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Career Guideline

Questions of Punjab Public Service Commission for the posts of Medical/ Lady Medical Officers

Today we will share Questions most commonly asked in the exam of Punjab Public Service Commission for the posts of Medical/ Lady Medical Officers. So these questions are must to do.



1 What is differential diagnosis of 50 year old male with low GCS?
2 What will be the Management of patient with low GCS?
3 Deliver a 5 minutes lecture on different types of hernia.
4 What is Thyroid storm management?
5 What is Malabsorption syndrome?
6 What is Metabolic syndrome?
7 How to prevent drowning in children?
8 How to reduce fear of anything like drowning?
9 Differentials of pain RHC
10 how is asthama treated?
11 What is EPI schedule?
12 Explain investigation and treatment of Cholelithiasis.
13 What is courviser law?
14 What are the main features of Nephrotic syndrome?
15 What is Marasmus and kwashiorkor?
16 Who supervises field staff at BHU level?
17 How to diagnose and manage malnutrition at bhu level?
18 How to manage pregnant pt with ms in active Labor?
19 What are acute and chronic appendicitis?
20 Chylomicrons,apolipoproteins, respiratory distress syndrome,surfactant name,
21 What is lecithin sphingomyelin ratio PPH mangement placenta previa?
22 What are causes of compliance fatty liver?
23 What is difference between incised and lacerated wound?
24 What is Dry socket?
25 How is dry socket treated?
26 What is Local anesthesia dose?
27 What is Role of adrenaline in LA?
28 What are Complications of tooth extraction?
29 Waht are Objectives of surveyor in prosthodontics?
30 What is difference between open and closed extraction?
31 Describe Bhu organogram.
32 What is Differential diagnosis of Right Upper Quadrant Pain?
33 What is Treatment of acute cholecystitis?
34 An unconscious patient comes to your BHU How will you deal with it?
35 Why adult polio dose is given?
36 How to identify Intestinal perforation?
37 What is scabies? Organism causing scabies?
38 What is Psoriasis? Is it skin condition or systemic?
39 What is Eczema? Explain
40 For what health purpose malinda and bill gates are spending money in Pakistan?
41 What are causes of infertility?
42 What are ECG changes after 6 hrs of MI?
43 What are Laporotomy scars?
44 How many layers are opened during open cholecystectomy?
45 What is Incisions of appendectomy?
46 What is Normal and Random sugar levels?
47 How can you confirm a person is diabetic?
48 Tell about Dog bite management and vaccination?
49 Explain primary and secondary closure of dog bite.
50 What is Stroke, its types, risk factors and prevention?
51 Type of spinal needle and its gauge.
52 What is dose of lignocaine?
53 In which hand one use laryngeoscope?
54 What are Local anesthetics?
55 If a person’s comes to you at your Rhc wit BP over 200/120 what will you do?
56 Tell Typhoid investigation of choice.
57 Describe differential diagnosis of Right hypochondrial pain.
58 Describe differential diagnosis if a patient found unconscious in field.
59 What is intestinal perforation?
60 What is Scenerio of domestic violence?
61 What are difference types of joints?
62 What is the number of cervical vertebrae and nerves?
63 What is the total number of vertebre and name them.
64 Describe Atrial fibrillation management and ECG changes
65 Which things you wil check if pateints come during 2nd trinester but first visit?
66 What are the Causes of IUD?
67 Describe Sheehan syndrome.
68 Describe management of diarrhea in kids at THQ level.
69 If pt come with hx of Fitz what will ur steps of management at thq level?
