1.

A 35 year old female complaints of breathlessness, loss of appetite, apathy and

easy fatigability. Examination of the patient revealed pallor, koilonychia, increased
heart rate and systolic murmur
Lab Investigations:
Hb % : 6 .0 gm%
PCV: 30%
RBC Count:3 million/ cu.mm
S.Ferritin: 9 ng/ml
MCV: 70 fL
TIBC: 500 mg/dl
Peripheral Blood Film: RBC are microcytic and hypochromic
Answer the following questions: (2+3)
1.What is the Diagnosis?
2.Describe the Physiological basis of clinical features / symptoms of this disease?

GMC ,KADAPA -2025

2. A 45 year old male complains of indigestion, diarrhea, soreness in angles of
mouth, loss of appetite and tingling sensation in the hands and feet. Examination of
the patient revealed angular stomatitis, red beefy tongue and peripheral
neuropathy.
Lab Investigations:
Hb % : 9 .0 gm%
RBC Count:1 million/ cu.mm
S.Iron: 170 µgm /dl (normal: 60-170 µ/dl)
MCV: 100 fL
MCH: 50pg
Reticulocyte Count : 6% ( Normal 1-2%)
Answer the following questions: (1+2+2)
1.What is the Diagnosis?
2. What is the cause for peripheral neuropathy in the above condition?
3.What are the causes and treatment for above condition?

GMC ,KADAPA -2025

3. A young boy of 8 years old complained of swollen knees, after he fell from
bicycle. He also complained of some bluish discoloration of the skin of right arm.
His past history is suggestive of prolonged bleeding even after minor injury. On
examination he was found a hematoma of the Knee.

His Lab investigations shows prolonged Clotting Time, & APTT( Activated Partial
Thromboplastin Time) .

Bleeding time , Prothrombin Time and platelet count are normal . Hb: 9.0 gm% .

Answer the following questions: (1+2+2)

1. What is the probable Diagnosis?
2. Classify the condition with deficient clotting factors?
3. Why is the Bleeding time normal in this patient despite a prolonged Clotting
Time ?

GMC ,KADAPA -2025

4. A 25 year old lady comes to OPD with chief complaints of weakness and
fatigability. Generally during morning she does not feel any significant weakness,
but as the day passes and she gets involved in routine house hold works, weakness
gradually starts to increase. The condition improves by some rest or sleep. She also
reports double vision and difficulty in swallowing. Physical examination shows
Ptosis, Diplopia, Proximal muscle weakness, Normal deep tendon reflex, No
sensory impairment. Lab Investigations shows Anti-choline esterase test positive,
Electrodiagnostic test shows rapid reduction in amplitude of the repetitive nerve
stimulation (Decremental response).
Answer the following questions: (1+1+1+2)

1. What is the diagnosis ?

2. As the day passes why do the patient gradually starts to get more and more
fatigue ?
3. Why are the symptoms improving after the rest?
4. What could be the physiological basis of management?

GMC ,KADAPA -2025

5. A 2month old male child was bought to the Pediatrician with the complaint of
abdominal distention, constipation and excessive crying since 2 days. On
examination the abdomen is distended with hard palpable mass. Per-rectal
examination shows empty rectum.
Investigation:
Barium meal: Small rectum with dialation of colon above the narrowed segment.
Full thickness biopsy: Ganglionic cells are absent in the bowel.

Answer the following questions: (2+3)

1. What is the diagnosis?
2. What is the physiological basis for symptoms?

GMC ,KADAPA -2025

6. A 55 years old male presents to OPD with complaints of shortness of breath.
This breathlessness is associated with normal exertion which, a few years back, he
could do without any problem. During sleep, he often gets an attack of severe
shortness of breath and coughing, which awakes him from sleep. This episode of
coughing persists even in sitting position.
General Physical Examination: The patient is calm, conscious, well oriented to
time, place and person. Pulse-90/min with characteristic pulsus alternans, BP =
130/90 mm Hg, pitting edema is seen on the ankles (++), Jugular venous pressure
(JVP) is 4 cm.
Systemic examination of:
 Abdomen shows hematomegaly.
 Respiratory system: Bilateral dull percussion note on costophrenic angles.
 Ascultation reveals the basal crepitations in both the lungs.
 Cardiovascular Systems:
 X-Ray chest: Cardiomegaly
 ECG Shows signs of right and left ventricular hypertrophy.
 2D echocardiography shows dilation of all the cardiac chambers with
poor contractility of cardiac walls and reduced ejection fraction.

