CMT -LEVEL FIVE SEMESTER TWO |INTERNAL MEDICINE POSSIBLE QUESTIONS |

 

1. SECTION A

1. A 35 year old man presents in a clinic with history of chronic productive cough that is worse in the morning and brought and on by changes in posture. Sputum is copious and yellow. The most likely diagnosis in this patient is:

1. Bronchial asthma

2. Bronchiectasis

3. Bronchogenic carcinoma

4. Chronic bronchitis

5. Pulmonary tuberculosis

2. An important physical sign of portal hypertension in a patient of cirrhosis of the liver is:

1. Gynaecomastia

2. Hepatomegaly

3. Palmer erythema

4. Spider angioma

5. Splenomegaly

3. In bronchial asthma, all of the following are correct EXCEPT:

1. Wheeze and respiratory rate are good indicators of severity.

2. Cyanosis is a late sign, indicating life threatening asthma.

3. The most common triggering factor is upper respiratory tract infection.

4. Nocturnal cough is a feature.

5. Atopy history is important.

4. A 40 year old man gives history of high grade fever for last one week associated with cough productive of rusty sputum. Auscultation reveals bronchial breathing on right lower chest. Chest X-ray shows consolidation. The most likely causative organism is:

1. Anaerobic bacteria.

2. Gram negative bacilli

3. Mycobacterium tuberculosis

4. Staphylococcus aureus

5. Streptococcus pneumoniae.

5. One of the following is a complication of hypertension

1. Retinopathy

2. Cataract

3. Alzheimers disease

4. Sepsis

5. Parkinsonism tremors

6. A 6yrs old female is brought to your dispensary complaining of epigastric pain, , nausea and vomiting followed after administration of NSAID  but the symptoms resolve after few hours what is the diagnosis

1. Oesophagitis

2. Acute Gastritis

3. Gastroesophageal Reflux Disease

4. Acute abdomen

5. Allergic Rhinitis

7. A medical emergency in which symptoms are refractory to initial bronchodilator therapy after being exposed to irritant pollen. Which type of hypersensitivity Is that..????

1. ANTIBODY-MEDIATED (TYPE II) HYPERSENSITIVITY

2. IMMUNE COMPLEX-MEDIATED (TYPE III) HYPERSENSITIVITY

3. T-CELL-MEDIATED (TYPE IV) HYPERSENSITIVITY DISORDERS

4. IMMEDIATE (TYPE I) HYPERSENSITIVITY

5. ANTIGEN –MEDIATED (TYPE V) HYPERSENSITIVITY

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8. The following are true concerning transient ischemic attack except

1. Symptoms and signs resolve completely within 12–24 hours

2. Give aspirin 300mg od 7/7 then 75mg od

3. Initially looks like a stroke

4. Often a warning of a Cerebra Vascular Accident

5. Is treated by strong analgesics like morphine

9. One of the indication of giving Digoxin is

1. Arrythmiasis

2. Hypertension

3. Heart failure with high cardiac output

4. Ejection fraction of greater than 70%

5. Heart failure in a patient younger than 70

10. One of the following if a form of irregular heart action

1. Paroxysmal tachycardia

2. Coronary arteography

3. Phornocardiography

4. Angiography

5. Holter monitoring

SECTION B

2. Regarding peptic ulcer diseases(PUD):

1. TRUE 90% are caused by H.pylori.

2. FALSE Show no sex predilection.

3. FALSE Gastric ulcer more common in patients with blood group O

4. TRUE Duodenal ulcers are more common than gastric ulcers.

5. TRUE Gastric ulcers are associated with carcinoma stomach.

3. With regard to pharmacological management of hypertension:

1. TRUE Lasix decreases cardiac output.

2. TRUE Atenolol is a selective β1 blocker.

3. TRUE Hydralazine reduces blood pressure by causing peripheral vasodilation.

4. FALSE Nifedipine reduces blood pressure by blocking β2 receptors.

5. TRUE Aldomet works by reducing sympathetic nervous activity.

4. The following are true concerning muscarinic effect of organophosphate poisoning

1. TRUE… Increased bronchial secretions

2. TRUE….  Lacrimation

3. TRUE…… blurred vision

4. FALSE…… Paralysis and respiratory failure

5. FALSE…….. Fasciculations

5. Your clinician at Mlowa bwawan health centre and you attend a 21 years uncounsious boy with epilepsy. Regarding epileptic seizure’s

1. TRUE…..Do not force any objects into patient's mouth

2. TRUE….Do not restrain patient's movements

3. TRUE….Turn patient on his or her side to allow saliva to drain from mouth

4. TRUE……Stay with the patient until seizure ends naturally

5. TRUE……..Do not pour liquids into patient's mouth or offer any food, drink or medication until she/he is fully awake

6. The following are forms of irregular heart action

1. TRUE….Sinus arrhythmia

2. TRUE….Extrasystoles

3. TRUE…..Atrial fibrillation

4. TRUE……Atrial flutter

5. TRUE………Heart block

SECTION C

MATCHING ITEMS

COLUMN A DISEASE	COLUMN B CLINICAL FEATURES or CAUSES
F  Left sided heart failure	Unilateral pleural effusion.
E  EPILEPSY	Pain is relieved by food.
B  Duodenal ulcer	Pain may be exacerbated by food.
D  Liver failure	Asterixis and flapping tremors.
A  Right sided heart failure.	Prenatal injuries or hypoxia
	Pulmonary oedema.
	Blood tingled ascitis

COLUMN A CAUSE OF ANAEMIA	COLUMN B RED CELL MORPHOLOGY
B  Acute blood loss	Microcytic with anisocytosis and poikilocytosis
A  Iron deficiency	Normocytic normochromic with polychromatophilia
H  Folic acid deficiency	Normochromic microcytic
E  Chronic haemolysis	Sickle cells
C  Chronic inflammation	Normocytic normochromic with reticulocytosis
	Anisocytosis with nucleated RBCs
	Lymphoblastic cells
	Oval macrocytic with reticulocytopenia.