70 A patient has high BP in pregnancy. What will be the terminology for this? And how ill you manage it?
71 What is RCT?
72 Describe DD of chest Pain.
73 What is TTO of MI and investigation?
74 Case senario of Pulmonary embolism investigation and tto
75 What is Drug Reaction and TTO of shock?
76 What is ECG?
77 What are types of MI?
78 What are Ecg changes in MI (STEMI NSTEMI)?
79 Describe Criteria for SK
80 What are the types of Ventricular tachycardia? Describe its management.
81 What is Vasovasal syncope management and how to counsel patient and family?
82 Describe Cardiac arrest management at primary and secondary level
83 Describe Role of Neurosurgery in haemorrhage
84 What are different types of haemorrhage. Describe intra and extra management.
85 What are types of Raised ICP? How is it managed?
86 Whata are Types of shunt in ICP?
87 How to check patency of shunt?
88 What are Duties of MO IN RHC?
89 How is TB treated?
90 What are 2nd line drugs? What are Side effects?
91 How to collect data for such patients?
92 What is emergency treatmnent for dog bite and sanke bite?
93 Describe rabies management.
94 What is Spinal anesthesia complication?
95 Needle used for spinal anesthesia
96 Describe Preparation for spinal anesthesia.
97 What is CPR?
98 What does AED stands for?
99 Describe treatment of malaria.
100 What is role of breast feeding in contraception?
101 What is the schedule of measles vaccine if given after 9 months?
102 What is Hernias?
103 Appendicitis scoring system and interpretation
104 What is Scenerio of acute abdomen?
105 What are aflatoxins?
106 What are Social diseases?
107 Causes of pain abdomen?
108 During 3rd molar surgery, inferior alveolar artery is cut, how to manage? How will you clamp the artery?
109 What is the Classification of TMJ ankylosis?
110 Describe Adverse effects of LA.
111 What is ASA classification of local anesthesia?
112 What do you call a specialist in anesthesia? Anaesthetist or anesthesiologist?
113 What is Lumbar Stenosis and how do you treat it?
114 Describe management of DKA.
115 What is mantrels score for appendicitis?
116 A person came with trauma mark on the flank what would you do at the perihery?
117 wahWhat is Obesity and its risk factors.
118 What is a triphasic CT scan? Why we do triphasic CT scan in HCC complication of liver cirrhosis?
119 What are the techniques used in waste management?
120 What is the treatment of pre-eclampsia?
121 How would you treat pt with RTA at periphery?
122 How would you treat a patient of Cerebral malaria?
123 What is Pulmonary fuction test?
124 Can you give medical certificate for leave without examintaion of diseased person or on phone call?
125 Whta is Herd Immunity?
126 What is neonatal jaundice
127 The budget which is consumed to fullfill the vitamins requirements of population how this budget can be reduced?
128 In which speciality President Dr. Arif Alvi is a doctor.
129 What are the Side effects of face mask?
130 How will you manage a patient with femur fracture, EPI and covid?
131 Define shock and what are the types of shock?
132 How will you differentiate cardiac pain from other pains in emergency situation?
133 How can we kill spores?
134 What is Respiratory distress syndrome?
135 Describe asthama. Its pathophysiology, diagnosis and management.
136 What is perinatal mortality?
137 What is indication of C-Section?
138 What are the causes of perinatal mortality?
139 Describe pathophysiology of phototherapy.
140 What are the precautions and treatment of migraine?
141 How would you take antenatal care of mother?
142 how diabetes management is done?
