(MAIN) EXAM, 2009 · cover of the answer-book in the space provided for the purpose. No mariti will...

C. S. (MAIN) EXAM, 2009

Serial No. ( ____ 2_5 __ ) (c-DTN-J-NTB)

MEDICAL SCIENCE

Paper-U

(Time Allowed: Three Hours l [Maximum Marks : 300)

INSTRUCTIONS

Each question is printed both in Hindi and in English. Answers must be written in the medium specified in the Admission Certificate issueil to you, which must be stated clearly on the cover of the answer-book in the space provided for the purpose. No mariti will be given for the answers written in a medium other thali that specified in the Admission Certificate.

Candidates sJwuld attempt Question Nos. 1 and 5 which are compulsory, and any three of the remaining questions selecting at least one question from each Section. The number of marks carried by each question is indicated at the end of the question.

Wherever required, the candidates may use coloured pencils for drawing sketches and diagrams in the answer-book.

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SECfiON-A

1. Answer any FOUR of the following:-

(a) (i) A 40-year old male comes to you with history

of smoking 20 cigarettes per day for the last

15 years. What are the diseases he is prone to

get? How to deaddict such an individual?

5+5=10

(ii) Outline the management of a case of Alcoholic

Liver Cirrhosis. 5

(b) Enumerate Anti-retroviral Therapy in HIV infected

adult 15

(c) A 9-month old baby is brought with complaints of

3 episodes of diarrhoea since his mother stopped

breast-feeding at the age of6 months and started cow's

milk along with other food. The current episode of

diarrhoea began 18 days ago. The baby still takes

cow's milk but his mother has reduced his intake of

solid food since the dianhoea began. There is no blood

in the stool. He weighs 6 kg.

(i) How will you classify his illness ?

(ii) What will you look for during examination of

this baby?

(iii) How will you manage this baby ? 5+5+5= 15

2 (Contd.) X

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1. ~ t:=i fF!Rc4d -q -« fcl; .. ift ~ * \3t1 { ~ :-

(3T) (i) auq~ -crnr ~ 40 qcsfl'll ~ 3fffil ~ urr ~dldl ~ ~ ~ fCl0H 15 ~ ~ gfaf'a1 20 QIJI{C:

lfurr "Un ~ I ~ Cllfcttt fcF1-~ inTI "« ~ ~ Cfid I ~ ? ~ elf fcttt q,'T ftjj q 11 ~ ffif q;)

~'$1i:t * ~ 3Wf ~ d~~ Jtq11c(Tl ? 5+5=10

<n> Q:{'¥1~1fft ll~d Qf uRi~ * V6TU1 ~ ~q{(?41 ~I 5

(if) HIV-~·#i~d qlff<fi ~ eft ~ qfH) ts_lql'~<e

"U~ ~fchcttr fll11~Q\ 1 15

(t:r) ~ 9 ~ ctn fmJ, ~e~ "1ft ~ \ffl 6 ~ ~ ~ -q 31q11 ~u 'ifG ~ TfTlf ctn ~u ~ ~ ~1"11 ~ ~ ~ ~ ql ~ ffliCfillld cF ~ ffiltT "ildl

~ ~ ~ Cfi{~ * iJTG-« ~ ~ q;) 3 ~ Sfql~'fil rn ~ tiC: Pi let l?t ~ ~ 1 ~ ~ Sfql~'fi' ctn

1«? Sl ~·ll 18 ~ ~ W ~311 qr I Cffl" 31if ~ lm:f

ctn ~u -R m ~ q <::g: sr q t~Cfi1 * w ~ * ifTG "« \3~~ "1ft ~ \3~Cfil cS'rlf 3fltil { "Cfili ~ ~ ~ I \3~~ "lf<1 -q '"{<Rf 11ft ~ I 3~Cfil q"11 6 kg i I

(i) \3~~ -urr q;1 3fTCf ~ ~ -q <~·n ? (ii) ~ ~ ~ ~ Cfi <a ~ arrcr ~-fcl:;;:r =tft"11'

'IT ~!fltSf fAI-=1 ~ ? (til) ~ fmJ CfiT lJGft:A' arrq ~ q;{fl ?

5+5+5=15

3 (Contd) X

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(d) A 20-year old primigravida delivered a preterm baby by normal vaginal delivery at 3 1 weeks of Gestation. The baby breathed and cried at birth. Weight was 1.1 kg. At 1 hour of age the baby was found to be

in respiratory distress with Grunting.

(i) What is the likely diagnosis ?

(ii) What are the complications of this condition ?

