MBBS QUESTION answer history and Gen examination.pdf

Professor DR Md . TOUFIQUR RAHMAN , FCPS, MD
Professor & Head, Cardiology, CMMC, Manikganj
drtoufiq19711@yahoo.com; drtoufiq1971@gmail.com
MBBS questions medicine(cardiology)
Write down the clinical importance of occupational history in medical practice.
 Identification of potential health risks: Obtaining an occupational history can help
healthcare providers identify potential health risks associated with a patient's occupation.
For instance, a patient working in a factory that uses toxic chemicals may be at risk of
developing respiratory problems or cancer.
 Diagnosis and management of work-related illnesses and injuries: Understanding a
patient's work history can help healthcare providers diagnose and manage work-related
illnesses and injuries. For example, a patient with carpal tunnel syndrome may be
diagnosed with a work-related injury if their job involves repetitive hand motions.
 Appropriate preventive measures: Knowledge of a patient's occupation can help
healthcare providers provide appropriate preventive measures to reduce the risk of
developing work-related illnesses or injuries. For instance, a healthcare worker may be
advised to use personal protective equipment (PPE) to prevent exposure to infectious
diseases.
 Legal and insurance purposes: Occupational history can also be important for legal and
insurance purposes. For example, a worker's compensation claim may require
documentation of the patient's occupation and the circumstances surrounding the injury.
 Social and environmental factors: Occupational history can provide information about
a patient's social and environmental factors that may contribute to their health status. For
example, a patient with a stressful job may be at higher risk of developing mental health
conditions.
In summary, obtaining a patient's occupational history is crucial for healthcare providers to
understand potential health risks, diagnose and manage work-related illnesses and injuries,
provide appropriate preventive measures, and consider social and environmental factors.

Question: Mention the importance of past history in medical practice.
Past medical history is an important aspect of medical practice as it provides valuable
information about a patient's health status and can help healthcare providers make informed
decisions about their diagnosis, treatment, and management. Here are some points and
examples elaborating the importance of past medical history in medical practice:
 Understanding the patient's medical background: A patient's past medical history can
provide information about their medical conditions, surgeries, hospitalizations, and
medications. This information can help healthcare providers understand the patient's
medical background, which is essential for accurate diagnosis and treatment. For
example, a patient with a history of heart disease may be at higher risk of developing
complications from a respiratory illness.
 Identifying risk factors and potential health problems: Past medical history can help
identify risk factors and potential health problems that may be relevant to a patient's
current condition. For instance, a patient with a history of smoking may be at higher risk
of developing lung cancer or chronic obstructive pulmonary disease (COPD).
 Avoiding drug interactions: A patient's past medical history can help healthcare
providers avoid prescribing medications that may interact negatively with other
medications or medical conditions. For example, a patient with a history of kidney
disease may be at risk of developing complications if prescribed a medication that can
harm the kidneys.
 Planning for preventive care: Knowledge of a patient's past medical history can help
healthcare providers plan for preventive care, such as screening tests or vaccinations. For
instance, a patient with a history of breast cancer may require more frequent
mammograms or genetic testing.
 Understanding patient preferences and values: A patient's past medical history can
provide insight into their preferences and values regarding medical care. For example, a
patient with a history of alternative medicine use may prefer non-pharmacological
treatments for their condition.

In summary, obtaining a patient's past medical history is crucial for healthcare providers to
understand their medical background, identify potential health problems, avoid drug
interactions, plan for preventive care, and understand patient preferences and values.
Write down the clinical importance of taking drug history of a patient.
Taking a drug history of a patient is an important aspect of medical practice as it provides valuable
information about a patient's current and past medication use. This information can help healthcare
providers make informed decisions about their diagnosis, treatment, and management. Here are some
points and examples elaborating the clinical importance of taking a drug history of a patient:
 Avoiding medication errors: Knowledge of a patient's current and past medication use can
help healthcare providers avoid medication errors, such as prescribing medications that may
interact negatively with other medications or medical conditions. For example, a patient
taking blood thinners may be at risk of bleeding if prescribed a medication that can increase
bleeding risk.
 Identifying medication-related problems: Drug history can help identify medication-related
problems, such as adverse drug reactions or medication non-adherence. For instance, a patient
may experience nausea or diarrhea as a side effect of a medication they are taking.
 Understanding patient compliance: Knowledge of a patient's medication history can provide
insight into their medication compliance, including whether they are taking their medication
as prescribed, and whether they have experienced any difficulties or barriers to taking their
medication. For example, a patient with a history of forgetting to take their medication may
require a different medication regimen or medication reminder systems.
 Identifying drug abuse: Drug history can help identify drug abuse or addiction, which can be
important in diagnosis and treatment. For instance, a patient with a history of opioid abuse
may require medication-assisted treatment or referral to a substance abuse treatment program.
 Planning for medication changes: Knowledge of a patient's drug history can help healthcare
providers plan for medication changes or discontinuation. For example, a patient taking a
medication that is no longer effective may require a change in medication.
In summary, taking a drug history of a patient is crucial for healthcare providers to avoid medication
errors, identify medication-related problems, understand patient compliance, identify drug abuse, and
plan for medication changes.

Write down the clinical importance of taking family history of a patient.
Give five appropriate examples to support your statement.
Taking a family history of a patient is an important aspect of medical practice as it provides
valuable information about the patient's genetic risk for certain medical conditions. This
information can help healthcare providers make informed decisions about their diagnosis,
treatment, and management. Here are some points and examples elaborating the clinical
importance of taking a family history of a patient:
 Identifying genetic risk factors: Knowledge of a patient's family history can help
healthcare providers identify genetic risk factors for certain medical conditions, such as
heart disease, cancer, or diabetes. For example, a patient with a family history of breast
cancer may require more frequent mammograms or genetic testing.
 Planning for preventive care: Family history can help identify potential health
problems that may be relevant to a patient's current condition. This information can help
healthcare providers plan for preventive care, such as screening tests or vaccinations. For
instance, a patient with a family history of colon cancer may require regular
colonoscopies.
 Personalizing treatment: Family history can help personalize treatment and
management plans based on a patient's genetic risk factors. For example, a patient with a
family history of heart disease may require more aggressive treatment or lifestyle
modifications to reduce their risk of developing heart disease.
 Understanding disease progression: Family history can provide insight into the
progression and severity of certain medical conditions. For instance, a patient with a
family history of Alzheimer's disease may be at higher risk of developing the disease at a
younger age or experiencing a more aggressive form of the disease.
 Counseling and genetic testing: Knowledge of a patient's family history can help
healthcare providers provide counseling and recommend genetic testing for patients and
their family members. For example, a patient with a family history of hereditary breast
and ovarian cancer syndrome may benefit from genetic counseling and testing to
determine their risk for these conditions.

