Diagnostic Marking Scheme

8/13/2019 Diagnostic Marking Scheme

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CONTINUOUS ASSESSMENT

DIAGNOSTIC PAPER A

MARKING SCHEME

SINGLE CHOICE QUESTIONS:

Each question caies ! "a#$Tota% nu"&e o' questions 'o this section is ()*

hence tota% scoe 'o this +at is ()$

1 B 11 B 21 B 31 A 41 B2 D 12 D 22 C 32 C 42 B

3 C 13 B 23 B 33 A 43 A

4 B 14 C 24 C 34 A 44 D

5 B 15 D 25 D 35 D 45 A

6 D 16 A 26 A 36 C 46 C

7 B 17 B 27 B 37 B 47 D

8 B 18 D 28 D 38 C 48 D

9 A 19 C 29 A 39 A 49 D

10 E 20 B 30 C 40 D 50 B

PART II

SHORT QUESTIONS:

Each question caies ( "a#s$Tota% nu"&e o' "a#s 'o this section is ,($

List the features which should be included when writing thepresent history of a medical case record (in the correct order).

Onset and Duration Features of Chief symptoms Causes of illness and recipitating factors rogression of the illness !ccompanied symptoms


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re"ious treatment #eneral condition$O% DO %& %'& $& C$&F CO*L!+ !+D '&,&+$,O'- OF ! *&DC!L C!,& '&CO'D

n order to write a medical case record/the physician should firstta0e a complete history and perform a general physicale1amination of the patient.

$e should listen to the patients2and then con"ert whate"er thepatient has said into medical terms and then write the caserecord.Case record will only be used by medical officers/so/thewriting must be clear/in medical terms and to the point.

For e1ample the patient says3

Oh/doctor/im feeling a 0ind of pressure in my belly2as if my bellyhas become bigger 2a sensation li0e my belly is full/ and dontfeel li0e eating food/and feel tired.t all started 4 monthsago.hat is why came to the hospital today.

he Chief complaint indicates why the patient came to the

hospital.,o/the patient5s "ersion abo"e is what you need to useto write his chief complaint.

he Chief Complaint will be as follows3

Chief Complaint3 A&-o"ina% -istension. anoe/ia. 'ati0ue 'o"oe than 1 "onths$

!fter listening to the patient carefully/you can now write down

his resent $istory.here is a way of writing the present history.he format shouldcontain the 6 features we mentioned abo"e2and they shouldfollow the correct order.

&7!*L&3


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resent $istory3 he patient reports that since 4 months(8.Onsetand Duration)/ he noticed bloating/ ha"ing symmetrical pittingedema of lower limbs associated with fatigue/ wea0ness/anore1ia/ oliguria/ urine output of appro1imately 9:: ml ; day. $e

also complained of nausea/ "omiting/ fe"er/ abdominal pain/diarrhea/ cough/ sputum/ palpitations/ dyspnea and difficultybreathing/ no facial bloating or hematuria(


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3.Differentiate between Exudates and Transudates

E/u-ates Tansu-ates

Cause In'%a""ato6.tu"o Non!$)!? ;!$)!(

C%ot 'o"ation C%ot s+ontaneous%6 ne0ati5e

Ri5a%ta test +ositi5e ne0ati5e

Potein >1)0@L ;,(0@L

G%ucose ;1$1""o%@L >1$1""o%@L

hite ce%% count >1))/!)B@L ;1))/!)B@L

Di''eentia% count Neuto+hi%s in acutein'ection

state.%6"+hoc6tes in

chonic sta0e

e4 %6"+hoc6tes an-"esothe%ia% ce%%s

acteia Ma6 &e 'oun- none

4.Describe the different types of Pathological Proteinuria.

!"G%o"eu%a +oteinuia:

This is the commonest form of proteinuria!orma""# "ar$e proteins such as

a"%umin &o not pass throu$h the $"omeru"us'f the $"omeru"us is &ama$e&(a ran$e

of &ifferent si)es of proteins "ea* throu$h the $"omeru"us+a"%umin(transferin an&


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other "ar$e proteins,

Diseases such as $"omeru"onephritis(&ia%etes me""itus(some &ru$s etc are the

causes of $"omeru"ar proteinuria

2,3Tu&u%a +oteinuia:

-roteins ma# a"so %e "ost in urine if the tu%u"es are &ama$e& an& &o not rea%sor%the proteinsThe proteins .hich are "ost are sma"" enou$h to pass throu$h the

$"omeru"us

Causes of tu%u"ar proteinuria are/p#e"onephritis(acute tu%u"ar necrosis(papi""ar#

necrosis(hea# meta" poisonin$ etc

213Mi/e- +oteinuia:

