Q1. Define heart failure. Types of heart failure. Write down the Q5. Define Bronchial asthma.
chial asthma. How will you manage a case of acute Q9. Name five common causes of vomiting. Define & classify
causes of heart failure? Write down the common causes of chest
pain?
Ans: Definition: It is a clinical condition when heart cannot maintain
effective cardiac output.
Classification: (A) According to cardiac involvement: 1. Left heart
failure/LVF, 2. Right heart failure/RVF, 3. CCF. (B) According to onset:
1. Acute heart failure, 2. Chronic heart failure, 3. Acute or chronic
heart failure. (C) According to cardiac output: 1. High output failure
e.g. Anaemia Beriberi, 2. Low output failure e.g. COPD.
Causes of heart failure: 1. Systemic hypertension, 2. Cardiomyopathy,
3. Any valvular disease, 4. Ischaemic heart disease, 5. Pericardial
causes, 5. Other causes: anaemia, beriberi, thyrotoxicosis.
Common causes of chest pain: 1. Myocardial infarction,
2. Myocarditis, 3. Mitral valve prolapses, 4. Pneumonia, 5. TB
Q2. Define & classify hypertension. Write down the causes of
hypertension. Write down the management of hypertension. Write
down five anti-hypertensive drugs.
Ans: Definition: Hypertension is a clinical condition in which there is
sustained elevation of systemic arterial pressure, Systolic less than
140 mm Hg & diastolic less than 90 mm Hg. Classification: Systolic:
BP= 180/80 mm of Hg, Diastolic: BP= 120/95 mm of Hg. Causes:
(A): Primary: Idiopathic. (B): Secondary: 1. Vascular: Coarctation of
aorta. 2. Renal disease: Chronic kidney disease, AGN, Renal artery
stenosis. 3. Endocrine disease: Cushings syndrome, Hyper-
parathyroidism, Acromegaly. 4. Drugs: OCP, Corticosteroids, NSAIDs.
5 Alcohol, 6. Obesity. Management: Clinical features:
(A): Symptoms: angina pain, Blurring of vision, Palpitation, Vertigo,
Headache, Dizziness, Family H/O hypertension. (B): Signs: BP, Pulse,
Temperature, Respiration, Added sound, If bilateral basal crepitation.
Investigation:1. Blood for lipid profile, serum creatinine, blood urea,
blood glucose. 2. ECG. 3. Chest x-ray P/A view. 4. Ambulatory BP
controlling. 5. Urine for R/M/E. 6. Echocardiogram. 7. Coronary
angiogram. Treatment: (A): General treatment: Relief of stress, Diet,
Avoid alcohol & smoking, Cholesterol restriction. (B): Specific
treatment: 1. Diuretic – a. Thiazide group, b. Loop diuretic- Frusemide
(20-40 mg). 2. Anti-hypertensive drugs – a. ACE inhibitor-Enalpril
20mg daily, Ramipril (5-10mg) daily. b. Angiotensin receptor blocker-
Valsatan (40-160mg) daily. c. Calcium cannel blocker- Amlodipine (5-
10mg) daily, Nifedipin (10-30mg) daily, Diltiazam (200-300mg) daily.
d. β (Beta) Blocker- Propranolol 10mg 2/3 times daily, Metprolol (50-
100mg) daily, Atenolol (50-100mg) daily, Bisoprolol (2.5 – 5mg).
e. Losartan potassium (25-50mg). Five anti-hypertensive drugs:
Frusemide, Atenolol, Ramipril, Losartan, Amlodipine.
Q3. Define Myocardial Infarction. Write down the management of
MI. What are the components of acute coronary syndrome.
Ans: Definition: Myocardial infraction is the irreversible necrosis of
myocardium occurring as a result of critical imbalance between the
coronary blood supply & myocardial demand. Management of MI:
A. Clinical features: 1. Severe central chest pain radiating to arm,
throat & jaw. 2. Tightness of chest with respiratory distress. 3. Severe
weakness of fatigue. 4. Vomiting. 5. Sweating. 6. Hypotension.
7. Tachycardia with low volume pulse. B. Investigation: 1. ECG-
Changes. 2. Chest x-ray P/A view. 3. Eco-cardiography. 4. Coronary
angiogram. 5. CBC. 6. C- reactive protein (CRP): Elevated. 7. Other
test: Blood sugar, Serum lipid profile. C. Treatment: i. Early Treatment:
1.Immediate hospitalization (Under ICU). 2. Absolute bed rest in
propped up position. 3. O2 inhalation, high flow. 4. Open I/V channel
& give 5% DA. 5. Oral Aspirin 300mg stat, then 75-100 mg daily.
6. Sublingual glyceryl trinitrate. 7. Analgesics. 8. Lipid lowering agents:
Atorvastatin. 9. ACE inhibitor. 10. β-blocker: Metoprolol, Bisoprolol.
ii. Late treatment: 1. Secondary prevention by routine drug therapy:
Anti-platelet therapy, Lipid lowering agents, ACE inhibitor, Beta-
blocker, Control of comorbid conditions (DM, HTN). 2. Lifestyle
modification: Regular exercise, Weight control, Must avoid read meat,
yolk of egg & alcohol, Limitation of salts, Avoid high caloric & fatty
diet, Sound sleep. Components of acute coronary syndrome:
1. Ischaemia with no myocardial damage. 2. Ischaemia with minimal
myocardial damage. 3. Partial thickness (non-Q wave) myocardial
infraction. 4. Full thickness (Q wave) myocardial infraction.
Q4. Define rheumatic fever. Write down the major & minor criteria
of rheumatic fever. Write down the management of rheumatic fever.
Ans: Definition: It is a multi-system disorder characterized by- fever,
joint pain, followed by an episode of streptococcal infection. Criteria
of rheumatic fever: A. Major criteria: APRES- 1. A- arthritis,
2. P- pancarditis, 3. R- rheumatic nodule. 4. E- erythema marginatum.
5. S- sydenham’s cholera. B. Minor criteria: Fever, Arthralgia, Previous
history of rheumatic fever, Polymorph leucocytosis, Evidence of sore
throat. Management of Rheumatic fever: A. Clinical feature:
i. Symptoms: Fever, Loss of appetite, Joint pain, Chest pain,
Palpitation. ii. Signs: Tachycardia, Fever, Erythema marginatum,
Sydenham’s cholera, Carditis. B. Investigation: Blood for CBC, Throat
swab for C/S, Chest X-ray, Echocardiogram. C. Treatment: A. General
treatment: Complete bed rest (until recovery). B. Specific treatment:
1. Antibiotic therapy: a. Inj Benzyl penicillin 5 lac unit 8 or 12 hourly
I/M for 7 days. Or B. Tab. Phenoxymethyl penicillin 250mg 1 tab TDS
before meal for 7 days. C. Symptomatic therapy: 1. Joint pain: a. Tab.
Aspirin 70mg/kg body weight in divided doses (until symptoms
relives). b. Tab. Corticosteroid 1mg/kg body weight. D. Prophylaxis
treatment: 1. Inj. Benzyl penicillin 6-12 lac unit 3 weekly for 5 years.
Or 2. Tab. Phenoxymethyl penicillin 250mg 1 tab BD for 5 years. 3. If
hypersensitivity to penicillin: Tab. Erythromycin 250mg 1 tab BD daily
for 5 years.
bronchial asthma?
