NRSMC STUDENTS’ UNION 1

Pathology
General Pathology
Long Question:
 A 12year old boy met with an accident and broke his humerus without any skin
lesion.
a)Describe the mechanism of healing of fractured bone.
b)Enumerate the factors influencing the healing process.
c)What may be the complications? (6+2+2) (NRSMC)
 A 16years old boy while playing football suddenly fell on the ground and got an
injury in the left [Link] sometime the injured area showed pain,redness and
swelling.
a)Whattypeofreactionoccurredintheareainvolved?
b)Mentionthevascularandcellularphenomenoninthecase.
c)Describethechemicalmediatorsresponsibleforthisphenomenon.(1+3+6)(RGKMC)
 An 8 years old boy presented with high fever and multiple boils all over the skin.
a) What type of inflammation is this?
b) Describe the vascular phenomenon in such case.
c) Enumerate the cell-derived chemical mediators. (1+4+5) ( BMC)
 Define cell injury . Enumerate the causes of cell injury. Outline the role of
mitochondria in cell injury.(1+3+6) (NBMC)
 Define inflammation. Enumerate the mediators of inflammation. Explain the role of
any one of the mediators of inflammation in the pathogenesis of acute inflammation.
(2+6+2) (Malda)
 A 20 year old male had a closed (simple) fracture of shaft of tibia while playing
football.
a) What type of wound healing will take place?
b) Describe the process of healing.
c) Describe the local & systemic factors influencing wound healing . (2+4+4)
(Joka)
 Define infraction. Describe different types of infract. Enumerate the factors that
influenced the development of infract . (2+4+4) (Joka)
 A 10 years old boy sustained in injury over the skiin bone following which part
became red, swollen and tender. He also developed mild fever.
a) Define the basic pathological process of this ailment.
b) Describe the vascular changes in this condition .
c)Enumerate the outcome of this process. (2+5+3) (KPC)
 Define neoplasia. What are the characteristics of malignant neoplasm? Define the
role of different tumor suppressor genes in neoplasia. (2+3+5) (IQ City)
 Define inflammation. Describe the vascular events of acute inflammation.
Enumerate the morphological patterns of acute inflammation. (2+4+4) (ICARE)
 Write down the mechanism of irreversible cell injury. Differentiate between
metastatic calcification and dystrophic calcification. (7+3) (GIMSH)

NRSMC STUDENTS’ UNION 2

 70 year old male patient presented with bone pain, weakness and history of
recurrent [Link] study reveals punched out lesions involving skull
bones and [Link] is your provisional diagnosis? Give one differential
diagnosis. How will you investigate the patient to reach your diagnosis?
(1+1+8)(Malda)
 How benign tumors are different from malignant tumors? Describe the morphology
of a malignant cell? What is meant by carcinoma in-setu? (5+3+2) (Malda)
 A 56 years old male patient recovering from an attack of myocardial infraction,
suddenly developed left sided hemiparesis. Describe the underlying pathophysiology
responsible here. Explain which organ will be affected, if same pathophysiology plays
on venous system . (7+3) (Midnapore)
 Enumerate the risk factors & etiopathogenesis of MI. What are the
complications?(6+4) (GIMSH)

Comment On :
 Dystrophic calcification and metastatic calcification are not same . (5) (MCK,
Joka)
 All granulomas are not of tuberculous in origin. (5) (MCK)
 Red infracts and white infracts are different types of infract. (5) (MCK )
 Apoptosis serves many useful purposes. (5) (NRS)
 Thrombus differs from blood clot. (5) (NRS)
 Septic shock ends in multiple organ failure. (5) (NRS)
 Healing by primary intention and secondary intention is basically
same.(5)(RGKMC,BMC,CMSDH,Joka)
 Thrombus is antemortem phenomenon but clot is postmortem phenomenon. (5)
(RGKMC)
 Morphologically granuloma and granulation tissues are different. (5) (RGKMC ,
CNMC,CMSDH,Joka)
 Transduate differs from exudates. (5) (CNMC , IPGMER)
 Important cytokines of acute inflammation. (5) (IPGMER)
 Hyperplasia and hypertrophy. (5) (IPGMER)
 Metaplasia (5) (IPGMER)
 Metaplasia is an irreversible process. (5) (BMC)
 Virchow’s triad plays a pivotal role in thrombus formation. (5) (BMC, Kalyani)
 Cell death is not accompanied by inflammation. (5) (BSMC)
 Macrophages are the chief cells of chronic inflammation. (5) (BSMC)
 Symptoms of thalassaemia do not appear before the age of 6 months . (5) (BSMC)
 Activation of proto-oncogene is one of the fundamental steps of carcinogenesis. (5)
(NBMC)
 Anaplasia shows a number of morphological changes. (5) (NBMC)
 Mechanism of haematogenous spread of cancer. (5) (NBMC)
 Role of scarring in healing process. (5) (Midnapore)
 Causes of hypoproteinemic edema (5) (Midnapore)
 Importance of examination of urine in differential diagnosis of Jaundice. (5)
(Midnapore)
 Role of hyperuricemia in development of gout . (5) (Midnapore)

NRSMC STUDENTS’ UNION 3

  Acute inflammation is a double edged sword. (5) (Kalyani)
 Metastasis is the surest sign of malignancy. (5) (Kalyani)
 Necrosis differs from apoptosis. (5) (CNMC,CMSDH, Joka, KPC)
 Microscopic features of irreversible cell injury . (5) (Murshidabad)
 Cellular phenomenon of acute inflammation. (5) (Murshidabad)
 A malignant neoplasm has special characteristics. (5) (Murshidabad)
 Free radicals take part in cell injury. (5) (KPC)
 Health effects of outdoor air pollutants. (5) (IQ City)
 Endothelium has dual activity. (5) (ICARE)
 Phagocytosis is not only function of macrophages. (5) (ICARE)
 Apoptosis can be both physiological and pathological. (5) (ICARE,GIMSH)
 Antemortem and postmortem clot are different . (5) (ICARE)
 Wound contraction may give rise to deformities though it is an important step of
healing. (5)(GIMSH)
 Amyloid is not a single entity but all amyloid components have similar
appearance & staining character. (5) (GIMSH)
 Hyperplasia and neoplasia are not same. (5) (KPC)
 Role of oncogenes and tumour-suppressor gene in carcinogenesis. (5) (BMC)
 Para-neoplastic syndrome are symptom-complex not related to tumour itself.
(5)(BMC)
 Tumour markers may help in malignant tumour. (5) (GIMSH)
 Importance of tumour-markers. (5) (Midnapore)
 Type iv hypersensitivity reaction is essential in pathogenesis of granulomas. (5)
(Kalyani)
 Atherosclerosis is a chronic inflammatory condition. (5) (Kalyani)
 Metaplasia is a double edged sword (5) (IQ City)
 Decreased effective circulating blood volume is main pathogenesis of all types of
shock. (CNMC)
 Type II hypersensitivity reaction differs from Type III reactions. (CNMC)
 Gooty tophus and rheumatoid nodules are different (KPC)
 Pathological and phylogical giant cells are not same. (KPC)

Answer The Following:

 Differences between healing by primary intention and secondary intention. (5)
(MCK, Kalyani,ICARE)
 Difference between exudates and transudates. (5)
(MCK,RGK,Midnapore,Joka,KPC,ICARE)
 Pathogenesis of septic shock. (5) (MCK,RGK,BMC,MSD,Joka)
 Differences between coagulative necrosis and liquefactive necrosis. (5) (NRS)
 Pathogenesis of renal edema . (5) (NRS,RGK)
 Cellular events in acute inflammation. (5) (NRS)
 Pathogenesis of thrombosis . (5) (RGK)
 Enumerate the types of necrosis with appropriate examples. (5) (CNMC)
 Describe the pathogenesis of long term complications of diabetes mellitus. (5)
(CNMC)
 How repair is different from regeneration. (5) (IPGMER)

NRSMC STUDENTS’ UNION 4

 What is Granuloma. (5) (IPGMER)
 Difference between red infract and pale infrac (5) (IPGMER)
 Mechanism of Granuloma formation. (5) (BMC)
 Difference between Apoptosis and Necrosis. (5) (BMC)
 Vascular events of acute inflammation. (5) (BSMC)
 Gas gangrene. (5) (BSMC)
 Classification of granuloma with example. (5) (NBMC)
 Enumerate the morphological types of acute inflammation with example of each.
(5) (NBMC)
 Enumerate the types of metaplasia with example and clinical importance. (5)
(NBMC)
 Severe sepsis may lead to shock and multiple organ failure. (5) (Midnapore)
 Mantoux test is not reliable method of diagnosis of tuberculosis in
immunocompromised patients.(Midnapore)
 “Too much or too little” (dysregulated) apoptosis are harmful. (5) (Midnapore)
 Apoptosis vs Necrosis. Mention Types of Necrosis with example. (5)(Kalyani,
Malda,IQ City)
 Carcinoma vs Sarcoma . (5) (Kalyani)
 Septic shock (5) (CMSDH)
 Granuloma in tuberculosis (5) (CMSDH)
 Compare the primary and secondary healing. What are early complications of
healing?(malda)
 Compare the granuloma and granulomatous tissue. Write down the pathogenesis
of immunegranuloma. (Malda)
 Difference between Thrombophlebitis and Phlebothrombosis. (Murshidabad)
 Lab diagnosis of Amyloid. (Joka)
 Hypertrophy and hyperplasia. (NRS, KPC)
 Caseous necrosis and coagulative necrosis. (KPC)
 Thrombus and postmortem clot. (KPC)
 Type II hypersensitivity (IQ City)
 Complements in health & disease (IQ City)
 Dystrophic and metastatic calcification. (ICARE)
 Dry gangrene vs Wet gangrene (ICARE)
 Resonse to injury theory of Ross (IQ City)
 Type III hypersensitivity (IQ City)
 Tumour invasion and metastasis . (NRS)
 Tumour markers help in diagnosis of malignant tumour. (GIMSH)
 Type IV hypersensitivity (BMC)
 What is exfoliative cytology?What are its uses? (KPC)
 What are the routes through which malignant neoplasms are spread? (KPC)
 All Type I hypersensitivity is not anaphylaxis. (KPC)
 Intra vs Extravascular Haemolysis (BSMC)
 Antemortem and post-mortem clot. (BSMC)
 In sequential changes from adenoma to carcinoma,multistep process of mutation
is [Link] with example. (RGK)
 Pathogenesis of beta-thalassemia. (ICARE)
 Steps of Fracture Healing (IQ City)
NRSMC STUDENTS’ UNION 5
Short Note: ( 5 Marks)
 Vascular phenomenon of acute inflammation. (MCK,BSMC)
 Metaplasia (MCK,RGK,Midnapore,Joka,KPC)
 Leukamoid reaction. (MCK)
 Identification/Stain of Amyloid (NRS,CNMC, IPGMER, Kalyani,Malda,ICARE)
 Giant cells (NRS,BMC,Midnapore,KPC)
 Gaucher’s disease (NRS, Mushidabad,GIMSH)
 Dystrophic calcification. (RGK,IPGMER)
 Apoptosis (RGK,NBMC)
 WHO criteria of Diabetes mellitus (RGK)
 Viral carcinogenesis (CNMC)
 Complications of healing (CNMC)
 Caisson’s disease (CNMC,KPC)
 Vascular events of acute inflammation. (CNMC)
 Types of Embolism (IPGMER)
 Cardiogenic shock (IPGMER)
 Renal edema (BMC,Murshidabad)
 Metastatic calcification (BMC)
 Aplasia vs Agenesis (BMC)
 Gas gangrene (BSMC)
 Atrophy (NBMC)
 Reperfusion injury (NBMC )
 Acute phase reactants (Midnapore)
 Secondary amyloidosis (Midnapore)
 Down syndrome (Kalyani,KPC,GIMSH)
 Granuloma (Kalyani,Murshidabad)
 Air embolism (CMSDH)
 Reticulocytes count (CMSDH)
 Chemical mediators of acute inflammation . (CMSDH)
 Gangrene (CMSDH)
 Red infract (Malda)
 Septic shock (Malda)
 Fracture healing (Murshidabad)
 Chemokines (Joka)
 Pulmonary embolism (Joka)
 Morphological pattern of acute inflammation (Joka)
 Lines of Zahn (KPC)
 Turner’s syndrome (IQ City,NRS,BMC)
 Pathogenesis of Amyloidosis (IQ City)
 Ischaemia-reperfusion theory (ICARE)
 Embolism (ICARE)
 Role of calcium in cell injury (ICARE)
 Amniotic fluid embolism (GIMSH)
 Localised amyloidosis (GIMSH)

NRSMC STUDENTS’ UNION 6

  Angiogenesis (GIMSH)
 Structure of a tubercle (GIMSH)
 Autoimmunity (KPC)
 Paraneoplastic syndrome. (NRS)
 ‘Myc’ oncogene in human tumors. (IQ City)
 Necroptosis (IQ City)
 Diagnosis of Amyloidosis (IQ City)

Haematology
Long Question:
 A female patient aged 35 years was suffering from weakness, giddliness and
lassitude for few months. On examination severe pallor and shiny beefy tongue was
detected. On peripheral blood examination, the MCV (mean corpuscular volume) was
112fl.
a) What is the provisional diagnosis?
b) What is the underlying mechanism of this condition?
c) How will you confirm the diagnosis? (2+3+5) (MCK)
 A 28 years old female with history of menorrhagia presented with severe anemia,
weakness and dyspneoa. Blood examination showed :- Hb 6gm/dl, low MCV .
a) What is the possible diagnosis?
b) Enumerate the uses and describe the pathogenesis of this condition
c) What the laboratory tests will you perform to confirm the diagnosis?
(2+3+5)(CNMC)
 25 year old male presented with fever, cough ,hemoptysis and loss of weight.
a) What is your diagnosis?
b) How will you proceed for diagnosis?
c) Describe the morphological features for the commonest cause. (2+3+5) (IPGMER)
 48 year old female having a habit of walking barefoot, is suffering from increasing
weakness for last 6 months. Investigations show Hb 9.1 gm% , RBC morphology.
Microcytic [Link] is the etiological diagnosis of anaemia? State the
importance of walking barefoot .How will you proceed for confirmation for diagnosis?
(2+1+7) (BSMC)
 A 5 year old child presented with failure to thrive , severe pallor,hepatosplenomegaly
with history ofrepeated blood transfusion.
a) What is your provisional diagnosis?
b) How will you diagnose the case in laboratory?
c) Write down the molecular pathogenesis of the underlying disease?
(2+4+4)(Kalyani)
 A 30 year old male farmer with habit of walking on bare food presented with severe
anaemia.
a) What is your provisional diagnosis?
b) Mention laboratory investigations that will be helpful to arrive at diagnosis?
c) What do you mean by Plummer-vinson syndrome? (2+6+2) (CMSDH)
 Define megaloblastic anaemia. What are the aetiological factors of it? How will you
investigate to confirm the diagnosis of megaloblastic anaemia? (2+1+7) (Malda)

NRSMC STUDENTS’ UNION 7

 Enumerate causes of aplastic/hypoplastic anaemia. What are the presenting features
of aplastic anaemia? How will you establish diagnosis of aplastic anaemia? (3+3+4)
(Malda)
 A 6 year old boy presented to haematology opd with anaemia and [Link]
has history of repeated blood transfusion.
a) What is your provisional diagnosis?
b) How will you proceed to investigate in the laboratory?
c) Mention the pathogenesis of anaemia in this case? (1+7+2) (Murshidabad)
 A 65 year old male underwent emergency laporatomy four days back. He has been
having high grade fever for last two days. Now he has been anuria and
unconsciousness. On examination , his BP 60/40 mm Hg , pulse 135/min and
[Link] rate 38/[Link] investigation TLC 24000/cumm,
N=95%,L=4%,M=1%,E=0,B=0, CRP raised.
a) What is the clinical condition?
b) Define the clinical condition.
c) Describe the pathogenesis behind it. (1+2+7) (GIMSH)
 A 4 year old girl presented with sudden onset of gum bleeding with epistaxis
following a history of antecedent measles infection 2 weeks back. Peripheral blood
smear shows a markedly decreased platelet count with mild anaemia and normal
leukocyte count.
a) What is your provisional diagnosis?
b) What will be the bone marrow findings in above condition?
c) How will you proceed to investigate a case of thrombocytopenia? (2+2+6)
(Midnapore)
 A male child of 8 years age presented to the paediatrics opd with low grade
fever,generalized lymphadenopathy ,moderate anaemia, multiple petechial
haemorrhages ,enlarged testis & features of meningism.
a) What is your provisional diagnosis?
b) Explain the pathogenesis of meningism in this condition?
c) Describe the pathological blood picture of the condition with special reference to
cytochemical stain .
d ) Enumerate the prognostic factors of the disease? (1+2+4+3) (IQ City)
 A 42 year old male patient presenting with generalized weakness,
hepatosplenomegally,gum bleeding with sterna tenderness. His peripheral blood
shows high leucocyte count with presence of fair number of atypical cells. a) What is
your diagnosis? B) Outline the laboratory diagnosis of thiscondition. C) Common
cytogenic abnormalities associated with it.(2+6+2) (CNMC)
 A 40 year old male ,H/O chronic fatigue ,weight loss sice 6 months. O/E
:pallor,marked splenomegaly laboratory report shows Hb 10gm% ,TLC : 215000
/cumm, platelets :4lakhs/cumm.
a) What is your diagnosis?
b) What is the common genetic abnormality?
c) Blood and bone marrow findings to confirm your diagnosis?
d) Prognosis of the condition? (2+3+3+2) (ICARE)
 A 60 year old male complained of low back pain for last 6 months. On MRI it was
found that there were multiple osteolytic lesions in the scalp,clavicle and lumbar
vertebrae. Routine investigations shows that Hb 8 gm% ,serum calcium 11 mg/dl,

NRSMC STUDENTS’ UNION 8

 serum creatinine 2 mg/[Link] would be your provisional diagnosis? How will you
approach for confirmation of diagnosis? (1+9) (RGK)
 A 55 year old male alcoholic patient presented in emergency with distension of
abdomen,hematemesis,altered [Link] is the provisional diagnosis?Describe
the pathogenesis of cause of distended abdomen in this patient .Enumerate the
laboratory investigations with expected findings done in this case. (2+4+4) (Kalyani)
 A 5 year old boy has marked pallor and hepatosplenomegally and unconjugated
hyperbilirubinemia .On eliciting history, it was found that no premarital medical
screening was done to his parents.
a) What can be the provisional diagnosis?
b) How the case is to be investigated to confirm the diagnosis?
c) What could be the hazards of repeated blood transfusions in this case? (2+6+2)
(NRS , BMC)
 A middle aged woman presented with weakness,pallor and glossitis. Gastric analysis
shows [Link] is the probable diagnosis?How will you proceed to
investigate the case?What are “ring sideroblasts” and how will you demonstrate
them? (2+5+3) (IPGMER)
 A 5 year old child presented with acute onset of high fever, severer anemia, gum
bleeding,generalized lymphadenopathy and sternal tenderness. -----------------------
What is the probablediagnosis? How will you proceed to confirm your diagnosis?
(2+8) (KPC)
 A 55 year male came to hospital OPD with complaints of weakness,paraesthesia and
numbness. He was strict vegetarian, on examination moderate pallor, diminished
reflexes are [Link] is the possible type of anemia? Describe the etiological
classification of such type of anemia. How can you reach the final diagnosis? (1+5+4)
(GIMSH)
 Discuss the pathogenesis of idiopathic thrombocytopenic purpura . What are the
bone marrow changes in ITP? How will you confirm the diagnosis of ITP? (3+2+5)
(Malda)
 Discuss the pathogenesis of chronic myeloid leukaemia? What is the diagnostic
hallmark of CML?Discuss the natural course of CML? (4+1+5) (Malda)
 A 30 years old female presented with history of menorrhagia along with
pallor,weakness and easy fatiguability. Blood examination showed:- Hb : 6.8 gm/dl,
low MCV ,normal platelet count.
a) What is the possible diagnosis?
b) Outline the pathogenesis of this condition?
c) Lab diagnosis. (2+3+5) (CNMC)

