Ultimate Guide for the MBBS Student.: March 2010

GURU THE FINAL MBBS MANUAL
HAFEESH FAZULU
     CONTENTS MEDICINE 6 PAPER 1 6 General Medicine 6 Clinical Biochemistry and Metabolism 7 Kidney and Urinary Tract Disease 7 Cardiovascular Disease 8 Endocrine Disease 10 Diabetes Mellitus 10 Alimentary Tract and Pancreatic Disease 11 Liver and Biliary Tract Disease 11 Blood Disorders 12 Musculoskeletal Disorders 13 Neurological Disorders 13 Unallocated 16 PAPER 2 18 Poisoning 18 Medical Psychiatry 18 Oncology 18 Infectious Diseases 18 HIV 19 Sexually Transmitted Diseases 20 Respiratory Disease 20 Skin Disease 21 Unallocated 21 PRACTICALS 21 COMMON CLINICAL PROCEDURES 21 Measurement of Pulse 21 Measurement of Blood Pressure 21 Measurement of Temperature 21 Looking for Pallor 22 Looking for Cyanosis 22 Looking for Clubbing 22 Looking for Jaundice 22 Pain 22 Long Cases 22 Mitral Stenosis 22 Mitral Incompetence 22 Aortic Stenosis 22 Aortic Incompetence 22 Bacterial Endocarditis 22 Pleural Effusion 22 Pneumothorax 22 Hydropneumothorax 22 Consolidation 22 COPD/Asthma 22 Viral Hepatitis 22 Liver Cirrhosis 22 Pyloric Stenosis 22 Hemiplegia 22 Paraplegia 22 Parkinsonism 22 Peripheral Neuropathy 22 SHORT CASES 22 Lung Collapse 22 Superior Mediastinal Syndrome 22 Ascites 22 Abdominal Lump 23 Hepatosplenomegaly 23 Cerebellar Disorder 23 Bulbar Palsy 23 SURGERY 24 PAPER 1 24 Unallocated 24 Peritoneum 24 Abdominal Tuberculosis 24 The Liver 24 Gallbladder 25 The Spleen 26 The Pancreas 26 Retroperitoneal Space 27 Mass Abdomen 27 Abdominal Wall and Umbilicus 27 Hernia 27 Oesophagus 28 Stomach 28 The Small Intestine 30 Large Intestine 30 Intestinal Obstruction 31 The Vermiform Appendix 31 The Rectum and Anal Canal 31 ORTHOPEDICS 32 Anatomy of Bone and Fracture Healing 33 Treatment of Fractures 33 Splints and Tractions 33 Recent Advances in Fracture Treatment 33 Approach to Fracture 33 Complications of Fractures 33 Dislocations and Subluxations 34 Fractures in Children 34 Peripheral Nerve Injuries 34 Treatment of Orthopedic Disorders 35 Shoulder Injuries 35 Elbow Injuries 35 Forearm and Wrist Injuries 36 Hand Injuries 36 Pelvic Fractures 36 Injuries around Hip 37 Fracture shaft of Femur 37 Injuries around Knee 37 Injuries to Leg, Ankle and Foot 37 Spinal Injuries 38 Infections of Bones and Joints 38 Tuberculosis of Bones and Joints 39 Infections of the Hand 39 CTEV 39 Congenital Dislocation of Hip 39 Poliomyelitis 40 Bone Tumours 40 Prolapsed IV Disc 40 Scoliosis 40 Backpain 40 Arthritis 40 Degenerative Disorders 41 Affections of Soft tissues 41 Metabolic Bone Diseases 41 Miscellaneous affections of Bone 41 Miscellaneous Regional Diseases 42 Amputations and Prosthetics 42 Sports Medicine 42 PAPER 2 44 General Surgery 44 Infectious Diseases 44 Swellings 45 Electrolyte and Nutrition 45 Shock 45 Haemorrhage and Blood Transfusion 45 Burns 45 Trauma 46 Hand and Foot 46 Arterial Diseases 46 Hamartoma and Vasculoar Lesions 47 Venous Diseases 47 Lymphatics 47 Peripheral Nerves 47 Neoplasm 48 Skin Tumours 48 Sarcomas 48 Amputations 48 Reconstruction 48 Transplantation 48 Faciomaxillary Diseases 48 Oral Cavity 48 Salivary Glands 49 Neck 49 Thyroid 50 Parathyroid and Adrenals 51 Breast 51 Urology 52 Kidney 52 Urinary Bladder 53 Prostrate 54 Urethra 54 Penis 55 Scrotum 55 Testis 55 Neurosurgery 55 Thorax 56 Anaesthesia 56 Adjuvant Therapy 56 Advanced Imaging Methods 56 Operative Surgery 56 PRACTICALS 58 INSTRUMENTS TO CARRY 58 BASIC SURGERY 58 COMMON CLINICAL PROCEDURES 58 Long Cases 58 Breast 58 Thyroid 62 Varicose Veins 68 Peripheral Vascular Disease 70 Abdominal Lump 72 SHORT CASES 73 Hernia 73 Swelling 74 Swelling – Lipoma 74 Swelling – Sebaceous Cyst 74 Swelling - Thyroglossal Cyst 74 Swelling - Dermoid Cyst 74 Swelling - Hemangioma 74 Swelling - Ganglion 74 Swelling - Bursitis 74 Diabetic Ulcer 74 Sinus 74 Marjolin's Ulcer 74 BCC 75 Cervical Lymphadenopathy 75 Parotid Tumour 75 Carcinoma Cheek 75 Gynaecomastia 75 Umbilical Hernia 75 Femoral Hernia 75 Hydrocele 75 Varicocele 75 Cellulitis Leg 75 Funiculitis 75 OBSTETRICS & GYNAECOLOGY 76 PAPER 1 – OBSTETRICS 76 Anatomy of Female Reproductive Organs 76 Fundamentals of Reproduction 76 Placenta and Membranes 76 The Fetus 76 Physiological Changes in Pregnancy 76 Endocrinology in relation to Reproduction 76 Diagnosis of Pregnancy 77 Fetus in Utero 77 Fetal Skull and Maternal Pelvis 77 Antenatal Care 78 Antenatal Assessment of Fetal Well Being 78 Normal Labour 78 Normal Puerperium 79 Vomiting in Pregnancy 79 Haemorrhage in early Pregnancy 79 Multiple Pregnancy 80 Hypertensive Disorders in Pregnancy 81 Antepartum Haemorrhage 81 Medical & Surgical Illness complicating Pregnancy 81 Gynaecological Disorders in Pregnancy 82 Preterm Labour & IUD 82 Special Cases 82 Contracted Pelvis 83 Abnormal Uterine action 83 Malposition, Malpresentation and Cord Prolapse 83 Prolonged Labour, Obstructed Labour and Dystocia 83 Complications of Third Stage of Labour 84 Injuries to Birth Canal 84 Abnormalities of Puerperium 84 Neonatology 84 Pharmacotherapeutics 85 Induction of Labour 85 Contraception 85 Operative Obstetrics 86 Special Topics 86 Imaging in Obstetrics 86 Unallocated 86 PRACTICALS 87 Long Cases 87 Pregnancy Induced Hypertension 87 PAPER 2 – GYNAECOLOGY 88 Not Allocated 88 Anatomy of the Female Pelvic Organs 88 Congenital Malformations of the Female Genital Organs 88 Puberty and Menopause 88 Neuroendocrinology in relation to Reproduction 88 Menstruation 89 Examination of a Gynaecological Patient 89 Pelvic Infection 89 Sexually transmitted Diseases 89 Infections of the Individual Pelvic Organs 89 Dysmenorrhoea and other disorders of Menstrual Cycles 90 Abnormal Menstrual Bleeding 90 Displacement of the Uterus 91 Infertility 91 Benign Lesions of the Vulva and Vagina 92 Benign lesions of the Cervix 92 Benign lesions of the Uterus 92 Benign lesions of Ovary 93 Endometriosis and Adenomyosis 93 Premalignant Lesions 94 Genital Malignancy 94 Urinary Problems in Gynaecology 94 Genital Fistulae 95 Genital Tract Injuries 95 Intersex 95 Amenorrhoea 95 Contraception 95 Radiotherapy Chemotherapy Immunotherapy Genetherapy in Gynaecology 96 Hormones in Gynaecological Practice 96 Special Topics 96 Operative Gynaecology 97 Endoscopic Surgery in Gynaecology 97 Practical Gynaecology 97 PEDIATRICS 98 Normal Growth 98 Disorders of Growth 98 Normal Development 98 Developmental Disorders 99 Adolescent Health and Development 100 Fluid and Electrolyte Disturbances 100 Nutrition 100 Micronutrients in Health and Disease 100 Newborn Infants 101 Immunity and Immunisation 102 Infections and Infestations 102 Diseases of Gastrointestinal System and Liver 103 Hematological Disorders 104 Diseases of Ear, Nose and Throat 105 Disorders of Respiratory System 105 Disorders of Cardiovascular System 106 Disorders of Kidney and Urinary Tract 106 Endocrine and Metabolic Disorders 107 Central Nervous System 107 Neuromuscular Disorders 108 Childhood Malignancies 108 Rheumatological Disorders 108 Genetic Disorders 108 Inborn Errors of Metabolism 108 Eye Disorders 108 Skin Disorders 108 Poisonings, Injuries and Accidents 108 Pediatric Critical Care 108 Common Medical Procedures 108 Rational Drug Therapy 108 Integrated Management of Neonatal and Childhood Illnesses 108 Rights of Children 109 Unallocated Questions 109    MEDICINE  Paper 1    GENERAL MEDICINE   1. Drug Addiction 32 APR-2004 2. Human Genome Project 38 APR-2004 3. Klinefelter's Syndrome 46 OCT-2002 4. Burkitt's Lymphoma 47 DEC-2006 5. FISH 51 AUG-2002 6. Fragile X Syndrome 52 AUG-2002 7. Prenatal Diagnosis 57 SEP-2003 8. Genetic Counselling 57 SEP-2003 AUG-2001 9. Gene Therapy 61 APR-2004 AUG-2001 DEC-2006 10. Natural Immunity 65 OCT-2002 11. Antigen Presentation  DEC-2004 12. TNF a Antagonist  JUN-2005 13. Mast Cells 68 JUN-2005 14. Natural Killer Cells 68 APR-2004 15. CD4 Count 70 AUG-2001 16. Cell mediated Immunity 69 OCT-2002 17. Diagnosis of Amyloidosis 79 MAR-2003 18. Draw & Label : Schematic diagram of Major Histocompatibility Complex (HLA) 80 DEC-2006 19. Sjogren Syndrome 80 OCT-2002 20. Rheumatoid factor 81 APR-2004 JUN-2006 21. Antinuclear Antibodies (ANA) 81 APR-2004 MAR-2003 22. Anti neutrophil cytoplasmic antibodies 83 SEP-2003 23. Type I Anaphylactic Reaction 86 MAR-2003 24. Anaphylactic Shock 87 MAY-1999 25. Adrenaline 87 JUN-2005 26. Immune Complex mediated reaction  OCT-2002 DEC-2006 27. Decayed hypersensitivity  FEB-2001 28. Immunotherapy 88 JUN-2005 APR-2004 29. Health hazards of Smoking 97 APR-2004 SEP-2000 30. Smoking Cessation 97 SEP-2003 31. Malignant Hyperpyrexia 102 DEC-2004 32. Frost Biote 102 JUN-2005 33. Heat Stroke 103 JUN-2005 DEC-2004 DEC-2006 34. Management of Drowning 105 OCT-2002 35. Obesity 111 AUG-2001 36. Hypervitaminosis  DEC-2006 37. Pellagra 124 JAN-2002 38. Treatment of Pellagra 124 OCT-2002 39. Thiamine deficiency 124 MAR-2003 40. Scurvy 125 MAR-2003 41. Weil Felix Reaction 143 OCT-2002 42. Broad Spectrum Antibiotic  DEC-2004 43. Broad Spectrum Penicillin  DEC-2004 44. Betalactamase 146 JUN-2006 45. Penicillinase 148 DEC-2004 46. Polymerase chain reaction 142 JUN-2006 47. Ziehl Neelson Technique 142 MAR-2003 48. Western Blot Test 142 SEP-2003 49. Generations of Cephalosporins 149 DEC-2004 50. Aminoglycosides 150 JAN-2002 51. Quinolone Antibacterials 151 DEC-2004 52. Interferon 157 OCT-2002 DEC-2006 53. Positive Pressure Ventillation  JUN-2005 54. Postural Hypotension 167 DEC-2004 55. Management of Hypotension 167 DEC-2006 56. ARDS 188 AUG-2002 DEC-2006 57. Nosocomial Infections 190 AUG-2001 58. Vasodilators 192 FEB-2001 59. Oxygen therapy 193 AUG-2001 60. Mechanical Ventillation 193 FEB-2002 61. Total Parentral Nutrition 197 OCT-2002 62. Barbiturate Poisoning  DEC-2006 63. Organ Transplantation 200 APR-2000 64. Salicylate Poisoning 209 FEB-2001 65. Heroin 215 JUN-2006 66. Management of CO Poisoning 216 AUG-2002 67. Organophosphorous poisoning  AUG-2001 68. Treatment of Organophosphrous Poisoning 218 AUG-2001 69. Atropine  JUN-2006 70. Complications of Organophosphorous poisoning  DEC-2006 71. Phobias 239 JUN-2006 72. Hysteria 250 JUN-2006 73. Cardiac Tamponade 261 AUG-2002 74. Motion Sickness 279 MAR-2003 75. Eosinophil 296 DEC-2004 76. Retrovirus 299 1039 FEB-2001  CLINICAL BIOCHEMISTRY AND METABOLISM   1 SIADH 430 793 AUG-2001 FEB-2001 2 Psychogenic Polydipsia 430 472 DEC-2006 3 Hypokalemia 432 OCT-2002 4 GIK regime Glucose-Insulin-Potassium iv infusion. given in diabetic patients.   5 ECG changes in Hyperkalemia 433 JUL-2007 6 Anxiety Disorder 439 DEC-2004 OCT-2002 7 Metabolic Acidosis 437 APR-2004 8 Hyperlipidemia 446 AUG-2002 9 Classification of Hyperlipidaemia 447  10 Hypercholesterolaemia 447 SEP-2000 11 Remnant Hyperlipideamia 448  12 Why Phaeochromocytoma is called 10% tumour 450 JUL-2008  KIDNEY AND URINARY TRACT DISEASE   1 Dysuria  JUL-2007 2 Draw & Label : Nephron  JUN-2005 3 Draw & Label : Glomerulus - AUG-2002 4 Draw & Label : Casts in Urine 457 AUG-2002 5 Casts in Urine 457 DEC-2004 6 Retroperitoneal fibrosis 466 509 JUL-2008 7 Urinary tract infections in a female 467 FEB-2001 8 Treatment of Acute Cystitis 467 OCT-2002 9 Acute Urethral Syndrome 467  10 Asymptomatic Bacteruria 470 MAR-2003 11 Acute Pyelonephritis 470 OCT-2002 12 Erectile Impotence 476 JUN-2005 13 Haematuria 477 FEB-2002 14 Evaluation for Haematuria 477 OCT-2002 15 Diet therapy in Nephrotic Syndrome 478 DEC-2006 16 Complications of nephrotic syndrome.  FEB-2001 17 Differential diagnosis of protenuria 479 FEB-2001 18 Acute Tubular Necrosis (ATN) 482 OCT-2002 JUL-2008 19 Prerenal causes of ARF 483 JUL-2007 20 A 18 years old female is admitted with hlo swelling oflimbs puffiness of face and decreased urine output with normal blood pressure. 1 What is the provisional diagnosis? 2 What is the immunological injury ? 3 What are the other types of immunological injuries to glomerulus? 4 Outline the investigations. 5 Outline the management. 485 DEC-2006 21 Renal Osteodystrophy 489 JAN-2002 22 Hemodialysis  FEB-2001 23 Peritoneal Dialysis 491 APR-2004 24 Urinary findings in Acute Glomerulonephritis 491 OCT-2002 AUG-2001 FEB-2001 25 IgA Nephropathy 500 FEB-2002 26 Henoch-Schonlein Purpura 500 1141 OCT-2002 27 Lupus Nephritis 501 515 JUL-2008 28 Goodpasteur's Syndrome 503 AUG-2002 29 Features of Acute Nephritis 504 JUL-2007 30 Alports Syndrome 504 AUG-2002 31 Polycystic Disease of Kidneys 506 DEC-2006 32 Non Diabetic Milituria [G. meli, honey, + ouron, urine] 508 DEC-2004 33 Rectal Examination 510 DEC-2004 34 Nephrocalcinosis 510 MAR-2003 35 Medical therapy of enlarged Prostrate 511 JUN-2005 JUN-2006 36 Addisonian Crisis  AUG-2001  CARDIOVASCULAR DISEASE   1 Non modifiable risk factors for ischaemic heart disease (IHD)  JUL-2008 2 Draw & Label : Auscultogram in Mitral Regurgitation  JUL-2008 3 Coronary Angiography 523 JUN-2005 4 Coronary Artery Disease 526 SEP-2000 5 Draw & Label : JVP - AUG-2002 JUL-2007 6 Draw & Label : Conduction system of the Heart 527 JUN-2005 APR-2004 7 2D Echo 530 DEC-2006 8 MRI 532 APR-2004 9 NYHA Classification 534  10 Paroxysmal Nocturnal Dyspnoea. 539 JUN-2006 11 Orthopnoea 540 MAR-2003 12 ESSAY – HEART FAILURE   13 DD of Peripheral Edema 545  14 Cardiac Cachexia 545  15 Complications of Heart Failure 546  16 ACE Inhibitors adverse reactions 30 aortic regurgitation 628 atherosclerosis prevention 581 chronic renal failure 488 diabetic cardiovascular disease and nephropathy 838 diabetic nephropathy 514 drug-induced cough 658 effect on renal function 496, 5 17 effect of renal insufficiency 26, 27 heart failure 546, 549 dosages 550 site of action 549 hypertension 613, 614, 615 microalbuminuria in type I diabetes 842 mitral regurgitation 622 myocardial infarction 600 549 DEC-2004 17 Cardiac Transplantation 550  18 Hypertensive Heart Disease 551 608  19 Syncope 551 AUG-2001 20 Carotid Sinus Syndrome 553  21 Management of cardiac arrest. 554 FEB-2001 SEP-2000 22 Second Sound 558 JUL-2008 23 DD of Mid-Diastolic murmer at apex 559 AUG-2001 24 Paroxymal Tachycardia 561 APR-2004 25 Atrial Fibrillation 562 APR-2004 AUG-2002 26 Treatment of atrial fibrillation  SEP-2000 27 Draw & Label : ECG of WPW Syndrome 565 APR-2004 28 Draw & Label : ECG of First Degree Heart Block 570 JUN-2005 29 Complete Heart Block 570 JUN-2005 30 Defibrillation 575 APR-2004 31 Digoxin 575 JUL-2007 32 Cardiac Pacemakers 576 JUN-2005 JUN-2006 33 Pathogenesis of Atheroma formation 579  34 Treadmill test Bruce Protocol 582 528  35 Low Dose Aspirin Therapy 75-150mg 583  36 Manaagement of Angina Pectoris 583 MAY-1999 37 NYHA Classification 534  38 Unstable Angina 589 537 581 JUL-2008 39 Syndrome X 589  40 Acute Coronary Syndrome 589  41 Treatment of Unstable Angina 590 FEB-2002 42 Silent MI 591  43 Signs of MI 591  44 Draw & Label : ECG changes in Acute Myocardial Infarction 592 DEC-2006 45 Investigations in Myocardial infarction. 592 SEP-2000 46 Troponin 593 538 525 JUL-2008 47 Draw & Label : Graph showing Enzyme changes after MI 594  48 Role of Analgesia in MI 595  49 Thrombolytic therapy Steptokinase 1.5mU in 100ml saline over 1hr Alteplase 15mg over 90min followed by… Tenecteplase… Reteplase (rPA) 595 728 1207 JUL-2008 50 Mechanical Complications of MI 597  51 Ventricular Remodelling 598  52 Dresslers Syndrome …The post-myocardial infarction syndrome (Dressler's syndrome) is characterised by persistent fever, pericarditis and pleurisy, and is probably due to autoimmunity. The symptoms tend to occur a few weeks or even months after the infarct and often subside after a few days; prolonged or severe symptoms may require treatment with high-dose aspirin, an NSAID or even corticosteroids…. (Davidson p. 598) 598 AUG-2002 53 Renal Hypertension - AUG-2001 54 Raynaud's phenomenon 604 DEC-2006 SEP-2000 55 A 3oyr old man admitted with headache, giddiness, vomitinf of 2 days duration. His BP was 180/110 of Hg. What is the provisional Diagnosis? What are the common causes of secondary Hypertension? Outline the investigation? Outline the management?  JUL-2008 56 Antihypertensive Drugs 608 AUG-2002 57 Drugs used in hypertensive emergencies 613 JUL-2008 58 Malignant Hypertension 614 498 MAR-2003 FEB-2001 59 Management of Hypertensive crisis  JUL-2007 60 Endocrine causes of Hypertension  JUL-2008 61 RHEUMATIC FEVER   62 Achoff's Nodules 616 FEB-2002 63 Jones Criteria 617  64 Syndenham's Chorea 617  65 Lab Diagnosis of Rheumatic fever 616 DEC-2006 66 Radiological features of Mitral Stenosis 619 AUG-2002 MAY-1999 67 Peripheral signs of Aortic Regurgitation 626 DEC-2006 68 Pulmonary Stenosis 629 JUL-2007 69 Bacterial Endocarditis  SEP-2000 70 Discuss the aetiology, clinical features, investigations, treatment of infective endocarditis  APR-2000 71 Subacute Endocarditis 630  72 Osler's Nodes 630  73 Modified Duke's Criteria 631  74 Treatment of SABE 632 OCT-2002 75 Valve Replacement 633 APR-2004 76 Eissenmenger's Syndrome 636 550 629 634 639  77 Chest X-ray findings in Lt to Rt shunt like ASD/VSD.  DEC-2006 78 Chest Xray findings in Coarctation of Aorta 637 JUL-2007 79 VSD 638 634  80 Radiological features of TOF 639 OCT-2002 81 Viral Myocarditis 641 306 JUL-2007 82 TB Pericarditis 645 MAR-2003 83 Constrictive Pericarditis 646 JUL-2008 84 Kussmaul's Sign 646 AUG-2002 85 Cyanosis - AUG-2002 86 Differential Cyanosis.  JUN-2006 87 Left Ventricular Hypertrophy - FEB-2002 88 Cardiomegaly  FEB-2002 89 Beta Blockers - JAN-2002 90 Collapsing Pulse - AUG-2001 JUL-2007 91 Corrigan's Pulse  MAY-1999 92 Acute Left Ventricular Failure  AUG-2001 93 Discuss the aetiology, clinical features investigations and treatment of acute left ventricular failure.  FEB-2001 94 ACE inhibitors in medicine  SEP-2000  ENDOCRINE DISEASE   1 Thyroid Function Tests 745 OCT-2002 2 Management of Thyroid Storm 749 JUL-2007 3 Features of Hypothyroidism 750 MAR-2003 4 Causes of Hyperthyroidism 755 JUL-2007 5 Neomercazole (Carbimazole) 755 OCT-2002 6 Radioiodine Therapy 761 APR-2004 7 Thyroid Stone - AUG-2001 8 Hypogonadism 766 AUG-2001 9 Hypercalcaemia 772 AUG-2001 10 Addison's Disease 782 APR-2004 AUG-2002 11 Carcinoid Syndrome 791 AUG-2002 12 Dwarfism 793 FEB-2001 13 Acromegaly 801 OCT-2002 14 Somatostatin 810 853 859 DEC-2006 15 Insulin Resistance Syndrome 813  16 Diabetic Ketoacidosis 822 JUL-2007 17 Oral antidiabetics 831 FEB-2001 18 Newer Sulphonnylureas 832 JUN-2006 19 Dawn Phenomenon 835 AUG-2002  DIABETES MELLITUS   1 Diagnostic Criteria for Diabetes  OCT-2002 2 Non Ketotic Hyperosmolar Diabetic Coma 823 APR-2004 AUG-2001 3 Human Insulin 834 DEC-2004 4 Insulin Analogues  JUN-2005 DEC-2004 JUN-2006 5 Insulin Pens and Insulin Pumps 834 JUN-2005 JUN-2006 6 Dieary management in a Diabetic Patient  FEB-2002 DEC-2006 7 Oral hypoglycaemic agents  SEP-2000 8 Diabetic Nephropathy 841 FEB-2002 MAY-1999 9 Microalbuminuria 842 APR-2000 10 Specific test for Glucose in Urine - JUN-2005 11 Somogyi Effect in diabetes, a rebound phenomenon of reactive hyperglycemia in response to a preceding period of relative hypoglycemia that has increased secretion of hyperglycemic agents (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone); described in diabetic patients given too much insulin who developed unrecognized nocturnal hypoglycemia that made them hyperglycemic (suggesting insufficient insulin) when tested the next morning. - OCT-2002 12 Hypoglycemic Coma - JAN-2002 13 Myxoedemic Coma  MAY-1999  ALIMENTARY TRACT AND PANCREATIC DISEASE   1    2 Barium Enema 848 FEB-1998 3 ERCP 860 DEC-2004 4 Barium Swallow 860 OCT-2002 5 Dysphagia 864 OCT-2002 6 DD of Haematemesis  MAY-1999 7 Causes of upper GI Bleeding 866 DEC-2006 8 Differentiate Haemoptysis and Haematemesis  SEP-2000 9 Describe the pathogenesis and management of acute haematemesis in a chronic alcoholic male aged 55.  SEP-2000 10 Occult blood in stools 869 DEC-2004 11 Medical causes of Acute Abdomen 874 JUL-2008 12 Oral thrush 877 OCT-2002 13 Treatment of GERD 877 AUG-2002 14 H Pylori 885 AUG-2002 SEP-2000 15 Antacids for Peptic Ulcer 887 MAR-2003 16 Treatment of H Pylori Infection 888 APR-2004 17 Dumping Syndrome 888  18 Proton Pump Inhibitors Refer George Mathew pg 501 889 AUG-2001 19 Types of Abdominal Tuberculosis 902 OCT-2002 20 Carcinoid Tumour 903 DEC-2006 21 Complications of Acute Pancreatitis 905 MAR-2003 22 Inflammatory Bowel Disease 910 OCT-2002 23 Chimeric Monoclonal Antibody 917 DEC-2004 24 Ascites 947 JUL-2008 25 Investigations for diagnosis of Ascites 948 MAY-1999 26 Stomach Wash   27 Pancreatic Abscess  JUL-2007  LIVER AND BILIARY TRACT DISEASE   1 Ehrlich's Test  JUN-2006 2 Urine in Jaundice 940 MAY-1999 3 Draw & Label : Hepatic Lobule - FEB-2002 4 Liver Biopsy 942 APR-2004 5 Alkaline Phosphatase 943 AUG-2001 6 TIPPS 949  7 Factors precipitating Hepatic Encephalopathy 950 MAR-2003 8 Cryptogenic Cirrhosis   9 Complications of Liver Cirrhosis 956 AUG-2001 10 Portal Hypertension 957 JUL-2008 11 Management of portal hypertension  SEP-2000 12 Portosystemic Shunts Portocaval Shunts 960 JUN-2005 13 Caput Medusae  JUL-2008 14 Hepatitis B  SEP-2000 15 HbsAg  JAN-2002 16 Outline the transmission, clinical features and complications of Hepatitis B infection. Mention a note on Hepatitis B prophylaxis?  SEP-2000 17 Causes of Viral Hepatitis 962 MAR-2003 18 Complications of Acute Viral Hepatitis 963 MAY-1999 19 Prevention of viral hepatitis.  FEB-2001 20 Control of Hepatitis A infection in Community  DEC-2006 21 Hepatitis B Prophylaxis  JUN-2006 22 Hepatitis B Vaccines.  JUN-2006 23 Chronic Persistant Hepatitis (CPH)  JUL-2007 24 Post Hepatitis Syndrome   25 Anicteric Hepatitis   26 Wilsons Disease 975 AUG-2002 27 Cardiac Cirrhosis 983  28 Draw & Label : Hydatid Cyst  JUN-2006 29 Hepatic Amoebiasis 987 AUG-2001 30 Lab diagnosis and treatment of Amoebic liver abscess  SEP-2000 31 Liver Transplantation 989 APR-2004 32 Indian Childhood Cirrhosis   33 Types of Gallstones  JUL-2007 34 Risk factors for Cholesterol Gallstones  JUL-2007  BLOOD DISORDERS   1 Platelet Transfusion  JUL-2007 2 APTT 1011 FEB-2002 3 Blood Groups  AUG-2001 4 Hazards of Blood Transfusion  MAY-1999 5 Mismatch Blood Transfusion 1023 JUN-2005 6 Exchange Transfusion  APR-2004 7 Draw & Label : PS of Fe deficiency Anemia - MAR-2003 8 Causes of normocytic normochromic anaemia 1012 DEC-2006 9 Polycythemia 1014 FEB-2002 10 Treatment of Polycythemia Vera 1014 AUG-2001 11 Hypersplenism 1015 AUG-2002 12 Thrombocytopenia 1017 AUG-2002 13 Prevention of Deep Venous thrombosis 1018 MAR-2003 JUL-2007 14 Causes of Pancytopenia 1018 JUL-2008 15 Pernicious Anaemia 1028 MAR-2003 16 Anaemia of Chronic Renal Failure 1030 FEB-2002 17 Splenectomy 1031 JUN-2006 18 Coombs Test 1033 JUN-2005 19 Sickle Cell Disease 1035 AUG-2001 JUL-2007 20 Methhemoglobinemia 1035 AUG-2002 21 Paroxysmal Nocturnal Hemoglobinuria  MAR-2003 22 Hemoglobin AIC  MAR-2003 23 Thalassemia 1038 MAY-1999 JUL-2008 24 Desferrioxamine 1038 MAR-2003 25 Treatment of acute leukemia. 1040 FEB-2001 26 Bone marrow transplantation 1043 JAN-2002 27 Draw & Label : PS in CML 1045 JUN-2006 28 Treatment of Chronic Myeloid Leukemia  DEC-2006 APR-2000 29 Myelodysplastic Syndromes 1047 MAR-2003 FEB-2001 30 Hodgkin's Lymphoma 1048 MAY-1999 31 Draw & Label : RS Cell 1048  32 Staging of Hodgkin's Lymphoma Ann Arbor Classification 1048  33 Pel-Ebstein Fever the remittent fever common in Hodgkin disease -  34 CHOP Regimen 1051  35 International Prognostic Index (IPI) (Harrison p. 692) The International Prognostic Index (IPI) is a clinical tool developed by oncologists to aid in predicting the prognosis of patients with aggressive non-Hodgkin's lymphoma. Prior to 1993, when the IPI was developed, the primary consideration in assessing prognosis was the Ann Arbor stage alone, but this was increasingly found to be an inadequate means of predicting survival outcomes, and so other factors were studied. Low risk (0-1 points) - 5-year survival of 73% Low-intermediate risk (2 points) - 5-year survival of 51% High-intermediate risk (3 points) - 5-year survival of 43% High risk (4-5 points) - 5-year survival of 26% http://en.wikipedia.org/wiki/International_Prognostic_Index 1051  36 Paraproteinemias 1051 DEC-2006 37 ESSAY – MULTIPLE MYELOMA   38 Diagnosis of Multiple Myeloma 1052 FEB-2002 39 Treatment of Multiple Myeloma 1052  40 Aplastic Anemia Causes of Aplastic Anemia 1054 DEC-2006 APR-2000 41 Management of ITP 1055 AUG-2001 42 Haemophilia 1057 OCT-2002 43 Management of Haemophilia  AUG-2002 44 DIC 1060 AUG-2002  MUSCULOSKELETAL DISORDERS   1 Rheumatoid Factor 1074 81 JUN-2006 2 Serum Alkaline Phosphatase 1076 DEC-2006 3 Electromyography 1076 1154 DEC-2004 APR-2004 JUN-2006 4 Polymyositis 1078 1083 82  5 Selective COX 2 Inhibitors 1091 JUN-2005 6 Juvenile Rheumatoid Arthritis  SEP-2003 7 Stills Disease  OCT-2002 8 Intraarticular Injection Therapy 1095  9 Hand deformities in Rheumatoid Arthritis 1103 JUN-2005 10 Ocular lesions of Rheumatoid Arthritis  APR-2004 DEC-2004 11 Biological response modifiers in Rheumatoid Arthritis Therapy  SEP-2003 12 Management of rheumatoid arthritis  FEB-2001 SEP-2000 13 Felty's Syndrome 1105 AUG-2001 14 DMARD 1105 APR-2004 15 Ankylosing Spondylitis 1106 DEC-2006 16 Seronegative Spondyloarthropathy 1106 OCT-2002 17 Sulfasalazine 1108 JUL-2008 18 Reiter's Syndrome 1108 1034 917 1309 APR-2004 19 Psoriatic Arthritis 1109 DEC-2004 JUN-2006 20 Gout  MAY-1999 21 Acute Gouty Attack 1112 JUN-2005 22 Gouty Tophi 1113 DEC-2004 23 Colchicine 1112 OCT-2002 24 Diagnosis of Osteoporosis  JUN-2006 25 Radiological features in Osteoporosis 1121 DEC-2006 26 Osteomalacia. 1126 SEP-2000 27 Steroids in Medicine 1126 973 APR-2000 28 CREST Syndrome 1135 AUG-2002 29 Charcots Joint 1144 DEC-2004 JUN-2006 30 Assistive Device in Chronic Arthritis - JUN-2005 JUN-2006  NEUROLOGICAL DISORDERS   1 Abdominal reflex  JUN-2006 2 Dissociated Sensory loss  JUN-2006 3 False localising signs in CNS Disease  JUL-2008 4 Draw & Label : Course of the Cortico Spinal Tract.  JUN-2006 JUL-2008 DEC-2006 5 Draw & Label : Course of Facial Nerve - FEB-2002 6 Draw & Label : Circle of Willis - MAR-2003 7 Berry Aneurysm  JUN-2006 8 Draw & Label : Reflex arc of Knee Jerk  JUN-2005 9 Pendular Knee Jerk 1147 DEC-2004 10 Sildenafil 1150 JUN-2005 DEC-2004 JUN-2006 11 Draw & Label : EEG in Primary Generalised Epilepsy 1154 1167  12 Lumbar Puncture 1159 MAR-2003 FEB-2002 13 Nerve Biopsy 1159 JUN-2006 14 Migraine 1162 DEC-2006 15 Treatment of Migraine  APR-2000 16 Cluster Headache 1163 FEB-2002 17 Simple Partial Seizures 1167 DEC-2006 18 Petitmal 1168  19 Temporal Lobe Epilepsy 1169 APR-2004 20 Jacksonian Epilepsy 1169  21 Todd's Paralysis paralysis of temporary duration (normally not more than a few days) that occurs in the limb or limbs involved in jacksonian epilepsy after the seizure. Syn: Todd postepileptic paralysis. (Stedman) 1169 FEB-2002 22 Sturge-Weber Syndrome [MIM*185300]. in its complete form, a triad of unilateral occurrence of 1) congenital capillary malformation (flame nevus) in the distribution of the trigeminal nerve; 2) leptomeningeal vascular malformations with intracranial calcification and neurologic signs; and 3) vascular malformation of the choroid, often with secondary glaucoma. Inheritance is unclear with most cases sporadic. See Also: encephalotrigeminal vascular syndrome. Syn: cephalotrigeminal angiomatosis, encephalotrigeminal angiomatosis, Sturge-Weber disease, Sturge-Kalischer-Weber syndrome. (Stedman) 1170 OCT-2002 23 Classify Epilepsy Discuss the clinical picture of Generalised Tonic Clonic seizure. Describe the investigations of Epilepsy Describe the management of Status Epilepticus 1170 AUG-2001 24 Surgery for Epilepsy - DEC-2004 25 SUDEP Sudden unexplained death in epilepsy 1173  26 Status Epilepticus 1173 OCT-2002 DEC-2006 27 Pseudoseizures 1176  28 Transient Amnesia 1176  29 Narcolepsy 1177 SEP-2003 30 Draw & Label : Pyramidal Tract 1178 OCT-2002 31 Draw & Label : Extrapyramidal System  JUL-2007 32 Draw & Label : Visual Pathway  DEC-2004 33 Draw & Label : Visual Field Defect  OCT-2002 34 Cerebellar Ataxia 1181 FEB-2002 35 Tremors 1181 FEB-2001 36 Hemiballismus 1182 AUG-2001 37 Clonus 1183 DEC-2004 38 Dementia 1188 MAY-1999 39 Wernic's Aphasia 1191 APR-2004 40 Sensory Aphasia  MAR-2003 41 Lateral Medullary Syndrome 1192 DEC-2004 42 Pseudobulbar Palsy 1192 MAR-2003 43 Draw & Label : Pathway of Pupillary Reflex 1197 DEC-2004 44 Pupillary Reflex 1197 DEC-2004 45 Draw & Label : Optic Neuritis 1198 OCT-2002 46 Fundus examination in Medicine 1198 APR-2000 47 Neurogenic Bladder 1200 JUN-2005 48 STROKE A 24yr old female is admitted with chest pain, palpitation, breathlessnessfollowed by weakness of left half of body. What is the provisional diagnosis? List four common causes of stroke in young? Pg 1204 What are the clinical triads of mitral stenosis? Outline the management ?  JUL-2007 49 Transient Ischaemic attacks (TIA) 1200 OCT-2002 AUG-2002 DEC-2006 50 Reversible Ischemic Neurological Deficit (RIND) ischemic neurologicla deficit lasting 24-96 hours   51 Amaurosis Fugax transient monoocular blindness 1200 1194  52 DD of Stroke 1201  53 Reversible Ischemic Neurological Deficit   54 Evolving Stroke 1200  55 Complete Stroke 1201  56 Mini Stroke   57 Stroke Syndromes TACS PACS POCS LACS From 3rd European Stroke Conference 1201  58 Wallenberg Syndrome   59 Lacunar Infarct 1202 1206 FEB-2002 DEC-2006 60 Ischaemic Penumbra Penumbra - The region of partial illumination or radiation caused by light or x-rays not originating from a point source; also called geometric unsharpness. Origin [Mod. L., fr. L. paene, almost, + umbra, shadow] (Stedman) 1202  61 Discuss the aetiology, clinical features investigations and management of intra cerebral haemorrhage. 1203 FEB-2001 62 Subarachnoid Hemorrhage 1210 1161 1203 DEC-2006 63 Subdural Hematoma 1211 JUL-2008 64 Methylprednisolone [see also 196 918 990 1088 1137] 1216 JUN-2006 65 Alzheimer's Disease 1217 JUN-2005 AUG-2002 66 Management of Parkinsonism  JUL-2007 67 L Dopa 1220 JUN-2005 JUN-2006 68 Stereotaxic Surgery for Parkinsonism 1221 JUN-2005 APR-2004 69 CSF in Meningitis  JUL-2008 70 Discuss the aetiology, clinical features, investigations and treatment of acute pyogenic meningitis in children  AUG-2001 71 Treatment of Pyogenic Meningitis 1227 AUG-2001 72 Management of TB Meningitis 1228 OCT-2002 73 Viral Encephalitis 1229 FEB-2002 74 Management of Dog Bite 1229 APR-2004 75 Rabies vaccination  SEP-2000 76 Non Nerve Tissue Vaccine against Rabies  JUN-2005 77 Pulse Polio Immunisation 1230 JUN-2005 78 Polio Vaccines 1230 SEP-2003 79 A 40 year old manual labourer is admitted with Trismus; List 2 differential diagnosis. List 2 important points each in favour of each of these 2 diagnosis. List 4 drugs useful in treating one of these conditions. List 2 complications of one of these conditions. How this condition can be prevented?  