RESPONSE TYPE OSPE

ROSPE.1
A pregnant women at 24 weeks of gestation
was advised to undergo oral glucose
tolerance test. Oral glucose tolerance test has
been performed and graph is displayed .
 OGTT
275 3; Blood Glucose ; 270

4; Blood Glucose ; 240

225 5; Blood Glucose ; 220
2; Blood Glucose ; 210

175 1; Blood Glucose ; 170

BLOOD GLUCOSEE (mg/dl)

125

75

25

1; Time (Hrs); 0 2; Time (Hrs); 0.5 3; Time (Hrs); 1 4; Time (Hrs); 1.5 5; Time (Hrs); 2
1 2 3 4 5
Time (Hrs) 0 0.5 1 1.5 2
Blood Glucose 170 210 270 240 220
1.Comment on graph displayed .(1mark)
2.What is probable diagnosis ? (1mark)
3.Mention reference ranges for fasting and
postprandial blood Glucose? (2marks)
4. Mention normal renal threshold level for
glucose . (1mark)
 Answers
1.Decreased Glucose tolerance
2. Gestational Diabetes Mellitus
3. FBS: 70-100 mg/dl
PPBS : 70-140 mg/dl
4. 180 mg/dl
 NORMAL OGTT
150
3; Blood Glucose ; 145
2; Blood Glucose ; 135
130

110
4; Blood Glucose ; 100
90 1; Blood Glucose ; 90
BLOOD GLUCOSEE (mg/dl)

70 5; Blood Glucose ; 70

50

30

10
1; Time (Hrs); 0 2; Time (Hrs); 0.5 3; Time (Hrs); 1 4; Time (Hrs); 1.5 5; Time (Hrs); 2
1 2 3 4 5
Time (Hrs) 0 0.5 1 1.5 2
Blood Glucose 90 135 145 100 70
ROSPE.2.
A 35 yr old man present to Medicine OPD
with complaints of increased thirst and
urination and increased appetite for the past 6
weeks .The physician advised OGTT. Oral
glucose tolerance test has been performed
and graph is displayed
Time (Hrs) Blood Glucose
0 220
0.5 260
1 320
1.5 290
2 270
 325 3; Blood Glucose ; 320

4; Blood Glucose ; 290

275 5; Blood Glucose ; 270
2; Blood Glucose ; 260

225 1; Blood Glucose ; 220

175

125

75

25

1; Time (Hrs); 0 2; Time (Hrs); 0.5 3; Time (Hrs); 1 4; Time (Hrs); 1.5 5; Time (Hrs); 2
1 2 3 4 5
Time (Hrs) 0 0.5 1 1.5 2
Blood Glucose 220 260 320 290 270
1.Comment on graph displayed .(1mark)
2.What is probable diagnosis ? (1mark)
3.What are the signs and symptoms of
Diabetes mellitus ? (1mark)
4. What is WHO criteria for diagnosing
Diabetes mellitus. ?(2 marks )
 Answers
1. Decreased Glucose tolerance
2. Severe /uncontrolled diabetes
3. Polyuria, polydypsia,Polyphagia ,loss of
weight.
4. WHO’s CRITERIA
Parameters values
Fasting plasma glucose ≥126mg/dl

Random blood glucose ≥200 mg/dl

HbA1c >7
ROSPE.3.
1.Based on the above findings , what is the probable
diagnosis? (1 mark)
2.What are Bence jones proteins? (1 mark)
3. Name any 2 tests to detect them in urine. (1mark)
4. Mention the confirmatory test.(1 mark)
5.Which type of immunoglobulins are elevated in this
disorder. (1 mark)
 ANSWERS
1.MULTIPLE MYELOMA
2.These are light chain proteins excreted in urine
of Multiple myeloma patients.
3.Bradshaw’s test and Acetic acid test
4.Immunofixation electrophoresis
5.IgG.
ROSPE.4.
1.Identify the sign in the picture.(1 mark)
2.In which disease you will see this sign? (1 mark)
3.In which mineral deficiency you will observe this
sign .(1 mark)
4.Which protein transports this mineral. (1 mark)
5.What are the functions of this mineral? (1 mark)
 Answers
1.Keiser fleisher ring
2. Wilson’s disease.
3. Copper.
4. Ceruloplasmin.
5.Cofactor for many enzymes like
cytochrome oxidase and ALA synthase
ROSPE.5.
A 34 year old woman visited general practitioner
because of dizziness, excessive tiredness and was
out of breath on walking. On examination she had
pallor and her nails appeared as shown in fig.
• Lab findings shows
• Hb-8.7 gm%
• RBS-106 mg/dL
• Serum total proteins:7 gm/dL
• Blood smear showed hypochromic microcytic
RBC
1.What is the sign u see in this picture? (1mark)
2. In which condition do you see this sign?
(1mark)
3.What is the main cause of this condition in
children? (1mark)
4.What is RDA of this mineral. (1mark)
5.What are the factors influence this mineral’s
absorption? (1mark)
 Answers
1.Koilonychia
2.Iron defeciency anaemia
3.Hook worm infestation
4.Adult-10 mg/day
Children -30 mg/day
Pregnant and lactating women-40 mg/day
5.Ascorbic acid, Acidity promote absorption
Phytates and oxalates inhibit absorption.
ROSPE.6.