Ans: Definition: Bronchial asthma is a clinical condition characterized
by cough, tightness of chest, wheezing & airflow obstruction.
Management of bronchial asthma: A. Clinical feature: Sticky cough,
tightness of chest, respiratory difficulty, fever, bilateral chest pain,
wheezing, tachycardia, tachypnea. B. Investigation: Chest X-ray, Blood
for CBC, FEV1 (Force expiratory volume in one second). C. Treatment:
A. General treatment: Avoidance of allergen. B. Symptomatic
treatment: Antibiotic (If cough, fever present). C. Specific treatment:
1. Mild case: Bronchodilator e.g. Salbutamol 2-4mg 2-3 times daily.
2. Moderate case: Bronchodilator + Corticosteroid. 3. Acute severe
bronchial asthma: i. Propped up position in bed. ii. Inj. Hyrocortisone
100-200mg 8 hourly I/V. Or iii. Inj. Dexamethasone 8-16mg 8 hourly
I/V. iv. Antibiotic- Inj. Ceftriaxone (1-2 gm) I/V or I/M. V. Nebulisation-
Bronchodilator + Corticosteroid.
Q6. Define & classify ARI. Write down the management of ARI.
Ans: Definition: ARI is the inflammation of respiratory tract anywhere
from nose to alveoli caused by wide range of microorganisms.
Classification: (A). According to site of involvement: 1. Upper
respiratory tract infection: Common cold, Tonsilitis, Sinusitis. 2. Lower
respiratory tract infection: Epiglottitis, Bronchiolitis, Pneumonia.
(B). According to WHO classification: 1. Age < 2 months: Severe
pneumonia, No pneumonia. 2. Age 2 months to 5 years: Very severe
pneumonia, severe pneumonia, no pneumonia. Management:
(A) Clinical features: 1. Symptoms: High fever, Cough, Wheeze,
Pleuritic chest pain, Headache. 2. Signs: Pyrexia, Tachycardia,
Tachypnoea, Evidence of hypoxaemia, Stridor. (B) Investigation:
Chest X-ray P/A view, Sputum examination, Blood for CBC.
(C) Treatment: General measures: 1. Immediate hospitalization,
2. Bed rest, 3. O2 inhalation, 4. Nebulization, 5. Analgesics, 6.
Antipyretics, 7. Syrup pholcodine. Drug therapy: a.) If mild to
moderate cases: 1. Amoxicillin 500 mg 8 hourly orally, OR
Flucloxacillin 500 mg 6 hourly orally. 2. If patient is allergic to
penicillin: Clarithromycin 5oomg 12 hourly orally. OR
Erythromycin 500 mg 6 hourly orally. b) If severe cases:
1. Clarithromycin 500mg 12 hourly I/V OR Erythromycin 500mg 6
hourly I/V + 2. Co-amoxiclav 1.2 g 8 hourly I/V OR Ceftrixone 1-2 g
daily I/V + 3. Flucloxacillin 1-2 g 6 hourly I/V.
Q7. Define Pneumonia. Classify pneumonia. How will you manage a
case of pneumonia?
Ans: Definition: Acute inflammation of lung with development of
radiological pulmonary opacity is called pneumonia. Classification:
A. Anatomical: 1. Bobar pneumonia. 2. Bronchopneumonia.
B. Clinical: 1. Community acquired pneumonia. 2. Hospital acquired
pneumonia. C. Classification of pneumonia in children: No
pneumonia, Pneumonia, Severe pneumonia, Very severe pneumonia.
Management of Pneumonia: A. Clinical feature: i. Symptoms:
1. Sudden onset of high fever with chills & rigor. 2. Cough. 3. Sputum:
Rusty coloured or even frankly blood-stained. 4. Pleuritic chest pain.
5. Loss of appetite. ii. Signs: 1. Pyrexia, 2. Tachycardia, 3. Evidence of
hypoxaemia, 4. Hypotension & confusion, 5. Pleurisy. 6. Upper
abdominal tenderness. B. Investigation: 1. Chest X-ray P/A view,
2. CBC, 3. ESR with CRP: Raised, 4. Sputum study: Microscopic &
culture. C. Treatment: i. Symptomatic: Immediate hospitalization, O2
inhalation, Nebulization, Analgesics, Anti-pyretic, Syrup Pholcodin.
ii. Drug therapy: (a) Uncomplicated pneumonia: 1. Amoxacillin 500mg
8 hourly orally. 2. If patient is allergic to penicillin: Erythromycin
500mg 6 hourly orally. 3. If staphylococcas is suspected: Flucloxacillin
1-2g 6 hourly I/V + Clarithromycin 500mg 12 hourly I/V.
4. If mycoplasma is suspected: Erythromycin 500mg 6 hourly orally or
I/V + Rifampicin 600mg 12 hourly i/v in severe cases. (b) Severe
pneumonia: Clarithromycin 500mg 6 hourly I/V + Ceftriaxone 1-2g
daily I/V + Flucloxacillin 1-2g 6 hourly I/V.
Q8. Define TB. What are the risks factors of TB. Write down the
management of pulmonary TB. What are the common side effects
of anti-tubercular drugs?
Ans: Definition: Tuberculosis is a chronic communicable,
granulomatous disease caused by mycobacterium tuberculosis.
Risk factors: (A) Patient-related: Age, First-generation immigrants
from high-prevalence countries, Overcrowding , Homelessness, chest
radiograph evidence of self-healed TB, Primary infection, Smoking.
(B) Associated diseases: Immunosuppression, Malignancy, DM,
Chronic kidney disease, Silicosis, Deficiency of vitamin A & D.
Management: (A) Clinical features: Symptoms: Chronic cough, Low
grade fever, Anorexia, weight loss, Weakness, Night sweating.
Sings: Mild crepitation may be found, Signs collapse due to
enlargement of lymph nodes, Signs of spontaneous pneumothorax
due to rupture of pleural cavity, Signs of complications.
(B) Investigation: 1. Blood for CBC, 2. Chest x-ray P/A view, 3.
Montoux (MT) test, 4. Sputum for AFB & Gene Xpert.
(C) Treatment: Short course chemotherapy for 6 months by “DOTS” in
two phases - 1. Initial phases (2 months): 4FDC- Rifampicin +
Isoniazide + Ethambutol + Pyrazinamide. 2. Continuous phase (4
months): 2FDC- Rifampicin + Isoniazide.
diarrhoea. Write down the causes of diarrhoea. Write down the
management of diarrhoea.
Ans: Five common causes of vomiting: 1. Carcinoma of stomach.
2. Peptic Ulcer Disease. 3. Appendicitis. 4. Pancreatitis. 5. Meningitis.
Definition of diarrhoea: Passage of loose stool more than three times
a day is called diarrhoea (WHO definition). Classification: 1. Acute
watery diarrhoea, 2. Acute bloody diarrhoea, 3. Persistent diarrhoea,
4. Diarrhoea with severe malnutrition. Causes of diarrhoea:
(A) Infective causes: 1. Bacterial: Salmonella, Shigella. 2. Viral: Rota
virus. 3. Fungal: Histoplasmosis. 4. Parasitic: Entamoeba histolytica,
Giardia intestinalis. (B) Non infective causes: Inflammatory bowel
disease, Diverticular disease, Ischaemic colitis, Malabsorption, Pelvic
inflammatory disease. (C) Endocrine: Thyrotoxicosis, Zollinger-Ellison
syndrome, Carcinoid Syndrome. Management of diarrhoea: Clinical
features: Symptoms: passage of loose watery stool more than three
times a day, Fever, Abdominal pain, Abdominal cramps, Bleeding.