JUN-2006 80 Treatment of Tetanus 1232 OCT-2002 81 Jacob-Creutzfeldt Disease 1234 APR-2004 82 Management of Raised ICT 1235 AUG-2002 83 MRI of Brain 1236 1205 DEC-2006 84 Paraneoplastic syndromes 1238 APR-2000 85 Opsoclonus 1239  86 IV Disc Prolapse 1241 JUN-2005 87 Medical complications of cervical spondylosis 1241 SEP-2000 88 Subacute combined degeneration of Cord 1245 AUG-2002 89 Entrapment of Neuropathy 1246 1104 JUL-2007 90 Metabolic causes of Peripheral Neuropathy 1246 JUL-2008 91 A 40 year old male is admitted with headache, vomitjng, tinnitus and ataxia of right side.Clinical examination showed Nerve Deafness. LMN Facial Palsy and Cerebeilar Signs on theRight side only. Ophthalmoscopy showed bilateral early papilloedema: 1 What is the most likely diagnosis? 2 Mention two points to be specifically looked for during general examination ofthis patient. 3 List four Investigations which willl help in conlirming the diagnosis here. 4 List four points to differential between LMN and UMN Facial Palsy. 5 List four causes for Bilateral LMN Facial Palsy.  JUN-2006 92 Bell's Palsy 1249 JUL-2007 93 Claw Hand Deformity 1251 DEC-2004 94 Management of Myasthenia 1253 JUL-2008  UNALLOCATED   1 Biological warfare  JUL-2007 2 Side effects of steroid therapy  JUN-2005 FEB-2002 3 Aura of Epilepsy 1168 JUN-2005 4 Radioimmunoassay  JUN-2005 5    6 Cyclooxygenase Isoenzymes  DEC-2004 7 TNF-a Agonists  DEC-2004 8 Intravenous Drug Abuse  DEC-2004 SEP-2003 9 X linked Inheritence   APR-2004 10 X linked Recessive Disorder  MAR-2003 11 Formic acid Poisoning  APR-2004 12 Antigen presenting Cell  SEP-2003 13 Superantigens  SEP-2003 14 QBC  MAR-2003 15 Hyperkalemia  DEC-2006 16 Treatment of Hyperkalemia  MAR-2003 OCT-2002 17 Malignant Otitis Externa  OCT-2002 18 Glycosylated Hb  SEP-2000   Paper 2    Recombinant DNA Technology  APR-2000  POISONING   1 Theophylline intoxication 212 OCT-2002 2 A 14 year old boy is brought with history of snakebite 2 hours ago. If there is ptosis and dysarthria what is the most likely explanation? Briefly describe the first-aid measures which should have been given at the place of bite itself? Which are the "Parameters" to be included in observing the patient's progress' with a "Progress monitoring chart". Enumerate the complications this patient could develop. List the steps in treatment.  APR-2004 3 Non poisonous snake bite 221 SEP-2003 4 Treatment of Snake Bite 221 MAR-2003 OCT-2002 APR-2000 5 Universal Antidote - MAR-2003 6 Traube's Space  MAR-2003 7 Octreotide  MAR-2003  MEDICAL PSYCHIATRY   1 Define Hallucinations and Illusions 232 MAR-2003 2 Hallucinations 232 APR-2004 OCT-2002 3 Delusion  OCT-2002 4 Conversion Disorders 236 AUG-2002 5 Electroconvulsive Therapy (ECT) 237 DEC-2004 SEP-2003 MAR-2003 6 Treatment of Depression 241 AUG-2001 7 Antidepressants 241 APR-2004 8 Schizophrenia 242 JAN-2002 FEB-2001 9 Complications of Alcoholism 245 APR-2004 10 Alcohol withdrawal  SEP-2003 11 Anorexia Nervosa 248 AUG-2002 12 Hysteria 250 APR-2004 JUN-2006 13 Hysterical uncounsciousness  SEP-2003 14 Paranoid State  SEP-2003 15 Lucid Interval - MAR-2003  ONCOLOGY   1 Tumour markers 258 SEP-2000 2 Antimalignant Drugs  DEC-2006 3 Cyclophosphomide 266 OCT-2002  INFECTIOUS DISEASES   1 Diagnosis of Typhus fever  JUN-2006 2 Liver Biopsy 287 DEC-2004 OCT-2002 3 Correction of Dehydration 294 OCT-2002 4 Chronic Diarrhoea 295 AUG-2001 5 Larva Migrans 298 DEC-2004 FEB-2001 6 Complications of Mumps 302 DEC-2006 7 Shingles/Herpes Zoster 305 OCT-2002 JAN-2002 8 Dengue Hemorrhagic Fever 309 SEP-2003 9 Japanese Encephalitis 312 APR-2004 10 Transmission of JE 312 JUN-2005 JUN-2006 11 Prevention of JE  DEC-2004 12 TSS 314 SEP-2003 13 Relapsing Fever 320 APR-2004 14 Leptospirosis/Weils Disease 321 AUG-2001 MAY-1999 15 Diagnosis of Leptospirosis  DEC-2006 16 A 20 year old man gives a history of fever of 1 week and is disoriented. Discuss the differential diagnosis and relevant investigations. Mention the drugs used in typhoid fever with correct dosages.  SEP-2000 17 Plague 322 SEP-2000 18 Carrier State in Typhoid 324 JUN-2005 19 Complications of Typhoid 324 JUN-2005 20 Describe the etiology, pathogenesis, clinical features and managemne tof enteric fever.  JAN-2002 21 Chemoprophylaxis of Typhoid  AUG-2002 22 Typhoid Vaccines 325 DEC-2004 APR-2004 23 Management of Typhoid fever  DEC-2006 24 Widal Test  JUN-2006 25 Control of spread of Cholera in the community  JUN-2006 26 Difference between Bacterial and Amoebic Dysentry 330 APR-2004 27 Management of Dysentry 331 AUG-2002 28 Botulism 333 JUN-2005 29 Lepra Bacillus  SEP-2003 30 Lepra Reaction 335 JUN-2005 OCT-2002 AUG-2002 31 Reactions in Leprosy 335 APR-2004 JUN-2006 32 Lab diagnosis of Leprosy  DEC-2004 33 Biological Warfare 342 APR-2004 34 Draw & Label : Gametocytes of all four species of Plasmodia 344 APR-2004 35 Draw & Label : Ring forms of all four species of Plasmodia 344 SEP-2003 36 Gametocytes of Malaria  JUN-2006 37 Cerebral Malaria 345 SEP-2000 38 Chloroquine 347 DEC-2004 39 Artemeter 347 MAR-2003 40 Treatment of Malaria  OCT-2002 41 Drug resistance in Malaria  SEP-2003 42 Chemoprophylaxis of Malaria  JUN-2005 DEC-2004 JUN-2006 43 Cerebral Malaria  APR-2004 44 Treatment of Cerebral Malaria  MAR-2003 45 Draw & Label : Entamoeba Histolytica 359 DEC-2004 46 Draw & Label : Schematic diagram of Amoebic Ulcer in Intestine  DEC-2006 47 Extraintestinal Amoebiasis  AUG-2002 48 Treatment of Extraintestinal Amoebiasis  MAR-2003 49 Hepatic Amoebiasis 987 JAN-2002 50 Draw & Label : Life Cycle of Ankylostomiasis  MAR-2003 51 Draw & Label : Hook Worm Ova as seen in stools.  JUN-2006 52 Draw & Label : Ova of Trichuris Trichura 360 OCT-2002 53 Draw & Label : Ova of Round worm & Hook worm 360 APR-2004 54 Broad Spectrum Antihelminthics 360 JUN-2005 55 Strongyloidosis 361 AUG-2001 56 Draw & Label : Ascariasis Ova 362 OCT-2002 57 Describe the aetiology, clinical features, complications, investigations and management of Bancroftian filariasis. 363 FEB-2001 58 Ivermectin 363 MAR-2003 59 Guinea Worm 366 MAY-1999 60 Draw & Label : A Segment of Pork Tapeworm 370 DEC-2004 61 Neurocysticercosis 371 DEC-2004 62 Hydatid Disease 371 SEP-2000 63 Draw & Label : Hydatid Cyst 371 SEP-2003 64 Hydatid Cyst 371 DEC-2004 65 Oral Candidiasis 373 AUG-2001 DEC-2006  HIV   1 HIV Infection  SEP-2000 2 Cutaneous manifestations of HIV  MAR-2003 3 Oral manifestations of HIV infection.  FEB-2001 4 Diagnosis for HIV Infection  SEP-2003 AUG-2001 JUN-2006 5 Prevention of HIV Infection  JUN-2005 6 Opportunistic infections 383 APR-2000 7 Oesophageal Candidiasis 386 MAR-2003 8 Pneumocystis carinii 389 AUG-2001 9 PCNSNL 392  10 Kaposi Sarcoma 396 AUG-2002 JAN-2002  SEXUALLY TRANSMITTED DISEASES   1 Primary Syphilis  DEC-2006 2 Specific Tests for Syphilis 411 APR-2004 JUN-2005 3 Jarisch Herxheimer reaction 413 MAR-2003 4 Congenital syphilis  JUN-2006  RESPIRATORY DISEASE   1 Pulmonary Edema  DEC-2006 2 Complications of Lobar Pneumonia  JUN-2006 3 Management of Acute Pulmonary Oedema  JUN-2006 4 Draw & Label : Pulmonary Segments 650 MAR-2003 5 Management of Acute Breathlessness 658 AUG-2002 6 Differentiation between Hemoptysis and Haematemesis 662 SEP-2003 7 Bronchial Adenomas 663 FEB-2002 8 Investigations for Pleural Effusion 664  9 Causes of Pleural Effusion 665  10 Pleural tap 665 AUG-2002 11 Pleural aspiration diagnostic value 665 SEP-2000 12 Sleep Apnoea Syndrome 666 SEP-2003 AUG-2002 13 Leukotriene Antagonist 674 JUN-2005 JUN-2006 14 Management of Asthma 675 AUG-2001 15 Aminophylline 678 DEC-2004 JUN-2006 16 BCG Vaccination  MAR-2003 17 Pulmonary function tests in obstructive airway disease. 680 FEB-2001 18 Discuss the aetiology, clinical features and management of bronchiectasis. Enumerate its complications  APR-2000 19 Cystic Fibrisis 685 FEB-2002 20 Community Acquired Pneumonia 689 FEB-2002 21 Describe the etiology, clinical features, complications, investigations and treatment of lobar pneumonia? 690 691 JAN-2002 22 Pathogenesis of Consolidation 698 DEC-2006 23 Treatment of Lung Abscess 694 MAR-2003 24 ESSAY : A 25 year old mal-nourished adult presented with evening rise of temperature, chestpain, breathlessness and cough of two weeks duration. What is the provisional diagnosis? Enumerate the investigations. What are the complications? Outline the management.  DEC-2006 25 What is primary complex? Enumerate the symptoms of primary complex? what are the complications of childhood tuberculosis? discuss the investigations and treatment of primary complex? 695 FEB-2001 26 Miliary Tuberculosis  JAN-1999 27 Tuberculin Testing 700 JUN-2005 28 Mantoux Test 700 MAR-2003 AUG-2001 29 Drug Resistance in TB 702 APR-2004 JUN-2006 30 MDRTB 702 AUG-2001 31 Prevention of Drug Resistance in TB  JUN-2005 32 Atelectasis 707 MAR-2003 33 Hypersensitivity Pneumonitis 719  34 Farmer's Lung 719  35 Byssinosis / Monday Fever 720  36 SCWP 721  37 Progressive Massive Fibrosis (PMF) 721  38 Caplan Syndrome 721 723  39 Silicotuberculosis 721  40 Asbestos Bodies 722  41 Pulmonary eosinophilia 723 FEB-2001 42 Pulmonary Thromboembolism 724 OCT-2002 43 Empyema Pus in a body cavity; when used without qualification, refers specifically to pyothorax. 732 DEC-2006 44 Pyothorax Empyema in a pleural cavity. 732 DEC-2006 45 Pyopneumothorax   46 Intercostal tube drainage   47 Spontaneous Pneumothorax   48 Tension pneumothorax. 734 SEP-2000 49 Closed Pneumothorax 734  50 Mesothelioma 734  51 Causes of elevation of Hemidiaphragm 736 FEB-2002 52 Pigeon Chest deformity 737   SKIN DISEASE   1 Treatment of Urticaria 1270 MAR-2003 2 Nail in Systemic Disorders 1281 AUG-2002 3 Clubbing 1283 850 MAR-2003 4 Psoriasis 1287 MAY-1999 5 Scabies  AUG-2001 JUN-2006 6 Norwegian Scabies 1298 APR-2004 7 Treatment of Scabies  SEP-2003 MAR-2003 8 Exfoliative Dermatitis 1307 OCT-2002 9 Steven Johnson Syndrome 1308 AUG-2002 10 Xanthoma 1308 DEC-2004  UNALLOCATED   1 Serum Protein Electrophoresis 420 JUN-2005 2 Telemedicine Telemedicine is a rapidly developing application of clinical medicine where medical information is transferred through the phone or the Internet and sometimes other networks for the purpose of consulting, and sometimes remote medical procedures or examinations. Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and videoconferencing equipment to conduct a real-time consultation between medical specialists in two different countries. Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care. en.wikipedia.org/wiki/Telemedicine - JUN-2005 JUN-2006 3 Prefrontal Leucotomy  DEC-2004 4 Ehrlich's Test  DEC-2004 5 Paraneoplastic Endocrinopathies  APR-2004 6 H2 Receptor Blocking Agents  APR-2004 7 Bed Sore  APR-2004 8 Features of Chron's Disease  FEB-2002 9 Hysterical Conversion Reaction  AUG-2001 Practicals COMMON CLINICAL PROCEDURES VIVA QUESTIONS IN GENERAL EXAMINATION Measurement of Pulse 1. Measurement of Blood Pressure Measurement of Temperature 2. Sites to measure temperature? 3. Which site will you prefer ? 4. What is the difference in the oral and axillary temperatures? oral is 1°F higher than axilla 5. Types of Fever? ▪ THREE types ▪ continued ▪ remittent ▪ intermittent Looking for Pallor Looking for Cyanosis 6. What is Cyanosis? bluish or purplish discoloration of skin OR mucous membrane due to the presence of excessive amount of reduced Hemoglobin in the UNDERLYING blood vessels 7. Amount of REDUCED Hb to present to show cyanosis? 5g/dl (or say 5 g%) NOTE: avoid mistakes like 5mg% etc 8. Types ? central peripheral Looking for Clubbing 9. Grades of Clubbing Looking for Jaundice ▪ Examine in day light 10. Sites to look for Jaundice? Sclera Nail Bed Ear Lobule Nose tip Tongue undersurface 11. How to differentiate Jaundice from Hypercarotenemia? by its absence in sclera, but presence in face, palms and soles seen in vegetarians (excess carrot intake) 12. Cause of jaundice? presence of lipid soluble yellow pigments in the plasma Pain 13. LONG CASES 14. CVS Mitral Stenosis Mitral Incompetence Aortic Stenosis Aortic Incompetence Bacterial Endocarditis RESPIRATORY SYSTEM Pleural Effusion Pneumothorax Hydropneumothorax Consolidation COPD/Asthma GIT Viral Hepatitis Liver Cirrhosis 15. x 140/1990 mmHg or more with proteinuria after the 20th week 16. How to differentiate jaundice from carotenemia? x Pyloric Stenosis CNS Hemiplegia Paraplegia Parkinsonism Peripheral Neuropathy SHORT CASES RESPIRATORY SYSTEM Lung Collapse Superior Mediastinal Syndrome GIT Ascites Abdominal Lump Hepatosplenomegaly CNS Cerebellar Disorder Bulbar Palsy    SURGERY 1 Paper 1   2 UNALLOCATED   3 Draw & Label : Branches of Abdominal Aorta  DEC-2004 4 Anastamosis in the Gastrointestinal Tract  SEP-2003 5 Intestinal Anastamosis  FEB-2008 6 Surgical care of Abdominal Distension  FEB-2008 7 Indications of OSD Exploration  JUL-2008 8 Internal Bleeding  FEB-2008 9 PERITONEUM   10 A ten year old child is brought to casualty with the history of acute abdominal pain of one day duration. There is history of vomiting and blood stained motion. On examination the child is having abdominal distension. The child cries immediately on touching the abdomen. What are the conditions to be considered in diagnosis? Discuss the pathology of any one condition? How will you investigate? Detail the different types of treatment of the most common condition? In what way the treatment differes from the adult?  APR-2004 11 Resuscitative measures to be done in a patient who has perforative peritonitis of 12 hours duration  MAR-2003 12 Spontaneous peritonitis 504  13 Pneumococcal Peritonitis   14 Types of Tubercular Peritonitis   15 Stages of Peritonitis    16 Complications of Peritonitis   17 Pelvic Abscess 506  18 Subphrenic Spaces   19 Subphrenic Abscess   20 Sub-diaphragmatic Abscess 507 MAY-1999 21 Common causes of Subphrenic abscess Clinical features and investigations of Subphrenic abscess Management of subphrenic abscess Complicaitons of subphrenic abscess 508 AUG-2001 22 Draw & Label : Peritoneal Spaces 508 APR-2004 JUL-2007 23 Classify Cysts 510 MAR-2003 24 Types of Mesenteric Cysts 510 APR-2004 25 Carcinoma Peritonei 511  26 Investigations in a case of Peritonitis  MAY-1999 27 Clinical Significance of Douglas Pouch  APR-2004 28 Transpyloric plane  FEB-2002  ABDOMINAL TUBERCULOSIS   29 Management of Caecal Tuberculosis  AUG-1998 30 Tuberculous lesions of intestines  SEP-1997 31 Tuberculous Peritonitis 518 AUG-2001 32 Treatment of Tuberculous Peritonitis  SEP-2000 33 Types of Tuberculous Peritonitis 518 JUL-2008 34 THE LIVER 525  35 Sites of Portosystemic anastamosis   36 Primary Biliary Cirrhosis   37 Draw & Label : Segments of Liver 526  38 Liver Biopsy 527  39 Your are seeing a surgeon doing a needle liver biopsy for a case of hepatomegaly in male of 65 years old who is jaundiced. 1 What precautions should have been taken before the procedure to prevent undue bleedingand risk of infection? 2 Which area ofthe abdomen is chosen for the needle biopsy and why? 3 What are the types of liver biopsy needles you know? 4 To enhance the chance of targeting the truly representative sample, what other investigation may be combined with this. 5 What is hepato renal syndrome?  MAR-2003 40 Amoebic Liver Abscess 528 AUG-2001 41 Comlications of Amoebic Liver Abscess ▪ Rupture into Lungs ▪ Rupture into peritoneum 529  42 Management of Liver Abscess 528 656 JUL-2007 43 Pyogenic Liver abscess 537  44 Malignancies of Liver 538 AUG-2002 45 Types of Hepatoma 539  46 Histological types of Liver Malignancy 540 MAR-2003 47 Portocaval Anastomosis 546 DEC-2004 48 Sites of Portosystemic anastomosis 546 MAR-2003 49 TIPSS 552  50 Budd Chiari Syndrome 557 NOV-2002 51 Discuss the causes of Splenic enlargement? Discuss the management of Portal Hypertension? Discuss the management of Splenic Injury?  JAN-1999 52 Hepatic Encephalopathy 558 DEC-2006 53 Portal Hypertension  MAY-2002 54 A 45 year old male is brought to the casuality with history of severe vomitting of blood of six hours duration. He is in shock with a blood pressure of 60 systolic. There is history of alcoholism. What are the possible conditions to be considered in the diagnosis? Discuss the pathology of any one condition? How will you investigate the patient? Detail the different types of treatment of the most common condition? How will you resuscitate the patient in the casuality?  DEC-2004 55 A 30 year old man is brought to the casuality with history of 7 bout of vomitting of blood. He has history of alcoholism. On Examination the patient is in shock. He has abdominal distension. Aspiration yields clear fluid. What are the possible conditions to be considered in the diagnosis? What is the emergency management of any one condition? How will you investigate the patient? Detail the different type of treatment for the most common condition?  SEP-2003 56 Draw & Label : Types of Portal Obstruction  JUN-2005  GALLBLADDER   57 Oral Cholecystogram (OCG) 6 tabs of iopanoic acid 562 MAY-1999 58 Parts of extra hepatic biliary duct 562 AUG-2002 59 Draw & Label : Duodenum with Pancreatic Biliary Ducts supraduodenal part retroduodenal part intraduodenal part 562 FEB-2002 60 Calot's Triangle 562  61 ERCP 563 APR-2004 JUL-2008 FEB-1998 62 PTC   63 T Tube 565 JUN-2005 64 Choledochal Cyst 567  65 Types of Biliary Atresia 569  66 Caroli's Disease 569  67 Gall Stone 571 AUG-2001 JUN-2006 AUG-2001 68 Types of Gall Stones 571 APR-2000 69 Types of Biliary Stones 571 MAR-2003 70 Cholesterol Stones 571  71 Pigment Stones 572  72 Moynihan's hump [see Bailey 1112] 572  73 Treatment of Gall Stones 571 APR-2000 74 Management of Calculous obstruction of common bile duct  FEB-2001 75 Seagull Sign 572  76 Saints triad Gallstones Diverticulosis of Colon Hiatus Hernia 572 726 820 MAY-2002 77 Limey Bile 573  78 Complications of Gall Stones 574 APR-2000 79 Mirizzis's Syndrome 575  80 Cholecystitis 576 APR-2004 81 Management of Acute Cholecystitis 577 MAY-1999 82 Mucocele of Gall Bladder 580 JAN-1999 83 Murphy's Sign 581  84 Charcot's Triad intermittent pain intermittent fever intermittent jaundice 583 FEB-2002 JUL-2008 85 Implications of Charcot's triad in Surgery 583 SEP-2003 86 Acalculous Cholecystitis 586 578  87 Courvoisier's Law "In a pt with jaundice if there is palpable GB, it is not due to stones" 586 632 AUG-2002 MAR-2003 88 A 60 year old male presents with progressive jaundice of 3 months duration. There was no fever or abdominal pain. He has severe itching all over the body and passes clay coloured stools. What is the most probable diagnosis? How will you investigate this patient? Name the surgical procedure for periampullary carcinoma? What are the palliative procedures in inoperable Ca head of Pancreas? What is the treatment for CSD stones?  JUL-2008 89 Obstructive Jaundice 587 SEP-2003 MAY-1999 90 Surgical causes of Obstructive Jaundice 587 FEB-2001 91 Klatskin's tumour 587 592  92 Investigations for Obstructive Jaundice 588 FEB-2001 MAY-1999 93 Investigation of Surgical Jaundice 588 JUL-2007 JUN-2006 94 Biliary Stricture 589 OCT-2002 MAY-2002 95 Management of CBD Stone 589 APR-2000 96 Pringle's Manoevre 590 APR-2004 97 Primary Sclerosing Cholangitis 590  98 Cholangiocarcinoma 592  99 Gallstone Illeus 593  100 White Bile 594 SEP-1997 101 Cholecystectomy 595 OCT-2002 102 Laparoscopic Cholecystectomy   103 THE SPLEEN   104 Splenenculi 600  105 Splenic Rupture 600 JUN-2005 JUN-2006 FEB-2001 106 Traumatic rupture of spleen 600 FEB-2002 MAR-2003 107 Splenosis 601  108 Kehr's Sign 601 FEB-2002 109 Ballance's Sign 601  110 Diagnostic Peritoneal Lavage (DPL) 602 124  111 Indications for Splenectomy 608  112 Complications of Splenectomy 608 603 126 OCT-2002 MAY-2002 113 OPSI 609  114 Hypersplenism 610 JUL-2008 DEC-2006 115 THE PANCREAS   116 Draw & Label : Anatomy of Pancreas 612  117 MRCP 613  118 PANCREATITIS Causes of Acute Pancreatitis Investigations in Acute Pancreatitis Management of Acute Pancreatitis  AUG-1998 119 Inflammation of Pancreas 613 SEP-2003 120 Clinical features of Acute Pancreatitis 614 DEC-2004 121 Cullen's Sign 615 JUN-2006 122 Grey turner's Sign 615  123 Treatment of a patient having positve Cullen's Sign 615 SEP-2003 124 Octreotide 618 641  125 Sentinel Loop   126 Complications of Acute Pancreatitis 618 JUL-2008 127 Pseudocyst of Pancreas 620 OCT-2002 MAY-2002 AUG-2001 128 Pathology of Pseudopancreatic Cyst 620 618 659 JUN-2005 129 Ranson's Criteria 620 APR-2004 JUN-2006 130 Juraz Operation 622 APR-2004 JUN-2006 JUN-2005 131 Puestow's Operation 627  132 PANCREATIC CARCINOMA   133 Investigation in a case of Pancreatic Malignancy 633 SEP-1997 134 Treatment of Ca Head of Pancreas 634 FEB-2008 JUN-2005 135 Treatment of carcinoma ampulla Vater. 635 FEB-2001 136 Whipples Operation 635 627 629 FEB-2002 137 Whipple's triad Hypoglycemia Blood Sugar <45 mg% Relieved by Glucese infusion 638 OCT-2002 138 Zollinger Ellison Syndrome 640  139 Annular Pancreas 641 MAR-2003 140 Pancreatis Divisum 642  141 RETROPERITONEAL SPACE   142 Seatbelt Syndrome (Bailey p. 1003) -  143 MASS ABDOMEN 653  144 DD of Epigastric mass 658 JUL-2007 FEB-2008 145 DD of Epigastric Lump 658 711 DEC-2004 146 Management of Intussusception 663 863 AUG-2001 147 A 53 yr old female attends the surgical OP with history of anorexia, nausea and vomiting. On examination there is a lump in the abdomen. What are the possible conditions to be considered in diagnosis? Discuss the pathology of any one condition? How will you investigate the patient? Detail the different types of treatment of the most common condition? What are the complications if the patient is untreated?   148 Discuss the clinical features, investigations and management of a patient with Carcinoma Caecum? 663 JAN-2002 149 DD of Lump in Right Illiac Fossa 663 JUN-2006 150 Appendicular mass  APR-2000 FEB-2001 FEB-1998 151 ABDOMINAL WALL AND UMBILICUS 666  152 Surgical Causes of Abdominal Distension  JUN-2005 153 Desmoid Tumour 672 71 FEB-2008 154 HERNIA 677  155 Classify Inguinoscrotal Swellings - SEP-2003 156 Anatomical types of Inguinal Hernia 679 JUL-2008 157 Surface marking of inguinal ligament 680 FEB-2002 158 Draw & Label : Complete Inguinal Hernia 683 MAR-2003 159 Internal Ring Occlusion Test 683 FEB-2002 160 Herniorhaphy 687 MAR-2003 161 Bassini's Hernia Repair 687  162 Conservative Treatment for Hernia 691  163 Taxis 691  164 Complications of Inguinal Hernia  FEB-2008 165 Laparoscopic Hernia Repair 694 FEB-2008 166 Incarcerated Hernia 697  167 Strangulated Hernia 697 JAN-1999 168 Management of Strangulated Inguinal Hernia 697 APR-2000 169 Maydle's Hernia 698 DEC-2004 170 Sliding Hernia 701 FEB-2002 MAR-2003 MAY-1999 171 Procedure for surgery of Pantaloon Hernia 702  SEP-2003 172 Femoral Hernia 702 APR-2000 AUG-1998 173 Incisional Hernia 706 AUG-2001 APR-2000 SEP-1997 174 Umbilical Hernia 709 JAN-1999 175 Paraumbilical Hernia 710 JAN-2002 176 Mayo's Operation 711 MAR-2003 177 Spigelian Hernia 712  178 OESOPHAGUS   179 Hamman's Sign   180 Bleeding Oesophagial varices  AUG-2001 181 Dysphagia Lusoria 720  182 Barium Swallow 721 383 MAY-1999 183 GORD 722  184 Belsey mark IV Procedure 724 004 APR-2004 185 Gastroplasty 724  186 Hiatus hernia 726 1079 OCT-2002 187 Rolling Hernia 726  188 Reflux Oesophagitis 727 OCT-2002 189 Barret's Oesophagus 728 JUL-2008 190 Heller's Operation 730 JUN-2005 191 Achalasia Cardia 730 JUL-2008 FEB-2001 AUG-1998 JAN-2002 192 Plummer Vinson Syndrome 731  193 Boerhave's Syndrome 733  194 Schatzkis Ring 733  195 Tracheo oesophageal fistula 734  196 Mallory Weis Syndrome 734  197 Zenker's Diverticulum 735  198 Management of Carcinoma Oesophagus   199 STOMACH   200 Function of Gastric Mucus …Gastric mucus is an important physiological barrier to protect the gastric mucosa from mechanical damage, and also the effects of acid and pepsin. Its considerable buffering capacity is enhanced by the presence of bicarbonate ions within the mucous. Many factors can lead to the break down of this gastric mucous barrier. These include… (Bailey) - MAR-2003 201 Phases of secretion of Gastric juice ... Classically, three phases of gastric secretion are described. The cephalic phase is mediated by vagal activity secondary to sensory arousal as first demonstrated by Pavlov. The gastric phase is a response to food within the stomach that is mediated principally, but not exclusively, by gastrin. In the intestinal phase, the presence of chyme in the duodenum and small bowel inhibits gastric emptying and, as mentioned above, the acidification of the duodenum leads to the production of secretin that also inhibits gastric acid secretion, along with numerous other peptides originating from the gut…. (Bailey p. 1047) - MAR-2003 202 Investigation of a patient with Bleeding Oesophageal Varices  SEP-2000 203 Stomach 745 JUL-2007 204 Draw & Label : Parts of Stomach 745 MAR-2003 205 Draw & Label : Blood Supply of Stomach 745 OCT-2002 AUG-2002 206 Draw & Label : Lymphatic drainage of Stomach 747  207 (a) Enumerate the causes of upper gastro-intestinal bleeding. (b) Discuss the management of oesophageal variceal bleeding. (c) Discuss the management of duodenal ulcer haemorrhage.  FEB-2001 208 H Pylori 751  209 Visible gastric peristalsis 752 AUG-2002 210 Types of Gastritis 753  211 Treatment of Chronic Duodenal Ulcer 759 JUL-2007 JUN-2006 212 Management of Duodenal Ulcer Perforation 762 MAY-1999 FEB-1998 213 Enteric Perforation Management of Enteric Perforation 762 JAN-1999 MAY-1999 FEB-2001 214 Surgical Procedure for Peptic Ulcer 762 AUG-2002 215 Common causes of Intestinal Perforation - SEP-2000 JAN-1999 216 Gastric Tetany 762  217 Paradoxic aciduria 762  218 Management of Bleeding Duodenal Ulcer 766 SEP-2000 JAN-1999 219 Pneumoperitoneum 766 FEB-2002 220 Causes of Haematemesis 769 JUN-2005 JUL-2007 SEP-2000 221 Stomal Ulcer ulcer in the anastomotic site of GJ/GD 772  222 Dumping Syndrome 772  223 Trichobezoars Trichobezoar (hair balls) are unusual and are virtually exclusively found in female psychiatric patients, often young. It is caused by the pathological ingestion of hair which remains undigested in the stomach. The hair ball can lead to ulceration and gastrointestinal bleeding, perforation or obstruction…. (Bailey) 773  224 Phytobezoars Phytobezoars are made of the vegetable matter and found principally in patients who have gastric stasis. (Bailey) 774  225 Wilkie's Syndrome Ileus - Mechanical, dynamic, or adynamic obstruction of the bowel; may be accompanied by severe colicky pain, abdominal distention, vomiting, absence of passage of stool, and often fever and dehydration. Origin [G. eileos, intestinal colic, from eilb, to roll up tight] (Stedman) 774 748  226 Volvulus of Stomach 775  227 Gastric Polyps 776  228 CARCINOMA STOMACH   229 Precursor lesions of Carcinoma Stomach 778  230 Types of Gastric Carcinoma 779  231 Krukenburg's tumour 782 235 JUL-2008 232 Sister Mary Joseph nodules 782  233 Linitis Plastica 783 AUG-2002 234 Marnagement of Carcinoma Stomach 787 JUL-2007 DEC-2004 235 Treatment of Carcinoma Stomach 787 JUN-2006 236 D2 dissection in Carcinoma Stomach 787 SEP-2003 237 MALTOMA 790  238 GIST 791 812  239 Pyloroplasty 792 APR-2004 240 Gastrostomy 793 83 DEC-2004 SEP-2003 241 Draw & Label : Billroth Anastomosis 794  242 Billroth II Gastrectomy 794 787  243 Gastrojujunostomy 794 APR-2004 244 Poly Gastrectomy 794 OCT-2002 245 Blind Loop Syndrome … It has been shown in dogs that, if a blind loop of the small intestine is made,defects of absorption will appear. If this occurs in the upper intestine the defect is chiefly of fat absorption; if in the lower intestine there is vitamin B12 deficiency. This has been found to occur in humans and is referred to as the blind loop syndrome. Essentially, the stasis produces an abnormal bacterial flora, which prevents proper breakdown of the food (especially fat) and mops up the vitamins that are present. Sometimes the only manifestation is anaemia, resulting from vitamin B12 deficiency, but if steatorrhoea appears, other serious malabsorption features follow. In general, high loops produce steatorrhoea, whereas low loops tend to produce anaemia. (Bailey) stagnation of intestinal contents with bacterial overgrowth producing substances that interfere with absorption of fat, vitamins, and other nutrients, usually occurs in a portion of small intestine that has been excluded from the flow of chyme. (Stedman)   246 Complications of Gastrectomy 794  247 Types of Vagotomy 795  248 Draw & Label : Highly Selective Vagotomy 795 746 AUG-2002 249 Complications of Vagotomy   250 IHPS Infantile hypertrophic pyloric stenosis (Bailey) ?  251 Debulking surgery Ulcer crater Augmented histamine test   252 THE SMALL INTESTINE   253 A 32yr old female was admitted with severe central abdominal pain, vomiting and constipation. There was nothing significant in the past history except the appendix operation when she was young. Abdomen was distended. Xray abdomen showed distension of the ileum with fluid levels. What is the most likely diagnosis? What is the immediate treatment? What is the procedure of choice? What are the complications following specific treatment? How will you prevenet the recurrence?  MAY-2002 254 Meckel's Diverticulum 799 AUG-2002 FEB-2001 MAY-1999 255 Meckel's Diverticulectomy 799 OCT-2002 MAY-2002 256 Crohn's Disease 800 JAN-1999 257 Typhoid perforation of ileum 803 AUG-2001 258 Treatment of Typhoid Ulcer Perforation 803 SEP-2000 259 Acute Mesenteric Ischaemia 806  260 Carcinoid Syndrome 813  261 LARGE INTESTINE   262 Draw & Label : Blood Supply of Colon and Rectum  SEP-2003 263 Hisrchsprung's Disease 818 JUL-2008 OCT-2002 MAY-2002 264 Diverticulosis 821  265 Ramsted's Operation 824  266 Complications of Ulcerative Colitis 828 MAY-2002 267 Ulcerative Colitis 827  268 Classification of Carcinomoa Colon   269 Predisposing factors of CA Colon 830 AUG-2002 270 Carcinoma left side of colon  AUG-1998 271 Polyps of Colon and Rectum 830 OCT-2002 272 Peutz Jeghers Syndrome 831  273 Types of Colostomy 843 APR-2004 AUG-2002 274 Complications of Colostomy   275 Duodenal Atresia 858  276 Hartmann's Procedure 858 868 897  277 Bishop Koop Procedure 862  278 Intussusception 863 663  279 Radiological Features of Volvulus of Sigmoid Colon 866 JUN-2005 280 Ogilvie's Syndrome 868 842  281 Management of Volvulus of Sigmoid Colon   AUG-1998 282 Volvulus  JUN-2006 AUG-1998 283 Left Hemicolectomy  MAY-2002 284 Rectal Polyp 830 AUG-2001 MAY-1999 285 Adenomatous Polyp 832 SEP-2000 286 Familial Polyposis 834 JUL-2008 287 INTESTINAL OBSTRUCTION   288 A 40 year old male with a/c Bowel Obstruction since 20 hrs. What is the purpose of passing Ryles Tube? Distance between incisor teeth and GO jn in an adult male? How do you find out radiographically the tip of Ryles tube? What is third space?  