Answer the following questions: (1+4)

1. what is your probable diagnosis based on physical and lab findings?

2. What is the pathophysiology of this Condition?

GMC ,KADAPA -2025

7. Parents of a 5-year-old girl had brought her to emergency in a semi-conscious
state. She had 7-8 episodes of loose motions and 4 episodes of vomiting in a day. It
was associated with intermittent abdomen pain. Previously she had some food
from a street vendor.

General physical examination: The patient is drowsy, opening eyes only for
painful stimuli. Pulse = 100/min, regular, low volume pulse, BP = 90/70 mm Hg,
temperature 100°F. Skin turgor is reduced; mouth and tongue are dry. Respiratory
rate is 24/min and shallow.

Answer the following questions (1+2+2)

1. What is your likely diagnosis for this patient?

2. What is the pathogenesis behind this clinical condition?

3. How can you manage this patient based on pathophysiology?

GMC ,KADAPA -2025

8. Satish, 20 year old, resident of Delhi,went for a 4 day trip to a hill station (2900
m height) in Himachal Pradesh. Few hours after reaching the hill station, he started
to feel mental and physical fatigue, headache, dizziness and nausea.

Clinical examination:

Radial pulse rate -76 pulse per minute

Respiratory rate - 17 breaths per minute

Body temperature - 97°F.

Answer the following questions:( 1+2+2)

1. What is your provisional diagnosis?

2. Why does a person develop pulmonary edema at a very high altitude?

3.How will you manage the above patient?

GMC ,KADAPA -2025

9. A 50-year-old housewife complains of progressive weight gain of 5 kg in 1 year,
fatigue, slight memory loss, slow speech, dry skin, constipation, and cold
intolerance.

Physical examination: Vital signs include a temperature 96.8°F, pulse 58/minute

and regular, BP 140/100 mm Hg. She is moderately obese and speaks slowly and
has a puffy face, with pale, cool, dry, and thick skin. The thyroid gland is slightly
enlarged, firm, not nodular, mobile, and not tender. The deep tendon reflex time is
delayed.

Lab investigations:

CBC and differential WBC are normal.

Serum T4 concentration is 3.8 ug/dL (Reference value: 5-12 µg/dL)
Serum TSH is 23.0 mIU/L (Reference value: 0.4-4.0 mIU/L)
Serum cholesterol is 255 mg/dL (Reference value: <240 mg/dL)

Answer the following questions:( 1+2+1+1)

1. What is your probable diagnosis?

2. What are the causes for the above condition?

3. How is the thyroid function tests in this patient?

4. What is the management?

GMC ,KADAPA -2025

10. Harish, a-60-year-old male, reported difficulty in initiating any motor activity
like walking, brushing his teeth, etc. He also mentioned that, with aging, his motor
activities had become slower. Doctor also noted that while he was sitting, there
were tremors in his hand. On further questioning, Harish mentioned that these
tremors stop while doing any activity. Doctor also noted that, along with the
change in emotions, there was no change in facial expressions.
On Examination
His vitals were normal with temperature 98.6°F, pulse 75/min, BP = 130/80 mm
Hg. He was conscious, calm and well oriented to time, place and person.
The general facial expressions of the patient were lost resulting in a mask-like face.
Examination of CNS Revealed
Motor functions:
Tone: Hypertonia with cogwheel type rigidity in limbs.
Power of muscles is Grade +4/+5.
Reflexes: Deep tendon reflexes are normal. Plantar response is flexor.
Pill rolling resting tremor of the hands.
Shuffling gait with narrow base and a tendency to fall forward and backwards. He
walks with slight flexion at hip and knee joints.
Cerebellar function tests are normal.
Sensory function: Normal.
Cortical sensations: Normal.
Higher functions: Normal.

Answer the following questions:(1+2+2)

1. What is your probable diagnosis?

2. What is the pathophysiology of the disease?

3. What is the management?

GMC ,KADAPA -2025