.jpg)
KATHMANDU UNIVERSITY
University Examination
January/February 2026
Level: MBBS
Paper: IX – Introduction to Clinical Medicine
Exam: II MBBS
Time: 2 hours 30 minutes
Marks: 50
Date: February 25, 2026
#INSTRUCTION TO THE CANDIDATE
Answer each section in a separate answer book.
Write brief, relevant and legible answers.
Illustrate your answer with well labeled diagrams wherever required.
All questions are compulsory.
#SECTION “B”
#Short Answer Questions
1. Define fever. List 4 common infectious and non-infectious causes of fever. Compare and contrast any 3 types of fever patterns with one example of each.
[1 + 1 + 3 = 5]
2. Why is the assessment of the JVP important in clinical examination? Describe how it is measured and list 4 conditions where it is elevated.
[1 + 3 + 1 = 5]
3. A 25 years old woman presents with abnormal vaginal discharge. What are the key history questions and physical examination steps?
[2.5 + 2.5 = 5]
4. Enumerate common causes of dehydration in adult and children. List the clinical signs used to assess dehydration in a patient.
[1.5 + 1.5 + 2 = 5]
5. Describe clinical features that help distinguish between hyperthyroidism and hypothyroidism. Enlist any 4 clinical findings specific for Graves’ disease.
[4 + 1 = 5]
6. What are the danger signs (red flag signs) in a patient presenting with headache? Enumerate the key CNS findings you would look for in a patient with suspected meningitis. Describe the technique to elicit any one of them.
[1.5 + 1.5 + 2 = 5]
#SECTION “C”
#Problem Based Questions
#Problem – I
7. A 60 years old male, known case of hypertension and COPD was brought to the hospital with complaints of cough and increased shortness of breath.
a. What are your differential diagnoses for shortness of breath in this case? [2]
b. What further history would you like to elicit in this patient and why? [4]
c. Compare and contrast the clinical findings of any two of the differential diagnosis involving respiratory and cardiovascular system. [4]
#Problem – II
8. A 46-years old female, presents to the hospital with right upper quadrant (RUQ) abdominal pain associated with fever, nausea and decreased appetite. She is non-smoker and drinks alcohol occasionally.
a. List the most likely differential diagnosis for this patient’s RUQ pain. (Include at least one abdominal and one thoracic cause) [2]
b. What features in the history and physical exam would help differentiate between any two of them? [5]
c. What is Murphy’s sign and what is its clinical significance in this case? [3]