FEB-2002 289 A 70 year old man is brought to the casuality with h/o abdominal distension and constipation of 5 days duration. Hb – 6 GM -/dL Differential Diagnosis Investigations Pathology of your Diagnosis? Discuss the physiology of Abdominal Distension?  JUN-2005 290 Cardinal features of intestinal Obstruction 851 FEB-2002 291 Common causes of Acute Small Intestinal Obstruction 851 AUG-2001 AUG-1998 292 Causes of Intestinal Obstruction 851 DEC-2004 293 Different types of Intestinal Obstruction 851 SEP-2003 294 Management of Roundworm bolus obstruciton 852 AUG-2001 295 Closed loop Obstruction of large intestine 854 838 841 FEB-2002 296 Radiological findings in intestinal Obstruction 855 SEP-2003 297 Types of Jejunal Atresia 858  298 Meconium ileus 862  299 Diagnosis of Acute intussusception 863 663 DEC-2004 300 Signe de Dance 865 DEC-2004 301 Paralytic Illeus 868 DEC-2004 302 Paul Mikulikz Procedure 868  303 Intestinal Bands 869  304 Internal Herniations 872 JUL-2007 305 Draw & Label : Internal Herniations 872 JUN-2006 306 THE VERMIFORM APPENDIX   307 A 27yr old male colleg estudent attends the surgical casuality with history of acute abdominal pain radiating to the back. He has history of alcoholism. On examination he is in severe shock. What are the possible conditions to be considered in diagnosis? Discuss the pathology of any one condition? How will you investigate the patient? Deatil the different types of treatment of the most common condition? What are the complications if the patient is untreated?  JUL-2007 308 Management of Appendicular Perforation  SEP-2000 309 Appendicular abscess 875 883 FEB-2002 AUG-1998 JAN-1999 310 Clinical features of Acute Appendicitis 876 JUN-2006 311 DD of Acute Abdomen  877 DEC-2004 312 Interval Appendicectomy 882 AUG-2002 313 Paracentesis abdominis   314 Pseudomyxoma peritonei 884  315 THE RECTUM AND ANAL CANAL   316 Solitary Rectal Ulcer  SEP-2000 317 Lymphatic Drainage of Rectum and Anal Canal  SEP-2000 318 Anal Stenosis  MAY-1999 319 Proctoscopy 890 1125 APR-2004 320 Obstruction due to Rectosigmoid malignancy  AUG-2001 321 Draw & Label : Distribution of Colorectal cancer by site 891 JUL-2008 322 A 60 year old man with past history of rectal bleeding was admitted with abdominal pain, vomitting , and constipation. Is said he lost weight and anorexic. O/E his temperature was 99c, pulse 90/min. BP was 150/90. Abdomen was distended with no hepatosplenomegaly. PR was empty What is the most likely diagnosis? What are the investigations? What is the operation required for this patient? Mention the precancerous conditions of the colon and rectum?  OCT-2002 323 Duke's Staging 892 MAY-2002 324 Anterior Resection 896 JUL-2007 325 Pilonidal sinus 903 AUG-2002 AUG-1998 JAN-2002 SEP-1997 FEB-2008 326 Complications and management of Hemorrhoides 905 SEP-1997 327 Lord's Dilatation 909  328 Fissure in Ano 911 DEC-2004 MAY-1999 FEB-2001 SEP-1997 329 Acute Anal Fissure  FEB-2001 330 Sentinel Pile 913 FEB-2002 331 Prolapsed thrombosed Pile Mass  SEP-1997 332 Perianal Abscess Ischiorectal Abscess 914 AUG-2002 JAN-1999 MAY-1999 333 Management of Ischiorectal Abscess 914 APR-2000 334 Fistula in Ano 915 JUL-2008 SEP-2000 MAY-2002 FEB-1998 335 Management of Anal Canal Tumour 920 APR-2000 336 Laparaoscopic Surgery 1139 SEP-2003 337 A 45 year old male attends the casualty with complaints of bleeding pel' rectum. He is in a moribund state and is lying listless. (a) What are the possible causes of bleeding per rectum? (b) What is your diagnosis in this patient who is lying listless? Explain the pathology. (c) How will you investigate the patient to reach your diagnosis? (d) What is the emergency management? (e) Detail the different types of treatment for your diagnosis.  JUN-2006 338 You are witnessign a surgeon doing per rectal examination on a women who complains of mucous discharge per anum. What is the patients position during examination? What is Goodsaal's rule? What are the common positions of primary piles? Define Partial prolpse of rectum?  AUG-2002 339 Investigation of Bleeding per Rectum  JUL-2007 FEB-2008 JUN-2005 340 Causes of Bleeding PR  JUN-2006 341 Carcinoma Anal Canal  SEP-1997  ORTHOPEDICS   342 Finkelstein's Sign   343 Austin Moores Prosthesis   344 Draw & Label : Ossification centres at elbow with age of appearance in X Ray  JUL-2007 345 Bryant's triangle  JAN-2002 346 Butcher's thigh  JUL-2007 347 Satellar tap  JUL-2007 348 Swan neck deformity  OCT-2002 349 Garden's Classification  OCT-2002 350 Erb's Palsy  AUG-2002 351 Tuberculous Granuloma  AUG-2002 352 Draw & Label : Tuberculous Granuloma  FEB-2002 353 A 16yr old girl is admitted to the ward with severe pain above the knee of 3 month duration. O/E bony swelling all around lower end of femur. What are the possible conditions Name the muscles at the level Investigations Treatment of any one condition How will you ambulate the patient after amputation  JUN-2005 354 Classification of Fractures Traumatic and Pathological Displaced and Undisplaced Open and Closed Transverse, Oblique, Spiral, Comminuted and Segmental 1  355 Open fractures 1 JAN-2002 FEB-2008 356 A 35yr old man was brought to the orthopedic casuality with open fracture of the Rt Tibia following a road traffic accident. How are open fractures graded? What can be the associated injuries to the Right Leg? What are the steps in the management of open fractures? How th open fractures of tibia normally stabilised? Enumerate the immediate and late complications associated with open fractures?  OCT-2002 357 Pott's fracture of Ankle bimalleolar 2 JUN-2005 358 Draw & Label : Potts Fracture 3 degrees   359 Hangman's Fracture subluxation of c2 over c3 fracture through pedicle and lamina of c2 vertebra 3  360 Pathological Fracture. Surgical conditions producing pathological fractures of Bones. 3 JUN-2005 APR-2000 JUN-2006 OCT-2002 361 Sprain 4  362 ANATOMY OF BONE AND FRACTURE HEALING   363 Draw & Label : Blood Supply of a Long Bone 8  364 Stages of Fracture Healing 8  365 Callus formation 9 AUG-2002 366 Factors affecting fracture Healing 10  367 TREATMENT OF FRACTURES   368 Methods of Fracture Reduction closed reduction continuous traction open reduction 12  369 Indications for Open Reduction 12  370 Plaster of Paris 13 FEB-2002 371 Internal Fixation 15  372 External Fixator 16 JUN-2005 373 Classification of Open Fractures 17  374 SPLINTS AND TRACTIONS   375 Draw & Label : Thomas Splint 120 degrees 20 AUG-2002 376 Thomas Splint 20 OCT-2002 FEB-2002 377 Tractions in Orthopedics fixed and sliding traction skin & skeletal traction 21 JAN-1999 378 Skeletal Traction 21 JUL-2007 379 RECENT ADVANCES IN FRACTURE TREATMENT   380 Static Compression 23  381 Dynamic Coxmpression Plate (DCP) 23  382 LCDCP 25  383 Functional Bracing 25  384 Interlocking nail 25 JUL-2007 MAY-2002 385 Illizarows technique 26  386 APPROACH TO FRACTURE   387 Old Fracture   388 COMPLICATIONS OF FRACTURES   389 Late Complications of Fracture Mal Non Delayed Cross 34 MAR-2003 390 Crush Syndrome 35  391 Compartment Syndrome 37 JAN-2002 MAY-2002 392 Non Union Define Non Union process of fracture healing comes to a stand before completion Classify Non Union Atrophic & Hypertrophic Common causes of Non union Treatment of Non union Bone grafting Excision of Fragments No treatment Ilizarow's Technique 38 JAN-2002 JUL-2008 DEC-2004 MAY-1999 SEP-1997 APR-2004 393 Non Union of Tibia  FEB-2001 394 Delayed Union 38  395 MalUnion 39  396 Sudek's Osteodystrophy 41 JUN-2005 FEB-1998 397 Myositis Ossificans ossification of hematoma around a joint 42 AUG-1998 OCT-2002 FEB-2002 398 DISLOCATIONS AND SUBLUXATIONS   399 Define Dislocation all apposition between the articular surfaces are lost 43  400 Define Subluxation retain some contact between them 43  401 Traumatic Dislocation 43  402 Recurrent Dislocation 44  403 Fracture Dislocation   404 FRACTURES IN CHILDREN   405 Common fractures in children 46  406 Epiphyseal Injuries 46  407 Salter and Harris Classification 47  408 Green Stick Fracture 47 MAR-2003 MAY-2002 409 PERIPHERAL NERVE INJURIES   410 Draw & Label : Structure of a Nerve 49  411 Crutch Palsy 50  412 Seddons Classification Classify Nerve Injuriess (NAN) Neurapraxia – disruption of conduction Axonotmesis – axons are damaged Neurotmesis – nerve structure damaged, wallerian degeneration occurs. 50  413 Wrist Drop seen in radial nerve palsy 51 AUG-2002 414 Foot Drop common peroneal nerve palsy 51 JUL-2008 FEB-2001 APR-2004 AUG-2002 415 Ulnar Claw hand ulnar nerve palsy more marked in low ulnar nerve palsy Reson for clawing in ulnar claw hand deformity 51 JUL-2008 FEB-2008 JUN-2006 MAR-2003 416 Ulnar Paradox   417 Pointing Index 52  418 Froments Sign 56  419 Tinel's Sign 57 MAR-2003 420 Electromyography graphical recording of the electrical activity of a muscle 57 JUL-2007 421 Nerve Repair Nerve suture Nerve grafting 59  422 Nerve Suture Epineural suture Epi-Perineural suture Perineural suture Group Fascicular suture 59  423 Nerve Grafting when the gap is > 10cm   424 Neurolysis 60  425 TREATMENT OF ORTHOPEDIC DISORDERS   426 Drugs in Orthopedics 67  427 Osteotomy 67  428 Arthrodesis fusion of bones forming a joint Types – intra articular, extra articular, combined 68  429 Arthroplasty construction of a new movable joint Types – Excision, Hemiarthroplasty, Total replacement   430 Types of Bone Grafting Autograft Allograft – other human Xenograft – other species Artificial Bone 69 DEC-2004  431 Techniques of Bone Grafting Solid slab. Eg fibula Cancellous bone chips. Eg illiac crest 70 DEC-2004 432 Tendon Transfers 71  433 SHOULDER INJURIES   434 FRACTURE CLAVICLE   435 Discuss the clinical features of fracture of clavicle. How will you manage a fracture clavicle patient aged 25 years? Enumerate the complications? 73 AUG-2001 436 Fracture Clavicle 73 APR-2000 JUL-2008 437 SHOULDER DISLOCATION   438 Describe the clinical features of anterior dislocation of the shoulder? How will you manage a case of acute anterior dislocation of the shoulder? Enumerate three possible complications of dislocation of the shoulder?  FEB-2001 439 Anterior Dislocation of Shoulder 74 MAR-2003 440 Clinical features of anterior dislocation of shoulder 74  441 Luxatio erecta rare position head comes to lie in the sub-glenoid position 74  442 Hill Sach's Lesion 74  443 Kocher's Manoevre in Shoulder dislocation 75  444 Fracture shaft of Humerus 76  445 ELBOW INJURIES   446 Carrying angle male – 11 female – 14 79  447 Draw & Label : Epiphyseal centres around elbow 80  448 SUPRACONDYLAR FRACTURE   449 Discuss the clinical diagnosis, radiologicla features and management of supracondylar fracure of humerus in a six year old child. Enumerte four comlications of this condition 80 APR-2000 SEP-1997 450 A 7yr old child presents with supracondylar fracture of the right humerus with severe pain in the right forearm and absent radial pulse. What is your disgnosis? What are the signs of Volkmann's ischaemia? What is the treatment for Acute Compartment Syndrome? What is the late consequence of untreated compartment syndrome? What is Volkmann's sign? 80 MAR-2003 451 Describe the mechanism, clinical features and management of supracondylar fracture of Elbow. Enumerate the complications?  AUG-1998 452 Supracondylar Fracture 80 DEC-2004 453 Types of Supracondylar fracture of humerus in Children Extension type – 80% Flexion type – 20% 80 FEB-2008 454 Management of supracondylar fracture of humerus Closed reduction + percut K wire Open reduction + K wire Continuous traction 81 JUN-2005 455 Complications of Supracondylar fracture of the Humerus Injury to Brachial Artery Injury to Nerves Volkmanns ischaemia Malunion Myositis ossificans VIC 82 JUN-2006 456 Cubitus varus / Gun stock deformity 85 JAN-2002 FEB-2008 FEB-2002 457 Volkman's Ischaemic Contracture 85 JUN-2006 MAY-2002 458 Volkmann's Sign   459 Cubitus Valgus 86  460 Discuss the etiology, clinical features management of dislocation of elbow joint. Enumerate the complications?  JAN-1999 461 Pulled elbow when a child is lifted up by the wrist, the head of radius slips out. treated by – fully supinating the forearm and pressure over radial head. 88  462 Fracture head of radius 89  463 FOREARM AND WRIST INJURIES   464 Monteggia fracture Ulna fracture (upper third) + radial head dislocation hyperpronation injury Two types – flexion and extension 92  465 Galeazzi fracture Radius fracture (lower third) + dislocation of radio-ulnar joint 93 JAN-2002 466 COLLE'S FRACTURE   467 A 70yr old lady was brought to the Orthopedic casuality with history of fall on the outstretched left hand. The clinical and radiological examination revealed Colle's fracture on Lt side. Why Colle's fracture is common in elderly women? What are the other injuries she could have sustained due to this? How Colle's fracture differ from Smith's Fracture? What are the steps in reducing Colle's Fracture? What are the complications of Colle's Fracture?  MAY-2002 468 A 60yr old lady is brought to the casuality after a fall on outstretched hand. Clinical examination reveals Colle's fracture of Right Radius. What are the complications you expect in this patient? Name two late complications? What Is the deformity the patient presents with? What is the treatment for a closed undisplaced Colle's fracture? How will you immobilise the wrist?   FEB-2002 469 Enumerate the fractures following fall on an outstretched hand. Describe the fractures and management of Colle's fracture? 92 MAY-1999 470 Draw & Label : Displacement in Colle's Fracture 94 JUL-2008 471 Clinical features of Colles Fracture 94 FEB-2008 472 Dinner fork deformity 94  473 Management of Colle's fracture in a 60 yr old lady 95 JUN-2006 474 Complication of Colle's fracture 95 FEB-2008 JUN-2006 475 Displacements and Complications of Colle's Fracture 95 APR-2004 476 Smith's Fracture Reverse of Colles Fracture distal fracgment displaces ventrally and tilts ventrally 96 FEB-2002 477 Barton's Fracture 96  478 Two complications of Fracture Scaphoid 97 FEB-2002 479 HAND INJURIES   480 Bennett's Fracture extra-articular fracture at base of 1st metacarpal 99 MAY-2002 481 Rolando's Fracture intra-articular fracture at base of 1st metacarpal   482 Mallet finger mallet – a hammer distal inter-phalangeal joint sudden passive flexion avulsion of the tendinous attachment 100 JUL-2007 AUG-2002 483 PELVIC FRACTURES   484 Fracture of the Pelvis 104 APR-2004 JUN-2005 485 Types of Pelvic Fractures 105  486 Open Book Pelvic Fracture 106  487 Complications of Pelvic Fractures Rupture Urethra & Bladder Injury to Rectum, Vagina, major vessels, nerves Rupture of Diaphragm 108  488 INJURIES AROUND HIP   489 Draw & Label : Blood supply of proximal femoral neck and head in adult Retinacular vessels Foveal vessels Medullary vessels 110 MAR-2003 OCT-2002 490 Posterior dislocation of Hip 111  491 FRACTURE NECK OF FEMUR   492 Describe the etiology, clinical features and management of fracture neck of femur in an elderly female aged 65 years 112 FEB-1998 493 Impacted Fracture the patient arrives walking 114  494 Unsolved Fracture 115  495 Management of transcervical type of neck of femur fracture in a 60 yr old lady McMurray's Osteotomy Hemiarthroplasty Meyer's Procedure 115 FEB-2008 496 Mc Murrays Osteotomy 116 68  497 Complication of Fracture Neck of Femur Non-union Avascular Necrosis Osteoarthritis 117 JUN-2005 FEB-2001 MAR-2003 498 Mc Murray's Test - MAY-2002 499 Intertrochanteric Fracture 118  500 FRACTURE SHAFT OF FEMUR   501 Hip Spica 120  502 Interlocking Nailing 121  503 Kuntscher's Nail (K Nail) 121  504 Gallows Traction 122  505 INJURIES AROUND KNEE   506 Draw & Label : Extensor Lag 124  507 Fracture Patella 125 AUG-2002 508 Stellate Fracture comminuted fracture of the whole of patella 126  509 Tension band wiring 126  510 O'Donoghue triad Injury to : Anterior Cruciate ligament Medial Collateral Ligament Medial Meniscus 128  511 Drawer Test 128  512 Meniscal injuries Medial meniscal injury 129 JAN-2002 JUL-2007 513 Draw & Label : Types of Meniscal Injury Bucket Handle (commonest) Radial Anterior horn Posterior horn Complex 129  514 Arthroscopy 283 130 JUN-2005 515 Recurrrent dislocation patella 131 JAN-2002 516 INJURIES TO LEG, ANKLE AND FOOT   517 Phemister Grafting Phemister - Dallas B., American surgeon, 1882–1951 134  518 Fracture Calcaneum 140  519 Aviator's Fracture   520 March Fracture fatigue fracture of metatarsal bones heals spontaneously 142 003 MAY-2002 521 Jone's Fracture # at base of 5th metatarsal 142  522 SPINAL INJURIES   523 Classify Spinal injuries according to mechanism 144 JUN-2005 524 Chance Fracture due to the seat belt 146  525 Jefferson's Fracture 149  526 INFECTIONS OF BONES AND JOINTS   527 Draw & Label : Types of Metaphyses intra articular & extra articular 157  528 OSTEOMYELITIS   529 Causes of Acute Osteomyelitis Staphylococcus Streptococcus Pneumococcus 157 FEB-2002 530 Pathogenesis of Acute Osteomyelitis 157 FEB-2008 531 Clinical features of Acute Osteomyelitis 158 JUN-2006 532 Complications of Acute Osteomyelitis femur Septicemia & pyaemia Chronic Osteomyelitis Pathological Fracture Pyogenic Arthritis Growth plate disturbances  JUN-2006 533 A 17yr old boy is brought to the casuality with severe pain in the right thigh of 4 days duration. He is febrile and there is tenderness and thickening of the femur. Xray confirms the diagnosis. What Is the diagnosis? What are the differential diagnosis you suspect in this patient? Discuss the pathology of the condition? What are the xray changes that occur as the disease progresses? How will you treat the acute condition? How will you treat the possible comlications of the condition?  APR-2004 534 Discuss the etiology, pathology, clinical features and management of acute Haematogenous Osteomyelitis. Enumerate the complications?  JAN-1999 535 A 35 year old male with chronic osteomyelitis for femur with draining sinus. What are the causes of his draining sinus in the femur. Enumerate the investigations ? Which is the commonest organism which causes osteomyelitis ? What surgery you perform ? Enumerate the complications of this infection ?  JUL-2008 536 A 7 year old boy is brought to the orthopaedic casualty with severe pain in the left leg and high fever. (a) What is the differential diagnosis? (b) Discuss the pathology of bone inflammation? (c) What are the poss ible radiological features in this patient? (d) How will you manage the condition? (e) What are the complications of your diagnosis?  JUN-2006 537 Chronic Osteomyelitis 160 MAR-2003 538 Sequestra / Diaphyseal Sequestrum sequestrum, (pural is sequestra) A piece of necrotic tissue, usually bone, that has become separated from the surrounding healthy tissue. Origin [Mod. L. use of Mediev. L. sequestrum, something laid aside, fr. L. sequestro, to lay aside, separate] (Stedman) 160 AUG-1998 SEP-1997 MAR-2003 539 Radiological features of chronic Osteomyelitis 161 FEB-2008 540 Involucrum involucrum, pl. involucra 1. An enveloping membrane, e.g., a sheath or sac. 2. The sheath of new bone that forms around a sequestrum. Syn: involucre. [L. a wrapper, fr. in-volvo, to roll up] Origin [L. a wrapper, fr. in-volvo, to roll up] (Stedman) 161  541 Garre's Osteomyelitis 163  542 Brodie's Abscess Management of Brodie's Abscess 163 JAN-2002 JUN-2005 AUG-2002 543 Management of Acute Septic Arthritis 165 SEP-1997 544 Tom Smith's Arthritis septic arthritis of hip in infancy 165  545 TUBERCULOSIS OF BONES AND JOINTS   546 Types of Vertebral Tuberculosis 173  547 TB SPINE   548 Management of Tuberculosis of dorsolumbar spine 172 JUN-2005 549 Draw & Label : Trendelenburg Gait Trendelenburg Gait ? DEC-2004 MAY-1999 550 Pott's Spine 172 DEC-2004 551 Classification of Spine Fractures   552 Gibbus Extreme kyphosis, hump, or hunch; a deformity of spine in which there is a sharply angulated segment, the apex of the angle being posterior. Origin [L. a hump] (Stedman) 174  553 Kyphus 174  554 Pott's Paraplegia 178 JUL-2007 555 TB HIP   556 Draw & Label : Changes in Tuberculosis of Hip 181 JUN-2006 557 Wandering Acetabulum 181  558 Pathogenesis of Tuberculossi of Hip Joint 182 JUN-2006 559 TB KNEE   560 Describe the etiology, clinical features and management of Tuberculosis of knee joint? 185 AUG-1998 561 Name triple deformity in TB Knee  JUL-2008 562 Caries sicca 187 JUL-2007 563 Spina Ventousa 188  564 INFECTIONS OF THE HAND   565 Acute Paronychia 188  566 Apical Abscess 190  567 Felon 190  568 Middle Volar Space Infection 190  569 Management of Thenar Space Infection 191 SEP-2000 570 Acute Suppurative Tenosynovitis 192  571 Kanavel's Sign 192  572 CTEV   573 [L. talus, ankle, + pes, foot] [L. equinus, fr. equus, horse] [Varus . L. bent inward,]   574 CTEV   575 Club Foot Management of Club Foot 193 JUL-2008 FEB-2002 576 Congenital Club Foot  MAY-2002 577 A newborn baby is brought with inward deviation of both feet. What are the deformities in club foot What are the causes of club foot Name the spinal anomalies which are associated with club foot When will you start treatment What are the radiological features of clubfoot  JUL-2007 578 Discuss the aetiological factors in Congenital Club Foot? What are the clinical features of the same? How do you conservatively manage a newborn child with club foot? 193 AUG-2001 579 Describe the etiology, pathology, clinical features and management of congenital talipes equino varus  FEB-1998 580 Deformities of CTEV and the mention three types of treatment  APR-2004 581 CONGENITAL DISLOCATION OF HIP   582 Treatment of Congenital Dislocation of Hip 200 JUN-2005 583 Barlow's Test 201 AUG-2002 584 Ortolanis Test 201  585 Galeazzis sign 202  586 Psedarthosis 205  587 POLIOMYELITIS   588 Triple displacement of Knee 207 OCT-2002 589 Spina bifida 210  590 BONE TUMOURS   591 Classification of tumours of Bone 214 JUN-2005 592 Premalignant Bone Lesions   593 Serum Alkaline Phosphatase   594 Osteoma   595 Metastatic Bone Tumours   596 Osteoid Osteoma 214 FEB-1998 APR-2004 597 Adamantinoma 215  598 Osteoclastoma 216  599 Draw & Label : Radiological appearance in Giant Cell Tumour 216 FEB-2008 600 Soap Bubble Appearance 216 FEB-2002 601 Describe the etiology, pathology clinical features and management of osteogenic sarcoma of lower end of femur?  MAY-1999 602 Osteosarcoma 218  603 Radiological differences between Osteosarcoma and Osteoclastoma  JUN-2006 604 Draw & Label : Microscopic appearance of Osteosarcoma  MAY-2002 605 Draw & Label : Radiological features of Osteosarcoma  JUN-2005 APR-2004 606 A 14yr old male presents with pain and swelling over the lower end of right femur of 3 months duration. A clinical diagnosis of Osteosarcoma was made. What are the xray features of this condition? How will you confirm the diagnosis? What is the treatment of choice? What are the modalities of treatment other than surgery? What are the common sites of this tumour?  AUG-2002 607 Discuss the clinical and radiological features of Ewing's Sarcoma. How would you manage an eight year old child with ES of the tibia? 221 APR-2000 608 Ewing's Sarcoma 221 JAN-2002 JAN-1999 609 Bence Jone's Proteins 223 OCT-2002 610 Chondrosarcoma 224 JUN-2005 APR-2004 611 Osteochondroma Complications of Osteochondroma 225 FEB-2008 SEP-1997 612 Enchondromas 226  613 Solitary Bone Cyst 226 AUG-2002 614 Fibrous Dysplasia 227  615 PROLAPSED IV DISC   616 IV Disc Proplapse 228 OCT-2002 617 Pathology of Disc Prolapse 229  618 SCOLIOSIS   619 Cobb's Angle 234  620 Kyphosis 236 JAN-2002 621 Differentiate Gibbus and knuckle deformities  236  622 Seronegative Arthritis  MAY-2002 623 Scottish Dog Sign   624 Spondylolysis 237  625 Spondylolisthesis 237 204 35  626 BACKPAIN   627 Sciatica 243  628 ARTHRITIS   629 RHEUMATOID ARTHRITIS   630 What are the clinical features of Rheumatoid Arthritis? How will you manage conservatively a case of Rheumatoid arthritis? 244 FEB-2001 631 Diagnostic Criteria for RA 244  632 Deformities in Rheumatoid Arthritis 245  633 Ankylosing Spondylitis Ankylo - [G. ankylos, bent, crooked; ankylbsis, stiffening of the joints, fr. ankos, a bend, a hollow] Spondylo - [G. spondylos, vertebra] (Stedman) 248  634 DEGENERATIVE DISORDERS   635 OSTEOARTHRITIS   636 Describe clinical features and management of chronic Osteoarthritis of Knee Joint 252 SEP-1997 637 Clinical features of Osteoarthritis 252  638 AFFECTIONS OF SOFT TISSUES   639 Causes, pathogenesis and Treatment of Bunion A localized swelling at either the medial or dorsal aspect of the first metatarsophalangeal joint, caused by an inflammatory bursa; a medial bunion is usually associated with hallux valgus. Origin [O.F. buigne, bump on the head] (Stedman) 256 APR-2004 640 Tenosynovitis Acute Tenosynovitis 256 190 FEB-2001 APR-2000 641 Dupuytren's Contracture 256 MAR-2003 642 Tennis Elbow inflammation at origin of extensor tendons 257 AUG-2001 MAY-1999 MAR-2003 643 Golfer's Elbow inflammation at origin of flexor tendons 257 MAY-2002 644 Dequervain's Disease pain and swelling over radial styloid process Dequervain's Tenosynovitis 257 JAN-2002 JUL-2008 APR-2004 MAY-2002 645 Trigger finger 257 JUL-2007 FEB-2001 646 Ganglion mucoid degeneration of tendon sheath or joint capsule 258  647 Carpal Tunnel Syndrome 258 DEC-2004 OCT-2002 648 Phalen's Test maneuver in which the wrist is maintained in volar flexion; paresthesia occurring in the distribution of the median nerve within 60 sec may be indicative of carpal tunnel syndrome (Stedman)   649 Frozen Shoulder 258 JUL-2008 650 Painful arc Syndrome mid range of gleno humeral abduction 259  651 Meralgia Paresthetica 259  652 Causes of Heel Pain 259  653 METABOLIC BONE DISEASES   654 Osteoporosis 261  655 Osteomalacia 261 OCT-2002 656 Rickets Clinical features of Rickets 263 FEB-2008 JUN-2006 JAN-1999 657 Renal Rickets  MAY-2002 658 Radiological features of Rickets  APR-2004 659 MISCELLANEOUS AFFECTIONS OF BONE   660 Achondroplasia failure of normal ossificaiton of long bones 268  661 A 7 year old presented 10 orthopaedic outpatient with h/o limping and pain in the left Hip. (a) What is the differential diagposis ? (b) Discus the pathology of Perthe's disease. (c) What are the radiological features? (d) How will you treat the patient? (e) What are the complications? 269 FEB-2008 662 A 14yr old boy is brought to the orthopedic OP with a history of limping for three months. He has shortening of the right lower limb What are the possible causes How will you differentiate between the most common conditions How will you treat one of them What are the common dislocations in the body 269 DEC-2004 663 Multiple Exostosis 269 MAR-2003 664 Exostosis Two Types of Exostosis  APR-2004 665 Paget's Disease Osteochondritis Dessicans 269 JUN-2005 APR-2004 FEB-2002 666 Perthe's Disease osteochondritis of epiphysis of femoral head 269 DEC-2004 667 Perthe's Disease (Coxa Plana, Pseudocoxanglia)   668 Kienbocks Disease 269  669 Osgood Shlatters Disease Osteochondritis 269  670 Avascular necrosis of Hip 270  671 Sulcus Sign Ledge Sign   672 MISCELLANEOUS REGIONAL DISEASES   673 Congenital Torticollis 272 FEB-2008 674 Adolescent coxa vara 274 JUL-2007 675 Slipped Capital Femoral Epiphysis 274 OCT-2002 676 Baker's Cyst 276 OCT-2002 AUG-2002 677 Loose Bodies in Knee 276  678 Flat Foot 276 AUG-2001 679 AMPUTATIONS AND PROSTHETICS   680 Below Knee amputation Complications of Below Knee amputation 278 DEC-2004 JUL-2008 MAY-2002 681 Genu Varum  AUG-2001 APR-2000 682 Genu Valgum  AUG-2002 683 SPORTS MEDICINE   684 Arthroscopy 283 130 JUN-2005   Paper 2   685 Conn's Syndrome  MAY-2002 686 Classify Lymphoderma  FEB-2008 687 Thomos Test  FEB-1998 688 CDH  AUG-1998 689 Muscle Relaxants  AUG-1998 690 Tinnel Sign  JAN-1999 691 Fluids and Electrolytes  JUN-2005 692 Usual derangements of Water, Sodium and Postassium  JUN-2005 693 Classify swellings of neural origin  DEC-2004 694 Bone Scan  DEC-2004 6957 TNM Classification  DEC-2004 APR-2004 696 Ann Arbor Staging  APR-2004 697 Pinhole meatus  MAR-2003 698 Methods of spread of a malignant tumour  MAR-2003 699 3 Dimensional Excision  MAR-2003 700 Abdominal Angina  MAR-2003 701 BUJ Obstruction  NOV-2002 702 Local Gigantism  AUG-2002 703 Functions of Lymph Node  SEP-1997 704 PCKD  FEB-2002 705 Tuberculous Empyema  MAY-2002 706 Therapeutic Embolisation   707 Triage   708 Focussed Abdominal Sonogram for Trauma (FAST)   709 Missile Injury   710 Hidradenitis Suppurativa   711 Necrotising Fascitis   712 GENERAL SURGERY   713 Wound Healing 4 JUN-2005 714 Healing by Secondary Intention  MAR-2003 715 Factors influencing Wound Healing  FEB-2008 716 Wound Dehiscence  NOV-2002 717 Delayed primary closure of Wounds  AUG-2002 718 Keloid 8 AUG-2002 JAN-1999 MAY-2002 719 Hypertrophic Scars   720 Marjolin's Ulcer 11 MAY-2002 721 Types of Edges in an Ulcer 12 FEB-2002 722 Management of Ulcers 17 APR-2004 723 Trophic Ulcer 18 175 AUG-1998 724 INFECTIOUS DISEASES   725 Cold Abscess 37 391 393 APR-2004 FEB-1998 MAR-2003 726 Tuberculous Sinus  SEP-2000 727 Drainage of Abscess by Hiltons method 36  728 Hidradenitis Suppurativa ▪ blockage of apocrine glands ▪ commonly in axilla and groin ▪ seen in women 38  729 Diabetic Carbuncle 39 AUG-1998 730 Management of Carbuncle 39 FEB-2001 731 Tetany 42 JUL-2008 732 Post operative Tetany 42 AUG-2002 733 Management of severe form of Tetanus 43 APR-2000 MAY-2002 734 Treatment of Tetanus 44 AUG-2001 FEB-2001 735 Gas Gangrene Gangrene of Lower Limb 45 AUG-2002 AUG-2001 736 Treatment of Gas Gangrene 45 JUN-2005 FEB-2001 AUG-1998 737 DD for Gas Gangrene 45 JUN-2005 738 Actinomycosis 49 NOV-2002 JAN-2002 739 Madura Foot 50 AUG-2002 SEP-1997 MAY-2002 AUG-2002 740 SWELLINGS   741 Lipoma 61 AUG-2001 APR-2000 FEB-2001 742 Different types of Cystic Swelling 63 SEP-2003 743 Epidermal Cyst 66 SEP-2003 744 WEN 66 JUN-2005 745 Dermoid Cyst  AUG-1998 746 Sequestration Dermoid  FEB-2002 747 Sebaceous Cyst  MAY-1999 748 Glomus Tumour 70  749 Neuroma 75  750 MEN 77  751 ELECTROLYTE AND NUTRITION   752 Hypokalemia Post Operative Hypokalemia 82 NOV-2002 MAY-2002 753 Parentral Nutrition 88 APR-2004 NOV-2002 754 Complications of TPN 89  755 Gastrostomy feeding 88 793  756 SHOCK   757 SHOCK What is Shock? Describe the clinical features and management of a patient with hemorrhagic shock?  