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1. PHYSIOLOGY OSPE LAST MINUITE REVISION IN 39 “Stronger Together, Achieving Forever!”

2. A B C a) Identify the A, B and C distributions b) State three features of the distribution A c) In graph B what is the best parameter to express its central tendency 2

3. a) A – Normal Distribution B – Right Skewed (Positive skewed) Distribution C – Bimodal Distribution b) D istribution is symmetric mean=mode=median The distribution can be described by two values: the mean and the standard deviation c) Mode

4. Identify the type of oedema ?

5. 1)Pitting Oedema

6. 1)Identify the type of oedema ? 2)Reason for this type of oedema to occur? 3)Name 2 clinical conditions causing this type of oedema ?

7. Non pitting oedema When the cells swell instead of interstitium . The interstitium is clotted with fibrinogen. Fibrosis of surrounding cells cause non pitting oedema Myxoedema in thyroid deficiency Elephantitasis filariasis

8. Identify Briefly explain the mechanism of oedema in this condition

9. Elephantiasis filariasis

10. Identify a, b and c Which of the above could be administered in hypertonic dehydration Explain the distribution of b in the body b a c

11. 1. Oral rehydration fluid – Jeewani 5% dextrose Hartmann Solution / Ringer Lactate solution 2. 5% dextrose 3. 5% glucose solution is isotonic when initially infused intravenously but glucose is metabolized, so the net effect is that of infusing a hypotonic solution. Fluid shift from intravascular compartment to interstitium to ICF.

12. A- Myasthenia gravis B- Edrophonium C- Neostigmine,Pyridostigmine

13. 50 year old Patient present with an auto immune disease. He complained of fatigability towards evening. Edrophonium test was positive Clinical sign 2. Possible clinical conditions. 3. Type of antibody responsible 4. Treatment

14. Partial ptosis Myasthenia Gravis IgG Neostigmine immunosuppressant

15.   Which type of Hb is identified by above test ? How does it form ? What are responsible for above formation ? What are the final results of this type of Hb formation ?

16.   Which type of Hb is identified by above test ? * Methaemoglobin . How does it form ? *When iron molecule of Hb is oxidized from normal ferrous to ferric state. What are responsible for above formation ? *Drugs like nitrites & nitrates. What are the final results of this type of Hb formation ? *Cyanosis. *Hypoxia.

17. What is identified here ? How does it form ? What are responsible for this formation ? What is the speciality of this molecule ?

18. What is identified here ? * Sulfhaemoglobin . How does it form ? *by combination of Hb with hydrogen sulphide. What are responsible for this formation ? *drugs such as sulfonamides . What is the speciality of this molecule ? * Sulfhaemoglobin cannot be converted back into Hb . *So, it remains in the body until RBC are destroyed after the life span.  

19. A B C Identify the A,B,C State a condition where the absolute count of each A,B,C can increase separately

20. A- Monocyte (Kidney shaped nucleus) B- Lymphocyte (Rim of cytoplasm) C- Neutrophil A- Bacterial Infections eg : Tuberculosis B- Viral infections C- Bacterial infections

21. 1 . What is the type of blood cell marked by the arrow? 2. State one feature used to identify above cell. 3. State 2 functions of it. 4. Name one condition where its count is increased in blood.

22. 1. Lymphocytes 2. Round nucleus, filling almost the entire cytoplasm of the cell. 3. Formation of antibodies Cell mediated Immunity 4. Viral infections, Autoimmune Diseases

23. X Above shows a blood film (X) of a vegetarian patient. Identify the morphological appearance of the blood film X Comment on the MCV MCH

24. Large oval shape RBC( Macrocytes ),Hyper segmented neutrophils in peripheral blood smear MCV-High MCH-Normal

25. Blood from a 30year old woman who shows features of anemia was taken to test What is the instrument? What is the reading? What is the other test for diagnosis?

26. Micro- haematocrit reader 35% Blood picture

27. Following shows the blood indices of a female patient. Result Reference range MCV ( fL ) 75 80-99 MCH ( Pg ) 20 27-31 MCHC (g/ dL ) 27 32-36 Serum ferritin (µg) 11 14-200 What would be the condition of this patient State the morphological appearance of the patient’s RBC in a blood film State a cause for above condition you mentioned in (a)

28. a)Iron deficiency anemia b)Microcytic hypochromic blood cells c)Hookworm infestation

29. A -MCV, MCH reduce B - Microcytic hypochromic anemia C - Malabsorption,Increase iron demand,GI tract bleeding D -Total iron binding capacity

30. What is this condition What is the reason for this condition

31. Spina bifida Deficiency of folic acid before or during pregnancy

32. Identify this functional unit. Identify A,B and C. State a condition where function of this unit can be abnormal.

33. Neuromuscular junction A-Na+ influx via ligand gated Na+ channel B-Voltage gated Ca+2 channels C-Motor end plate 3. Myasthenia Gravis, Organophosphate poisoning

34. Identify the instrument. What is the measurement that is taken up by this instrument. State an accessory which help in taking measurement from the instrument mentioned above.