143 What is the treatment of Choriocarcinoma?
144 Define complete and partial mole. What are their complications?
145 What is the daily requirement of Iodine?
146 Describe following: Eclampsia, stone disease, upper GI bleed and APD
147 What is the presentation of MI
148 Describe following: ECG findings, ECG leads and Apgar score.
149 Describe Investigations and management of Meningitis.
150 What are the Sign and symptoms of fracture if base of skull?
151 Describe management of cardiac arrest.
152 Describe Management of bronchial asthma.
153 Whata is Water borne disease?
154 What are Vector born diseases?
155 What things are required for folleys catheter?
156 What are Signs symptoms of acute appendicitis?
157 What is Compartment syndrome/
158 What is population explosion? What are its side effects and how to control it.
159 Waht are maternal mortality rates ratios?
160 Which model is used for breaking the bad news?
161 What are the four fundamentals of ethics?
162 What are the causes of iron deficiency and anemia?
163 What are types of contraceptives?
164 Which contraceptives can be used patient of breast cancer?
165 What is mirena, its composition, for how long it provides contraception
166 Whata are Contraindications of contraceptive?
167 Which anti psychotic causes weight gain?
168 What is primary health care?
169 What are the types of consent?
170 Name an Anti diabetic.
171 What is Eczema?
172 What is pediatric diarrhea?
173 What are medicolegal cases?
174 Case of RTA
175 What is Urology?
176 What is URS?
177 How to approch kideny stones?
178 What is Oncology.
179 What are the types of Lung cancer ?
180 What is Breast cancer and its treatment options?
181 What are Signs of depression?
182 What are Negative symptoms of schizophrenia?
183 How do SSRI act? Why are they called a wonder drug?
184 How would you manage Acute Myocardial Infarction in a BHU? Emergency to admission to follow up?
185 What are the Antibiotics used for typhoid, amebiasis and gastroenteritis?
186 What is the Use of diloxanide furoate?
187 Describe management counselling of Diabetic foot.
188 What is the difference between Neonatal jaundice and pathological janudice ?
189 What is humidity? Its reasons and covid cases during humidity.
190 Describe following : infant, toddler, diarrhea management and TB dots.
191 What are parts of Fallopian tube?
192 What are contraindicated and indicated drugs during pregnancy?
193 How to prevent maternal mortality in Pakistan?
194 What is the best IV antibiotic to treat pneumonia?
195 How Hypertensn is treated?
196 What is mole, CBC and lipid profile. What do you check in these tests?
197 What are the types of Anemias?
198 What are Causes of respiratory failure?
199 What is cyanosis and it’s types?
200 How to run polio compaign?
201 What is Organophosphates Poisoning?
202 What is the difference between Typhoid and Paratyphoid fever?
203 What is bacillary dysentery?
204 What is the diagnostic criteria of Typhoid fever?
205 What is HTN?
206 What is Hyperthyroidism?
207 What are C-Section complications?
208 What are Anesthesia complications?
209 Have you seen CT angiography?
210 What can be the side effects of contrast used for CT scan?
211 What can be side effects of steroids?
212 What is acute abdomen?
213 What is hystereotomy?
214 What are sites of ectopic pregnancy?
215 What is Green stick fracture?
216 What is disease surveillance?
217 What is type of hemmorrage in patient regarding surgery?
218 What are different type of bleeding disorder?
219 What is extrinsic and intrinsic pathways?
220 What is Pulmonary edema?
221 What is Epidemics and Hepatitis?
222 Dhq AWD in children?
223 What are types of shock?
224 What is Integrated program of child management?
225 What is Dehydration plan?
226 What is Pre-ecclampsia?
227 What is Palliative treatment?
228 A child injected measles vaccine and suddenly collapsed what will you do?
229 Which is the most important step in management of status asthmaticus?
230 How to treat gestational diabetes?
231 Describe meningitis in children.
232 What are viral bac differentiation and complications?
233 What is pneumothorax and tension pneumothorax? and its emergency management at the level of RHC.
234 Waht are Common urological emergencies?
235 What is APH
236 What is PPH? How would manage PPH
237 How a mother will feed the twins?
238 Waht is Absolute contraindication of breast feeding?
239 What is Stevens Johnson Syndrome and how will you manage the patient at BHU.
240 Waht are types and used of Burnishes?
241 What is Plunger?
242 Where is pear shaped bur used?
243 Give detail about Sjogrens.
244 What is Xerostomia
245 What is Tuberculosis
246 What is Gumma
247 What is Tongue tie
248 How will you manage a child with RTA avulsed tooth?
249 What is Dentigerous cyst fate?
250 How can we get these collected questions ??
251 What is Diastolic murmers?
252 What are several nephrotic syndrom complains in patient?
253 What is Tension pneumothorax and Open pneumothorax?
254 What are I/V fluids?
255 What are Rules of 9 for burn patient?
256 What is CPR and ATLS?
257 which column of spinal cord is damaged by Polio virus?
