The Board of Examiners. CASES FOR COMMENTARY. 1. A. B., ætat 50, cabman, on admission into the hospital complains of vomiting, headache and drowsiness. His face is pale, the temporal arteries are moderately prominent and tortuous; the pupils are normal and react slowly to light; the muscular system is flabby, but he is not emaciated. The tongue is covered with a thick creamy fur; there is some tenderness in epigastrium; liver dulness is normal; bowels are confined; no cough; percussion note is good all over chest, except at the bases posteriorly, where, although the note is not very dull, it is not so clear as elsewhere; vesicular murmur is heard all over both lungs, at the bases somewhat harsh, and there are a few scattered moist râles in these localities. The арех beat of the heart is removed towards the nipple line, and a little downwards; the impulse is well marked; the heart-sounds are everywhere well defined; the aortic second sound is accentuated; pulse 80, incompressible, arteries atheromatous. Pain in the back, which was present a few days ago, has disappeared. Urine, although still in good quantity, is not so copious as before his present illness; it is of a dark smoky hue, neutral in reaction, sp. gr. 1012; on boiling and adding nitric acid a precipitate falls, which, on standing, occupies more than half the column of urine; blood cells, and a few pieces of epithelial and granular casts are seen on microscopical examination. Temperature 99° F. Patient attributes his present illness to exposure during a cold wet night a week ago. Before this he considered himself in good health, although he admits that he was in the habit, for the last two or three years, of getting up at night two or three times and passing pale urine in considerable quantities. He also states that he has been a fairly temperate man, especially so during the last ten years. He has had several attacks of gout, the last a year ago. Comment on the above case, giving pathology, diagnosis, prognosis, and treatment. 2. C.D., ætat 25, clerk, complains of loss or power in the lower extremities, and giddiness; these symptoms have been gradually getting worse during the last four years. He admits that his habits have been intemperate, and states that he had a fall on his head about four years ago, and that his memory is defective. On examination, the pupils are found to be irregular, but react to light; the optic discs are normal; there is nystagmus of both eyes. The expression of the face is somewhat vacant, but there is no facial paralysis. The speech is "scanning." tongue is protruded in the straight line. On attempting to drink a glass of water, either hand that is raised to his mouth, though before perfectly steady, is seized with a tremor, and the glass comes against the mouth with a jerk. He walks with difficulty, the gait is more paralytic than ataxic, and the deep reflexes are exaggerated. The electrical reaction of the muscles is normal. The bowels are much confined. The Comment on the above case, giving the pathology and prognosis, and the differential diagnosis between it and the other diseases for which it might be mistaken. OBSTETRICS AND DISEASES OF WOMEN The Board of Examiners. 1. Describe the formation and structure of the placenta, giving the more important theories. 2. Discuss the subject of extra-uterine fœtation. 3. Give the mechanism of delivery in head presenta- (a) In contraction of the pelvic brim. FORENSIC MEDICINE AND PSYCHOLOGICAL The Board of Examiners. 1. Enumerate the different conditions which constitute impotence in the male and sterility in the female. 2. Mention circumstantially the various reasons which are claimed by insurance companies to invalidate a life policy. 3. What are the cadaveric appearances severally in death by lightning, cold, and starvation? 4. What are the sources of error to be guarded against in examining stains supposed to be those of blood? A 5. When the plea of insanity is raised as a bar to punishment in criminal cases, what is the mode of procedure to be adopted in the examination of the subject of such plea? 6. What methods are resorted to by those who engage in the practice of criminal abortion? 7. Give the symptoms and post mortem appearances in poisoning by oxalic acid, hydrocyanic acid, acetic acid, and carbolic acid. HONOUR EXAMINATION IN SURGERY. SURGERY. The Board of Examiners. 1. Describe the symptoms, diagnosis, prognosis, and treatment of the two following forms of disease: -(a) The common polypus of the nasal cavities. (b) The naso-pharyngeal polypus. Supposing operation to be determined on, give the details of the operation you would select for the removal of each of these forms of disease respectively. 2. Describe the mode of formation of a renal calculus, the symptoms following its formation, the diagnosis, and the treatment. 3. What are the malpositions of the fragments which sometimes follow a simple fracture in the middle third of the shaft of the radius? How are they caused, and how prevented? SURGERY. The Board of Examiners. CASES FOR COMMENTARY. 1. A man received a smart blow from the end of a blunt iron chisel on the side of his head, just above the ear, causing a linear fracture about an inch long; he was not rendered insensible, but continued to go about for several days, and was not brought under surgical treatment till ten weeks after the receipt of the injury; he was then dying, and died in a few days. Describe the probable condition of the parts at the seat of injury a few hours after its infliction, and the proper treatment at that period. Describe also the subsequent changes, local and constitutional, likely to follow in this case, and their proper treatment. 2. A patient is placed under your care who a few hours previously was wounded by a pistol shot, which struck him on the outer side of the right nipple; he is suffering from emphysema and hæmoptysis, with difficult breathing, and some collapse. What are the points that require special investigation and attention in the examination and treatment of such a case? |