35. Sphygmomanometer Arterial blood pressure Stethoscope

36. Sphygmomanometer (Mercury-column type ) Aneroid Sphygmomanometer Digital Sphygmomanometer

37. A – Koilonychia B – Iron deficiency anemia C – Chronic blood loss, Malabsorption D – Total iron binding capacity

38. Laboratory Results Name of patient : Mrs Sellamma ( Male/ Female) Age : 45 years Date : 08/03/2016 Normal range Haemoglobin - 9.0 g/ dL 12-14 g/ dL RBC count - 3.4 x 10 12 / L 3.9 – 5.6 x 10 12 /L Packed cell volume - 28% 36 – 48% MCV - 72 fl 80 – 95 fl MCH - 22 pg 27 – 34 pg MCHC - 28 g/ dL 30 – 35 g/ dL Retic count - 0.6% 0.5 – 2.5 % What type of anemia is she having? Name 3 probable causes for this condition.

39. Iron deficiency anaemia (microcytic, hypochromic) Multiple pregnancy (5 children) Menstrual bleeding Breast feeding Hookworm infestation (Tea worker) Poverty {Vitamin B12: vegetarian, tea colour urine: haemolytic , (conjugated bilirubin)}

40. What is the condition What is the hereditary pattern?

41. A – Thalassaemia B – Autosomal recessive.

42. A- A+ B- Rh+ C- A,B,AB

43. Identify the ABO and Rh blood group of P and S patients? What is the probability that P and S are the biological parents of R?

44. P- A+ S- O- Probability is 0%

45.   Name the instrument State the use of the above instrument Name 2 conditions in which the above reading increased

46. Westergren tube Erythrocyte Sedimentation rate Acute infection and inflammation, Anaemia , malignancy, pregnancy

47. Westergren Tube

48. ESR - Normal values Normal range : for male - 0 – 5 mm/1 st hour for female - 0 – 7 mm/1 st hour ESR value more than 20 mm is Pathological conditions.

49. Mechanism of ESR ESR depends on the shape and the number of RBC in plasma and rouleaux formation. Rouleaux formation The RBC's stacked together in long chains. This is known as “ Rouleaux formation“.

50. ESR elevates; Acute inflammation & infection Chronic inflammation & infection Malignancy Pregnancy Anaemia ESR decreases; Polycythemia Congenital spherocytosis Sickle cell disease

51. B A 1) What is the name of this tube? 2) Calculate the ESR using picture B. 3) Name one physiologic and pathologic condition where ESR could be elevated above normal. I. Physiologic: II.Pathologic :

52. 1 ) Westergren tube 2) 20 mm/hour 3) Physiological - pregnancy Pathalogical - Infectious diseases, infective hepatitis, infective endocarditis, Malignancies, Rheumatic fever, Renal diseases, severe anaemia

53. Packed Cell Volume Aim : To find out ; Mean corpuscular volume (MCV) Mean corpuscular haemoglobin (MCH) Mean corpuscular haemoglobin concentration (MCHC)

54. Wintrobe tube

55. Micro- haematocrit method

56. Normal values; Adult male – 45% (40-50%) Adult female- 42% (37-47%) New born- 50%

57. PCV estimation is done by 2 methods, Macro- haematocrit method ( Wintrobe method). Micro- haematocrit method.

58. Clinical significance of PCV/ Haematocrit It is a simple and reliable test to detect conditions in which RBC count increases or decreases. PCV Increases in; polycythemia, dehydration, dengue shock syndrome PCV decreases in; Anemia, Pregnancy Use in determination of blood indices; MCV,MCH,MCHC.

