HONOUR EXAMINATIONS IN MEDICINE.

THEORY AND PRACTICE OF MEDICINE.

The Board of Examiners.

1. State fully the points to be attended to in the differential diagnosis of tumours of the medias

tinum.

2. What are the causes of dilatation of the bronchial tubes, its signs, symptoms, and proper treatment ?

3. Describe the pathology of the condition known as infantile paralysis, with its symptoms, prognosis, and treatment.

CLINICAL MEDICINE.

The Board of Examiners.

CASES FOR COMMENTARY.

1. A. B., æt. 32, male, by occupation exposed to great and sudden changes of temperature, when seen had been ill for about a month. He had first felt "pins and needles" in fingers of both. hands, followed by numbness and increasing weakness, the feet becoming affected in a similar

way a fortnight later. With the numbness there was a dead aching pain about the wrists and ankles, with some tenderness on pressure. On examination there was such loss of power in arms and legs that he could not raise himself from the bed without assistance, and when supported in the sitting posture could not put one leg over the other. He could not pick up a pin from a flat surface. Sensation was greatly impaired in the hands and forearms, and in the feet and lower part of the legs, especially down the front. Patellar and plantar reflexes were lost, and there was no ankle clonus. The bowels had, all along, been regular; and there was no difficulty in micturition; the general health was good, and he ate and slept well; and while he was under observation there was no rise of temperature observed. Though so helpless, there was never any threatening of bedsore.

Discuss the nature of the condition, its prognosis, and the treatment to be adopted.

2. C. D., aged 40, butcher, of intemperate habits, complains of shortness of breath on exertion and inability to lie down in bed; also of some cough, with slight viscid expectoration. On examination the feet and legs are found to be oedematous. The veins of the neck are distended and pulsating, no apex beat is visible in the ordinary position, but there is epigastric pulsation. Both heart sounds are heard free from any bruit at the mitral, aortic, and pulmonary areas, the second sound being accentuated in the latter position. At the lower end of the sternum there is a distinct bruit, systolic in time and not transmitted.

The area of liver dulness is increased, the spleen is enlarged, and there is evidence of fluid in the peritoneal cavity. The pulse is regular and of fair strength. Urine is diminished in quantity, higher than natural in colour, of sp. gr. 1030, and depositing pink lithates on standing. On heating, at first the deposit dissolves, and then the urine becomes cloudy and does not clear up on the addition of nitric acid. No tube casts.

Comment on the above case, giving etiology, diagnosis, prognosis, pathology, and treatment.

OBSTETRICS AND DISEASES OF WOMEN
AND CHILDREN.

The Board of Examiners.

1. Describe fully the life-history of the Decidua.

2. What are the causes, conditions, and treatment of difficult Occipito-Posterior positions?

3. Give the etiology, progress and results, diagnosis, and treatment of Salpingitis.

SURGERY.

FIFTH YEAR.

The Board of Examiners.

1. Describe the local and constitutional symptoms, also the dangers, attending acute deep-seated

abscess in the neck. Give the treatment you would adopt.

2. Describe the various forms of ankylosis of the knee joint. State the causes, diagnosis, and treatment of each respectively.

3. Give the history, symptoms, and treatment of an ordinary case of tubercular testis in which the disease commenced in the epididymis.

SURGERY.

FIFTH YEAR.

The Board of Examiners.

CASES FOR COMMENTARY.

1. A lady, aged 45, seeks your advice in consequence of an irreducible swelling proceeding from the femoral ring on the right side. She says that she has suffered from femoral hernia on this side for five or six years, and has worn a truss, the hernia being always reducible until lately; she cannot state the exact time when it became irreducible. Her attention was directed to it ten days ago, for it then became painful, and she could not reduce it; in three or four days both pain and swelling had increased. There was no vomiting, and the bowels acted naturally. Rest, a restricted diet, and the application of ice, were prescribed, without improvement, beyond diminution of pain.

On examination you find that there is a circumscribed fluctuating tumour, the size of a large duck's egg, occupying the usual situation of a femoral hernia, and extending outwards to within two inches of the anterior superior spine of the ileum. There is no particular pain or tenderness in it at this time, no direct impulse on coughing, it is dull on percussion, there is no abdominal distension, no vomiting, the bowels have acted three days before, the tongue is slightly furred, the pulse and temperature are both normal. She is very anxious to get rid of the swelling.

What would be your diagnosis, prognosis, and treatment in this case? State the reasons for

the conclusions you arrive at.

2. A man, aged 50, is admitted to a hospital. A few hours ago he was working in a mine, and while lying on his side a large mass of stone fell and struck his right thigh and leg. On admission he was suffering slightly from shock, but was perfectly conscious. There was a simple fracture of the femur just above the condyles, a little shortening of the limb, with slight deformity at the knee, which was easily reduced. There was some swelling of the limb, both at the seat of fracture and in the calf; below the knee the limb was cold to the touch, and no pulsation could be felt in either of the tibial arteries.

Explain the causes of these symptoms, and describe what you believe to be the precise nature of the injuries both to bone and soft parts. How would you treat the patient? Give your reasons for the treatment you would adopt.