258 Describe diarrhea management.
259 What is APGAR score?
260 Meningitis
261 Whta is Palliative treatment?
262 Describe 1st Aid of RTA.
263 Is cardiac syncope pathological or physiological?
264 What should a patient do before syncope to prevent it?
265 Is snoring caused by URT or LRT?
266 Which is the danger area of face?
267 Which is the Tumor causing hypertension?
268 Give definition of eczema
269 Give types of hypertension?
270 Describe Managment of CLD patient.
271 What is Portal hypertention?
272 What is Normal pressure in portal vain
273 Give Types of wound?
274 What is the Difference between firearm entry and exit wound?
275 What are Anti tuberculosis drugs with one side effect each.
276 Describe anemia in pregnancy and it’s treatment in each trimester.
277 Describe Management of eclampsia.
278 How would you treat dehydration of 1 year kid in emergency?
279 Which is the latest vaccine added in EPI, and why?
280 What is the Percentage of pregnant women having iron deficiency anemia?
281 What is anemia
282 What is Colle’s fracture?
283 Describe following : Hemoptysis, hematemesis, ECG and TOF
284 What are the types of surgical incisions for abdominal surgery?
285 What does Sirs mean in COVID?
286 What are mantrels in acute appendicitis?
287 What is Hydatid cyst?
288 What is Rabies?
289 How will you treat anemia in pregnancy?
290 What are Protozoal diseases?
291 Describe Treatment of heart failure.
292 What are the Effects of beta blockers all over the body?
293 What is BMR and how to calculate it?
294 A women in her 50s came to you with the complaint that she had excessive sweating and feels too hot what would you do?
295 What is the Difference between isolation and Quarantine?
296 What is the Difference between epidemic and pandemic?
297 Describe specific Treatment of Covid.
298 Which Antiviral is used for treatment of COVID?
299 What is anaphylactic shock?
300 Describe managment of Honey bee bite.
301 How to d-potash a patient?
302 What is Lipid profile and its values?
303 What is Cardiac arrhythmias
304 What is Gestroentritis?
305 Which is the most dangerous arythme?
306 What are the Causes of spread of HIV?
307 What is rheumatic fever and most commonly valve involvement?
308 Describe management of fever in BHU?
309 What is OGTT and it’s normal values?
310 What is fistula and it’s examples?
311 What is ruptured ectopic pregnancy?
312 What are Causes of tooth decay?
313 Tell steps of RCT.
314 What are vesicullobullous lesions?
315 What are the Principles of instruments in extraction?
316 What are the Causes of crown breakage during extraction?
317 How to retrieve broken root?
318 What does HIDA stands for? How it is performed?
319 What are Rhinolith, Rhinitis, labour 3rd stage and pneumothorax of both lungs management?
320 What is upper and lower bleed?
321 What is the difference between hemoptysis and haematemesis?
322 Give Methods of contaception.
323 How fulminant hepatic failure is managed?
324 You are sitting in DHQ Hospital on Duty as Medical Officer Suddenly a Staff Nurse Comes to you and tells you that while she was administering Medicine to the Patients a Patient Suddenly have collapsed and Stopped Responding whatwill you do first?
325 What is the definition of mother health care?
326 What is normal Uric Acid level?
327 Which disease is caused by Clostridium perfinges?
328 which receptors present in uterus?