59. Icterus – Jaundice Bilirubin Haemolytic anaemia, Cirrhosis Immature liver, Haemolytic disease of new-born/ erythroblastosis fetalis e) Phototherapy

60. Identify the condition What substance is responsible for above condition. State two possible causes for above condition. Mention a possible treatments for an infant with this condition

61. Identify the condition. * Icterus – Jaundice. b. What substance is responsible for above condition. * High unconjugated / conjugated bilirubin level. c. State two possible causes for above condition. * Haemolytic anaemia * Cirrhosis * Bile duct obstruction d. Mention a possible treatments * Phototherapy * Exchange transfusion.

62. What is this treatment What is the use of this treatment

63. Phototherapy I somerization of Bilirubin to water soluble Lumirubin which is excreted in Bile without conjugation or with urine.

64. Identify the above test? Is the reading normal or abnormal?

65. Duke’s Test for bleeding time Reading = (19+1)x30 = 10min 60 Abnormal

66. A-Dukes method B- ( 5+1)30 60 C- Thrombocytopenia, vWF Deficiency

67. Name the above test Write the first few steps for the above test What are the occasions where the above test becomes positive

68. 1. Torniquet Test (Hess’s Test) 2. • Cuff inflated at the mid value between systolic and diastolic pressure • Keep cuff for 3-5 minutes. • Reading – number of haemorrhagic petechiae in 2.5 cm diameter circle or square of 2.5cm2 where most petechiae are seen. 3. Thrombocytopenia, Dengue Hemorrhagic Fever

69. What are the three responses in homeostasis? Identify X, Y pathways in clotting cascade. What are the hematological tests available to detect the abnormalities in X &Y pathways? d)What is the reaction that is indicated by P?

70. Vascular Response Platelet Response Clotting Response X – Intrinsic Pathway Y – Extrinsic Pathway X – activated Partial Thromboplastin Time Y – Prothrombin Time Prothrombin  Thrombin

71. 1.Identify X and Y?

72. X – Va  Inactive Va Y – Plasminogen  Plasmin

73. What are the W, X, Y and Z

74. X – Thrombomodulin Y – Protein C Z – Tissue plasminogen activator W – Factor VIII

75. 1. Identify what are marked by the following letters. A: B: C: D: 2. What is the electrical process of the heart depicted by A? 3. What is the mechanical outcome of the phenomenon depicted by C?

76. 1. A: P wave B: PR interval C: QRS complex D: ST segment 2. Atrial depolarization 3. Ventricular Systole (Contraction)

77. Identify A,B,C and D

78. Resting length Total tension Active tension Passive tension

79. 1. Calculate the heart rate 2. Comment on the ECG

80. 1500/14 = 107 bpm Sinus tachycardia

81. Blood pressure of the 50 year old man is 140/80mmHg Calculate the followings in this person Pulse pressure Mean arterial pressure

82. 140 – 80 = 60 mmHg Mean pressure = Diastolic P + 1/3(pulse P) = 80 + 1/3(60) = 100 mmHg

83. Tall T wave. Hyperkalaemia . IV glucose and insulin infusion to enhance potassium uptake by cells.

84. 1. Calculate the heart rate using above chart. 2. What does P wave, QRS wave complex and T wave represent? 3. State why the electrical activity of atrial repolarization is not shown separately in this chart.

85. 1.300/large squares = 300/5 = 60 bpm 1500/small squares = 1500/25 = 60 bpm 2. P - Atrial depolarization QRS - Ventricular depolarization T - Ventricular repolarization 3. The occurrence of atrial repolarization and the ventricular depolarization take place almost at the same time. Or Ventricular depolarization has higher amplitude than atrial repolarization .

86. 1.What is the ECG abnormality? 2.How did you identify the above abnormality stated in 1?

87. Atrial fibrillation Absence of P waves ,Irregular QRS rhythm

88. A B C This graph illustrate the Jugular venous pulse (JVP) What is indicated by JVP graph Identify A, B and C waves State the mechanical activity responsible for B wave Name a situation where you can observe cannon waves

89. Central Venous Pressure/ Pressure changes in the right atrium A – a wave B – c wave C – v wave Bulging of Tricuspid valve during Isovolumetric Contraction of right ventricle. 3 rd degree Heart Block/ Ventricular Tachycardia/ Junctional Rhythm

90. Following are JVP recordings taken from four different individuals admitted to a medical ward for monthly check –ups. Find suitable conditions for A,B,C.

