BLOCK EXAM 2 (AUGUST 2025)

Medicine 1

1) 19 years old girl presented with papules and pustules on face for last three months. She has
some atrophic scars on her face.

Acne vulgaris ( diagnosis+pathophysiology+treatment+complications)

2)Young girl took multiple paracetamol tablets, drowsy presented in ER.

Treatment and complications

3)A young boy know case of sickle cell anemia, presented to ER with fever, abdominal pain,
tender hepatomegaly, spleen was not palpable Hb was 4, platelets normal.

Sickel cell crisis (diagnosis, management, other complications)

4)A young patient with 3 days history of fever 100°F, vomiting, head ache, neck stiffness.

Diagnosis+treatment+4 investigations and their findings

5)55 years old patient feeling dizziness on standing up for one day SIGNIFICANT postural drop
was there. Passing black color stools for three days. He is diabetics, hypertensive, MI episode 2
years back, taking Aspirin, losartan, and other CCB. Urea and creatinine normal. LFTs normal.

Upper GI bleed leading to anemia; risk factors hypertension and aspirin, age etc. (Diagnosis and
why?, management )

6)65 years old with presented with drowsiness, responding to pain and voice. Splenomegaly,
shifting dullness, raised AST + ALP, flapping tremors. Other labs were normal.

(Write composite diagnosis, investigations, management)

7)A known case of hokgins lymphoma presented with sudden onset of painful first joint
swelling on foot.
Secondary gout due to tumor lysis syndrome (diagnosis+investigations+management)
8)Systemic sclerosis scenario (easily identifiable): diagnosis, diagnostic investigation,
management

9)A young female with uncontrolled hypertension (not controlled by three anti-HTN
medications), palpitations, sweating, anxiety; diagnosed as anxiety patient and treatment given
but symptoms not improved. Abdominal CT and MRI unremarkable.

Pheochromocytoma (diagnosis, 4 diagnostic investigations, management)

10)16 years old girl with nausea and abdominal pain for three dags, mild dehydration. Raised
urea and creatinine. CBLS normal.
DKA (diagnosis, d/d, 4 investigations with results, management)

Medicine 2

1. Maj depressive disorder: diagnosis, medical treatment, Non-pharmacological treatment

options.
2. Polycythemia: Diagnosis, specific investigations, treatment
3. B12 def: diagnosis, investigations, management
4. St elevation MI (anteroseptal): diagnosis, artery involved, ideal treatment options
5. Peripheral neuropathy from isoniazid (patient on ATT): diagnosis with reason, treatment, side
effects of ATT.
6. Pneumothorax: diagnosis, investigations, management
7. Pre renal aki from acute gastroenteritis: diagnosis, investigations, management
8. Patient with fever, vomiting, headache, body pains, spleenomegaly, thrombocytopenia, mild
anemia, started passing black water urine: most probably black water fever (complicated
malaria- Black water fever)
9. DIC from malignancy: diagnosis, treatment.
10. Paracetamol poisoning: diagnosis, emergency management

Surgery 1

1- *a* BMI calculation and caloric requirement *b* protein sparing nutrition *c* monitoring of
patient on TPN

2- Massive transfusion and its complications

3- Define SIRS, Sepsis, Severe sepsis *b* sepsis six

4—Burn classification and management

5- Contrast based investigations and their complications *b* Note on mammography *c*
preparation of a patient before ERCP

6- Complications of open fracture and management of open communitaed fracture of tibia

7- GCS scale use and clinical features of base of skull fracture

8- BCC and its management

9- Barret esophagus its complications and management

10- Wound healing phases, local and systemic factors affecting wound healing
 Surgery 2

1- Multimodal analgesia

2- Squamous cell carcinoma of tongue

3- Breast lump history and investigations

4- Retro sternal goiter( Multinodular)

5- Left Inguinal hernia( Direct)

6- Umbilical hernia

7- ARDS
8- Mallory weis tear

9-Obstructive jaundice

10- Transitional cell carcinoma of bladder

Obstetrics

1- Woman at 41 weeks of term presents in OPD her management plan

2- Breech presentation delivery methods and counseling of patient for these methods

3- Uterine inversion management

4- Placental abruption management

5-BMI 31 of the mother its effect on mother and fetus

6- Eclampsia management

7-FGR management
8-Polyhydramnios management plan

9-Shoulder Dystocia management

Gynaecology

1- Endometriosis management

2- PID management

3- Fibroid treatment options

4- Sterilization methods for a couple and female sterilization methods detail

5- Ovarian carcinoma management plan

6- History questions before initiating HRT

7- Stress incontinence Surgical options after failure of non surgical treatment

8- Imperforate hymen

9-Ruptured ectopic pregnancy management

Paediatrics
Question 1

Write EPI schedule along with routes of administration?

