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Key for Trophy Test --- 4th year
(Questions 26 - 50)
(Back to Questions 1 - 25)

26- Causes of Pansystolic murmurs. (5)
a- Mitral regurgitation.
b- Tricuspid regurgitation.
c- Ventricular septal defect.
d- Leaking mitral or tricuspid prosthesis.
e- Mitral valve prolapse.

27- Draw features of Patent ductus arteriosus. (4)

28- Tabulate the differences between Thrombosis in a limb & Limb embolism. (4)

29- Give common causes of Haemoptysis. (7)
a- Pulmonary infarction.
b- Bronchial carcinoma.
c- Tuberculosis.
d- Bronchiectasis.
e- Lung abscess.
f- Acute & Chronic Bronchitis.
g- Chronic obstructive pulmonary disease.

30- Give conditions in which following characters of sputum are there. (5)
i/ Serous. (2) ii/ Mucoid. (2) iii/ Rusty. (1)
a- Serous:
- Acute pulmonary oedema.
- Bronchoalveolar carcinoma.
b- Mucoid:
- Chronic bronchitis.
- Cronic asthma.
c- Rusty:
- Pneomococcal pneumonia.

31- Give causes of Acute breathlessness without chest pain, cough or wheeze. (4)
a- Pulmonary embolism.
b- Tension pneumothorax.
c- Hypovolemic shock.
d- Metabolic acidosis.

32- Give Respiratory causes of clubbing. (6)
a- Bronchial carcinoma.
b- Bronchiectasis.
c- Empyema.
d- Lung abscess.
e- Fibrosing alveolitis.
f- Asbestosis.

33- Clinical signs in a patient with right sided pneumothorax. (5)
a- Chest expansion --- decreased.
b- Percussion note --- Hyperresonant.
c- Breath sounds --- Absent or decreased.
d- No added sounds.
e- Decreased vocal resonance.
f- Mediastinal shift.

34- Causes of low pitched bronchial breath sounds. (3)
a- Chronic pulmonary tuberculosis.
b- Chronic suppurative pneumonia.
c- Chronic fibrosis.

35- Causes of painful mouth associated with systemic disorder. (5)
a- Drug allergies.
b- Iron, folate & Vitamin B12 deficiency.
c- Leucopenia, acute leukemia.
d- Leiter's syndrome.
e- Bechet's disease.
f- Crohn's disease.
g- Ulcerative colitis.
h- Coelic disease.

36- Causes of Dysphagia. (12)
a- Painful mouth/throat.
b- Aphthous ulcers.
c- Glandular fever, tonsillitis.
d- Neuromuscular cause.
e- Myasthenia gravis.
f- Achalasia.
g- Systemic sclerosis.
h- Pseudo bulbar palsy.
i- Bulbar palsy.
j- Ca-Oesophagus.
k- Ca-Stomach.
l- Peptic stricture.
m- Bronchial carcinoma.

37- Causes of vomiting (Non alimentary causes). (18)
a- Pharmacological.
- Digoxin.
- Opiates.
- Alcohol.
- Theophyllin.
b- Neurological.
- Fear.
- Severe pain.
- Shock.
- Vasovagal syncope.
- Migraine.
c- Metabolic.
- Hypercalcemia.
- Pregnancy.
- Diabetic ketoacidosis.
- Addison's disease.
- Hepatitis.
d- Acute labyrinthine disorders.
- Intra-cranial hypertension.

38- Causes of painless haematuria. (8)
a- Urinary tract infection.
b- Tuberculosis.
c- Schistosomiasis.
d- Urogenital tumors.
e- Glomerulonephritis.
f- Renal cystic disease.
g- Hypertension.
h- Chronic vasular disease.

39- Check list for patients with renal colic. (10)
a- Mental state.
b- Corneal calcification.
c- Gouty tophi.
d- Parathyroid glands.
e- Blood pressure.
f- Epigastric pain.
g- Renal calculi.
h- Constipation.
i- Bladder.
j- Gouty arthritis.

40- Causes of massive Splenomegaly. (10)
a- Cronic malaria.
b- Myelofibrosis.
c- Kala-azar.
d- Chronic myeloid leukemia.
e- Haemolytic anemia (esp. Thalassemia).
f- Gaucher's disease.
g- Tropical splenomegaly.
h- Portal hypertension.

41- Give extracranial causes of headache. (8)
a- Temporomandibular joint --- Osteoarthritis.
b- Cervical spine --- Cervical spondilosis.
c- Ophthalmological --- Glaucoma.
d- Teeth --- Dental sepsis.
e- Middle ear --- Otitis media.
f- Paranasal sinuses --- Sinusitis.
g- Arteritis --- Cranial arteritis.

42- Causes of upper GI blood. (4)
a- Gastric ulcer.
b- Esophageal varices.
c- Duodenal ulcer.
d- Erosive gastritis, duodenitis.
e- Esophagitis.

43- What is Apraxic gait? (4)
Broad bases, small steps, difficulty in turning around.
a- Hydrocephalus.
b- Multi-infarct states.

44- What is Argyl Robertson pupil & its clinical significance. (4)
a- Small, irrgular, unequal pupil.
b- No reaction to light.
c- Normal reaction to accomodation.

45- Causes of upper motor neuron type VII N palsy. (4)
a- Vascular.
b- Cerebral tumor.
c- Multiple sclerosis.
d- Motor neuron disease.

46- Causes of B/L VII N palsy. (6)
a- Vascular.
b- Motor neuron disease.
c- Neuro sarcoidosis.
d- Generalized polyneuropathies.
e- Some myopathies. |
f- Bulbar palsy. | D/D
g- Myasthenia gravis.
The last three points are written as causes in Macleod's but these are differential causes of B/L 7th nerve palsy not the actual 
causes.

47- A patient is having diminished hearing in left ear, its air conduction is better than bone conduction and Weber test is lateralizing to right ear. What type of deafness the patient is suffering from? (5)
a- Sensorineural.

48- Causes of Bilateral X-N-Palsy. (5)
a- Motor neuron disease.
b- Pseudo bulbar palsy.
c- Cerebro vascular disease.
d- Multiple sclerosis.
e- Cerebral tumor.

49- Root values for, i/ Biceps. ii/ Triceps. iii/ Brachioradialis. iv/ Knee jerk. v/ Ankle jerk.
a- C5, C6.
b- C6, C7.
c- C5, C6.
d- L3, L4.
e- S1.

50- A patient presented with H/O sudden onset of paralysis of right half of the body followed by profuse vomiting, headache and then unconsciousness. On examination, he is having VII N palsy (UMN type) on same side of paralysis. What is likely diagnosis? (2)
Intracerebral bleed, right sided uncrossed hemiplegia.
Probable site: Internal capsule.