91. A-Pulmonary hypertension B-Tricuspid regurgitation C-Constrictive pericarditis

92. l) A - Aortic area B - Pulmonary area C - Tricuspid area D - Mitral area Il) S4 sound, Mitral Stenosis, Mitral Regurgitation

93. Auscultation areas of chest Aortic area – just right to upper sternal edge at 2 nd intercostal space Pulmonary area – just left to upper sternal edge at 2 nd intercostal space Tricuspid area – left lower sternal edge Mitral area – 5 th intercostal space just lateral to midclavicular line

94. 1.For a patient with Left ventricular failure what is the suitable curve? 2.Give one drug that can shift the plot back to normal EDV

95. B Digitalis

96. This illustrate the pressure volume loop of the heart State the actions responsible for a-b b-c c-d d-a

97. a – Isovolumetric contraction b – Ventricular ejection c – Isovolumetric relaxation d – Ventricular filling

98. Identify A & B. What is the murmur here? State one condition where you will get the same phonocardiogram. What is the murmur you get in Patent ductus arteriosus? A B phonocardiogram

99. A – S 1 Heart sound B – S 2 Heart sound b) Ejection systolic murmur c) Aortic stenosis, Pulmonary stenosis d) Continuous murmur

100. What is this maneuver? What are the essential steps in performing this procedure?

101. CPR 2. A - Open the Airway B - Check for Breathing C - Start Chest Compressions for Circulation

102. This illustrate the vascular action of two neurotransmitters Identify A and B Where does this substances are produced. State the specific Place. State two other actions of these neurotransmitters

103. A- Epinephrine B- Norepinephrine b) Adrenal medulla c) CVS : Increase HR Metabolism : increase blood glucose level, free fatty acids GIT: Decrease motility Decrease urination by constrict bladder sphincter Bronchodilator

104. Name A B C marked in the graph? Define “A”?

105. A - Vital Capacity B - Tidal Volume C - Residual Volume 2) Vital capacity - maximum volume of air exhaled after a maximal inspiratory effort

106. This is a chart of lung volumes Identify A,B,C,D,E What are the volumes that add up to form the total lung capacity

107. A-Inspiratory reserve volume B-Inspiratory capacity C-Vital capacity D-Functional residual capacity E-Residual volume 2. Tidal volume+ Inspiratory reserve volume +Expiratory residual volume + Residual volume

108. Identify the instrument What is the objective of this instrument Give an indication for a reduced value

109. Peak expiratory flow meter Measure the peak expiratory flow rate Obstructive Lung Disease e.g. Bronchial Asthma To assess the severity of obstruction and response to treatment

110. V italograph FOLLOW RED LINE What is the FEV1? What is the FVC? What is the FEV1/FVC ratio? What is your diagnosis?

111. 2.5mL 4.0mL 2.5/4.0 x 100% = 62.5% Obstructive Lung Disease

112. O bstructive Restrictive Characterized by limitation of airflow due to partial or complete obstruction Characterized by reduced expansion of lung parenchyma accompanied by decreased total lung capacity Eg are emphysema, chronic bronchitis, bronchiectasis and asthma Eg are ILD like fibrosing alveolis, idiopathic pulmonary fibrosis, interstitial pneumonia, pneumoconiosis, sacroidosis, and chest wall neuromuscular diseases T otal lung capacity normal D ecreased F orced vital capacity (FVC) normal D ecreased D ecreased expiratory flow rate, measured as forced expiratory volume at 1 second (FEV1) D ecreased FEV1 FEV1/FVC ratio < 0.80 FEV1/FVC N ormal or Increased

113. 1) Give 1 clinical example each for A and B 2) Define compliance

114. A-Emphysema, B-Pulmonary fibrosis Volume change per unit change in pressure

115. Identify B and C State two examples for the above mentioned

116. B - obstructive lung disease C - restrictive lung disease B - Asthma, Emphysema, Chronic bronchitis, Bronchiectasis C - Pulmonary fibrosis, Sarcoidosis, scoliosis, asbestosis

117. 10. A-Peak flow meter B- Peak flow rate C- Broncho dilators

118. a. X -pO2 Y - % of oxygen saturated Hb b. Higher c. High

119. 1. Identify this diagram 2. List 3 factors which shift this curve to right 3. What happens to the affinity of haemoglobin to oxygen if it is shifted to right?

120. O2 dissociation curve of Hb I ncreased CO2, Reduced pH, Increased temperature 3. Affinity reduced to O2

121. A B Identify the clinical sign in A and B Give two differences between these two conditions Patient suffering from chronic lung disease presented with following observations. He was found to be suffering with hypoxia. Blood tests showed increased ratio of deoxy- haemoglobin and increased 2,3 BPG level.