Signs: (A) No sign: Patient is well alert, Eyes normal, Drinks normally,
not thirsty, Skin pinch goes back quickly. (B) Some sign: Patient is
restless & irritable, Eyes sunken, Thirsty & drink eagerly, Skin pinch
goes back slowly. (C) Severe sign: Patient is lethargic or unconscious,
Eyes very sunken & dry, Drink poorly or not able to drink, Skin pinch
goes back very slowly. Treatment: Correction of dehydration by ORS
& cholera saline, antimicrobial agent, Anti-amoebic agent, Antiemetic
drug for vomiting, Antispasmodic drug for abdominal pain, Treatment
according to causes.
Q10.What is PUD? What are the bacterial causes of PUD? Write
down the management of PUD.
Ans: Definition: Peptic ulcers are acute or chronic, most often solitary
lesion that occur in any portion of the gastrointestinal tract exposed
to aggressive action of acid peptic juices. Bacterial causes of PUD:
Helicobacter pylori. Management of PUD: A. Clinical feature:
i. Symptoms: 1. Recurrent upper abdominal pain, 2. Vomiting,
3. Anorexia, 4. Nausea, 5. Weight loss, 6. Feature of complication.
ii. Signs: 1. Examination is usually unhelpful, 2. Epigastric tenderness
is quite common in non-ulcer dyspepsia, 3. Anaemia from cronic
undetected blood loss. B. Investigation: 1. Upper GIT endoscopy.
2. H.pylori antibody. 3. Blood for CBC. 4. Barium meal X-ray of
stomach & duodenum. C. Treatment: a. General measure: 1. Bed
rest, 2. Diet: Normal, 3. Anti-spasmodic drug, 4. Anti-emetic drug,
5. Sedative, 6. Avoid smocking & alcohol, 7. Avoid aspirin & NSAIDs.
b. Acid Neutralizing drugs: 1. H2 blocker: Famotidine. 2. Proton Pump
Inhibtor: Omeprazole, Esomeprazole, Pantoprazole. C. Triple Therapy:
Rabeprazole 20mg + Clarithromycin 500mg + Amoxacillin 1g/
Metronidazole 400mg. Dose: Each strip twice daily for 7-14 days.
Q11. Define & classify jaundice. What are the causes of obstructive
jaundice. Give the management of obstructive jaundice.
Ans: Definition: Jaundice is the yellow colouration of the skin, sclera
& mucous membrane resulting from an increased bilirubin
concentration in the body fluids. Classification: 1. Prehepatic or
haemolytic jaundice. 2. Hepatic or hepatocellular jaundice.
3. Obstructive or cholestatic jaundice. Causes of obstructive jaundice:
i. Extrahepatic: 1. In the lumen: Round worms, gall stone. 2. In the
wall: Atresia, Stricture. 3. Carcinoma of bile duct & pancreas.
ii. Intrahepatic: 1. Primary biliary cirrhosis. 2. Alcohol. 3. Cystic fibrosis
4. Post operative. 5. Hodgkin lymphoma. Management of obstructive
jaundice: A. Clinical feature: i. Symptoms: 1. Yellow colouration of
skin & eye. 2. Passage of pale colour stool & dark urine. 3. Itching.
4. Pain in right upper abdomen. 5. Fever & rigor. ii. Signs: 1. The
depth of jaundice: marked. 2. Scratch mark on skin: due to pruritus.
3. Anaemia may present. 4. Ascitis. B. Investigation: 1. Blood for CBC.
2. Urine for R/M/E. 3.HBsAg. 4. Liver function test: S. bilirubin, ALP,
SGPT & SGOT. 5. Plain X-ray of abdomen. C. Treatment: (a) Pre-
operative treatment: 1. Correction of dehydration & electrolyte
imbalance: i. Open I/V channel & give 5% DA/DNS. ii. Treatment of
hypokalaemia: Potassium ion (K+). 2. Correction of prothrombin time
& other clotting time: Vitamin K supplementation. 3. Prevention of
HRS: i. 10% Mannitol 500 ml I/V before & during operation. ii. Broad
spectrum antibiotics. iii. Catheterization & record pre-operative &
post operative urine output (>40 ml/h). If decrease: 10% Mannitol
200 ml I/V, If not improve- Inj. Frusemide, If not improve- Inj.
Dopamine. (b) Surgical treatment: 1. Choledocholithotomy: If
choledocholithiasis. 2. Whipple’s operation: If carcinoma of head of
the pancreas.
Q12. Write down the causes of cirrhosis of liver. How will you
diagnose a case of cirrhosis of liver?
Ans: Causes of cirrhosis of liver: (A) Common causes: 1. Prolonged
excessive alcohol consumption. 2. Chronic viral hepatitis. (B) Others:
1. Any causes of chronic hepatitis. 2. Non-alcoholic fatty liver. 3. Cystic
fibrosis. 4. Autoimmune liver disease. 5. Wilson’s disease. Diagnosis
of cirrhosis of liver: (A) Clinical feature: i. Symptoms: 1. Anorexia,
nausea & vomiting, 2. Upper abdominal discomfort. 3. Diarrhoea or
constipation. 4. Amenorrhoea. 5. Loss of libido & impotence. ii. Signs
(Stigma): 1. Face: Hepatic facies, Fetor hepaticus, anaemia. 2. Hand &
nails: Digital clubbing, Leukonychia, Palmar erythema. 3. Cheast:
Spider naevi, Loss of axillary hair, Gynaecomastia (in male).
4. Abdomen: Ascitis, Caput medusa, Testicular atrophy. 5. Leg: Pitting
oedema. 6. Skin: Generalised hyper-pigmentation. (B) Investigation:
1. CBC, 2. Liver Function Test, 3. Ascites fluid study, 4. Barium swallow
X-ray of oesophagus. 5. Endoscopy of upper GIT, 6. Liver biopsy.
Q13. How does hepatitis B virus spread? Write down the
management of viral hepatitis.
Ans: Route of transmission: 1. Parenteral route, 2. Sexual
transmission, 3. Vertical transmission, 4. Horizontal transmission,
5. Share of shaving razors, blade, tooth brushes, towels,
6. Transmission by blood sucking arthropods, 7. Transmission of some
body fluid of infected person. Management: (A) Clinical features:
i. Symptoms: 1. Headache, Myalgia. 2. Anorexia. 3. Nausea &
vomiting. 4. Diarrhoea. 5. Mild fever. ii. Signs: 1. Jaundice. 2. Dark
urine. 3. Pale colour stools. 4. Liver moderately enlarged & tender. 5.
Mild splenomegaly. 6. Cervical lymphadenopathy. (B) Investigation:
1. Blood for CBC. 2. Liver function test: S. Bilirubin, S. Albumin, SGPT
& SGOT. 3. Viral hepatitis markers: For A- Anti-HAV IgM, For B- HBsAg,
For C- Anti-HCV IgM, For E- Anti-HEV IgM. 4. USG of HBS.
C. Treatment: There is no specific treatment. Treatment is only
symptomatic that includes- 1. Bed rest (3-5 weeks). 2. Hospitalization
may be required for severe illness. 3. Diet- Normal. 4. Drugs- All drugs
should be avoided. 5. Alcohol should be avoided. 6. If severe vomiting
I/V fluid, glucose & anti-emetic. 7. Laxative to prevent constipation.