Question 2

A 2-year-old child residing in flats presented in pediatric OPD with C/O delayed walking. The
mother also gives history of poor nutritional intake O/E the child has significant frontal bossing
and bowed legs.

a) What is the most likely diagnosis

b) How will you investigate this child?

c) How will you treat him?

Question 3

A 1% year old child presents to the emergency room with a 3-day history of cough and high
grade fever. On examination child is pale with a temperature 100 F, pulse 140/min, respiratory
rate 55/min, and oxygen saturation 78% in room air. There is nasal flaring, intercostal and
subcostal retractions with diffuse rhonchi and crepitation on auscultation. On right side of chest
there is dullness on percussion and air entry is decreased.
a) What is the diagnosis?

b) Name 2 commonest organisms, responsible for this disease?

c) What complication has developed in this case?

d) Enlist 4 steps of management?

Question 4
A 10-year-old is brought with history of lethargy, nausea and low grade fever for 1 wk and
yellow discoloration of urine and vomiting for 2 days. There is history of eating contaminated
food. Ole; He is icteric, has tenderness in right hypochondrium and liver is palpable below costal
margin. Investigations: Hb-12 gm/dl WBC-5000cmm/PLT-15 C-5000cmm/PLT-
150,000/cmmSGPT-500/dl

a) What is the most likely diagnosis?

b) What is the most likely organism?

c) What other investigations will you do?

d) How could it be prevented?
Question 5

A 9-month-old previously well, thriving child seen in Emergency Room with cough and coryzal
symptoms for the last one week, reluctant to feed since morning and grunting for the last 2 hours.
There is nothing of note in birth, vaccination and developmental history. On examination child
has saturations of 90% in air 96% with oxygen, R/R was 60 breaths/min, H/R 190 beats/min,
distant heart sounds with gallop rhythm. Other systemic examination revealed bilateral crepts
and 5 cm tender hepatomegaly.

a) What is the most likely diagnosis?

b) How will you manage this case?

Question 6

A 5 years old previously healthy male is brought with history of high-grade fever, vomiting and
headache for 1 day. O/e GCS is 10/15, Temp is 101 F and H/R is 100 beats/min. CNS
examination shows neck stiffness, bilateral up going plantar and papilledema. Investigations:
CBC: Hb 12 gm/dl, TLC 25,000/mm³, Platelets 200000/mm², CRP 100.
a) What is the most probable diagnosis?

b) List 3 common organisms at this age.

c) What specific investigations will you do to reach the diagnosis

d) What are the long-term neurological complications?

Question 7

A 5 month old baby boy presents with H/O constipation since birth, on further inquiry he is also
unable to hold his head, O/E baby has hypotonic coarse facies with umbilical hernia, No
investigations have been done yet.
a) What is the most probable diagnosis?
b) How would you investigate the child?

c) How will you treat this baby?

d) Give two important complications in untreated baby?

Question 8

A 3-year-old girl is brought with history of sudden onset of nasal bleeding and rash all over the
body. She had fever and runny nose 1 week back. O/E she is playful, afebrile with generalized
petechiae and few ecchymotic patches. Rest of examination is unremarkable.
Investigations: Hb-11 gm/dl, WBC 5000/, Platelet count 50,000/.No abnormal cells on peripheral
examination.

a) What is the diagnosis?

b) Enlist treatment options.

c) What is the prognosis?

Question 9

A 6-year-old boy presents with oliguria, periorbital swelling and red coloured urine. He had skin
infection 3 weeks ago. His blood pressure is 145/100:

a) What is the likely diagnosis?

b) How will you investigate this patient?

c) Name 4 important complications of this condition.