't occurs .hen %oth the $"omeru"us an& tu%u"es are &ama$e&

293Histic Poteinuia:'t occurs .hen the rena" tissue is &ama$e& or tu%u"e is secretin$ much more

proteins

2(3O5e'%o4 +oteinuia:

't occurs .hen p"asma concentration of a%norma" immuno$"o%u"ins an& other "o.

mo"ecu"ar .ei$ht proteins are increase&(.hich resu"t in ecess $"omeru"ar

fi"tration that ecee&s tu%u"ar rea%sorptie capacit#(such as

m#o$"o%u"inuria(hemo$"o%u"inuria an& Bence ones proteins

#.$uppose you ha%e to ta&e the physical exa'ination of a

patient ad'itted in your depart'ent(and you are about to begin

palpating the ly'ph nodes to loo& for any abnor'ality.)ist the

na'es of all the ly'ph nodes fro' top to botto' which you are

going to palpate in the correct order during this physical

exa'ination.

Peauicu%a

Postauicu%a$ Mastoi-

$ Occi+ita%


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Su&"a/i%%a6 Su&"enta% Anteio ce5ica% tian0%e

Posteio ce5ica% tian0%e Su+ac%a5icu%a 'ossa A/i%%a6 'ossa E+itoch%ea Goins2In0uina%3 Po+%itea%


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NOTE:

h6 the L6"+h no-es ha5e to &e +a%+ate- -uin0 a

Ph6sica% E/a"ination

Pa%+ation o' %6"+h no-e is a "aFo +at o' the +h6sica% e/a"ination$6

+a%+atin0 the %6"+h no-es.+h6sicians can #no4 4hethe the %6"+h

no-es ha5e &een en%a0e- o ae +ainin0*an- can ha5e an i-ea 4hethe

the %6"+h no-es ae so't.ha-."o&i%e o i""o&i%e.etc$

These ae 5e6 he%+'u% in'o"ation 4hich "a#e the -ia0nosis an-

%ocation o' -iseases easie so"eti"es$

o e/a"+%e.

"ost en%a0e- %6"+h no-es that +ain.in-icate in'%a""ationo in'ection$

En%a0e- %6"+h no-es that -o not +ain can in-icate cance

such as %6"+ho"a$

Moeo5e. the %ocation o' the a&no"a% %6"+h no-e a%so

0i5es c%ues a&out 4hich -isease it cou%- &e$o e/a"+%e. a&no"a%

a/i%%a6 %6"+h no-es can 0i5e +h6sicians an i-ea that the -isease is

e%ate- to the thoa/ 2it can &e %un0 in'ection.&east cance.%un0cance.tu&ecu%osis3$Then othe tests shou%- &e +e'o"e- to con'i" the

-ia0nosis$

A&no"a%it6 o' the In0uina% %6"+h no-e can 0i5e an

in-ication that the +o&%e" is 'oun- in the %o4e +at o' the &o-6$

So.+a%+ation o' %6"+h no-es is a 5e6 i"+otant ste+ in +h6sica%

e/a"ination


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PART III

CASE ANAL=SIS:

Tota% nu"&e o' "a#s 'o this section : ,( "a#s

!$The -ia0a" &e%o4 sho4s +at o' an ECG esu%t o' a +atient:

2a3La&e% c%ea%6 on the -ia0a" : one P 4a5e. one QRS co"+%e/ an- one T 4a5e

2 !"a#3

2&3 Da4 %ines on the -ia0a" to in-icate c%ea%6 the %ocation o' the:


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2i3 PR inte5a%

2ii3ST se0"ent

2iii3QRS inte5a%

2i53QT inte5a%

253 R


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P-R interval )$!,)$,)QT interval )$1,


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!$Acco-in0 to this +atients Histo6 an- the ECG esu%t.4hat -o 6ou thin# shou%- &e the

Dia0nosis 21 "a#s3

Dia0nosis: Anteio M6oca-ia% In'action@Anteio Heat Attac#

,$Gi5e easons to su++ot 6ou -ia0nosis$2Reasons 'o" the Histo6 an- the ECG3

29 "a#s3

Reasons 'o" Histo6:

A0e:(9 6eas* Ma%e

Past "e-ica% histo6: Hi0h cho%esteo% %e5e%*An0ina +ectois 4hich use- to &e

e%ie5e- &6 "e-ication$

Su--en etostena% chest +ain acco"+anie- &6 shotness o' &eath an-

s4eatin0 4hich -oes not e%ie5e &6 su&%in0ua% nito0%6cein$Reasons 'o" ECG:

