FINAL EXAM NATIONAL BOARD OF EXAMINATIONS
DECEMBER 2017
EMERGENY MEDICINE
PAPER II
POSSESSION USE OF CELL PHONES OR ANY SUCH ELECTRONIC GADGETS IS NOT PERMITTED INSIDE THE
EXAMINATION HALL.
EM.MED/D/17/52/II
Time 3 hours
Max. Marks 100
Important instructions:
• Attempt all questions in order.
• Each question carries 10 marks.
• Read the question carefully and answer to the point neatly and legibly.
• Do not leave any blank pages between two answers.
• Indicate the question number correctly for the answer in the margin space.
• Answer all the parts of a single question together.
• Start the answer to a question on a fresh page or leave adequate space between two answers.
• Draw table/diagrams/flowcharts wherever appropriate.
Write short notes on:
1. A 32 year old is brought to the ED one hour after an
accident. On arrival, he is talking in incomprehensible
words. His vitals are: RR- 32/min and SpO2 92% on
room air, PR- 118/min, and BP- 88/60mmHg. He is
opening his eyes to painful stimulus. He withdraws right
upper and lower extremities on painful stimulus with no
movement of left side. The right pupil is fixed and dilated.
What is his Glasgow Coma Scale?
Describe step-wise approach to the patient in the
ED.
How will you prevent further deterioration in brain
injury?

2. A 16 year old boy presents to ED complaining of shortness
of breath and pain on right side of chest. He informs being
beaten by hockey sticks in playground 30 minutes ago. His
vitals are: Respiratory rate 28/minute, oxygen saturation
80% on room air, pulse 110/min, blood pressure
90/50 mmHg. His Glasgow Coma Scale is 15/15 with
normal pupils and no deficits.
What are the possible chest injuries in this patient?
How will you detect various chest injuries in the
ED?
How will you relieve him of his pain?
The patient was intubated by an intern and put on
ventilator. However, the boy suddenly collapsed
with unrecordable blood pressure. Enumerate the
probable causes of his deterioration?

3. A 56 year old male has been wheeled into your ED with
deep second degree burns involving both upper limbs. He
had an unsuccessful attempt trying to save his wife from
fire within a closed compartment having wool garments.
He is highly agitated and coughing black sputum.
What are your initial concerns in managing this


patient?
How will you manage various inhalational injuries
produced by smoke?
Discuss Parkland's formula for fluid resuscitation of
burn in adults.
4. Enumerate common causes of acute pancreatitis.
How do you assess severity of acute pancreatitis in
ED?
Diagnostic studies in a patient with suspected acute
pancreatitis.
What are the local complications seen in acute
pancreatitis?

5. A 25 year old female presents with sudden loss of vision in
her right eye.
Describe briefly various causes of painless vision
loss.
Describe briefly various causes of painful vision
loss.
5+5
6. List the incomplete spinal cord syndromes.
Management of neurogenic shock.
Mechanisms of injuries encountered in cervical spine
trauma with an example in each category.

7. Discuss briefly about various causes of acute scrotal
pain.
How do you differentiate clinically among them?
Discuss the treatment options for testicular torsion in
ED.

8. Anatomy of knee relevant to trauma.
Discuss important neurovascular complications of
injuries to knee.
Meniscal and ligament injuries around knee joint.

9. Regional nerve entrapment syndromes of the hip
Bursal syndromes of the knee
Knee myofascial syndromes

10. Chest pain during third trimester of pregnancy
Severe preeclampsia
Abruptio placentae