Comment On :
 Blood transfusions also bears some hazards. (CNMC)
 Peripheral blood smear gives immense information. (NRS, IPGMER)
 Teratoma and hamartoma are not the same. (NRS)
 Leukamoid reaction and leukaemia are not easy to distinguish. (NRS, CNMC)
 Microcytic hypochromic feature in the peripheral blood suggests only iron
deficiency status.(RGK)
 In autoimmune hemolytic anemia, temperature has got a significant role for
interaction of antibody and red cell antigens. (RGK)
NRSMC STUDENTS’ UNION 9
  ITP is diagnosis of exclusion. (RGK)
 Bone marrow study is essential for diagnosis & confirmation of acite
leulaemia. (RGK)
 Significance of Coomb’s test. (IPGMER)
 Differential diagnosis of unconjugated hyperbilirubinemia. (IPGMER)
 All bleeding disorders are not coagulopathy. (Midnapore)
 Lesions of heart valves differs etiologically. (Midnapore)
 Role of serum cardiac markers in the diagnosis of acut myocardial infraction. (IQ
City)
 Morphological classification of anemia. (CNMC)
 Evidence of haemolytic anemia & its investigations. (ICARE)
 Idiopathic thrombocytopenic purpura. (ICARE)
 Leukaemoid reaction and chronic myeloid leukemia are different names of same
entitity?(Kalyani)
 Rheumatism licks the joints but bites the whole heart. (GIMSH)
 A carefully prepared & surpervised blood transfusion is mandatory for
patient safety. (GIMSH)
 Justification of coomb’s test in Auto-immune Hemolytic Anemia (AIHA). (BMC)

Answer The Following:

 Laboratory investigation of Immune Thrombocytopenic Purpura. (NRS,BMC)
 Blood picture of CML. (RGK, Midnapore)
 Basic haematological investigations are usually done in a case of bleeding
disorder. (RGK)
 Pathogenesis of atherosclerosis. (CNMC, IPGMER)
 Progression of different phases in chronic myeloid leukaemia (CML) (BMC)
 Pathogenesis of aplastic anemia. (Midnapore, KPC)
 Blood and bone marrow picture in megaloblastic anaemia. (ICARE)
 Bombey blood group. (KPC, ICARE)
 Diagnosis of Acute Myeloid Leukaemia. (ICARE)
 Lab diagnosis of chronic myeloid leukaemia. (IQ City)
 Pathogenesis of hemolytic disease of newborn. (IQ City)
 What are the diseases when we utilize Prothombin time as a diagnostic and
monitary tool.( Midnapore)

Short Note: ( 5 Marks)

 Rh incompatibility .. (NRS)
 Reticulocyte count (RGK, IPGMER)
 Intrinsic factor (IPGMER)
 Use of different stains to distinguish different blasts. (BMC)
 Von-willebrand’s disease (RGK, BMC)
 Standard methods of Blood grouping. (BMC)
 G6PD deficiency. (KPC)
 Bombay blood group (KPC)
 Blood picture of CML. (GIMSH)
 Haemophilia A (GIMSH,ICARE)
NRSMC STUDENTS’ UNION 10
  Erythrocyte sedimentation rate (ICARE)
 Leukamoid reaction and how it differs from leukaemia. (ICARE)
 Coomb’s test (Midnapore,Murshidabad, ICARE)
 Left sided blood failure (Midnapore)
 Pulmonary hypertension (Midnapore)
 Sickling test (RGK)
 Hodgkin lymphoma. (NRS,Midnapore)
 Hodgkin cell (BSMC)
 Glycosylated hemoglobin (Murshidabad)
 Reed Sternberg cell (CNMC, Murshidabad)
 Hydrops Foetalis. (KPC)

Systemic Pathology
Long Question:
 A 10 year old boy admitted in the ward with complaints of fever for last 2 weeks ,
migratory polyarthritis and severe palpitation.
A) What is your provisional diagnosis?
B) What is the pathogenesis of disease?
C) What is the pathological (morphological) changes of the organ predominantly
affected?(2+3+5) (MCK)
 A 7 year old boy developed puffiness of face ,oliguria and smoky urine two weeks
after an attack of sore throat.
a) What is the provisional diagnosis?
b) Laboratory findings of the case. C) Pathogenesis of this condition. (1+6+3) (NRS)
 A 55 year old male,presented with anaemia, weight loss ,anorexia and occasional
[Link] is non responsive to proton pump inhibitors and on endoscopy
a large ulcerative lesion of size 4cm was detected near pyloric [Link] is the
probable diagnosis? Describe the morphological and histopathological pattern in
favour of your diagnosis?(1+3+6) (RGK)
 A 15 years old boy presented with rapidly growing swelling around his right knee
joint along with pain and pathological [Link] is the probable diagnosis? What
is the expected X-ray finding of the condition? Describe the morphological of the
condition along with a diagram. (2+2+6) (CNMC)
 A 70 year old male presented with pain in vertebrae followed by pathological
fracture. There are multiple osteolytic lesion in humerus on [Link] is the
probable diagnosis? How will you investigate the case? What are the prognostic
factors in this disease? (2+6+2) (IPGMER)
 60 years male,chronic alcoholic presented with huge ascites,bilateral pedal edema,
shrunken face and dragging pain in left hypochondriac region.
a) What is the probable diagnosis?
b) what is the laboratory diagnosis of this condition?
c) Enumerate the other causes of such illness.
d) What are the complications of such illness? (1+3+3+3) (BMC)
 A 68 years old male suffering from pain abdomen, anorexia, weight loss and bouts of
haematesis for last 2 months. O/E a hard, fixed lump on epigastric region with

NRSMC STUDENTS’ UNION 11

 tender [Link] is the probable diagnosis? How should you approach for
confirmation? (2+8) (BSMC)
 A 55 year old lady presented with lump in right breast of 3 months duration. On
examination there is a hard mass of 3 cm diameter with fixity with deeper structure
and skin. Nipple is [Link] is the probable diagnosis ? What should be your
approach to diagnose the lesion? What would be the most likely natural course of the
disease if the condition is kept unattended? (1+6+3)
 A 7 year old child presented with acute onset cola coloured urine and oliguria. She
had a history of fever and sore throat 7 days [Link] is the provisional diagnosis?
How will you investigate the case in lab? Write down the underelying pathogenesis
of the condition? (2+4+4) (Kalyani)
 A female aged 61 year presented with post-menopausal uterine bleeding. Bimanual
recto-vaginal palpitation reveals bulky uterus and mass in cul-de-sac of
[Link] the causes that can result in this type of clinical picture. Proceed
algorithmically to establish any one of your mentioned causes as definite diagnosis,
with the help of laboratory [Link], if your final diagnosis is/are
attached with any reproductive/genetic/hormonal factors.(2+5+3) (Midnapore)
 A 60 year male presented with pedal edema, ascites , haematemesis and moderate
proteinuria.
a) What is the probable diagnosis?
b) What is the pathogenesis of ascites in this case?
c) What are the etiological factors responsible for this condition? (1+4+5) (KPC)
 58 years old male presented with painless intermittent haematuria, a lump in the
lumber region.
a) What is the probable diagnosis?
b) How will you proceed to diagnosis in the lab?
c) Enumerate the possible complications of the disease? (1+7+2) (Murshidabad)
 A 59 year old male presented with acute precordial crushing chest pain, severe
dyspneoa, profuse sweating with rapid pulse.
a) What is the probable diagnosis?
b) What is the pathogenesis of this case?
c) Enumerate the laboratory markers for evaluation of this condition? (1+4+5) (IQ
City)
 Enumerate the gross and microscopic types of gastric carcinoma. Describe the
microscopic features of the most common type of gastric carcinoma. (6+4)
 Classify Glomerulonephritis. Acute nephritic syndrome vs Nephrotic syndrome.
(5+5)
 What are the causes of cirrhosis of liver? Mention two complications of liver cirrhosis
and explain their pathogenesis?. (3+7)
 Pathogenesis of Acute rheumatic fever. Mention the morphological changes of
Rheumatic diseases?(4+6)
 Morphology of different types of tuberculosis of lung in adult. (10)
 What are the different methods of staining used in cytology(exfoliative and FNAC)?
(10)
 70 year old male patient presented with bone pain , weakness and history of
recurrent infections,Radiological study reveals punched out lesions involving skull
bones and [Link] is your provisional diagnosis? Give one different
NRSMC STUDENTS’ UNION 12
 diagnosis. How will you investigate the patient to reach the diagnosis? (1+1+8)
(Malda)
 A 55 year old male alcoholic patient presented with distension of abdomen,
hematemesis & alteredsensorium.
a) What is your provisional diagnosis?
b) Describe the pathogenesis of the cause of distended abdomen ?
c) Enumerate the laboratory findings done in this case . (2+4+4) (Kalyani)
 A 55 year old female patient was brought to the emergency with cold clammy
extremities,rapid thready pulse and hypotension. She had recurrent episodes of
burning sensation and increased frequency of micturation with low grade [Link]
is your provisional diagnosis? Describe the pathogenesis of above mentioned
condition. What are the clinical stages? (1+6+3) (ICARE)

Comment On :
 Not all hepatitis viruses cause cirrhosis of liver. (MCK)
 Smoking is not the only etiological factor for all COPD. (MCK)
 All colonic polyps are not malignant lesions . (MCK)
 Reperfusion in myocardial infraction may be harmful. (NRS)
 Tobacco smoking and lung cancer. (NRS)
 Ulcerative lesions of stomach are not always benign. (NRS)
 Rheumatic vegetation and vegetation of infective endocarditis are structurally
same &share equal possibility of causing embolic phenomenon. (RGK)
 Selective proteinuria is found in minimal change and membranous
glomerulonephritis. Why selective?Explain. (RGK)
 Typhoid ulcer and tubercular ulcer morphologically same and have similar
complications. (RGK)
 Alcoholism is not a prerequisite for cirrhosis. (IPGMER)
 Carcinoma of colon is a genetic disorder. (IPGMER)
 Pathogenesis of atherosclerosis. (IPGMER)
 Cirrhosis of liver has various etiologies. (CNMC)
 Morphology of benign gastric ulcers differs from that of malignant counterpart.
(CNMC)
 Rheumatic heart disease is a pancarditis. (CNMC)
 Pattern and location of immune complex deposition help distinguishing types of
Glomerulonephritis.(Midnapore )
 Clinical and histomorphological differences between Crohn’s disease and
ulcerative colitis.(Midnapore)
 Common skeletal(Bone) lesions of lower third of thigh at 10-15 years of age
group. (Midnapore)
 Pathophysiology of post necrotic and cardiac cirrhosis differs considerably.
(Midnapore)
 Carcinoma vs Sarcoma . (BSMC)
 Ulcerative colitis (BSMC)
 GCT of bone from other giant cell containing lesions of bone. (BSMC)
 [Link] infection plays a dominant role in malignant condition of stomach.
(Kalyani)

NRSMC STUDENTS’ UNION 13

  Carcinoma spreads through haematogenous route and sarcoma spreads through
lymphatic route.(Kalyani)
 Nephritic syndrome and Nephrotic syndrome are almost synonymous. (MCK,
BMC)
 Primary tuberculosis can involve any segment of lung parenchyma. (BMC)
 Giant cell tumour of Bone is a classical example of malignant neoplasm. (BMC)
 Thyroid swelling is always due to colloid goiter. (Murshidabad)
 A small percentage of Hepatitis B infections may lead to Hepatocellular
carcinoma.(Murshidabad)
 Rheumatic heart disease is pancarditis. (Murshidabad)
 Tobacco smoking can cause bronchogenic carcinoma. (KPC)
 Adult polycystic kidney disease is hereditary. (KPC)
 Osteosarcoma and osteoclastoma are not the same. (MCK , KPC)
 Inflammatory response in Tuberculosis. (IQ City)
 Lesions of the heart valve differs etiologically (Midnapore)
 Immunofluroscence microscopy is useful in the diagnosis of Glomerulonephritis .
(IQ City)
 [Link] gastritis is premalignant (IQ City)
 Many etiological factors are responsible for cirrhosis (CNMC)
 Benign gastric ulcer differs morphologically from malignant ulcer (CNMC)

Answer The Following:

 Compare typhoid ulcer with tuberculous ulcer of small intestine. (MCK)
 Nephritic syndrome vs Nephrotic syndrome. (MCK)
 Pathogenesiss and complications of cirrhosis of liver. (NRS)
 Pathogenesis of Cervical carcinoma. (NRS , Murshidabad)
 Prognostic factors of carcinoma in breast. (NRS)
 Pathogenesis of Post streptococcal glomerulonephritis. (CNMC)
 Role of tobacco smoking in pathogenesis of lung cancer. (CNMC)
 Role of HPV in cervical carcinoma. (CNMC)
 Germ cell tumour of ovary (IPGMER)
 Polycystic Kidney disease (IPGMER)
 Renal lesion in Diabetes mellitus . (IPGMER)
 Pathogenesis of Glomerulonephritis on the basis of immune complex mechanism.
(RGK)
 Mention the serological markers in favour of diagnosis of acute hepatitis B
infection. (RGK)
 Describe the morphological changes of myocardium in a case of acute myocardial
infraction in context to its duration. (RGK)
 Pathogenesis of emphysema. (RGK)
 Role of FNAC in Breast carcinoma. (BMC)
 Role of protein and urine electrophoresis in Multiple Myeloma. (BMC)
 Role of Helicobactor pylori in development of Gastric diseases.. (BMC)
 Minimal change glomerulonephritis will lead to nephritic syndrome. (BSMC)
 Centriacinar emphysema and pan-acinar emphysema differ in disease
distribution.(BSMC, Kalyani)

NRSMC STUDENTS’ UNION 14

  Myocardial infraction usually develops from a moderately stenotic plaque.
(BSMC)
 Pathogenesis of DIC. (Kalyani)
 Giant cell containing lesions of bone. (Kayani)
 Classification of Bone tumours. (Murshidabad)
 Difference between Tubercular meningitis and Pyogenic meningitis. (KPC)
 Pathogenesis of Osteomyelitis (KPC)
 Laboratory investigations in Acute myocardial infraction. (KPC)
 Complications of Myocardial infraction and their consequences (MIdnapore)
 Pathogenesis of Non-alcoholic steatohepatitis (NASH) (IQ CITY)
 Morphology of Bronchogenic carcinoma (CNMC)
 Pathogenesis of Chronic osteomylitis. (Kalyani)
 Pathogenesis of Hashimoto’s thyroiditis (Kalyani)

Short Note: ( 5 Marks)

 Seminoma of testis (MCK , NRS, Murshidabad)
 Crohn’s disease (MCK)
 [Link] infection in stomach- consequences. (MCK)
 Morphology of Osteogenic sarcoma. (NRS)
 Mucinous cystadenoma of Ovary (NRS)
 Grave’s disease (CNMC)
 Meningioma (CNMC)
 Phylloides tumour of breast (CNMC)
 Neuroendocrine tumour of lung (IPGMER)
 Hashimoto thyroiditis (IPGMER , Midnapore)
 Retinoblastoma (IPGMER)
 Lesions in heart due to Acute Rheumatic fever (IPGMER)
 Ghon’s complex (RGK)
 Cervical intraepithelial neoplasia (RGK)
 Ashcoff nodule (RGK)
 C.S.F findings in Tuberculous meningitis (BMC)
 Germ cell tumours of testis (BMC)
 Basal cell carcinoma of skin (BMC)
 Histology of dysgerminoma (BSMC)
 PSA (BSMC)
 Precancerous stage of cervical carcinoma
 Nodular hyperplasia of prostate (Kalyani)
 Histopathological features of conventional osteosarcoma
 Prognostic factors of carcinoma of breast (Kalyani)
 Diagnostic criteria for multiple myeloma (Kalyani)
 Pleomorphic salivary adenoma (Midnapore)
 Diagnosis of Rheumatic fever (KPC)
 Bence jones protein (CNMC, KPC)
 Fibroadenoma (KPC)
 Adenomatous polyps of colon (Kalyani , KPC)
 Left sided Heart failure (Midanpore)

NRSMC STUDENTS’ UNION 15

 Molecular basis of Bronchogenic carcinoma (IQ City)
 Primary billiary cirrhosis (IQ City)
 Osteosarcoma (CNMC)
 RPGN (CNMC)
 FNAC (kalyani)
 Squamous intraepithelial lesion of cervix (Kalyani)
 Subacute bacterial endocarditis (GIMSH)

NRSMC STUDENTS’ UNION 16

 Pharmacology
Genaral Pharmacology
Long Question :(12 marks)
• What is pharmacokinetics?Mention the various routes of drug administration with
[Link] are the advantages and disadvantages of administering the drug in
intermuscular route?[MCK] (2+2+4)
• What is biotransformation?What are the phases of biotransformation?Give 4 examples
of microsomal enzyme inducers?[MCK] (2+4+2)
• What is bioavailability?Mention the factors that influence the bioavailability of a drug
administered via oral [Link] is bioavailability measured for an orally administered
drug?[RGK,BSMC](2+5+3)
• Enumerate and define various pharmacokinetic [Link] are their clinical
significance?[CNMC] (5+5)
• What is receptors? Classify receptors. Give example of different types of receptors.
What do you mean by spare receptor and orphan receptor. Give example of non receptor
mediated action of drugs.(1+2+2+3+2) [BMC]

• Define [Link] discuss the factors modifying the [Link]

is the clinical significance of Plasma protein binding?Give one example each of the
drug having high and low volume of distribution.[2+4+2+2](IQ)

Short note:(3 marks)

• Dose responsive curve(NRS)
• Plasma half life( IQ city, IIMSAR)
• Volume of distribution(Rgkar)
• Fixed dose combination of drugs. (COM-SDH)
• Zero order kinetics ( RGK,Midnapore)
• Therapeutic index ( Midnapore)
• Utility of pharmacogenomic knowledge in therapeutics. (IPGMER)
• Non-Competitive Drug antagonism. (IPGMER)
• Orphan drug ( Murshidabad)
• Receptor. (NBMC)
• Essential medicines ( Ipgmer)
• Auto receptors( Ipgmer)
• Plasma Protein Binding. (BMC)
• Antidotes used for drug overdose( Ipgmer)
• Drug tolerance( IQ city)
NRSMC STUDENTS’ UNION 17
 • Bioavailability(IIMSAR)
• First pass metabolism (CNMC)
• Drug synergism( CNMC)
• P -drugs( CNMC)
• Clearance of Drugs. (IPGMER)
• Nuclear Receptors. (IPGMER)
• Teratogenicity of Drugs. (BSMC, COM-JNM, Malda MC)
• Transdermal drug delivery system(IIMSAR)
• Different methods of drug transport. (NRS)
• Receptor antagonism. (RGK, BSMC)
• Idiosyneratic drug reactions. (ICARE)
• Therapeutic drug monitoring. (Gouri Devi)
• First order kinetics and steady state concentration. (Gouri Devi)
• Pharmacovigilance. (ESIC-JOKA, IQ City)
• Non-Receptor Mediated drug action. (ESIC-JOKA)
• Quantal Dose Response. (ESIC-JOKA)
• Loading dose and maintenance dose. (ESIC-JOKA)
• Enzyme induction. (KPC, Gouri Devi)
• Bioequivalence. (KPC)
• Enzyme inhibition. (KPC)
• Competitive antagonism. (COM-SDH)
• Upregulation of receptors. (KPC)
• Advantages and disadvantages of oral route of drug administration. (COM-SDH)
• Parenteral route of Drug administration. (Malda MC)
• Vasomotor Reversal of Dale. (IQ City)
• Drugs to Test error of refraction. (Murshidabad MC)
• New Drug-Development : Different phases. (Murshidabad MC)
• Essential Drugs. (COM-JNM, IQ City)
• Tachyphylaxis. (NBMC)
• Volume of Distribution. (Midnapore MC, ESIC-JOKA)

Explain Why:
• Eliciting Medical history is important for rational therapeutics( burdwan)
• Intravenous route is the choice for emergency( IIMSAR)
• Alkalisation of urine is done in acidic drug poisoning. (ICARE)
• Atropine and Pralidoxime is used in Parathion poisoning. (ESIC-JOKA)
• Genetic factors often influence effect and adverse effects of drugs. (Murshidabad
MC)
• Apparent volume of distribution is an important pharmacokinetic parmeter.
(Murshidabad MC)

NRSMC STUDENTS’ UNION 18

 • Log dose response curve is preferred over dose response curve in therapeutics.
(Malda MC)

• Pralidoxime is useful in the treatment of Organophosphorus poisoning.