A&no"a% Q 4a5es can &e seen in %ea-s 8! an- 8,

ST e%e5ations in %ea-s 8,.81.89


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,$A 25 #ears o"& ma"e came to the emer$enc# &epartment %ecause of feer for 1

month(an& no. comp"ainin$ of confusion an& nec* stiffnessis past me&ica" histor#sho.s that he ha& a --D positie test in chi"&hoo&After a carefu" histor# an& ph#sica"

eamination(he .as a&mitte& to the 'nfectious Disease Department for further

inesti$ations an& treatments

is C f"ui& eamination sho.e& the fo""o.in$ /


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Appearance/ "i%-%6tu&i-

"ucose/ -ecease-

-rotein: )$!( 0@L


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Ch"ori&e/ ;!,) ""o%@L

C pressure/ ,)) ""H,O

actate Deh#&ro$enase+D,/ no"a%

icroscop# Eamination/ 4ith &oth L6"+hoc6tes an- Neuto+hi%s())!)@L

ther eamination resu"ts are pen&in$

Acco-in0 to his CS e/a"ination.

2a3 hat cou%- &e the "ost a++o+iate -ia0nosis o' this +atientGi5e e5i-ence to

su++ot 6ou ans4e$+4 mar*s,

Dia0nosis: Tu&ecu%ous Menin0itisE5i-ence:PPD2J3 in chi%-hoo-*"eans he su''ee- 'o" Tu&ecu%osis in

Chi%-hoo-$

CS: "i%-%6 tu&i-.0%ucose -ecease-.+otein -ecease-ch%oi-e

-ecease-.+essue incease- an- "ost i"+otant%6 "icosco+ic e/a"ination

4ith incease- L6"+hoc6tes an- Neuto+hi%s not "oe than ())!)@L $

2chaacteistic o' tu&ecu%ous "enin0itis3

2NOTE:=ou 4i%% note that hee.'e4 o' the CS 'in-in0s ae not e/act%6 ho4 the6ae su++ose- to &e in Tu&ecu%ous "enin0itis$o e/a"+%e.the a++eaance o'

CS hee is "i%- tu&i- &ut in &oo#s it is "a6&e 0oun- 0%ass a++eaance 'o

Tu&ecu%ous Menin0itis$This c%ea%6 in-icates that "ost o' the CS e/a"ination

esu%ts -o not sho4 a%% the a&no"a%ities +ossi&%e 'o the coes+on-in0

-ia0nosis$e4 a&no"a%ities ae +esent an- 'e4 can a%so &e a&sent*&ut this

-oesnt "ean that the +atient is not ha5in0 Tu&ecu%ous Menin0itis=ou shou%-

&e cae'u% 4hi%e -ia0nosin0 such -iseasesGoo- Histo6 ta#in0*+h6sica%

e/a"ination an- -oin0 othe in5esti0ations can he%+ con'i" the -ia0nosis3

2&3 hat cou%- &e the -i''eentia% -ia0nosis

2NOTE:Di''eentia% Dia0nosis "eans othe -ia0nosis that cou%- ha5e &een +ossi&%e

o si"+%6 othe a%tenati5e -ia0nosis3

Differentia" Dia$nosis/

Puu%ent Menin0itis

8ia% Menin0itis

C6+tococca% Menin0itis


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8ia% Ence+ha%itis

2, "a#s3

2c3 Concenin0 his CS e/a"ination.4hat "oe -etai%s 6ou nee- to #no4 ino-e to con'i" his -ia0nosis 2, "a#s3

acteio%o0ica% e/a"ination esu%ts*"a6&e in this case Aci- ast Stain to con'i"

tu&ecu%ous "enin0itis$

It can a%so inc%u-e Ga" stain to e/cu%-e &acteia% "enin0itis O In-ia In# stain to

e/c%u-e C6+tococca% Menin0itis

2-3! 4ee# a'te teat"ent.anothe sa"+%e o' CS 4as ta#en 'o

ana%6sis$Acco-in0 to 6ou.4h6 4as this -one 2, "a#s3

o the E5a%uation o' the thea+eutic e''ects o' the -u0s 0i5en o to 'o%%o4 the

teat"ent in o-e to #no4 4hethe the CS has etune- &ac# to no"a% an- i'

so.to 4hat e/tent

In si"+%e 4o-s. to "a#e sue that "ost o' the M6co&acteiu" ha5e &een

e%i"inate- &6 the teat"ents 0i5en*an- a%so to "a#e sue that the a&no"a%

'in-in0s o' the CS ha5e a%"ost etune- to no"a%$

ANSERS

PREPARED =

UNDHUN PRA8ESH KUMAR

POST GRADUATE

DEPARTMENT O

INTERNAL MEDICINE

, APRIL ,)!1

Diagnostic Marking Scheme

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