Serum calcium -4 mg/dl

Serum inorganic phosporus – 2.5 mg/dl
 Questions
1. What is the clinical sign elicited in the above
picture? (1mark)
2. Comment on blood reports (1mark)
3. Mention the normal serum Calcium level and
serum Phosphorus levels . (1mark)
4. Mention two causes for the above condition.
(1mark)
5. What is RDA of required mineral ? (1mark)
 Answers
1.Trosseau ‘ sign ,Chevstek sign
2.Hypocalcemia -Tetany
3. Normal serum calcium – 9-11mg/dl
Normal serum phosporus -3-5 mg/dl
4.Postmenopausal women ,Vitamin D deficiency .
5.Adult -800 mg/day ,child -1.2g/day
Pregnancy, lactation ,Postmenopausal women
1.5g/day
ROSPE.7.
A 12 yr old girl visited oral medicine
OPD with complaints of yellow to
brownish discoloration of teeth. Her
brief history revealed similar cases in
her locality after drinking locally
available water. On examination of her
oral cavity following findings are seen.
 Questions
1 What is the propable diagnosis? (1mark)
2.Mention safe limit and toxic level of above
required mineral ? (2mark)
3. What are the clinical features of deficiency of
this mineral(1mark)
4. How do you prevent mottling of teeth ?
(1marks)
 Answers
• 1.Dental flourosis
• 2. Safe limit <1 PPM
• Toxic limit >5 PPM for dental fluorosis
• >20 PPM for skeletal fluorosis
• 3.i. Dental caries
ii. Skeletal Flourosis .
• 4.Flouride free water , restriction of jowar
intake , regulation of flouride content .
ROSPE.8.

Investigations Method Report

Urinary sugar Benedicts test ++
Urinary sugar Glucose oxidase Method -
1.what is the probable diagnosis ? (1mark)
2.what is the biochemical defect ? (1mark)
3.What is the mode of inheritance? (1mark)
4.What foods should be avoided in above
condition? (1mark)
5.What is the cause of Cataract in this condition?
(1mark)
 Answers
1. Galactosemia
2. Galctose -1- Phosphate uridyl Transferase
3. Autosomal Recessive
4.Cow milk,butter,yougurt ,cheese ,ice cream
5.Cataract formed from production of
Galactitol ,which osmotically damages lens fibre
ROSPE.9.
10 months old boy presents with pallor and
abdominal distension both of which are
progressive . The perinatal history was un
eventful and boy is noted to be pale , with poor
feeding decreased activity and failure to thrive .
Hepatospleenomegaly and mild bony
abnormalities of skull is noted( frontal parietal
bossing)
 Questions
1.What is your pobable diagnosis ? (1mark)
2. What is biochemical defect? (1mark)
3.What is the cause of this disease ? (1mark)
4.What are the types of above condition?
(1mark)
5.What is diagnostic test advised ? (1mark)
 Answers
1.Thalassemia
2.Decreased production of atleast one type of
globin polypeptide chain
(alpha,beta,gamma,delta)
3. Defect in post transcriptional processing of
mRNA
4.Alpha thalassemia and Beta thalassemia
(major ,minor,intermedia)
5.Hemoglobin electrophoresis .
ROSPE.10.
 Questions
1.What is your probable diagnosis ? (1mark)
2 .What is the biochemical defect? (1mark)
3.What is pathophysiology behind
vaso occlusive events ? (1mark)
4.What are the investigations required to
diagnose the condition? (1mark)
5.What is the treatment ? (1mark)
1.Sickle cell anemia
2.Glutamic acid in 6th position of the beta chain is
replaced by valine in HbS.
3.Polymerisation of sickle hemoglobin in RBC can be
triggered by hypoxia and acidosis ,which causes
cells to become rigid and deform into sickle
shaped, causing vasoconstriction .
4.Electrophoresis, HPLC, Peripheral blood smear,
Reticulocyte count ,Serum Iron estimation
5.Repeated blood transfusions, Antisickling agents-
hydroxyurea,cyanate,sodium butyrate will induce
HbF production .
ROSPE 11.
A 15 year old girl from remote village
came to medicine OPD with complaints
of frequent episodes of diarrhoea,
rashes around the neck and poor
performance in school .History revealed
that that her family’s staple food was
maize .Her blood sample was sent for
investigations .
 Questions
1.Spot the diagnosis ? (1mark)
2.What vitamin defeciency causes above
disease? (1mark)
3.Which amino acid supplement will reduce the
symptoms? (1mark)
4.Mention the coenzyme forms of the vitamin ?
(1mark)
5.What are the other clinical features? (1mark)
 Answers
• 1.Pellagra
• 2.Staple food –Maize
• 3.Tryptophan
• 4.NADP+ and NAD+
• 5.Dementia,Dermatitis,Diarrohea.
ROSPE :12