In summary, taking a family history of a patient is crucial for healthcare providers to identify
genetic risk factors, plan for preventive care, personalize treatment, understand disease
progression, and provide counseling and genetic testing.
How family history can help in the clinical diagnosis of disease?
Family history can help in the clinical diagnosis of disease in several ways.
Here are some examples:
 Identifying genetic risk factors: Knowledge of a patient's family history can help
healthcare providers identify genetic risk factors for certain medical conditions. This
information can help healthcare providers determine if a patient is at increased risk
for developing a specific disease or condition. For example, a patient with a family
history of breast cancer may be at higher risk for developing the disease, and the
healthcare provider may recommend earlier and more frequent screening.
 Supporting a clinical diagnosis: Family history can provide additional information
that supports a clinical diagnosis. For example, a patient with a family history of type
2 diabetes may have a higher likelihood of developing the condition, and a diagnosis
of diabetes may be more likely in this case.
 Narrowing down differential diagnoses: Family history can help healthcare
providers narrow down a list of possible diagnoses when a patient presents with
symptoms that could be caused by multiple conditions. For example, if a patient
presents with abdominal pain, knowing their family history of inflammatory bowel
disease can help narrow down the possible diagnoses.
 Identifying hereditary conditions: Family history can help healthcare providers
identify hereditary conditions that may be passed down through generations. For
example, a patient with a family history of Huntington's disease may be at risk for
inheriting the condition and developing symptoms later in life.
 Guiding genetic testing: Family history can guide genetic testing to help confirm a
clinical diagnosis or identify a genetic mutation that may be responsible for a patient's
symptoms. For example, if a patient has a family history of a certain genetic
condition, genetic testing may be recommended to confirm or rule out the presence of
the mutation.

In summary, family history can be a valuable tool in the clinical diagnosis of disease by
identifying genetic risk factors, supporting a clinical diagnosis, narrowing down differential
diagnoses, identifying hereditary conditions, and guiding genetic testing.
What information would you gather from examination of face of a
patient? / or Write down the clinical importance of examining face
during general examination.
During a general physical examination, healthcare providers gather important information by
examining the face of the patient. Here are some examples of the information that can be
gathered from a face examination:
 Skin abnormalities: The face examination can help identify any skin abnormalities,
such as rashes, lesions, or discolorations, which can indicate underlying health
problems.
 Facial asymmetry: Facial asymmetry can indicate neurological or musculoskeletal
issues, such as a stroke, Bell's palsy, or nerve damage.
 Swelling or edema: Swelling or edema in the face can indicate a range of conditions,
from allergies to congestive heart failure.
 Eye abnormalities: Eye abnormalities, such as unequal pupils or drooping eyelids,
can indicate neurological or ophthalmological problems.
 Facial expressions: Facial expressions can provide information about a patient's
emotional state, which can be useful in diagnosing mental health conditions.
 The clinical importance of examining the face during a general physical examination
is significant as it can provide important clues to the patient's overall health and
wellbeing. Here are some examples of the clinical importance of a face examination:
 Early detection of skin cancers: The face is one of the most common areas for skin
cancers to develop, and an examination can help detect any suspicious lesions or
growths.
 Neurological assessment: Facial asymmetry or abnormalities can indicate
neurological problems, such as a stroke or nerve damage, and an examination can
help identify these issues.
 Diagnosis of systemic conditions: Facial edema or swelling can indicate a range of
systemic conditions, such as heart failure or kidney disease, which may require
further investigation.

 Assessing mental health: Facial expressions and movements can provide
information about a patient's emotional state, which can be useful in diagnosing and
managing mental health conditions.
 Monitoring chronic conditions: Regular facial examinations can help monitor
chronic conditions, such as lupus or scleroderma, which can affect the skin and cause
facial abnormalities.
In summary, examining the face of a patient during a general physical examination can
provide important information about skin abnormalities, facial asymmetry, swelling or edema,
eye abnormalities, and facial expressions, which can help in the early detection and diagnosis
of a range of health problems.
Write down the importance of examining hands of a patient.
Examining the hands of a patient is an important aspect of a general physical examination.
Here are some reasons why:
 Assessment of circulation: The examination of the hands can provide information
about the patient's circulation, as the color, temperature, and capillary refill time of
the hands can indicate poor circulation or arterial blockages.
 Detection of joint abnormalities: Examination of the hands can help detect joint
abnormalities such as swelling, deformities, or limited range of motion, which can be
indicative of rheumatoid arthritis or other joint-related conditions.
 Identification of skin abnormalities: Skin abnormalities, such as rashes or
discoloration, can be identified during a hand examination, which can indicate
underlying systemic or dermatological conditions.
 Diagnosis of neurological conditions: Hand tremors or other abnormalities can
indicate neurological conditions such as Parkinson's disease or peripheral neuropathy.
 Identification of occupational hazards: Hand examination can also provide
information about occupational hazards such as calluses, cuts, or other injuries, which
can help in identifying and addressing potential workplace risks.

In summary, the examination of the hands during a general physical examination can provide
important information about the patient's circulation, joint health, skin abnormalities,
neurological conditions, and occupational hazards. This information can be crucial in
identifying and diagnosing a range of health conditions, and in guiding appropriate treatment
and management plans.
==================================================================
Evaluation of muscle strength: The hands are a good indicator of muscle strength, and any weakness or
atrophy in the hands can indicate neuromuscular disorders such as ALS or muscular dystrophy.
 Detection of peripheral artery disease: Abnormalities in the pulse or blood pressure in the
hands can indicate peripheral artery disease, a condition where blood flow to the limbs is
restricted due to blocked or narrowed arteries.
 Assessment of hydration levels: The texture and moisture of the hands can provide
information about the patient's hydration status, which can be useful in identifying
dehydration or overhydration.
 Identification of nutritional deficiencies: Abnormalities in the nails, such as ridges or
discoloration, can indicate nutritional deficiencies such as iron or vitamin B12 deficiency.
 Diagnosis of connective tissue disorders: Examination of the hands can help identify
connective tissue disorders such as systemic lupus erythematosus or scleroderma, which can
cause hand abnormalities such as Raynaud's phenomenon or sclerodactyly.
 Identification of drug use: Examination of the hands can reveal signs of drug use, such as
needle marks or track marks, which can be useful in identifying substance abuse and
providing appropriate treatment.
In summary, the examination of the hands during a physical examination can provide important
information about muscle strength, peripheral artery disease, hydration levels, nutritional deficiencies,
connective tissue disorders, and drug use. These findings can be essential in identifying and diagnosing
a wide range of health conditions and guiding appropriate treatment plans.
How examination of face helps in the clinical diagnosis of disease?
Examination of the face is an important part of a physical examination, as it can provide
valuable information for the clinical diagnosis of various diseases. Here are some ways that
examination of the face can help in the clinical diagnosis of disease:

