Completely Solved SEQs of PMDC Step II Conducted By DOW on 13-05-2012

Solved SEQs of PMDC Step II Conducted By DOW on 13-05-2012

1-i. What are some common psychiatric problems in Pakistan?
ii. How would you manage them?

i-Depression
Anxiety
OCD
Schizophrenia
ii-MX=Depr=CBT
TCAs,MAOi
ECT
Anxiety=Relaxation techniques SSRIs,MAOi,alprazolam
OCD=Relaxation tech,thought stopping technique,exposure paradoxical intent SSRIs,Clomipramine Schizophrenia=Hospitalization, Antidepressants,antiosycotics,Benzodiazipines

2 i. What is the effect of stress on physical and psycosocial health of a person?
ii. Give non-pharmacological interventions for reducing stress.

i-Physical Effects of Stress
cardiovascular system=HTN,MI,MVP,CAD
GI SYSTEM=IBS,gastric ulcer,Duodenal ulcer,CD,UC
HORMONAL=Hypoglycemia,DM,Hyperthyroidism,Hypothyroidism
IMMUNE=Allergic disorders,SLE,RA,AIDS
DERMATOLOGICAL=Eczema,Psoriasis,Urticaria,Hyperhidrosis
Skeletal,CNS=Chronic pain,Headache,Raynauds disease
RESPIRATORY=Asthma,Hyperventiation
ii-NPIs for reducing stress:
Improve time management
improve sense of humor
persue personal and vocational activities
explore the meaning of life
Calrify values
Cultivate social support network
increase assertiveness
Help others
reduce exposure to un necessary stressors

3-iA 25 years obese lady has come to you with blood sugar of 160mg/dl.
What further test will you advice her?
What advice will you give her about diet nd exercise?
What drugs can be prescribed according to priority?

i-Fasting Blood sugar
Random Blood sugar
Glucose tolerance test
Glycosylated HbA1c
Urine for ketones
urea,Electrolytes

ii-Diet=Obese,mildage,elderly patients with mild diabetes=1000-1600kcal/day
Elderly diabetics=1400-1800kcal/day
young,active diabetics=1800-3000kcal/day
Proteins=60-110gms/day
Carbohydrates=100-300gms
Salt=upto 6gms/day
Foods to b avoided=Sucrose,Glucose
Foods which can be taken in moderation=Bread,Biscuits,cereals,baked beans,pasta,custard,milk,meat,fish,eggs,cheese,fresh and dried fruits
Foods that can be taken as desired=Green vegs,soups,tea,coffee,lemon juice,tomatoes
Do exercise regularly
iii-Rx=Start with Metformin(Biguanide)
Sulfonylureas(Glibenclamide,Gliclazide,Glipizide)
Alpha glucosidase inhibitor(Acarbose)
Insulin

4-14 year boy from Lahore has come to you with history of malaise,fever,generalized weakness and bodyache.He has a purple rash on shoulder.ANaemia and jaundice negative,
No hepatospleenomegaly
Platelet=80,000
TLC23000/UL
i-Write Differentials?
ii-What further investigation will you advice?
iii-How would you manage the patient?

i-DDs=Dengue fever,Malaria,Typhoid,Leptospirosis,Shigellosis,Rickettsial Disease
ii-Blood CP
Virus Detection from Blood
iii-Mx=IV Fluids
paracetamol
Parenteral Antiemetics
Platelet Monitoring
Patelet Replacement(if necessary)

5-Lady has come to you with history of lump.The lump is mobile and is not fixed
i- Give two differentials?
ii-How will you manage the case?

i- Fibroadenoma,Fibrocystic Disease
ii-Exclude Malignancy (By triple assesment i.e. History n examination,Radiological Study,Biopsy)
Reassurence
Surgical excision is not needed unless the cytology is suspicious or mass >5cm

6-55 year man with history of anuria from 16 hours
on examination the bladder is palpable
i-What is the Diagnosis?
ii-What further clinical examinations will you do?
iii-What re the drugs prescribed to him for this condition?

i- Benign prostate Hypertrophy
ii-History
Abdominal examination
Digital Rectal Examination
iii-Rx=alpha blockers(Doxazosin,Terazosin,Tamsulosin)
5alpha reducatse inhibitor
Transurethral prostatectomy
Transvesical prostatectomy
Holmium Laser enucleation of prostate
Transuretheral needle ablation of prostate

7-25 year girl come with the history of papules and comedones on her face and back of shoulder
There is no telangiectasia
i-What is the Diagnosis?
ii-What is the pathogenesis and what are the precipitating Factors?
iii-How will you treat this case?
i-Acne Vulgaris
ii-Pathogenesis:This condition has a multifactorial pathogenesis, of which the key factor is genetics.[1] Acne develops as a result of an interplay of the following 4 factors: (1) follicular epidermal hyperproliferation with subsequent plugging of the follicle, (2) excess sebum production, (3) the presence and activity of the commensal bacteria Propionibacterium acnes, and (4) inflammation
Precipating Factors:High humidity
Temperature
Psycological Factors
Drugs(bromides,iodides,steroids,phenobarbitone)
iii-Rx=General=Eliminate acnigenic drugs and chemicals
avoid chocolates,nuts
avoid greasy cosmetics
Specific:Topical:Keratolytic agents lyk salicylic acid
Retinoic acid lotion
Erytromycin,Tetracycline creams and ointments
Azelaic acid cream 20%
Systemic:Tetracyclines
Cotrimoxazole
Antiandrogens(Cyproterone acetate)
Isotretinoin