8. If there is fever: Ampicillin 500mg 6 hourly orally for 7 days &
Multivitamin 1 tab TDS.
Q14. Define Nephrotic syndrome. Give the management of
nephrotic syndrome. Write down the complication of it.
Ans: Definition: Nephrotic syndrome is a clinical condition
characterized by- Massive proteinuria, Hypoproteinaemia,
Hypercholesterolaemia, Generalized oedema. Management of NS:
A. Clinical features: i. Symptoms: Gradual swelling of the whole body,
Scanty micturition, Abdominal distention & discomfort, Anorexia,
Nausea & vomiting. ii. Signs: Pale & puffiness of the face with baggy
eyelids, Generalized oedema, Blood pressure- usually normal, Ascites-
may be present, Pleural effusion- may be develop. B. Investigation:
1. Urine for R/M/E, 2. Blood for CBC, 3. Chest X-ray P/A view, 4. Blood
Urea, 5. Serum Creatinine, 6. Serum Electrolyte, 7. USG of KUB region,
8. RBS, 9, HBsAg. C. Treatment: i. General measure: 1. Bed rest.
2. Diet: Normal protein diet & salt restriction 80-100 mmol/day.
3. Control of oedema. ii. Specific measure: 1. Steroid therapy:
Prednisolone (up to a maximum 80mg/day) in 4 divided doses for
next 4 weeks. For relapse- repeat the above the course.
2. Membranous glomerulonephritis: Corticosteroid + immune-
supprasive drugs. iii. Prevention & treatment of complications:
1. Infection (sepsis): Appropriate antibiotic. 2. Venous thrombosis:
Heparin followed by oral anticoagulant. iv. Dialysis: Dialysis is advised
if the patient goes into renal failure. Complications of Nephrotic
Syndrome: 1. Hypovolaemia. 2. Electrolytes imbalance.
3. Thromboembolism. 4. Renal failure. 5. Hyperlipidaemia &
atherosclerosis.
Q15. Define acute glomerulonephritis. Write down the management
of AGN. Write down the difference between AGN & NS.
Ans: Definition: Acute inflammation of glomerulus of kidney is called
AGN. Management of AGN: A. Clinical feature: i. Symptoms: 1. Age:
5-15 years. 2. Scanty micturition, smokey colour. 3. Swelling of face.
4. Fever. ii. Signs: 1. Periorbital oedema. 2. Hypertension.
3. Microscopic haematuria. B. Investigations: 1. Urine for R/M/E.
2. Blood for CBC. 3. Asotitre. C. Treatment: 1. Diet: Protein restriction.
2. Antibiotic: Inj. Cefitriaxone 1gm for 7 days. 3. Diuretics: Frusemide
with or without spironolactone. Difference between AGN & NS:
Points AGN NS
Aetiology Post streptococcal Other secondary
infection causes
Urine Smoky colour Normal colour
Albumin in urine Mild to moderate Moderate to
severe
Blood cholesterol Normal High
Treatment Antibiotic + Corticosteroid +
Diuretic Diuretic
Prognosis Usually good Usually bad
Q16. Write down the causes of polyarthritis. What are the
diagnostic criteria of rheumatoid arthritis? What are the drugs used
in rheumatoid arthritis?
Ans: Causes of polyarthritis: A. Common causes: Rheumatoid
arthritis, Viral arthritis, Osteoarthritis, SLE, Rheumatic fever.
B. Less common: Juvenile idiopathic arthritis, Chronic gout.
Diagnostic criteria of RA: Rheumatoid arthritis is diagnosed when 4
or more criteria are present. These are – Morning stiffness (> 1 hour),
Arthritis of three or more joint areas, Arthritis of hand joint,
Symmetrical arthritis, Rheumatoid nodules, Rheumatoid factor.
Drugs used in rheumatoid arthritis: 1. NSAIDs – Naproxen/
Indomethacin/Ibuprofen. 2. DMARDs – Methotrexate or Hydroxy-
chloroquine. 3. Corticosteroid – Prednisolone 5mg daily.
Q17. Define diabetes mellitus. Classify diabetes mellitus. Write
down the management & complications of diabetes mellitus.
Ans: Definition: It is a clinical condition characterized by
hyperglycaemia due to absolute or relevant deficiency of insulin.
Classification of DM: 1. Type I diabetes/ Juvenile onset DM/ Genitical.
2. Type II diabetes/ Adult onset DM/ Acquired. 3. Other types:
Gestational diabetes, Pancreatic diabetes, Endocrine disorder
diabetes mellitus, Drug induced diabetes mellitus. Management of
Diabetes mellitus: A. Clinical feature: i. Symptoms: Polyuria,
Nocturia, Polyphagia, Weight loss, fatigue, Ulcer with delayed
healing. ii. Signs: Obesity, Cataract, Hypertension, Ulceration of foot.
Gangrene of toe. Investigation: Urine for sugar & ketone bodies,
Blood sugar, Lipid profile, S. Creatinine, ECG, USG.
Treatment: A. General treatment: 1. Maintenance of life style:
a. Exercise, Lowering of over weight, No smoking & Alcohol.
2. Diet: a. To maintain nutritional state, To avoid atherogenic diet, to
avoid rich protein diet. 3. Health education & diabetic care.
B. Specific treatment: 1. Type I (IDDM): Insulin. 2. Type II (NIDDM):
a. Fatty person- Tab. Metformin. B. Under weight person- Gliclazide,
Glimipride, Pioglitazone. C. Associated treatment: 1. Hyper-
cholesteremia: Atovastatin 10mg daily. 2. Hypertension: Amlodipine
5mg once daily. Complication of DM: A. Acute complication:
1. Diabetic ketoacidosis, 2. Non ketoacidosis. B. Chronic complication:
1. Eye- cataract. 2. CVS- Hypertension, IHD. 3. Kidney- Diabetic
nephropathy. 4. Lungs- Pulmonary TB. 5. Nervous system- Peripheral
neuropathy. 6. Infection- Fungal infection of genital organ.
Q18. Define vitamins. Classify vitamins. Name the diseases due to
deficiency of each vitamin.
Ans: Definition of vitamins: Vitamins are low molecular mass organic
compounds occurring in natural foods, which are required in very
small amounts for the maintenance of optimal health.
Classification: A. Fat soluble vitamins: Vitamin A or Retinol, Vitamin D,
Vitamin E, Vitamin K. B. Water soluble vitamins: Vitamin B complex,
Vitamin C or Ascorbic acid. Name the deficiency disorders of soluble
vitamins are given below: i. Fat soluble vitamins: 1. Vitamin A- Night
blindness, Keratomalacia. 2. Vitamin D- Rickets, Osteomalacia. 3.
Vitamin E- Sterility, Alopecia. 4. Vitamin K- Generalized bleeding,
Prolonged clotting time. ii. Water soluble vitamins: A. Vitamin B-
complex: 1. Thiamine (Vit B1)- Beriberi. 2. Riboflavin (Vit B2)- Cheilitis,
stomatitis. 3. Niacin (Vit B3)- Glossitis. 4. Pantothexin acid (Vit B5)-
Fatty liver. 5. Pyridoxine (Vit B6)- Peripheral neuropathy. 6. Folic acid-
Megaloblastic anaemia, GIT disturbance. 7. Vitamin B12-
Megaloblastic anaemia. B. Vitamin C- Scurvy.