JAN-2002 758 Management of Septic Shock 91 93 MAY-1999 759 SIRS 92 97  760 MODS 92 42  761 Expand and Define : SIRS TPN MRSA ATLS SIRS – Sytemic inflammatory response syndrome TPN – Total Parentral Nutrition 97 88 JUL-2008 762 Central Venous Pressure 96 NOV-2002 763 HAEMORRHAGE AND BLOOD TRANSFUSION   764 Secondary Hemorrhage 100 AUG-2002 765 Blood Fractions 103  766 Blood Substitutes   767 Complications of Blood Transfusion 103 AUG-1998 768 Blood Component Therapy  JUL-2008 769 Autotransfusion 104 NOV-2002 770 BURNS   771 A 42 year old lady weighing 40 kg is brought to the casuality with history of attempted suicide by self immolation. How do you asses the severity of burns? What is the managemnet if 60% body surface is burnt? What investigations will you do in this case? What are the late complications? What are the medicolegal implications? How will you get a dying declaration?  SEP-2003 772 A 55 year old woman with 35% of the body surface burn of the chest and abdomen. How burns are classified? Under what circumstances should burns be stem grafted? What are the priorities in the initial treatment of a burns patient? How should the burns wound be treated?  NOV-2002 773 Discuss the clinical features and management of a patient with 50% butns?  JAN-2002 774 Types of Burns   775 Wallace's Rule of Nine   776 Pathology of Burns  APR-2004 777 Complications of Deep Burns 109 DEC-2004 778 Management of Burns  AUG-1998 779 Electric Burns   780 Le Forte Classification   781 TRAUMA   782 Blast Lung   783 Revised Trauma Score   784 Role of Crystalloids and Colloids in Surgery  APR-2004 785 HAND AND FOOT   786 Paronychia Causes and Treatment of Paronychia 132 APR-2004 JAN-2002 MAY-2002 787 Terminal Pulp Space Infection 133 SEP-2000 FEB-2001 788 Collar Stud Abscess 133 392 MAY-1999 JAN-2002 JUL-2008 789 Deep Palmar Space infection 134 SEP-1997 790 Compound Palmar Ganglion 135 MAY-1999 791 Management of Acute Tenosynovitis 135 AUG-2001 SEP-1997 792 Kenawel's Sign 135 NOV-2002 793 Ingrowing toe nail 142 APR-2000 794 ARTERIAL DISEASES   795 Scalene Triangle 144 NOV-2002 796 Thoracic Outlet syndrome 144  797 Intermittent Claudication 145  798 A 32 year old male patient attends the surgery OP with complaints of pain in the right calf on walking for two months. He had been a chronic smoker for ten years. On examination he has reduction in peripheral pulses in the affected lower limb. What is the differential diagnosis? What is Boyd's grading and the principle behind it? What investigations will you do in this case? What are the amputtions usually performed in the lower limb? What procedures can be done to improve lower limb circulation? Explain one operation? 145 APR-2004 799 A 60 yr old lady with myocardial infarction on the 7th day suddenly developed severe pain, pareaesthesia and pallor of the right lower limb. What is the cause? What is the treatment? What are the associated complications if the treatment is delayed? What is Forgarty's Catheter? Are lytic enzymes helpful? Regime of Anticoagulant therapy?  MAY-2002 800 Rest pain 146 MAR-2003 801 Critical Limb Ischaemia Pre-Gangrene 146 JUL-2008 802 Classification of Gangrene 147 JAN-1999 FEB-2008 803 Dry Gangrene 147 APR-2000 804 Line of Demarcation 147 FEB-2008 805 Harvey's Sign 148 MAR-2003 806 Lerich's Syndrome 148 164 MAR-2003 JUL-2008 807 DSA (Digital substration Angiography) 150  808 TAO Pathology of Thromboangitis obliterans 152 DEC-2004 SEP-2003 MAY-2002 809 Raynaud's Phenomenon 155 SEP-2003 AUG-2002 MAY-2002 810 Horner's Syndrome 160 325 395 1075 NOV-2002 811 Draw & Label : Lumbar Sympathectomy 160 DEC-2004 812 Fat Embolism 165 APR-2000 JUL-2008 813 Aneurysm 166 JUN-2005 814 Types of Aneurysm fusiform saccular dissecting 166 APR-2004 815 Aortic Aneurysm 168  816 Popliteal Aneurysm 170 NOV-2002 817 Dissecting Aneurysm 171  818 Diabetic Foot 174 FEB-2001 819 Wagner's Classification of Diabetic Foot -  820 Management of Diabetic Foot  MAY-1999 821 Diabetic Gangrene of Foot  FEB-2002 822 HAMARTOMA AND VASCULOAR LESIONS   823 Haemangioma Classify Haemangiomes 179 SEP-2003 AUG-1998 JAN-1999 FEB-2008 824 Cirsoid Aneurysm pulsating bag of worms 182  825 AV Fistula 183 NOV-2002 826 Branham's Sign 185  827 VENOUS DISEASES   828 Draw & Label : Venous drainage of lower limb 187  829 DEEP VEIN THROMBOSIS   830 Deep vein Thrombosis 187 MAR-2003 AUG-2002 JAN-1999 AUG-2001 FEB-2002 MAY-2002 831 Risk factors for Deep Vein Thrombosis   JUL-2008 832 Prophylaxis for Deep Vein Thrombosis  MAY-2002 833 Treatment of Deep Vein Thrombosis 188 JUN-2005 834 Virchows Triad 188  835 Causes of Acute Swollen Limb -  836 VARICOSE VEINS   837 Newer Modalities in the treatment of Varicose Veins ▪ Endovenous Laser Therapy ▪ Radiofrequency ablation   838 White Cell trapping Hypothesis 192  839 CEAP Classification 193  840 Saphena Varix 194 703 SEP-2003 841 Modified Perthe's Test 195 APR-2004 842 Plethysmography 197  843 Cokketa Dodd's Operation 201 NOV-2002 844 Hook Phlebotomy -  845 Brown's Vasomotor Index ? FEB-2008 846 Varicose Veins  MAY-1999 847 Complications of Varicose veins 204 APR-2000 848 Test for Varicose Veins  FEB-2008 849 Management of Varicose Veins  MAY-1999 850 Trendelenberg Operation   851 Venous Ulcer  AUG-1998 852 Management of Venous Ulcer 204 SEP-2003 853 Complications of Varicose Ulcer  FEB-2008 854 Bisgaard's Regimen 204 FEB-2002 855 Migrating Thrombophlebitis 206 OCT-2002 MAY-2002 856 LYMPHATICS   857 Lymphangitis  SEP-2000 858 Lymphoedema Aetiological Classification of Lymphoedema 209 SEP-2000 JUL-2008 859 Primary Lymphoedema 209 NOV-2002 860 Milroy's Disease 210  861 LYMPHOMAS   862 Treatment of Hodgkin's Lymphoma 219 DEC-2004 863 MOPP Regimes for Hodgkin's Disease  JUL-2008 864 Classification of clinical staging of the Hodgkin's Lymphoma  SEP-1997 FEB-2008 FEB-2002 865 Investigations of Lymphoma  SEP-1997 866 Management of stage III of Hodgkins Lymphoma  SEP-1997 867 PERIPHERAL NERVES   868 Tinel's Sign prognostic indicator of nerve regeneration 225 MAR-2003 869 Carpal Tunnel Syndrome compression of median nerve 227 APR-2004 870 NEOPLASM   871 Soft tissue sarcoma 232  872 Types of Biopsy 237  873 FNAC 240 478 DEC-2004 MAR-2003 874 SKIN TUMOURS   875 Draw & Label : Layers of Skin 243 FEB-2002 876 Inflammations of Skin 243 SEP-2003 877 Premalignant lesions of skin 248 FEB-2008 APR-2004 878 Squamous cell carcinoma 248  879 Precancerous lesion in SCC   880 Basal Cell Carcinoma 252 AUG-2002 881 Rodent Ulcer 252 MAY-1999 JAN-2002 882 MOHS 254  883 Naevus 255 DEC-2004 884 Junctional Naevi 255 NOV-2002 885 MALIGNANT MELANOMA   886 Malignant Melanoma Types of Malignant Melanoma 256 AUG-1998 FEB-2008 FEB-2002 887 Breslow's Staging 257  888 Clarks Grading 257  889 Management of Malignant Melanoma 260 APR-2004 890 SARCOMAS   891 Treatment of Fibrosarcoma 267 SEP-2003 892 AMPUTATIONS   893 Types of Amputation   894 Syme's Amputation   895 RECONSTRUCTION   896 Skin Grafting Types of Skin Grafts 282 AUG-1998 FEB-2002 897 Myocutaneous Flap 286 AUG-2001 898 TRANSPLANTATION   899 Graft rejection 293  900 Types of Allograft Rejection 293 JUL-2008 901 Cimino Fistula therapeutic fistula created for dialysis 295 185  902 FACIOMAXILLARY DISEASES   903 Cleft Lip   904 Cleft Palate Repair 304  905 Draw & Label : Types of Maxillary fractures 305 SEP-2003 906 Fracture of Mandible 311 FEB-2001 AUG-1998 907 Epulis 315 APR-2004 908 Odontomes 316  909 Adamantinoma 317 FEB-2001 910 Dentigerous Cyst 318 JAN-2002 911 Alveolar Abscess 319 JAN-1999 912 ORAL CAVITY   913 Rannula 321 SEP-2003 MAY-1999 914 Premalignant lesions of Oral Cavity   915 Leukoplakia   916 Erythroplakia 324 JUL-2008 917 Submucous fibrosis 324  918 Draw & Label : Lymphatic Drainage of Tongue 341 MAY-2002 919 Lymphatic Drainage of Tongue 341 SEP-1997 920 Carcinoma Tongue 342  921 Describe the aetiology, clinical features and treatment of a case of Ca tongue?  JAN-2002 922 A male aged 45 comes with a painless indurated ulcer on the lateral border of the tongue of 4 months duration. What is the investigation to be done to clinch the diagnosis? What histopathological type is most common, if it is a malignant condition? If the patient complains of pain in the left ear what is your inference? What are the etiological factors for a malignant ulcer of the tongue? What are the various modalities of treatment for the condition? What is the ideal treatment for a lesion which is less than 2cm in sixe without palpable nodes? If the lesion has extended to involve the neighbouring mandible, what clinical and radiological features wound be appreciable? What terminal events may bring death from an uncontrolled primary tumour? 342 MAR-2003 923 Hypoglossal Nerve Palsy  FEB-2002 924 DD of Ulcers in Cheek  DEC-2004 925 SALIVARY GLANDS   926 Surface anatomy of Parotid Duct 356 MAR-2003 927 Draw & Label : Surgical Anatomy of Parotid gland  NOV-2002 928 Xerostomia 358  929 Sialography 359 FEB-2001 930 Parotid Abscess 362 FEB-2001 JAN-1999 931 Management of Parotid Abscess  SEP-2000 932 Sialectasis 362 SEP-2003 933 Sailolithiasis   934 Sailosis   935 Salivary Calculi  FEB-2001 MAY-1999 FEB-2002 936 Salivary fistula 363 APR-2000 937 Sjogrens Syndrome 364  938 Mikulikz Syndrome 365  939 Classification of Salivary Gland Tumours    940 Pleomorphic Adenoma   941 Mixed Parotid tumour  MAY-1999 MAY-2002 942 Malignant Parotid tumours Classify Parotid Gland Neoplasms  SEP-1997 FEB-2008 943 Warthins Tumour 368 AUG-2002 APR-2004 944 Adenoid Cystic Carcinoma 369  945 Freys Syndrome 373 FEB-2008 946 NECK   947 Ludwig's Angina ?  948 Bezold's Abscess   949 You are witnessing a surgeon doing an excision biopsy of a nodular mass n the posterior triangle of neck of male aged 20yrs under local anaesthesia. What are the boundaries of posterior trinagle? What drug is used for local anaesthesia? What are the types of Biopsies? What are the advantages of adding adrenaline with local anaesthetic agent? Where is Adrenaline + LA contraindicated? What are the histological types of Hodgkins Disesae? What are the chemotherapeutic agents used in Hodgkins Disease? What is staging Laparotomy?  FEB-2002 950 Lymphatic Drainage of Neck  JAN-1999 951 Levels of Lymph Nodes in Neck 394  952 Cervical Ribs 379 AUG-2001 NOV-2002 SEP-2000 JAN-2002 JAN-1999 953 Vascular complications of Cervical Rib  AUG-2002 954 Adsons Test 380 148 FEB-2008 955 Branchial Cyst 381 APR-2000 AUG-2001 FEB-2002 956 Branchial Fistula  SEP-2000 JAN-1999 MAY-2002 957 Pharyngeal Pouch   958 Laryngocele   959 Cystic Hygroma 384 AUG-2001 APR-2000 JUN-2005 DEC-2004 960 Carotid Body Tumour Chemodectoma 388 AUG-2001` 961 Waldeyer's Ring 377 MAR-2003 962 DD of a swelling in the middle of the neck 377 DEC-2004 963 Tuberculous Lymphadenitis 391  964 Cold Abscess 393 AUG-1998 965 Treatment of TB Cold Abscess of Neck 393 AUG-2001 APR-2000 966 Types of Neck Dissection 398  967 Management of Tuberculous Cervical Lymphadenitis   JAN-1999 968 THYROID   969 Adenoma Thyroid  AUG-1998 970 A patient underwent sub total thyroidectomy for Grave's Disease and is in the post operative ward and six hours after surgery develops acute respiratory distress with swelling of operated site. What is the cause of this respiratory distress? What should be done immediately to relieve the respiratory distress? What is thyroid storm? How do you manage a case of thyrotoxic crisis? What part of thyroid is left behind in subtotal thyroidectomy and why?  AUG-2002 971 Development of Thyroid   972 Draw & Label : Blood Supply of Thyroid 404 JUN-2005 FEB-2002 973 Thyroglossal Cyst 405 JAN-1999 FEB-2008 MAY-2002 974 Thyroglossal Fistula  JUL-2008 975 Lingual Thyroid 405 SEP-2000 JUL-2008 976 Lateral Aberrant Thyroid Misnomer; cervical lymphadenopathy due to papillary carcinoma of thyroid. 407 MAR-2003 977 Investigations of Thyroid Swelling 407 DEC-2004 978 Thyroid Function Tests 407 NOV-2002 979 Natural history of Goitre   980 Colloid Goitre 410 MAR-2003 981 FNAC in thyroid Malignancies  MAR-2003 982 Causes of clinically solitary nodule  JUL-2008 983 Retrosternal Goitre 415 AUG-2002 984 Grave's Disease 417 APR-2000 AUG-1998 985 A 30yr old female patient with history of thyroid swelling of six months duration. She had symptoms and signs of thyrotoxicosis. Examination of neck revealed uniform enlargemnet of thyroid gland. What is the likely diagnosis? How should the patient be investigated? How would you treat this patient?  FEB-2008 986 Treatment of Thyrotoxicosis 417 DEC-2004 987 Preop preparation of a toxic thyroid   988 Clinical features of thyrotoxicosis 417 JUN-2005 989 Signs and symptoms of Hyperthyroidism 418 SEP-2003 990 Eye Signs in Thyrotoxicosis 418  991 Malignant Exophthalmos 419  992 Thyroid Acropachy 421  993 Carcinoma of Thyroid  FEB-2001 994 Rule of 12 (Bailey p. 779)   995 Classify malignancy of Thyroid 425 DEC-2004 996 Pathological types of Carcinoma Thyroid 425 SEP-2003 997 Papillary Carcinoma Thyroid   998 Microcarcinoma Thyroid ▪ tiny foci of papillary carcinoma ▪ no clinical symtoms/signs ▪ foci less than1 cm (Bailey p. 794)   999 Hurthle Cell Carcinoma ▪ a variant of follicular ca thyroid ▪ poor prognosis ▪ syn: Askanazy Cells (Bailey p. 794)   1000 Medullary Carcinoma Thyroid  FEB-2002 1001 Treatment of Carcinoma Thyroid 430 JUN-2005 1002 Hashimoto's Thyroiditis 434 FEB-2008 FEB-2002 1003 De-Quervain's Thyroiditis 434  1004 Complications of Thyroidectomy 438 1134  1005 Thyroid Crisis 439 1134  1006 Signs and symptoms of Hypothyroidism 440 APR-2004 1007 Myxoedema   1008 Recurrent Laryngeal Nerve Paralysis 441 AUG-2002 1009 PARATHYROID AND ADRENALS   1010 Development of Parathyroids  NOV-2002 1011 Parathyroid Adenoma  MAY-2002 1012 Acute Parotitis  AUG-2002 1013 Secondary Hyperparathyroidism  APR-2004 1014 Types of Hyperparatyroidism and their differentiation  JUL-2008 1015 Hyperadrenalism  SEP-2003 1016 Clinical features of Addisons Disease  MAR-2003 1017 Von Hippel Lindau Disease 451  1018 BREAST   1019 Draw & Label : Cross sectional Anatomy of Breast  JUL-2008 1020 Draw & Label : Lymphatic Drainage of Breast 455 JUN-2005 SEP-2003 1021 Lymphatic Drainage of Breast 455 SEP-2000 1022 Mammography 455 MAR-2003 1023 Mondor's Disease ▪ cord like feel beneath skin 455  1024 ANDI 456 JUN-2005 AUG-2002 JUL-2008 1025 Fibroadenoma 456 APR-2000 MAY-1999 FEB-2002 1026 Giant Fibroadenoma   1027 Fibroadenosis 458 AUG-2001 SEP-1997 1028 Hard fibroadenoma 458 JUN-2005 1029 Breast Mouse another name for fibroadenoma called so bcoz fibroadenoma is not fixed to the breast tissue and is mobile.[Refer Clnical DAS]  MAR-2003 1030 Phylloides Tumour Cystosarcoma Phyllodes 459 AUG-2002 FEB-2008 1031 Galactocele 460 JAN-1999 1032 Breast Abscess 461 APR-2000 FEB-2001 SEP-1997 1033 Management of Breast Abscess 462 SEP-2000 1034 Antibioma ▪ occurs when breast abscess is treated only with antibiotics and not by drainage ▪ sterile pus surrounded by thick fibrous tissue cover 463 1991 1035 Duct ectasia 464  1036 Tietze's Disease ▪ costochondritis of second costal cartilage ▪ mimics mastalgia 465  1037 Duct Papilloma of Breast 466 1985 1038 Gynaecomastia 466  1039 Carcinoma Male Breast 466  1040 Pathological Types of Carcinoma Breast 469 APR-2004 1041 Pagets Disease of Nipple 470 1987 1989 1042 Paget's Disease of Breast 470 MAY-1999 1043 Cancer en cuirasse 474  1044 BSE 476  1045 Manchester Staging for Carcinoma Breast 476 1994 1990 1046 TNM Classification for Carcinoma of Breast 476 1986 1993 1047 Sentinel Node Biopsy (SLNB) 479 APR-2004 1048 Triple Assesment 480  1049 Treatment of Carcinoma Breast 480 SEP-2003 1050 Surgical procedures for early carcinoma of female breast  1992 1051 QUART   1052 Types of Mastectomy 484  1053 Complications of Mastectomy   1054 Advanced carcinoma Breast  1990 1055 TRAM 495  1056 Retracted Nipple 497  1057 Classification of discharge from nipple 497 JUN-2005 1058 BBD Classification ?  1059 Investigations in a case of abnormal nipple discharge  1986 1060 UROLOGY   1061 KIDNEY   1062 Boari's Operation ?  1063 KUB X Ray 930 AUG-1998 1064 IVC   1065 Intravenous Pyelogram 932 JAN-1999 1066 Reflux Nephropathy 932 982  1067 MCU 932  1068 Swan Ganz Catheter a balloon-tipped flexible catheter commonly used in the treatment of critically ill patients; introduced via a major peripheral vein, usually jugular or subclavian, and floated under pressure waveform guidance, with or without fluoroscopy, sequentially through the right atrium, right ventricle, and pulmonary artery, ultimately to wedge, when the balloon is inflated, in a small arterial branch where the tip measures pressure-transmitted retrograde from the left side of the heart, which is assumed to represent left ventricular end-diastolic pressure; side holes allow measurement of central venous pressure; with the balloon deflated, catheter measures pulmonary artery systolic, diastolic, and mean pressures; also allows infusion via catheter; some catheters are fitted with pacing electrodes. Syn: pulmonary artery catheter. (Stedman)  NOV-2002 1069 Cabot's Nephrostomy 938 962  1070 Percutaneous Nephrostomy 938  1071 Causes of Hematuria 939 FEB-2008 1072 Benzidine Test a test for blood; the suspected fluid is treated with glacial acetic acid and ether, and the latter is then decanted and treated with hydrogen peroxide and a solution of benzidine in acetic acid; the presence of blood is indicated by a bluish color turning to purple. Syn: Adler test. (Stedman)   1073 Horseshoe Kidney 940 FEB-2008 1074 Crossed Dystopia …Unilateral fusion (syn. crossed dystopia) is rare but the urogram appearance is striking. Both kidneys are in one loin and are usually fused. The ureter of the lower kidney crosses the midline to enter the bladder on the contralateral side. Both renal pelves can lie one above each other medial to the renal parenchyma (unilateral long kidney) or the pelvis of the crossed kidney faces laterally [unilateral S-shaped kidney… (Bailey)   1075 Polycystic Kideney Disease autosomal dominant 941  1076 Postcaval Ureter/Retrocaval Ureter The right ureter passes behind the inferior vena cava instead of lying to the right of it. If this causes obstructive symptoms, the ureter can be divided and rejoined in front of the cava using a long oblique anastomosis without tension. Unusually, the retrocaval portion of the ureter is fibrotic and must be excised (Bailey) 943  1077 Ureterocoel 943  1078 Classification of Renal Injury 944  1079 Draw & Label : Types of Renal Trauma 945 FEB-2008 1080 Renal Tuberculosis 946  1081 Draw & Label : Types of Renal Tuberculosis 946 APR-2004 1082 Describe the clinical features and management of Hydronephrosis? 948 FEB-1998 1083 Hydronephrosis 948  1084 Causes of Hydronephrosis 948 DEC-2004 1085 Draw & Label : Intrarenal Pelvis 951 MAR-2003 1086 Renal Carbuncle renal parenchymal necrosis by Staph aureus 954  1087 Sources of Perinephric Abscess 954  1088 Periurethral Abscess Periurethral abscesses can be either penile, bulbar or chronic. A penile periurethral abscess usually arises as an acute gonococcal infection of one of the glands of Littré. The tender induration felt on the underside of the penis points and discharges externally, often leaving a fistula. Treatment. An anterior urethrotomy will encourage the abscess to burst into the urethra. When the abscess lies behind a stricture, it should be opened externally. A bulbar periurethral abscess is a spreading cellulitis due to infection with streptococci and anaerobic organisms. It may or may not be associated with a urethral stricture, and extravasation of urine is not unusual. Clinical features. There is perineal pain with pyrexia, rigors and a rapid pulse rate. Tenderness and swelling rapidly spread from the perineum to the penis and the anterior abdominal wall. Treatment. Appropriate antibiotics are essential. Collections of pus should be drained and the urethra should be defuntioned by inserting a suprapubic urinary catheter. A chronic periurethral abscess sometimes results from a long-standing urethral stricture. The multiple loculi of pus should be drained and the stricture treated appropriately. Urethral fistula may occur either spontaneously or as a result of incision of the abscess. (Bailey) -  1089 Ureteric Stones Renal Stones Types of urinary stones 956 JUN-2005 APR-2000 AUG-1998 1090 Obstructive Nephropathy …More than 70 per cent of the kidney function must be lost before renal failure becomes evident: there is a large functional reserve. It follows that renal damage must be extensive before changes occur in blood constituents whose level is controlled by renal excretion. Such damage is of three main types: reduction of renal plasma flow, destruction of glomeruli or impairment of tubular function. In severe hypertension or renal artery stenosis, the plasma flow is impaired. In glomerulonephritis or acute cortical necrosis, there is a loss of glomeruli, while in pyelonephritis tubular function is most severely affected. In obstructive nephropathy, back-pressure on the renal parenchyma causes all three types of damage…. (Bailey)   1091 ESWL 957  1092 Wilm's Tumour 962  1093 Treatment of stag horn calculus Nephropyelolithotomy PCNL is becoming popular now 963 JUN-2005 1094 Renal Carcinoma 964 MAY-2002 1095 Grawitz Tumour 964  1096 Discuss the clinical fatures and management of Hypernephroma 964 MAY-1999 1097 Canon ball Secondaries 965  1098 Stauffer's Syndrome 966  1099 URINARY BLADDER   1100 Vesical Calculi 970 MAY-1999 1101 Ectopia Vesicae 970  1102 Hunner's Ulcer 974  1103 Thimble Bladder a contracted bladder, unable to relax and distend 975  1104 Endemic Hematuria 975  1105 Discuss the clinical features and management of Bladder Tumours 976 AUG-1998 1106 Painless Hematuria …Painless haematuria is by far the most common symptom and should be regarded as indicative of a bladder carcinoma until proven otherwise… (Bailey)   1107 Rupture Bladder 979  1108 Bladder Diverticulae 982  1109 Urinary Fistula   1110 Urethral Syndrome   1111 Urinary Diversion 983  1112 PSA ?  1113 PROSTRATE   1114 Draw & Label : Anatomy of Prostrate  MAY-2002 1115 Draw & Label : Various zones in the prostrate gland (Mc Neal)  AUG-2002 1116 Discuss the clinical features and management of BPH  APR-2000 1117 BPH  FEB-1998 FEB-2002 MAY-2002 1118 Prostratism sans prostrate - MAR-2003 1119 Prostatism  AUG-2002 1120 Discuss Carcinoma Prostrate in the following headings : Clinical features Investigations of the diseae Treatment of the disease  SEP-1997 AUG-2001 1121 Retropubic Prostatectomy 989 NOV-2002 1122 TURP 989 AUG-2002 1123 Carcinoma Prostrate ? SEP-1997 1124 Investigations of Obstructive Uropathy 990 JUN-2005 1125 Ureteric Colic This is an acute pain felt in the loin and radiating to the ipsilateral iliac fossa and genitalia. The patient often rolls around in agony as waves of excruciating sharp pain are imposed upon a continuing background of discomfort. Contrast this with the patient suffering from penitoneal pain who lies still to avoid exacerbating the pain by movement. Ureteric colic is caused by the passage of a foreign body, usually a stone. The site of the pain can be a guide to the progress of the stone: the more the pain radiates into the groin, the more distal the stone. Local tenderness is much less than would be expected from the severity of the pain. (Bailey)   1126 Secondary Urinary Bladder Stone  JUL-2008 1127 A 40 year old man had a fall from a building site. He has not passed urine for 12 hours. Catheterisation produced severe bleeding. What are the possible causes of retention of urine in this patient? What is the emergency treatment? What all investigations will you do for this patient? How will you manage the condition and its complications?   1128 A 65yr old male attends the surgery casuality with c/o inability to pass urine 2 days. O/E Bladder distended upto umbilicus. Causes of retensionof urine in this patient? Investigations ? Emergency management given in the casuality? Complications possible if treatment not instituted in this patient? Operations to cure the original cause for the complaint? 990 JUN-2005 1129 URETHRA   1130 Draw & Label : Rupture of male membranous urethra 995 DEC-2004 1131 Clinical features of rupture of Urethra 996 JUN-2005 1132 Rupture of Bulbar Urethra 996  1133 Management of Rupture Urethra 996 SEP-2003 1134 Stricture Urtethra Management of Stricture Urtethra 997 SEP-2003 JAN-1999 FEB-2001 MAY-2002 1135 Treatment of Stricture Urethra 997 JUN-2005 1136 Hypospadiasis 999 AUG-2002 JUL-2008 1137 Epispadiasis 999  1138 Posterior Urethral Valve 1000 982  1139 Extravasation of Urine 1001 SEP-1997 1140 Urine Extravasation Supr v/s deep 1001  1141 Reiter's Syndrome 1001  1142 Retension of Urine Management of Retension 1002 APR-2004 JAN-1999 1143 PENIS   1144 Paraphimosis 1004 JUL-2008 1145 Management of Phimosis 1004 JAN-1999 1146 Circumcision 1006 1131  1147 Balanoposthitis 1007  1148 Priapism 1007  1149 Peyronie's Disease 1007  1150 Chordee 1007 997  1151 Draw & Label : Lymphatic drainage of Penis  JUL-2008 1152 Premalignant conditions of Carcinoma Penis  JUL-2008 FEB-2002 1153 Carcinoma Penis Treatment of Carcinoma Penis 1011 DEC-2004 APR-2004 APR-2000 SEP-1997 1154 SCROTUM   1155 Layers of Scrotum 1015 FEB-2002 1156 Classify Scrotal Swelling - DEC-2004 1157 Fournier's Gangrene 1015  1158 Draw & Label : Types of Hydrocele 1016 FEB-2008 APR-2004 1159 Hydrocele 1016 DEC-2004 1160 Clinical features of Secondary Hydrocele 1018 FEB-2002 1161 Filarial Hydrocele Ram's Horn Penis 1018  1162 Chylocele 1018  1163 DD of a Scrotal Swelling 1019  1164 Jabouley's Operation 1020  1165 Lord's Plication 1020  1166 Spermatocele 1022  1167 Epididymal cyst Management of Epididymal cyst 1022 APR-2004 NOV-2002 APR-2000 JAN-1999 1168 Varicocele 1023 FEB-1998 SEP-1997 FEB-2008 FEB-2002 1169 TESTIS   1170 Complications of undescended testes 1028  1171 Orchiopexy ▪ Surgical treatment of an undescended testicle by freeing it and implanting it into the scrotum. ▪ Syn: cryptorchidopexy, orchidorraphy, orchiorrhaphy. 1029  1172 Indications for Orchidectomy ▪ torsion of testes ▪ undescended testes even after 8yr ▪ Prostrate Carcinoma   1173 Ectopic Testes 1029 NOV-2002 1174 Retractile Testes 1030 MAR-2003 1175 Testes Torsion 1030 MAR-2003 1176 Classify Testicular Tumours 1031 APR-2004 1177 Discuss the clinical features and management of seminoma testis?  FEB-2001 1178 Seminoma 1032 AUG-2002 1179 A 38yr old man presented with a painless swelling in his right testes. Ultrasound scan of the right testes showed ill-defined hypo echoic mass in the upper pole. Left testes is normal. What is the diagnosis? How is the condition classified? Name the tumour markers related to this condition? Which of the histological types is the most sensitive? What is the long term prognosis?  JUL-2008 1180 Teratoma Testes 1032  1181 Tuberculous Epididymoorchitis 1035  1182 Different types of Urinary Diversion 845 SEP-2003 1183 Ileal Urinary Diversion 845  1184 Lateral Sphicterotomy  MAR-2003 1185 NEUROSURGERY   1186 Lucid Interval  FEB-2008 SEP-2003 MAR-2003 1187 Coupe injury   1188 Counter Coupe injury   1189 Cerebral Concussion 1038 DEC-2004 1190 Subdural Hemorrhage  AUG-2002 1191 Extradural Hematoma   1192 Anterior cranial fossa fracture   1193 Glasgow's Coma Scale 1039 MAY-2002 1194 Treatment of Subdural Hemorrhage 1043 APR-2004 1195 Chronic Subdural Abscess 1047 APR-2000 1196 THORAX   1197 Treatment of Blunt Trauma to Chest 1060 DEC-2004 1198 Classify Chest injuries 1060 DEC-2004 1199 Stove in Chest   1200 Flail Chest 1063 NOV-2002 1201` Pneumothorax 1064 MAR-2003 FEB-2002 MAY-2002 1202 Tension Pneumothorax 1064  1203 Empyema Necessitans 1066 1067  1204 Intercostal Tube Drainage 1069 SEP-2003 1205 Diagnosis of Pulmonary Embolus 1070 NOV-2002 1206 Pulmonary Embolism 1070  1207 Pancoast tumour 1074  1208 Pericardial Tamponade 1077 AUG-2002 1209 Sites of herniation in diaphragm 1077  1210 Immunosuppresive therapy 1096 NOV-2002 1211 Whiplash injury  AUG-2002 1212 ANAESTHESIA   1213 Regional Anaesthesia 1103 SEP-2003 1214 Local Anaesthesia 1104 MAY-1999 1215 Bier's Block 1104  1216 Epidural Anaesthesia  FEB-1998 MAY-2002 1217 Spinal Anaesthesia  JAN-1999 FEB-2001 FEB-2008 1218 Difference between Spinal and Epidural Anaesthesia  JUL-2008 1219 ADJUVANT THERAPY   1220    1221 ADVANCED IMAGING METHODS   1222 Ultrasound Scan 1107 DEC-2004 1223 Endoluminal Ultrasound   1224 Disphragmatic Hernia 1077 JUL-2007 1225 CT Scan 1109 JUN-2005 1226 Tubes used in the Gastrointestinal Tract 1124 SEP-2003 1227 Diathermy 1129 DEC-2004 1228 Types of Diathermy 1129  1229 Short wave Diathermy  MAY-2002 1230 Vasectomy 1131 JAN-1999 1231 Hypoparathyroidism 113444  1232 Hypocalcaemia 1134 MAR-2003 1233 MRI  JUN-2005 APR-2004 AUG-1998 1234 Contraindications of MRI   1235 USS  JUN-2005 1236 Day surgery unit 1146  1237 OPERATIVE SURGERY   1238 Ideal Theatre   1239 Principle of Autoclave 1114 FEB-2002 1240 Sterilisation of Instruments 1114 JUN-2005 SEP-2003 1241 Suture materials used in Surgery 1127 SEP-2003 1242 Why braided and multifilament sutures are less ideal than monofilament sutures?  FEB-2002 1243 Post Operative Drainages  SEP-2003 1244 Tracheostomy 1135 JAN-2002 1245 Cryosurgery 1136   Practicals INSTRUMENTS TO CARRY 1. Tape 2. Torch 3. Seven Torniquet 4. Illuminoscope 5. Thread – to measure depth of ulcer 6. Cotton – to measure area of ulcer 7. Knee Hammer 8. Stethoscope 9. Hall Ticket 10. Identity Card 11. Writing Board 12. Pen, Scale etc BASIC SURGERY 1. What is a Symptom? 2. What is a Sign? can be elicited and demonstrated 3. When do you say "Chronic"? Chronicity? 4. What is a Sinus? (Das p. 55) 5. What is a Fistula? abnormal blind tract lined by epithelium, connecting internal to external OR two str in the body (Das p. 55) 6. What is an Ulcer? 7. What is a Boil? 8. what is a Furuncle? 9. What is a Carbuncle? 10. Wound Healing? 11. Difference in the wounds healed by Primary intention and secondary intention? 12. Skin Grafting? 13. Suture Materials? 14. Complications of Absorbable Sutures? 