8-6 year child has come with history of redness and pain in his left eye
there is also stickiness in eye
i-
ii-Write differentials for this condition
ii-What is the Dx?
iii-How will yo u treat this patient?

i-Bacterial Conjuctivitis,blepharitis,keratoconjuctivitis
ii-Bacterial Conjuctivitis
iii-Topical agentseye drops)
Trimethoprim with polymixin B
Gentamicin
Tobramycin
Neomycin
Ciprofloxacin
Ofloxacin
Gatifloxacin
Erythromycin

9-Young boy has come to you with 3 year history of nasal obstruction,itching in nose,watry discharge from noseand sneezing esp in winters
Give a detail management for this patient

Allergic Rhinitis
Mx=Total and differential count
Nasal smears
Skin prick test
radioallergosorbent test(RAST)
Avoidance of Allergen
Antihistamine
Sympathetomimetic Drugs
Corticosteroids
Sodium Cromoglycate
Immunotherpay
Desensitization Therapy
10-EPI schedule in Pakistan?
ii-How can you prevent poliomyelitis according to latest interventions

i-At Birth=BCG,OPV0
6 WEEKS=DPT1,OPV1,HBV1,H INFLUENZA
10WEEKS=DPT2,OPV2,HBV2,H INFLUENZA
14WEEKS=DPT3,OPV3,HPV3,H INFLUENZA
9 MONTH=MEASLES
15 MONTH=OPTIONAL MMR
18 MONTH=DPT BOOSTER,OPV BOOSTER
5 YEARS=DT BOOSTER,OPV BOOSTER
10 YEARS=Td BOOSTER
ii-PREVENTION=Oral polio vaccine,Booster dose of OPV

11- 4 year old female child come wiith Diarrhea and Vomiiting for 3 days.
There is also mucus and blood in stool.
i-What is the Dx?
ii-What further ques will you ask in history?
iii-Which organism is involved?
iv-What is the best antibiotic to treat her?

i-Shigellosis(Bacillary Dysentry)
ii-History=presenting complaints
loose motions(duration,frequency,grade,blood and mucus in stool?)
Vomitting(Duration,frequency,relation with food,nature,quantity,color,blood in vomitting)
Fever
anay assoc illness(cough,rash)
urine(passed or not in last 6 hrs)
Abdominal distension
Past history of diarrhea
Rx givem previously
Feeding histroy
Developmental history
Vaccination history
Social and family history
iii-Organism=Shigella
iv-Antibiotics=Ampicillin
Ciprofloxacin
TMP-SMX

12-25year old lady have came to your office with her husband .She is not able to achieve pregnancy.
i-Write 3 common causes of infertility?
ii-Name 3 investigations useful to know the cause?
iii-What drugs can be prescribed to her to achieve pregnanacy?

i-Endometriosis
Polycystic ovarian Disease
Tubal blockage
Azospermia
ii-Ix=FSH,LH
Tubal patency
Hysterosalpinography
Laparoscopy
Semen analysis
iii-Rx=Clomiphene Citrate
injectables;HCS,FSH,GnRH

13-Young Lady with 8 week pregnancy have come with lower abd pain and bleeding per vaginum
How will you investigate a case of Ectopic Pregnanacy?
What are the methods to deal with it?
i-Vitals
BhcG level,Hb,Blood cross match
transvaginal USG
ii-Mx=Medical:Systemic Methotrexate
Surgical:
Laparotomy
Laparoscopy
Salpingotomy
Salpingectomy

14 A man has came wity history of stab on lt. Chest
His BP is 100/70,RR30/min,Tachycardiac and silent left chest
i-What is the Dx?
ii-What immediate investigation will you perform?
iii-Give the management Plan?

i-Pneumothorax
ii-CXR
CT
USG according to FAST protocol
iii-Mx=ABCs
Needle decompression
Chest intubation(sealed one)
15-Boy has come to you with severe dyspne and wheezing ,He is cyanosed and have history of Dyspnea and wheezing in past.He is also having Tachycardia
i-Write down his immediate management?
ii-What Lab tests will you do?
iii-Write the long term management of this atient?

i-Status asthmaticus
High conc Oxygen
Inhled B2 agonist(Salbutamol,Terbutaline)
Systemic Corticosteroids(Hydrocortisone)
Antibiotics
Assisted Ventilation
ii-Blood picture
ABGs
PEEP
iii-Long term management:Inhaled Corticosteroids(Betamethasone,Beclomethasone)
Long acting Beta agonist(Salmetrol)
Theophylline
Cromolyn Sodium
Nedocromil Sodium
Leukotriene Receptor Antagonist(Montelukast)

Courtesy : PFDA ,Dr.MARIA ZAFAR ,dr watson