Q19. Define & classify anaemia. How will you manage a case of
anaemia due to PUD?
Ans: Definition of anaemia: Deficiency of haemoglobin is called
anaemia. Normal Hb% = 14-18mg/dl. Classification of anaemia:
A. Morphological classification: 1. Normocytic – Haemorrhagic (acute
or chronic). 2. Macrocytic – Megaloblastic or pernicious anaemia.
3. Microcytic – Iron deficiency anaemia. B. Aetiological classification:
1. Haemorrhagic - Acute or chronic blood loss. 2. Haemolytic –
Thalassemia, malaria. 3. Haemopoiletic – Lymphoma, Leukaemia,
Aplastic anaemia. Management of anaemia due to PUD:
H/O the patient: Previous PUD. Previous haematemesis, melaena.
A. Clinical features: i. Symptoms: 1. Epigastric pain, nausea &
vomiting. 2. Fatigue, Headache. 3. Palpitation. 4. Angina.
5. Paresthesia in finger & toes. ii. Signs: 1. Epigastric tenderness,
haematemesis. 2. Pallor of skin, mucosa, palm of hands &
conjunctiva. 3. Tachycardia. 4. Cardiac dilatation. 5. Oedema in foot.
B. Investigations: 1. CBC. 2. Peripheral blood film. 3. RBC (MCV, MCH,
MCHC) reduced. 4. Blood biochemistry. 5. Barium meal x-ray of
stomach & duodenum. 6. Endoscopy of upper GIT.
C. Treatment: a. General measures: 1. Bed rest, 2. Diet normal,
3. Antispasmodic, 4. Antiemetic, 5. Sedative, 6. Avoid aspirin &
NSAIDs. b. Acid neutralizing drugs: 1. Antacids, 2. H2 blocker,
3. Proton pump inhibitor. c. Eradication of Helicobacter pylori: Triple
therapy – 1. Rabeprazole/esomeprazole/omeprazole/dexlansoprazole
12 hourly, Plus (+) 2. Clarithromycin 500mg 12 hourly, plus (+)
3. Amoxacillin 1g 12 hourly or metronidazole 400mg 12 hourly.
For 10-14 days. d. Blood transfusion: If needed.
Q20. What are the causes of iron deficiency anaemia. Give the
management of iron deficiency anaemia.
Ans: Causes of iron deficiency anaemia: A. Physiological cause:
1. Children during period of growth. 2. Menstrual loss. 3. Pregnancy.
4. Lactation. B. Pathological cause: 1. Hook worm infestation. 2. Peptic
ulcer. 3. Carcinoma of stomach, colon. 4. Ulcerative colitis. C. Dietary
causes: 1. Less intake of iron. 2. Less absorption of iron. Management
of iron deficiency anaemia: A. Clinical features: i. General features:
Anorexia, Weakness, Fatigue, Pallor, Palpitation. ii. Characteristic
features: Angular stomatitis, Glossitis, Brittle finger nails,
Splenomegaly (in severe cases). Investigations: 1. CBC. 2. Peripheral
blood film. 3. RBC (MCV, MCH, MCHC) reduced. 4. Blood
biochemistry. 5. Barium meal x-ray of stomach & duodenum.
C. Treatment: 1. General treatment: Intake iron rich food.
2. Eradication of hook worm: Albendazole 400mg single dose, or
Mebendazole 100mg BD for 3 days. 3. Oral iron therapy: Tab. Ferrous
sulphate 200mg 1 tab TDS for 2-6 months.
Q21. Write down the causes of unconsciousness/coma. Write down
the management of unconsciousness/coma.
Asn: Causes of unconsciousness: 1. Brain cause: Brain tumor, Brain
abscess, Head injury. 2. Haemorrhage: Pontine haemorrhage,
Subdural haemorrhage, Extradural haemorrhage, Subarchnoid
haemorrhage. 3. Cerebro-vascular accident: Intra-cerebral
haemorrhage, Brain stem haemorrhage, Cerebral venous sinus
thrombosis. 4. Metabolic disorder: Diabetic coma, Renal failure,
Hepatic failure. 5. Others: Epilepsy, Hypoglycaemia, Hypoglycaemia,
Hypotension, Hypothermia. Management of unconsciousness/Coma:
A. Immediate assessment of airway, pulse, pupil, presence of trauma.
B. Immediate management: 1. Maintenance of airway. 2.
Maintenance of breathing. 3. Maintenance of circulation. 4. If head
injury presence, anticipate deterioration. C. Further assessment:
1. History from attendance of trauma, HTN, DM, epilepsy, Poisoning,
Liver disease. 2. Level of consciousness – Glasgo coma scale.
3. General examination – Pulse, BP, Temperature, Skin colour, Smell of
breath, Vomitting, Respiration rate. D. Neurological examination:
1. Signs of head injury. 2. Pupillary size, shape & reaction of light.
3. Findi, ocular movement, reflexes. 4. Limbs movement, signs of
meningeal irritation – neck rigidity. E. Specific management:
According to the causes.
Q22. Write down the causes of fever. Write down the C/F &
treatment of Mumps.
Ans: Causes of fever: A. Infection (30%): Tuberculosis, Enteric fever,
Malaria, Dengue fever, Sepsis, Viral infections. B. Malignant disease
(20%): Leukaemia, Lymphoma, Myeloma. C. Connective tissue
disorders (15%): Rheumatic fever, Rheumatic arthritis, Polyarthritis
nodosa. D. Miscellaneous (20%): Inflammatory bowled disease,
Cirrhosis of liver, Sarcoidosis. E. Ediopathic (15%).
Clinical Feature’s of Mumps: 1. Fever. 2. Headache, Malaise &
Anorexia. 3. Trismus & pain near the angle of jaw. 4. Tenderness of
one or both parotid gland. 5. Swelling of one or both parotid gland.
Treatment of Mumps: 1. Bed rest. 2. Oral hygiene should be
maintained. 3. Antibiotic therapy – Azithromycin. 4. Analgesics for
pain. 5. Antipyretic for fever. 6. Prednisolone (40mg orally for 7 days)
to prevent orchitis. 7. Treatment according to cause.
Q23. Define Covid-19. Route of transmission & Incubation period of
Covid-19. Write down the Management of Covid-19.
Ans: Definition: Covid-19 is a new respiratory disease caused by
SARS-CoV-2, Which is usually manifested by fever, dry cough, fatigue
& shortness of breath. Route of transmission: Animal to human then
human to human. Incubation Period: 2-14 days. Management of
Covid-19: A. Clinical features: 1. Fever. 2. Dry cough. 3. Fatigue.
4. Shortness of breath. 5. Sore throat. 6. Headache. B. Investigation:
1. RT-PCR. 2. Chest X-ray P/A view. 3. Chest HRCT of Chest.
C. Treatment: Treatment is only symptomatic- 1. Immediate
hospitalization of the patient. 2. Bed rest with propped-up position.
3. High flow O2 inhalation. 4. Antibiotic (if respiratory infection):
Azithromyxin, Cefixime, Moxifloxacin. 5. Steroid: Injection/Oral
Dexamethasone. 6. Anti-leukotriene drugs: Montelukast. 7. H2
blocker: Femotidine. 8. Antihistamine: Fexofenadine, Rupatadine,
Ebastatine. 9. Vitamin C & Vitamin D3 . 10. Treatment according to
cause.