 Skin abnormalities: The face can show signs of various skin conditions such as acne,
rosacea, or eczema. These findings can help diagnose the underlying dermatological
condition and guide appropriate treatment.
 Facial asymmetry: Facial asymmetry can be indicative of conditions such as Bell's
palsy or stroke.
 Abnormalities in the eyes: Examination of the eyes can reveal abnormalities such as
redness, swelling, or discharge, which can indicate eye infections or allergies.
Additionally, eye exam can reveal conditions such as glaucoma, cataracts or diabetic
retinopathy.
 Mouth and throat examination: Examination of the mouth and throat can help
diagnose oral health problems, such as gum disease, oral cancer, or tonsillitis.
 Neurological conditions: Certain neurological conditions, such as Parkinson's
disease, can be identified by examining the face for characteristic features such as
tremors or a "mask-like" expression.
 Respiratory distress: Examination of the face can also reveal signs of respiratory
distress such as labored breathing, cyanosis, or pursed lips.
In summary, examination of the face during a physical examination can provide important
information for the diagnosis of a range of diseases and conditions, including dermatological
conditions, facial asymmetry, eye abnormalities, oral health problems, neurological
conditions, and respiratory distress.
How examination of tongue helps you in the clinical diagnosis of
disease?
Examination of the tongue can provide valuable information for the clinical diagnosis of
various diseases. Here are some ways that examination of the tongue can help in the clinical
diagnosis of disease:
1. Oral health problems: Examination of the tongue can help diagnose oral health
problems, such as infections, ulcers, or oral cancer.

2. Nutritional deficiencies: The tongue can show signs of nutritional deficiencies such
as iron or vitamin B12 deficiency, which can present as smooth, glossy tongue or
fissures.
3. Systemic diseases: Examination of the tongue can also reveal signs of systemic
diseases such as Kawasaki disease, which can present with strawberry tongue, or
autoimmune disorders, which can cause oral ulcers.
4. Medication side effects: Certain medications can cause changes to the appearance of
the tongue, such as inflammation or discoloration, which can help identify medication
side effects.
5. Allergies: Examination of the tongue can also reveal signs of allergies, such as
swelling or redness, which can help identify the allergen causing the reaction.
6. Tongue-tie: An abnormal attachment of the tongue to the floor of the mouth, also
known as tongue-tie, can cause speech and feeding difficulties.
In summary, examination of the tongue during a physical examination can provide important
information for the diagnosis of a range of diseases and conditions, including oral health
problems, nutritional deficiencies, systemic diseases, medication side effects, allergies, and
tongue-tie.
Write down the importance of examination of hand of a patient.
Examination of the hands can provide important clinical information for the diagnosis of
various diseases and conditions. Here are some of the importance of examining the hands
during a physical examination:
 Diagnosing joint problems: Examination of the hands can reveal signs of joint
problems such as arthritis, such as swelling, tenderness, and deformities.
 Neurological disorders: Examination of the hands can help identify neurological
disorders, such as tremors, muscle weakness or wasting, or sensory deficits.

 Circulatory disorders: Examination of the hands can help identify circulatory
disorders, such as peripheral artery disease, which can present with decreased pulse,
cold skin, or skin discoloration.
 Skin conditions: Examination of the hands can reveal skin conditions such as
eczema, psoriasis, or contact dermatitis.
 Occupational hazards: Examination of the hands can provide information about
occupational hazards, such as exposure to chemicals or repetitive motion injuries,
which can cause specific patterns of hand abnormalities.
 Nail abnormalities: Examination of the nails can reveal abnormalities such as
clubbing or spoon-shaped nails, which can indicate underlying medical conditions
such as respiratory or heart disease.
 Infections: Examination of the hands can reveal signs of infections such as fungal or
bacterial infections, which can cause skin changes, discharge, or swelling.
In summary, examination of the hands during a physical examination can provide important
clinical information for the diagnosis of a range of diseases and conditions, including joint
problems, neurological disorders, circulatory disorders, skin conditions, occupational hazards,
nail abnormalities, and infections.
Write down the importance of nail examination of patient.
Nail examination is an essential aspect of a physical examination and can provide important clinical
information for the diagnosis of various diseases and conditions. Here are some of the importance of
examining the nails during a physical examination:
 Diagnosing systemic diseases: Examination of the nails can reveal signs of systemic diseases
such as liver disease, kidney disease, or thyroid disease, which can present with nail changes
such as clubbing, spoon-shaped nails, or white or yellow discoloration.
 Skin conditions: Examination of the nails can reveal skin conditions such as psoriasis or
eczema, which can affect the nails and cause changes in color or texture.
 Nutritional deficiencies: Examination of the nails can reveal nutritional deficiencies such as
iron or vitamin B12 deficiency, which can cause nail changes such as spoon-shaped nails,
brittle nails, or nail ridges.

 Fungal infections: Examination of the nails can reveal fungal infections such as
onychomycosis, which can cause thickened, discolored, or brittle nails.
 Trauma: Examination of the nails can reveal signs of trauma, such as subungual hematomas
or nail bed injuries.
 Medication side effects: Certain medications can cause changes to the appearance of the nails,
such as discoloration or ridges.
 Occupational hazards: Examination of the nails can provide information about occupational
hazards, such as exposure to chemicals or repetitive trauma, which can cause specific patterns
of nail abnormalities.
In summary, examination of the nails during a physical examination can provide important clinical
information for the diagnosis of a range of diseases and conditions, including systemic diseases, skin
conditions, nutritional deficiencies, fungal infections, trauma, medication side effects, and occupational
hazards.
What clinical information you can elicit by examination of nails?
Examination of the nails can provide important clinical information for the diagnosis of various
diseases and conditions. Here are some of the clinical information that can be elicited by examining the
nails:
 Color changes: Changes in nail color can indicate systemic diseases such as liver disease,
heart disease, or lung disease, as well as local infections or trauma.
 Nail bed abnormalities: Changes in the shape or contour of the nail bed can indicate systemic
or local disorders such as lung disease, heart disease, thyroid disease, or psoriasis.
 Texture changes: Changes in nail texture such as roughness or brittleness can be an
indication of nutrient deficiencies, fungal infections, or nail trauma.
 Nail plate abnormalities: Changes in the nail plate, such as thickening, splitting, or lifting,
can be an indication of psoriasis, eczema, fungal infections, or other local disorders.
 Clubbing: Clubbing of the nails, which is an enlargement of the fingertips and nails, can be
an indication of respiratory or cardiovascular disease.

