FINAL EXAM NATIONAL BOARD OF EXAMINATIONS
JUNE 2016

POSSESSION USE OF CELL PHONES OR ANY SUCH ELECTRONIC GADGETS IS NOT PERMITTED INSIDE THE
EXAMINATION HALL.
FAMILY MEDICINE
PAPER I
FLM/J/16/08/I
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.
1. Use of mean, median and mode in descriptive statistics.
Define a case control study, indicating advantage and
disadvantages.
When is a paired student test used?

2. A 55-year-old man, non-smoker, with no co-morbidities is
found to have fasting total cholesterol of 240 HDL 46
LDL 150 mg% TG 200 mg%. What is your advice?
Give reasons.
A 75 year old lady suddenly develops breathlessness and
is found to have atrial fibrillation. Outline the management
in primary care and in hospital.
4+6
3. A 25 year old man with refractory nocturnal low back pain is
under your care:
State the likely diagnosis.
What tests are required to be done to substantiate the
diagnosis?
What other clinical features will help to clinch the
diagnosis?

4. A 45 year old man present with generalized pruritus; no skin
abnormality is noted.
List common systemic diseases, with mechanism.
Outline the treatment of each.
What are the sequalae of chronic pruritus?

5. An 80 year old lady complains of involuntary loss of urine,
bothering her a lot.
What are the likely causes?
How will you arrive at a clinical diagnosis?
Outline the treatment in each case.

6. Diarrhea is reported by patients in the following circumstances.
Give the etiology and treatment:
While receiving treatment for respiratory tract infection.
A stroke patient discharged after 2 weeks of hospitalization.
5+5
7. A 30 year old housewife complains of insomnia, palpitations
and fear of going to the market.
What is the likely diagnosis?
How can she be helped?
2+8
8. A middle-aged healthy man develops pins needles in both
feet.
What relevant clinical examination, history and laboratory
tests will you do?
When why would you consider referral to a specialist?
5+5
9. A routine pre-employment chest X-ray in a 25 year old man
reveals left upper zone streaky opacities.
How will you establish whether active or past TB is causing
this shadow?
If active TB is found, what is the advice regarding
employment?
5+5
10. Primary care management of:
A patient receiving thyroid replacement for hypothyroidism
due to Hashimoto's thyroiditis.
A patient with multinodular goitre: give management
principles.
5+5