(m) How will you manage this baby ? 4+5+6= 15

(e) Enumerate differences between Allergic and Irritant contact dermatitis. 15

2. (a) A 40-year old person comes with acute abdominal pain of 4 hours duration. What is the differential diagnosis ? How will you manage a case of acute pancreatitis? 10+10=20

(b) A 3-day old neonate was found to be cyanosed on routine pre-discharge check-up. The baby was otherwise well with no dyspnoea and only a mild tachycardia of 140/MT. On examination there are normal femoral pulses, no hepatomegaly, a loud second heart sound and no murmur.

(i) What are the likely diagnoses ?

(ii) Chest X -ray demonstrated a typical appearance of a particular cyanotic heart disease. What complications are likely to arise in the neonatal period for this baby ?

(iii) How will you manage this baby? 5+ 7+8=20

4 (Contd) X

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("G) ~ 20 cttsfft~ '!itt''Pt"lf ;f 31 e"dr~ ~ ll'ifctfn 'tR ff I "f I ... q ~Pi "f JJf Sf e q Gm ff "f tl ~ cf fmj qq \if.-"f

~I ~ fmj ;l ~ ~ (1"ftl mtr ~ afn- C$

frliT \ft I \3 ff Cfll q \i1 ;!f l. 1 kg ~ I "' ~"' ~ 1 tlZ "ifTG \ffi trffi "AA -q Cfl R;;!f 1 { m "Uft' qr aft{ 9) <!! <1 ~ e ~I

(i) lT'JiJPcid Pl Gi4 ~ ~ ? (ii) ~ Pc!Cflr< ctt ctm "'fZC1olct ~ ? (iii) ~ fmJ q;r ~U1 am ~ q;'{·~ ?

4+5+6=15 (f) SI("Y\uf\1J\Jf.-q ~ ~~ (1·fll~f ("qiCfl~Tif:T ~ afTq ~

~~d{ ITI-=ti~CJ> I 15

2. (ar) ~ 40 ct~ll ~fcffi 4 ~ C}l'T (ftsr \3Gtlll ~ ~ tm:f 31ffiT ~ I ~ Olf fcffi ~-~ Wr f4 Cfll (f -ij-cft~d m eCfldl i ? tfisr ~~ ... qJ~ICf!tTif:T ~ inft q;r

~&1 3TfCT ~ Cfllfl ? 1 0+ 1 0=20 (-ar) ~ftldlct -e- ~it ~ ff"ftl S{ ~~ ~ -q 3 ~

q;r "1ct\i11d ~ !llliCf -qrliT lJliT I ~ ~ ~ 3f(11ctl

~~ ~~ ~ CfitS:eQctlfl ~ ~ 3ih:" ~ ti~ctft 140~C: ctt t; <(~Sf d I qr I \;ffq Cfl <;) 'tTt \3 e ctn ~ ftiG"i eJlii--Cf ~~ CfctJdtf.si 11ft tft, @d)q ~ ~ ~ ~ Afch;!f ~ m ~ m 1

(i) ~ ~ ~-fcl;;; -wr-~Cfli<Y -e- t1l~a m- eCfiar ~ ?

{ii) qe:r ~-t 11{ ~ ~!fltSf QtiiCf ~ m- cf; f4~1CSC:: Re:JUT ~I ""fct"'ld ~qfa -q ~ ~ ~ Cfi11~ "'fZcldJQ: \3(\i"i ~ ~ tr"flct11 GFft ~ ?

(iii) ~ ~ q;r ~tT-1 3lTtf ~ Cflltt ?

5+7+8=20 (Contd.) 5

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(c) Describe Etiology, Clinical features and Prognostic scoring points of mortality of Stevens-Johnson syndrome. 8+8+4=20

3. (a) A 35-year old male took Anti-TB Treatment {ATI) for 9 months with first-line drugs. His sputum is still positive for AFB. Discuss causes of treatment failure and his management now. 10+10=20

(b) (i) What is the definition, etiology and importance of Dysentery in yotmg children ?

(ii) What are the clinical features and complications of Dysentery in children ?

(iii) How will you manage a child brought with Dysentery? 6+7+7=20

(c) What are points of difference between Erythema Multifonne and Toxic Epidermal Necrolysis (TEN)? 20

4. (a) Enumerate common life style diseases in adults in India and the causes for their increasing incidence.

10+10=20

(b) A 2-year old boy is brought with a history of recurrent eptsodes of fever, cough and breathlessness. He was well till 10 months of age. When suddenly for the first time he developed breathing difficulty when left in the care of his elder sibling.

(i) What is the most likely diagnosis ?

(ii) How will you investigate this child ?

(iii) How will you manage this child? 3+7+ 1 0=20

(c) Discuss Etiopathogenesis ofVitiligo.

6 X

20

(Contd.)