 Beau's lines: Beau's lines are horizontal depressions in the nails that can be an indication of
severe illness or injury.
 Koilonychia: Koilonychia, or spoon-shaped nails, can be an indication of iron-deficiency
anemia.
Overall, examination of the nails can provide important clinical information for the diagnosis of a
range of diseases and conditions, including systemic diseases, skin conditions, nutritional deficiencies,
fungal infections, trauma, and occupational hazards.
Write short note on : Non- pitting oedema.
Non-pitting edema is a type of swelling that occurs when there is an accumulation of fluid in
the tissues that does not indent or pit when pressure is applied. Here are some important
points to know about non-pitting edema:
 Causes: Non-pitting edema can be caused by a variety of conditions, including
lymphedema, lipedema, myxedema, and certain types of systemic diseases.
 Symptoms: The main symptom of non-pitting edema is swelling that does not pit or
indent when pressure is applied. Other symptoms may include heaviness, tightness,
and discomfort in the affected area.
 Diagnosis: Diagnosis of non-pitting edema involves a physical examination, medical
history, and tests such as blood tests, ultrasound, or MRI.
 Treatment: Treatment of non-pitting edema depends on the underlying cause and
may involve compression therapy, exercise, massage, diuretics, or surgery.
 Management: Self-care measures such as elevation, exercise, and avoiding
prolonged sitting or standing can also help manage non-pitting edema.
 Complications: If left untreated, non-pitting edema can lead to skin changes,
infection, impaired mobility, and decreased quality of life.
Overall, non-pitting edema is a type of swelling that should be evaluated by a healthcare
provider to determine the underlying cause and appropriate treatment.
2. Write short note on : Unilateral leg oedema. with points
Unilateral leg edema is a type of swelling that occurs in only one leg, and it can be caused by
a variety of conditions. Here are some important points to know about unilateral leg edema:
Causes: Unilateral leg edema can be caused by a number of different conditions, including
deep vein thrombosis (DVT), lymphedema, cellulitis, venous insufficiency, and trauma.

Symptoms: The main symptom of unilateral leg edema is swelling that occurs in only one leg.
Other symptoms may include pain, tenderness, redness, warmth, and skin changes such as
thickening or discoloration.
Diagnosis: Diagnosis of unilateral leg edema involves a physical examination, medical
history, and tests such as ultrasound, blood tests, or MRI.
Treatment: Treatment of unilateral leg edema depends on the underlying cause and may
involve compression therapy, exercise, medications such as diuretics or antibiotics, or surgery.
Management: Self-care measures such as elevation, exercise, and avoiding prolonged sitting
or standing can also help manage unilateral leg edema.
Complications: If left untreated, unilateral leg edema can lead to skin changes, infection,
impaired mobility, and decreased quality of life.
Overall, unilateral leg edema is a type of swelling that should be evaluated by a healthcare
provider to determine the underlying cause and appropriate treatment. If you experience
swelling in only one leg, you should seek medical attention right away as it could be a sign of
a serious condition such as deep vein thrombosis.
3.How would you clinically assess and investigate a case of unilateral
leg swelling?
When assessing and investigating a case of unilateral leg swelling, a healthcare provider will typically
take the following steps:
 Medical history: The healthcare provider will ask the patient about their medical history,
including any recent surgeries, injuries, or illnesses that could be contributing to the leg
swelling.
 Physical examination: The healthcare provider will perform a physical examination of the
leg, looking for signs of redness, warmth, tenderness, and discoloration. They may also assess
for pitting or non-pitting edema.
 Imaging tests: Imaging tests such as ultrasound, CT scan, or MRI may be ordered to help
identify any blood clots or other issues in the leg.
 Blood tests: Blood tests may be ordered to check for any underlying medical conditions, such
as kidney or liver disease, that could be contributing to the leg swelling.
 Doppler study: Doppler ultrasound may be used to evaluate blood flow in the veins and
arteries of the affected leg.
 Venography: A venography test may be used to take an X-ray of the veins in the leg, which
can help identify any blockages or clots.

Based on the findings of these tests, a healthcare provider will be able to determine the underlying
cause of the leg swelling and recommend appropriate treatment. If a blood clot is found, immediate
treatment may be needed to prevent further complications such as pulmonary embolism. Other
treatments may include compression stockings, medications to reduce swelling, or surgery to repair
damaged veins or remove clots.
Mention five (5) important causes of cyanosis?
Cyanosis is a clinical sign that refers to the bluish discoloration of the skin and mucous membranes. It
is caused by a reduced level of oxygen in the blood or poor circulation of blood. Here are five
important causes of cyanosis:
 Respiratory diseases: Respiratory diseases such as pneumonia, asthma, chronic obstructive
pulmonary disease (COPD), and acute respiratory distress syndrome (ARDS) can lead to
cyanosis due to reduced oxygenation of blood.
 Cardiovascular diseases: Cardiovascular diseases such as congenital heart defects, heart
failure, and pulmonary embolism can cause cyanosis due to poor circulation of blood.
 Hypoxemia: Hypoxemia is a condition in which there is a low level of oxygen in the blood,
and it can be caused by various factors such as high altitude, lung diseases, or cardiovascular
diseases.
 Raynaud's phenomenon: Raynaud's phenomenon is a condition in which the blood vessels in
the fingers and toes constrict in response to cold temperatures or stress, leading to cyanosis.
 Exposure to cold: Exposure to cold temperatures can cause constriction of the blood vessels,
reducing blood flow to the skin and causing cyanosis. This can be seen in conditions such as
frostbite or hypothermia.
Write down the importance of examination of pulse of a patient.
Examination of the pulse is an important component of the physical examination of a patient. The pulse
is the wave of blood flow that can be felt at various points in the body, such as the wrist, neck, or groin.
Here are some reasons why examining the pulse is clinically important:
 Assessing the heart rate: The pulse rate is a direct reflection of the heart rate, which is the
number of times the heart beats per minute. By assessing the pulse, healthcare providers can
determine the heart rate and identify any irregularities, such as tachycardia (fast heart rate) or
bradycardia (slow heart rate).
 Evaluating the rhythm of the pulse: The rhythm of the pulse is the regularity of the beats.
An irregular pulse can indicate arrhythmia, which is an abnormal heart rhythm.