122. A – Peripheral cyanosis B – Central Cyanosis 2. Central cyanosis – due to diseases of heart and lungs. At lips, tongue, nail tips, earlobes. Warm to touch. Peripheral cyanosis – due to slowed peripheral circulation. At earlobes, finger tips. Cold to touch.

123. Identify the gases A, B and C. Mention whether the above you mentioned gases are diffusion limited or flow limited. The diffusion of various gases across the alveolar capillary membrane is graphically represented below

124. 1) A - N2O B - O2 C - CO 2) A - Flow limited B - Flow limited C - diffusion limited

125. The graph shows ventilation changes That occurs in exercise What are the stimuli that causes A and B What is the reason for C State two biological activities on phase C

126. 1) A – Psychic stimuli / Proprioceptive stimuli. B – ↑ level of K+, H+, PaCO2, Temp, Hormones. 2) Oxygen debt. 3) Restore the myoglobin with O2, restore creatine phosphate, eliminate lactic acid level in the body by converting it into pyruvate

127. This is single breath N2 curve What is the use of this What is the physiological dead space

128. Calculate the dead space Volume of the respiratory tract that does not involve in gas exchange

129. What is the tonicity of the solution made from this packet? State two uses of this solution List the constituents of this solution

130. 1) Isotonic 2) Diarrhea & Vomiting (Dehydration) Jeewani uses as a treatment for gastrointestinal fluid losses Glucose NaCl KCl Trisodium Citrate

131. Name A,B,C A C B CCK-B receptor

132. A- H+ /K+ exchanger B- Prostaglandin C- Gastrin

133. 1.What are A and B processes ? 2. Write two substances that act on C site 3. Write two substances that act on D site

134. 1. A-Segmentation B-Peristalsis 2. Ach, Substance P 3. NO,VIP

135. Identify the condition What are the reasons for this condition

136. Achalasia Cardia Due to deficiency of myenteric plexus Deficiency of release NO and VIP

137. Identify the syndrome Mention two treatments

138. Sjogren’s syndrome A rtificial tears can be used for treating dry eyes. using Pilocarpine to increase salivary production

139. Identify the above device Indicate the condition where the above device is administered Name the first 3 steps in administering the above device How to determine whether the above device is inserted correctly

140. NG tube To carry food when oral nutrition is not possible ( e.g burn patients) or for patients having difficulty in swallowing. To drain gastric contents in drug over dosage or poisoning 1. Examine nostrils for deformity/obstructions to determine best side for insertion 2. Measure the distance between nostril to tragus and tragus to xiphisternum 3. Apply xylocaine jelly in the nostril, and a spray of xylocaine to the back of the throat to ease the discomfort 4.Introduce the NG tube to the patient in sitting position 5. When the tube reaches the pharynx ask the patient to swallow it Check for placement of the tube by attaching syringe to free end of the tube, aspirate sample of gastric contents and test the pH of the aspirated content to ensure that the content is acidic. Push air through a syringe in the open end and auscultate over the stomach for sound of air escape

141. GI Hormone A - Gastrin B - Secretin C - Somatostatin D - GIP E - Motilin   Action P – Increase alkaline and watery secretion by pancreas Q – Increase gastric acid secretion R – Reduce gastrin secretion S – Control GI motility between meals T – Increase insulin production Stimulus GI hormone Action Acids in the duodenum Absence of nutrients in the lumen Glucose and fats in the duodenum Match the GI hormone, action and the stimulus for secretion

142. stimulus GI hormone Action Acids in the duodenum B P Absence of nutrients in the lumen E S Glucose and fats in the duodenum D T

143. 1.Increased H+ / Decreased HCO3- Metabolic Acidosis 2. Diarrhea Diabetes Ketoacidosis

144. A- Urinometer B- 1.020 C- Dehydration ,Increase secretion of ADH

145. Name the instrument What is the use of this instrument? What is the reading? State one condition which would give a higher reading than the above reading

146. Urinometer Measure specific gravity 1.0 25 NO UNIT Dehydration ( Diarrhea , vomiting), excessive sweating, glycosuria

147. Identify the above test? What is the observation that can be seen in a diabetic patient?

148.   Specific gravity of urine Diabetes Mellitus – High Specific Gravity Diabetes Insipidus – Low Specific Gravity

149. This graph shows the clearance of inulin , glucose and PAH at various plasma level of each substance in humans Identify A, B and B What do you mean by renal clearance? Calculate Effective renal plasma flow( ERPP) if, Concentration of PAH in urine (U PAH ): 14 mg/mL Urine flow ( ύ ): 0.9 mL/min Concentration of PAH in plasma (P PAH ): 0.02 mg/mL