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(1*fOI Cfm 911~141 Mft:ll 3TCflT CFT quf<=t ~ I

8+8+4=20 3. ( 3T) 1!,CF 3 5 q tSff~ ~ :f 9 q ~ ;fj' (fqi" "9"~ qfc:ffi GCfT3iT

-ij- itsft-fl"tft '3q:q I ( fftt~l I '36Cfll ~ 3TGr '4T AFB cF fRQ: qj~ftq ~I '3q~l( ~ m cF Cfli{Off q,'T elf I (.OQ I ~ ~ d 6 Cfll 3fif ~ -gafu;; fCh ltJ "1141 I

iti@C(, ~e~ ~ROQI ~ ~I 10+10=20 (ar) (i) mt (il-ei(l' ~ q~~l ctT ~, ~ (fm

&ii:;("q <fliT w ? (ii) a,-eifl. ~ q~~~ cF Fcffi;:ftCfiH f1*f01 om \i1R:f1diQ

~ ? Cfl.IT ~ .

(iii) 3T1R Cfil-{ &1 -e:q I 311 q ~

{9141 "''a' ~ m 3Tf'Cr {Tl ? Cfl .

'tff« ~~~~ ~ mq d6Cfll l1ifET1 -t~

6+7+7=20 (-e-) a,~~cfl ("CtJ <fcffi&il om eJFcffiq; atl~:kCfill ilst11f1t"4~e

cF ~ ~-~ ~3TI "tiT &id( ~ ? 20 4. ( 3l) m«l ~ q 4 ~ 'i -q ~ "Cfffi 3lll1 un ct.., --m:n -u-sr

ctlT 171 "1 I ~QO aTR d "1 q,') at q;d) 3t I q co ., cF Cfi I (Off "CfiT

~ fll<=t I~QO I 1 0+ 1 0-=20 (6T) ~ 2 q~~ &llflCfi q?r GfT(-am ~ &R, <.'ilij) m

3ltt lfRi 47f1rt cF Sl6.ll m ~ ~ aft\ cw anqc:6 "tffi1 C\ •

ffiliT \itld I ~ I Cffl" 1 0 ~ ~ \3"';f "ijCf) ~ ~ qr I ~ ~ ~ ~ 6Ql<:\( ct)-~ ~ 0h?l TftiT ~ ~ q$fft 6lR m-e- ~ ~ Cfif6rt I{ st I (i) ~ ~ ~ tfcqlf4d ~GI<i Cfl.IT ~ ?

(ii) ~ &1-eit eFT ~ 3TfCf ~ q;{"~ ? (iii) ~ ~ -e~ CFT ~~ 3TT'tf ~ Cfl{~ ?

3+7+10=20 (tr) f4ftffpfl cF ~1~Cfikl\i1"11 eFT c~f@QI qf{ I 20

7 (Contd.) X

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SECTION-B

5. Answer any THREE of the following:- 20x3=60

(a) Discuss the management of a 30 yrs. old lady presenting

with complaints of repeated attacks of pain in upper

abdomen, jaundice and fever. 20

(b) Enumerate the premalignant lesions of oral cavity.

How would you manage a 40 yrs. old smoker with

a 2 x 2 ern ulcer on the right lateral border of tongue.

5+15=20

(c) A lady comes with 2 months of amenorrhoea to the

antenatal clinic. How would you diagnose pregnancy

in her? Describe the regular antenatal care with its

aims and advantages. 20

(d) Discuss briefly Iodine deficiency disorders. 20

6. (a) Describe the management of a 30 yrs. old man

presenting with painless bleeding per-rectum. 20

(b) Enwnerate the cystic lesions of the breast How would

you manage a 18 yrs. old girl presenting with

8x8 em, lobulated, soft to firm lump in right breast

without any lymphadenopathy? 5+ 15=20

8 (Contd.) X

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<?TS~

5. f){ &--tRtf<ctct ~ ~ fch ... ift ~ CJn' \3t1 { ~ :- 20x3=60

(3T) ~ 30 ct~tl ii~<11 ~ 6fiT-arR Z3G { cfi a;q {l mrr ~ G<f :a6rt, tftf<1t~t ~ 3iR $(ql < ~ ~ q{!illo:ft m -uft i, \3ti~ ~u;; ~ ~ROQI Cfit I

20

(ar) ~!Xlil ~ ~ ~ $G4dl'~<f ~&1Riin cfl1m f11--ti~QO I ~ 40 ~~ ~~41"1 Cfi{~ qffi Cllf<R1 ~~~ ~ cf; ~01 41fVctCfi ~"!&II 'q'"{ 2 X 2 em~ SfOT ~, \3f1Cfll