24. Define dysentery. Name the organisms of dysentery. What are
the types of dysentery? Write down the difference between
amoebic & bacillary.
Ans: Definition: Dysentery is an acute inflammation of large intestine
characterized by diarrhoea with blood & mucus in the stool.
Organisms of dysentery: 1. Amoebic dysentery. 2. Bacillary dysentery.
Types of dysentery: 1. Amoebic dysentery (amoebiasis): Caused by
Entamoeba histolytica. 2. Bacillary dysentery (shigellosis): Caused by
Shigella group, mainly – Shigella dysentery, Shigella flexneri, Shigella
sonnei, Shigella boydii. Difference between amoebic & bacillary
dysentery are given below:
Point Amoebic Bacillary
1. Number 6-8 motion a day Over 10 motion a day
of motion
2. Amount Relatively copious Small amount
3. Odour Offensive Odourless
4. Colour Dark red Bright red
5. Nature Blood & mucous Blood & mucous no
mixed with stool stool
6. Reaction Acidic Alkaline
7. RBC In clump In rouleax form
8. Pus cell Scanty Numerous
9. Organism Entamoeba histolytica Shigella Species
10. Bacteria Nill Many
11. Parasite Cyst & Trophozoite Nill
of E. histolytica
12.Treatment Metronidazole Ciprofloxacin &
Rehydration
Q25. Define dengue fever. Classify dengue fever. Write down the
management of dengue fever.
Ans: Definition: Dengue is an acute vector born disease caused by
dengue virus, which is transmitted during bite by infected aedes
aegypti mosquito. Classification: 1. Dengue fever (DF). 2. Dengue
haemorrhagic fever (DHF). 3. Dengue sock syndrome (DSS).
Management of dengue fever: A. Clinical features: i. Asymptomatic.
ii. Symptomatic: 1. Dengue fever: Headache, Retro-orbital pain,
Myalgia, Rash. 2. Dengue haemorrhagic fever: Positive tourniquet
test, Petechiae, Epistaxis, Thrombocytopenia. 3. Dengue shock
syndrome: Rapid & weak pulse, Narrow pulse pressure, Hypotension,
Restlessness. B. Investigation: 1. CBC. 2. ELISA to detect NS1 antigen.
3. Antibody titre: Four-fold rise in IgG titre. 4. Isolation of dengue
virus from blood. 5. Detection of dengue virus RNA by PCR.
6. Tourniquet test: positive in (DHF). C. Treatment: 1. Complete bed
rest. 2. Antipyratic – Paracetamol 500mg 8 hourly. 3. Aspirin should
be avoided. 4. At least 2.2 liter electrolyte should be taken daily, e.g.
ORS, Rice saline, Dub water. 5. In case of DHF & DSS – even should
begive I/V fluid & needed blood transfusion. 6. No existing antivirals
are effective. 7. Patient are nursed under a mosquito net.
Q26. Name five common causes of itching. Write down the
management & complications of eczema.
Ans: Five common causes of itching: 1. Macular rash – chicken pox,
measles, vitiligo. 2. Papular rash – chicken pox, scabies, ance.
3. Vesicular rash – Chicken pox, herpes simplex, burn, insect bite.
4. Erythematous rash – Cellulitis. 5. Pustular rash – Acne, psoriasis.
Management of Eczema: A. Clinical features: i. Acute eczema:
1. Severe itching, burning sensation & pain. 2. Redness & swelling
usually with ill-defined margin. 3. Papules, vesicles & occasionally
bullae. 4. Exudation, fissuring & scaling. ii. Chronic eczema:1. Severe
itching, 2. Lichenification, 3. Fissures, scratch marks & pigmentation
changes. B. Investigation: i. patch testing to allergens. Ii. Prick testing,
iii. Culture for bacteria & fungus. C. Treatment: i. General treatment:
1. Explanation, reassurance & encouragement, 2. Avoidance of
contact with irritants, 3. Regular use of greasy emollients,
4. Appropriate use of tropical corticosteroids. Ii. Local treatment:
1. KMnO4 solution wash twice daily, 2. Calamine lotion applied 4-6
times daily, 3. Tropical steroids 2-3 times daily. iii. Systemic treatment:
1. Bacterial: Flucloxacillin 500 mg 6-hourly for 7-10 days. 2. Viral:
Acyclovir. 3. Fungal: Ketoconazole, fluconazole. 4. Antihistamine:
Diphenhydramine 25-50 mg two times daily. 5. Oral corticosteroids:
prednisolone. Complication of Eczema: 1. Superinfection, 2. Sleep
disturbance, 3. Loss of schooling & behavioural difficulties, 4.
Reaction to local medication, 5. Psychological- anxiety.
Q27. Define scabies. Name the organism of scabies. Write down the
management & complication of scabies.
Ans: Definition: Scabies is a highly contagious disease caused by itch
mites on close contact characterized by superficial burrows, intense
pruritus & secondary infection. Organism of scabies: Sarcoptes
scabiei. Management of scabies: A. Clinical features: 1. It occurs in all
irrespective of age & sex, 2. Intense itching specially at night,
3. Papular lesion in affected area with burrows, 4. Affects other
member in family, 5. Affects axilla, antecubital fossa, hands,
areola,abdomen , genitalia, legs & feet. 5. Exemption of head, neck &
face except infants. B. Treatment: i. Tropical scabicide can be used:
5% permethrin or 25% Benzyle benzoate is still used occasionally but
it can be very irritant. Ii. Adjunct treatment with any one is helpful:
Crotaminaton cream or An emollient or A mild tropical steroid.
iii. Flucloxacillin 250 mg 6 hourly for 7 days or Clindamycin 300 mg 8
hourly for 7 days or Cefuroxime axetil 250 mg 12 hourly for 7 days or
Tetracycline 250 mg 6 hourly for 7 days. iv. Antihistamine:
Fexofenadine or Rupatidine. C. Complication: AGN, Eczematization,
Lichenification, Scarification, Infection.
Q28. Name some common poisoning in Bangladesh. Write down the
management & complication of OPC poisoning.
Ans: Common poisoning in BD: OPC poisoning, Diazepam poisoning,
Kerosene poisoning, Alcohol poisoning, CuSO4 poisoning, Harpic
poisoning, Rat killer poisoning. Management of OPC poisoning:
A. Clinical features: Vomiting, Diarrhoea, Abdominal pain,
Bronchorrhoea, Bronchospasm, Salivation, Pin point pupil,
Respiratory failure, Circulatory failure. B. Investigation: CBC, Blood
sugar, ECG. C. Treatment: 1. Immediate hospitalization of the patient,
2. General measures: Clearance of airway & mouth, Stomach wash: If
patient comes within 4 hours of poisoning, O2 administration in high
dose , Keep the patient NPO, Open I/V channel & give I/V fluid, Broad-
spectrum antibiotic, Catheterization, Care of skin & eye.
3. Inj. Atropine 0.6 mg/ 1ml I/V. 4. Inj. Pralidoxime 1000mg/ml, I/V
5. Inj. Ceftriaxone 1gm I/V. 6. Inj. Omeprazole 40mg I/V.
D. Complication: Aspiration pneumonia, Retention of urine,
Tachycardia, Heart failure, Pyrexia, Atropine toxicity.
Q29. Define & classify PEM. Write down the management of PEM.
Write down the differences between marasmus & Kwashiorkor.