(Midnapore MC
• Oral preparation are not suitable for all drugs. (BMC)
• Loading dose is required in some situations. (BMC)
• Wide therapeutic window indicates a greater level of safety for a drug. (RGK)
• All fixed dose combinations are not rational. (NRS)

Autonomic Nervous System

Long Question :(12 marks)
• Enumerate the drugs used in [Link] the rationality of using different
anti-glaucoma drugs in chronic simple [Link] down the indications and
contraindications of atropine in different ophthalmological conditions.[NRS] (2+5+3)
• Enumerate the drugs used for the treatment of organophosphorus [Link]
the reasons for use of each of these drugs?Why oximes are contraindicated in
carbamate poisoning?[RGK] (2+5+3)

• Enumerate the drug used in [Link] the rationality of use of levodopa

in idiopathic [Link] is on and off [Link] one antiviral
drug used in parkinsonism.[3+3+3+1](IQ)

• Enumerate anticholinergic drugs. Write down their pharmacological actions.

Mention the uses of atropine substitutes. How will you treat a case of atropine
poisoning.[3+3+3+1](CNMC)

Short note:(3 marks)

• Selective alpha 1 blockers(Rgkar)
• Succinyl choline(MCK,IQ city)
• MAO-B inhibitors. (NRS)
• Neostigmine. (CNMC)
• Clinical uses of Atropine Substitutes. (Gouri Devi)
• Therapeutic uses of Atropine substitutes. (IPGMER)
• Treatment of organo-phosphorus poisoning. (ICARE)
• Treatment of acute congestive glaucoma. (ICARE)
• Management of Myasthenia Gravis. (ICARE)
• Anticholinesterase agents. (ICARE)
• Cilnical uses of Atropine. (NBMC)
• Non-Depolarising Neuromuscular blockers. (RGK)
• Diagnostic Uses of adrenergic drug. (Murshidabad MC)
• Atropine Substitutes. (Malda MC)
• Myaesthenic crisis and cholinergic crisis. (Murshidabad MC)

NRSMC STUDENTS’ UNION 19

 • Long lasting β2 agonist. (COM-SDH)
• Atropine Congeners. (Midnapore MC)
• Extracardiac Roles of β Blockers. (BSMC)
• Dobutamine. (MCK)
• Atracurium. (CNMC)

Mechanism of Action:
• Oximes in organophoporous
poisoning[NRS,IPGMER,BMC,MALDA,MURSHIDABAD]

• Propranolol in thyrotoxicosis.[RGK]

• Beta blocker in glaucoma[MALDA]

• Timolol in glaucoma[IPGMER]
• Pralidoxime as an enzyme reactivator[BSMC]

• Pilocarpine as antiglaucoma agent[SAGORE DUTTA]

• Atropine as cycloplegic[MALDA]

• Beta blocker in glaucoma[MALDA]

• Acetazolamide in glaucoma[MURSHIDABAD]

• Atropine and pralidoxime in parathion poisoning[ESI]

• Miotics in both open and closed angle glaucoma[IQCity]

• Atropine in organophosphorous poisoning[BMC]

• .Pyridostigmine in the management of myasthenia gravis[CNMC]

• Latanoprost in glaucoma[IQ]

• Prostaglandin analogue in glaucoma[BSMC]

• Pralidoxime in organophosphorus poisoning[IQ]

• Succinyl choline as muscle relaxant[GOURIDEVI]

• Beta blockers for hypertension. (IIMSAR)

Explain Why:
• Beta 2 receptor agonists are preferred over anticholinergic agents in the
management of acute excerbation of asthma[BMC,IPGMER]

• Phenylephrine is preferred over atropine for fundoscopy(Malda)

NRSMC STUDENTS’ UNION 20

• Atropine should not be used in angle closure glaucoma( bankura)

• Pyridostigmine is used in myasthenia gravis( Ipgmer)

• Succinyl choline should be used cautiously (CNMC)

• Beta blockers are not used in variant angina( IQ city)

• Adrenaline injection is used in anaphylactic shock ( IIMSAR)

• Neostigmine is used in myasthenia gravis. (Gouridevi)

• Succinyl choline can cause prolonged apnoea in some patients. (Sagoredutta,

Gouridevi)

• Propranolol in thyrotoxicosis( IIMSAR)

• Beta 2 receptor agonists are preferred over anticholinergic agents in the

management of acute exacerbation of asthma. ( Burdwan)

• Atropine is used in organophosphorus poisoning. (Burdwan)

• Centrally acting anticholinergic is useful in drug induced Parkinsonism. ( IQ

city)

• Inhaled corticosteroid is combined with selective β-2 agonists. (ICARE)

• Subtherapeutic dose of atropine is added with diphenoxylate. (ICARE)

• Sudden withdrawal of β-blockers is discouraged? (ICARE)

• Prazosin is prescribed in low dose at bed time. (KPC)

• Few sympathomimetics are often associated with tachyphylaxis. (Murshidabad

MC)

• Non-specific α-Blockers should not be given alone in the treatment of

Pheochromocytoma. (Midnapore MC)
• Neostimine is preferred in myasthenia gravis. (NBMC)
• Adrenaline is used in anaphylactic shock. (IPGMER, BSMC, COM-SDH, ESIC-
JOKA, KPC)
• Latanoprost is given wide angle glaucoma. (CNMC)

• In Pheochromocytoma non-selective α-blocker should be used prior to β-blocker.

(CNMC)

• Pilocarpine is used in both acute congestive and open angle glaucoma. (MCK)

NRSMC STUDENTS’ UNION 21

 Autacoids & Respiratory System
Long Question :(12 marks)
• Enumerate anti [Link] how histamine lowers the mean arterial blood
[Link] the therapeutic indications of [Link] why betahistine
is contraindicated in asthma patients.[NRS] (3+3+2+2)
• Enumerate the drugs used in the treatment of bronchial asthma. How do
corticosteroid act in bronchial asthma?What are the advantages of inhalation therapy in
asthma?[IPGMER] (6+2+2)

Short note:(3 marks)

• Therapeutic uses of prostaglandin analogues(malda)
• Methotrexate( Murshidabad)
• COX II inhibitors( KPC)
• Cetirizine( CNMC)
• DMARDs(IQ city)
• Treatment of Status Asthmaticus. (NBMC)
• Therapeutic Uses of Prostaglandin analogues. (COM-JNM, Malda MC)
• Non sedative Anti-Histaminics. (BMC)
• Inhalational Corticosteroids. (RGK)
• Inhaled Glucocorticoids in Bronchial asthma. (Malda MC)
• Salmeterol. (RGK)

Mechanism of Action:
• Methylxanthene[IQ]
• Promethazine in motion sickness and vomitting[MURSHIDABAD]

• Salbutamol in bronchal asthma[CNMC]

• Montelukast in bronchial asthma[MMC,MCK]
• Salmetrol in asthma and COPD[MURSHIDABAD]

• Oxymetazoline as a nasal decongestant[KPC]

• Probenecid in gout[IQCity]
• Colchicine in acute gout[KPC]
• Amitriptyline in depression[KPC]
• Methotrexate in rheumatoid arthritis[KPC,IPGMER,MMC]
• Aspirin in rheumatic fever[KPC]

NRSMC STUDENTS’ UNION 22

 • Allopurinol in gout[IPGMER]
• Paracetamol in fever[IPGMER]

Explain Why:
• Non selective beta blockers should not be given in patients with bronchial
asthma( Midnapore)
• Prostaglandin analogues are used for prevention of NSAID induced peptic
disease( MCK)
• Latanoprost is used in glaucoma( Ipgmer)
• N-acetylcysteine is used in paracetamol poisoning(CNMC)
• Nasal decongestants should not be used for prolonged period (CNMC)
• Leucovorin rescue is Mandatory in methotrexate therapy ( burdwan)
• Salbutamol and ipratropium bromide are used in combination in bronchial
asthma. ( Malda)
• Propylthiouracil is used for treatment of hypothyroidism in pregnancy.
(Midnapore)
• Corticosteroids are useful in bronchial asthma. ( IQ City)
• Aspirin should not be used as an analgesic-antipyretic in children. (Gouri Devi)
• N-Acetyl cysteine is used in paracetamol poisoning. (Gouri Devi)

• Pentazocine is not recommended in acute myocardial infarction patients. (Gouri

Devi)
• Sodium Chromoglycate is not used in acute attack of bronchial asthma.
(Murshidabad MC)
• Montelukast is ineffective in acute bronchial asthma. (COM-SDH)
• β-2 agonists and anti-cholinergics are used through nebulizer during acute attack
of asthma. (COM-JNM)
• 1st generation anti-histaminics are prophylactically used in motion sickness.
(COM-JNM)
• Glucocorticoids are useful in the treatment of Bronchial Asthma. (Midnapore
MC)
• Ipratropium Bromide is preferred in COPD and not Bronchial Asthma. (NBMC)
• Inhalational Ipratroprium Bromide is useful in chronic obstructive pulmonary
disease. (RGK)
• Pentazocine should not be coadministered with morphine. (NRS)

NRSMC STUDENTS’ UNION 23

 Central Nervous System
Long Question :(12 marks)
• Enumerate antipsychotic drugs. Describe the mechanism of action of antipsychotic
drugs. Write down a short essay on clozapine.[CNMC] (4+3+3)
• A 16 year old girl presents with persistent generalized tonic clonic convulsions. Her
parents give a history of sudden stoppage of antiepileptic drugs. Give an outline of
management of this patient. State the mechanism of action of any one AED you have
[Link] 4 long term adverse reactions to phenytoin therapy. State two non epileptic
uses of AED.[CNMC] (3+3+3)
• Enumerate opioids. Mention some important therapeutic uses of morphine. Explain
why methadone is used in the treatment of opioid withdrawal.[Malda MC] (3+3+2+2)

• Enumerate the ligands acting on opioid receptor based on intrinsic activity. What is
the pharmacological basis of the use of morphine in AMI. Explain why morphine is
contraindicated in undiagnosed abdominal pain. Mention an opioid can used in
transdermal patch.[IQ city] (3+3+2+2)

• Enumerate different anti psychotic drugs. Write down common adverse effects of
classical antipsychotic. What are the advantages of atypical antipsychotic. Mention two
uses of atypical antipsychotic.[BMC] (3+3+2+2)

• Enumerate opioid analgesic. What are the different stimulatory actions of morphine
on CNS? Why is it contraindicated in patients of head injury?[RGK] (5+3+2)

• Enumerate the antiepileptic agents and discuss the mechanism of action uses and
adverse effects of valproic acid.[IIMSR] (4+2+2+2)

• Define neuroleptics. Enumerate typical and atypical anti psychotics. Describe the
neurological side effects of typical anti psychotics.[KPC] (2+4+4)

• A 30 year old female brought to the emergency department with the complain of
severe throbbing pain on the right of the head accompanied by nausea vomiting and
extreme sensitivity to light and sound. It is diagnosed as the acute attack of severe
migraine. Outline the pharmacological management of the case. Write down the
different drugs used for the prevention of further attack of similar episodes. Write down
the different therapeutic uses of propanolol.[GouriDevi] (4+3+3)

• Enumerate different [Link] the uses and adverse effects of

[Link] discuss directionality of use of Morphine in case of acute
pulmonary edema[.2+3+3+2](ICARE)

• Classify antidepressants agents. What are the advantages of SSRIs over TCAs?
Mention other uses of SSRIs.[3+3+2](MCK)

• Enumerate the drugs used in epilepsy. Write down the mechanism of action of
sodium valproate as antiepileptic. What are the side effects and uses of sodium
valproate?[4+3+1+2](CNMC)

NRSMC STUDENTS’ UNION 24

Short note:(3 marks)
• Tricyclic antidepressants(NRS)
• Pethidine(malda)
• SSRI( Midnapore)
• Drugs acting on GABA/Benzodiazepine-chloride channel complex. (IQ City)
• Opiod receptor antagonists. (BMC)
• Pre-anaesthetic medication. (KPC, COM-SDH)
• Sumatriptan( Murshidabad, MCK )
• Preanesthetic medication( CNMC, Murshidabad)
• Clozapine( CNMC)
• Lithium carbonate( KPC)
• Propofol. (MCK)
• Alcohol de-addiction therapy. (NRS)
• Treatment of acute attack of migraine. (ICARE)
• Treatment of Drug Induced parkinsonism. (Gouri Devi)
• Dopamine. (COM-SDH)
• Dissociative Anaesthesia. (BSMC)
• Levetiracetum. (CNMC)

Mechanism of Action:
• Lignocaine as local anaesthetic.[MCK,NRS,CNMC,KPC]

• Alprazolam[MALDA]

• Morphine in pulmonary oedema[MURSHIDABAD]

• Ropinitrole as antiparkinsonian agent[NRS]

• Sodium valporate as antiepileptic[NRS,MCK]

• SSRI as anti depressants[NRS]

• Sumatriptan[MALDA,IPGMER]

• Alkali mixture in salicylate or barbiturate poisoning[CNMC]

• Z compounds on sleep architecture[IPGMER]

• Tramadol as analgesic[BSMC]

• Triptans in migrane[IQCity]

NRSMC STUDENTS’ UNION 25

 • Diazepam[gouridevi]

• Glycopyrrolate as a pre anasthetic medication[gouridevi]

• Sumatriptan[MALDA,IPGMER]

• Morphine in pulmonary oedema[MURSHIDABAD]

• Promethazine in parkinsonism [SAGORE DUTTA]

• Carbidopa is combined with levodopa in treatment of parkinsonism[RGK]

• Methadone is used in morphine withdrawal[RGK,CNMC]

Explain Why:
• Propofol is used for both induction and maintenance of anaesthesia(NRS)

• Carbidopa cannot be used as monotherapy in Parkinsonism(bankura)

• Pyridoxine should not be co administered with L-DOPA in treatment of

Parkinsonism(Midnapore)

• Propofol is used in day care anaesthesia( Midnapore)

• Aspirin should be stopped one week before elective surgery( Murshidabad)

• Morphine is used in acute left ventricular failure (MCK)

• Nimodipine is used in sub arachnoid haemorrhage(MCK)

• Tricyclic antidepressants are not preferred in elderly male subjects( burdwan)

• Low dose aspirin is used as anti platelet agent(CNMC)

• SSRI avoided in MAOIs ( IIMSAR)

• Morphine is used in head injury (IIMSAR, KPC)
• Lithium avoided with thiazide( IIMSAR)
• Adrenaline is given along with lignocaine in local anaesthesia( IQ city, IIMSAR)

• SSRI are preferred over tricyclic antidepressants(IQ city)

• Thiopentone sodium is not used for maintenance of general anaesthesia. (Malda)

• Adrenaline is generally combined with local anaesthetics .(Gouridevi)

• Promethazin can be used in drug induced Parkinsonism.(Sagoredutta)

• Levadopa and Vitamin B complex should not be given together. (Sagoredutta)

• Morphine is used in the treatment of acute left ventricular failure. (KPC)

• SSRI are preferred to tricyclic antidepressants in the treatment of endogenous
depression. (KPC)

NRSMC STUDENTS’ UNION 26

 • Propofol is a commonly used Intravenous anaesthetic. (Ipgmer)
• Methadone is used in morphine withdrawal. ( Rgkar)

• Carbidopa is combined with levadopa in treatment of Parkinsonism. (Rgkar ,

IIMSAR)

• Ethanol is used in treatment of methanol poisoning. (Malda)

• Centrally acting anticholinergic is useful in drug induced Parkinsonism. ( IQ

city)

• Tramadol is used in palliative care of cancer patients. (Gouri Devi)

• Lorazepam is preferred over diazepam in status epilepticus. (Gouri Devi)

• Fentanyl is used in neurolept analgesia. (Gouri Devi)

• Adrenaline is added with lidocaine for local anaethesia. (ICARE)

• Methylsergide is used in prophylaxis of migraine and Sumatriptan is used in

acute migraine attack but not vice versa. (COM-JNM)
• Atypical anti-psychotics are preferred to topical ones in Schizophrenia.
(IPGMER, BSMC)

• Mivacurium is used in daycare anaesthesia. (IPGMER)

• Morphine is contraindicated in head injury. (CNMC, BSMC)

• Propofol not thiopental is used for the maintenance of general anaesthesia.

(NRS)

• Sumatriptan is preferred over ergotamine in acute attack of migraine. (NRS)

• Benzodiazepine is preferred over barbiturate as sedative. (MCK)

Cardiovascular System
Long Question :(12 marks)
• A 50 year old man with long standing poorly controlled hypertension and ischemic
heart disease presents with bilateral pedal edema, dyspnea and easy
[Link] investigations suggest symptomatic CHF. State the drugs that can
be prescribed for the patient. State the mechanism of action of any of the drug you have
listed. Name the drugs that can provide mortality benefit in CHF. What is the current
status of digoxin in heart failure?[IPGMER] (3+3+2+2)
• Enumerate the anti hypertensive drugs. Mention the mechanism of action and
adverse drug reactions and uses of ACE inhibitors.[Midnapore] (4+2+2+2)

• Classify antihypertensive agents and discuss therapeutic uses and adverse effects of
ACE inhibitors.[IIMSR] (4+3+3)

• Enumerate the drugs used in CCF. Mention the uses of diuretics in heart failure. Why
digoxin is not considered as the first line drug in chronic heart failure.[KPC] (4+4+2)

NRSMC STUDENTS’ UNION 27

• Enumerate antihypertensive drugs. Describe the mechanism of action and side effects
of any three different classes of antihypertensive.[NRS](4+6)

• Enumerate 4 antihypertensive drugs (one from each group). What are the roles of beta
blockers in treatment of hypertension? How will you treat a case if hypertensive
crisis?[Gauri Devi](2+4+4)

• Outline the mechanism of action of combined hormonal oral contraceptive

[Link] the adverse drug reactions and contraindications of oral contraceptive
[Link] the additional benefits of using OCP.[3+3+2+2] (BSMC)

• Enumerate the drug used in acute and chronic heart [Link] the
pharmacological basis of high cardiac remodeling Comment on the current status of
digoxin.[3+3+2+2 ](IQ)

• Enumerate antianginal drugs. Define unstable angina. How do you manage a case of
unstable angina?[3+1+4](MCK)

• Classify drugs used in treatment of heart failure with examples in class. Briefly
mention the role of ACE inhibitors in chronic heart calorie. What is the present
status of digoxin in management of cardiovascular disorders.[5+3+2] (IPGMER)

• Enumerate the drugs used in hypertension. Describe the mechanism of action and
adverse effects ACE inhibitors. Outline the management of myocardial infarction.[3
+ 4 + 3](MURSHIDABAD)

• Enumerate the antianginal [Link] the mechanism of action of glyceryl

trinitrate in acute attack of [Link] some therapeutic indication of organic
nitrate other than angina.[4+4+2](CNMC)

Short note:(3 marks)

• Verapamil ( MCK)
• Rosuvastatin( Murshidabad)
• Inodilators. (IQ City)
• Streptokinase. (COM-JNM)
• Losartan. (Gouri Devi)
• Styptic agents. (COM-JNM)

Mechanism of Action:
• Ligocaine as antiarrythmic agent[MMC]
• Captopril in hypertension[MMC]
• Beta blocker as hypertensive agent[MCK,MMC,KPC]

• Dopamine in cardiogenic shock[RGK,NBMC,MMC,ESI,CNMC]

• Fibrinolytics in AMI[IPGMER]
• Alpha methyldopa in essential hypertension[MURSHIDABAD]

NRSMC STUDENTS’ UNION 28

 • Nitrates in ischemia[IQCity,MIDNAPORE,BMC,KPC,BSMC]
• Labetatol in hypertensive emergency[MURSHIDABAD]

• Hydrochlorthiazide in essential hypertension[CNMC]

• Statins[IQ]

• Glyceryl trinitrate[BSMC]
• Ranolazine as antianginal[NRS]

• Lignocaine. (Gouri Devi)

• ACE inhibitors as antihypertensive[GOURIDEVI,ICARE]

• Ramipril as antihypertensive drug.[ SAGORE DUTTA]

• Atrovastatin as hypolipidemic agent[SAGORE DUTTA]

• ACE inhibitors in post myocardial infarction[KPC]

• Digoxin in CHF. (IIMSAR)

• Beta blockers for hypertension. (IIMSAR)

Explain Why:
• Mannitol is NOT used in heart faliure[BMC]

• Sodium nitroprusside is antihypertensive but not used for same mostly[BMC]

• Dopamine is used in carcinogenic shock (Rgkar)

• ACE inhibitors are contradicted in bilateral renal artery stenosis ( MCK)

• Enalapril and Spironolactone should not be used concurrently( CNMC)

• Carvedilol is used in congestive cardiac failure. (NRS)