 Determining the strength of the pulse: The strength of the pulse provides information on the
stroke volume of the heart, which is the amount of blood that is ejected with each heartbeat.
Weak pulses can indicate reduced blood flow, such as in shock or heart failure.
 Monitoring the response to treatment: Changes in the pulse can indicate the response of the
body to treatment, such as the effect of medications on the heart rate or rhythm.
 Assessing the blood flow to specific areas: The pulse can be examined at specific sites, such
as the foot or wrist, to evaluate the blood flow to these areas. This can be important in
assessing peripheral arterial disease or other circulatory disorders.
 Screening for cardiovascular diseases: The pulse can be used to screen for cardiovascular
diseases, such as hypertension, peripheral arterial disease, or atherosclerosis.
 Monitoring the progress of disease: Changes in the pulse over time can provide information
on the progression of certain diseases, such as heart failure or chronic obstructive pulmonary
disease.
 Identifying drug toxicity: Certain medications, such as beta-blockers or calcium channel
blockers, can affect the heart rate or rhythm. By monitoring the pulse, healthcare providers
can identify drug toxicity or adverse effects.
 Assessing fitness levels: The pulse can be used to assess fitness levels, as regular exercise can
result in a lower resting heart rate.
 Providing reassurance to the patient: Finally, examining the pulse can provide reassurance
to the patient that the healthcare provider is taking a thorough approach to their evaluation and
care.
Overall, examination of the pulse is an important aspect of the physical examination that can provide
valuable information on the heart rate, rhythm, and blood flow to various areas of the body.
What information will you gather from examination of pulse of a
patient?
By examining the pulse of a patient, healthcare providers can gather several important pieces
of information, including:
 Heart rate: The pulse can be used to determine the heart rate, which is the number of
times the heart beats per minute.
 Rhythm: The pulse can also provide information on the rhythm of the heartbeat. An
irregular pulse may suggest an arrhythmia or other heart condition.
 Strength: The strength or amplitude of the pulse can be used to assess the cardiac
output and the blood volume. A weak or thready pulse may suggest low blood
volume or decreased cardiac output.

 Character: The pulse can also provide information on the character or quality of the
heartbeat. For example, a bounding or full pulse may indicate hyperthyroidism or
aortic regurgitation.
 Peripheral perfusion: Finally, examining the pulse can provide information on the
peripheral perfusion, or blood flow to the extremities. A weak or absent pulse may
suggest peripheral artery disease or other vascular disorders.
What information you may gather from examination of neck of a
patient?
Examination of the neck of a patient can provide several important pieces of information,
including:
 Thyroid gland: The neck examination can provide information on the size and
consistency of the thyroid gland. Enlargement or nodules on the thyroid gland may
suggest thyroid disease.
 Lymph nodes: The neck examination can also provide information on the size and
consistency of the lymph nodes in the neck. Enlarged or tender lymph nodes may
suggest infection or malignancy.
 Carotid arteries: Examination of the carotid arteries in the neck can provide
information on the presence of carotid artery disease, such as carotid stenosis or
atherosclerosis.
 Trachea: The position and deviation of the trachea can provide information on the
presence of mediastinal masses or other thoracic abnormalities.
 JVP: Examination of the jugular venous pulse (JVP) in the neck can provide
information on the right-sided heart function and the presence of heart failure.
 Cervical spine: Finally, the neck examination can provide information on the
cervical spine, including the presence of neck pain, stiffness, or deformities.
Write down the importance of neck examination in clinical medicine.

The neck examination is an important component of the clinical examination in medicine. It
provides valuable information about the health status of various organs and structures in the
neck region. Some of the key reasons why the neck examination is important include:
 Diagnosis of thyroid disorders: The thyroid gland is located in the neck, and the
examination of the gland can provide information on its size, shape, and consistency.
This can help in the diagnosis of thyroid disorders such as hyperthyroidism,
hypothyroidism, and thyroid nodules.
 Assessment of lymph nodes: The examination of the neck can help identify any
enlarged or tender lymph nodes, which may indicate an underlying infection or
malignancy.
 Diagnosis of carotid artery disease: The carotid arteries are located in the neck, and
the examination of the arteries can provide information on the presence of carotid
artery disease such as atherosclerosis or carotid stenosis.
 Assessment of jugular venous pressure (JVP): Examination of the jugular veins in
the neck can help assess the JVP, which can provide important information about the
patient's fluid status and cardiac function.
 Evaluation of cervical spine disorders: The neck examination can help identify any
abnormalities in the cervical spine, such as neck pain, stiffness, or deformities.
Overall, the neck examination is an essential part of the clinical evaluation of patients and can
provide important diagnostic and prognostic information for a variety of medical conditions.
What information would you gather from examination of lymph nodes
of a patient?
Examination of lymph nodes is an important part of the clinical examination in medicine, and
it can provide valuable information about the patient's health status. During the examination, a
healthcare provider would palpate various lymph nodes in the body to check for any
abnormalities. The information that can be gathered from examination of lymph nodes
includes:

 Location and size: The location and size of lymph nodes can provide important clues
about the underlying condition. For example, enlarged lymph nodes in the neck can
be a sign of a throat infection or head and neck cancer.
 Consistency and texture: The consistency and texture of lymph nodes can provide
information on the underlying pathology. Enlarged lymph nodes that are soft and
tender are often indicative of inflammation, while hard and fixed lymph nodes can be
a sign of malignancy.
 Tenderness: Tender lymph nodes can be a sign of infection or inflammation, while
painless lymph nodes may be indicative of malignancy.
 Mobility: Lymph nodes that are freely movable and not fixed to surrounding tissues
are less likely to be malignant.
 Presence of other symptoms: The presence of other symptoms such as fever, fatigue,
or night sweats, along with enlarged lymph nodes, can help in the diagnosis of
various medical conditions.
Overall, examination of lymph nodes can provide valuable information about the underlying
condition and help guide further diagnostic and therapeutic interventions.
Describe the clinical types of fever with examples.
Fever is a common symptom that can present in different ways, depending on the underlying
cause. The clinical types of fever can be described as follows:
 Intermittent fever: Intermittent fever is characterized by fever spikes that occur at
regular intervals. The fever spikes are followed by a return to normal body
temperature. Examples of diseases that can cause intermittent fever include malaria
and some bacterial infections.
 Remittent fever: Remittent fever is characterized by fluctuations in body
temperature that remain above normal but do not return to normal levels. The fever
spikes are not as regular as in intermittent fever. Examples of diseases that can cause
remittent fever include infectious mononucleosis and some viral infections.