15. Enema? Types? Retension enema Evacualtion enema 16. Types of Drainage? ▪ Open ▪ Closed ▪ Closed Suction ▪ Sump Suction ▪ Underwater (SRB p. 1123) 17. Disadvantages of Open Drain? soiling cannot measure infection 18. Types of Anaesthesia? COMMON CLINICAL PROCEDURES Refer Medicine Practicals on page 19 LONG CASES THE FIVE IMPORTANT LONG CASES IN SURGERY ARE : 1. Breast 2. Thyroid 3. Abdominal Lump 4. PVD 5. Varicose Veins  The following questions will help you in self assessment after reading Clinical DAS Breast Based on Class by Dr.Vishwanathan. MS Based on Class by Dr.Abid Ali. MS Prepared by : Hafeesh, Gouri (Das pp. 308-324) (SRB pp. 453-497) (Bailey pp. 837-847) (Synapse p. 61) (IBS p. 185) (Robbins pp. 710-716) 1. Three Common diagnosis in Breast Cases? Carcinoma *** (common Breast Case for exam) Fibroadenoma Fibroadenosis EXAMINATION OF PATIENT CASE SHEET PRESENTATION HISTORY 2. Significance of Menstrual history? Early menarche and late menopause  increased estrogenic activity  breast cancer Menstruation and Breast Surgery? Breast surgery is best during LUTEAL phase of menstuation INSPECTION 3. Positions for Breast examination? Sitting Semi-recumbent Recumbent Bending forward 4. Various positions while sitting? hands by side arms raised  nipple retraction or deviation hands on hips  lump is more evident (contraction of PM) bending forwards  any fixity to chest, both breasts should fall forward equally, fibrosis behind nipple 5. @ Extent of Breast? 2 to 6th rib in midclavicular line sternum to mid-axillary line axillary tail of spence (SRB p. 453) 6. Best Position to detect nipple retraction? 7. Cause of Nipple retraction in carcinoma? infiltration of lactiferous ducts with subsequent fibrosis (Das p. 322) 8. Types of Nipple Retraction? slit like – duct ectasia & periductal mastitis circumferential – carcinoma (SRB p. 497) 9. Demonstrate eversion of a retracted nipple? 10. Types of Nipple Discharge? Fresh Blood – Carcinoma & Duct Papilloma Black – Duct Papilloma with Obstructed Duct Watery/Greenish – Fibroadenosis Milky/White – Lactation, Galactocoele, Galactorrhoea, Mammary Duct Ectasia Purulent – Acute Mastitis, Chroinic breast abscess with duct ectasia 11. What is Pagets Disease of Nipple? 12. Best Position to see a lump? 13. Demonstrate Peau'd orange appearance? squeezing a segment of skin over the breast Das Color Plate IX 14. Significance of Peau'd orange appearance? 15. Mechanism of Peau'd orange appearance? blockage of subcuticular lymphatics by cancer cells 16. Why is the edema in Peau'd Orange pitting? fixation of hair follicles and sebaceous glands to the subcutaneous tissue (Das p. 322) 17. How to differentiate ulceration due to carcinoma and phyllodes tumour? pass a probe under skin margin carcinoma  not possible phyllodes tumour  possible 18. How to estimate the level of nipples? measure vertical distance from clavicle and horizontal distance from midline Das Color Plate IX 19. Accessory Nipple ? 20. Quadrants of the Breast? How is breast divided? FIVE quadrants Central Upper outer Upper inner Lower Outer Lower Inner 21. Milk Line ? 22.  Development of Breasts 23. Describe a normal areola? 24. What is 'Cancer en cuirasse'? coat of armour 25. Brawny Oedema? 26. Why the arms become oedematous after Mastectomy? lymphatic obstruction PALPATION 27. Demonstrate the palpation of breast? position of patient? hands by side palpate normal breast first palpate with palmar surface of FINGERS palpate between pulp of fingers and thumb when a swelling is felt palpate quadrant wise palpate for axillary tail palpate just behind the nipple 28. Demonstrate fluctuation in the swelling? stand behind the patient (Das p. 313) 29. Causes of a Cystic Swelling in the Breast? Fibroadenosis Chronic abscess Haematoma Galactocele Hydatid Cyst Lymph Cyst Phyllodes tumour Colloid Carcinoma … (Das p. 321) 30. Condition in which a cystic swelling shows negative fluctuation test? tense cystic swelling 31. Conditions to diagnose a cyst as non-malignant? not blood stained on aspiration no residual lump no refilling no malignant cells in cytology (Das p. 321) 32. Demonstrate Transillumination test? 33. Demonstrate fixity to skin? move lump side to side/up and down move skin over lump pinch the skin 34. Differentiate Tethering and Fixity? Tethering  infiltration of COOPERS ligaments & shortening Fixity  infiltration of skin 35. Demonstrate Tethering? move lump side to side and look for dimpling of skin Significance? infiltrating carcinoma 36. Explain the terms? Dimpling Tethering Puckering- skin is pulled towards lesion and shows folds 37. Demonstrate fixity to breast tissue? use both hands 38. Demonstrate fixity to Pectoralis Major? press hip as hard as possible check for mobility of the lump Das Color Plate X 39. Demonstrate fixity to serratus anterior? ask patient to push against examiner's shoulder(without flexing elbow) with the hand of affected side check for mobility of the lump 40. Implication of Serratus anterior fixity? it implies chest wall fixity ie T4a (Pectoralis fixity does not alter the T staging) 41. Demonstrate fixity to chest wall? same as serratus anterior fixity 42. Demonstrate fixity to Latissimus Dorsi? extending the shoulder against resistance (SRB p. 472) 43. Demonstrate Axillary LN Palpation? Das Color Plate XI 44. Name the axillary LN groups? 45. Levels of Axillary Lymph Nodes I – anterior, posterior, lateral II – central III - apical 46. Demonstrate Supraclavicular LN Palpation? 47. @ Lymphatic Drainage of Breast? (SRB p. 455) (IBS p. 185) DIAGNOSIS 48. Findings in Early Carcinoma? no axillary LN 49. Findings in Locally Advanced Carcinoma? ulceration over breast 50. Findings in Metastatic Carcinoma? INVESTIGATIONS 51. Mammography? Indication? 52. Features of malignancy in Mammography? Spiculation Microcalcification Tentaculation 53. Role of Mammogram? screening purpose to evaluate contralateral breast to detect recurrence following breast conserving surgery 54. Xeroradiography? (Das p. 318) 55. USG? to differentiate solid from cystic swellings greater than 2.5cm 56. FNAC? 23G needle 57. Specificity of FNAC? almost 100% 58. Grading of FNAC C0 - C1 - C2 - benign C3 C4 C5 - malignant 59. Frozen Section? not useful in breast cases, but useful in thyroid cases 60. Trucut Biopsy? 11G needle 61. Advantage of Trucut Biopsy ▪ to differentiate DCIS and invasive ca ▪ receptor status 62. Pathological Grading of the Tumour? Based on : ▪ nuclear pleomorphism ▪ tubule formation ▪ mitotic rate Graded as : ▪ Grade 1 - well differentiated ▪ Grade 2 - moderately differentiated ▪ Grade 3 - poorly differentiated 63. Incisional Biopsy? lump is more than 4cm a portion of the lump is removed and sent for biopsy 64. Excisional Biopsy? lump is less than 4cm whole lump is removed with 1 cm margin and sent for biopsy 65. Sentinel Node Biopsy? Sentinel Node is the first node encountered by the tumour cells (Makhanlal p. 196) 66. Other Malignancies in which sentinel node biopsy is practiced? Carcinoma Penis Malignant Melanoma 67. MRM? Types? Patey's Scalon Auchincloss TREATMENT 68. Treatment for ? Early Ca – Breast Conserving Surgery WITH ADJUVANT THERAPY Locally advanced Ca – give neoadjuvant chemo (induction) tumour size reduced  simple mastectomy + chemo + radio. Metastatic Ca- 69. Criteria for Breast Conserving Surgery? lump <4cm no axillary LN adequate sized breast  for RADIATION (6wks) 70. Name the incisions for Breast Surgery? 71. Types of Breast Surgeries? 72. The Most Important Prognostic Marker in Ca Breast? Axillary LN 73. Axillary Sampling? 74. Why Curvillinear incision in Breast Conserving Surgery? 75. QUART? 76. What are the Adjuvant Therapies? ▪ Radiotherapy ▪ Chemotherapy  CMF, CAF (6 cycles) ▪ Hormone Therapy  Tamoxifen (20mg/day for 5yrs) (SRB p. 490) 77. Dose of Radiations after Breast Conservative Surgery? 78. What do you mean by Tumour Clearance? CARCINOMA (SRB p. 467) 79. What is your diagnosis? Carcinoma of Breast in Stage ? 80. Why do you say this is Carcinoma? from HISTORY middle aged woman painless lump h/o loss of wt INSPECTION Paeu d'Orange appearance Ulceration and fungation Nipple drawn upwards Nipple retraction Dimpling of skin Edema of arm PALPATION stony hard mass in upper and outer quadrant uneven surface irregular margin fixed to skin, breast tissue, pectoralis & serratus, OR thoracic wall Nipple discharge Palpable LN's 81. Commonest Breast Carcinoma? Cirrhous type (60%) cartilaginous consistency 82. In which quadrant Carcinoma is common? upper outer Why? breast tissue is more here 83. Classify Breast Carcinoma? ▪ non-invasive (ductal* & lobular) ie DCIS & LCIS ▪ invasive (ductal & lobular) ▪ DUCTAL Ca is common. ▪ LOBULAR Ca is only an incidental finding and does not produce any swelling 84. How to manage DCIS? Breast Conservative Surgery 85. How to differentiate Carcinoma from traumatic Fat necrosis? history of injury discolouration of skin no enlargement of LN (Das p. 320) 86. How to differentiate Carcinoma from Antibioma? h/o pain and antibiotic treatment lump is soft at centre (Das p. 320) 87. Risk Factors? ▪ Oestrogens ▪ Genetic – BRCA1 and BRCA2 genes ▪ OCP use ▪ Ionising Radiations (SRB p. 468) 88. Estrogen and Breast Cancer? 89. Medical Adrenelectomy? Adrenal gland is the main source of endogenous estrogen in POST MENOPAUSAL women. AMINOGLATETHEMIDE (mititane) was used. 90. Types? Scirrhous, Medullary, Colloid, … 91. Staging of Breast Carcinoma? 92. Anterior Chemotherapy ? 93. Breast Self Examination? 94. Demonstrate the mobility of the mass ? 95. Trosier's Sign? 96. Why edema in upper limb post-operatively? 97. Complication of limb edema? Lymphangioasarcoma? occurs 5yrs after edema of UL 98. Cardinal Symptoms of Breast Carcinoma? Pain, Lump, Discharge 99. Puberty Mastitis? 100. Lactational Mastitis? (SRB p. 461) 101. Dangers of taking biopsy in Breast Carcinomas? Severe bleeding 102. Commonest Site of Metastasis? Bone( Cancellous) – 50-65%  skull 103. Other Sites? Lung Pleura Soft tissue Liver Brain Adrenals 104. Order of Metastasis? Lumbar Vertebra > Femur > thoracic vertebra > Ribs 105. How to determine Bone Metastasis? Bone Scan 106. What is Colloid mucinous Carcinoma? 107. What do you mean by Neo-adjuvant therapy? 108. Toilet Mastectomy? 109. Advice on discharge? 110. How to Followup? 1-2yr – every 2 months 3-5yr – every 6 months >5yr - yearly 111. Male Breast Malignancy? FIBROADENOMA (SRB p. 457) 112. Why do you say this is Fibroadenoma? PALPATION firm mass well deinfed margin NOT fixed to skin, breast tissue, pectoralis & serratus, OR thoracic wall highly mobile Axillary nodes NOT ENLARGED (Das p. 322) 113. How to differentiate Fibroadenoma and early carcinoma of Breast? 114. What is ANDI? variety of benign breast disorders 115. Commonest manifestations of ANDI? cyclical pain + lump 116. Types of Fibroadenoma Pericanalicular – hard – young Intracanalicular – soft – middle aged (Das p. 322) more dangerous metastasis are more common Thyroid Based on Class by Dr.Mujeeb Rahman. MS (Das pp. 284-297) (SRB pp. 403-443) (Bailey pp. 772-806) EXAMINATION OF PATIENT CASE SHEET PRESENTATION Chandrika, 46yr old female residing at Kondotty is a House wife PC Swelling in the neck for 6 months ; Hoarseness of voice for 2 months HPC Swelling in the neck was initially seen as a small swelling of a marble size which gradually increased in size to attain the present large size. There is no history of a sudden increase in the size of the swelling. There is no associated pain. She has no difficulty in breathing, swallowing, and no change in voice. She also gives a history of hoarseness since 2 months, No other pressure symptoms like dysnoea, dysphagia, She has increased sweating and intolerance to heat. Tremor of the hands is also present. No other toxic symptoms like loss of weight, muscle weakness etc. She has diplopia. No other eye symptoms like difficulty in closing the eyes No history of diarhoea No symptoms of hypothyroidism On Inspection an irregular shaped swelling is noticed in the front and sides of the neck. The right half of the swelling measures around 6x4 cm and the left half measures around 5x3 cm. The swelling in the midline measures 3x4 cm. On either sides the swelling extends above one finger breadth from the level of thyroid cartilage and below upto the clavicle. Laterally the swelling passes under the SCM muscle. The midline swelling extends below upto suprasternal notch and above two finger breadth from the suprasternal notch. Surface is nodular (avoid saying bosselated). A transverse scar of about 10 cm is seen over the swelling. No redness, sinuses to rule out a thyroglosssal fistula ,or dilated veins over the swelling. No visible pulsations in the swelling. Margins are rounded. Skin over the swelling normal. The Swelling moves with deglution but does not move with protrusion of tongue. No evidence of any retrosternal extension. On Palpation, there is no local rise of temperature and no tenderness. The swelling was palpated from the back with the patient sitting, hands by the side and neck slightly extended. Inspectory findings are confirmed. Swelling is firm soft, hard, variable in consistency. It is mobile in vertical and but restricted mobility in horizontal direction. Skin is pinchable. It is possible to get below the thyroid gland(tracheal rings are felt). Trachea is central(deviated in solitary nodule thyroid). Carotid pulsations are palpable. No palpable thrill in the upper pole. No enlarged cervical LNs. Circumference of the neck at the maximium extent of the swelling is --- cm. Toxic manifestations like lid retraction, exophthalmos, are present. Eye signs like Von-Graffe, Joffroy's, Moebius, Darlympe's Stellwag's are positive. Tremor is present in outstretched hands and tongue. Kocher's test is negative. On Percussion over the manubrium sterni, it is resonant On Auscultation, no bruit (systolic) primary toxic goitre heard over the upper pole of the thyroid. The Diagnosis is a toxic, multinodular goiter without any pressure symptoms 117. Word meaning of thyroid? shield like Greek word 118. Word meaning of goiter? Latin. guttur  throat HISTORY 119. Some Important points to ask in history? Sleep? Voice change? Any difficulty in swallowing? Stridor? loss of wt? heat intolerance? excessive sweating? tremor? goitrogenic drug intake? 120. Significance of Hoarseness? denotes infiltration of Recurrent Laryngeal Nerve 121. Muscles supplied by Recurrent Laryngeal Nerve 122. Symptoms of HYPOthyroidism? weight gain intolerance to cold 123. Drugs causing Hypothyroidism? Anti-thyroid Drugs Lithium, Amiodarone 124. Symptoms of Hyperthyroidism? weight loss INSPITE of GOOD APPETITE (should be a recorded weight to be significant) intolerance to heat, preference to cold 125. WAYNE'S Index? (SRB p. 419) 126. What is the importance of Age in this case? 127. What is the importance of Sex in this case? eight time commoner in females 128. What is the importance of Place in this case? hilly areas 129. Name the goitre's seen in families? Iodine deficiency goiter Medullary* carcinoma thyroid 130. Cause of a rapid increase in the thyroid swelling ▪ Hemorrhage into nodule ▪ anaplastic carcinoma ▪ Thyroiditis 131. Cause of pain in thyroid case? ▪ Thyroiditis ▪ Anaplastic Carcinoma 132. Causes of Respiratory distress in a thyroid case? ▪ Carcinoma thyroid ▪ Retrosternal goiter ▪ Long standing MNG ▪ CCF due to thyrotoxicosis 133. Significance of Menstrual History in a Thyroid Case? 134. Bedside test for Thyrotoxicosis? Sleeping pulse rate done at around 4am before the patient wakes up fast & irregular pulse  AF 135. How to asses the degree of thyrotoxicosis based on pulse rate? CRILE's GRADING mild - <90 moderate – 90-110 severe - >110 (SRB p. 421) INSPECTION 136. Extent of Thyroid Gland? lies against c5 c6 c7 and T1 vertically – middle of thyroid cartilage to 4th or 5th tracheal rings horizontally – Isthmus – 2-4 tracheal rings 137. Normal size of Thyroid? Each lobe  5x3x1.5cm 138. Position for Inspection of Thyroid? patient sitting, neck slightly extended hand by the side 139. Pizillo's Method? only for short necked and obese occiput pressed against the clasped hands 140. Why thyroid moves with deglutition? 141. Why thyroid does not move with protrusion of tongue? 142. Development of Thyroid? 143. Levator Glandular Thyroidae? part of thyroglossal duct from hyoid bone to thyroid isthmus persists to form this fibrous cord 144. Sites of Ectopic Thyroid? 145. Anoalies in Thyroid Development? 146. Explain the anatomy of Cervical fascia? 147. What is Berry's Ligament? 148. Why Larynx moves up with deglutition? 149. Mechanism of deglutition? 150. Enumerate Midline swellings of neck? 151. Enumerate Lateral swellings of neck? 152. Conditions in which a thyroid swelling does not move up with deglutition? a large thyroid swelling Reidel's thyroiditis 153. Other swellings that move with deglutition? Thyroglossal cyst Subhyoid bursa prelaryngeal/pretracheal LN's Extrinsic carcinoma of larynx 154. How to differentiate thyroid from thyroglossal cyst? thyroglossal cyst moves up with protrusion of tongue 155. Demonstrate the movement of the swelling with protrusion of tongue? Ask the patient to keep mouth open. Then ask him to protrude the tongue in and out. 156. Why thyroglossal cyst moves up with protrusion? thyroglossal duct extends from foramen caecum of tongue to the isthmus of the thyroid gland 157. What else moves with protrusion of tongue? ▪ subhyoid bursitis ▪ sublingual dermois ▪ Thyroglossal fistula Anything attached to Hyoid Bone moves with protrusion of tingue. 158. Thyroglossal Cyst ▪ tubulodermoid Management – sistrunk procedure 159. Different Sites for a Thyroiglossal Cyst ? 160. Branchial Cyst? 161. Inspectory findings in retrosternal goiter? dilated veins 162. Demonstrate Pemberton's Sign? both hands above the ears for 2-3 min congestion of face, respiratory distress denotes retrosternal extension compression of veins  SUPERIOR THORACIC OUTLET Syndrome 163. Define Retrosternal Goitre? more than 50% lies below thoracic inlet 164. Types of Retrosternal Goitre? primary & secondary 165. Suspision of Retrosternal Goitre? lower border not seen 166. Complications of Retrosternal Goitre 167. What is "Plunging" Goitre? present only during coughing 168. What is the plane of the swelling in this case? 169. How will you determine the plane of swelling? Extend the neck – Press chin against pressure – 170. Fascia in the neck? 171. Strap Muscles? Sternothyroid Sternohyoid Thyrohyoid 172. Most superficial Strap Muscle? 173. FNAC and Srap Muscles? adhesion of strap muscles to thyroid during surgery 174. Nerve Supply of the Strap Muscles? Ansa Cervicalis c1 c2 c3 (lower part) So, during surgery divide the muscle at the upper part to avoid injury to these nerves PALPATION 175. Demonstrate Thyroid Palpation? never forget to flex neck forwards stand behind the patient thumb on the occiput and four fingers in front flex neck to right/left to palpate the righ/left lobe 176. Demonstrate feeling for local rise of temperature? Never forget to compare with the body temperature. 177. Which method will you choose to palpate in this patient and why? 178. Methods to palpate thyroid? Standard Method from back  for anterior surface of thyroid Lahey's  for posteromedial surface of thyroid Crile's  for small nodules 179. Demonstrate Lahey's Method of palpation? 180. Indication for Lahey's Method? to palpate the posteromedial surface to palpate each lobe separately 181. Demonstrate Crile's Method of palpation? using thumb 182. Indication of Criles method? to palpate for small nodules 183. Various consistencies you expect? firm – MNG, cystic nodule hard – carcinoma & reidel's thyroiditis soft – colloid, adenoma 184. How to contract both SCM's simultaneously? ask patient to press chin against pressure 185. Demonstrate the mobility of the swelling? 186. Demonstrate how to get below the thyroid? keep finger below the lower border and ask to swallow palpate for the tracheal rings above the suprasternal notch 187. Demonstrate position of trachea? 188. Trails Sign? 189. Demonstrate Kocher's Test? Explain ? Note – push from the side 190. Who was Kocher? First Noble Prize winner in Surgery, 1909 Done max no of thyroidectomies. Kocher's Collar Incision Kocher's Forceps Kocher's Vein Kocherisation (SRB p. 440) 191. What is tracheomalacia? 192. Scabbard Trachea? seen in large and long standing MNG, infiltrating malignancy x-ray appearance of narrowed trachea Meaning of Scabbard ? 193. Demonstrate Cervical LN Palpation? 194. Name the cervical Lymph Node groups? I – submandibular & submental II – upper jugular III – mid jugular IV – lower jugular V – posterior triangle + supraclavicular VI – pre-tracheal and pre-laryngeal VII – mediastinal 195. Lymphatic Drainage of Thyoid? Delphian Nodes (SRB p. 404) 196. Lateral aberrant Thyroid? 197. Demonstrate Carotid Palpation? 198. Where to look for Carotid Pulsations? antr border of sternocleidomastoid at the level of upper border of thyroid cartilage NOT with thumb 199. What is Berry's Sign? 200. What do you mean by positive Berry's Sign? when the carotid pulsations are OBLITERATED (avoid saying ABSENT) Berry's sign is positive 201. Significance of Berry's Sign? 202. Branches of External Carotid Artery? CODE – Sister Luci's Powdered Face Often Attracts Silly Medicos ▪ Superior Thyroid ▪ Lingual ▪ Posterior Auricular ▪ Facial ▪ Occipital ▪ Ascending Pharyngeal ▪ Superficial temporal ▪ Maxillary (IBS p. 805) 203. Sites of Percussion in Thyroid Case? Manubrium Sterni Medial end of Clavicle 204. Where do you auscultate? Why? upper pole coz superior thyroid artery is more superficial there (inferior thyroid artery in the lower pole enters the gland from deeper plane) it is the main artery Note – use the bell of steth 205. Why vascularity is increased in Thyrotoxicosis? increased thyroxine secretion  increased vascularity to take up the hormone 206. @ Blood Supply of Thyroid? 207. Inferior Thyroid Artery is a branch of ? 208.  Branches of SubClavian Artery ? 209. What are the toxic symptoms? loss of wt inspite of good apetite increased sweating intolerance to heat palpitation GENERAL EXAMINATION  210. Significance of Clubbing in Thyroid Case? Thyroid Acropachy INVESTIGATIONS 211. What are the investigations? FNAC USG Thyroid Scan Laryngoscopy (Makhanlal p. 210) 212. Normal T3 T4 TSH Levels? T4 – 4.5 to 12 µg/dL T3  0.45 to 2 ng/dL TSH  0.3 to 4 U/L 213. Which is the best TFT value to assess Hyperthyroidism? FREE T3 214. Steps of Thyroxine synthesis? 215. Peripheral conversion of T4 216. Classification of Anti-thyroid Drugs? synthesis inhibitors release inhibitors … 217. Replacement Dose of Thyroxine? 0.1mg of L-thyroxine 218. Maintanence Dose of Thyroxine? 219. Supplemental Dose of Thyroxine? 220. Suppressive Dose of Thyroxine? 0.3mg OD to suppress TSH level given in papillary carcinoma 221. Lugol's Iodine? 222. Anti-thyroid drug in pregnancy? Propylthiouracil 223. MOA of Propylthiouracil? blockade of peroxidase enzyme 224. Why to test for Serum Creatinine? Increased muscle catabolism  raised creatinine levels 225. Why to test for WBC Count ? anti-thyroid drugs causes agranulocytosis 226. Complication encountered in surgery due to repeated FNAC? adhesion of muscles to thyroid which muscles ? 227. Investigation to detect a retrosternal extension of thyroid that is not clinically appreciable? CECT Avoid CECT if any plan for radioiodine therapy 228. Isotopes of Iodine? I123 - diagnostic I131 – therapy I127 – organic 229. Dose of radioidine for Radioiodine Scan? 5 micro curie SURGERY 230. Classify Thyroid Swellings? 231. DD of a Solitary nodule thyroid? ▪ Thyroid Adenoma ▪ Papillary CA ▪ palpable nodule of a MNG ▪ thyroid cyst 232. Radioiodine Therapy? Indications? age > 45yr 233. Radioisotope used? Dose? I¬¬131 5-10 millicurie 234. Precuation before giving Radioiodine therapy? stop thyroxine supplementation before 6wks 235. What are the pre-op preparations? On the Evening before surgery ▪ Carbimazole ▪ Propranolol  20-40mg bds ▪ Lugol's Iodine 15drops for 10 days prior to surgery 236. Making the patient euthyroid before surgery? Carcimazole(NEOMERCAZOLE) 10mg 6-8hrly for 6-8wks Last dose of carbimazole has to be given on the evening before the day of surgery 237. Position for Surgery? neck extended, but head should be a little higher than body. Why ? to prevent venous congestion 238. Drugs and dosages to attain Euthyroid state before surgery? 239.  Anti-Thyroid Drugs & MOA ? 240. What are the pre-op investigations? 241. Why Laryngoscopy? asymptomatic unilateral vocal cord palsy 242. Tensor of Vocal Cord? Cricothyroid. Supplied by  External Laryngeal Nerve 243. Nerve Supply of Larynx? Recurrent Laryngeal Nerve  supplies all intrinsic muscles of Larynx Superior Laryngeal Nerve  internal and external External supplies CRICOTHYROID 244. Which is more dangerous? Unilateral / Bilateral vocal cord Palsy? Why ? 245. Simmond's Law? 246. Symptosms of Injury to Ext Laryngeal Nerve? feeling of food going into trachea 247. Recurrent Laryngeal Nerve? Difference in the course of Right and Left? Which is longer? Right is longer as it loops around the aorta 248. Types of Thyroidectomy? ENUCLEATION - LOBECTOMY - HEMI – benign one lobe SUBTOTAL* – toxic thyroid – 1/8th of thyroid retained at lower pole PARTIAL – non-toxic multinodular NEAR-TOTAL* – papillary carcinoma – tissue at TE grove retained TOTAL – follicular/medullary/papillary carcinoma 249. Berry Picking? (SRB p. 427) 250. Completion Thyroidectomy ? hemithyroidectomy  frozen section  if report positive  Completion thyroidectomy (SRB p. 430) 251. Name the Incision? Kocher's Collar Incision 252. Precaution while ligating Inferior Thyroid Artery? ligate away from the gland to avoid injury to RLN 253. Dangerous Thyroid Vein during surgery? Middle Thyroid Vein severe bleeding  air embolism Middle thyroid drains into ? internal Jugular 254. Normal Weight of Thyroid 20-22gm 255. FNAC report was nodular goiter, but BIOPSY report is Follicular CA? What will you do? 256. How can you investigate for Thyroid CA, during Surgery? send for frozen section biopsy result within 20 min 257. Important Commplication during surgery? 258.  Tracheostomy 259. How to identify the parathyroid during surgery? Superior Parathyroid seen between true and false capsule at the jn of upper 1/3rd of thyroid in the post surface yellow gland seen 260. Most important and common complication immediately after thyroid surgery? 261. How will you manage it? 262. Complication likely to occur if the trachea is accidently incised during Thyroidectomy? Management? Surgical Emphysema 263. Earlierst manifestations of Hypoparathyroidism after thyroid surgery? 264. Chvostek Weiss Sign? gentle tap on the facial nerve as it emerges in front of external auditory meatus 265. Trousseau Sign? 266. Management of Hypoparathyroidism after Thyroidectomy? 10ml of 10% Calcium gluconate IV 8th hrly Oral Calcium 500mg 8th hrly Supplemt Vit D. Why? it favours Ca absorbtion (SRB p. 439) 267. Thyroid Storm? 268. Type of Drain used after Thyroidectomy? continuous, closed 269. When to remove the drain? within 10 days 270. When to remove the sutures? within 5-7 days 271. Anatomy of Larynx? 272. Nerve Supply of Larynx? 273. Radical Neck Dissection? (SRB p. 398) 274. What are the structures removed in Classical? 275. What are the structures preserved in Modified ? nerve  spinal accessory muscle  sternocleidomastoid vein  internal jugular 276. Eltroxin? TOXIC GOITRE 277. Differentiating features between Primary and Secondary Thyrotoxicosis? Primary  symptoms appear first, eye signs Secondary  swelling appear first, cardiac features (SRB p. 420) 278. Name the toxic eye signs? Lid Retraction over activity of LPS Exophthalmosretroorbital infiltration Ophthalmoplegiainfiltration of muscles(LR&IO) Chemosisblockage of venous drainage 279. First sign to appear ? Stellwag's sign 280. Earliest sign of Ophthalmoplegia? Moebius Sign 281. Order of appearance of signs? Stellwag Von Graffe Joffroy Moebius (SRB p. 418) 282. Difference between Lid lag and Lid retraction? Lid Retraction is due to spasm of LPS  which is due to sympathetic overactivity *LPS is partly innervated by sympathetic fibres 283. What are the other signs Tremor Moist hands Thyroid Briut 284. Demonstrate the toxic eye signs? 285. Demonstrate Lid Lag? Von-Graffe's Sign? Note - move the examiner's finger very slowly Do 5-6 times 286. Demonstrate Joffroy's Sign? fix the patients head by keeping examiners left hand over head. Patients head should be tilted downwards a little 287. Clinical estimation of Exophthalmos? What is Naffziger's Method? superior orbital margin is the landmark 288. Measurement of Exophthalmos? using exophthalmometer 289. Demonstrate Naffziger's Test? 290. Difference between Exophthalmos and Proptosis? Exophthalmos  a bulge due to retro-orbital infiltration Proptosis  a bulge due to intraorbital mass 291. How to differentiate Exophthalmos and Proptosis? Exophthalmos eversion of upper eyelid is not possible. Proptosis  eversion if possible 292. Gifford's Sign? 293. What are the features of Progressive Exophthalmos? 294. Malignant Exophthalmos? loss of vision (SRB p. 419) 295. What causes Retrobulbar Infiltration? 296. How will you manage the exophthalmos? Sleeping in propped up position Lateral Tarsorhaphy 297. Complications likely to occur if exophthalmos is not managed? 298. Orbital Muscles affected in Thyroid Ophthalmoplegia? LR & IO so, patient cannot look upwards & outwards 299. Why should it cause Chemosis? retrobulbar infiltration  blockage of the venous drainage (Das p. 291) 300. Werner's Classification? (SRB p. 420) 301. Grading of Exophthalmos? mild  widening of palpebral fissure moderate bulging of eyes severe congestion, chemosis, ophthalmoplegia progressive continues as severe grade, inspite of treatment (SRB p. 420) 302. Causes of Horner's Syndrome in a thyroid case? infiltration of sympathetic trunk 303. Features of Horner's Syndrome Enophthalmos – sinking eyeball Pseudoptosis – drooping lid Miosis – narrow pupil Anhidrosis – no facial sweating 304.  @ Cervical Sympathetic Ganglia? 305. Importance of Pulse in thyroid case? tachycardia in thyrotoxicosis sleeping pulse rate 306. Demonstrate Tremor in this case? Outstretched hands with slight fanning of fingers Another method is to keep a paper over the outstretched fingers 307. Demonstrate Tremor at another site? open the mouth fully and put the tongue out for 15-30 seconds tongue should not touch the teeth 308. Thyroid Acropachy ? clubbing of fingers and toes in primary thyrotoxicosis (SRB p. 421) 309. DD of a thyroid swelling? 310. What do you mean by the term goiter? any enlargement of the thyroid gland CARCINOMA 311. Why do you say this is Carcinoma Thyroid? 