• Adenosine is used in PSVT. (CNMC)

• Sodium nitroprusside is antihypertensive, but not used as a first line drug in

hypertension. (Burdwan)

• Sodium valproate is considered as a broad spectrum anti-epileptic drug. (Gouri

Devi)

• Sumatriptan is avoided in patients with Ischaemic Heart Disease. (ICARE)

• Low dose aspirin is used in post myocardial infarction patients. (ICARE)
• ACE inhibitors are contraindicated in bilateral renal artery stenosis. (IQ City)

• Low dose aspirin is used in Coronary Artery Disease. (IQ City)

• Low molecular weight heparin is preferred to unfractionated heparin. (KPC)

• Glyceryl Trinitrate is administered sublingually in acute angina. (KPC)

NRSMC STUDENTS’ UNION 29

 • Dopamine is used in cardiogenic shock. (Murshidabad MC, ESIC-JOKA, IQ City)

• Low molecular weight heparin is used in the treatment of Acute Coronary

Syndrome. (Midnapore MC)

• Powerful arterial dilators are not used as anti-anginal drugs. (IPGMER)

Endocrine Pharmacology
Long Question :(12 marks)
• Enumerate the anti diabetic drug. Discuss the management of diabetic ketoacidosis.
Describe the mechanism of action,therapeutic uses and adverse effects of Metformin.
[Midnapore,Malda MC]

• Enumerate corticosteroid used in treatment. Mention their indications. Why

corticosteroid should not be withdrawn suddenly after prolonged use?[RGK] (4+4+2)

• Enumerate antithyroid drugs. Describe the role of different forms of iodine in

hypothyroidism and [Link] the management of thyroid storm.
[NRS](3+4+3)

• Outline the mechanism of action of combined hormonal oral contraceptive

[Link] the adverse drug reactions and contraindications of oral contraceptive
[Link] the additional benefits of using OCP.[3+3+2+2] (BSMC)

• Enumerate 4 corticosteroid preparation as per different routes of administration

with an appropriate indication for [Link] the indications and the role of
corticosteroids in infective diseases.(4×1.5+4) (BMC)

• Define insulin [Link] different insulin preparation according to their

onset [Link] the management of diabetic [Link] the
pharmacological basis of use of Alpha glucosidase inhibitor in postprandial
hyperglycemia.[2+3+3+2]

• Enumerate commonly used [Link] the uses and adverse effects of

[Link] on glucocorticoid receptor antagonist with its use.[2+4+3+1]
(ICARE)

• Enumerate antidiabetic agents including preparations of [Link] the

management of diabetic ketoacidosis[.6+4] (ICARE)

• Classify the oral antidiabetic drugs. Discuss the mechanism of parenterally

Administrative antidiabetic substances. What are the adverse effects of
insulin.[3+4+3](MURSHIDABAD)

• Enumerate the drug used in treatment of diabetes mellitus. Write down the
mechanism of action and adverse effects of SGLT2 and DPP 4 inhibitors. What are
the indication of insulin in type 2 Diabetes mellitus.[4+4+2](CNMC)

• Enumerate the oral antidiabetic agents. What are the indications of insulin therapy?
Outline the treatment of diabetic ketoacidosis.[4+3+3](KPC)

NRSMC STUDENTS’ UNION 30

Short note:(3 marks)
• Oral contraceptive pills (NRS, IQ city )
• Health benefit of OCP(BMC)
• Insulin Lispro(burdwan)
• Inhalational corticosteroids(IQ city)
• Carbimazole(Midnapore)
• Sitagliptin ( MCK)
• Alendronate. (RGK)
• Short acting insulin preparation( Ipgmer)
• SERM(selective estrogen receptor modulators) (IIMSAR, CNMC)
• Biophosphonates (IIMSAR)
• Emergency contraceptive(IIMSAR, CNMC )
• Antithyroid drugs( IIMSAR)
• Radioactive iodine( IQ city)
• Bisphosphonates. (Midnapore MC, BMC, IPGMER, NRS)
• Clopidogrel. (Midnapore MC)
• GnRH Analogue. (BMC)
• Anabolic Steroid. (BMC)
• Inhalational Steroids. (NRS)
• Drug treatment of Osteoporosis. (CNMC)
• Lugol’s Iodine. (Malda MC)
• Insulin analogues. (Midnapore MC, BMC)
• Newer Insulin Preparation. (Malda MC)

Mechanism of Action:
• Dapagliflozine as antidiabetic agent[MMC]

• Metformin as first line antidiabetic agent[MCK]

• Metformin in diabetes mellitus[BMC,IPGMER]

• Mifepristone in post coital contraception[BMC]

• Adrenaline in anaphylatic shock[BMC,MALDA,ESI,SAGORE

DUTTA,MURSHIDABAD]
NRSMC STUDENTS’ UNION 31
 • Bisphosphonates[MALDA,BSMC]

• Combined OCP[MALDA]

• Corticosteroids as antiinflammatory agent[MIDNAPORE]

• Ormeloxifen(centcroman) as contraceptive[BMC]

• Carbimazole as an anti thyroid agent[KPC]

• Mifepristone in MTP[ICARE]

• Oral contraceptive pills[ICARE]

• Clomiphene citrate used in male and female

contraception[ICARE,MURSHIDABAD]

• DPP4 inhibitors as oral antidiabetic agent[ICARE]

• Propylthiouracil as an antithyroid agent[ICARE]

• Glimepiride[MALDA]

• Sulphonylurea as oral hypoglycemic agent[NRS]

• Mifepristone as emergency contraceptive[NRS]

• Insulin is preferred over other antidiabetic agents in pregnancy[RGK]

• Clomiphene is used in infertility[RGK]

Explain Why:
• Levothyroxine is preferred over liothyronine in hypothyroidism (NRS)
• Oxytocin is preferred over ergometrine for induction of labor (NRS)
• Lugol’s iodine is used for pre operative preparation of thyrotoxicosis( KPC)

• Glucocorticoids should not be withdrawn abruptly after chronic therapy( KPC,

CNMC)

• Propranolol in thyrotoxicosis( IIMSAR)

• High dose levonorgestrel is used for emergency contraception. (Ipgmer)

• Insulin is administered by subcutaneous rather than intramuscular injection.

(Ipgmer)
• Insulin is preferred over any other antidiabetic agents during pregnancy. (Rgkar)
• Propylthiouracil is used for treatment of hypothyroidism in pregnancy.
(Midnapore)

• Glucocorticoids are used in thyrotoxic crisis. (BMC)

• β-Blockers are not given in diabetic patients receiving insulin. (BMC)

NRSMC STUDENTS’ UNION 32

 • Erythropoeitin is used in anaemia of chronic kidney disease. (MCK)

Chemotherapy
Long Question :(12 marks)
• Classify antimalarial drugs. Write the pharmacological basis of administration of
artemisinin based on combination therapy. Brief out the management of falciparum
malaria in pregnant women. What is the rationality of the use of primaquine in vivax
and falciparum malaria.[IQ city] (2+3+3+2)

• An adult male patient presents with chills rigor and alternate day spikes of
temperature. Peripheral blood smear shows occasional red cells with double chromatin
dots. How will you treat this patient as per national vector borne disease control
program guidelines? Why is artemisinin always given in combination with other
antimalarials? Why is it not used in malaria prophylaxis?[IPGMER] (5+3+2)

• Classify beta lactam antibiotics. Discuss causes of penicillin resistance. What are the
therapeutic indications of penicillin?[Gauri Devi] (3+4+3)

• 36 year old male patient brought to the out-patient Dept with productive cough since
last 8 weeks with the evening rise in temperature, sputum microscopy demonstrated
acid fast bacillus. It is diagnosed as a case of newly diagnosed pulmonary tuberculosis.
Outline the pharmacological management of the case. What are the adverse drug
reactions of Rifampicin. Write down the different therapeutic uses of Rifampicin.[Sagore
dutta](5+3+2)

• Enumerate antimalarial [Link] down the mechanism affection adverse effects

and therapeutic uses of [Link] chloroquine is administered in loading
dose? [3+2+2+1] (NRS)

• Enumerate orally administrered [Link] therapeutic uses of oral

cephalosporins according to their generation. Describe the mechanism of action and
mechanism of development of drug resistance.[ 2+3+3+2 ](NRS)

• Enumerate the first and second line antitubercular [Link] the

pharmacotherapy of a new case of TB [Link] the important adverse effects
of first line antitubercular drugs.[3+3+4] (BSMC)

• Enumerate [Link] the mechanism of action of [Link] why

amoxicillin is combined with clavulanic acid in therapeutics.[3+5+2] (malda)

• Enumerate drug used in urinary tract iinfectionsWrite down the therapy of acute
urinary tract infection[.6+4] (BMC)

• Enumerate antitubercular drugs. Mention two sides effects of each first line
antitubercular drugs. Outline the management of MDR TB.[3+4+3](MMC)

• If 8 year old man was diagnosed with multibacillary leprosy now state the regimen
that will be used for this treatment? State the mechanism of action of [Link]
drugs used in treatment of lepra reaction?[5+2+3](IPGMER)

NRSMC STUDENTS’ UNION 33

• Enumerate the drug used in malaria. How will you manage a patient of complicated
falciparum malaria. Outline malaria prophylaxis.[3+4+3](MURSHIDABAD)

• Name two cephalosporins from each generation. Briefly outline the mechanism of
action and adverse effects of [Link] are the advantage of Beta lactams
inhibitors?[3+3+2+2]

Short note:(3 marks)

• Amphotericin-B(NRS,bankura)
• HAART(bankura, burdwan )
• Amino glycosides(bankura)
• Management of uncomplicated falciparum malaria(bankura)
• Metronidazole(malda)
• Therapeutic uses of Flouroquinolones. (IPGMER)
• D- Penicilliamine(Rgkar)
• Post exposure HIV prophylaxis ( Murshidabad, Rgkar)
• Azithromycin ( Murshidabad)
• Amino glycoside toxicity(Murshidabad)
• Doxycycline( CNMC)
• Protein synthesis inhibitors. (IQ City)
• Albendazole ( KPC)
• Post-exposure prophylaxis of HIV. (COM-SDH)
• Rifampicin( KPC)
• Lamivudine( KPC)
• Mechanism of Anti-Microbial Resistance. (COM-SDH)
• Amikacin. (CNMC)
• Superinfection. (CNMC, Gouri Devi)
• Treatment of multi-drug resistance tuberculosis. (ICARE)
• Treatment of Chloroquine resistant malaria. (ICARE)
• Treatment of multi-bacillary leprosy. (ICARE)
• Interferons. (ICARE)
• 3rd generation cephalosporins. (ICARE)
• Treatment of Neurocysticercosis. (IQ City)
• Bisphosphonates. (Midnapore MC, BMC, IPGMER, NRS)

NRSMC STUDENTS’ UNION 34

 • Allopurinol. (Midnapore MC)
• HAART regimen. (IQ City)
• MDR TB Management. (IQ City)

Mechanism of Action:
• Metronidazole in amobiasis[NBMC]
• Beta lactams as antimicrobial agent[SAGORE DUTTA]
• Amphoterisin B[IQ]
• Fluconazole[MALDA,KPC,CNMC]
• Artemisinin derivatives in malaria[IPGMER]

• Azoles[IQ]

• Penicillin against gram +ve bacteria[BSMC]

• Rifampicin in TB[BSMC]

• Diethyl carbamazine(DEC)[BSMC]

• Sulphonamide as antiinfective[GOURIDEVI]

• Ciprofloxacin in thyphoid fever[GOURIDEVI]

Explain Why:
• Cotrimoxazole is a bactericidal agent (NRS)
• Sulfamethoxazole and trimethoprim is combined together( bankura)

• Mesna is used along with cyclophosphamide(bankura)

• Primaquine is used in falciparum malaria(malda, Rgkar)

• Atracurium can be used in patients with renal and hepatic dysfunction (malda)

• Tetracyclines are contradicted in pregnant women and children( Rgkar)

• Clauvalanic avid is combined with amoxicillin in treatment of bacterial
infection(Midnapore)

• Ondansetron is used in chemotherapy induced vomiting( Murshidabad)

• Multi drug therapy is used in leprosy( Murshidabad)

• Tetracycline is C/I in pregnancy (Murshidabad)
• Rifampicin is used once daily in tuberculosis but once in a month in leprosy(
CNMC, Ipgmer)
• Tetracycline should not be prescribed along with Penicillins ( CNMC)
• Aminoglycosides maybe given once daily( Ipgmer)

NRSMC STUDENTS’ UNION 35

 • Metronidazole should not be advised to chronic alcoholic patients( KPC)

• Imipenem is used in combination with cilastin ( Murshidabad)

• Loading dose of itraconazole is required for deep mycosis( burdwan)
• D-Penicillamine used in copper poisoning( IQ city)
• MESNA is used in cyclophosphamide toxicity(IQ city)

• Neomycin is used in hepatic coma( IQ city)

• Doxycycline is preferred in relation to other tetracyclines. (Gouridevi)

• Multi drug therapy is used in tuberculosis.(CNMC)

• INH given with pyridoxine. (IIMSAR)

• Primaquine is used both in [Link] and P. falciparum infection. (CNMC)

• Gentamicin can be given by once daily doing strategy. (Ipgmer)

• Mechanism of action of Amphotericin-B as anti fungal agent. (IIMSAR)

• Piperacillin is used in combination with tazobactam. (Ipgmer)
• Clomiphene is used in infertility. (Rgkar)

• Cilastatin is combined with imipenem. (IQ City)

• Despite short half life aminoglycosides are effective for long duration.( IQ City)

• Chloroquine needs to be given in a loading dose. (Gouri Devi)

• Levodopa and carbidopa combination is preferred over levodopa alone in the

treatment of Parkinson’s Disease. (Gouri Devi)

• Amoxicillin and Clavulanic acid is a fixed dose combination. (ICARE)

• Penicillin and Doxycycline should not be combined together. (COM-SDH)

• Folic acid supplementation is advocated in early pregnancy. (COM-SDH)

• Penicillin alone has lesser mortality than penicillin in combination with
tetracycline in pneumococcal meningitis. (NBMC)

Drugs Acting on Blood

Short note:(3 marks)
• Alteplase(NRS)
• Warfarin ( Midnapore)
• Directly thrombin inhibitors( Ipgmer)
• Desferioxamine. (Murshidabad MC)
• Parenteral Iron therapy. (MCK)
NRSMC STUDENTS’ UNION 36
 • Oral Iron preparations.(RGK)
• Iron preparations. (Midnapore MC)
• Injectable Iron. (BMC)
• Parenteral Iron Preparations. (KPC)
• Folic Acid. (NBMC)
• Low molecular weight Heparin. (COM-SDH)
• Anti-Platelet drugs. (IPGMER)
• Drug treatment of Anaemia in pregnancy. (IPGMER)
• Fibrinolytic agents. (BMC)

Mechanism of Action:
• Warfarin in deep vein thrombosis[RGK,MMC,KPC]

• Aspirin as antiplatelet agent[SAGORE DUTTA,KPC]

• Desferrioxamine[gouridevi]
• LMWH in deep vein thrombosis[CNMC]

• Acetylsalicylic acid as antiplatelet drug[IQ]

Explain Why:
• Erythropoietin is used in chronic renal failure( IQ city)
• Low molecular weight heparin preferred over unfractionated heparin( IQ city)
• Warfarin is given with NSAIDs. (IIMSAR)
• Low molecular weight heparin is preferred over unfractionated heparin as anti
coagulant. (NRS)
• Low dose aspirin is used as an anti platelet agent. (Midnapore)
• Aspirin is used as an anti-platelet agent. (Gouri Devi)
• Indomethacin is used for closure of Patent Ductus Arteriosus. (COM-JNM)

Drugs Acting on Uterus

Short note:(3 marks)
• Tocolytic agents(bankura)

Explain Why:
• Tocolytic drug is used for management of preterm labor( IIMSAR)
• Oxytocin is used for induction of labor and ergometrine to control PPH.( Malda)

NRSMC STUDENTS’ UNION 37

 • Ergometrine is preferred over oxytocin in PPH. (NRS)

Gastrointestinal System
Long Question :(12 marks)
• Enumerate 4 major classes of antiemetics with [Link] down the mechanism of
action of 5HT3 receptor antagonist in prevention and control of chemotherapy induced
nausea and vomiting. Write down two uses and two adverse effects of 5HT3 receptor
antagonist.[BMC](4+4+1+1)

Short note:(3 marks)

• Mucolytic(malda)
• Anti [Link] regimens(burdwan)
• Treatment of H pylori infection. (ICARE)
• Botulinum toxin in Therapeutics. (COM-JNM)
• Digestant Drugs. (KPC)
• Eradication of H pylori infection. (IPGMER)

Mechanism of Action:
• Proton pump inhibitor as antiulcer agent.[MCK,IQ]

• Domperidone as an antiemetic agent[RGK]

• Metoclopramide as prokinetic agent[BSMC,SAGORE DUTTA]

• Metoclopramide as antiemetic[CNMC,NBMC]

• Omeprazole in acidity[MURSHIDABAD,SAGORE DUTTA]

• Ondasetron as antiemetic agent[MIDNAPORE,BMC]

• Ondesteron in chemotherapy induced vomiting[IPGMER]

• Pantoprazole in peptic ulcer[KPC]

• Oral Rehydration Solution. (KPC)

Explain Why:
• Ondansetron is used in chemotherapy induced vomiting( Murshidabad)
• Sucralfate is not co administered with antacid(malda)
• Stomach wash is given in intravenous morphine poisoning(Rgkar)
• Sucralfate is not administered with proton pump inhibitors. (KPC)
• Long term use of purgatives are generally avoided in all kinds of
constipation.(KPC)
NRSMC STUDENTS’ UNION 38
 • Sucralfate and omeprazole should not be co administered. (Midnapore)
• Purgatives are contraindicated in dynamic intestinal obstruction. (COM-JNM)
• PPI is administered in empty stomach. (NBMC)
• Ondansetron is preferred in chemotherapy induced vomiting. (MCK)

Renal Pharmacology
Short note:(3 marks)
• Spironolactone (IQ city, MCK)
• Lactulose. (Midnapore MC)

Mechanism of Action:
• Thiazide diuretics in diabetes insipidus[MCK]

• Frusemide in acute left venticular faliure[MALDA,MURSHIDABAD]

• Lactulose in hepatic encephalapathy[IPGMER]

Explain Why:
• Spironolactone is used in cirrhosis of liver. (NRS)

• Mannitol is not used in heart failure.(Burdwan)

• Frusemide is known as high ceiling diuretic. (CNMC,Sagoredutta)

• Diuretics are combined with ACE inhibitors or ARBs. (IIMSAR)

• Frusemide is called high ceiling diuretic. ( Midnapore)

• Thiazide is helpful in diabetes insipidus. (IQ City)

Miscellaneous
Short note:(3 marks)
• Drugs used in benign prostatic hyperplasia( IQ city)
• Tamsulosin( CNMC)
• Monoclonal antibody( IQ city)

Mechanism of Action:

• Tamsulosin is preferred over prazosin in benign hypertrophy of prostate[ESI]

• Cyclosporin[IQ]

• Dantrolene in mailgnant hyperthermia[BSMC]

NRSMC STUDENTS’ UNION 39

 • Tamsulosin in BPH[NBMC]

Explain Why:
• Tamsulosin is preferred over Prazosin for the management of benign
hypertrophy of prostrate. (ESIC-JOKA)

• Expectorants are used in productive cough but antitussives are used in dry
cough. (COM-JNM)

• Alfuzosin is used in the benign hypertrophy of prostrate. (Malda MC)

• Both tamsulosin and finasteride are useful to treat benign hypertrophy of

prostrate. (Murshidabad MC)

NRSMC STUDENTS’ UNION 40

 Microbiology
General Microbiology
Long Question:(10 marks)
 Define sterilization and disinfection. Mention different procedures followed for
sterilization/disinfection based on application of heat with their principle and one
usage of each type.(2+2+6)

Short Notes:(4 marks)

 Gaseous sterilization
 Biomedical waste disposal
 Transduction
 Plasmid
 Bacterial Capsule
 Graft vs host reactions
 Koch postulates
 Blood agar media
 Anaerobic culture
 Sterilization by heat
 Enrichment media
 Bacterial spore
 High level disinfectants
 Bacterial flagella
 Transport media
 Lysogenic conversion
 Satellitism
 Elek’s gel precipitation tests
 Sterilisation of operation theatre
 Adjuvant
 Immunoprophylaxis in Diptheria
 Bacterial growth curve
 Hot air oven
 Pilli
 Urease medium
 Robertson Cooked Media

Comment On:(4 marks)

 Bacterial gene transfer can occur in various ways.
 All bacteria do not obey Koch Postulates.
 Anaerobic bacteria cannot survive and grow in presence of oxygen.
NRSMC STUDENTS’ UNION 41
  Transduction may alter the bacterial properties in many ways.
 Bacterial mobility can be demonstrated in many ways.
 Plasmid plays an important role in drug resistance.
 All culture media can not be sterilized byheat.
 Chocolate agar media has many growth factors necessary for a class of
microorganism.
 An ideal disinfectant should have some some imp properties.
 All bacteria do not grow in artificial media.
 Negative staining is useful for determination of bacterial capsule.
 Transport media is necessary for delicate organisms.
 Sterilisation control is necessary rto check for proper functioning of autoclave.
 Application of PCR is versatile tool in molecular genetics.
 MacConkey Agar is a selective medium.
 Enrichment media is required for isolation of salmonella from stool.