 Continuous fever: Continuous fever is characterized by a sustained elevation in body
temperature without any significant fluctuation. Examples of diseases that can cause
continuous fever include typhoid fever and some bacterial infections.
 Pel-Ebstein fever: Pel-Ebstein fever is a rare type of fever that is characterized by a
regular pattern of fever spikes that last for several days followed by a period of
normal body temperature that lasts for several days. This pattern repeats itself, with
the fever spikes occurring at regular intervals. This type of fever is often seen in
patients with Hodgkin's lymphoma.
 Hectic fever: Hectic fever is characterized by irregular spikes in body temperature
that can be quite high, followed by a rapid return to normal body temperature. It is
often associated with severe infections such as sepsis.
Understanding the type of fever and associated symptoms can help healthcare providers to
diagnose and manage the underlying condition.
What are the types of fever? Give example.
There are several types of fever based on their patterns and underlying causes. Some of the
common types of fever include:
 Continuous fever: In this type of fever, the body temperature remains consistently
elevated with minimal fluctuations. Examples include typhoid fever, urinary tract
infection, and pneumonia.
 Remittent fever: In this type of fever, the body temperature remains elevated but
fluctuates by more than 1 degree Celsius (1.8 degrees Fahrenheit) throughout the day.
Examples include infective endocarditis and acute rheumatic fever.
 Intermittent fever: In this type of fever, the body temperature alternates between
periods of fever and periods of normal temperature. Examples include malaria and
septicemia.
 Relapsing fever: In this type of fever, the body temperature spikes for a few days
and then resolves completely, only to recur again after a few days. Examples include
tick-borne relapsing fever and Borrelia infections.

 Pel-Ebstein fever: This is a rare type of fever associated with Hodgkin's lymphoma,
in which the body temperature spikes for a few days and then subsides for an equal
period.
It is important to note that fever can also be categorized based on its duration (acute, sub-
acute, or chronic) and underlying cause (infectious, non-infectious, neoplastic, or drug-
induced).
Write down the patterns of fever with example
There are different patterns of fever that can occur in different diseases or conditions. Some
of the common patterns of fever are:
 Continuous fever: In this type of fever, the body temperature remains elevated
throughout the day with no significant fluctuations. Examples include urinary tract
infections, typhoid fever, and pneumonia.
 Remittent fever: In this type of fever, the body temperature fluctuates over a range
of 1-2°C throughout the day, but never returns to normal. Examples include infective
endocarditis, tuberculosis, and infectious mononucleosis.
 Intermittent fever: In this type of fever, the body temperature returns to normal or
below normal between episodes of fever. There are two subtypes of intermittent fever:
 Quotidian fever: Fever occurs daily with a cycle of 24 hours. Examples include
malaria caused by Plasmodium falciparum and Plasmodium malariae.
 Tertian fever: Fever occurs every other day with a cycle of 48 hours. Examples
include malaria caused by Plasmodium vivax and Plasmodium ovale.
 Pel-Ebstein fever: This is a specific type of fever associated with Hodgkin's
lymphoma, characterized by a cyclic pattern of fever that lasts for 1-2 weeks,
followed by an afebrile period of 1-2 weeks.
 Hectic fever: In this type of fever, the body temperature fluctuates greatly, often
reaching high levels, and there is no definite pattern. Examples include septicemia,
pyelonephritis, and bacterial endocarditis.

Name 5 commonly used parenteral fluid with one indication of use of
each in medicine ward.
 Normal saline (0.9% NaCl) - used for intravascular volume replacement in patients
with dehydration, hypovolemia, and hypotension.
 Lactated Ringer's solution - used for fluid and electrolyte replacement in patients
with hypovolemia, burns, and surgical procedures.
 5% Dextrose in water (D5W) - used for maintenance fluid therapy and to treat
hypernatremia and dehydration associated with hyperglycemia.
 10% Dextrose in water (D10W) - used as a source of calories in patients with
hypoglycemia or those unable to take oral feedings.
 Plasma-Lyte A - used for maintenance fluid therapy, and in patients with metabolic
acidosis or hyponatremia.
It is important to note that the use of parenteral fluids should be guided by a healthcare
professional based on the patient's individual needs and medical condition.
A 45- year- old man presents with fever for 6 weeks. Write down
clinical information you will search to reach a diagnosis.
When evaluating a patient with a prolonged fever, the following clinical information can be
useful in reaching a diagnosis:
 Medical history: Any relevant past medical history, such as recent infections, travel
history, autoimmune diseases, and medication history, can provide valuable clues to
the underlying cause of the fever.
 Physical examination: The presence of other symptoms such as rash, joint pain,
abdominal pain, lymphadenopathy, or hepatosplenomegaly can be helpful in
narrowing down the list of possible diagnoses.
 Laboratory tests: Blood tests, including complete blood count (CBC), erythrocyte
sedimentation rate (ESR), C-reactive protein (CRP), liver and kidney function tests,
serologic tests, and cultures, can provide important information on the presence of
infection, inflammation, or other underlying disorders.