312. Risk factors for Malignancy Thyroid h/o radiation long standing MNG (Bailey) 313. Dunhill's Classification Differentiated (Papillary & Follicular) Undifferentiated Medullary Malignant Lymphomas (SRB p. 425) 314. Carcinoma which causes LN Metastasis? Papillary 315. Commonest site for Secondaries? skull 316. Papiillary and Follicular Carcinoma? Papillary – spread by lymphatics – 60% Follicular – spread by blood – 17% Papillary is more common than follicular 317. Investigations in Thyroid Carcinoma? FNAC USG TFT Radioiodine Study S.Thyroglobulin for follicular 318. TFT findings in Papillary Carcinoma? TSH raised  hormone dependent tumour 319. Thyroid Paradox? seen in Papillary Carcinoma Cellular tumours  soft Cystic tumours  hard 320. FNAC for papillary and follicular? Papillary  very useful (always done) Follicular  not useful; cannot differentiate follicular adenoma and follicular carcinoma 321. Surgery for ? Papillary  Total or Subtotal Follicular  Total 322. Any role of Thyroglobulin estimation? to followup in follicular carcinoma 323. Prognosis of Thyroid Carcinoms? AGES PARATHYROID 324. Blood Supply of Parathyroid? superior  Inferior  inferior thyroid artery THYROIDITIS Hashimoto's De-Quervains's Reidel's MYXOEDEMA 325. Demonstrate Tendon Reflexes? THYROGLOSSAL CYST 326. Surgery ? Sistrunk Operation 327. Thyroglossal fistula? TG cyst bursts to produce fistula 328.   Varicose Veins (Das pp. 73-80) (SRB pp. 187-208) (Bailey) EXAMINATION OF PATIENT CASE SHEET PRESENTATION Ahamed, 42yr old male, residing at Kottakkal is a Shopkeeper  PC Irregular swelling in the Rt lower limb for 6 months Dull aching pain in the calf region for 6 months Dark pigmentation for 4 months Ulcer in the ankle for 4 months  HPC The swelling was insidious in onset, is present along the inner aspect of the right leg. The swelling was initially noticed in the lower part and it gradually ascended upwards. Swelling gets aggravated on prolonged standing and walking and is relieved by taking rest. He also has dull aching pain in the Right calf region. Pain is experienced more towards the evening. No h/o night cramps. He also has dark pigmentation around his ankles An ulcer was seen in the inner aspect of the Lf ankle since 4 months. He has dull aching pain over the ulcer. There is serous discharge from the ulcer. Ulcer was increasing in size since it was first seen. Now he is using crepe bandages. No history suggestive of DVT  329. Define Varicose vein dilated tortuous elongated veins 330. Other Sites of Varicosities ? Oesophagus Rectum Spermatic Cord 331. Ambulatory Venous Hypertension? Value? 200 o r more Normal Venous Pressure – 20mmHg (at ankle) (Bailey p. 927) HISTORY 332. What causes pain in Varicose Veins? Compare with Claudication Pain in PVD? stretching of vein 333. Claudication Distance? PALPATION 334. Demonstrate Trendelenberg test One? Torniquet is tied BELOW Saphenous opening 335. What does it indicate? incompetence of SF jn. 336. Demonstrate Trendeleberg test two? 337. What does it indicate? 338. How to identify the saphenous opening? 3.5cm below and lateral to pubic tubercle 339. How to locate the pubic tubercle? ADDUCT thigh against resistance palpate along the adductor longus 340. Demonstrate Torniquet Test? 341. Demonstrate Multiple Torniquet Test? 342. Another name for Multiple Torniquet test? Oschner's Mahorner's Test 343. Name the perforators in lower limb? [HDBCM] Hunterian - thigh Dodd – mid thigh Above Knee perforator Boyd – gastronemius perforator (Below Knee perforator) Cockett – lower leg perforators (I, II, III) – 5,10,15cm above the medial malleolus May or Kuster – ankle perforators Other inconstant perforators 344. Which is the largest Perforator? SF Jn 345. Demonstrate Modified Perthe's Test? 346. What is the modification in Perthe's Test? 347. What does it indicate? 348. Demonstrate Pratt's Test? 349. Demonstrate Morrissey's Test? 350. How do you mark the perforators clinically? Fegan's Method 351. Demonstrate Fegan's Method? palpate for CRESENTRIC gap in the deep fascia along the GSV 352. Surface Marking of GSV? DIAGNOSIS 353. What is your diagnosis? 354. What is the grade of this case? 355. Causes of Varicose Veins Primary Secondary (Das p. 77) 356. What are the DD's ? ▪ Lymphoedema ▪ AV Malformation ▪ Orthostatic Oedema ▪ Renal and Cardiac diseases ▪ Hepatic causes ▪ Vasculitis ▪ Metebolic Diseses like Gout ▪ Chronic Infections like TB, Syphilis 357. CEAP Classification? (SRB p. 193) INVESTIGATIONS 358. What investigations you do? Doppler USG Duplex imaging Venography Plethysmography USG Abdomen (SRB p. 197) 359. Any Role for Venography? 360. Other Routine investigations? Blood – Hb. TLC, DLC, ESR Sugar, Urea, Creatinine Chest X Ray ECG 361. Complications of Varicose veins? Superficial thrombophlebitis DVT Haemorrhage Skin pigmentation Lipodermatosclerosis Venous Ulcer Periosteitis SURGERY - TRENDELENBERG 362. What is the conservative treatment for Varicose Veins? ▪ Exercise ▪ Crepe Bandages ▪ Ulna Boots ▪ Diosmin therapy 363. What surgery will you do in this case? Trendelenburg + stripping + perforator ligation 364. Surgeries for Varicose? ▪ Trendelenberg ▪ Stripping of vein ▪ SEPS ▪ Subfacial ligation of Cocket and Dodd ▪ Linton's ▪ Hook Phlebectomy ▪ VNUS ▪ Trivex Method ▪ EVLA 365. @ Anatomy of venous system in the LL? 366. Tributaries of LSV? 367. Tributaries of SSV? 368. Pre-op Preparation mark the main trunk and perforators with gentian violet 369. What do you mean by flush ligation? as close as possible to the femoral vein, to prevent any stump from the femoral vein 370. Why is it ligated very close to the femoral vein? the stump of the femoral vein will produce SAPHENA VARIX 371. Name the tributaries that you ligate? ▪ Superficial Circumflex ▪ Superficial External Pudental ▪ Superficial Epigastric 372. What is Saphena Varix? dilated terminal end of the great saphenous vein where a thrill maybe palpable 373. Post-op ? compression bandage for 2 days elastic stockinette for 7 days 374. Complications? Bleeding injury to nerves echymosis recurrence (most common) 375. Other options ? injection sclerotherapy compression bandages 376. Stripping of the GS vein? Upto what level will you strip? ▪ Myers Stripper ▪ strips only upto knee, to prevent inury to saphenous nerve  numbness (saphenous neuralgia) 377.  Cutaneous nerves of Lower Limb? ▪ Saphenous Nerve ▪ Sural nerve 378. How will you manage small varicosities? 379. Newer modalities of treatment? Endovenous Laser (EVLA) Radiofrequency Ablation (RFA) (Bailey p. 931) SCLEROTHERAPY 380. Mechanism? causes aseptic inflammation 381. Indication? ▪ minor varicosities ▪ residual varicosities after a surgery 382. Contraindication? 383. Sclerosants used? 2% Polidocanone STDS (sodium tetra decyl sulphate) Phenol in Olive/Almond Oil 384. Why mixed with air? Foam ? air displaces the blood and provides more surface area for the sclerosant to act 385. Procedure? USG guided, ideally 386. Complications? Pigmentation Ulceration Superficial Thrombophlebitis DVT (rarely) 387. Microsclerotherapy? venous stars and reticular veins cosmetic treatment VARICOSE ULCERS 388. Characteristics? 389. How it develops? 390. Management? ulcer heals after the VV surgery compression bandage DEEP VEIN THROMBOSIS 391. How did you rule out DVT in this case? h/o fever, pain and swelling in leg Modified Perthe's Test 392. Homan's Sign? found only in ACUTE cases of DVT 393. Moses Sign? found only in ACUTE cases of DVT 394. Neuhof's Sign? 395. Inverted Champagne Bottle Sign? (SRB p. 194) 396. Virchows Triad? ▪ Stasis ▪ Hypercoagulability ▪ Vein wall injury 397. DD for DVT? ▪ Ruptured Bakers Cyst ▪ Ruptured Plantaris tendon ▪ Calf muscle hematoma ▪ Cellulitis leg ▪ Superf Thrombophlebitis 398. Thrombolytic therapy for DVT? 399. Prevention of DVT? ▪ leg elevation ▪ crepe bandages ▪ LMVH – 5000 U (subcut 2hr before surgery) Peripheral Vascular Disease (Das p. 59 to 72) (SRB p. 144 to 178) (Bailey p. 900 to 918) TAO is the common diagnosis in PVD 400. What is PVD ? HISTORY 401. Intermittent Claudication cramp like pain in the muscle during walking due to inadequate blood supplu 402. Cause of Claudication pain accumulation of substance P, inadequate blood flow 403. How to asses the claudication distance? Treadmill test 404. If patient has only Claudication as the probem, How will you treat? Encourage patient to walk  collaterals develop and improvement DRUGS – Pentoxyphylline, Cilistazole (not very helpful) 405. Neurological Claudication? pain due to some neurological cause, usually NERVE COMPRESSION 406. How to differentiate from neurogenic claudication? pain persists on rest  compression of nerves but relieves on assuming some posture All peripheral pulses will be palpable 407. Why Paresthesia occurring in a PVD Case? shunting of blood from skin to muscle What is paresthesia? excess sensitivity to touch 408. Boyd's Grading? 409. Fontaine's grading of chronic limb ischemia I – asymptomatic II – intermittent claudication III – rest pain IV – ulceration/gangrene (SRB p. 146) 410. Meaning of 'Claudio" I limp 411. Cause of rest pain? ischemia of the nerves present throughout day and night 412. Since this patient is diabetic, what precautions will you take before surgery? ▪ Avoid Anti-diabetics in the morning before surgery, coz as a reflux response to trauma(surgery)  hyperglycemic hormones(insulin) will be released patient may go into hypoglycemia ▪ Investigate – FBS, PPBS ▪ So, Switch over to Insulin 413. Important Negative histories to ask and Why? h/o Syncope –vertebrobasilar insufficiency INSPECTION 414. Demonstrate the estimation of Buerger's Angle? at the level of sternum less than 30 – severe ischemia 415. Can you estimate the pressure in the foot vessels clinically? the height in cm between the sternal angle and the level of heel at elevation indicates the pressure in mm of Hg in the foot vessels. 416. Demonstrate the assessment of time for Capillary FILLING? >30 seconds  ischemia 417. What are the signs of Ischemia? loss of hair loss of subcut tissue shiny skin brittle nails some color change, compared to opposite limb 418. First symptom of ischemia? claudication pain PALPATION 419. Demonstrate Capillary REfilling? 420. Demonstrate the Dorsalis Pedis pulse palpation? lateral to tendon of EXTENSOR HALLUCIS LONGUS at the proximal first intermetatarsal space from a point midway between the two malleoli 421. Demonstrate the assessment of wasting of muscles? 422. Demonstrate Reactive Hyperemia Test? DIAGNOSIS 423. Why do you say PVD in this case? from history (claudication pain etc) Smoker middle aged male so this maybe  TAO 424. What is the structural change in the vessel? T.intima is damaged T.media causes vasospasm (autonomous nervous system) INVESTIGATIONS 425. Name the investigations for this case? Arterial Doppler Duplex  Arteriography 426. When will you do Arteriography? ▪ only when planning arterial surgery ▪ to know the exact site and extend ▪ to get an idea regarding collateral circulation 427. Types of Arteriography? Retrograde  preferred Lumbar (direct) 428. Complications of Arteriography? it can worsen the condition dissection 429. Doppler? Duplex? Principle? 430. Difference between Doppler and Duplex scan? 431. Advantage of Duplex? vessel can be visualised 432. Doppler Shift Principle ? 433. Angiography? 434. ABPI? 435. Brown's Vasomotor Index? Normal - <3 (Das p. 67) TREATMENT 436. What are the treatment options? Conservative Surgery (direct & indirect) 437. Role of exercises? exercise opens up the collaterals 438. Drugs? Pentoxiphylline Psilosamine ? Vitamins 439. What is the MOA of Pentoxiphylline? alters the shape of RBC's prevents platelet aggregation 440. Surgery? Lumbar Sympathectomy 441. LUMBAR SYMPATHECTOMY? removal of L1 to L4 442. How does it help? increases CUTANEOUS blood supply  healing of skin flaps and ulcer level of amputation can be lowered after sympathectomy SYMPATHECTOMY DOES NOT IMPROVE CLAUDICATION 443. Steps of Lumbar Sympathectomy? (SRB p. 160) 444. How to differentiate genitofemoral nerve and the sympathetic trunk during surgery? GFN lies on the anterior aspect of the psoas muscle while sympathetic trunk lies medial 445. How to differentiate lymphatics and Sympathetic trunk? presence of distinct ganglia and the rami communicantes 446. How to asses the success of the surgery? limbs become warm rest pain disappears 447. Bilateral Sympathectomy? Precaution? Preserve L1 on one side, otherwise failure of ejaculation DRY EJACULATION 448. Will you remove theStellate ganglion? Why? No. Horner's Syndrome will be produced. If necessary, the lower portion is removed. 449.  Anatomy of Stellate Ganglion? 450.  Anatomy of Sympathetic Ganglia ? 451.  Structure of Spinal Cord ? 452. Chemical Sympathectomy? 5ml phenol in water (1:16) 453. Precuation during chemical sympathectomy? never inject into aorta or IVC 454. Omentopexy? principle – neovascularisation 455. Endarterectomy? 456. Artificial Dacron? 457. Autograft? saphenous vein used GANGRENE 458. Define gangrene 459. Dry and Wet Gangrene? 460. When do you get Wet gangrene? ▪ sudden occlusion of vessel ▪ both arterial and venous occlusion ▪ supra-added infection 461. How to differentiate Gas Gangrene? crepitations h/o of deep penetrating wound from road traffic accident etc 462. Types of Separation? aseptic and septic 463. FIVE Signs of Gangrene Color Temperature Sensation Pulsation Function (Das p. 68) 464. What is pregangrene? (Das p. 68) 465. Causes of Gangrene? 466. Line of demarcation ? Importance line between viable and dying tissue, marked by a band of hyperemia helps in deciding the level of amputation 467. Features of Arterial Embolism 5 P's – Pain, Paralysis, Pallor, Pulseless, Paresthesia (Bailey p. 910) (Das p. 71) 468. Bed Sore gangrene caused by local pressure (Bailey p. 913) AMPUTATION 469. dead, deadly and dead loss? 470. Why high amputation in Dibetic? 471. Why low amputation in TAO? 472. Types of Amputation? 473. Symes Amputation 474. Wagner's Classification ? 0 – 1 – superficial ulceration 2 – involving deep 3 – muscle involvement 4 – Bone involvement 5– Frank Gangrene RAYNAUDS DISEASE SENILE GANGRENE DIABETIC GANGRENE 475. Why Diabetics prone for gangrene? microangiopathy peripheral neuritis vasculitis ERGOT POISONING LERISCH SYNDROME SUBCLAVIAN STEAL SYNDROME 476. Cervical Rib? 477. Surgeris for Cervical Rib? 478. Adsons Test? 479. Scalenus Anticus Syndrome? 480. Features of Horner's Syndrome Enophthalmos Pseudoptosis Miosis Anhidrosis (Das p. 289) Abdominal Lump (Das pp. 337-384) (Das pp. 413-414) (SRB pp. 653-665) CASE SHEET Diagramatically depict the location of lump in the case sheet HISTORY 481. Pain ? 482. Radiating Pain? Characteristics? 483. Referred Pain? Mechanism? 484. Vomiting? (Das p. 12) INSPECTION Inspect from right, left, foot end, and eyes at the level of abdomen 485. Planes of Abdomen? Name the dividing Lines? 486. Qadrants of Abdomen? 4 quadrants (SRB p. 655) 487. Regions of Abdomen? 9 regions 488. Troisier's Sign? PALPATION 489. Difference between Guarding and Rigidity? 490. How to demonstrate and extra-abdominal swelling? Head raising test 491. Rising Test? 492. Carnett's Test? 493. Transmitted Pulsation? any swelling in front of aorta 494. Expansile Pulsation? aneurysm of aorta 495. How to differentiate the above? two fingers over swelling  fingers will be diverted knee-elbow position 496. Points in favour of a swelling from Liver? ▪ swelling continuous with the enlarged liver ▪ dullness in the swelling is continuous with the liver dullness ▪ not possible to insinuate fingers between costal margin and swelling. 497. Why Liver Absces common on right side? 498. Which side abscess is dangerous? Left, coz it will rupture into the pericardial cavity. INTESTINAL OBSTRUCTION 499. Demosnstrate VGP? give as much fluid as you can to the patient 500. How can you identify the source of GI obstruction from Visible Peristalsis? Stomach – left to right SI – step ladder (below upwards) LI – Right to Left 501. What is the X-Ray feature in intestinal Obstruction? multiple air fluid levels (more than 2) 502. Importance of Catheterisation in Intestinal Obstruction? Around 3L of fluid in the gut  Hypovolemia Catheterisation helps in measuring the urinary output, which reflects the ECF fluid status GASTRIC CARCINOMA 503. Types of gastrectomy? SHORT CASES Hernia HISTORY 504. What do you mean by Groin? 505. Reduces on lying down? What do you understand? that it is a hernia 506. Why do you say it is a hernia? 507. Does not extend to scrotum? meaning? Two possibilities – incomplete inguinal hernia OR femoral hernia 508. Cause of draggin pain? peritoneum gets pulled into the hernia sac 509. Why B&B habits important here? predisposing factors 510. BPH 511. Earliest sign of BPH? increased frequency at NIGHT → disturbed sleep 512. Young patient with micturition difficulty? Probable diagnosis? Stricture Urethra – due to gonococcal infection 513. How to differentiate BPH and Stricture Urethra clinically? BPH – strains more → pass less urine Stricture Urethra – strains more  pass more urine 514. Importance of Vomiting history? suggestive of intestinal obstruction TREATMENT 515. In Bilateral Hernia, will you do surgery on both sides together? No, the large hernia is done first After 4-6 wks the next one is done. 516. ----------------------------- 517. Difference between a compressible and reducible swelling? ▪ Compressible – reduaces partially; eg Hemangioma ▪ Reducible – disappears completely, but reappears on counter pressure; eg Hernia (Das p. 25) 518. Importance of the following in Hernia Case ? Abdominal Examination – to check the muscle tone, helps in chosing Hernioplasty Rectal examination – to detect BPH, chronic straining Chest examination – to detect COPD, chronic cough 519. How does MESH help? mesh induces fibrous reaction around it made of polypropylene 520. Complications of Heria Surgery? ▪ Hemorrhage ▪ Pain & unable to pass urine ▪ Spinal Shock ▪ Spinal Headache – CSF leakage  fall in CSF pressure headache 521. Predisposing factors for Hernia Recurrence? 522. What is Spigelian Hernia? 523. Occult Inguinal Hernia ▪ seen in sportsmen etc ▪ no swelling present 524. Hernia Surgery in Children? In children both the supf and deep rings are at same level Swelling 525. Difference between transmitted and expansile pulsation 526. Difference between Compresible and Reducible Swelling Swelling – Lipoma (Das pp. 17-44) POSITIVE FINDINGS lobulated surface slip sign – positive soft consistency freely mobile compressible but not reducible 527. What is Lipoma? benign tumour from mature fat cells PALPATION 528. Demonstrate Slip Sign? 529. Demonstrate Fluctuation in this swelling? 530. Demonstrate plane of the swelling? 531. How will you make the following muscles taut? Lattisimus Dorsi Trapezius Pactoralis Quadriceps femoris … (Das p. 27) DIAGNOSIS 532. Difference between a benign and malignant swelling? (Das p. 34) 533. Findings in a Malignant transformation? (Das p. 34) 534. Which lipomas undergo malignant chages usually? retroperitoneal lipomas lipomas in thigh, shoulder. 535. Common Sites for a Lipoma? 536. What is Universal tumour? 537. Types of Lipoma? 538. Commonest type ? subcutaneous lipoma 539. Pseudolipoma? 540. Lipomatosis? 541. Fibrolipoma? with excess fibrous tissue 542. Naevolipoma? with dilated blood vessels 543. Neurolipoma? 544. Dercum's Disease/adiposis dolorosa? 545. DD for Lipoma? Neurofibroma Fibroma Sebaceous Cyst Rhabdomyoma 546. Complications of Lipoma? myxomatous degeneration saponification calcification infection ulceration liposarcoma 547. Treatment? excision under GA/LA 548. Precautions during Lipoma Excision? try not to injure the capsule Swelling – Sebaceous Cyst Swelling - Thyroglossal Cyst Swelling - Dermoid Cyst 549. Sites of demoid cysts? Embryology? sites of fusion of embryonic processes eg : post auricular, outer canthus of eye Swelling - Hemangioma Swelling - Ganglion Swelling - Bursitis Diabetic Ulcer (Das pp. 45-54) INSPECTION 550. Zones in an Ulcer (Das p. 47) 551. Margin? JUNCTION between normal epithelium and ulcer 552. Edge? AREA between margin and floor 553. Types of Edges with examples? 554. Sloping edge is seen in ? ▪ healing ulcer ▪ venous ulcer 555. Base? on which the ulcer rests better felt than seen 556. Floor? exposed surface within the ulcer Sinus Marjolin's Ulcer BCC Cervical Lymphadenopathy (Das pp. 80-89) Parotid Tumour (Das p. 268) Carcinoma Cheek (Das pp. 260-268) 557. Neck Dissection? Carcinoma Lip 558. Etiology of this condition? Sunlight exposure 559. How will you manage? 560. Complication of Radiotherapy in this case? Mandibular Necrosis 561. Staging of the Secondaries? 562. Name the various flap surgeries for Ca Lip? Gynaecomastia Umbilical Hernia Femoral Hernia Hydrocele 563. Types of Hydrocele 564. Difference between Congenital and Adult Hydrocele? 565. Demonstrate fluctuation in Hydrocele? do in two planes 566. Demonstrate Transillumination in Hydrocele? 567. Why torch is kept at side? testes will obstruct if kept at back 568. How to differentiate Primary and Secondary Hydrocele? 569. Conditions you get a negative transillumination in Hydrocele? ▪ Haematocele ▪ Pyocele ▪ Chylocele ▪ THICK SAC 570. Principle of Lords Plication? secreting surface is reduced. 571. Principle of Jaboulays Operation? Secreting surface is exteriorized, so scrotal wall will absorb the fluid secreted 572. Layers of Scrotum? ▪ Skin ▪ Dartos ▪ External Spermatic fascia ▪ Creamasteric fascia ▪ Internal Spermatic fascia Varicocele Cellulitis Leg 573. Differentiate Cellulitis and Elephantiasis? 574. Why Fasciotomy done in Cellulitis? Funiculitis    OBSTETRICS & GYNAECOLOGY   Paper 1 – Obstetrics   1 Gravindex Test  FEB-1998 2 Corpus Luteum of Pregnancy  JUL-2008  ANATOMY OF FEMALE REPRODUCTIVE ORGANS   3 Perineal body 10 JUL-2007 JUN-2006  FUNDAMENTALS OF REPRODUCTION   4 Capacitation of Sperms 18  5 Functions of Zona Pellucida 21 637  6 Implantation 23  7 Decidua 24  8 Decidual Cast 24 JUN-2006 9 Chorionic Villi   10 Draw & Label : Structure of Chorionic Villus 25 JUL-2008 JUN-2006 11 Draw & Label : Diagram showing chorionic frondosum, decidua basalia, decidua parietalis and decidua capsularis. 27 MAY-2002  PLACENTA AND MEMBRANES   12 Draw & Label : Placenta and membranes 30 MAY-2002 13 Development of Placenta   14 Functions of Placenta 35  15 Draw & Label : Chorionic Villus 35 APR-2004 16 Amniotic Fluid 37  17 Umbilical Cord 39  18 Draw & Label : Cross section of Umbilical Cord 39 APR-2004  THE FETUS   19 Foetal Circulation  JUN-2006 20 Draw & Label : Fetal Circulation 44 JUL-2007 21 Draw & Label : Transition from foetal to adult type of circulation 45 DEC-2006  PHYSIOLOGICAL CHANGES IN PREGNANCY   22 Braxton Hicks Contraction irregular, infrequent, spasmodic and painless without any effect on dilatation of cervix 47 AUG-2002 DEC-2006 23 Goodell's Sign softening of the cervix 48  24 Breast changes in pregnancy. 49 FEB-1998 25 Pregnancy Mask 50  26 Linea Nigra 50  27 Striae gravidarum 50  28 Weight changes during Pregnancy 1 kg = 2.2 lb (pounds) Total wt gain = 11kg / 24lb 1 + 5 + 5 = 11 50 DEC-2004 JUL-2008 29 Cardiovascular changes in Pregnancy 52 AUG-2002 APR-2000 DEC-2006 APR-2001 30 Changes in the urinary tract during pregnancy 55 DEC-2004 31 Physiological anemia of Pregnancy  MAY-2002 32 ENDOCRINOLOGY IN RELATION TO REPRODUCTION   33 HCG 58 FEB-2002 FEB-2008 34 Significance of beta HCG estimation 61 APR-2004 35 DIAGNOSIS OF PREGNANCY   36 Diagnosis of pregnancy at first ANC  APR-2000 APR-2001 37 Fetilisation Age 280-14 = 266 days   38 Placental Sign scanty cylical bleeding in first trimester until approximation of decidual space   39 Signs of Pregnancy Vagina – bluish – Chadwick's Sign Vagina – pulsation – Osiander's Sign Cervix – soft – Goodell's Sign Uterus – fingers appose – Hegar's Sign Uterus – contractions – Palmer's Sign Breast – colostrum by 12 wks 64 MAY-2002 40 Hegars sign 65 FEB-2008 41 Immunological tests for pregnancy 66  42 Uses of Pregnancy Tests ectopic pregnancy in-vitro fertilization hydatidiform mole choriocarcinoma   43 Quickening perception of active fetal movements by 18wk 68 JUL-2007 44 Draw & Label : The level of fundus uteri at the different weeks of pregnancy 16, 24, 28, 32, 40, 36 69 DEC-2006 45 External Ballotement 69  46 Internal Ballotement 70  47 Uterine Souffle 70  48 Funic Souffle 70  49 DD of Pregnancy Pseudocyesis Cystic Ovarian tumour Fibroid Encysted Peritonitis Distended Bladder 72  50 Absolute signs of Pregnancy Palpation of fetal parts – 20wk Ausculation of fetal heart USG evidence of embryo – 6wk X-Ray evidence of skeleton – 16wk 72  51 Draw & Label : Nulliparous Cervix 72  52 Methods to calculate EDD 73 JUL-2007 53 Naegele's Formula 73  54 Estimation of Gestational Age   55 Estimation of Fetal Weight 74  56 FETUS IN UTERO   57 Lie relationship of the long axis of the fetus to the long axis of the centralized uterus 75  58 Presentation part of fetus which occupies the lower pole of uterus 76  59 Presenting Part part of the presentation which overlies the internal os 76  60 Attitude relation of the different parts of the fetus to one another 76  61 Denominator arbitrary bony fixed point on the presenting part which comes in relation with the various quadrants of the maternal pelvis 76  62 Leopold's Manoevre 79  63 Pawlik's Grip 79  64 Engagement 81  65 FETAL SKULL AND MATERNAL PELVIS   66 Draw & Label : Diameters of Fetal Skull 85 JUL-2008 SEP-2003 MAY-2002 67 Moulding 86  68 Caput Succedaneum 87 FEB-2002 FEB-1998 69 Diameters of Gynecoid Pelvic inlet   70 Draw & Label : Biparietal Diameter  AUG-2002 71 Biparietal diameter  FEB-2008 JUN-2006 72 Draw & Label : Diagonal Conjugate 88 APR-2004 AUG-2002 73 Diagonal Conjugate 88 FEB-2002  ANTENATAL CARE   74 Objectives of Antenatal Care 95 AUG-2002 75 Antenatal Care 95 DEC-2004 76 Booking Scan anomaly scan, 2nd trimester scan   77 Role of folic acid in pregnancy 101 104 209 255 263 343 409 467 DEC-2006 78 Preconceptional Folic acid administration  SEP-2003 79 Tetanus Toxoid administration during Pregnancy 102 APR-2004 80 ANTENATAL ASSESSMENT OF FETAL WELL BEING   81 Triple Test ▪ biochemical test to detect Down's Syndrome ▪ done at 15-18wk ▪ MS-AFP, hCG, and UE3(oestriol) 107  82 Prenatal Genetic Diagnosis ▪ CVS Amniocentesis ▪ COrdocentesis 107  83 Chorionic Villus Sampling (CVS) ▪ prenatal diagnosis of genetic disorders ▪ between 10-12 wks ▪ few villi collected from chorion frondosum under USG guidance ▪ cather introduced transcervically 108  84 Cordocentesis ▪ tapping blood from umbilical vein 108  85 Biophysical Profile (BPP) ▪ DFMC ▪ CTG ▪ NST ▪ BPP ▪ Doppler ▪ CST 109 464  86 Foetal Movement Count ▪ Cardiff Formula ▪ DFMC (Daily Fetal Movt Count) 109 FEB-2002 SEP-2003 87 Cardiff Count 109  88 Gravidogram   89 Cardiotocogram 110  90 Non Stress Test 110  91 Mannning Score 110  92 Draw & Label : NST Normal Pattern  DEC-2004 93 Draw & Label : A reactive nonstress test  FEB-2008 94 NST 110 JUN-2005  NORMAL LABOUR   95 A 22 year old Primigravida with occipito posterior presentation at term: How do you suspect occipito poterior position during clinical examination? Mention possible mechanisms of labour. Complications associated with occipito posterior deliveries.  FEB-2008 96 Normal Labour "series of events that take place in the genital organs in an effort to expel the products of conception out of the womb through vagina into the outer world"   97 Causes of onset of labour 114  98 False Labour Pain/Spurious Labour 116  99 Features of True Labour Pain ▪ painful contractions at regular intervals ▪ increasing in intensity and duration ▪ effacement and dilatation of cervix ▪ show + bag of waters   100 Prelabour changes ▪ 2-3 wks before true labour ▪ Lightning – welcome sign ▪ Cervix ripens 117 FEB-2001 101 Show "expulsion of cervical mucus plug mixed with blood"   102 Stages of Labour FIRST  12hr 6hr SECOND 2hr 30min THIRD  15min 15min FOURTH 1hr 1hr 117 FEB-2008 103 Lower Uterine Segment 120  104 Draw & Label : Stages of dilatation of cervix in primi and multigravida 121 DEC-2004 105 Methods of Placental Separation ▪ Central ▪ Marginal 123  106 Mechanism of Labour 125  107 Engagement define 125 DEC-2004 AUG-2002 108 Asynclitism "deflection of head in relation to pelvis" ▪ Anterior ▪ Posterior 125  109 Crowning "maximium diameter of the head stretches the vulval outlet WITHOUT ANY RECESSION of the head even after contraction is over" 127 137  110 Third Stage of Labour 133 JUN-2005 MAY-2002 111 Complications of Third Stage of labour   112 Write the physiology of third stage oflabour. How do you manage third stage oflabour?  FEB-1998 113 Draw & Label : Stations of Head in relation to ischial spine 134  114 Convulsions in Labour 136 SEP-2000 115 Care of the newborn from birth till discharge from hospital 139 448 APR-2001 116 Management of Third Stage of Labour 140 DEC-2004 117 Brandt Andrew's Method ▪ controlled cord traction 141  118 Fourth stage of Labour 142 AUG-2001 119 Late Decceleration  APR-2004 MAR-2003  NORMAL PUERPERIUM   120 Puerperium define 145  121 Lochia "vaginal discharge during first fortnight" ▪ L rubra ▪ L serosa ▪ L alba 147  122 Physiology of Lactation 149 JUN-2006 123 Contraindications for labour  FEB-2001 124 Suppression of Lactation 150 FEB-2002 APR-2000 APR-2001 125 Rooming in 151  126 Draw & Label : Puerperial Chart   127 Postnatal care 153  128 VOMITING IN PREGNANCY   129 Hyperemesis Gravidarum "incapacitates her in day to day activities" 155 MAY-2002 SEP-2000 DEC-2006 130 Complications of Hyperemesis Gravidarum    HAEMORRHAGE IN EARLY PREGNANCY   131 Abortion define   132 Different types of abortions 159 JUL-2007 133 Causes of First Trimerster Abortion   134 Causes of Second Trimester Abortion   135 Cervical Abortion "abortus accommodated in the cervical canal due to failure of dilatation of external os" 161  136 Threatened Abortion 161  137 Inevitable Abortion 163 APR-2000 APR-2001 138 Missed Abortion 164 DEC-2006 DEC-2004 MAR-2003 DEC-2005 139 Septic Abortion "any abortion associated with clinical evidence of infection" 165 JUL-2008 140 Recurrent Abortion "three or more consecutive spont abortion before 20 wks" 168  141 Habitual Abortion 168 DEC-2004 142 Mullerian Fusion Defects 169  143 Bicornuate Uterus 169  144 Cervical incompetence 169 MAY-2002 145 Explain MTP Law in India? Briefout MTP Methods available to terminate 20wks pregnancy?  