Differences: (2 marks)
 Dry heat sterilization and Moist heat sterilization
 Sterilisation and disinfection
 Eukaryotic and Prokaryotic ribosomes
 Cell wall of Gram postv and Gram negtv bacteria
 Exotoxin and endotoxin
 Flagella and Fimbrae
 Disinfectants vs Antiseptics
 Enriched media nd Enrichment media
 Mesophillic and Psycophillic organism
 Dasrk field and Fluoroscent microscopy
 Tyndallisation and Inspissation

Parasitology
Long Questions:(10 marks)
 A middle aged man residing in Bankura presented with low grade fever,gradual
swellings of both lower limbs and scrotum. On examination there was non-pitting
oedema. What is your diagnosis? Name the causative parasitic agents and the vector
responsible for the disease. Describe briefly the pathogenesis of the disease. How will
diagnose the case in the laboratory? (1+2+4+3) (NRSMC)
 A man of 45 yrs old complains of sudden onset of fever with chills and rigor. The
fever subsides with sweating after a few hours. On examination, he revealed mild
hepatospleenomegaly. What is the clinical condition? What are the etiological
factors? Which are the vectors transmitting the agents?How will you diagnose in
lab?(1+2+1+6)(BSMC)
 A 10 yr old girl, residing in a rural area with low socioeconomic status attended to
the OPD with complaints of indigestion, weakness and occasional pain in the
NRSMC STUDENTS’ UNION 42
 abdomen. On examination she is fund to be anaemic with haemoglobin level 8.2
gm/dl. Name the probable helminth causing such clinical condition. Discuss the
pathogenesis of such disease. How do you proceed for laboratory diagnosis?
(1+3+6)(Malda)
 A 17 year old young adult is brought to the emergency with complaints of high fever
with chill and rigor for four days with altered level of consciousness for last 1 day.
Fever subsides with sweating. On examination there is mild hepatomegaly and
pallor. What may be the probable diagnosis? Name the agent(s) causing it. How will
you diagnose the condition in lab? Write briefly the pathogenesis of the most serious
complication caused by organism. (1+1+5+3) (COJNMH)
 A 47 yr old poor farmer from South Dinajpur presents to the Medicine OPD with
persistent ever and weight loss for the past eight months. Examination reveals
hepatomegaly and huge splenomegaly extending to the [Link] laboratory
work up shows anaemia (5gm/dl), leucopenia(TLC2000/micro.L) and
thrombocytopenia (Platelet count70000/micro.L) and raised ESR of 80mnm/1st hr.
What is the most likely diagnosis? Name the causative pathogen. What is vector?
Discuss the laboratory [Link] two drugs tom treat this
infection.(1+1+1+5+2)(IQCITY)
 A 28 yr old male from a village of North Bihar attended the opd of your hospital with
fever lasting for past one month., weakness, emaciation and blackening of his face.
On examination, body temp was 39 c. There was hepatosplenomegaly and anaemia.
Discuss the laboratory diagnosis .Name the causative microbe. Name the vector.
Discuss the laboratory diagnosis.
 A 40 yr old male patient presents to the Neuromedicine OPD of IPGMER with a
history of vague abdominal discomfort, indigestion, persistant diarrhoea and loss of
appetite. There is history of epileptic attacks. The man is vegetarian but unhygienic
in food habits. CT scan of brain reveals intraparenchymal space occupying lesion.
Enumerate the possible causative agent. Describe lifecycle of parasite. Describe
mode of modes of transmission. . Discuss the laboratory diagnosis.
 A 38 yr old male came to the Medicine OPD of KPCMCH with C/O swelling in the
scrotum with passage of whitish urine(chyluria). What is the probable diagnosis?
What are etiological agents? Write about the lab Diagnosis of such a case.
 Enumerate some tissue nematodes that infect human beings. Discuss in detail life
cycle and lab diagnosis of any one of them which is commonly found in India?

Short Notes:(4 marks)

 Mycetoma
 Neurocysticercosis
 Occult filariasis
 Hydatid cyst
 Giardiasis
 Loffler’s syndrome
 Rapid diagnostic tests of malaria
 Congenital toxoplasmosis
NRSMC STUDENTS’ UNION 43
  Black water fever
 Inclusion Bodies
 PKDL
 Identification of giardia in stool sample
 Morphological form of Entamoeba histolytica

Comment On: (4 marks)

 Autoinfrction can occur in certain helminthic infections.
 Hookworm infestation can cause severe anaemia.
 Taenia sollium infestation is more dangerous is more dangerous than Taenia
saginata infestation.
 Stool examination is the main mode of diagnosis for intestinal parasites.
 Both thick and thin smear of blood are useful for detection of malarial parasite.
 Entamoeba histolytica causes extra intestinal lesions.
 Ascaris lumbricoides infestation may cause surgical complication.
 Tinea solium and Tinea saginata can be differentiated by studying the adult
worms and not the eggs.
 Falciparum malaria is more dangerous than vivax malaria.
 Schistosomes are different from other trematodes.
 Complications of Ascaris infection. Explain

Differences: (2 marks)
 Malaria relapse and recrudescence
 Nematode nd Cestode
 Plasmodium vivax nd Plasmodium falciparum
 Definitive host and Intermediate host
 Amoebic dysentery nd Bacillary dysentery
 Cutaneous larva migrans and Visceral larva migrans
 Proglottids of Tenia solium vs Tenia saginata
 Ova ofAscaris lumbricoides nd Ocva of Hookworm

Virology
Long Questions:(10 marks)
 A boy aged 23 yrs old, residing in Moulali, Kolkata attends the OPD with complaints
of fever for 6 days, severe bone pain associated with retro orbital pain. On
examination there are multiple haemorrhagic spots all over the body. What is the
clinical diagnosis? Name the viruses responsible for such clinical condition. Discuss
the clinical [Link] the pathogenesis and lab diagnosis.
(1+2+3+4)(NRSMC)
 A 25 yr old female attended to the emergency with high fever, severe headache,
vomiting and pain around the eyes for last four days. On examination petechial
NRSMC STUDENTS’ UNION 44
 lesions were noted on chest and forearm. Blood examination shows increased
haematocrit value and platelet count was 32000c/[Link]. What is your provisional
diagnosis? Name the causative agent. How do you proceed for laboratory diagnosis?
How do you prevent the disease?(1+1+2+6)(malda)
 Describe the structure of HIV. What are routes of transmission of the virus?Discuss
in detail the measures to be taken to prevent the transmission of the
virus?(3+2+5)(Burdwan)
 30 yr old lady is brought to emergency with bleeding through nose. She gave history
of high fever and red rashes over the body for last 6 [Link] may be the probable
clinical condition? What is the virus responsible for the condition? How will you
confirm case in laboratory?Name the other viruses that can cause haemorrhagic
fever in India?(1+1+6+2)(COJNMH)
 A 17 yr old girl is brought to the emergency department on Saturday night with
menorrhagia and epistaxis since the afternoon. She has also had fever and severe
muscle pain since Tuesday. Physical Position reveals muscle tenderness,
conjunctival hyperaemia,, and a generalised pink rash. Initial laboratory work-up
shows leucopenia( TLC 2700/microL)and thrombocytopenia(Platelet count
30000/microL). What is the most likely diagnosis? What is the name of the vector in
India? Discuss the three different microbiological test for diagnosing the infection.
How disease can be prevented?(1+1+6+2)(IQ CITY)
 A 26 yr old person presented with malaise, uppr abdominal discomfort,nausea and
yellowish of urine. He gives history of treatment by a local medical practitioner with
some injection for some injury, he faced four months back. Name the probable
diagnosis of such a case. Mention the measure by which such clinical condition can
be prevented.
 A 30 yr old nurse who had a history of needle stick injuryaround 10 months back,
presented with yellowish discoloration of skin and sclera associated with pain in the
right hypochondrium and palpable tender hepatomegaly. What are probable viral
agents causing such symptoms?Write about viral serological markers and their
significance in such a case. How she could have been protected following the needle
stick injury.
 14 yr old comes to the emergency with acute pain in knee accompanied with fever for
the last 3 days. He has a sore throat 4 weeks ago. Can you correlate his knee pain
with sore throat? How can you go for diagnosis of this condition in lab along with
serological test(if any) for confirmation of etiology.
 An epidemic of high fever with severe headache and progressive drowsiness within a
few days of illness is seen in the district of West Bengal. Lumbar puncture SHOWS
CLEAR CSF. What is the clinical condition? Name the causative agent including its
family. Discuss the mode of spread of this condition,. How will you diagnose in
lab?(1+1+3+5)(BSMC)
 A three year old girl is brought to the paediatrics OPD with bouts of non-stop cough
for the past one month. The bouts of coughing end with loud inspiration and often
lead to vomiting. The girl has not received any vaccine apart from OPV. Three other
children in the neighbourhood have similar illness and one of them has died.

NRSMC STUDENTS’ UNION 45

 Physical examination reveals irritability, emaciation, mild hydration and
subconjucntival haemorrhage in both eyes. There is no fever. What ios the most
likely diagnosis? Name the causative microbe. Briefly describe the pathogenesis.
What is the best specimen for laboratory diagnosis? Name a cuklture medium for the
organism. Wht do the microbes look like in gram stained smear? How can the
disease prevented?(1+1+3+1+1+1+2)(IQCITY)

Short Notes:(4 marks)

 Serological markers of Hepatitis B virus infection
 Rabies Vaccine
 Dengue haemorrhagic fever
 Oncogenic viruses
 Viral diarrhoea
 ToRCH complex
 Japanese Encephalitis
 Viral vaccines
 Chikungunya
 Prion disease
 NACO strategies for HIV testing in India
 Interferron
 Inclusion bodies
 Swine flu
 NIPAH virus
 Cytopathic effect(CPEE)
 Immunization against polio

Comment On: (4 marks)

 A single rapid serological test may not be sufficient to declare a case to be HIV
sero-positive
 Cytopathic effects produced by different viruses sometimes helps in the
identification of virus.
 Viral infection may lead to malignancy.
 In class III exposure of rabies, only ARV is not sufficient.
 Virus can not be cultivated in normal media.
 Diagnosis of HIV infection in asymptomatic person based on single ELISA test.
 Every dengue virus infection leads to dengue haemorrhagic fever.
 Both active and passive prophylaxis are necessary after a bite by arabid dog.
 Pregnant woman are advised not to handle cats.
 A new influenza vaccine has to be designed every single year whereas we have
been using the same vaccine for Hepatitis B for more than thirty years.
 Influenza virus shows antigenic variations.
 Some virus are diarrhoegenic.
 Vaccine development against influenza is very difficult.
NRSMC STUDENTS’ UNION 46
  Anti-rabies neural vaccines are not used now a days.
 Zoster is always secondary infection.
 Mosquitoes spread different viral and parasitic diseases.
 Genetically engineered vaccines are used to prevent viral infections.
 Interferron does not act on virus directly.
 Prions show viral diseases.
 Some viral infection during pregnancy may lead to congenital abnormalities.
 Bacteriophage can induce some bew properties to bacteria during transduction.
 Viruses are different from bacteria in many ways.
 Poliovirus eradiacation is possible.
 Gastroenteritis by virus is common in pediatric aj grrp.

Differences: (2 marks)
 Antigenic shift and antigenic drift.
 IPV nd OPV
 Orthomyxovirus nd Paramyxovirus
 Virion nd Prion
 Hepatitis A nd Hepatitis B
 Classical dengue vs Dengue shock syndrome
 HSV1 vs HSV2
 Street virus and Fixed virus

Mycology
Long Questions:(10 marks)
 What are the clinical features of Histoplasmosis? Discuss the pathogenesis of the
disease. Write in detail about the laboratory diagnosis of the
infection.(1+3+6)(Burdwan)
 40 yrs old man , farmer by occupation, attented dermatology OPD with complaints of
swelling in left foot and multip[le discharging sinuses for 2 months. A few granules
are seen dead to sinuses. Discuss theprobable diagnosis. What is the causative
agent? How will you diagnose? What do you mean by deuteromycetes?

Short Notes:(4 marks)

 Pneumocystis jirovecii
 Superficial Mycoses
 Cryotococcus meningitis
 Dimorphic Fungus
 Dporothrix schenkii
 Germ tube test
 Tropical Pulmunory Eosinophillia
 Opportunistic Mycoses
NRSMC STUDENTS’ UNION 47
  Opportunistic parasitic infection in HIV patients
 Dermatophytes
 Opportunistic fungal infection
 Eumycetoma
 Mycoplasma

Comment On: (4 marks)

 Germ tube test helps in species identification of Candida.
 Culture is necessary for diagnosis of dermatophytes.
 Cryptococcus neoformans always causes serious systemic infection.
 Mycetoma is seen almost exclusively among poor people who live in villages.
 Histoplasma capsulatum is a misnomer.
 Some fungal disease may be seen in immunocompromised patients.

Differences: (2 marks)
 Endothrix nd Ectothrix
 Acxtinomycetoma nd Eumycetoma
 Hyphae nd Pseudohyphae
 Candida albicans nd Non-albicans Candida
 Yeast and mycelia
 Dermatophytosis nd Dermatomycosis

Systemic Bacteriology
Long Questions:(10 marks)
 A middle aged man has come to the outdoor clinic with a history of painless penile
ulcer which began as a single papule 2 weeks ago. He has a bilateral enlargement of
inguinal lymph nodes which are painless, firm and non-suppurative. What is your
provisional diagnosis? Name the causative organism. How will you diagnose the case
in laboratory? Enumerate other bacteria which can infect people by the same mode
transmission?(1+1+6+2)(COJNMH)
 A 17 yr old boy was admitted in the ICU with history of high grade fever ,vomiting,
intense headache and photophobia. On examination Kernig’s sign was positive. What
is your provisional diagnosis? Name two common bacteria responsible for this
condition in this age group. How will you diagnose in lab?(1+7+2)(COJNMH)
 30 yr old male executive presets to the urology opd with dysuria (burning sensation)
while passing urine for past one week. The busy junior resident on duty thinks it is
cystitis and requsts a routine urine culture. After 48 hrs, the culture comes as “No
bacteria isolated”. The patient then goes to the consultant who examines the patient
properly and finds #Frank pus coming out of urethra. #Marked tenderness of the left
epidydimis. #No gernital ulcer. #No lymphadenopathy. Gram stained smear of
urehral pus. Shows numerous pus cells., some of whic are packed with many Gram
NRSMC STUDENTS’ UNION 48
 negtv diplococci. What ios the most likely diagnosis? Name the causative microbe.
Discuss the laboratory diagnosis. How can the disease prevented?What other
infections you like to test the patient for?
 Define Urinary tract infection with special reference to Kass’s conceopt of significant
bactiuria. Classify differrtent types of UTI. Enumertate the causative agents. Write
pathogenesis and lab diagnosis.
 Discuss in brief the pathogenesis of post streptococcal diseases.
 What are the causes of Bacterial food poisoning and how are they diagnosed in the
lab.
 A male baby 4 weeks old has been admitted to the hospital with fever,drowsiness,
irritability, vomiting and photophobia. On examination there is neck rigidity and
CSF is turbid. What is your clinical diagnosis? Name the bacterial agents causing
such illness . How will you diagnose the case in Lab?
 A 4 yr old child presented in OPD with acute sore throat dysphagia salivation and
mild fever. On examination an adherent thick greyish patch is found over tonsils and
oropharynx which bleeds on removal. What is the causative bacterium? How will you
collect the sample and proceed for laboratory diagnosis? What is method of
prevention?
 A 12 yr old presented with step ladder patern fever, malaise and [Link]
examination the tongue is coated, there is relative bradycardia and splenomegaly.
What is your provisional diagnosis? What are the causative agent? Discuss lab
diagnosis.
 A truck driver comes to skin OPD ith macula-papular rash over palms and soles and
eryththematous plaque like lesions in axilla and groin. He had a painless ulcer over
external genitalia 12 weeks previously. What is the probable diagnosis? What is the
causative agent? How will you proceed for lab diagnosis. Which test are useful to
detect congenital infection by this organisms?
 10 yr old boy no history of previous vaccinations presented with acute sore throat
and fever in the opd. On examination, a greyish white adherent patch was detected
on both tonsils which bled on trying to remove it. What is your clinical diagnosis?
What is the most probable laboratory diagnosis? Name the common agents
responsible? What re responsible measures?(1+5+2+2)
 A 5 yr old child with a history of contact in the family, presents to the Medicine OPD
with a history of low grade evening rise of temperature,anorexia, night sweats and
cough foer the last three weeks not responding to anti-biotics. Straight X-ray chest
reveakls a parechymatous focus of pneumonitis along with hiklr lymphadenopathy
and a positive intradermal tuberculin hypersensitivity reaction. What is the clinical
condition?Enumerate causative agents.. Describe approach to lab diagnosis.
 A 75 yr old woman long history of soft tissue & bone infection following fracture of
neck femur which were regularly dressed with a antibiotic containing dressing.
Exudate from the infected site was cultured & it shows gram positive cocci which are
resistant to multiple anti-biotics. Describe the mechanisms of gene transfer render
bacteria resistant to multiple organisms.

NRSMC STUDENTS’ UNION 49

 A sudden outbreak of diarrhoea with history of passing rice watery stool with no
faecal matter along with effortless vomiting has occurred in a remote place in the
district of Burdwan. What is the probable diagnosis and the causative organism?
How will you establish the diagnosis of such a case in the laboratory
 A 25 yr old female with past history of rheumatic heart disease presented with low
grade fever and shortness of breath for last 3 weeks. On examination there is a new
murmur Haemorrhagic spots on the palm and tender erythramatous nodules in the
fingers. What is your provisional diagnosis? Name the causative agents. Write
details of lab diagnosis.
 24 hrs later after a street accident in the NH-6, a truck driver was referredbfrom a
peripheral health centre qith crush injury in the right leg along with pain, swelling
and profuse serosanguinous discharge from the wound. He had toxic look and on
palpation the wound has crepitus. What is your provisional diagnosis? Name the
causative agents. Write details of lab diagnosis. Describe pathogenesis.
 Describe the morphology of Staphylococcus aureus after gram [Link] down
the colony morphology on Nutrient [Link] the different tests for identification
of Staphylococcus aureus.
 Describe the different methods of genetic alterations in bacteria. How a bacterium
does prevents the action of antibacterial agents through these genetic alterations?
How would you utilize the genetic make up ofn a bacterium for use in a clinical
microbiology lab for confirmation of diagnosis?
 A 70 yr old male known diabetic for more than 10 yrs presented with low grade
fever, cough, occasional haemolysis. There was significant weight loss since last 6
months. What is the provisional diagnosis? What is lab diagnosis?
 A patient presents in the emergency with oedema, cellulitis, discoloration of
overlying skin and crepitations on palpation. There was a history of road traffic
accident 10 days back. What is the most probable laboratory diagnosis? How does
immunization help in the recovery of this condition?