~Wf 3Tftf ~ Cfi{Tt ? 5+ 15=20

{tf) ~ i=f{g(1f, ~ 2 l"ft'l ~1· -« =;ti~ti ~~ ~ "S3IT, \i1r&f'{cf f#1 o:ftCfl ~ 31Rfi ~ I ~ ii ~<11 cfl ~ ~ CJn'

PiGI"1 3Tftf ~ Cfl{lt ? tili=fl.-t~ "1.-&f"j\cf ~€4{€4 CfiT

(1~· 3fR ~ ft~{t qof"1 ~ I 20

(G) 3!1l(l~"1tft"1ctl f4Cfil{i ~ "«~ ~ CllRCiQI 'fi't I 20

6. (3T) ~ 30 C1~ ~' ~ Ji(1PIIl4 "« <ft~l{~d VRf

"til'f ~ ~ q{!itlofl ~. :ae~ "1atu;:r ~ qof-=t 'fi't 1

20

(ar) ~ q,'l ~ihtl4 ~~ra~· * 1T'l tlt-=tr~ct 1 ~

18 q~tl a&oft , f';le~ Glttol ~ -q 8 x 8 em~

iflHfCkl, ~(11tlii ~ c5m- lJio ~ afR ~ ~ HRfCfirqcf~f& 11ft i , \3tiCfil Ycsifl~ 3l1'tf ~ Cfi{~ ? 5+ 15=20

9 (Contd.) )(

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(c) Enumerate the surgical causes of hypertension. How

would you manage a 25 yrs. young man with severe

hypertension with right adrenal mass ? 20

7. (a) Define dysfunctional uterine bleeding. Describe its

clinical features and investigations. How would you

manage a 34 yrs. old lady with an ovulatory

bleeding ? 20

(b) What is normal labour ? Describe the mechanism of

labour in left occipito anterior position. 20

(c) What is MIP ? Mention indications for MTP. Describe

different methods of termination in first trimester of

pregnancy. 20

8. (a) List the causative organisms and vectors of lymphatic

filariasis in India. What are its salient control

measures? 10+20=30

(b) How is the diagnosis of malaria confirmed ? Descnbe

the presumptive and radical treatment of malignant

fiUUaria 10+20=30

10 . (Contd.) X

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(~ ) '3 -c. :q <Cfd G 1 est ~ e Mcti H Cfi 1 <orr "CfiT fll-=11 ~CJ\ 1 "Q\Cfi

25 4~lt '¥f ~, ~ Slit:S \3-c.:q {CfdGicst t afrt tm:r ~ ~ ~ ftrs ~, deCfil VGtU1 3TfCf

~ Cflllt .? 20

7. (a:r) $~ltl("~Cfl lT'lfvrtr {Cfdtil4 "CfiT ~ q;t I dtP~

f4ft 4) Cfl(1 (1~ ofr aliT de* ~ q,'T \ifR 4lrll \i1 hir CflT qof-=t q;t I "Q\Cfi 34 qtSfl'tt ~ffiHI ~ ~cstl~{oft

{Cffiij 14 ~, \36Cfil VGff;Ff 3TfCf ~ ctillt ? 20

(ar) el~lr~ Slfl4 ~ ~ ? CfTlr q~:qCflqJ(1q~:q ~~ ~

Slfl4 ~ fsh~1fclfa "eN qof-=t q;t I 20

(«) MTP ~ ~ ? MTP cti<Pl ~ e·*d cstctlc( 1 ~

~ q5~1 ffitt1g) ~ S19:ffi ~-ett1q1 ~ ~ :Jql~

CflT qof-=t q;t I 20

8. (a:r) 141 <d -it HecttffiCflt 4lt~flft:~t ~ Cfll <Cfl Gflcn· am {) J I 4 I i!.ictl'f ~ rrfl1 fll-=tl ~Q\ I \3 fl c6l tlq:;~ tF ~ Jql~ ~ ~ ? 10+20=30

("est") liHft:ttl ~ PlGI-=1 ~ ~ ~ ~ \lfltft ~ ? ~

~Hftttl ~ 3li)lilPiCfi ~ Pltf\ficti ~f*cttl q;T qof-=t

Cflt I 1 0+20=30

11 X

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Serial No. [ ______ ) ( C-DTN-J-NTB)

Sil!l;::w-~-11

( ~oJfifi : 300)

9c-4cti JT"R fG,.cfJ 3fR &jguf) ifl;fl. -q fTC11 ~I

gq;fl· cf; \3'ff( ~ It/fAll -q ~ urr:r ill@<{

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?&7RI:if/*1CWTf ffPlT 31t?#t * fffc!; {Jf)*1 cff?IH Cf)T g4} If CfiT tiCf)d ~ I

Note : English version of the Instructions is printed on the front cover of this question paper.

12 )(

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