 Imaging studies: Radiologic imaging, such as chest X-ray, CT scan, or ultrasound,
can help in detecting any abnormalities or lesions that may be responsible for the
fever.
 Biopsy: In some cases, a biopsy of affected tissue, such as lymph nodes, bone
marrow, or liver, may be necessary to reach a definitive diagnosis.
By carefully considering these clinical information, the healthcare provider can make a more
accurate diagnosis and provide appropriate treatment for the patient.
What are the common presentations of genetic disease?
Genetic diseases can present in a variety of ways depending on the specific condition and the
severity of the genetic mutation. Here are some common presentations of genetic diseases:
 Developmental delays or intellectual disability: Many genetic diseases affect the
development of the brain and nervous system, leading to developmental delays or
intellectual disability. Examples include Down syndrome, fragile X syndrome, and
Rett syndrome.
 Birth defects: Genetic mutations can cause structural abnormalities in the body that
are present at birth. These can include heart defects, cleft lip and palate, and neural
tube defects.
 Abnormal physical features: Some genetic diseases can cause distinctive physical
features that are not typical of the general population. Examples include
achondroplasia (dwarfism), Marfan syndrome (long limbs and fingers), and Turner
syndrome (webbed neck, low hairline).
 Metabolic disorders: Genetic mutations can affect the body's ability to process
certain substances, leading to metabolic disorders. These can include phenylketonuria
(PKU), galactosemia, and Tay-Sachs disease.
 Cancer: Some genetic mutations increase the risk of developing certain types of
cancer, such as BRCA mutations that increase the risk of breast and ovarian cancer.

It's important to note that many genetic diseases can present with a combination of these
symptoms, and that the severity of symptoms can vary widely even within the same condition.
A thorough medical evaluation and genetic testing may be necessary to reach a diagnosis.
Write short notes on: Down’s syndrome. with points
Down syndrome, also known as trisomy 21, is a genetic disorder caused by the presence of an
extra copy of chromosome 21. This extra genetic material can cause developmental delays
and physical abnormalities. Here are some key points about Down syndrome:
Down syndrome occurs in approximately 1 in every 700 births.
The most common physical features of Down syndrome include upward slanting eyes, a flat
facial profile, and a small nose and mouth.
Individuals with Down syndrome often have intellectual disability and developmental delays
in motor skills, speech, and language.
Other common health issues associated with Down syndrome include heart defects, hearing
and vision problems, and increased risk for certain medical conditions such as respiratory
infections, thyroid disorders, and leukemia.
Early intervention and special education services can help improve the developmental
outcomes and quality of life for individuals with Down syndrome.
Prenatal screening and diagnostic tests can detect the presence of Down syndrome during
pregnancy.
Write short notes on: Down’s syndrome.
Down syndrome is a genetic disorder caused by the presence of an extra copy of chromosome
21. This extra genetic material results in developmental delays and physical characteristics
that are distinctive to the syndrome.
Causes:
 The most common cause of Down syndrome is the presence of an extra copy of
chromosome 21, also known as trisomy 21.
 Another cause of Down syndrome is mosaicism, where only some cells have an extra
copy of chromosome 21.
 A third cause is translocation, where a part of chromosome 21 breaks off and attaches
to another chromosome.
Physical findings:
 Intellectual disability, ranging from mild to severe
 Distinctive facial features, such as small ears, a flat nose, and upward-slanted eyes
 Low muscle tone and poor muscle development

 Short stature and a small head size
 Congenital heart defects
 Hearing and vision problems
 Gastrointestinal problems
Diagnosis:
 Prenatal testing, such as chorionic villus sampling (CVS) or amniocentesis, can detect
Down syndrome during pregnancy.
 Postnatal diagnosis can be confirmed through genetic testing, such as a karyotype or
fluorescence in situ hybridization (FISH) test.
Management:
 Early intervention and education can help individuals with Down syndrome reach
their full potential.
 Medical management includes treatment of associated conditions, such as heart
defects, hearing or vision problems, and gastrointestinal issues.
 Support from family, community, and medical professionals can also play a
significant role in managing the syndrome.
Write short notes on: Turner’s syndrome.
Turner syndrome, also known as monosomy X, is a genetic disorder that affects females due to a partial
or complete absence of one of the X chromosomes.
Causes:
Turner syndrome occurs due to a missing or abnormal X chromosome.
It is typically caused by a random error during the formation of the reproductive cells in either the
mother or the father.
Physical Findings:
 Short stature with a height typically below the 5th percentile for age and gender.
 Abnormalities of the reproductive system, including a lack of menstrual periods or delayed
puberty, infertility, and underdeveloped ovaries.
 Other physical features may include a broad chest, a low hairline at the back of the neck, and
swollen hands and feet.
Diagnosis:
 Diagnosis can be made through a blood test called karyotyping, which looks at the number
and structure of a person's chromosomes.

 Other diagnostic tests may include ultrasound to evaluate the reproductive system and the
heart, kidney, and liver function tests.
Management:
 Management of Turner syndrome is aimed at treating associated symptoms and complications.
 Hormone replacement therapy may be given to induce puberty and promote normal
development of secondary sex characteristics.
 Growth hormone therapy can be given to improve height.
 Other interventions may include surgery to correct heart and kidney abnormalities and
counseling to address social and emotional issues related to infertility and body image.
Name heat related illnesses and their management
Heat-related illnesses are a spectrum of medical conditions that arise due to exposure to high
temperatures and humidity. The following are some common heat-related illnesses and their
management:
 Heat cramps: These are painful muscle cramps that occur during or after exercise in
hot weather. Treatment includes rest, hydration with electrolyte-containing fluids, and
stretching.
 Heat exhaustion: This occurs when the body loses too much water and salt through
sweating. Symptoms include weakness, fatigue, nausea, dizziness, and headache.
Treatment involves resting in a cool place, drinking fluids, and electrolyte
replacement.
 Heat syncope: This is a sudden fainting spell that occurs in response to prolonged
standing or sudden exposure to high temperatures. Treatment involves moving the
person to a cool place, lying them down, and elevating their legs.
 Heat rash: This is a skin irritation caused by prolonged exposure to heat and sweat.
Treatment includes keeping the affected area clean and dry, using talcum powder or
anti-itch creams, and avoiding tight-fitting clothing.
 Heat stroke: This is a life-threatening condition that occurs when the body's
temperature regulation system fails, leading to a rapid rise in body temperature.
Symptoms include confusion, seizures, unconsciousness, and organ failure.

