & treat a case presenting with Arthritis and Carditis.
2. Write short answer on
   1. Halicobacter pylori infection
   2. Cretinism
   3. Haemophia A
   4. Black water fever

Section � �D�

1. Define & list the causes of Anaphylaxis. How will you manage a case of anaphylactic shock.
2. Write short notes on:
   1. Key signs of dehydration
   2. Iron poisoning
   3. Management of acute exacerbation of bronchial asthma

Subject:- Obst & Gynae

Section � �A�

1. Define P.P.H. Enumerate high risk factors for development of P.P.H. how would you manage a case of Primary P.P.H.
2. Write short notes on:
   1. BISHOP�S Score
   2. Coagulation failure in Obstetrics
   3. Hypotonic uterine inertia

Section � �B�

1. Describe an eclamptic convulsion. How would you manage a case of antepartum eclampsia ?
2. Write short notes on:
   1. Prophylaxis against Rh iso Immunization
   2. Band�s ring
   3. Role of ultra sound in Obstetrics

Section � �C�

1. Enumerate causes of post menopausal bleeding. How would you investigate a case of early carcinoma cervix.
2. Write notes on:
   1. Cu T 380
   2. Chocolate cyst
   3. Enumerate methods of detection of ovulation

Section � �D�

1. How would you investigate a case of Primary amenorrhea
2. Write notes on:
   1. Trichomonal vaginitis
   2. Advantages and disadvantage of H.R.T.
   3. Medical treatment of Leiomyoma

MBBS final exams

PAPER: I

SECTION: A

1. (a) Discuss diastolic murmurs in mitral area.

(b) Diagnosis of aortic regurgitation.

(c) Diagnosis of ST segment elevation MI

(d) Streptokinase therapy.

1. (a) Treatment of pulmonary tuberculosis in HIV negative and HIV positive individual

(b) Clinical findings in right sided pleural effusion.

(c) Bronchial breathing

1. (a) Classification and treatment of leprosy

(b) Diagnosis and treatment of psoriasis

(c) Treatment of staphylococcal infections

SECTION: B

1. (a) Diagnostic criteria of rheumatoid arthritis.

(b) Diagnostic criteria of SLE

(c) DMRD: name, dose and one side effect

1. (a) Acute renal failure: discuss diagnosis and treatment.

(b) Hematuria: discuss approach to its diagnosis.

1. (a) Treatment of Diabetes mellitus type II

(b) Acute mountain sickness

(c) Insulin

(d) Hypocalcaemia

MEDICINE AND ALLIED SUBJECTS

PAPER: II

SECTION: A

1. (a) Diagnosis @ treatment of acute bacterial meningitis.

(b) Treatment of status epileptics

(c) Tremors

1. (a) Bipolar disorder

(b) Enteric fever: Diagnosis, treatment and complications

1. (a) Treatment of falciparum malaria.

(b) Treatment of kalazar

(c) Lithium therapy

(d) rTPA therapy in acute ischemic stroke

SECTION: B

1. (a) Investigation of a case of microcytic hyprochromic anemia.

(b) Treatment of iron deficiency anemia

(c) What action you will take if a patient showed no response to treatment.

1. (a) Diagnosis and treatment of hepatitis B

(b) Portal hypertension

1. (a) Kleinfelter syndrome

(b) Genetic code

(c) Steroid therapy

SUBJECT: SURGERY I

SECTION: A

1. Classify wounds. What are the processes involved in healing of wound. What is healing by primary and secondary intention
2. (a) what do you understand by head injury? Classify the head injuries. How will you manage an extradural hematoma?

b) Describe the clinical features and management of mixed tumor the parotid.

3.� (a) Total parental nutrition

(b)� Decubitus ulcer

(c)� Dermoid cyst.

(d) Papillary carcinoma of thyroid

SECTION: B

1. Describe blood supply and lymphatic drainage of stomach. How do you investigate and manage a case of carcinoma of stomach.
2. (a) Outline the management of advanced carcinoma of breast.

(b) Describe the clinical features and investigation and management of haemothorax

5.� (a) Meckel�s diverticulum

(b) Ritcher�s hernia

(c) Acalculus cholecystitis.

(d) Desmoid tumor.

SUBJECT: SURGERY II

SECTION: A

1. What are the cause of acute retention of urine. What is the treatment of stricture urethra.
2. (a) Describe in detail the various invasive and noninvasive treatment methodologies for renal stone disesases.

(b) Describe the etiology, clinical features and treatment of carcinoma penis.

3.� (a) Technique and complications of brachial plexus block.

(b) Adamatinoma of mandible.

(c) ERCP

SECTION: B

1. Classify fracture neck of femur. Enumerate the causes of nonunion in fracture neck of femur.describe the management of fracture neck of femur according to age. How will you manage a case of fracture neck of femur with non union in a young patient.
2. What is pott�s fracture .how does the infection occur. What are the complications of pott�s disease and how will you manage a case.
3. (a) Recurrent dislocation of shoulder

(b) Radial nerve injury

(c) Osteosarcoma

(d) Colle�s fracture

SUBJECT: OB/GYN

SECTION: A

1. Describe the pathophysiology of pregnancy induced hypertension. How would you diagnose and treat a case of eclampsia.
2. (a) induction of abortion

(b) inversion of uterus

SECTION: B

1. What is post term pregnancy? How would you manage primigravida at 41 weeks of gestation?
2. (a) Active management of third stage labor.

(b) Puerperal sepsis

SECTION: C

1. How would you diagnose and treat a woman with hydatidiform mole?
2. (a) Intrauterine contraceptive device.

(b) Enumerate causes of chronic pelvic pain

SECTION: D

1. Discuss the diagnosis and treatment of malignant ovarian tumors.
2. (a) Visual inspection with acetic acid

(b) Treatment of recurrent uterovaginal prolapse.

SUBJECT: PAEDIATRICS

SECTION: A

1. Define growth and development. How do you assess growth and development? Describe milestones of development of a nine months old infant.
2. Write short notes on:

(a)�� early neonatal seizure

(b)�� hemorrhagic diseases of the new born

(c)��� clinical feature of down syndrome

(d)�� Benign skin lesions in neonates.

SECTION B

1. WRITE SHORT NOTES ON:

(a)�� Early neonatal seizure

(b)�� Hemorrhagic diseases of the newborn

(c)��� Clinical feature of syndrome

(d)�� Benign skin lesions in neonates

SECTION C

1. Define nephritic syndrome .describe complications and treatment of a six year old child suffering from idiopathic nephritic syndrome.
2. Discuss the pathogenesis,clinical features and management of beta thalassemia major.
3. Write short notes on

(a)�� Primary tuberculosis and its consequences.

(b)�� Tetralogy of Fallot

(c)��� Meningococcal meningitis.

(d)�� Rubella

SECTION: D

1. A 18 month old child weighing 10 kg has been admitted to emergency room with severe watery diarrhea and vomiting of 3 days duration. How will you manage the patient.
2. (a) Acetaminophen poisoning

(b) Management of status epileptics(c) Hemolytic uremic syndrome