Short Notes:(4 marks)

 Staphylococcal food poisoning
 VDRL test
 Outer membrane of Gram negtv bac.
 Non Gonococcal Urethritis
 Post exposure prophylaxsis
 Clostridium difficile
 HACEK
 Meticilin Resistant Staphylococcus aureus
 Atypical Mycobacteria
 Lepromin test
 Agglutinition test
 MRSA
 Botulism
 ELISA
NRSMC STUDENTS’ UNION 50
  Interpretetion of Widal test
 EPEC
 Tuberculin test
 Coombs test
 Non-suppurative complications of streptococcus pyogens infection
 Halophilic vibrios
 Nagler’s reaction
 Well Felix reaction
 Pathogenesis of shigellosis
 Prophylaxis and prevention of Hbv
 Cholera toxin
 Standard test for syphilis
 CB-NAAT
 Toxic shock syndrome
 CONS

Comment On: (4 marks)

 TORCH agent detection test is very important during pregnancy.
 In some conditions we consider UTIO without significant bacteriuria.
 Slit skin smear test has significant value in bacteriology.
 In endemic area, a low titre Widal positive report can definitely diagnose a case
of enteric fever.
 Immunising pregnant women with tetanus toxoid protects infant against tetanus
for 6 months.
 Antibiotic resistance can be spread rapidly among Gram-negative bacilli.
 Bacterial endocarditis is treated with bactericidal drugs, not bacteriostatic drugs.
 A positive Mantoux test does not necessarily mean that the person is suffering
from tuberculosis.
 Leprosy diagnosis is based on non-cultural laboratory methods.
 Anti-biotic resistance ismuch more common in hospital set up.
 Well-Felix test is an example of heterophile agglutination test.
 Most imp test of congenital syphilis is FTA_ABS test.
 Toxic Shock Syndrome may be fatal.
 All urethiritis isare not caused ny Neisseria gonorrhoea.
 Inclusion bodies can be formed by some bacteria.
 Staphylococcus infection may produce food poisoning.
 Diptheria is preventable disease.
 Lancefield is known for his work on Staphylococcus.
 Penicillin is no longer the antibiotic of choice of many infection as it was
previously.
 The mechanism of tetanus involves rigid sapsm of voluntary muscles.
 Fimbrial adhesions have multiple functions.
 Toxins are responsible for [Link] induced diarrhoea.

NRSMC STUDENTS’ UNION 51

  Lepromin test is diagnostic of leprosy.
 VDRL/RPR has more prognostic value than specific treponemal test in leprosy.
 A patch over throat may have aetiologies.
 Pneumococcal vaccine has some indication.
 Capsular swelling reaction has a diagnostic value.
 Pathogenesis of diarrhoea in cholera is not inflammatory.
 Diagnosis of pulmunory and extra pulmunory TB is more advanced at present.
 Enterococcus differs from other Streptococcus.
 Only the presence of C. Dipheriae in the throat sdoes notsuggest person suffering
from diphtheria.
 Non suppurative post streptococcal lesion can be prevented.
 Enteroxins are imp in pathogenesis of [Link] induced diarrhoea
 Mycopllasma shows pleomorphic property.
 Antigen antibody reaction help in diagnosis of syphilis.
 SingleWidal test may not be sufficient for diagnosis of enteric fever.
 Satellitism shown by Haemophilus influenza.

Differences: (2 marks)
 Streptococcus pyogenes nd Streptococcus pneumonia
 Bacillus anthracis nd Anthracoid bacilli
 Tuberculoid leprosy nd Lepromatous leprosy
 Vibrio cholera nd Halophilic vibrios
 Mycobacterium Tuberculosis complex vs Primary complex
 Classical nd El Tor Vibrio
 Food poisoning by Clostridium perringens nd Clostridium butulinum
 Type I nd Type II lepra reaction
 Acute rheumatic fever nd Acute glomerulonephritis

Clinical Microbiology
Short Notes: (4 marks)
 Tumor Antigen

Comment On: (4 marks)

 Biomedical waste management is essential for safe disposal of waste.
 More than 10^5 CFU/ml of bacteria in in urine denotes UTI.

Differences: (2 marks)
 Mutational drug resistace nd Transferable drug resistance

NRSMC STUDENTS’ UNION 52

 Immunology
Long Questions:(10 marks)
 Define and classify hypersensitivity. Describe in details about type 3
hypersensitivity.
 Define Antigen. Discuss briefly the determinants of antigenicity. Discuss the role
of superantigens.

Short Notes: (4 marks)

 Type of T cells and its functions
 Autoimmunity
 Type 2 Hypersensitivity reaction
 IgE
 Functions of lymph node in immune response
 Monoclonal Antibody
 Type 4 hypersensitivity
 Biological effects of complement
 Heterophil antibodies
 Primary Immune response
 IgM
 Anaphylaxis and preventive measures
 Precipitation test and its example
 Cell mediated delayed hypersensitivity
 Major Histocompatibility Complex
 Prozone phenomenon
 Tube coagulase test

Comment On: (4 marks)

 Antigen presenting cells take very important part for induction of immune
reponse.
 Type II hypersensitivity is different from type III.
 All type I hypersensitivity is not anaphylaxis
 In some conditions passive immunization is helpful.
 Innate immunity is mediated by several factors.
 Complement is normally present in circulation in inactive forms.
 Unrelated antigens may be used as diagnostic test.
 Activators of classic and alternate pathways are innumerable.
 Fc portion of antibody has lot of biological functions.
 Lymphocytes have predominant role in immune reponse.
 T cell help in maturation of B cell.
 In case of intrauterine infection detection of IgM on blood is considered as
diagnostic, but not IgG.
NRSMC STUDENTS’ UNION 53
  Sec Immunodeficiency depends on several factors.
 Adjuvents potent immunity.
 Mismatched blood transfusion is caused by a hypersensitivity.

Differences: (2 marks)
 Primary immune response and Sec immune response
 Type I and Type IV hypersensitivity
 T cell dependent immune response and T cell independent immune reponse
 Innate immunity and acquired immunity
 IgG vs IgM
 Killer cell And Natural killer cell
 Arthus reaction and Serum sickness
 Classical and Alternate complement pathway
 Live and Killed vaccines

NRSMC STUDENTS’ UNION 54

 Forensic Medicine & Toxicology
Medical Jurisprudence & Ethics
Long Question:
 Define serious professional misconduct. Write the example enumated by MCI.
Mention how state medical council takes disciplinary action for serious professional
misconduct. (1.5+3+1.5)(Kalyani)
 Define medical negligence. Discuss the condition must be satisfied to sue a doctor for
medical negligence. What are the defence and precautions to avoid charges of
medical negligence. (1.5+2+2.5)(Kalyani)
 What is defensive medicine what are the factors responsible for it. Discuss the
results of practising defensive medicine by doctors in healthcare system. (5) (NRS)
 i)Santa, a 4 years old female child was admitted at a super speciality hospital with
diagnosis of pneumonia. The attending paediatrician treated her as per accepted
treatment protocols. The paediatrician prescribed the injection amoxicillin clavulanic
acid IV as antibiotic of choice after taking proper drug history and also advised skin
sensitivity testing before administration. Skin sensitive testing was negative. Santa
started to respond well following treatment initially. On 2 nd day of admission
following the antibiotic injection. Santa suddenly developed facial edema, urticarial
rashes,prutitis, periorbital edema with severe respiratory distress. Attending
paediatrician suspected anaphylaxis and started necessary treatment immediately.
Unfortunately Santa died even after necessary resuscitative measures taken by the
doctor. Following Santa’s death the persons ransacked the hospital and also
assaulted the treating physician. Santa’s parents lodged a FIR against the treating
physician claiming medical [Link] above mentioned case could be an
example of what in medical practice? Describe whether the above mentioned case is
satisfying all the essential four ingredients to establish a case of medical negligence?
What are defences the treating physician can utilize to defend himself from alleged
negligence in this case? How the hospital and the doctor can utilize the existing law
in this case of violence against the doctor and damage of hospital properties? (
1+3+3+3)

ii)How vitreous humour potassium helps in the determination of time since death?
Why iris print is superior to finger print in biometrics? (2+3)(NRS)
 What are the duties of a registered medical practitioner? Discuss how ethical
medical practice helps to avoid negligence charges on a general practitioner? Legal
aspect of euthanasia. (5+6+4)(Malda)
 What is infamous conduct? Explain with examples. What are the punishments
prescribed? (2+1+2)

NRSMC STUDENTS’ UNION 55

Differentiate Between:[3 or 2.5 marks]

 Infamous conduct and civil negligence [Gouri Devi] [Kpc]

 Civil and criminal negligence [Midnapore] [Malda]
 Medical ethics and medical etiquette [Kalyani]
 Infamous conduct and professional negligence [Kalyani] [Midnapore] [Kpc]
 Professional negligence and professional misconduct [BSMC] [[Link]] [BMC]
 Ethics and morality [Malda]

Medicolegal Importance:
 Medical maloccurence [BSMC]

Short notes:
 Priviledged communications [Malda] [Gouri Devi] [NRS] [[Link]]
 ”Professional death sentence”[Midnapore]
 Declaration of Geneva [Kalyani]
 Infamous conduct [Sagore Dutta]
 Vicarious liability [Cnmc] [Midnapore]
 Contributory negligence [Cnmc]
 State Medical Council(formation and function) [BSMC]
 Contributory negligence [NRS]
 Professional secrecy [Ipgmer]
 Present status of Medical Council of India [Malda]
 Last clear chance doctrine [BMC]

Explain why:
 The Magistrate inquest is superior to Police inquest [IPGMER]
 A RMP is not bound to follow the general rule of professional secrecy in all
patients [Midnapore] [Sagore Dutta]
 Advertising is an infamous conduct
[Gouri Devi]
 A well written and maintained medical record is a very good defense for a doctor
in alleged medical
negligence cases [NRS] [BMC]
 A doctor cannot plea contributory negligence in presence of the “last clear chance
doctrine” [IQ City]
 In criminal medical negligence cases,expert medical opinion is not essential
[[Link]]
 Priviledged communication may be required by registered medical physician
during practice [KPC]

Acts Related To Medical Practice

Short notes:
 MTP Act 1971[Midnapore]
NRSMC STUDENTS’ UNION 56
 Legal Procedure
Long Question:
 Define evidence. Enumerate different types of evidence. What do you mean
by perjury and corpus delicti. ? (1+2+3) ( Kalyani)
 What is consent? What are the types of consent? What is informed consent?
(1+1+3) (KPC)
 What is dying declaration? Discuss in brief the procedure of recording of dying
declaration.
 Describe the steps of giving evidences in court of law
 A dead body of 50 years old male found in the remote place by local people. Police
on investigation found suspicion/foul play into the cause of death of the deceased.
On autopsy, there was clenching of right fist with some foreign matter held
tightly.
 Who is authorized to hold the inquest in such cases and under which
section?
 Comment on the finding on autopsy and mention the conditions similar to
it?
 Describe the duties of registered medical practitioner while performing
autopsy of such case? (2+3+5) (GIMSH)

Differentiate Between:[3 or 2.5 marks]

 Perjury and hostile witness [BMC]
 Dying declaration and dying deposition [Sagore dutta] [Icare,Haldia]
 Examination in chief and cross examination [Murshidabad]
 Police inquest and magistrate inquest [Kpc] [Icare,Haldia]
 Common witness and expert witness [[Link]]

Medicolegal Importance:
 Dying declaration [KPC]
 Cross examination [KPC]
 Exhumation [MCK] [KPC]
Short notes:
 Magistrate inquest [Cnmc]
 Cross examination [Cnmc]
 Importance of age in relation to judicial punishment [Cnmc]
 Exhumation [Ipgmer]
 Inquest [Nbmc] [Icare,Haldia]
 Magistrate’s inquest [Sagore Dutta]
 Dying declaration [Gouri Devi]
 Medical evidence [Nbmc]
 Hostile witness [Midnapore] [KPC]
 Witness [Murshidabad]
 Expert witness [Murshidabad]

NRSMC STUDENTS’ UNION 57

  Cognizable offence [Icare,Haldia]
 Warning notice [Malda]
 Civil responsibility of a mentally ill person [Kalyani]

Explain why:
 Oral evidence is considered superior than documentary evidence [NRS]
 Dying Deposition is superior than Dying declaration [Malda] [Midnapore]
 Leading questions are not permissible in examination in chief [Gouri Devi]
 Consent in clinical practice is legally required

Identification
Long Question:
 Describe the methods of developing of fingerprint in dead bodies.
 Define Intersex. Describe different types. What is important of Davidson’s body?
(1+2) (kalyani)
 Mention the cases where sex determination is required. Classify intersex. (2+3)
(malda)
 A young male apparently looking and stating his age as 25 years was placed in front
of medical board for estimation of age he has lost his birth certificate along with
other documents. You will have to examine only the teeth of the person. (3+6+1)
(KPC)
 What is Gustafson’s formula?
 What are the criteria of Gustafson’s formula?
 Which teeth shows the most adhesion?
 Ms. M.M. Roy aged about 20years was missing while returning from her college on
the evening of 28th December 2017. On 3rd January 2018 a female dead body was
recovered from the bush in a desolated place near NH2 with evidence of signs of
decomposition along with marbling and multiple stab wounds over her chest and
abdomen? How will you will you establish that the dead body belonged to Ms M.M.
Roy? How will you ascertain the death of cause? (3+3) (IQ CITY)

Differentiate Between:[3 or 2.5 marks]

 Temporary teeth and permanent teeth [[Link]] [Sagore dutta] [Ipgmer]

 Male and female mandible [Ipgmer]
 Animal hair and human hair [BSMC] [Nbmc] [Midnapore] [Esi,Joka] [Gouri
Devi]
 Primary and secondary dentition [Esi,Joka]
 Male sacrum and female sacrum [Icare,Haldia]
 Male and female hip bone [Nrs]
 Tattoo [Cnmc] [Midnapore] [KPC]
 Scars [Gouri Devi] [IQ City]
NRSMC STUDENTS’ UNION 58
  Superimposition [Ipgmer]
 GSR [BSMC]

Medicolegal Importance:
 Symphysis pubis [Nrs]
 Hair [Mck] [Cnmc] [Kalyani] [Sagore Dutta] [Gouri Devi] [KPC]
[[Link]]
 Tooth [Cnmc] [Malda] [Ipgmer]
 Cephalic index [Ipgmer] [Midnapore]
 18years of age [Ipgmer] [Sagore Dutta] [IQ City] [Icare,Haldia
 7years of age [BMC]
 Lip print [BSMC]
 molar teeth [Malda]
 Involuntary tattooing [Murshidabad]
 Study of ossification of skull suture [Malda]
 Compose Mentis [[Link]]
 16years of age [Midnapore]
 Bombay blood group [BMC]

Short notes:

 Grenz rays study of fingerprints

 Gustafson’s method [Kalyani]
[Malda]
 Intersex [[Link]]
 Tsuchihashi classification of lip print [BMC]
 Secondary changes of teeth(application in forensic medicine) [BSMC]
 Pseudo-hermaphrodite [Nbmc] [Gouri Devi]
 Development of latent fingerprint [Nbmc]
 Human hair [Murshidabad]
 Galton system of identification [Esi,Joka]
 Barr Body [Esi,Joka] [KPC]
 Klinefelter syndrome [Icare,Haldia]
 Age of majority [Icare,Haldia]
 Types of fingerprints [Gouri Devi]
 Involuntary tattooing [NRS]

Explain why:
 Biological age may vary from actual chronological age [MCK]
 Iris scanning is considered superior than Dactylography in certain aspects[NRS]
 Fingerprint is the surest data for identification [[Link]]

NRSMC STUDENTS’ UNION 59

  Short stature is one of the commonest findings of Ullrich-Turner’s Syndrome
[BMC]
 Superimposition is of more negative value [BSMC]
 DNA Fingerprinting is not an absolute data for identification [Nbmc]
 Buccal smears may be taken for the purpose of identification [Nbmc]
 Two identification marks must be recorded in all Medicolegal reports [Nbmc]
 Fingerprinting is the surest sign of identification but DNA Fingerprinting is not
so [Sagore Dutt]
 16years of age is not the attainment of majority for all [KPC]
 Iris scanning is considered superior than Dactylography in certain aspect.
 DNA testing is important in medicolegal field [Malda]
 sex of the person can be determined from the blood stain at the crime scene[NRS]
 usually DNA testing has immense importance in forensic science but DNA
fingerprinting is controversial too in some areas [NRS]

Medicolegal Autopsy
Long Question:
 Mention and explain , how one autopsy surgeon should proceed for post mortem of
one unknown dead [Link] the different types of skull fracture. (Malda)(10+5)
 What is post-mortem hypostasis? Describe the mechanism of development.

Differentiate Between:[3 or 2.5 marks]

 Pathological autopsy and medico legal autopsy [Ipgmer] [BMC]

 Obscure autopsy and negative autopsy [Sagore dutta]

Medicolegal Importance:
 Wearing apparel examination in a dead body [Ipgmer]
 Post mortem hypostasis [BSMC]
 Hydrostatic test [NRS]

Short notes:

 Establishment of identity of an unknown dead body during autopsy [NRS]

 Obscure autopsy [Ipgmer]

 Amusset’s sign[BMC]
 Second autopsy [MCK]
 Importance of examination of genitalia during post mortem [Malda]
 Virtual Autopsy [Cnmc]

NRSMC STUDENTS’ UNION 60

Explain why:
 No marks should be engraved on the surface of the recovered bullet from dead
body during autopsy [NRS]
 Formalin should never be used as a preservative of viscera for toxicological
examination [IPGMER]
 Bloodless dissection technique is used in cases of compression of neck [ESI,Joka]
 Preservation of viscera carries importance in post mortem of a case of
anaesthetic death [Malda]
 Abdominal cavity must be opened before thoracic cavity during autopsy of a new
born [Midnapore]
 Approximate stature can be estimated from dismembered body [IPGMER]
 Positive hydrostatic test is not a confirmation of live birth[BSMC]
 In hydrostatic test,respired lung may sink in water [KPC]

Signs of Death
Long Question:
 Define rigor Mortis. Write down mechanism of rigor Mortis. Discuss the factors
modifying onset and duration of Rigor Mortis. (1.5+2.5+2)(Kalyani)
 i) Describe Rigor Mortis. Discuss the mechanism of formation of rigor mortis. Write
down the medico-legal importances. (1+8+1)
ii)Define Stab wound. What are the different types? How will you differentiate the
track of stab wound? What is concealed punctured wound? (2+4+2+2)
iii)Define Mechanical Asphyxia. Discuss the effects of asphyxia in the body. (1+9)
(ICARE)

Medicolegal Importance
 Brain death [Nrs] [KPC] [Sagore Dutta]
 Maggots [Nrs]
 Mummification [Ipgmer] [IQ City]
 Livor mortis in case of natural death [Malda]
 Algor mortis [Gouri Devi]
 Adipocere [Sagore Dutta]
 Post mortem staining [Ipgmer] [IQ City]

Short notes:
 Rigor mortis [MCK]
 Changes in the eyes after death
 Adipocere formation [Ipgmer]
 PM Artifact [Esi,Joka]
 Post mortem staining [KPC]
 Algor Mortis [NRS]
 Mummification [Murshidabad]
NRSMC STUDENTS’ UNION 61
  Nystens’s Law [BMC]

Explain why:
 Estimation of time since death is only an approximation [MCK]
 In putrefaction, greenish discolouration first appears over of right iliac region of
abdomen [NRS]
 Post mortem hypostasis is not developed in a body found in running stream
water [Cnmc]
 Marbling is seen during the process of decomposition[IPGMER]
 The cooling curve of a human body is not a straight line [IPGMER]
 Adipocere and mummification can be found in the same dead body [BMC]
 First external sign of decomposition appears on right iliac fossa [Kalyani]
 Graph of Algor Mortis shows Sigmoid shaped curve [ESI,Joka]

Asphyxia
Long Question:
 Mention and explain how one autopsy surgeon can opine a case as suicidal hanging.
Note the different types of Intracranial Haemorrhages.(10+5)(Malda)
 A Deadbody of a female subject was recovered by local people on 3/4/18 at 6 am from
a waterbody at 6 am and sent to nearby mortuary by local ps. After being declared
brought dead in the local hospital. The Deadbody was received on the same date at
6:30 am autopsy started on that Deadbody at 3pm. Inquest report reveals that the
husband of the deceased reported that she left the house at 4:30 am on that day to
wash clothes and utensils in the waterbody as practised by her regularly but didn’t
return home after one hour. When the husband reached the spot he saw the slippers
of the wife on the stairs of the ghaat, but didn’t find her [Link] the mishap
he called local people who recovered the body from the water. Inquest report reveals
no external injury, no froth from nose and mouth. No evidence of soddening and
bleaching and the Deadbody was not showing an evidence of decomposition but
during autopsy , autopsy surgeon found that the Deadbody was in state of moderate
decomposition. Cadaveric spasm was not seen also, sand and mud was seen in mouth
cavity , in respiratory tract and inside stomach. Lungs features was suggestive of
edema aquosum instead of emphysema aquosum. There was extravasation of blood
measuring 3*2 inch over left side of temperoparietal region of scalp without any
intracranial hemorrhage. Internal organs were congested , autopsy surgeon opined
death was due to asphyxia in a case of drowning and manner was accidental. Justify
the opinion regarding cause and Manner of death given by autopsy surgeon.
Considering the findings mentioned above. What is edema aquosum and emphysema
aquosum. What is the possible explanation behind the discrepancy of general
conditions of the dead body mentioned in inquest with the observation by the
autopsy surgeon considering decomposition. (3+2)(1+2)(2) (Nrs)
 Mala, a 45 yrs old female was found hanging in her residence. Both her feet were
touching the floor and the knot was at the nape of the neck. What is the type of
hanging. How can you differentiate this from strangulation by ligature depending
upon the findings regarding the ligature mark. What are the sides of antimortem
hanging in this case. (1+1.5+2.5)(sagordutta)