150. A – PAH B – Inulin C – Glucose The volume of plasma that contained the amount of substace excreted by the kidneys in one minuite . ERPP = = = 630 ml/min  

151. Concentration of substance X in urine 150 mg/ml Urine flow 100 ml/min Concentration of substance X in plasma 75mg/ml a.Calculate the clearance of substance X b.Write whether there is a net tubular secretion or reabsorption

152. a) C x P = U x V = 100 x 150 75 = 200 ml/min (GFR = 125 ml/min or 155 dL/day) b) Net tubular Secretion

153. Reabsorption of various solutes in the proximal tubule is shown. Chose the correct substance for A,B,C,D,E out of following . K+ Na+ Inulin Glucose HCO3

154. A – Inulin B – K+ C – Na+ D – HCO3- E – Glucose

155. U rine sample under microscope State likely abnormalities seen in the above slide State two other conditions that will give rise to the above abnormalities Name one other constituent, which maybe found in this urine sample

156. C rystals, B acteria, WBC, RBC I nfections and inflammation in kidney, pyelonephritis, glomerular nephritis P roteins, A lbumin

157. Diagram shows plasma glucose levels in 75g Oral Glucose Tolerance Test performed in X, Y, and Z Select the curve that is compatible with I)Diabetes mellitus II) Impaired glucose tolerance How will you prepare this patient for the above investigation?

158. I) DM- Z curve II) I mpaired glucose tolerance - Z or Y curve OGTT procedure: P atient asked to fast overnight T est is generally done in the morning U rine and blood samples are collected for their glucose concentrations T he patient then drinks 75 of glucose in 300ml water over 5 mintues V enous blood samples are collected after 30, 60, 90, 120, 150 and 180 minutes U rine collected after 60 an 120 minutes

159. Normal glucose tolerance curve Glucose tolerance curve in Diabetes Mellitus F asting blood glucose 80 - 90mg/100ml >145 - 200mg/100ml U pper limit of blood glucose 110mg/100ml 300mg/100ml
(by 90mins) G lucose levels after ingestion of glucose 30-60 mins 130 - 140mg/100ml 4-5 hours fasting level reached 120-150 minutes 80 - 90mg/100ml (falls back to fasting level) (value at 120mins < 140mg/100ml) glucose levels fail to fall below the fasting levels no values exceeds the renal threshold of glucose of 180mg/100ml no sample of urine contains glucose urine samples show presence of glucose if the renal threshold is crossed Renal Threshold- “The plasma level of glucose in which glucose first appears in urine” 180mg/100ml

160. Name A,B,C Diabetes insipidus, Diabetes mellitus, SIADH, Hysterical polydipsia Plasma Osmolarity Urine Osmolarity

161. A-SIADH B-Diabetes insipidus C-Hysterical polydipsia

162. The diagram shows the site of action of a few diuretics. Name the diuretics A, B, C, D. What is the hormone inhibited by D? Name the transporter inhibited by B.

163. I. A- Acetazolamide B- Furosemide C- Thiazide D- Spironolactone II. Aldosterone III. Na+/K+/2Cl- cotransporter

164. a) Identify A, B, C & D. A - Renin B – Angiotensin I C - Aldosterone D – ACE inhibitors eg: captropil

165. 1. What is the clinical condition shown in the above picture? 2. What is the ion deficiency lead to this condition?

166. 1. Trousseau sign 2. Ca2+

167. a)Name the signs indicated by A and B? b)Explain the physiological basis of these signs in hyperventilation.

168. a) A - Chvostek sign B - Trousseau’s sign b) Hyperventilation  Respiratory Alkalosis  H+ bound to albumin released into plasma More plasma Ca2+ binds with albumin  Reduced ionized Ca2+ n plasma  Hypocalcemia  Increased excitability of tissues.

