This is exam paper of medicine resident kindly make answer sheet for t

This is exam paper of medicine resident kindly make answer sheet for the same

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PG4 GeneralMedicine AnswerSheet

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Here is a summary of what is covered in each answer:

Q.1 - Oliguria (20 marks)

Definition - Urine output < 400 mL/24h (or < 0.5 mL/kg/hr)

Classification with causes:

Pre-renal (hypovolaemia, cardiogenic, distributive)
Intrinsic renal (ATN, RPGN, AIN, TMA)
Post-renal (obstruction)

History + Examination - volume status, drug history, systemic features

Investigations - Complete urine indices table (FENa, urine osmolality, Na, BUN:Cr ratio), blood tests, renal USS, biopsy indications

Management - Pre-renal resuscitation, ATN supportive care, post-renal decompression, electrolyte management, RRT indications (AEIOU mnemonic)

Q.2 - Heart Failure (20 marks)

Classification - HFrEF/HFmrEF/HFpEF, NYHA Class I–IV, acute vs. chronic, L vs. R vs. biventricular

Aetiology - Ischaemic, hypertensive, valvular, cardiomyopathies, high-output states

Pathophysiology - SNS, RAAS, ADH, neurohormonal cascade, ventricular remodelling, BNP

Clinical features - Full symptom + sign description

Investigations - BNP/NT-proBNP, Echo, CXR, ECG, cardiac MRI

Management - The "Fantastic Four" (ARNi/ACEi + BB + MRA + SGLT2i), ADHF management (IV furosemide, NIV, inotropes), device therapy (ICD, CRT), advanced HF (LVAD, transplant)

Q.3 - G-Protein Receptor Disorders + Hyperthyroidism (20 marks)

Part A - Two complete tables of LOF mutations (PHP-Ia/Ib, congenital hypothyroidism, nephrogenic DI, retinitis pigmentosa, MC4R obesity, familial glucocorticoid deficiency) and GOF mutations (familial non-autoimmune hyperthyroidism, toxic adenoma, McCune-Albright syndrome, testotoxicosis, Jansen metaphyseal chondrodysplasia, ADH type 1)

Part B - Full approach to hyperthyroidism: causes with radioiodine uptake classification, symptoms/signs (including Graves-specific features), investigations (TFTs, TRAb, thyroid scan), management (ATDs, RAI, surgery, thyroid storm protocol with Burch-Wartofsky score)

Q.4 - Lymphadenopathy + Splenomegaly (20 marks)

Lymphadenopathy - Comprehensive causes (infectious, neoplastic, autoimmune, drug-induced, storage diseases, Castleman disease) with approach

Splenomegaly - Grading, "CCML" mnemonic for massive splenomegaly, complete causes (infective, haematological, congestive/portal HTN, inflammatory, infiltrative, neoplastic), full clinical approach and investigations (peripheral smear, bone marrow biopsy, JAK2 mutation), management including pre/post-splenectomy vaccination (OPSI)

Q.5a - RPGN Classification + Treatment (10 marks)

3-type classification table with IF pattern:

Type I: Linear IgG (anti-GBM / Goodpasture - 10-15%)
Type II: Granular/immune complex (PSGN, Lupus, IgA, MPGN - 40%)
Type III: Pauci-immune (ANCA-GPA/MPA/EGPA - 45-50%)

Immediate therapy - Pulse methylprednisolone, cyclophosphamide (CYCLOPS regimen), rituximab (RAVE trial), plasmapheresis (mandatory for Type I; PEXIVAS data for Type III), dialysis, PCP prophylaxis

Q.5b - LPV, Prone Positioning, NMB in ARDS (10 marks)

LPV - "Baby lung" concept, VILI mechanisms (volutrauma, atelectrauma, biotrauma), 6 mL/kg PBW + Pplat ≤ 30 cmH2O + driving pressure ≤ 15 cmH2O; ARMA trial (31% vs. 40% mortality; NNT = 11)

Prone positioning - V/Q mismatch correction, homogeneous VT distribution, ≥ 16h/day for P/F ≤ 150; PROSEVA trial (16% vs. 32.8% mortality; NNT = 6)

NMB - P-SILI concept, cisatracurium (Hofmann elimination), ACURASYS vs. ROSE trial debate; current indication limited to severe/refractory ARDS and ventilator dyssynchrony

Summary comparison table of all three interventions with key trials and NNTs

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PG4 GeneralMedicine AnswerSheet

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File details: PDF 1.4 format, 407 KB - contains all 5 questions with full detailed answers, tables (urine indices, GPCR mutations, RPGN IF classification, ARDS summary), and proper headings/subheadings throughout. Both formats (DOCX + PDF) are available for download.

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