Treatment involves rapid cooling of the body, intravenous fluids, and supportive care
in a hospital setting.
Prevention of heat-related illnesses involves staying hydrated, wearing loose-fitting and light-
colored clothing, avoiding prolonged exposure to the sun, and taking frequent breaks in cool
places.
What are the heat related disorders? (DU-19M)
Mention the clinical conditions related to excess environmental heat.
Heat related disorders are a group of clinical conditions that arise due to exposure to high
environmental temperatures. These conditions can range from mild heat cramps to severe heat
stroke, which can be life-threatening. Some common heat related disorders are:
 Heat cramps: Muscle cramps and spasms that occur during or after intense physical
activity in hot environments.
 Heat exhaustion: A heat-related illness characterized by weakness, dizziness, nausea,
headache, and sometimes fainting due to dehydration and electrolyte imbalances.
 Heat syncope: A sudden fainting episode caused by prolonged standing or sudden
changes in posture in hot environments.
 Heat rash: A skin irritation caused by sweat that cannot escape the skin due to
blockage of sweat ducts.
 Heat stroke: A medical emergency characterized by high body temperature (> 40°C),
confusion, seizures, and loss of consciousness.
Management of heat related disorders includes immediate removal from the hot environment,
rest, hydration, cooling measures, and electrolyte replacement therapy in severe cases. In case
of heat stroke, immediate medical attention is required.
How do you manage heat stroke?
Heat stroke is a medical emergency that requires prompt and effective management to prevent
complications and death. Here are some points on how to manage heat stroke:
 Call for emergency medical services: Heat stroke is a medical emergency that requires
immediate medical attention. Call for emergency medical services as soon as possible.
 Move the person to a cool and shaded area: Move the person away from the heat source
and into a cool, shaded area. Remove any excess clothing and place the person on their back.

 Lower body temperature: To lower the body temperature, apply cool water or ice to the
person's body, especially the head, neck, armpits, and groin. Fan the person to increase air
flow.
 Monitor vital signs: Monitor the person's vital signs, including their breathing, heart rate, and
blood pressure. Provide oxygen if needed.
 Provide supportive care: Provide supportive care, such as giving fluids to prevent
dehydration, and medications to treat seizures, muscle cramps, and other symptoms.
 Hospital admission: In severe cases, hospital admission is required for close monitoring and
treatment.
It is important to note that prevention is the best approach to heat stroke. This includes staying hydrated,
avoiding prolonged exposure to high temperatures, wearing loose, lightweight clothing, and taking
frequent breaks in cool, shaded areas.
Mention health hazards of global warming?
Global warming can have significant health impacts, including:
 Increased frequency and severity of heatwaves, leading to heat exhaustion and heat
stroke.
 Increased frequency and severity of natural disasters such as floods, hurricanes, and
wildfires, which can lead to injury, displacement, and mental health effects.
 Increased air pollution, leading to respiratory problems such as asthma and chronic
obstructive pulmonary disease (COPD).
 Increased spread of vector-borne diseases such as Lyme disease and malaria as the
range of disease-carrying insects expands.
 Food insecurity due to changes in weather patterns, which can lead to malnutrition
and associated health problems.
 Mental health impacts due to displacement, loss of livelihoods, and other climate-
related stressors.
 These health hazards highlight the need for concerted efforts to address and mitigate
the impacts of global warming.
Mention the disease you can encounter in a smoker.
Smoking is associated with a wide range of diseases, including:
 Lung cancer
 Chronic obstructive pulmonary disease (COPD)
 Emphysema

 Bronchitis
 Cardiovascular diseases such as heart attack, stroke, and atherosclerosis
 Respiratory infections such as pneumonia and influenza
 Oral cancer
 Bladder cancer
 Kidney cancer
 Pancreatic cancer
 Stomach cancer
 Periodontitis (gum disease)
 Reduced fertility in men and women
 Complications during pregnancy and childbirth.
What are the clinical features you will get in case of chronic
arsenicosis .
Chronic arsenicosis refers to the long-term exposure to arsenic, which can cause various clinical
features. Some of the common clinical features of chronic arsenicosis include:
 Skin lesions: Painless skin lesions, such as hyperpigmentation, hyperkeratosis, and
hypopigmentation, may occur due to chronic arsenic exposure.
 Respiratory problems: Chronic arsenic exposure can cause respiratory problems such as
bronchitis, chronic obstructive pulmonary disease (COPD), and lung cancer.
 Neurological symptoms: Chronic arsenic exposure can cause various neurological symptoms
such as peripheral neuropathy, muscle weakness, and paralysis.
 Gastrointestinal problems: Chronic arsenic exposure can cause gastrointestinal problems
such as abdominal pain, nausea, vomiting, and diarrhea.
 Cardiovascular problems: Chronic arsenic exposure has been associated with an increased
risk of cardiovascular diseases such as hypertension, coronary artery disease, and peripheral
vascular disease.
 Cancer: Chronic arsenic exposure has been linked to an increased risk of various types of
cancer, including skin, lung, liver, bladder, and kidney cancer.
It is important to note that the clinical features of chronic arsenicosis may vary depending on the level
and duration of exposure.

Write down the illnesses which may occur at high altitude.
Exposure to high altitude can lead to a variety of medical conditions due to decreased oxygen levels
and changes in atmospheric pressure. Some of the common illnesses that can occur at high altitude
include:
 Acute mountain sickness (AMS): A mild form of altitude sickness that can cause symptoms
such as headache, nausea, fatigue, dizziness, and difficulty sleeping.
 High altitude cerebral edema (HACE): A more severe form of altitude sickness that can
cause swelling of the brain, leading to symptoms such as confusion, loss of coordination,
seizures, and coma.
 High altitude pulmonary edema (HAPE): Another severe form of altitude sickness that can
cause fluid buildup in the lungs, leading to symptoms such as shortness of breath, cough, and
chest pain.
 Hypoxia: A condition that occurs when the body doesn't get enough oxygen, which can lead
to symptoms such as fatigue, weakness, and shortness of breath.
 Frostbite: A condition that occurs when body tissues freeze due to exposure to cold
temperatures, which can cause damage to the affected area.
 Dehydration: At high altitudes, the air is usually very dry, and people may not feel thirsty
despite losing fluids through breathing and sweating. Dehydration can lead to symptoms such
as headache, dizziness, and fatigue.
 Sunburn: The higher altitude means increased exposure to ultraviolet (UV) radiation from the
sun, which can lead to sunburn and increase the risk of skin cancer.

MBBS QUESTION answer history and Gen examination.pdf

Recommended

Recommended

More Related Content

Similar to MBBS QUESTION answer history and Gen examination.pdf

Similar to MBBS QUESTION answer history and Gen examination.pdf (20)

More from PROFESSOR DR. MD. TOUFIQUR RAHMAN

More from PROFESSOR DR. MD. TOUFIQUR RAHMAN (20)

Recently uploaded

Recently uploaded (20)

MBBS QUESTION answer history and Gen examination.pdf