Ans: Definition: Protein energy malnutrition is a group of clinico-
pathological conditions of varying degree of severity arising from a
lack in varying proportion of proteins & calories, occurring mostly in
infants & young children & commonly precipitated by attacks of
infections. Classification of PEM: 1. Kwashiorkor, 2. Marasmic
kwashiorkor, 3. Marasmus, 4. Nutritional dwarfing, 5. Under-weight
child. Management of PEM: A. Clinical features: i. Clinical features
of Marasmus: 1. Wasting- marked, all skin & bone, 2. Muscle wasting-
Severe, 3. Growth retardation, 4. Super-added infections are common
ii. Clinical features of Kwashiorkor: 1. Oedema present of the lower
segment, sometimes face, 2. Muscle wasting- sometimes, 3. Hair &
skin changes, 4. Diarrhoea. B. Investigation: 1. Blood for CBC,
2. Chest x-ray P/A view, 3. Throat swab for culture, 4. Urine for R/M/E,
C/S, 5. Stool for R/M/E, C/S, 6. Serum total protein: Albumin: globulin
ratio, electrolytes. C. Treatment: 1. Correction of water & electrolyte
imbalance, 2. Treat infections & worm infections, 3. Dietary support:
3-4 g protein & 200 Kcal/kg body wt./day + Vitamins & minerals.
4. Prevention of hypothermia, 5. Counsel parents & plan future care
including immunization & diet supplements, 6. Feeding practice
should be: i. continue breast feeding, ii. Add frequent small feeds,
iii. Use liquid diet, iv. Give vitamin A & folic acid.
Give the differences between marasmus & Kwashiorkor: i
Point Marasmus Kwashiorkor
Age 1-4 years 6 months to 1 year
Cause Protein deficiency Protein & calorie
deficiency
Appetite poor Good
Appearance Moon face Monkey face
Oedema present Absent
Skin Pigmentation No skin change
Treatment Protein Protein & other
supplement supplement
Q30. What are the causes of joint pain in children? Write down the
management of pneumonia under 2 months of age. What are the
danger signs of ARI in children?
Ans: Causes of joint pain in children: 1 Acute rheumatic fever,
2. Juvenile idiopathic arthritis, 3. Infection, 4. Haemorrhage
5. Reactive arthritis. 6. Systemic lupus erythematosus.
Management of pneumonia under 2 months of age:
A. Clinical features: i. Clinical features of severe pneumonia:
1. Stopped feeding well, 2. Convulsions, 3. Fast breathing,
4. Severe chest indrawing, 5. Wheeze, 6. Central cyanosis,
7. Distended & tensed abdomen. Ii. Clinical features of no
pneumonia: 1. Cough or cold, 2. No fast breathing, 3. No signs of
pneumonia or very severe disease. B. Treatment: i. Treatment of
severe pneumonia: 1. Immediate hospitalization, 2. Give oxygen
inhalation if, 3. Antibiotic, 4. Nebulized salbutamol (5mg/ml), 5. Oral
salbutamol ½ tab tds for 5 days, 6. Supportive care, 7. Reassess twice
daily. ii. Treatment of no pneumonia: 1. Advice mother to give the
following home care: Keep the baby warm, Breast feed frequently,
Clear nose if it interferes with feeding. 2. No antibiotics. 3. Referral
knowledge- return the child quickly to health care centre if the
following signs appear: Breathing becomes difficult, Breathing
becomes fast, Child not able to drink, The young infant becomes
sicker. Danger signs of ARI in children: 1. Stopped feeding well,
2. Convulsion, 3. Fast breathing, 4. Severe chest indrawing,
5. Wheezing, 6. Central cyanosis, 7. Distended & tensed abdomen.
Q31. What are the causes of neonatal jaundice? Write down the
management of neonatal jaundice?
Ans: Causes of neonatal jaundice: A. Early jaundice ( with in 10 days
of age): 1. Within first 2 days of birth: i. Haemolytic disease of new
born, ii. Congenital spherocytosis, iii. Rh-incompatibility. 2. Within 3-
10 days: i. Congenital haemolytic anaemia, ii. Physiological jaundice,
iii. Hypoglycaemia, iv. Sepsis. B. Prolonged jaundice (After 10 days for
age): 1. Prolonged unconjugated hyperbilirubinaemia: i. Breast milk
jaundice, ii. Sepsis, iii. Hypothyroidism, iv. Rh-incompatibility.
2. Prolonged conjugated hyperbilirubinaemia: i. Infection,
ii. Galactosaemia, iii. Gaucher disease, iv. Billiary atresia.
C. Persistence jaundice: 1. Unconjugated hyperbilirubinaemia:
i. Breast milk jaundice, ii. Intestinal obstraction, iii. Ongoing
hemolysis. 2. Conjugated hyperbilirubinaemia: i. Neonatal hepatitis.
ii. Extra hepatic billiary atresia. Iii. Total parenteral nutrition.
Management of neonatal jaundice: A. Clinical Evaluation: i. History:
1. Age of appearance of jaundice. 2. Order of pregnancy. 3. History of
jaundice of previous child. 4. Blood group & Rh-typing of baby &
mother. ii. Physical examination: 1. Extent of jaundice. 2. Pallor.
3. Hepatosplenomegaly. 4. Any evidence of sepsis. 5. Abnormal
neurological behaviour. B. Investigation: 1. Bilurubin level:
Conjencted & unconjuncted. 2. Blood for TC, DC, Hb%. 3. Platelet
count. 4. Blood grouping & Rh-typing. 5. Peripheral blood film (PBF).
6. Direct & indirect comb’s test. 7. VDRL test for mother & baby.
C. Treatment: 1. Most of the neonatal jaundice are physiological &
usually do not require any treatment. Only exclusive breast feeding &
follow up is sufficient. 2. Drugs: Tab. Phenobarbiton 5mg/kg/day 2
times a day. 3. Phototheraphy: If serum bilirubin >12mg/dl in term
baby & more then 10mg/dl in preterm baby. 4. Exchange blood
transfusion: If conjugated bilirubin >18mg/dl in term baby &
>15mg/dl in preterm baby.
Q32. What are the common causes of neonatal sepsis? Give the
management of neonatal sepsis.
Ans: Common causes of neonatal sepsis: 1. Group B Streptococci,
2. Listeria monocytogenes, 3. Herpes simplex virus, 4. Enterovirus,
5. Candida, 6. Plasmodium, 7. Toxoplasma. Management of neonatal
sepsis: A. Clinical features: i. Mostly nonspecific: 1. Not feeding well/
refuse to suck, 2. Lethargy, poor muscle tone, poor cry, 3. Low body
temperature or fever, 4. No movement of all 5. Vomiting.
ii. Specific: 1. CNS: Irritability, Seizure, High pitch cry. 2. GIT: Vomiting,
Diarrhea, Abdominal distention, Paralytic ileus. 3. Respiratory system:
Grunting, Fast breathing, Severe chest indrawing or cyanosis. 4. CVS:
Bradycardia or tachycardia, Hypotension, shock. 5. Skin changes:
Multiple pustules, Foul smelling umbilical discharge.
6.Haematological: Bleeding, Purpura, Jaundice. 7.