NRSMC STUDENTS’ UNION 62

 A know young lady of 25 years brought to the mortuary during autopsy examination
excepting one 12*0.5 inch almost transversely placed discontinuous ligature mark
high up in the anterior aspect of neck. No other injury Mark anywhere in the body
including genitalia were found externally. Bluish discoloration of ear lobules tip of
nose and fingertips. How will you proceed to establish the cause of death. What are
the possibility of high up discontinuous ligature mark in the neck. Most likely
manner of death with explanation. Mention about location of postmortem staining in
this case.(3+3+2+2) (RGK)
 a)Pomona, a 25 year old newly married lady presented with active convulsion was
brought to the ER by her father- in-law and brother-in-law in the midnight. Loading
dose anti-convulsion therapy was given via I/V in the ER and she was shifted to ICU.
Next day early morning, toxicological screening of urine shows detection of BZDu.
Condition of the patient deteriorated subsequently. GCS was 7/15. She was on
ventilation for the next 5 days. On the 7 th day of admission, an oblique high up
abrasion mark: 2.2 cm breadth on the front of the neck crossing upper end of thyroid
obliquely below upwards towards left mastoid. Abrasion was black scabbed with
evidence of falling of scab at places was [Link] doctor referred the case to
Forensic Medicine for advice.
• Explain patho-physiology of such clinical presentation.
• How will you proceed to give your opinion regarding cause, age & manner of
injury over the neck?
• What would be the medico-legal advice to the attending doctor? (5+3+2)

 One dead body of 36 years old under trial prisoner is brought for medicolegal autopsy
with the following information that the deceased was found dead by suspension with
Gaamcha tied from window with touching of feet at ground. What medicolegal
procedure should be followed before and during autopsy to opine the different
medicolegal issues those may arise out of these incidents.? (7) (murshidabad)
 A 55 years old man was found dead with his mouth and nostrils dipped in water. In
a shallow ditch in the early morning near his house. On further enquiry, it was
revealed that the person was a habitual drinker. What may be the probable cause of
death? What are the expected Post Mortem findings in such a case? (1+6)
(Midnapore)
 A young lady was found in a paddy field with some nail scratch abrasions & discoid
bruise marks over the neck with slight bleeding from the nostrils. The face was
congested. What is the possible cause of death? Mention the external & internal
findings that can help you to confirm the diagnosis. (1+7)
 A dead body of 16 year old boy was found hanging from a tree in an abandoned bush.
The body was sent to autopsy surgeon for PM examination. How will the autopsy
surgeon opine regarding the cause and nature of death? (3+2)

Differentiate Between:[3 or 2.5 marks]

 Fresh water drowning and salt water drowning [[Link]] [IQ City]
 Hanging and ligature strangulation [Esi,Joka]
 Ligature mark of hanging and strangulation [IQ City] [Ipgmer] [Malda]
 Respired and unrespired lung[Cnmc] [Murshidabad] [IQ City]
 Neck findings of hanging and ligature strangulation [[Link]]
NRSMC STUDENTS’ UNION 63
Medicolegal Importance:
 Abrasion collar [BMC] [Cnmc]
 Froth from nose and mouth of the deceased in brought dead cases [Nrs]
 Tardieu’s spots [Icare,Haldia]
 Partial hanging [Midnapore]
 Hyoid [BSMC] [Ipgmer]
 Ligature material [Murshidabad
 Saliva stain [MCK]
 Café Coronary [KPC]

Short notes:
 Autoerotic asphyxia [MCK]
 Suspended animation [[Link]] [Malda] [Esi,Joka] [Icare,Haldia]
[[Link]]
 Cadaveric spasm [IQ City]
 Abrasion collar [Midnapore] [Ipgmer] [NRS]
 Diatom test [Ipgmer] [BSMC]
 Partial Hanging [Icare,Haldia]
 Froth of drowning [BMC]
 Café Coronary [KPC] [Icare,Haldia]
 Judicial hanging [Ipgmer]
 Chokehold [Kalyani]

Explain why:
 One cannot save one’s life by loosening the ligature at the right moment in cases
of partial hanging [Cnmc]
 Both pale and congested face may be found in hanging [BMC]
 Dribbling of saliva is considered an evidence of antemortem hanging [ESI,Joka]
 Information regarding floating of a dead body may help during autopsy of a
drowning case [Malda]
 Fresh water drowning causes earlier death than salt water drowning [MCK]
 Neck is dissected last in the autopsy of suspected asphyxial death [Cnmc]
 In drowning liquid may not be present in lungs [Murshidabad]

Injuries
Long Question:
 Define abrasions. How can you determine approximate time passed since infliction of
the injury (abrasion).Explain why medico legally abrasion is superior to
bruise.(1+3+2)(Sskm)
 Define abrasion. Describe different types. Write mechanism of formation of parallel
bruise. (1+2)
 What is an abrasion? What are different types of abrasions and how they can be
inflicted? (1+4)

NRSMC STUDENTS’ UNION 64

Differentiate Between:

 Post mortem staining and bruise [[Link]] [Ipgmer] [Nbmc] [Murshidabad] [IQ
City] [Gouri Devi]
 Suicidal and homicidal cut throat injury [Cnmc] [Nbmc] [Murshidabad] [IQ City]
[Ipgmer] [BSMC] [Mck]
 Chop wound and incised wound [Nbmc]
 Incised wound and lacerated wound [Cnmc] [Icare,Haldia]
 Ante mortem bruise and post mortem hypertasis [Esi,Joka]
 True bruise and false bruise [Kpc]
 Ante mortem and post mortem injuries [IQ City]
 Suicidal hanging and homicidal hanging [Icare,Haldia]
 Antemortem wound and post mortem wound [Kalyani]

Medicolegal Importance:
 Bevelled cut [Nrs] [Kalyani] [Midnapore]
 Tailing of incised wound [Mck] [BMC] [Midnapore] [Icare,Haldia] [IQ City]
 Hilt mark [Sagore Dutta]
 Stab wound [Malda]
 Bite mark [Murshidabad] [BSMC]
 Chop wound [IQ City]
 Fish tailing of stab wound [BMC]
 Abrasion [Icare,Haldia]
 Secondary injuries [Malda]
 Defence wound [KPC] [[Link]]
 Nail scratch abrasion [NRS]

Short notes:

 Delayed bruise [MCK]

 Patterned abrasion [Ipgmer]
 Plassification of laceration injury [BSMC]
 Shear strain
 Ectopic bruise [[Link]]
 Defense wound [[Link]] [Nbmc]
 Bevelled cut [Murshidabad]
 Concealed punctured wounds [KPC]
 Whiplash injury [[Link]]
 Fabricated wound [Icare,Haldia]
 Estimation of time of attack from bruise [IQ City]

NRSMC STUDENTS’ UNION 65

Explain why:
 Abrasion is medico-legally more important than bruise [[Link]]
 Bleeding is more in incised wound than lacerated wound[[Link]]
 Laceration over scalp bleed profusely [Midnapore]
 Depth of a stab wound may not always coincide with the length of the offending
weapon[Sagore Dutta] [IPGMER] [NRS]
 Wound and injury(Sec 44IPC) are not the same [Murshidabad]
 Lacerated injury may be misinterpreted as incised wound
 In stab wound depth of the wound may not correspond withlength of the
penetrating part of blade.
 Stab injury over left ventricle is less dangerous than over right ventricle of
heart[KPC]
 Surgical wound can be an injury [[Link]]
 Penetrating injuries over atrium during diastole are more fatal [MCK]

Firearm Injuries
Long Question:
 By examining the wound of entry how Will you determine the distance of firing in
case of gunshot by rifle firearms. (5) (mck)
 A dead body of a housewife was recovered from a room bolted from inside with open
window showing multiple gunshot injuries on the person. The place of occurrence
showing multiple bullets in the floor with ricocheting effect in the walls. Dead body
was lying in the floor in a pool of blood.
 How the autopsy surgeon will ascertain the cause and nature of death after
examining the dead body?
 How will the autopsy surgeon determine the wound of entry and exit in this
case. (3+2) (IQ CITY)

Differentiate Between:
 Gunshot entry wound and exit wound [[Link]] [Midnapore] [Icare,Haldia]
[Sagore dutta]
 Tandem bullet and tandem catridge [BSMC]
 Suicidal and homicidal firearm wounds [Murshidabad]

Medicolegal Importance:

 Gunshot residue [Mck]

 Choking of gun [Icare,Haldia]

 Test bullet [Murshidabad]

 Tattooing in firearm injury [BMC]

NRSMC STUDENTS’ UNION 66
  Range of firing in rifled bore gun [[Link]]

Short notes:

 Detection of gunshot residues

 Catridge of a rifled weapon(description with diagram) [BSMC]

 Shot gun catridge [[Link]]

 Entry wound of bullet injury from close range [Malda]

Explain why:
 Entry wound of a firearm injury may not always be smaller than exit
wound[[Link]]
 Tattooing may not be found on skin of dead body even in close distance gun shot
injury [[Link]]
 To identify the offending firearm,secondary markings of bullet is more important
than primary
Markings [Kalyani] [NRS]
 No marks should be engraved on surface of recovered bullet from dead body
during autopsy?
 Possibility of single entry wound,no exit wound and no bullet found inside the
body [Midnapore]
 Firearm wound is lacerated wound [KPC]

Regional Injuries
Long Question:
 Enumerate the type of intracranial hemorrhage along with the most commonly
involved blood vessels. What is the mechanism of production of counter coup
injury?(3+3)(Sskm)
 A 34 yrs old man Rajesh is found by the side of a highway in unconscious [Link]
was admitted by the police at the casualty ward of NRSMCH. Examination revealed
he had GCS score E1V1M1. The patient dies after 24 hours of [Link] of
death given in death certificate” raised intracranial pressure in a case of head injury
to be confirmed by medicolegal autopsy”. His family members came to the police
station and informed that he left the home with one of his friend name Rohit riding
on a motorcycle. Police interrogated Rohit who revealed that they met with a
accident on road and Rajesh fell down from motorcycle and on the fear he left Rajesh
on road but the family members alleged that Rohit killed Rajesh. The Deadbody of
Rajesh was sent for autopsy in the morgue. Autopsy revealed extravasation of blood
in right temporal region of scalp with underlying fissured fracture of squamous part
of right temporal bone. Cerebral contusion over right temporal lobe measuring 1.5
inch * 1 inch and cerebral contusion over left temperoparietal lobe measuring 3.5*3
inch . Subdural hemorrhage all over the left parietotemporal region and multiple
petechial hemorrhage in grey-white matter junction, white matter of both cerebral
hemisphere. , In region of corpus callosum and cerebellar peduncle. What is the

NRSMC STUDENTS’ UNION 67

 pathophysiology of multiple petechial hemorrhage in white matter and corpus
callosum in this case. How will you confirm your diagnosis by histology and immuno-
histo chemistry. Write down the different causes of death following an intracranial
hemorrhage. Being the autopsy surgeon how you opine weather the deceased
sustained the injury following fall or due to assult by striking the head with a hard
blunt weapon with possible explanation.(2+2+2+4) ( NRS)
 A 60 yes old hypertensive lady was occasionally having headaches for last few days.
One day she experienced a thunderclap headache, which she described as the worst
headache of her Life. She was immediately rushed to the hospital. On the way she
had generalized seizures and became unconscious. She was declared brought dead .
a) what could be the possible cause of death in this case.
b) what is the commonest source of bleeding in this case.
c) how Will you confirm your diagnosis during autopsy.
d) what is lucid interval. Mention the medicolegal importance. (2+2+2+4) (MCK)
 Enumerate different types of skull facture,with brief description. What is
countercoup lesion. What is puppe & #39;s rule in relation to skull facture. (10)
(cnmc)

Medicolegal Importance:
 Decorticate and decerebrate rigidity in head injury patient [Nrs]
 Bumper fracture [BMC]

Short notes:

 Key-Hole fracture of Skull [BMC]

 Fracture ala signature” [Midnapore]
 Extradural haemorrhage [Midnapore]
 Subdural haemorrhage [IQ City]
 Contra coup injury [MCK]

Explain why:
 Extradural haemorrhage is seen less in people of extremes of ages [BSMC]
 Usual colour changes of bruise is not seen in Subconjunctival Haemorrhage
[Nbmc]
 Sub-conjunctival Haemorrhage does not show colour changes of contusion
[ESI,Joka]
 Cephalhematoma cannot cross the suture lines but caput succedaneum does
[Sagore Dutta]
 Sometimes patient with h/o head injury is advised to admit for observation
[Murshidabad]
 Haemorrhagic shock is not a cause of death in intracranial haemorrhages
[NRS]

NRSMC STUDENTS’ UNION 68

 Thermal Injuries
Long Question:
 One Deadbody of 35 yrs old female subject with almost 100% burn injuries, with
pujilistic attitude of limbs found in an open paddy fields. On autopsy black charring
of superficial skin, almost whole trunk muscle and lungs deep red congested, no soot
particles in trachae . Stomach empty, how Will you proceed to establish
a) The identity of deceased
b) cause of death
c) likely manner of death
d)time of death.
 Probable reason of absence of soot particles in trachae(RGK)(10)
 A)Mention the type of classification commonly followed in the autopsy of burn
[Link] are the names of other classifications used in burn injuries with
criteria in [Link] are the important criteria that will establish ante mortem
burn? (1+4+2)
B)What are the types of intracranial haemorrhage with source of bleeding? What is
thunderclap headache? What is lucid interval and its medicolegal importance?
(4+1+3)(CNMC)
 One 19 yrs pregnant mother with history of 40 weeks gestational period ,attended at
Murshidabad medical college in conscious state. With burn injuries involving both
upper extremities , anterior chest, both lower extremities all round. What steps will
you follow at emergency and Indoor ward from medical and medicolegal point of
view.?Being admitted if the patient unfortunately died after 72 hour’s what may be
the possible causes of death and how will you determine it. (4+2+2)(murshidabad)
 i) A 37yrs old lady (Body Wt-60 kg) was admitted in the burn unit of BMCH on 21 st
May 2018 at 10am, 3hrs after the incidence of burn in a closed room. The body found
having superficial dermal burn over whole of front and back of chest and abdominal
wall all [Link] the time and the amount of IV fluid to the infused
according to Modified parkland Formula? b)How can you monitor the patient to
ensure optimal amount of fluid resuscitation? c)Classify and describe the burn injury
according to Dupuytren’s classification. d)If the patient dies on 31 st May, 2018 then
what may be the expected findings of the external burn injury and trachea? e)What
may be the expected patho physiology of death in this case? (2+2+3+2)
ii)30yrs old male person got into fight with other inmates of hostel. He sustained
multiple fractures of bones, bilateral black eyes and was admitted in hospital in
unconscious condition.
a)Would you classify his injury as ‘simple’ or ‘grievous’ hurt?
b)Mention the relevant causes of relevant section of IPC related with the case?
c)Enumerate medico-legal importance of black eye. (1+2+2) (Burdwan)
 What are the causes of death in Burn injury? What is the clinical rule of Wallace’s
rule of Nine?

Differentiate Between:[3 or 2.5 marks]

 Thermal burn and chemical burn [Mck] [[Link]]

 Antemortem blister and post mortem blister [Mck] [Sagore dutta] [Icare,Haldia]

NRSMC STUDENTS’ UNION 69

  Burn and scald [[Link]] [Midnapore] [Malda] [Ipgmer]
 Frost bite and immersion feet [IQ City]
 Burn caused by dry heat and moist heat [Nrs]
 Heat stroke and heat exhaustion [Kalyani]
 Antemortem and postmortem burn [KPC]

Medicolegal Importance:
 External findings at PM of a burn injury case [Malda]

Short notes:
 Rule of nine [Malda] [Ipgmer] [Icare,Haldia] [Sagore Dutta] [KPC]
 Histo-pathological findings of entry wound of Joule Burn [BMC]
 Joule Burn [Icare,Haldia]

Explain why:
 Superficial burn is more painful than deep burn [Malda]
 Absence of electric entry mark does not rule out Electrocution
[Midnapore]
 ”Wallace Rule of Nine”is more important to the treating physician than to the
autopsy surgeon [NRS]
 Soot is not found in trachea in all cases of antemortem burn [Sagore Dutta]
[BSMC]

Transportation Injuries
Long Question:
 A unconscious male about 40 yrs of age is bought to the emergency department by
passerby with history of road traffic accident. After examination and investigation
the doctor diagnosed that he has sustained head injury leading to an accute EDH
Which requires an immediate life saving surgery. But no one is available for giving
consent.
a) Should the doctor proceed for life saving surgery without consent.
b) If he does so which section of IPC will safeguard him from future litigation for
not taking consent before life saving surgery.
c) Briefly state the essence of that section.
d) What is the component of a legally valid informed consent.
e) What is locoparentis.? Give examples. (1+1+2+4+1+1)( MCK)

Medicolegal Importance:
 Secondary injuries in traffic accident [BSMC]
Short notes:
 Seat belt injury [Kalyani]

NRSMC STUDENTS’ UNION 70

 Medicolegal Aspect of Injuries
Long Question:

 Enumerate IPC 320

 What do you understand by the term grievous hurt? Under which section
of IPC “causing hurt by grievous hurt by dangerous weapon” is
punishable? (3+1)

Medicolegal Importance:
 Grievous injury [Malda] [Icare,Haldia
 320 IPC [Kalyani]

Short notes:
 Grievous hurt [Nbmc] [Malda]

Explain why:
 Cutting of an extra finger in polydactyly will constitute grievous hurt
[IPGMER]
Deaths:
Long Question:

 One unknown dead body, showing mutilated face has been brought by
police to the autopsy room. Write down the datas based on which you can
proceed to establish the identity of the person. How can you estimate time
since death of the deceased? What is forensic entomology? (4+4+2)
 Define forensic entomology. Enumerate the post-mortem changes that
help in estimating time since death? (2+3)

Differentiate Between:[3 or 2.5 marks]

 Somatic death and molecular death [Mck] [Kpc]

 Rigor mortis and cadaveric spasm [Cnmc] [Malda] [Esi,Joka] [IQ City]
[[Link]]
 Homicide amounting to murder and homicide not amounting to murder [Nbmc]
[Icare,Haldia]

Medicolegal Importance:
 Death trance [Kalyani]
 Brain stem death [Kalyani]
 Zone of vital reaction [Nrs] [Cnmc]

NRSMC STUDENTS’ UNION 71

Short notes:
 Forensic entomology(Basic principles and usefulness in forensic practice)
[BSMC]
 Post mortem findings of starvation [Malda]
 Homicide and its types [Sagore
Dutta]
 Harvard criteria of Brain stem death
[Esi,Joka]
 Brain death [Ipgmer]

Explain why:
 Declaration of “Brain Death” is more important legally
[[Link]]
 All murders are culpable homicide but the reverse is not true
[Kalyani]
 Hesitation acts may be seen in suicidal cut throat injury [Icare,Haldia]
 Causes of death in cut-throat injury [Icare,Haldia]

Infanticide & Child Abuse

Long Question:
 A deadbody of a male baby was found in a garbage disposal container of a locality in
Kolkata the local municipality cleaner after noticing the same informed [Link]
came and the body was send for autopsy.
a) How Will the autopsy surgeon ascertain gestational age of the foetus.
b) What are the differentiating features seen in lung before and after respiration.?
c) What is the principle of hydrostatic test. ? What are the fallacies.?
(3+3+4)(ipgmer)

Differentiate Between:[3 or 2.5 marks]

 Caput succedaneum and cephalhematoma [BMC] [[Link]] [Nrs] [Ipgmer]

[Kalyani]
 Kidnapping and abduction [Icare,Haldia]
 Still born and dead born baby [Malda] [[Link]] [BSMC]

Medicolegal Importance:
 Raygate’s test [BMC]

Short notes:
 Caffey’s Syndrome [Sagore Dutta]
 SIDS(Epidemiology and probable causes) [BSMC]
 Acrodynia [IQ City]

NRSMC STUDENTS’ UNION 72

  Munchausen syndrome by proxy [MCK]
 Battered baby Syndrome [[Link]] [KPC]

Abortion
Long Question:

 A 27 yrs married women brought to emergency with shortness of breath,delirium.