169. A- Increased growth hormone B- Big Tongue, Prognathism C- Bitemporal hemianopia

170. Acromegaly

171. State one abnormality seen in the above photograph Give a reason for the above mentioned abnormality Name a hormone that is likely to be I) Increased II) Decreased in this patient

172. Protruding tongue ( macroglossia ) Cretinism , Congenital Hypothyroidism, Thyroid Hormone Deficiency I) TSH increase II) T3 and T4 decrease

173. Identify A and B and give endocrine condition of above. Give two differences of above conditions ? (a) (b)

174. A - Pituitary dwarfism – Growth Hormone deficiency in childhood B - Cretinism/ Thyroid dwarfism – Thyroid hormone deficiency in childhood 2. Thyroid dwarfism Pituitary dwarfism No proportional growth Proportional Growth Mental retardation Intelligence is normal

175. A- Cushings syndrome B- Buffolow hump,Abdominal striae C- Increase cortisol

176. What is this condition? Give 2 clinical features observed in this patient Give the physiological basis for one of the above clinical features

177. Cushing’s syndrome B uffalo hump, purple striae , moon face, pendulous abdomen M oon face, B uffalo hump - prolonged exposure to glucocorticoids (cortisol) cause adiposity of face (moon face) neck (buffalo hump), and abdomen (pendulous abdomen). This is due to effect of cortisol on redistribution of fat P urple striae - As the skin of the abdomen is stretched by the increased subcutaneous fat deposits, the subdermal tissues rupture to form prominent reddish purple striae

178. Cushing syndrome

179. Cushing syndrome

180. Identify the condition What causes this condition State two clinical features that you can observe in this patient

181. Addison's Disease Adrenocortical insufficiency Pigmentation General wasting loss of hair

182. Addison’s Disease

183. Addison’s Disease

184. A- Graves disease B- Thyroid gland C- Goitre, Lid retraction, Exophthalmos, Thyrotoxicosis D- Serum T3,T4, Serum TSH

185. Hyperthyroidism

186. Hypothyroidism

187. Hypothyroidism

188. A & B are patients with endocrine disease due to tumors of glands. (a) Name the glands of A & B (b) On whom does hyper pigmentation occur? (c) write two features that both A & B have. A B CRH ACTH CORTISOL

189. A – Pituitary Gland B – Adrenal Gland Patient A Purple Abdominal striae, Truncal Obesity, Moon Face, Buffalo hump, Hypertension

190. A- Gynocomastia B- Oestrogen/ Prolactin C- Liver Cirhossis , Hyperthyroidism, Prolactinoma

191. Identify A , B and C State one function of A in the body State a condition where A level is increased and give two clinical signs and symptoms that you can observe

192. A - Thyroid hormone B - GH C- Androgen A - Maturation, Differentiation & growth – bone, teeth, lung, Metabolic functions , other systemic functions B - Effect on growth, protein and electrolytes metabolism, CHO and fat metabolism C - Develop Secondary sexual characteristics c) Graves disease Exophthalmos/ lid retraction Goiter

193. Name the deformity that can be seen in this patient? What could be the possible causes for the deformity? List another two features this patient may be having?

194. Bow legs Vitamin D deficiency or rickets Eruption of teeth is late/ delay development/ Difficult to sit and walk at normal age

195. Name A B C ? What are the advantages of “B”?

196. 1. A – Cu IUCD B – Condom C – COCP 2. Prevent STD

197. A B Identify A and B State the action of A State two advantages of A over B

198. A ) a – Combined Oral Contraceptive Pills b – Male condom Prevent ovulation Increase cervical mucus thickness and reduce sperm entry. Cause endometrial alterations that would impair implantation. No barrier to sexual intercourse. Has very low failure rate if taken daily.

199. 1) What is this contraceptive method? 2) List 3 advantages of this method 3) Give a disadvantage of this method

200. Barrier method - Male condom less invasive, cheap, Useful for prevent from STD Require partner corporation, Allergy to condom material is possible

201. Basal Body Temperature Days A B C Name the phases indicated by A and B State the important occurrence at point C Name two changes that occur in the endometrium during phase A

202. A- Proliferative phase B- Secretory phase C- Ovulation occurs During the A phase the growth of stroma, epithelial cells, and glands occur. Elongation of endometrial arteries occurs. Cervical mucus becomes thin and alkaline.

203. Identify. Explain briefly how it works to achieve the desired effects. State one disadvantage of using this.

204. IUCD • Induce an inflammatory response in the endometrium that prevents Implantation • Local hormone effects on cervical mucus and endometrium. • Prevents sperm from fertilising ova • Those containing copper appear to exert a spermatocidal effect Increased menstrual blood loss Increased dysmenorrhoea Risk of pelvic inflammatory disease ↑ risk of ectopic pregnancy

205. B C D A GnRH LH FSH testosterone

206. Identify the hormones A, B, C, D. Give one function of each.

207. A-FSH, B-LH, C- Oestrogen , D- Progesteron A-FSH stimulates the growth of ovaries and stimulate follicular development. Also stimulates the production of estrogen. B-"LH surge" triggers ovulation. C - Development of female secondary sexual characteristics, Growth of myometrium in pregnancy. D – Endometrial changes during luteal phase, prevent LH surge

208. Identify the Chart? How do you determine the safe period for sexual intercourse?

209. 1. Basal Body Temperature chart 2. After 3rd day where the consecutive daily temperature has been above the level of previous six days. Safe to have intercourse from this day until the next menstrual cycle begins

210. Choose the best container used to collect sample for seminal analysis State one(01) advice given to the patient prior to the above investigation. State two(02) precautions that should be taken after collecting sample for investigation.