------------------------------------- SHORT NOTE ------------------------------------
01. Short note on: AIDS.
Ans: Definition: AIDS is a communicable retroviral disease caused by
HIV which progressively reduces the effectiveness of the immune
system. Route of Transmission: 1. Sexual transmission. 2. Kissing or
touching of an infected person. 3. From mother to fetus. 4. Parenteral
transmission. 5. Sharing of infected blades, razors, syringes &
toothbrush. 6. Others: a. Organ & tissue donation such as kidney, eye
etc. b. Transmission of some body fluid of infected person such as
semen, blood etc. Management of AIDS: A. Clinical features:
1.Weight loss, 2. Prolonged fever for more than 1 month, 3. Persistent
cough, 4. Herpes zoster, 5. Oropharyngeal candidiasis.
B. Investigation: 1. Screening test for HIV antibodies, 2. Virus isolation
by PCR. C. Treatment: 1. In mild disease two drug combinations
(Zidovudine + Lamivudine) are used, 2. In severe disease triple
therapy (Zidovudine+ Lamivudine+ Indinavir) is effective,
3. Symptomatic treatment is given. D. Prevention: 1. Public
awareness campaigns for HIV, 2. Safe sex practices & safe sex
methods at sex works, 3. Not to share needles, blades, razors, surgical
instruments & tooth brushes. 4. Reduction of unnecessary blood
transfusions, 5. Disposable syringes & needles should be used,
6. Perinatal, 7. Social welfare measures, 8. Health & sex education on
AIDS.
02. Short note on: Ascites.
Ans: Definition: Accumulation of free fluid in the peritoneal cavity is
called ascites. Causes: 1. Cirrhosis of liver, 2. Cardiac failure, 3.
Nephrotic syndrome, 4. Hepatic venous occlusion, 5. Tuberculosis,
6. Pancreatitis, 7. Lymphatic obstruction, 8. Hypothyroidism.
Management: A. Clinical features: 1. Abdominal distension with
fullness of flank, 2. Distortion & evertion of the umbilicus, 3. Hernia,
abdominal striae, 4. Pleural effusion in right side, 5. Scrotal oedema.
B. Investigation: 1. USG of whole abdomen, 2. Aspiration & analysis
of ascitic fluid. C. Treatment: 1. Bed rest until ascites subside, 2. Diet:
Sodium & water restriction.
03. Short note on: Bell’s palsy.
Ans: Definition: Paralysis or weakness of the muscle on one side of
the face due to lower motor neuron lesion of facial nerve is called
bell’s palsy. Causes of Bell’s palsy: 1. Idiopathic, 2. Viral infection,
3. Cold exposure, 4. Trauma, 5. Vascular damage.
Clinical features: 1. Onset is sub-acute, 2. Pain in face & around the
region of stylomastoid foramen, 3. A unilateral facial paralysis. 4. The
eye on the affected side cannot be closed, 5. Saliva & fluid escape
from the angle of the mouth. On examination: 1. Paralysis of the
upper & lower parts of the affected side of the face, 2. The lines of
expression are flattened, 3. Patient is unable to wrinkle the brow or
whistle or retract the angle of the mouth. Treatment: 1. 70-80%
patients recover spontaneously within 2-12 weeks, 2. Tab.
Prednisolone 40-60 mg daily for 7 days, 3. Antiviral therapy: Tab.
Acyclovir 200-400 mg 5 times daily for 7 days, 4. If eye closure is
failed, use antibiotic eye ointment & wear a pad over the eye to
protect the cornea, 5. Physiotherapy, 6. Surgical decompression of
fascial nerve is in the facial canal.
04. Short note on: Dengue Fever.
Ans: Definition: Dengue fever is a mosquito-born disease caused by
dengue virus which is transmitted to man principally by the bite of
Aedes female mosquito. A. Clinical features: i. Asymptomatic.
ii. Symptomatic: 1. Headache, 2. Retro-orbital pain, 3. Myalgia,
4. Rash, 5. Leucopenia. B. Investigation: 1. CBC, 2. ELISA to detect NSI
(Non structural Protein-I), 3. Serum electrolyte, 4. Isolation of dengue
virus from blood, 5. Detection of dengue virus RNA by PCR.
C. Treatment: 1. Complete bed rest. 2. Antipyratic – Paracetamol
500mg 8 hourly. 3. Aspirin should be avoided. 4. At least 2.2 liter
electrolyte should be taken daily, e.g. ORS, Rice saline, Dub water. 5.
In case of DHF & DSS – even should begive I/V fluid & needed blood
transfusion. 6. No existing antivirals are effective. 7. Patient are
nursed under a mosquito net.
05. Short note on: EPI Schedule
Ans: EPI Schedule: The WHO officially launched a global
immunization program known as expanded program on immunization
to protect all children of the world against some preventable disease
known as EPI. Latest EPI schedule in Bangladesh: 1. At birth: BCG,
OPV-0. 2. At 6 weeks: Pentavalent-1, OPV-1, PCV. 3. At 10 weeks:
Pentavalent-2, OPV-2, PCV. 4. At 14 weeks: Pentavalent-3, OPV-3, PCV.
5. At 9 months: MR, OPV-4. 6. At 15 months: Measles.
06. Short note on: ORS
Ans: ORS: ORS means of oral rehydration salts. When ORS is
dissolved in adequate amount of water then the solution is called oral
rehydration saline. Aim: To reduce or prevent dehydration and reduce
mortality. Different types of ORS: 1. ORS- Citrate. 2. ORS -
Bicarbonate. 3. ORS - Cereal. (Rice based ORS).

07. Short note on: Oedema.

Ans: Definition: Excessive accumulation of fluid in the interstitial
tissue space is called oedema. Classification: i. Localized oedema:
1. Peripheral oedema, 2. Abdominal oedema, 3. Ankle oedema.
ii. Generalized oedema. Causes: 1. Renal causes: Nephrotic syndrome,
AGN, Renal failure, Nephropathy. 2. Heart cause: CCF, Right heart
failure. 3. Liver cause: Cirrhosis of liver, Carcinoma of liver.
4. Abdominal causes: Carcinoma of stomach, Carcinoma of large gut.
5. Other cause: Beriberi, PEM, Severe anaemia, Pregnancy.
Treatment of oedema: 1. Restricted dietary sodium to 100 mmol/day.
2. Diuretics: Thiazide or low dose Frusemide. 3. Specific treatment:
a. ACE inhibitor in the heart failure, b. Corticosteroids in the minimal
change of nephropathy.

08. Short note on: Scabies.

Ans: Scabies: It is a contagious infectious disease caused by sarcoptes
scabiei. Clinical features: 1. It occurs in all irrespective of age & sex.
2. Intense itching specially at night. 3. Papular lesion in affected area
with burrows. 4. Affects other members in family. Treatment:
A. General treatment: 1. Strict personal hygiene, 2. Scrub bath before
medication, 3. All member affected to be treated at a time, 4.
Washing of cloths with soap, water heated in sun. B. Specific
treatment: 1. Topical scabicide: 5% permethrin lotion single
application. 2. 1% GBH lotion use whole body below the neck. 3. For
secondary infection: Flucloxacillin 250 mg 6 hourly for 7 days.
4. Antihistamine: Fexofenadine, Rupatadine.

09. Short note on: Thalassaemia:

Ans: Thalassaemia: It is an inherited impairment of hemoglobin
production in which there is partial or complete failure to synthesis a
specific type of globin chain. Types: 1. Beta thalassemia. 2. Alpha
thalassemia. Diagnosis: By clinical triad of: Anaemia. Jaundice.
Splenomegaly. Treatment: Special treatment: Bone marrow
transplantation.