Upon examination we found feeble regular pulse 112/min paleness of whole body cold
clammy skin. Her wearing apparels over lower part of body found wet with blood. on
enquiry their husband told they were married for 21 month’s and 4 hour’s back she
was taken to a quack for abortion. As an attending doctor-
a)What are the medical and legal duties to be fulfilled.
b)If the patient dies, will you issues a death certificate. Justify your actions.
c)What are the genital finding expected in this case.
d)What are the probable methods of criminal abortion that leads to the
situation.(4+2+2+2) (Burdwan)
 Write the complications of criminal abortion. What are the characteristics of wound
of entrance of a gunshot injury. (2+3)(IPGMER)
 One pregnant woman (10 wks) comes to the Gynaecology emergency dept on 26th
may 2018 with history of bleeding per vagina for last one day. She was down with
high fever. She died on 29th may 2018. On tracing the history it was found that her
husband forced her to abortion. So that she was brought to a local quack doctor and
performed her abortion. What is the cause of death? What is the pathophysiology of
this condition? What will be the autopsy findings in this case? what material will you
preserve during autopsy? (1+4+3+2)

Impotence & Sterility

Long Question:
 i)In a matrimonial suit the husband has been charged with Impotence. How would
you examine him to determine his sexual potency ? (5)
ii) Describe briefly regarding the drugs which are commonly used for the purpose of
clinical abortion. What are the causes of death in such cases? (3+2)
iii) Classify sexual offences. Define ‘Rape’ according to S.375 IPC. (1+4)(Midnapore)
 What is artificial insemination? Discuss the types of artificial insemination. What
are the legal and ethical issues associated with artificial insemination
donor.(1+2+3)(Sskm)
 In a matrimonial suite , husband has been charged with impotent. How will you
examine him to determine his sexual potential. Describe in breif the neurovascular
physiology of erection of penis (5) (Burdwan)

Medicolegal Importance:
 Artificial insemination [[Link]]
 Quad Hanc
NRSMC STUDENTS’ UNION 73
Short notes:
 Disorders of sexual development [MCK]
 Artificial Insemination [Icare,Haldia]

Explain why:
 Impotence is a ground for divorce but sterility is not [MCK]
 Potent male may be impotent at time of medical examination [[Link]]
 In Artificial Insemination , washed semen is more effective thean
unwashed semen[NRS]

Virginity,Pregnancy,Delivery
Long Question:
 Discuss the type of hymen and the ultrasonographic finding considered as in case of
positive signs of pregnancy. (2.5+2.5)(sagordutta)
 Rina Devi aged 35 yrs a mother of 3 daughters, was admitted to a rural hospital with
c/o labour pain and was discharged 3 days later. She reached her home with a male
baby. There was a complain of a baby missing from the hospital. What is a
supposititious child. Name the recent sign of delivery. What are the factors that will
help to determine paternity of such child. (2+5+3) (CNMC)

Differentiate Between:[3 or 2.5 marks]

 External genitalia of deflorated and virgin woman[Malda]

 Nulliparous and parous uterus [Malda] [Nrs]
 Virginity and defloration [Midnapore] [Murshidabad]
 True virgin and false virgin [IQ City] [Kpc] [Ipgmer]
 Natural abortion and criminal abortion [Murshidabad]

Medicolegal Importance:
 Lochia [Nrs] [[Link]]
 Hymen [Ipgmer]
 Quickening [Midnapore] [Cnmc] [BMC]
 Placenta [Midnapore] [[Link]]
 28th week of gestation [Kalyani]
 Precipitate labour [Midnapore]

Short notes:
 Pseudocyesis [IQ City]
 Umbilical cord [[Link]]
 Positive signs of pregnancy [NRS]
 Hymen [Cnmc]
 Hegar’s sign [Midnapore]

NRSMC STUDENTS’ UNION 74

Explain why:
 Foetal heart sound may not be audible even though the foetus is
alive[Midnapore]
 Amenorrhea is not sure sign of pregnancy [Cnmc]
 Spermatozoa may not be detected in vaginal swab/smear collected from a victim
girl with positive
evidence of sexual intercourse [[Link]]
 Pregnancy as a result of Fecundum Ab Extra does not consummate
marriage[Icare,Haldia]

Sexual Offences
Long Question:

 Pros and cons of legalization of 377 IPC (MALDA) (15)

 A mother 32 years old went to a shopping mall for shopping [Link]
she was abducted by a miscreant and in a lonely place she was subjected to sexual
assault as stated by her. On her complain the police sent her to a medico legist for
examination of the said victim. Comment on the followings:
a)How the medico legist will opine that forceful sexual intercourse has taken place
or not? (4+1)
b)How the medico legist will ascertain that it was done against her will? (5)
(IQCITY)
 16 year old Mena while returning home from coaching class was followed by a group
of drunk young men. Who dragged her to nearby field and allegedly raped [Link]
morning he was brought to you by police for medical examination.
a) From whom will you take the consent. What information must be disclosed in
informed consent in these case.
b)What specimen must be preserved for FSL examination and how it should be
preserved.
c)In case of forceful penetrative assault what should be your observations during
examination of private parts.
d)In case of absence of any injuries anywhere on her body what should be your
professional opinion after examining her. (3+3+3+1)( Bankura)
 18 years old girl without prior history of sexual intercourse lodges complain to local
police station about being raped in the previous evening.
 What are steps of examination?
 What will be the findings if she was actually raped?
 What is SAFE kit? (4+5+1) (KPC)

Differentiate Between:[3 or 2.5 marks]

 Sadism and sodomy [Murshidabad]

Medicolegal Importance:
 Run Amok [Sagore Dutta]
 Transvestism [[Link]]
NRSMC STUDENTS’ UNION 75
  Blood stain [Murshidabad]
 Vaginal swab and smear examination in sex offence cases [Kalyani]
 Unnatural sexual offences [Icare,Haldia]

Short notes:
 Lust murder [IQ City]
 Rape kit(SAFE kit) [IQ City]
 Hymen injury in a case of sexual assault [Malda]
 Rape Trauma Syndome [Kalyani]
 Sadism [Cnmc]
 Voyeurism [KPC]

Explain why:
 Amendments of laws on Sexual Assault have been a correct step taken by the
judiciary [Malda]
 Incest is not punishable in India [IPGMER]
 Rape is a legal definition,not a medical opinion [MCK]
 Absence of bodily injury and signs of resistance do not always imply that “rape”
has not taken place
 Medical proof of intercourse is not the legal proof of rape[BMC]
 Whether rape has been committed or not—it is upto the judiciary and not the
examining doctor to decide [IQ City]
 The birth of a child is not a conclusive evidence that the marriage has been
consummated
 Impotency is not a ground for exemption from 375 IPC [Icare,Haldia]

Forensic Pschiatry
Long Question:
 Deadbody of unknown 45 yrs male subject has been recovered by police and brought
to morgue by police. How do you proceed to establish the identity of the subject as an
autopsy surgeon. (5)
 A 65 Yrs old Ramesh stabbed his only son , to death and wrote a will stating he is
donating his property to a ashram. On enquiry by police he reveals that he killed his
son as per order’s given by God during meditation.
a) What is the possible explanation of his behaviour.
b) Will he be criminally responsible for his crime. Justify your answer with reason.
c) Comment regarding the validity of the will. (1+2+2) (Bankura)

Differentiate Between:[3 or 2.5 marks]

 Section 84 IPC and Mc Naughten’s rule [Mck]

 True insanity and feigned insanity [BMC]

Medicolegal Importance:
 Lucid interval [Ipgmer] [[Link]] [NRS] [KPC]
NRSMC STUDENTS’ UNION 76
  Impulse disorder [MCK]
 Delirium tremens [KPC]

Short notes:
 Legal aspects of delusion [Malda]
 Delirium Tremens [[Link]] [KPC]
 Delusion [NRS] [IQ City] [BMC] [Midnapore]
 Impulse
 McNaughten Rule [Cnmc]

Explain why:
 Mc Naughten Rule is not the same as Sec 84 IPC
 Diagnosed delusion has implication during court proceeding one crime
 Belief in God is not a delusion [Cnmc]

Other Short Notes:

 Punch drunk syndrome(definition, features,PM findings)[BSMC]
 Parrot’s perch(features) [BSMC]
 Mainlining [BSMC]
 Hypothermia [Murshidabad]
 Maceration [Cnmc]
 Marshall’s Triad [Cnmc]
 Plaque James [BMC]
 Heat cramp [BMC]
 RFLP(basic principle and medicolegal application [BSMC]

Toxicology
Long Question:
 Mr. Sunil was brought to BSMCH ER in drowsy condition. His wife said that he was
working on plants since morning on the roof and spraying chemicals on rose plants.
When she went to call him for lunch, she found that he was lying unconscious,
sweating with froth around mouth. On examining you find breathing is rapid,
bradycardia, constricted pupil and hypotension.
 What is your provisional diagnosis? Enumerate common differential
diagnosis.
 Assuming it is a case of poisoning, enumerate and classify probable group of
poisons responsible for Mr. Sunil’s condition.
 How will you approach to treat this case? (3+3+3)(Bankura)
 Justify With Reason:(2x4) (Bankura)
 In Hooch poisoning, antidote of choice is ethyl alcohol.
 In case of snake bite, tying a tourniquet above the bite mark is not advised.
However, if a patient is brought to you with tourniquet tied above the bite
marl, it should not be untied immediately
NRSMC STUDENTS’ UNION 77
  In case of Heroin overdose, Heroin is never found in victim’s body.
 Breathalyzer is an important Field Sobriety Test.

 A 27 years old male while working in paddy field was bitten by a snake over left
ankle. After 4 hours he came to emergency with reddish urine. Which type of snake
bite can present such a symptom? What are other signs and symptoms you expect in
this patient? How will you treat this patient? (1+3+6)
 Rohini, a 17 year old girl was brought to the emergency in an unconscious state
along with convulsions with history of consumption of bitter almond. What is your
probable diagnosis? How does the almond become toxic in the body? How will you
manage the case? (1+2+3)(NRS)
 A 30 year old male accompanied with a friend came to emergency of your hospital
with the history of sudden abnormal high rise of temperature, abnormally dilated
pupils and picking up at bed clothes with signs of delirium. By examining the patient
how the examining doctor will opine:
 About the type of poison/s that causes this?
 What is the line of management in this case? (1+4)
 A farmer who was spraying insecticide was found in unconscious sate at field and is
brought to emergency by relatives. On examination you find constricted pupils,
sweating, salivation with bradycardia and also two pin head sized punctured wounds
½ “ apart at right great toe. How will you manage this case from medical and
medico-legal point of view immediately, after admission and if died later on. (4+3+2)
 What are the viscera preserved during autopsy of a suspected case of unknown
poisoning? Name the common preservatives which are used to preserve the viscera.
Name the condition when those common preservatives cannot be used for viscera
preservation. (2+1+1)
 Write down the mechanism of action of organophosphorus compounds in human
body. Outline the management of case of OPC poisoning. (2+3) (NRS)
 Answer Briefly:-(4x2) (Murshidabad)
 How BAL is administered with indication?
 Examination of peripheral blood smear is helpful to plumbism-why?
 What are the signs and symptoms of alcohol withdrawal?
 What are features of cocaine habit?

 A person from a small under privileged village in Southern Bengal presented in local
PHC with multiple hard wart-like growth on palms and soles, finely mottled brown
pigmentation, irregularly thick and brittle nails. Person gives a history of
consumption of water from deep tube wells and deep wells for last 40 years, which
are rarely reformed.
 What is your provisional diagnosis?
 What are the other signs and symptoms that can be expected in this case?
 How will you establish your diagnosis?
 Write in short about the treatment to be given in this case. (1+3+3+3)

NRSMC STUDENTS’ UNION 78

 A man invites his unmarried uncle, who is creating trouble with his property, to his
house on the day of Diwali and offered whisky. The uncle, an occasional drinker
finds the drink more bitter than usual. After some time he becomes restless and
shows stiffness and twitching with generalized convulsion. The body also showed
opisthotonus position in which he was carried to the local hospital. In between two
paroxysms of convulsions the patient’s muscles were completely relaxed.
 What is the probable diagnosis?
 What are the common signs and symptoms?
 Differentiate this poisoning with a disease that mimics such condition.
(2+4+4) (CNMC)

 A 24 year old male was brought to the Emergency Dept. with a history of unknown
snake bite.
 What clinical features and tests will you perform, in order to diagnose it was
a snake bite.
 How will you diagnose a case of neurotoxic snake bite?
 Briefly discuss the management of neurotoxic snake bite. (3+2+5)
 Briefly discuss the findings of ethyl alcohol poisoning. During examination of
drunkenness, name the samples that you will preserve, along with the preservatives.
(3+2) (MCK)
 Several male person from a small locality from Galsi P.S. brought to BMCH in almost
unconscious state with same type of signs and symptoms with a peculiar alcohol like
odour from mouth and twelve person died soon after admission.
a) What is Hooch tragedy/death?
b) What is the pathophysiology of such illness?
c) How will you manage such patients in the hospital? (2+3+2) (Burdwan)
 A 45 year old female from North 24 Parganas district of West Bengal was declared
brought dead at the Emergency Department of a hospital. The deceased was sent for
post mortem examination. During P.M. examination, multiple mottled brownish
pigmentation were found over eyelids, forehead, neck, shoulders and there was
presence of transverse white lines on the finger nails. What may be the probable
cause of death? What are he expected P.M. findings in this case? Which specimen
should you preserve other than the usual viscera? (1+3+2)
 Discuss briefly:(3x4) (Midnapore)
 Run amok and its criminal responsibility.
 Pathophysiology of anaemia in chronic lead poisoning.
 Carboluria
 Phossy Jaw
 Write down the clinical features and management of vasculotoxic snake bite.

 What are the duties of a Doctor during conduction of autopsy of a case of

organophosphorus poisoning? Mention the expected findings durig P.M. of a case
Viper poisoning death. Give a note on importance of Poison Information Centre.
(6+5+4)

NRSMC STUDENTS’ UNION 79

 Discuss on Brain Death and Organ Trasplantation. (15) (Malda)
 One rainy morning a 45 yrs old farmer comes to the rural health center with c/o
unknown bite and sudden onset of respiratory distress along with generalized
weakness of the body. On examination ptosis reduced muscle power and faint
puncture wound over dorsum of right hand.
a) Explain the possible cause of such presenting complains.
b) How do you manage the case.
c) if the patient dies in hospital after autopsy how do you form opinion on cause of
death and Manner of death. (4+3+3)

 Fill in the blanks (1x5)

 Magnan symptom is seen in chronic _______ poisoning.
 The toxalbumins present in rati seeds and castor seeds are ______ & _______
respectively.
 Antidote of choice in acute opium poisoning is _______ which is given in _____
route.
 Signs and symptoms of aconite poisoning & oxalic poisoning mimic _______ &
_______, two natural diseases, respectively.
 Smoky stool symptom is seen in ______ poisoning and opisthotonus is seen in
_______ poisoning.
 A 27 year old male patient while working in paddy field was bitten by a snake over
his left ankle. After 4 hours he came at emergency with reddish urine.
 Which type of snake bite can present such symptom and what is the probable
species?
 What are the other signs/symptoms you expect in this patient?
 How will you manage this patient?
 What are the traditional first aid methods that must be avoided in this case
and why? (1+3+4+2)
 Answer the following questions:- (2.5x2) (Kalyani)
 Injury caused by corrosive alkali is more dangerous than corrosive acid. Why?
 Stomach wash is required in case of intravenous morphine overdose. Why?

 A 25yrs old male was brought to the emergency with alleged history of ingestion of
insecticide poison. On examination, Emergency Medical Officer found pin point
pupil, typical Kerosene like smell coming from nose and mouth, profuse sweating
and [Link] group of insecticide the person has consumed? Classify that
group of insecticide. How will you treat the patient? What is carphologia? (1+3+4+2)
 Several male patients from a small locality brought to hospital in almost unconscious
state with same type of signs and symptoms with a peculiar alcohol like smell from
mouth and two person died soon after admission.
• What is Hooch tragedy/death?
• Describe the patho-physiology of such illness.
• How do you manage the patients in hospitals? (1+5+4)([Link] )
 What is the active principle of Dhatura poison? Mention signs & symptoms of
Dhatura poisoning. (2+3) (ICARE Institute)

NRSMC STUDENTS’ UNION 80

 In a village of purulia,70% of the people residing there have developed
hyperkeratosis of skin of Palms and soles. What is the most Probable cause and what
is the source of that cause?what are the other signs of symptoms you can get in these
cases. What is the typical findings of peripheral blood smear in these
cases.?(1+3+1)(sagordutta)

Short Note:

 Chronic mercury poisoning

 Whole bowel irrigation
 Post-mortem diagnosis of snake bite
 Metal fume fever.
 Ideal homicidal poison
 Acrodynia
 Preservation of viscera in poisoning cases
 Gastric lavage
 Chelating agent
 Ideal homicidal poison [IQ City]
 Preservation of viscera in poisoning cases [IQ City]
 Post mortem diagnosis of snake bite [NRS]
 Metal fume fever [NRS]
 Whole bowel irrigation [NRS]
 Chronic mercury poisoning [NRS]
 Rodenticide poison
 Vitriolage

Explain:
 Alkali burn is more damaging than acid burn.
 Some amount of antidote is left as left as residential in the stomach after
gastric lavage.
 Post mortem staining in Potassium Chlorate poisoning is chocolate brown in
colour
 Some amount of antidote is left as residual in the stomach after gastric
lavage[Cnmc]
 Stomach wash is contraindicated in mineral acid ingestion cases[[Link]]
 An alcoholic patient with history of fall and transient unconsciousness must
be admitted to hospital for observation [[Link]]
 Stomach tube should not be introduced for stomach wash in certain poisoning
cases[Sagore Dutta]
 In case of snake bite, tying a tourniquet above bite mark is not
[Link],if a patient is brought with tourniquet tied above the bite
mark, it should not be untied immediately[BSMC]
In case of Heroin overdose ,Heroin is not found in victim’s body[BSMC]
 In Hooch poisoning ,antidote of choice is ethyl alcohol[BSMC]
 Pralidoximes if not given early does not help in case of organo-phosphorous
compound poisoning[[Link]]
NRSMC STUDENTS’ UNION 81
  A residual amount of lavage fluid is always retained after completion of
stomach wash[Cnmc]
 Ethyl alcohol is used in the treatment of methyl alcohol poisoning[Cnmc]
 Aconite is good homicidal poison
 Gastric lavage is contraindicated in corrosive acid and alkali poisoning
 Chelating agents used in heavy metal poisoning
 Hypertension of spine is more fatal than hyperflexion of spine[BMC]
 Breathalyzer is an important tool of Field Sobriety Test[BSMC]
 Arsenic is an ideal homicidal poison
 Medicolegal role of a doctor in a suspected case of poisoning [Sagore
Dutta]

Differentiate Between:[3 or 2.5 marks]

 Drunkenness and concussion [BSMC]
 Hypostasis and congestion [Icare,Haldia]
 Capsicum and dhatura seed[Cnmc]
 Neurosis and psychosis [Nrs]
 Drug addiction and drug habituation [Sagore dutta]
 Strychnine poisoning and tetanus [BSMC] [Icare,Haldia]
 Drug dependence and drug habituation[Nrs]
 Secretor and non secretor [Mck]
 Datura poisoning and pontine haemorrhage [[Link]]
 Acid injury and alkaline injury [[Link]]
 Poisonous and non poisonous snakes [Icare,Haldia]

-----------------Best Of Luck-----------------
Koustav Akhuli, Mahabub Islam

Subhajit Mandal, Tapas Patra

NRSMC STUDENTS’ UNION 82