329 Where in the body beta agonist act?
330 What is B hcg levels in pregnancy?
331 How to dispose waste ?
332 For what purpose yellow bin used for?
333 Where to dispose off organ waste?
334 Classify Drugs for Diabetes mellitus.
335 What are thyroid hormones and most active?
336 Name drugs of TB and side effects.
337 What is placental abruption?
338 Define Abortion and it types.
339 What is the number of Doses of tetnus vaccine given in pregnancy?
340 What are Emergency C section indications?
341 What is PPH?
342 What techniques are used for sterlization?
343 What is autoclacve? and what is the temperature of autoclave?
344 What are local anesthetics?
345 What is acute renal injury?
346 What is acute renal failure? Describe its treatment.
347 What are the causes of cardiac failure?
348 What are types and causes of edema?
349 What is stridor? Give its causes and treatment.
350 What is quinsy?
351 What are the X-Ray findings in bronchitis child?
352 What are types of microcytic hypochromic anemias?
353 Which anemia is life threatening?
354 What are causes and treatment of iron deficiency anemia in our setup?
355 What is the quantity of elemental iron in different iron formulations?
356 How will you manage a female pt in labour about to deliver who is also about to collapse if you are in BHU?
357 How will you manage if such pt collapses and goes into cardiopulmonary arrest?
358 Will you refer the pt to better care hospital in such condition?
359 What is Bishop score and its interpretation?
360 What are Clinical stages of AIDS?
361 How many diseases are in epi?
362 What is RIF pain ? give its differential diagnosis.
363 Give differential diagnosis of LIF.
364 Describe folowing: Chronic HTN, shock, snake bite, dog bite, MI, Angina, CVA, DKA, acute pancreatitis.
365 Whata are the cases in medical urgency?
366 Differential diagnosis of lower abdominal pain in females?
367 Describe PPH mangment at RHC
368 Which is safe antimalrial in 2nd trimestr pregnancy?
369 Describe scabies counsling.
370 How is asthma managed?
371 What are types of placnta previa?
372 What is high grade fever?
373 Describe method of tepid spongin.
374 In which type of abortion in pregnancy can be saved?
375 What are antenatal visits in last trimester?
376 What are different positions of baby?
377 How to decide for normal or C-Section?
378 What are the types of anemia in pregnancy?
379 What are indications of dialysis?
380 What type of dialysis which is more common?
381 What is Shoulder presentation?
382 What is Cord presentation?
383 What is Brow presentation?
384 Describe Acidosis due to renal failure.
385 What is Electrolyte disturbance(hyperkalaemia)?
386 What is Uremic encephalopathy?
387 What is Fluid overload( pulmonary edema)?
388 Which nerve is involved in foot drop and wrist drop?
389 What is difference between uremia nd azotemia?
390 What is Radial nerve damage?
391 What is Common peroneal nerve damage?
392 Describe Blunt Abdominal Trauma and its management?
393 What is Acute abdomen and brust abdomen?
394 What are types of C.section. Describe steps.
395 What is kangaroo care?
396 Which disease kangaroo care prevents in neonate?
397 What is PPH and APH?
398 What is postnatal Care and advice given to mother related to neonate?
399 Des rabies management in bhu?
400 What to do with rabid dog?
401 What is BMI formula?
402 What are air borne diseases?
403 What are water borne diseases?
404 What is treatment of eclampsia?
405 What is treatment of pre-eclampsia?
406 How chest pain is managed in emergency and BHU?
407 How are chest(MI,ANGINA,SHOCK), Acute diarrhea, asthema,PPH and CPR are managed at BHU level.
408 What is active immunization?
409 What are the stages of labour?
410 What are the types of abortions?
411 Describe delivery Of fetus.
412 What is the product of conception during implantation?
413 What is controlled cord traction?
414 Difference between staging and grading?
415 What is HCC tumor marker?
416 What protocol you will follow for diabetic patients delivery and also for patient who was on heparin treatment.
417 What are the complications of spinal anesthesia and ketamine?
418 What is Teeth eruption? Age and its types.
419 What is neonatal jaundice?
420 What is hyperemesis gravidarum?
421 What is difference between heparin, disprin and streptokinase?
422 What are labs for Hepatitis A??
423 Why BCG given at birth??
424 When and how is Hepatitis B is treated?
425 Give ways of approaching a patient with chest pain?
426 Describe VVM, ILR, PPH Management at BHU level?
427 What is relative bradycardia?
428 What are serotypes of dengue?
429 What are cause of maternal mortality??
430 What is major cause of Maternal mortality in Pakistan?
431 Organisms of pneumonia
432 Clically differentiate in obstructive and non obstructive jaundice
433 What is shock
434 What is vertical transmission
435 Tell some antibiotics that are safe in pregnancy?
436 Tell some Antihypertensive that are safe in pregnancy and it’s side effects?
437 What are Blood transfusion complications?
438 What are Complications of cholilithiasis?
439 What is pneumonia
440 Which three bins are used for waste disposal?
441 What is Congestive heart failure?
442 What is Hyperkaleamia?
443 What is Hypothermia?
444 What is Thrombophelebitis?
446 What is Guillain Barre Syndrome?
447 Explain Transverse Myelitis.
448 What is Traumatic Neuritis?
449 Describe Muscle hypotonia.
450 What is Hypokaleamic Paralysis?
451 Describe POTT’s disease
452 What happens when you have encephalitis?
453 Give definition of CVA.
454 Give definition of Osteomyelitis?
455 Give types of active imunization?
456 What is oligouria?
457 What does a GCS mean?
458 For what purpose glucophage is given?
459 What are the causes of rectal bleeding?
460 What is haemorrhoids and its treatment?
461 Define epidemic and pandemic?
462 What is Gout?
463 Difference between arthritis and rheumatoid arthritis?
464 What is Lipid profile?
465 Which view and angle we take for DNS X-Ray?
466 What is Mastoiditis?
467 Difference between M.I and angina?
468 Difference between acute and chronic tonsillitis?
469 Give complications of tonsillectomy.
470 What are the temperatures for sterilization and pasteurization?
471 What are causes of Rectal bleed?
472 Describe folowing haemorrhoids, rectal carcinoma, G.I.T ulcer, trauma.
473 If two patients in ER comes with h/o RTA, one has head injury and the other has chest trauma. Which patient would you attend first and why? Emphasis on detailed reason.