FEB-2001 146 Methods of First trimester MTP  FEB-1998 147 Methods of Second Trimester MTP   148 Cervical Encirclage 171 JUL-2008 149 MTP Act of India ▪ upto 20wks 173 AUG-2002 JAN-2002 150 Medical Abortion ▪ Mifepristone 600mg oral (DAY 1) ▪ Misoprostol 400µg oral (DAY 3) 175  151 Second trimester MTP ▪ 13-20wks 176 SEP-2000 152 ECTOPIC PREGNANCY   153 Draw & Label : Different sites of Ectopic gestation ▪ tubal ▪ ovarian ▪ abdominal ▪ cervical ▪ cornual  FEB-2008 154 Tubal abortion ▪ common mode of termination if implantation occurs in ampulla/infundibulum 181 FEB-2008 155 Cervical Pregnancy 193  156 Causes of Ectopic Pregnancy   157 Sequelae of Tubal Pregnancy   158 Criteria for ovarian pregnancy   159 Decidual Cast   160 SAM   161 Treatment of Ruptured Ectopic   162 Medical Management of Ectopic Pregnancy   163 Conservative Management of Ectopic Pregnancy   164 Diagnosis and management of unruptured Ectopic Pregnancy 185 AUG-2001 165 Medical management of ectopic  DEC-2004 166 Conservative surgical procedures in case of tubal ectopic  JUL-2008 167 One Reliable investigation for diagnosis of Ectopic Pregnancy 186 MAR-2003 168 Postmolar Bleeding - SEP-2000 169 Follow up of molar pregnancy.  FEB-1998 JUL-2008 DEC-2004  MULTIPLE PREGNANCY   170 Discordant twins ? JUL-2007 171 Aetiology of Multiple Pregnancy 205 SEP-2003 172 Vanishing Twin 205  173 Complications of Multiple Pregnancy 207 MAY-2002 174 Twin to Twin Transfusion 209  175 Delivery of 2nd of the twins 210 AUG-2002 176 Polyhydramnios ▪ exceeds 2000ml 213 JUL-2007 177 Acute Hydramnios 217 JUN-2006 178 Chronic Polyhydramnios   179 Oligohydramnios ▪ less than 200ml 218 JUL-2007 180 Succenturiate Lobe 219 DEC-2006 181 Placenta Spuria   182 Vasa Praevia 220 260 DEC-2006 SEP-2003 183 Placenta Acreta 420   HYPERTENSIVE DISORDERS IN PREGNANCY   184 Impending signs of Eclampsia 221  185 HELLP Syndrome 224 SEP-2003 186 Antihypertensive therapy in pregnancy 506 DEC-2006 187 Roll over Test ▪ measure BP ▪ side & back position ▪ increase of 20mmHg in DIASTOLIC 229 FEB-2002 SEP-2003 188 A 28 year old primigravida at 30 weeks of gestation was brought to hospital with H/O convulsions Mention differential diagnosis. Relevant investigations. Complications that are expected. Briefly management of a care of Eclampsia at term.  JUL-2007  ANTEPARTUM HAEMORRHAGE   189 "Bleeding from or into genital tract after 28 weeks"   190 What are APH's ? Clinical features, diagnosis and management of one of the commonest type of APH's in different period of gestation?  APR-2001 191 Classification of Placenta Praevia ▪ low lying ▪ marginal ▪ partial central ▪ central   192 DANGEROUS - type II posterior   193 Placenta Praevia – Bleeding at 32 weeks 243 AUG-2002 194 Grading of Abruptio Placenta ▪ Retroplacental Hematoma ▪ Revealed ▪ Concealed ▪ Mixed   195 Couvelaire Uterus ▪ Uteroplacental apoplexy 256 AUG-2001 JUL-2007 196 Indications for caesarean section in Abuptio placenta 259 FEB-2008  MEDICAL & SURGICAL ILLNESS COMPLICATING PREGNANCY   197 ANAEMIA IN PREGNANCY   198 What are the complications of anaemia in pregnancy? How would you investigate a case of anaemia in pregnancy? Discuss the management of anaemia in pregnancy.  FEB-1998 199 Causes of Anemia in Pregnancy 262 DEC-2004 FEB-2002 FEB-2008 200 Treatment of Iron deficiency Anemia in pregnancy  APR-2004 201 Copmlications of Anemia 266  202 Parentral Iron Therapy 269  203 Iron metabolism in Pregnancy  APR-2000 204 Estimation of Iron requirement ▪ 0.3 x W(in pounds) (100-Hb%)mg of elemental iron 269  205 HEART DISEASE IN PREGNANCY   206 Functional grading of Heart Disease in Pregnancy 278  207 Dry Management v/s wet   208 GDM   209 GCT 284 DEC-2004 DEC-2006 JUN-2006 210 Glucose Challenge Tests 284 APR-2004 AUG-2002 211 O Sullivans Blood Glucose Values   212 Gestational Diabetes  FEB-1998 213 Obstetric management of Gestational Diabetes 284 SEP-2003 214 Baby born to Diabetic mother 287 MAY-2002 SEP-2000 215 Placentosis 289  216 Viral Hepatitis in pregnancy 291 FEB-1998 217 Pyelonephritis in pregnancy 296 APR-2004 AUG-2002 FEB-2002 SEP-2003 218 Complications of UTI   219 Asymptomatic Bacteruria ▪ above 105/ml in mid-stream clean catch specimen on 2 occasions, without symptoms of UTI 297 MAR-2003 FEB-2008 JUN-2006 AUG-1998 220 Management of HIV during pregnancy 300 JUL-2007 221 Albuminuria 303 FEB-2002  GYNAECOLOGICAL DISORDERS IN PREGNANCY   222 Trichomonas Vaginalis 306 JUL-2008 223 Fibroids complicating pregnancy   224 Red Degeneration 309 FEB-2002 225 Ovarian tumour in Pregnancy 310 SEP-2000 226 Hematocolpos - JUN-2005 227 Asherman's Syndrome absence of menses because of endometrial scarring or cervical stenosis resulting from injury or disease. - JUN-2005 228 Dysgerminoma A malignant neoplasm of the ovary (counterpart of seminoma of the testis), composed of undifferentiated gonadal germinal cells and occurring more frequently in patients less than 20 years of age. The neoplasms are gray-yellow and firm, contain foci of necrosis and hemorrhage, and tend to be encapsulated; characteristically, they spread by way of lymphatic vessels, but widespread metastases also occur. [dys- + L. germen, a bud or sprout, + G. -bma, tumor] (Stedman) - JUN-2005 229 Fixed Retroverted Uterus 311 FEB-2001  PRETERM LABOUR & IUD   230 Preterm Labour "labour starts before 37 completed wks, counting from first day of last menstrual period" 315 FEB-2002 231 Causes of Preterm labour ▪ activation of HPA axis ▪ UTI ▪ multiple pregnancy 315 APR-2004 232 PROM ▪ PreLABOUR ROM or ▪ PreMATURE ROM   233 Drugs used in PROM   234 PPROM define   235 A 25-year old primigravida with amenorrhoea of 42 weeks not in labour: Describe the methods by which you will confirm postdatism. Complications related to postdatism. Methods of induction. 317 DEC-2006 236 Intraamniotic Saline   FEB-1998 237 Post Maturity 318 JUN-2005 238 Causes of Post term labour   239 Complications of Post term labour 320  240 Causes of Recurrent IUD   241 Term IUD   242 Spalding Sign 324   SPECIAL CASES   243 Requisites for VBAC 329  244 Indications for Recurrent CS   245 Rh Incompatibility 331  246 Isoimmunisation 333  247 Prevention of Rh Isoimmunisation   248 Hydrops Fetalis 333  249 Icterus Gravis Neonatorum 333  250 Kleihauer Count 334 652  251 Indirect Coombs Test 335 338 DEC-2006 252 Liley Chart 336  253 Bad Obstetric History "present obstetric outcome is likely to be affected by the nature of previous obstetric disaster" 343   CONTRACTED PELVIS   254 Gynaecoid Anthropoid Android Platypelloid   255 Draw & Label : Brim of Gynaecoid Pelvis 345 APR-2004 256 Anthropoid Pelvis 346 JUL-2008 257 Android Pelvis 346 JUN-2005 258 Flat Pelvis 348 JUN-2006 259 Internal Pelvimetry 349  260 CPD 352 MAR-2003 261 Munro Kerr Muller Method 353  262 Trial Labour "conduction of spont labour in a moderate degree of CPD, in an institution under supervision" 355  263 Mention the causes of unengaged head at term in a primigravida. How do you manage Trial Labour? 355 AUG-1998  ABNORMAL UTERINE ACTION   264 Incordinate Uterine Action 359 JUL-2008 265 Precipitate Labour "combined duration of 1 & 2 stage is less than 2hrs" 361 SEP-2003 266 Bandl's Ring / Retraction Ring "a groove formed between US and LS" 362 JUN-2005 AUG-2002 AUG-1998 267 Constriction Ring 363   MALPOSITION, MALPRESENTATION AND CORD PROLAPSE   268 A Primigravida at 40 weeks of gestation is admitted with labour pain. The head is mobile. What are the causes for mobile head in a primi at term? What investigations will you do? How will you diagnose occipito-posterior position? How will you manage deep transverse arrest?  JUN-2006 269 Persistant Occipito Posterior 369  270 Mento Posterior   271 Deep transverse arrest "no progress in descent of head even after ½ - 1 hr of full cervical dilatation" 372 SEP-2000 FEB-1998 272 Footling Presentation legs and thighs are partially extended, bring the legs to present at the brim 375 JUN-2005 273 Burn-Marshall technique` delivery of the after coming head 384  274 Mauriceau-Smellie-Veit technique 384  275 Pinard's manoeuvre 386  276 Lovset's Manoever 387  277 Neglected Shoulder   278 Face Poster Position 388 AUG-2001 279 Brow Presentation 392 DEC-2004 280 Mechanism of Delivery in face   281 Transverse lie "long axis of the fetus lies perpendicular to maternal spine/centralized uterine axis" 393 JUL-2008 282 Discuss the aetiology, diagnosis and management of transverse lie.  FEB-1998 283` Cord Prolapse "cord lies inside vagina or outside vulva after membrane rupture" 398 MAY-2002 SEP-2000 284 Cord Presentation "cord is slipped down below the presenting part and is felt lying in the intact bag of membranes" 399  285 Face to pubis delivery  FEB-2001  PROLONGED LABOUR, OBSTRUCTED LABOUR AND DYSTOCIA   286 Shoulder Dystocia 406  287 Hydrocephalus 407 JUN-2005 DEC-2006 288 Anencephaly 408  289 Neural Tube Defects 408  290 Cephalocentesis 408   COMPLICATIONS OF THIRD STAGE OF LABOUR   291 A 3rd gravida just delivered having profuse post partum hemorrhage. Describe predisposing factors for post partum hemorrhage? Management of post partum Hemorrhage? Complications of massive PPH?  JUL-2008 292 Following a term delivery a multiparous woman developed profuse vaginal bleeding. How will you differentiate Atonic and Traumatic PPH? What are the drugs(with dosage) you will utilise if it is an atonic PPH? Name two surgical options for intractable atonic PPH? How will you prevent atonic PPH?  SEP-2003 293 Define Postpartum haemorrhage. (PPH) What are the different causes of PPH ? Outline the management (both prophylactic and therapeutic) of atonic PPH.  SEP-2000 294 POST PARTUM HEMORRHAGE   295 Atonic PPH  APR-2000 APR-2001 296 Treatment of Atonic PPH 413 APR-2004 297 Traumatic PPH   298 Manual removal of placenta. 414 FEB-1998 299 Causes of retained Placenta 419  300 Placenta accrete "placenta directly anchored to myometrium" 420 JUL-2007 JUN-2006 301 Acute inversion of Uterus 421 MAR-2003 FEB-1998  INJURIES TO BIRTH CANAL   302 Draw & Label : Degrees of Perineal tear 423  303 Complete Prineal Tear 422 APR-2004 AUG-2002 JUL-2008 304 Cervical Tear 425 MAR-2003 305 Causes of Rupture Uterus   306 What are the causes of Rupture Uterus? How will you diagnose Rupture Uterus? How do you manage a case of complete rupture? 427 FEB-1998 307 Scar Dehiscence 429 328  308 Evidence of impending Rupture 430   ABNORMALITIES OF PUERPERIUM   309 Define Puerperium. How do you manage Puerperal Sepsis?  AUG-1998 310 Puerperial Fever "rise of oral temp 100.4°F or more on TWO separate occasions at 24hrs apart, within first 10 DAYS following delivery" 433 MAY-2002 SEP-2000 JUL-2007 311 Puerperial Sepsis "infection of the genital tract as a complication of delivery" 433  312 Causes of subinvolution of uterus 437  313 Post Natal Retention of Urine 438 FEB-2002  NEONATOLOGY   314 Management of newborn immediately after delivery 448 AUG-2001 315 Advantages of Breast Feeding 451 JUN-2005 AUG-2001 SEP-2003 316 LBW baby "birth wt < 2500 irrespective of gestational age" 457  317 Pre-term Baby "born before 37 completed wks of gestation"   318 IUGR "birth wt is below the 10th percentile of the average for the gestational age" 462 JUN-2005 319 Assymetric IUGR ▪ 80% ▪ extrinsic to fetus ▪ total cell number is normal ▪ head larger than abdomen ▪ Ponderal Index – low ▪ Eg – reduced utero-placental blood flow 463 APR-2004 320 Foetal distress 469 FEB-2008 AUG-1998 321 Apgar Score 471 MAR-2003 FEB-2002 DEC-2006 322 RDS 474 APR-2001 323 Hyaline Membrane Disease 475  324 Meconium aspiration syndrome. 477 JUL-2007 APR-2001 325 Physiological Jaundice 477 APR-2001 AUG-2001 326 Causes of jaundice in newborn 477 AUG-2001 327 Significance of Meconium stained liquir 477 APR-2004 MAR-2003 328 Neonatal Convulsions 482 FEB-2001 APR-2001 329 What are the various birth injuries in neonate? Explain the causes and treatment of Facial Palsy and Erb's Palsy  APR-2001 330 Draw & Label : Cephalhematomoa 484 JUN-2005 331 Significance of Cephalhematoma 484 MAR-2003 332 Erb's Palsy ▪ 5 & 6 Cranial Nerve Roots are involved 486 SEP-2000 FEB-1998 333 Necrotising Enterocolitis 491 AUG-2001 334 Down's Syndrome 495 APR-2004 MAR-2003 335 Mongolism 495 APR-2001 336 Hydrops Fetalis 497 333 FEB-2001 337 Lumbosacral Meningomyelocele - FEB-2001 338 Nappy Rash - FEB-2001  PHARMACOTHERAPEUTICS   339 1 ml = 15 drops   340 Oxytocin 498 115 MAR-2003 341 Oxytocin Challenge Test 501  342 Oxytocin Sensitivity Test 501  343 Methylergometrine 502 AUG-2001 344 Prostaglandins in Labour 503 115  345 Tocolytic Agent 507 JUN-2005 346 Placental Barrier 511  347 Gestational Clock 511  348 Epidural Analgesia in Obstetrics 516  349 Vaginismus 518  350 INDUCTION OF LABOUR   351 Bishops Score ▪ cervical scoring system [CODE – DLCPS] ▪ Dilatation ▪ Length ▪ Consistency ▪ Position ▪ Station Total Score 13 Favourable Score 6-13 522 AUG-2002 FEB-1998 352 Medical Induction of Labour 522  353 Surgical Induction of Labour 523  354 Controlled ARM 523  355 Artificial rupture of membranes 523 FEB-2008 356 Stripping "digital separation" ▪ release of PG's ▪ Ferguson reflex   357 Draw & Label : Partograph 528 131 JUN-2005 JUN-2006 JUN-2006 358 Partogram 528 131 FEB-2008 359 Ethacridine lactate    CONTRACEPTION   360 Eligible Couple "wives in the reproductive age groups of 15-45yrs who require FP" 531  361 PEARL Index 531  362 Failure of Female Sterilisation 550 SEP-2000 363 No Scapel Vasectomy 551  364 Natural method of Family Planning.  FEB-1998 365 Mechanism of action of Copper-T  FEB-1998  OPERATIVE OBSTETRICS   366 Indication of Dilation and Curettage  AUG-1998 367 Vaccum Extraction 565 DEC-2004 DEC-2006 JUL-2007 368 Advantages of Vaccum over Forceps  MAR-2003 SEP-2000 369 Menstrual Regulation 565  370 Episiotomy 567 JUN-2005 JUN-2006 DEC-2006 DEC-2005 371 RMLE  APR-2004 MAR-2003 372 Draw & Label : One blade of Outlet Forceps 572 FEB-2002 373 Indication for Forceps Delivery 573 JUN-2005 MAY-2002 374 Complications of Forceps Delivery 578  375 Outlet forceps operation 577 FEB-2001 FEB-2008 376 Ventouse Application 579 AUG-2002 377 External Cephalic version. 582 FEB-2008 JUN-2006 378 Internal Podalic Version 583 FEB-2002 SEP-2003 379 Indications for Caesarian Section 588 DEC-2004 FEB-1998 380 Classical CS 590 JUN-2005 JUL-2008 JUN-2006 381 Steps of LSCS 592  382 Management of Previous CS  DEC-2004 383 Internal Rotation  JUN-2006  SPECIAL TOPICS   384 RCH   385 ICDS   386 MMR 602 FEB-2002 387 Causes of Maternal Mortality 602 DEC-2004 388 Perinatal Mortality 602 FEB-2002 SEP-2003 AUG-1998 389 Perinatal Mortality 605 JUL-2008 390 Still Birth   391 Septic Shock 614  392 Amniotic fluid Embolism 628  393 Obstetric causes of DIC 628 MAY-2002 394 High Risk Pregnancy    IMAGING IN OBSTETRICS   395 Amniocentesis 642 336 217 111 107  396 Uses of Ultrasound in Obstetrics 645 MAY-2002 FEB-2001 397 Singers Test 652 AUG-2001  UNALLOCATED   398 First Referral Units  SEP-2003 399 Universal Precautions in Labour Room  SEP-2003 400 Face to Pubis Delivery  JUN-2005 401 Problems of short primi  DEC-2004 402 Acute left ventricular failure  AUG-2002 403 Teenage Pregnancy  AUG-2002 404 Causes of Large for Date Pregnancy  MAY-2002 405 VDRL  MAY-2002 406 Posterior Colpocentesis  FEB-2001 407 Pseudocyesis  DEC-2006 408 Magnesium sulphate in obstetrics.  FEB-2008 409 Chorioamnionitis.  JUL-2007  Practicals LONG CASES Pregnancy Induced Hypertension 575. Deine Pre-Eclampsia? 140/90 mmHg or more with proteinuria after the 20th week 576. What do you mean by MAP? test 577.         Paper 2 – Gynaecology    NOT ALLOCATED   1 Mesntrual Regulation  DEC-2004 2 Ethacridine Lactate  DEC-2004 3 MTP Act of India 173 AUG-2002 JAN-2002 4 Methods of Second Trimester MTP  JAN-2002 5 List the methods of Second Trimester MTP. Explain the procedure of any one of them?  JAN-2002  6 Hysterotomy  DEC-2006 7 Mirena  DEC-2006  ANATOMY OF THE FEMALE PELVIC ORGANS   8 Bartholins Gland 2 DEC-2005 9 Doderlein's Bacillus 7 APR-2004 JUL-2007 10 Vaginal Epithelium    11 Draw & Label : Fallopian Tube 10 APR-2004 12 Draw & Label : Parts of Fallopian tube 10 DEC-2004 13 Female Urethra   14 Pelvic Ureter  1994 1989 15 Pelvic Diaphragm   16 Levator ani 17 1995 1990 17 Pelvic Floor 17 DEC-2004 18 Draw & Label : Cross section of Pelvic Ligaments  JUL-2007 19 Cardinal Ligaments   20 Draw & Label : Attachments of uterosacral ligament 22 AUG-2002 21 Draw & Label : Blood Supply to Uterus  JUN-2006 22 Branches of Internal Illiac   23 Draw & Label : Lymphatic Drainage of Uterus 28 JUN-2005 24 Lymphatic Drainage of Vulva  FEB-1998 25 Draw & Label : Parts of Uterus 7 41 JUL-2007 26 Lymphatic Drainage of Cervix 28 AUG-2002 27 Draw & Label : Female Genital Tract 32 DEC-2005  CONGENITAL MALFORMATIONS OF THE FEMALE GENITAL ORGANS   28 Imperforate Hymen 39 AUG-2002 29 Haematocolpos 39 413 MAR-2003 JUN-2006 DEC-2006 30 Cryptomenorrhoea 40 413 APR-2004 31 Mullerian Duct Anomalies 41   PUBERTY AND MENOPAUSE   32 Precocious Puberty 48 JUN-2005 33 Precocious Menstruation 48  34 Puberty Menorrhagia 50 JUN-2006 35 Climateric 52  36 Symptoms of Menopause 53  37 HRT 55 APR-2004  NEUROENDOCRINOLOGY IN RELATION TO REPRODUCTION   38 Ovarian Steroidogenesis 65  39 Draw & Label : Hypothalamo-Pituitary Ovarian Axis 70   MENSTRUATION   40 Graafian Follicle 77  41 Draw & Label : Graffian Follicle 77 JUN-2005 JUL-2007 MAR-2003 42 Follicular Study - AUG-2002 43 LH Surge 78 85  44 Corpus Luteum 79 DEC-2005 45 Endometrium 81  46 Draw & Label : Endometrium in Secretory Phase 82 FEB-2008 DEC-2005 47 Artificial Postponement of Menstruation Combined pill 2tabs daily OR Norethisterone 5mg twice daily Taken 3-6 days before the expected date Menstruation occurs 2-3 days after stopping the drug 87   EXAMINATION OF A GYNAECOLOGICAL PATIENT   48 Importance of Breast Examination in Gynecology 91 513  49 Pap Smear* 102 JUN-2005 DEC-2006 50 Cornification Index 105  51 Cervical Mucus study 106 224  52 Post Coital Test 106  53 Colposcopy 107 DEC-2005 54 Fern Test 106 1989 55 Ultrasound in Gynaecology 108 JUL-2007 56 Culdocentesis 111  57 Diagnostic Laparoscopy in Gynecology 112 1995  58 Second look Surgery 112   PELVIC INFECTION   59 Discuss the clinical features diagnosis and management of a case of Pelvic inflammatory disease 118 AUG-1998 60 Stages of PID 119  61 Management of PID 122   Tuberculous lesions in Fallopian Tube 129  62 HSG findings in TB Fallopian tube lead pipe tubes tobacco pouch appearance 132   SEXUALLY TRANSMITTED DISEASES   63 Gonorrhea 138  64 LGV ▪ Chlamydia trachomatis ▪ painless papule/pustule which breaks down  abscess 142  65 Granuloma Inguinale ▪ Donovan bodies 142  66 Bacterial Vaginosis ▪ creamy vaginal discharge with fishy smell ▪ Clue Cells 142 DEC-2004 67 Genital Herpes 143 MAR-2003 68 Condyloma Accuminatum ▪ HPV type 6 & 11 ▪ paint with 20% PODPHYLLIN resin in liquid paraffin 146  69 Molluscum Contagiosum 147   INFECTIONS OF THE INDIVIDUAL PELVIC ORGANS   70 Bartholin's Cyst 152 APR-2004 FEB-1998 71 Marsupialisation 152 MAR-2003 72 Vaginitis Trichomonas Vaginalis (TV) ▪ strawberry cervix 153 AUG-2002 JUN-2006 AUG-1998 73 Draw & Label : Trichomonas Vaginalis ▪ undulating membrane ▪ 4 flagellae ▪ axostyle ▪ nucleus 153 101 APR-2004 MAR-2003 74 Candidiasis 154 101  75 Monilial Vaginitis ▪ Candida Albicans 154 DEC-2006 JAN-2002 76 Draw & Label : Monilia 101  77 Senile Vaginitis 155 FEB-2008 JAN-2002 78 Toxic Shock Syndrome ▪ use of vaginal tampon    79 Chronic Cervicitis ▪ commonest lesion in gynec OP ▪ infection of endocervix 157  80 Pyometra ▪ collection of pus in the uterine cavity CAUSES ▪ infection of lochia ▪ Ca uterus, cervix ▪ senile endometritis ▪ tb endometritis 159 APR-2004 DEC-2006 81 Hydrosalpinx ▪ collection of mucus secretion in the fallopian tube ▪ repeated endosalpingitis 161 JAN-2002 82 Salpingitis Isthmica Nodosa 163 130 JAN-2002 83 Pelvic Abscess ▪ encysted pus in the POD 165   DYSMENORRHOEA AND OTHER DISORDERS OF MENSTRUAL CYCLES   84 Dysmenorrhoea ▪ "painful menstruation of sufficient magnitude so as to incapacitate day to day activities" 168 DEC-2004 85 Spasmodic Dysmenorrhoea ▪ seen in adolescents ▪ no identifiable pelvic pathology ▪ Mefenamic acid 250-500mg ▪ Ibuprofen 400mg ▪ Surgery – Cervical Dilatation 168  86 Congestive Dysmenorrhoea ▪ seen in thirties ▪ presence of pelvic pathology 171  87 Ovulation Pain ▪ Mittelschmerz's Syndrome 172 AUG-2002 88 Premenstrual Syndrome ▪ psychosomatic disorder of unknown etiology, prior to menstruation 172 FEB-2008  ABNORMAL MENSTRUAL BLEEDING   89 55yr old obese, hypertensive and diabetic lady complaining of bleeding per vaginum. What is the most probable diagnosis? Discuss the clinical features of that condition? Discuss one reliable investigation for diagnosing the condition? What are the steps of abdominal hysterectomy?  AUG-2002 90 A 45 year old lady with Menorrhagia: 1 History you elicit to arrive at diagnosis. 2 Differential diagnosis. 3 Investigations. 4 How will you manage a case of fibroid uterus?  JUL-2007 91 MENORRHAGIA POLYMENORRHOEA METRORRHAGIA OLIGOMENORRHOEA HYPOMENORRHOEA   92 Causes of Menorrhagia 175  93 Metrorrhagia irregular acylic bleeding Causes of Metrorrhagia 176 FEB-2008 FEB-2001 94 What are the common causes of Metrorrhagia? Explain clinical features, investigations and management of one of the common condition in a 40yr old multiparous woman coming with metrorrhagia?  JAN-2002 APR-2000 95 DYSFUNCTIONAL UTERINE BLEEDING   96 Endometrial findings in DUB 177  97 Classification of DUB ▪ ovular & anovular bleeding 177  98 DOC in Ovulatory Menorrhagia   99 Management of DUB 177  100 Cystic glandular Hyperplasia Metropathia Hemorrhagica 178 AUG-2002 101 Cystic glandular Hyperplasia in a woman aged 33yrs 178 FEB-2001 102 Draw & Label : Endometrium in Cystic Glandular Hyperplasia ▪ swiss cheese appearance 179 DEC-2006 103 Endometrial Ablation ▪ Laser ▪ TCRE ▪ Roller Ball 183 564   DISPLACEMENT OF THE UTERUS   104 A 52 year old postmenopausal lady with mass per vaginum. Discuss. 1 Relevant history you would ask. 2 Differential diagnosis. 3 Investigations. 4 Describe, briefly the steps of Fothergill's operation  FEB-2008 105 Symptoms of Retroversion ▪ "long axis of corpus and cervix are in same line" ▪ Chronic pelvic pain ▪ Bakache ▪ Dyspareunia ▪ Infertility 188  106 Pessary Test ▪ Hodge-Smith pessary 188  107 Supports of Uterus Upper Tier ▪ Round Lig ▪ Broad Lig Middle Tier ▪ Transverse Cerv Lig ▪ Uterosacral Lig ▪ Pubo-cerv Lig Inferior Tier ▪ musculofacial tone of vagina 190 JUN-2005 JUN-2006 108 Nulliparous Prolapse - FEB-1998 109 Draw & Label : Various degrees of Prolapse of Uterus ▪ 1 - ext os inside vaigna ▪ 2 – uterus body inside vagina ▪ 3 – uterus body outside the introitus 194 JUN-2006 110 Procidentia 194 APR-2004 111 Decubitis Ulcer ▪ diminished circulation 274 194 JUN-2006 112 Cystocele 195 AUG-1998 113 Draw & Label : Cystocele 195  114 Diagnosis and Treatment of Cystocele 192 195 198 JAN-2002 115 Rectocele 196 AUG-2002 116 Draw & Label : Rectocele   117 Ring Pessary 198 585 FEB-2008 118 Fothergill's Operation 203 JUN-2006 JAN-2002 119 Steps of Vaginal Hysterectomy 205  120 Le Fortes Repair 207  121 Sling Surgery for Prolapse 208   INFERTILITY   122 Causes of Male Infertility 212 FEB-2001 123 A 24yr old woman married for 5yrs with infertility. How will you investigate the male partner? ▪ Routine Blood & Urine ▪ Semen Analysis ▪ Serum Testosterone, FSH, LH, Prolactin, TSH ▪ Testicular Biopsy ▪ TRUS ▪ Karyotype ▪ Immunological Tests Describe one test to diagnose ovulation? ▪ BBT ▪ Cervical Mucus Study Desribe briefly two treatment orotocols if she is found to have anovulation? How will you treat her if she is having bilateral tubal block?  APR-2004 124 Discuss the clinical features, investigations and treatment of female infertility?  JAN-2002  125 How do you investigate a couple for primary infertility?  FEB-1998 126 Semen Analysis 217 MAR-2003 127 Draw & Label : Structure of Spermatozoon - FEB-2008 128 Azoospermia 218 AUG-2002 129 Effective Sperm Count   130 Tests for Ovulation 220  131 Tests for Tubal patency ▪ Rubin's Test ▪ HSG* ▪ Laparoscopy ▪ SonoHSG ▪ Falloposcopy ▪ Salpingoscopy 223  132 Cervical Mucus in infertility ▪ SCMCT ▪ mid-cycle cervical mucus + semen ▪ penetration of spem on shaking movements 224 1994 1992 133 Induction of Ovulation ▪ Clomiphene ▪ hMG ▪ FSH ▪ hCG ▪ GnRH SURGERY ▪ Wedge Resection … 229 JAN-2002 134 Artificial Insemination 234  135 IVF 235  136 GIFT ▪ Gamete Intra-Fallopian Tube Transfer 237  137 ZIFT ▪ Zygote Intra-Fallopian Tube Transfer 238  138 ICSI ▪ Intra Cytoplasmic Sperm Injeciton 238   BENIGN LESIONS OF THE VULVA AND VAGINA   139 Types of Vulval Dystrophies ▪ Lichen Sclerosis 242  140 Gartner's Cyst ▪ retension cyst in remnants of wolfian duct ▪ anterolateral wall of vagina ▪ DD - Cystocele 246 196 48  141 Vulvodynia ▪ burning sensation over vulva 247   BENIGN LESIONS OF THE CERVIX   142 Carcinoma insitu Cervix  MAR-2003 143 Cervical Erosion ▪ "squam epith of ECTOcervix is replaced by colum epith, which is continuous with ENDOcervix" 248 1992 144 Cervical Ectopic 248 JUL-2007 145 Ectropion 250 157  146 Cervical Tear 250  147 Nabothian follicle ▪ multiple ▪ blockage of cervical gland mouths 250 157   BENIGN LESIONS OF THE UTERUS   148 A 35 year old nulliparous lady comes with HlO menorrhagia, dysmenorrhoea and-mass abdomen (a) What are the differential diagnosis? (b) How will you evaluate the lady? (c) What is the most probable diagnosis? (d) How will you manage this condition?  JUN-2006 149 What are the clinical features of fibroid uterus? Discuss the investigations and treatment of fibroid uterus in a 30yr old nulliparous married lady?  JAN-2002 150 Draw & Label : Common sites of origin of Fibroid Uterus 253 DEC-2004 151 Draw & Label : Diagram of Uterus with various tyes of Fibroids 253 DEC-2006 152 Changes in fibroids CODE - DANIVS ▪ Degeneration ▪ Atrophy ▪ Necrosis ▪ Infection ▪ Vasular changes ▪ Sarcomatous changes 256  153 Red Degeneration ▪ carneous degeneration ▪ necrobiosis ▪ raw-beef appearance ▪ fishy odour 256 DEC-2004 154 Complications of Fibroids ▪ Degeneration ▪ Haemorrhage ▪ Necrosis ▪ Infection ▪ Torsion ▪ Sarcomatous changes ▪ Polycythemia 257  155 Cervical Fibroids 264  156 Fibroid Polyp ▪ extrusion of submucous fibroid into uterine cavity ▪ confused with uterine inversion 267 MAR-2003 157 Cervical Polyp 267   BENIGN LESIONS OF OVARY    Functional Cyst of Ovary ▪ < 5cm ▪ regresses spontaneously ▪ Unilocular ▪ clear fluid ▪ lined by fn epithelium of the unit 270 FEB-1998  Follicular Cyst of Ovary ▪ commonest fn cyst ▪ multiple ▪ hyper-estrinism ▪ follow up for 3 months ▪ OCP  regress 270 FEB-2008  Write the differential diagnosis of mass per Abdomen. How do you manage a case of Benign Ovarian Cyst?  AUG-1998  Lutein Cyst of Ovary ▪ bilateral ▪ excess hCG secretion (GTN) ▪ lined by theca lutein cells ▪ spont regression 271   WHO Classification of Ovarian tumour ▪ Epithelial ▪ Sex Cord ▪ Germ Cell ▪ Lipid Cell ▪ Gonadoblastoma ▪ Unclassified ▪ Secondary Mets 272   LMP tumours -   Brenner tumour 272   Mucinous Cystadenoma Ovary 272   Serous Cystadenoma Ovary 273   Dermoid Cyst 274 FEB-2008 JUN-2006 DEC-2005 JAN-2002  Teratoma Ovary 274   Struma Ovarii ▪ predominant thyroid tissue  hyperthyroidism 275   Complications of Ovarian Tumours 279   Decubitis Ulcer 274 194 JUN-2006  Meig's Syndrome ▪ Ascites + Hydrothorax (rt) ▪ + Ovarian tumour 277 AUG-2002  Pseudomeig's Syndrome ▪ Ascites + Hydrothorax 277   Pseudomyxoma Peritonei ▪ mucinous ascites ▪ assoc with mucinous cystadenoma ovary  spont perforation 280 FEB-2008  Surgical Treatment of Ovarian Tumour 281 JAN-2002   Ovarian Cystectomy 281 DEC-2006  Bordeline ovarian tumours 282   Parovarian Tumours 282   Staging Laparotomy -   Management of Twisted Ovarian Cyst - 1987  ENDOMETRIOSIS AND ADENOMYOSIS   158 A 65 y:ear old lady is admitted with HlO bleeding per vaginum : . (a) How will you clinically arrive at a diagnosis ? (b) What are the differential diagnosis? (c) What are the investigations you will do ? (d) How will you manage early care of Ca endometrium? 285 DEC-2005 159 A 60yr old lady is admitted with progressive distension of the abdomen and loss of weight of short duration. What are the differential diagnosis? What clinical features help you to diagnose the condition? What are the investigations? How will you manage the case? 285 MAR-2003 160 ENDOMETRIOSIS   161 "presence of fn endometrium in sites other than uterine mucosa"   162 Theories of Endometriosis ▪ Retrograde menstruation ▪ Coelomic metaplasia ▪ Direct implantation ▪ Lymphatic theory 285  163 Chocolate Cyst of Ovary ▪ endometriotic implant on ovary ▪ rupture  thick, tarry material 288 APR-2004 JUL-2007 FEB-2001 164 Management of Endometriosis 290  165 Danazol 291 483 DEC-2004 MAR-2003 166 Adenomyosis ▪ "ingrowth of endometrium into myometrium" 293 603 DEC-2005  PREMALIGNANT LESIONS   167 VIN ▪ Vulval Intraepithelial Neoplasia 297  168 CIN III ▪ whole thickness except one or two superficial layers 299 APR-2004 AUG-2002 169 LLETZ ▪ Large loop excision of the transformation zone 306   GENITAL MALIGNANCY   170 Staging of Carcinoma Cervix 318  171 Radiotherapy for Ca Cervix  1992 1993 172 Endocervical Carcinoma   173 VIA   174 A 45yr old lady with c/o post coital bleeding. How will you evaluate her? What are the common causes of such complaints? What is the etiology of CA Cervix? How will you manage CA in situ Cervix?  DEC-2004 175 A 40 year old lady with postcoital bleeding. Discuss (a) Differential diagnosis. (b) Investigations. (c) Treatment options available in a case of carcinoma cervix stage II A.  DEC-2006 176 What are the causes of post menopausal bleeding? Discuss the clinical features of Ca Cx? How will you investigate and treat a case of Ca Cx Stage I ?  JAN-2002 177 Schiller's Test 320 JUL-2007 1991 178 Discuss the pre-disposing factors and management of endometrial carcinoma.  