211. 1.B 2. Abstain from ejaculating for 2 to 5 days before collecting the sample. 3. Take the sample to the lab as soon as possible. Use a pocket in own clothing to carry the container (To keep the semen close to the body temperature)

212. Left partial ptosis Left Oculomotor nerve (III) palsy

213. This illustrate the visual pathway. What type of visual defect can occur if there is damage on C During the pituitary tumor which area vulnerable to get damage. Why ? What is the visual defect can be occur in a pituitary tumor.

214. Homonymous hemianopia B ,Due to tumor ,over proliferation of pituitary gland resulting hypertrophy of gland. Enlarged gland would compress the optic chiasma . Bitemporal hemianopia

215. A- Test for planter response B- Babinski sign C- Upper Moter neuron leision

216. Identify the ‘a’ and ‘b’ test. What are the likely condition ‘b’ is positive. Which tuning fork that are use for this test? (a) ( b )

217. 1. a. Webber’s test b. Rinne’s test Normal hearing of the right ear 2. 256 Hz/ 512 Hz Webber’s test Masking effect Rinne’s test air conduction is better than the bony conduction. To confirm the condition Audiometry

218. A 35-year-old woman complains of decrease hearing from her left ear a. What is the test b. If she best heard (during the test) from her left ear what is the likely diagnosis c. Give 2 causes leads to above condition

219. a) Weber’s test b) Conduction deafness in left ear c) Ear wax, otitis media, otitis externa

220. What is the problem here? What is the nerve involved?

221. Right eye lateral rectus muscle palsy Right Abducens nerve (6 th Cranial nerve)

222. a) Identify the Lesion

223. a) Left Side LMN Facial Nerve Palsy

224. Which part of the face is paralyzed Identify the lesion Name 2 tests to confirm your diagnosis

225. Right lower quadrant 2. Left side UMN facial nerve palsy 3. Puff out the cheeks Reveal the teeth Keep eyes closed against resistance Crease up the forehead

226. What is the nerves A and B Give 2 direct stimuli to the VMC Give 2 excitatory and inhibitory inputs State the effect of the damage to A and B

227. A-Glossopharyngeal nerve B- Vagus nerve 2. Hypoxia,Hypercapnea 3. Excitatory- Chemoreceptors, Cerebral cortex Inhibitory-Baroreceptor, Cerebral cortex, Stretch receptors in lungs 4. Causes neurogenic hypertension

228. 1.What is this? 2.What is the purpose of it? 3.If patient can see up to the level of arrow when stand at standard distance, express the reading. 36 24 18 60 12 9 6 5

229. Snellen Chart Check the Distant Visual Acuity 6/36

230. What is this chart Why property of vision is checked using this What is the most common type of colour blindness

231. 1.Ishihara colour plates (charts) 2.Colour vision 3.Red green colour blindness

232. Name the instrument? Name two causes of deafness which can be identified using this instrument

233. Otoscope Deformities of tympanic membrane External ear canal occluded due to ear wax

234. 1. What type of reflex is shown in pathway  ? 2. How will this reflex be affected in an Upper Motor Neuron lesion & Lower Motor Neuron lesion?

235. 1 . Stretch Reflex / Monosynaptic reflex 2. In UMN lesion the Reflex intensity will be increased (hyperreflexia) The excitability and strength of the reflex will be increased In LMN lesion the Reflex will be lost /decreased

236. This is a patient with Parkinson What is the cause for this condition State 3 features of this disease What is the treatment

237. Lesion in basal ganglia(degeneration of dopaminergic neurons) Shuffling gait Arm fixed at elbow and wrist Hypokinesia Expressionless face (Mask Face) Rigidity 3. Levo dopa

238. Identify X in this normal visual field? What is the area in retina responsible for it? What is the condition where you get more other X like places in retina

239. Blind spot Optic disk Scotoma