474 What does triage mean?
475 What are macrovascular complications of DM?
476 What are glands? Difference between Endocrine and exocrine system. Names of endocrine glands in body.
477 Which gland can cause hypertension?
478 Describe dog bite scenario and management.
479 Give ARV schedule.
480 Describe Scabies scenario and management.
481 Name of water borne diseases.
482 Name of Air borne diseases.
483 What is HbA1c and for how much duration it calculates the blood sugar?
484 What is normal fasting and random blood sugar levels?
485 What are number of beds in DHQ hospitals and in tertiary care hospital?
486 What does Immunity, immunization, EPI stands for?
487 Which two new vaccines are added in the the new EPI schedule?
488 What is herd immunity?
489 What causes albumin in urine during pregnancy?
490 What is first line infertility treatment for Polycystic ovarian syndrome?
491 What is Nephrotic syndrome?,
492 What are causes of hematuria a man age less than 40 years?
493 What is Chronic kidney disease?
494 What are causes of chronic eenal failure.
495 Describe Derranged Renal function tests.
496 Describe fistula formation after Total abdominal Hysterectomy.
497 What are the types of fistula?
498 What is renal carcinoma and lung carcinoma?
499 What is stress urinary incontinence?
500 Describe over active bladder case scenario.
501 What is Myocardial infarction
502 Describe Management of MI.
503 What is Pneumothorax?
504 What are findings of Pulmonary embolism ECG?
505 Give types of Anesthesia?
506 Describe Hypertensive emergency and urgency.
507 What are signs and symptoms of mumps?
508 What is HCC tumor marker?
509 What is down syndrome?
510 What are ACE inhibitors name and their side effects.
511 What are duties of MO in BHU?
512 What is DNC? and purpose of DNC.
513 What is bishap score?
514 What is mottling?
515 What instruments are used in pelvic surgery?
516 What are complications of pelvic surgery?
517 What is Parkinson’s disease ?
518 What is Alzheimer’s disease?
519 What are sign, symptoms and drugs used for typhoid?
520 What are types of cyst?
521 Describe differential diagnosis of lower abdominal pain in females?
522 What is ACS?
523 What is difference between unstable angina and NSTEMI
524 Which is antidote to Heparin?
525 How to determine age of a married girl?
526 At which age epiphyseal reunion happens?
527 Describe snake bite management.
528 Describe gose of anti venom?
529 What are congenital heart defects?
530 What is EEG
531 What is difference between Extradural hematoma and subdural.
532 What are Anti hypertensive drugs
533 What is Burr hole craniotomy
534 Describe Laparoscopic cholecystectomy steps.
535 What is direct and Indirect Bilirubin?
536 What are peripheral smear finding of Hemolytic anemia?
537 What are causes of highly elevated and mildly elevated AST?
538 When Is Spinal Anaesthesia used at which level?
539 What is High Spinal?
540 What is spinal headache and Spinal Shock?
541 How you will give anesthesia in a pt with Liver disease?
542 What is Toxicity of lignicaine?
543 What are the side effects of Ciprofloxacin?
544 Describe managment of RTA pt with chest and limb injuries.
545 What is chemical Name of Plaster of Paris?
546 Describe managment of pt with 30% burn.
547 What is rule of 9?
548 How to calculate fluid in burn cases?
549 What is osteoarthritis & RA? Difference b/w them.
550 What are First line ATT drugs?
551 How to check optic nerve?
552 What is Bipolar disprder?
553 What is Depression?
554 What is Barbiturates?
555 What is Communited fracture?
556 Describe types of pacemaker.
557 How to diagnose intestinal perforation?
558 What is chest tube intubation?
559 What is difference between marasmus and kwashikior?
560 How to rehydrate 6month child with severe dehydration?
561 What are types of fracture?
562 What is VDRL and how is it managed?
563 What is whipple procedure?
564 What are ETT indications?
565 What is length of esophagus?
566 What are constriction points of ureter?
567 What does COPD stands for?
568 Why do we call status asthmaticus with this name?
See also  Guidelines for FCPS Part 1 by Dr. Shahan Saleem

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