Serum TSH:120mU/L
Serum T3:75 ng/dL
Serum T4:2.5 սg/dL
 Questions
1.Identify endocrine deficiency of this entity?
(1mark)
2.Interpret the hormonal assay? (1mark)
3.In children this condition is called -----(1mark)
4.How is BMR status in this condition? (1mark)
5.How is cholesterol level in this condition ?
(1mark)
 Answers
1.Hypothyroidism
2. Increased TSH,Decreased T3 AND T 4
3.Cretinism
4.BMR is decreased
5.Hypercholestralemia-
ROSPE :13
 Questions
1.Identify the sign favoring the diagnosis?
(1mark)
2.In which disorder do you see this?(1mark)
3.What are other clinical features? (1mark)
4. Which hormone is decreased ,mention it’s
normal level ?(1mark)
5. What is the cause for hyperglycemia? (1mark)
 Answers
1.Exopthalmos
2.Graves disease (Hyperthyroidism)
3 . Tachycardia, menstraul irregularities,
sleeplessness, tremors and muscle weakness,
Weight loss inspite of increased appetite , heat
tolerance, palpitations, restlessness, swaeting,
tremors .
4. Serum TSH: 0.5-5 mU/L
5. Hyperglycemia: Thyroid Hormone promote
intestinal absorbtion of glucose, increases
glycogenolysis and gluconeogenesis.
ROSPE :14

D B

C
 Questions
1.Identify the structure and comment on the
shape. (1mark)
2. Identify the A site and site B ? (1mark)
3.Which enzyme cleave the structure? (1mark)

4. What are functions of A,B,C,D ? (2mark)

 Answers
1.t RNA clover leaf shaped structure.
2.Acceptor arm, D Arm
3.Ribozyme
4.Acceptor Arm- carries the amino acid
Anticodon arm-recognises the triplet nucleotide
codon present in m-RNA.
D Arm-recognition site for the enzyme which adds
the amino acid .
T Ѱ C Arm-involved in binding t -RNA to ribosomes.
ROSPE :15
 Questions
1.Spot the diagnosis ? (1mark)
2. What is reason for this condition? (1mark)
3.What is RDA and good sources of above
required vitamin ? (1mark)
4.What are the functions of this vitamin?
(1mark)
5.What are other deficiency manifestations of
this vitamin ? (1mark)
 Answers
1.Scurvy
2.Vitamin C deficiency,
3.60-75 mg/day, amla and citrus fruits
4.Collagen formation, iron and hemoglobin
metabolism, antioxidant ,role in lipid
metabolism(carnitine),tyrosine and tryptophan
metabolism, phagocytosis and adrenal hormone
synthesis
5.Spongy sore gums, loose teeth, anemia, swollen
joints, fragile blood vessels, delayed wound healing
ROSPE :16
 Questions
1.What is your probable diagnosis ? (1mark)
2. what is biochemical defect? (1mark)
3.What is the effect of this biochemical defect?
(1mark)
4.What is mode of inheritance ? (1mark)
5.What are the clinical manifestations? (1mark)
 Answers
1.Albinism
2.Tyrosinase defeciency
3.Melanin is not synthesized in melanosomes.
4.Autosomal recessive
5. Skin and hair are milky white ,Photophobia,
Nystagmus, susceptibility to skin cancer