FEB-1998 179 Staging of Endometrial Cracinoma 330 1989 180 Draw & Label : Microscopic structure of Hydatidiform Mole 335 AUG-2002 181 Invasive Mole 336 JUN-2005 APR-2004 182 Choriocarcinoma 336 591 JUN-2006 183 Follow up in a case of Vesicular Mole -  184 Check Curettage -  185 MAC Regime 339  186 Suburethral Nodule -  187 Sarcoma Botryoides 342  188 Krukenberg Tumour ▪ metastatic tumour from stomach, breast, LIntestine to ovary ▪ retrtograde lymphatics ▪ signet ring appearance 345  189 Management of Ca Ovary Stage 1 350 1981 190 CA 125 350 477 FEB-2001  Dysgerminoma 352  191 Endodermal Sinus Tumour 354 MAR-2003 192 Granulosa cell tumour 355   URINARY PROBLEMS IN GYNAECOLOGY   193 Supports of Bladder 361  194 Stress Urinary Incontinence 366 JUL-2007 195 Urodynamics 368  196 Kelly's Plication 371 JUL-2007 197 Causes of Urinary retension in females 377 1993 198 Urethral Syndrome ▪ chronic form of urethritis ▪ dysuria, frequency & urgency 379  199 Urethral Caruncle 382   GENITAL FISTULAE   200 Vaginal Fistula 385  201 Vesicovaginal Fistula 386 DEC-2006 202 Three Swab Test ▪ to differentiate ▪ URETERO-vaginal ▪ URETHRO-vaginal ▪ VESICO-vaginal 387  203 Flap splitting Operations 393 1989  GENITAL TRACT INJURIES   204 Classification of Perineal Tear 395  205 Complete Perineal Tear 395 DEC-2006 206 Post coital tear 399   INTERSEX   207 Down's Syndrome - FEB-2008 208 Hermaphroditism 407  209 Pseudohermaphroditism -  210 Turner's Syndrome 405 APR-2004 JUL-2007 211 Androgen Insensitivity Syndrome 406 FEB-2008  AMENORRHOEA   212 Cryptomenorrhoea ▪ menstrual blood fails to come out from the genital tract CAUSES ▪ imperforate hymen ▪ vaginal septum ▪ vaginal atresia (upper third) … 413 40  213 Haematocolpos 39 413 MAR-2003 JUN-2006 DEC-2006 214 Primary Amenorrhoea ▪ "not menstruated by 16 yr"   215 Rokitansky Mayer Kuster Flauser syndrome 416 DEC-2006 216 Secondary Amenorrhoea 419 421 DEC-2005 217 Polycystic Ovarian Syndrome (PCOD) ▪ Stein Levinthal Syndrome 421 DEC-2004 JUL-2007 218 Asherman's Syndrome ▪ uterine synechiae formation after uterine curettage ▪ honey-comb appearance on HSG 421 432 602 130  219 Premature Menopause 425 57  220 Anorexia Nervosa 426 MAR-2003 221 Congenital Adrenal Hyperplasia (CAH) 427 404   CONTRACEPTION   222 Femilon -  223 Pearl Index - FEB-2008 224 Nonoxynol 9  DEC-2006 FEB-2001 225 Bromocriptine 432  226 Today Vaginal Sponge 437  227` Natural Methods of Family Planning 438 DEC-2006 228 Billings Cervical mucus method - JUL-2007 229 Conventional Contraceptives 436 JAN-2002 FEB-2001 230 Condoms ▪ polyurethane / latex ▪ 14/HWY 436 JUN-2006 231 Female Condom ▪ polyurethane ▪ 15cm ▪ 21/HWY 438 AUG-2002 232 Femshield ▪ female condom 438  233 IUCD ▪ 0.1 – 2/HWY 439 462 JUN-2005 234 Translocated IUCD  1988 1992 235 Copper T  FEB-2008 236 Insertion technique of Copper T 439 APR-2004 237 Progestacert 440  238 Post IUCD thread not seen 443 FEB-2001 239 Hormonal Contraception ▪ 0.1/HWY 445 DEC-2004 240 OCP 445 DEC-2005 241 Contraindications for OC Pills 446 JUN-2005 FEB-2001 242 Non Contraceptive Benefits of OCP 448 JUL-2007 243 Triphasic Pill 450 AUG-2002 JAN-2002 244 Progestin Only Pill 450 FEB-2008 245 Male Pill  FEB-2001 246 Depoprovera 451  247 Injectable Contraceptives 451 JUN-2006 248 Norplant 451 MAR-2003 AUG-2002 249 Post natal Contraception Method  FEB-2001 250 Emergency Contraception 452 JUN-2005 APR-2004 251 Interceptives 453  252 Vasectomy 453 DEC-2004 JAN-2002 253 Tubectomy 455 JUL-2007 DEC-2005 254 Modified Pomroy's method of Sterilisation 455 MAR-2003 255 Minilap Sterilisation 456  256 Medical Tubectomy  JAN-2002 257 Laparoscopic Sterilisation 457 DEC-2005 258 Complications of Laparoscopic Sterilisation 457 1992 1989 1990 259 Post Partum Sterilisation 460 JAN-2002 260 Centchroman ▪ Ormeloxifine ▪ CDRI, Lucknow ▪ 30mg twice a wk Saheli 461 APR-2004 JAN-2002 261 Medical Abortion - JUN-2005 JUN-2006 DEC-2005  RADIOTHERAPY CHEMOTHERAPY IMMUNOTHERAPY GENETHERAPY IN GYNAECOLOGY   262 Brachytherapy 465  263 After loading technique   264 EMACO Regime   265 Methotrexate 471 474 JAN-2002 266 Tumour Markers 477   HORMONES IN GYNAECOLOGICAL PRACTICE   267 Ovarian Hyperstimulation Syndrome (OHSS) 482  268 HCG 482 477 230 JUN-2006 DEC-2006 269 Danazol 483  270 Uses of Estrogen Preparations 485  271 Adverse effects of Estrogens 485  272 SERM 486  273 Clomiphene Citrate 486 JUN-2005 JUN-2006 274 Tamoxifen 487  275 Uses of Progesterone 487  276 Norethisterone 488  277 Mifepristone 490 APR-2004 278 Ru 486 490 MAR-2003 279 Antiandrogens 491   SPECIAL TOPICS   280 Leucorrhoea 503 JUL-2007 281 Discuss the differential diagnosis of Discharge PV ? What is the diagnosis and treatment of such discharge with itching in a young woman of 23 years?  FEB-2001 282 Pruritis Vulvae 505  283 Pruritis Ani 505 FEB-2008 284 Pelvic Pain Syndrome 507  285 Post Menopausal Bleeding 511  286 Uterine Perforation 516  287 Causes of Nipple Discharge 518  288 Dyspareunia   289 Virilising Tumour 521  290 Hirsutism 521   OPERATIVE GYNAECOLOGY   291 Dilatation and Curettage 533  292 Fractional Curettage - 1995 1992 293 Hysterosalpingogram (HSG) 536 599 JUL-2007 DEC-2005 AUG-1998 294 Biopsy Cervix 536 JUN-2006 295 Cone Biopsy 537 JUN-2005 296 Types of Abdominal Hysterectomy 541  297 Steps of Abdominal Hysterectomy   298 Myomectomy 551 MAR-2003 299 Bonney's Test 551   ENDOSCOPIC SURGERY IN GYNAECOLOGY   300 LAVH 561 FEB-2008 301 Hysteroscopy 562 112 DEC-2004 DEC-2005 JUN-2005  PRACTICAL GYNAECOLOGY   302 Speculoscopy 566   PEDIATRICS 1 A 5yr old boy is admitted with fever, cough and edema. He had oen episode of edema earlier also and was on some medication. What is the probable diagnosis? What investigations will you order? What treatment will you give? What are the likely complications?  JUN-2005 2 A 5•year old child is brought with bleeding gums. She also has irregular fever, tiredness and body pain for the last 3 months. What is the probable diagnosis? What physical examination findings will you look for? What investigations will you order? What are the differential diagnosis ?  DEC-2004 3 Anterior Fontanelle  FEB-2001 4 Juvenile Delinquency  JUN-2006 5 Kernig Sign  FEB-2002 6 Clinical features of Kernicterus  FEB-2002 7 Danger Sings in the New born  FEB-2002 8 NORMAL GROWTH   9 Define Growth net increase in size or mass of tissues 1  10 Define Development maturation of functions 1  11 Factors affecting Growth and Development  MAY-2002 JUL-2008 12 Laws of Growth 3  13 Perinatal Period 22wks to 7 days after birth 3  14 Toddlers 1-3 yrs 3  15 Primary Dentition 4 JUN-2006 MAR-2003 16 Lean Body Mass fat free components like muscle tissue, internal organs and skeleton 4  17 Head Circumference ▪ occipital protuberance to supra-orbital ridges ▪ crossed tape method 5 AUG-2002 FEB-2002 18 Midarm Circumference midway between tip of acromion process of scapula to olecranon of ulna 5 64 AUG-2001 19 Z Score   20 DISORDERS OF GROWTH   21 SHORT STATURE   22 Define Short Stature ht below 3rd centile or more than 2 SD below the median height for that age and sex according to the population standard 17  23 Causes of Short Stature ▪ undernutrition ▪ chronic systemic illness ▪ GH deficiency ▪ Hypothyroidism… 18 FEB-2008 24 MPH Mid-Parental Height 18  25 SMR Sexual maturity rating 18  26 Management of Short Stature ▪ counseling ▪ dietary advice ▪
℞ renal tubular acidosis/celiac disease ▪ limb lengthening procedures ▪ levethyroxine in hypothyroidism ▪ subcut GH in GHDeficiency   27 Define Failure to Thrive (FTT) physical growth is significantly less than theit peers of same age and sex infants and children upto 5 yrs 21 DEC-2005 28 A 1 ½ year old child is brought with failure to thrive, difficulty in breast feeding and recurrent respiratory infections.O/E there is a pansystolic murmer in the lower left sternal border. What is the probable diagnosis? How will you investigate the child? How will you treat this child? What are the complications of this condition?  FEB-2008 29 NORMAL DEVELOPMENT   30 Define Development maturation of functions 1  31 Developmental Milestones of a 4 month old baby GROSS MOTOR ▪ neck holding – 3 months FINE MOTOR ▪ reaching out for abjects with both hands (bidectrous reach) – 4 months SOCIAL ▪ social smile – 2 months ▪ recognizes mother – 3 months LANGUAGE ▪ alerts to sound – 1 month ▪ coos – 3 months  JUN-2005 32 Developmental Milestones of 7 month old infant GROSS MOTOR ▪ neck holding – 3 months ▪ sitting with support – 6 months FINE MOTOR ▪ reaching out for abjects with both hands (bidectrous reach) – 4 months ▪ unidextrous reach – 6 months SOCIAL ▪ social smile – 2 months ▪ recognizes mother – 3 months LANGUAGE ▪ alerts to sound – 1 month ▪ coos – 3 months 27 28  33 Developmental Milestones of 10 month old baby  JUN-2006 34 Developmental Milestones of 1 year old 27 28 DEC-2004 35 Developmental Milestones of 2 year old 27 28 DEC-2005 36 Developmental Milestones of 3 year old 27 28  37 Pincer Grasp 28 AUG-2002 38 Four Causes of Global Developmental Delay 31 JUL-2007 39 Developmental Quotient 32  40 DEVELOPMENTAL DISORDERS   41 Enuresus ▪ urinary incontinence ▪ after 4yr daytime ▪ after 6yr nighttime ▪ after 3 months of dryness ▪ wetting twice a wk for 3 consecutive months ▪ Normal Bladder Control – 5yr CLASSIFICATION ▪ Primary ▪ Secondary ▪ Nocturnal ▪ Diurnal 35 DEC-2004 42 Breath Holding Spells ▪ anger  crying  apnoea & cyanosis ▪ highly pampered children ▪
℞ - Iron Supplementation, 3mg/kg/day 37 AUG-2002 DEC-2005 43 Attention Deficit Hyperactivity Disorder 38 JUN-2005 44 Dyslexia ▪ poor word decoding abilty ETIOLOGY ▪ genetic – 50% MANAGEMENT ▪ remediation approach ▪ taught in small groups 39  45 Stuttering Spasmodic repetition of some syllables with pauses MANAGEMENT ▪ reassure that it resolves on its own,if 2-5yr ▪ speech therapist 39  46 Autism ▪ commonest of PDD's ▪ impairment in verbal and non-verbal communication ▪ imaginative activity ▪ social interactions ETIOLOGY ▪ genetic CLINICAL FEATURES ▪ poor eye contact ▪ delayed speech ▪ stereotypical body movements ▪ seizures DIAGNOSIS ▪ by 18 months MANAGEMENT ▪ intensive behavioral therapy 40 DEC-2005 47 Munchausen Syndrome 40  48 ADOLESCENT HEALTH AND DEVELOPMENT   49 ▪ Adolescent – 10 – 19 yr ▪ Youth – 15 – 24 yr   50 AFHS 46  51 Complications of Prematurity  JUL-2007 FEB-2001 52 FLUID AND ELECTROLYTE DISTURBANCES   53 Hyperkalemia CAUSES ▪ renal failure… MANAGEMENT ▪ moderate – glucose-insulin infusion ▪ severe – calcium gluconate i.v 53 JUL-2007 54 NUTRITION   55 Essential Amino Acids ▪ LILMPTTV ▪ Histidine and Arginine are essential during infancy. 57  56 Reference Proteins 57  57 Biological Value of Proteins 57 DEC-2004 58 Digestibility Quotient of Proteins 57 JUN-2005 59 Net Protein Utilisation (NPU) 57 JUN-2006 60 Chemical Score of Protein ? DEC-2005 61 Complimentary action of Protein   62 PUFA   63 Phrynoderma ?  64 Omega 3 Fatty Acids 59  65 Dietary Fibre 60  66 Balanced Diet 60 DEC-2005 67 IAP Grading of Nutritional status in <5yr   68 Difference between Stunting and Wasting 62  69 Wellcome classification in PEM   70 WHO Classification of Malnutrition ▪ wt, ht & edema ▪ moderate - -2 to -3 ▪ severe - < -3 63  71 IAP Classification of Malnutrition ▪ 50th percentile of Harvard standards ▪ weight for age 63 FEB-2008 72 Grading of Marasmus   73 Constant features of Kwashiorkar 67 MAR-2003 MAY-2002 FEB-2001 74 SEVERE MALNUTRITION   75 Complications of Severe Malnutrition 68 JUL-2007 76 National Nutritional Policy ▪ ICDS  anganwadi  six services ▪ Mid-day Meals Prog ▪ National Nutritional Anemia Control Prog   77 Weaning  AUG-2001 78 Weaning food in PEM   79 MICRONUTRIENTS IN HEALTH AND DISEASE   80 Antioxidants 78 DEC-2004 AUG-2002 81 Sources of Vitamin A Shark & Cod Liver Oil, Carrots, Dark green leafy vegetables, squash, oranges, tomatoes. 79  82 Functions of Vitamin A ▪ Vision ▪ Maintainence of epithelial tissues 79  83 WHO Classification of Xerophthalmia 79 JUN-2006 84 Draw & Label : Bitot's Spots - MAR-2003 85 Koplik's Spots - FEB-2002 86 Hypervitaminosis A ▪ > 50,000 IU/day ▪ fatigue, malaise, anorexia, vomiting, headache and diplopia 79  87 Carotenemia 80  88 Treatment of Vitamin A deficiency ▪ ORAL ▪ <6m – 50,000 IU ▪ 6-12m – 1 lakh ▪ >1yr – 2 lakh ▪ repeated next day and 4 wks later ▪ PARENTRAL ▪ <6m – 3/4th dose ▪ 6-12m – ½ dose 80  89 Vitamin A Prophylaxis ▪ less than 3 yrs only ▪ 9m – 1 lakh (with measles) ▪ 15m – 2 lakh (with DPT booster) 80 AUG-2002 90 Metabolism of Vitamin D 81  91 Draw & Label : Active Rickets 82 AUG-2002 92 Clinical features of Rickets 82  93 Rachitic Rosary 82  94 Radiological changes in Rickets 82  95 Treatment of Rickets ▪ oral, single dose, 6 lakh IU OR ▪ 60,000 IU for 10 days  400 IU / day 83  96 Causes of Rickets ▪ Familial Rickets ▪ Nutritinal Rickets ▪ Renal Tubular Acidosis ▪ Chronic Kidney Disease ▪ ONcogenous Rickets ▪ Metaphyseal Dysplasia ▪ Fluorosis 83 DEC-2005 97 Classification of Rickets ▪ Familial Rickets ▪ Nutritional Rickets 83  98 Vitamin D resistant Rickets 83  99 Role of Vitamin E ▪ co-factor in … glutamic acid  glutamate 85 DEC-2004 100 Hemorrhagic disease of New Born ▪ GI bleeding in the 1st week ▪ seen in breast fed infants ▪
℞ - 0.5 – 1.0 mg im at birth  1 mg every week 86  101 Beriberi ▪ def of Vitamin B1 ▪ cardiomegaly, cyanosis, dysnoea, aphonia ▪ three forms – dry, wet, acute ▪ breast fed infants of thiamine deficient mothers 87  102 Riboflavin Deficiency/Ariboflavinosis ▪ photophobia, glossitis, angular stomatitis, seborrhoec dermatitis, corneal vascularisation, cataracts 87  103 Pellagra ▪ 3 d's ▪ Dermatitis, Diarhoea, Dementia ▪
℞ - Oral 'Nicotinamide' 88  104 Infantile Scurvy/Barlow's Disease 91  105 Scorbutic Rosary 91  106 Role of Zinc 92 DEC-2005 107 Role of Selenium ▪ constituent of glutathione peroxidase ▪ scavenges free radicals ▪ prevents cell damage by free radicals 93 JUN-2006 108 Keshan Disease ▪ cardiomyopathy in young children   109 Role of Iodine 93 JUN-2005 110 Iodine Deficiency Goitre 94  111 Cretinism 94 MAY-2002 112 NEWBORN INFANTS   113 LBW   114 VLBW   115 ELBW   116 Secondary Apnea 96  117 Neonatal Resuscitation ▪ Apgar ▪ TABC 96  118 Apgar Score ▪ Heart Rate ▪ Respiration ▪ Tone ▪ Reflex ▪ Color 97 107 MAR-2003 119 TABC of Resuscitation 98 MAR-2003 120 Five Cleans ▪ clean hands ▪ clean delivery surface ▪ clean cord cut ▪ clean cord tie ▪ clean cord stump 103  121 Omphalitis 105  122 Physiological Jaundice ▪ > 5mg/dl ▪ subsides within 7-10 days ▪ seen in 60% of newborn 105 147 JUL-2007 123 Ponderal Index 109  124 Craniotabes ▪ skull feels like a ping pong ball ▪ delayed ossification & resorption 112  125 Cephalhematoma 112 AUG-2002 JUL-2008 126 Developmental Dysplasia of Hip ▪ Barlow's Test ▪ Ortolani's Test 114  127 Warm Chain ▪ TEN steps 116  128 Advantages of Breast Feeding 122 JUL-2008 SEP-2000 129 Reflexes in Breast Feeding 124  130 Draw & Label : Oxytocin Reflex 124 JUL-2007 131 Nipple Confusion ▪ seen in bottle fed infants ▪ finds it difficult and confusing 125  132 Colostrum ▪ milk secreted in the initial 3-4 days Composition of Colostrum ▪ antibodies ▪ Vit ADEK 125 JUL-2007 FEB-2002 133 Problems of Pre-Term Babies 129  134 Problems of LBW Babies 129  135 Neonatal Sepsis 136  136 Respiratory Distress Syndrome 143  137 Meconium Aspiration Syndrome 144 100  138 A 15 days old baby is brought with yellowish discolouration of eyes and skin. Is it physiological or pathological? What are the probable causes? What investigations will you order? What history will you specifically ask for?  JUN-2006 139 Prolonged Physiological Jaundice 147  140 Breast Milk Jaundice 147  141 Clinical Estimation of Jaundice 147  142 Causes of Jaundice in the new born 148 JUL-2008 143 Phototherapy 149 AUG-2002 MAY-2002 144 BFHI  JUN-2005 145 Significance of Moro Reflex  MAR-2003 FEB-2008 146 X-Ray findings in Congenital Diaphragmatic Hernia 153  147 IMMUNITY AND IMMUNISATION   148 Vaccine Failure 164  149 Live Vaccines 165  150 Vaccine Storage 166  151 Cold Chain  JUN-2005 152 National Immunisation Schedule   153 Vaccine preventable Diseases   154 Ring Immunisation   155 BCG Vaccine 166  156 Preservation of BCG Vaccine  MAR-2003 157 OPV 167 MAR-2003 158 IPV 168  159 Vaccine Vial Monitor  DEC-2004 160 Complications of DPT Vaccine 168 FEB-2008 JUL-2007 161 Contraindications of Pertusis Vaccine 169  162 Acellular Pertusis Vaccine 169  163 Measles Vaccine 171 JUL-2008 164 MMR Vaccine 171 SEP-2000 165 Congenital Rubella Syndrome  JUL-2007 166 Hepatitis B Vaccine 171  167 Management of Dogbite on Face 172 JUL-2007 168 Typhoral Vaccine 174  169 HIB Vaccine 175 DEC-2005 170 INFECTIONS AND INFESTATIONS   171 Normal Body temperature in children 36.1 – 37.8   172 PUO 183 DEC-2004 173 Causes of PUO in Children 183  174 Measles 185  175 Complications of Measles 185 FEB-2008 AUG-2001 176 Atypical Measles -  177 Modfiied Measles -  178 Infectious Mononucleosis 187  179 Complications of Mumps 188  180 Poliomyelitis 188  181 What are the causes of Acute Flaccid paralysis in a five year old boy? Poliomyelitis Guillen Barre Syndrome Transverse Myelitis Traumatic Neuritis Meningitis / Encephalitis Describe the clinical features of poliomyelitis. Enumerate the likely complications. Write about the management of poliomyelitis and strategies adopted towards its eradication. 190 SEP-2000 182 Three Causes of AFP ▪ Poliomyelitis ▪ Guillen Barre Syndrome ▪ Transverse Myelitis ▪ Traumatic Neuritis ▪ Meningitis / Encephalitis 190  183 Define AFP ▪ sudden onset of weakness and floppiness in any part of the body in a child < 15yr OR ▪ paralysis in a person of any age in whom polio is suspected 191 JUN-2006 FEB-2002 184 Oral Polio Vaccine  FEB-2001 185 Pulse Polio Immunisation 190 AUG-2001 186 AFP Surveillance ▪ notify AFP cases ▪ District Immunisation officer (DIO) investigates for 60 days ▪ Two stool samples to be collected 191 555 JUL-2008 187 Non-Polio AFP 191  188 Extrahepatic manifestations of Hepatitis B   189 Hepatitis C Virus 194 FEB-2002 190 Dengue Hemorrhagic Fever 196 JUN-2005 191 Draw & Label : Human Immunodeficiency Virus - DEC-2005 192 Diagnosis of HIV in Children ▪ HIV PCR ▪ HIV Culture 207 DEC-2004 193 AIDS Prophylaxis in Children ▪ Cotrimoxazole   194 Prevention of parent to child transmission of HIV ▪ MTCT 207 208 FEB-2008 195 Miliary Tuberculosis 210  196 Primary Complex 210  197 Mantoux Test 216 JUL-2008 198 Management of Tuberculosis 217  199 Rifampicin  AUG-2002 200 Advere effects of Rifampicin   201 Adverse effects of INH   202 Complications of Diphtheria 220 MAY-2002 203 Clinical features of Enteric Fever 222 AUG-2002 204 Investigations in Enteric Fever  JUL-2008 205 Complications of Enteric Fever   206 Draw & Label : Peripheral Smear showing falciparum  JUN-2005 207 Treatment of P vivax Malaria 233 JUL-2008 208 Drug of choice in Cerebral Malaria 233  209 Draw & Label : Roundworm Ova  FEB-2008 210 Draw & Label : Hookworm Ova  JUL-2008 211 Treatment of Hookworm Infestation 246 MAR-2003 212 Draw & Label : Whipworm Ovum  JUN-2006 213 Treatment of Scabies   214 DISEASES OF GASTROINTESTINAL SYSTEM AND LIVER   215 Inguinal Hernia in a Child   216 Vaccines to be given before Splenectomy   217 Two surgical causes for persistant vomiting in a 1yr old child   218 Hypertrophic Pyloric Stenosis 253  219 Common causes of constipation in an infant 255 JUL-2008 220 Define Acute Watery Diarrhoea ▪ passage of watery stools ▪ starts suddenly and persists for hours / days 260  221 A 9month old infant is brought with watery diarrhea and vomitting. On examination child is thirsty, irritable and oral mucous membrane dry. What is the diagnosis? What treatment will you advice? What are the criteria for discharge from hospital? What instructions will you give to the mother on discharge?  AUG-2002 222 A 1yr old weighing 8kg presents to the hospital with a one day history of vomiting and watery diarrhea, following an URTI. On examinationhe was found to be moderately dehydrated. What are the signs of dehydration you are ikely to find in this child? What are the important investigations you order and what are the likely results? What organisms are likely the causative agents?  MAY-2002 223 Define Dysentry 260  224 Persistent Diarrhoea ▪ 14 days or longer 260  225 Rotavirus 261  226 Treatment of Acute Bacillary Dysentry in a child   227 Key Signs of Dehydration 261 FEB-2002 228 Causes of Malnutrition in Diarrhea 261  229 Oral Rehydration Therapy 263  230 Composition of WHO ORS 263 MAY-2002 FEB-2008 231 Improved ORS 263  232 Management of Diarrhea 264  233 Treatment of Severe Dehydration 265 FEB-2008 234 Indications for Antibiotics in ADD 267  235 Four Clinical manoevers to diagnose Cholera 267  236 Seizures in Diarrhea 268  237 Lactose intolerance 273 JUN-2005 238 Milk protein intolerance 273  239 Four causes of Splenomegaly in children 279 JUL-2007 240 Fatty Liver in Children 281  241 Neonatal Hepatitis 281  242 Clinical signs of liver cell failure 286 JUL-2007 243 Management of Acute Fulminant Liver cell failure 287 FEB-2008 244 Hepatic Encephalopathy 288 DEC-2004 245 Portal Hypertension in Children 289  246 Causes of Liver Cirrhosis  MAY-2002 247 HEMATOLOGICAL DISORDERS   248 A 4yr old girl is brought with purpura and gum bleeding. On examination there is no lymphadenopath, bone tenderness or hepatosplenomgaly. What is the clinical diagnosis? Mention three important 'investigations to confirm diagnosis? What are the differential diagnosis? What are the drugs used for treatment?  FEB-2002 249 Draw & Label : Myeloblast   250 Draw & Label : Lymphoblast   251 Define Anemia in a 2yr old? What is Severe Anemia?   252 Lab findings of Iron Deficiency Anemia 300 JUN-2005 253 Treatment of Iron deficiency Anemia 301 FEB-2001 254 Iron requirement in Pediatric age Group   255 Iron rich foods   256 Causes of failure of Iron therapy in a child   257 Deferiprone   258 Types of Hemolytic Anemias 303 JUN-2006 259 Nutritional Anemia – Management and Prevention  SEP-2000 260 Most common Thalassemia? Defect in common secondary immunodeficiencies in children?   261 Draw & Label : Peripheral Smear in beta thalassemia major 308 JUL-2008 262 Investigations in a child with recurrent bleeding 318 JUL-2007 263 Lab Diagnosis of ITP 320 AUG-2002 264 Drugs used in ITP with dosage   265 Clinical features of ALL  MAY-2002 266 Bone Marrow Aspiration  MAY-2002 267 Draw & Label : Target Cell  AUG-2002 268 DISEASES OF EAR, NOSE AND THROAT   269 Management of Acute Epiglottitis  FEB-2002 270 DISORDERS OF RESPIRATORY SYSTEM   271 Draw & Label : Bronchial Breathing  FEB-2002 272 Draw & Label : Vesicular Breathing   273 Respiratory Noises 346  274 Causes of Wheezing 347  275 Staphylococcal Pneumonia 353  276 Clinical Signs of Severe Pneumonia  FEB-2002 277 Signs of very Severe Pneumonia   278 Oxygen therapy in Pneumonia   279 Indications of chest X Ray in Pneumonia   280 Treatment of Mycoplasma Pneumonia 352 DEC-2005 281 Define ARI 356 JUN-2005 282 ARI Control Programme   283 Management of a six month olf under ARI control programme  SEP-2000 284 A 4 month old baby is brought with a history of cold. cough a nd difficulty in breathin g. On examination his respiratory rate is 66/min. He has inte'costal and subcostal recession. His chest looks prominent and hyper•resonant to percussion. Auscultation reveals a scattered rhonchi. What is the probable diagnosis? What is the organism which causes this condition? What are the differential diagnosis? What are the Chest X-ray findings in this child? How will you manage this child?  JUL-2007 285 1 year old child is brought with pyoderma, fever and cough. On examination he is cyanosed, respiratory rate is 62/minute, grunting and chest retractions are present. What is the diagnosis? What treatment will you advise? What investigations will you order? What complication will you expect? What is the duration of antibiotic therapy?  MAR-2003 286 Bronchiolitis 356  287 Two common complications of Bronchiolitis   288 Triggering Factors of Bronchial Asthma 358  289 Prophylaxis of Bronchial Asthma   290 Classification of Asthma Intermittent Mild Persistent Moderate Persistant Sever Persistant 363  291 Treatment of Acute Severe Asthma 366 JUL-2008 JUN-2006 292 Treatment of Status Asthmaticus Status asthmaticus is an acute exacerbation of asthma that does not respond to standard treatments of bronchodilators and corticosteroids. Symptoms include chest tightness, rapidly progressive dyspnea (shortness of breath), dry cough, use of accessory muscles, labored breathing and extreme wheezing. It is a life-threatening episode of airway obstruction considered a medical emergency. Complications include cardiac and/or respiratory arrest. The lung failure means that oxygen can no longer be provided, carbon dioxide can no longer be eliminated, which leads to acidosis. It is characterized histologically by smooth muscle hypertrophy and basement membrane thickening. Interventions include initiating and maintaining IV access, bronchodilators as prescribed, telemetry monitoring in the PCU, usually arterial blood gas tests sometimes arterial lines are inserted and preparing for emergency intubation. Intravenous treatments such as Aminophylline, Theophylline and Salbutamol are typically given. Many patients eventually respond avoiding more aggressive measures. Status Asthmaticus does not respond adequately to nebulised treatment alone therefore the intravenous treatments such as those above sometimes in addition to Intravenous Magnesium Sulphate are also given. 366 MAY-2002 293 Salbutamol  MAR-2003 294 Tachypnea   295 Genetic causes of Bronchiectasis 368  296 DISORDERS OF CARDIOVASCULAR SYSTEM   297 Normal BP in a newborn?   298 Draw & Label : JVP   299 Causes of Collapsing Pulse  JUL-2008 300 Draw & Label : Pansystolic Murmer  FEB-2002 301 Causes of CCF 372  302 Treatment of CCF  DEC-2005 FEB-2002 303 Classification of Congenital Heart Diseases 372  304 Common Congenital Heart Diseases  AUG-2002 305 Features of CCF 375  306 Treatment of CCF 376 JUL-2007 307 Jones Criteria 380 AUG-2002 308 Rheumatic fever Prophylaxis 383 MAY-2002 309 Rheumatic MR   310 Treatment of Rheumatic Carditis  DEC-2004 311 What is the Serum therapeutic level of Aspirin in RF?   312 Draw & Label : Mitral Regurgitation Murmer 384 DEC-2005 313 Carey Coomb Murmer   314 Infective Endocarditis – C/F 391  315 Prophylaxis in Infective Endocarditis 393 JUN-2006 316 Fetal Circulation 394  317 NADAS Criteria 399  318 ASD – Types 401  319 Complications of ASD  MAR-2003 320 Draw & Label : Development of Interatrial Septum  MAY-2002 321 Draw & Label : ASD Murmer 402 DEC-2004 322 VSD – Types 403  323 Draw & Label : VSD Murmer 404 JUN-2005 324 VSD – Small v/s Large 403  325 Complications of VSD 403  326 Draw & Label : PDA Murmer 405 JUN-2006 327 Diagnostic features of PDA 405 FEB-2002 328 Components of TOF 408 AUG-2002 329 Complications of TOF 408 FEB-2001 330 Management of TOF 408  331 Chest X Ray in TOF 408  332 Fallots Physioogy 412  333 Cyanotic Spells  FEB-2008 334 Treatment of Hyper Cyanotic Spells 415 JUN-2005 MAR-2003 335 Causes of Hypertension In children 431  336 Draw & Label : Murmer of AR  MAR-2003 337 Hills Sign in aortic insufficiency, greater systolic blood pressure in the legs than in the arms; normal arterial systolic pressure in the leg is 10–20 mm of Hg above that in the arm, whereas in aortic insufficiency the difference may be 60–100 mm of Hg. Syn: Hill phenomenon.  MAR-2003 338 DISORDERS OF KIDNEY AND URINARY TRACT   339 Draw and Label : Nephron 440 MAY-2002 340 Heat and Acetic Acid Test 443  341 Significant Bacteruria 443  342 Asymptomatic Bacteruria 443  343 Causes of Hematuria 445  344 IgA Nephropathy 446  345 Proteinuris Define Proteinuria 447 FEB-2002 346 Define Massive Proteinuria 447  347 Complications of AGN 447  348 Draw & Label : PS in Hemolytic Uremic Syndrome   349 Draw & Label : Urinary findings in Acute Glomerulonephritis  FEB-2008 350 Treatment of Acute Glomerulonephritis  JUN-2006 351 Diagnostic criteria of Nephritic Syndrome  AUG-2002 352 Management of Nephrotic Syndrome 450  353 Complications of Nephrotic Syndrome 450  354 UTI in Children  JUN-2006 355 Management of UTI 456  356 Vesicourethral Reflex 457  357 Posterior Urethral Valves  MAY-2002 358 ENDOCRINE AND METABOLIC DISORDERS   359 Clinical features of Congenital Hypothyroidism 481 FEB-2008 360 Common causes of Acquired Hypothyroidism   361 Drug therapy in Hyperthyroidism  MAR-2003 362 Panhypopituitarism   363 CENTRAL NERVOUS SYSTEM   364 Management of Status Epilepticus ina 2yr old child   365 Causes of Convulsions in Children 523 DEC-2004 FEB-2008 366 Febrile Convulsions 528 JUL-2008 SEP-2000 367 A 6 month old baby is brought with history of fever of 2 days duration, refused to feed, extreme irritability and convulsions. What is the probable diagnosis? Name one important clinical sign you will elicit for diagnosis? How will you investigate? Name two complications? How will you prevent this condition?  JUL-2008 368 Petit Mal Seizures 530 MAY-2002 369 Treatment of Neonatal Seizures 531 DEC-2004 370 Infantile Myoclonic Seizures 531 JUL-2007 371 Organisms causing Pyogenic Meningitis 536  372 Complications of Pyogenic Meningitis 536  373 Management of Bacterial Meningitis in a 1yr old 536  374 Organisms causing Acute Bacterial Meningitis in a 18 month old baby  FEB-2008 375 CSF findings in Normal child  SEP-2000 376 CSF findings in Pyogenic Meningitis 539 SEP-2000 377 CSF findings in TB Meningitis  SEP-2000 378 CSF findings in Viral Meningitis   379 Clinical features of TB Meningitis 539  380 CSF findings in TB Meningitis 540 MAR-2003 381 Bilirubin Encephalopathy 542 JUN-2006 382 Reye's Syndrome 543  383 Hydrocephalous - Types   384 Guillen Barre Syndrome 554  385 Define Acute Flaccid Paralysis 555  386 Causes of Acute Flaccid Paralysis 555  387 DD of AFP 556 DEC-2004 388 Define Cerebral Palsy   389 Cerebral Palsy – Types 559  390 Neurocutaneous Markers 564  391 Autism   392 Myelodysplasia   393 Typical v/s Atypical seizures   394 NEUROMUSCULAR DISORDERS   395 Duchenne Muscular Dystrophy 566  396 DD of Floppy Infant 573 JUN-2005 397 CHILDHOOD MALIGNANCIES   398 Draw & Label : PS in Acute Lymphoblastic Leukemia 580 JUL-2007 399 Classification of ALL 580 DEC-2005 400 RHEUMATOLOGICAL DISORDERS   401 Juvenile Idiopathic Arthritis 599  402 A 5 year old child is brought with joint pain, abdominal pain, high coloured urine. She has sore throat 10 days back. OlE skin rash present in the lower limbs. What is the probable diagnosis? What investigations will you order? What treatment will you give? What are the differential diagnosis?  DEC-2005 403 GENETIC DISORDERS   404 Kawasaki Disease 609  405 Behcet's Disease   406 Clinical features of Down's Syndrome 613 DEC-2005 407 Two chromosomal pattern seen in Down's Syndrome   408 Kleinfelter's Syndorme 615  409 Chromosomal anomaly in Turner Syndrome 616 AUG-2002 410 Features of Autosomal Dominant Inheritance 617 MAY-2002 411 Marfans Syndrome   412 Craniosynostosis   413 INBORN ERRORS OF METABOLISM   414 Phenylketonurias 628  415 Gauchers Disease 638  416 Wilsons Disease 640  417 Alpha 1 Antitrypsin Deficiency 640  418 EYE DISORDERS   419 SKIN DISORDERS   420 Causes of Purpura in Children  JUN-2005 421 Treatment of Scabies 665 DEC-2005 422 POISONINGS, INJURIES AND ACCIDENTS   423 Keroscene Poisoning  JUL-2008 424 PEDIATRIC CRITICAL CARE   425 COMMON MEDICAL PROCEDURES   426 Contraindications for Lumbar Puncture 717 520 JUL-2007 427 RATIONAL DRUG THERAPY   428 INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESSES   429 Define Infant Mortality Rate 753 FEB-2008 430 RIGHTS OF CHILDREN   431 UNALLOCATED QUESTIONS   432 Age Independent Anthropometric Measurement  JUN-2005 433 Draw & Label : LE Cell  DEC-2004 434 Treatment of Methicillin Resistant Staphylococcal Infection  DEC-2004

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