SECTION D

1. A 23 years old female  come to your dispensary complaining of  retrosternal burning sensation that Worse after a big meal, burping and lying flat, she reports that the pain Often relieved on sitting up.

1. What is the diagnosis? (1mrk)

Oesophagitis

2. Mention any three (3) causes of the above condition(3mrk)

• Poor function of the gastro oesophageal valve

• Hiatus hernia

• Obesity

• Alcohol

• Smoking makes it worse

• Lying down after a big meal especially a high fat meal

• Coffee and chocolate may make it worse

3. Mention one treatment option of the above condition

• Omeprazole 20mg bd 

2. Mention any five differentials of raised jugular venous pressure (JVP) 5mrks

1. Right sided heart failure

2. Congestive heart failure

3. Co polmonale

4. Tricuspid valve disease

5. Hypertrophic/restrictive cardiomyopathy

6. Constrictive pericarditis

7. Obstructive superior vena cava

8. Pulmonary embolism

9. Cardiac temponade

10. Iv fluid overload

3. Mention the clinical features of congestive heart failure.(any 5 @1mark)

1. Exertional dyspnea

2. Orthopnea

3. Paroxysmal nocturnal dyspnea

4. Dyspnea at rest

5. Acute pulmonary edema

6. Chest pain/pressure

7. Palpitations

8. Ascites 

9. Rised JVP

10. Tender congestive hepatomegaly

11. Generalized edema including pedal, ankle, pretibial and sacral edema.

4. A 60 year old man presented at Haneti health centre with a 3 month history of morning headaches, chest pain, and productive cough of mucoid in nature. He has been smoking cigarette since his early 40’s. On examination: he is very Dyspnoeic.

1. What is the most likely diagnosis?

Answer: Chronic bronchitis. (2marks)

2. Outline three differential diagnoses of the above diagnosis.(@1mark=3)

1. Bronchiectasis.

2. Tuberculosis.

3. Congestive heart failure.

5. A 49 year old man, rice farmer, presented to a physician with complaints of abdominal swelling accompanied by yellowish coloration of the eyes for two months. On examination: jaundiced, massive ascites, splenomegaly and bilateral lower limb oedema. Ultrasound revealed a nodulated liver, and an endoscopy revealed oesophageal varices.

1. What is the most likely diagnosis?

Answer: Portal hypertension. (1mark)

2. What is the likely cause of the above diagnosis?

Answer: Schistosomiasis. (1mark)

3. If the oesophageal varices start to bleed, how will you treat this patient in hospital level?(@1mark=3)

• Resuscitation with i.v fluid,

•  Blood transfusion if massive bleeding,

•  give intravenous octreotide to decrease the portal pressure and do variceal band ligation or variceal scerotherapy.

• Propranolol, Atenolol

6. Your attending a 42 years old male with the complain of productive cough with pink frothy sputum he is breathlessness, anxiety and has profuse diaphoresis on investigation you observe that the patient has Tachypnea and tachycardia and rales on left side of the chest  and has  BP of (142/90mmHg) 

1. What is the diagnosis (1mrk)

Pulmonary oedema

2. Mention two classification of the above diagnosis (2mrks)

Cardiogenic pulmonary oedema (CPE)

Non-Cardiogenic pulmonary oedema

3. What are the two investigation option (2mrks)

Chest radiography

 Echocardiography

Blood count

Serum electrolyte measurements

 BUN and creatinine determination

Cardiac enzymes if available

 Electrocardiogram

7. Your attending a 21 years old boy with the complaining of severe sharp chest pain on inspiration  that radiate to the shoulder though he reported that the pain is relieved when he hold breath. You decided to do physical examination and you find that has temperature of 37.8c with intercostal tenderness on palpation and pleural friction rub on auscultation. With the evidence of neutrophils in full blood count.

What is the diagnosis

• Pleurisy

What are the 3 investigation option for this patient

• Chest x ray

• Sputum examination

• Pleural biopsy

• Thoracentesis for smear and culture

What is the treatment option for this patient

• Indomethacin

• Any ANSAID

8. (a)What cause dry cough in a patient using captopril in the management of hypertension(2marks)

………………………………………………………………………………………………………………………………………………………………..

(b) mention common 3 angeotension 2 receptor blockers used in the management of hypertension

SECTION E ESSAY

1. Mr. Mawenzi 26-year old from Dodoma Makulu comes at your clinic with complaints of epigastric pain, vomiting blood and passing black stool for 2 days.

Explain the diagnosis and management of this patient.

ANSWER:

Diagnosis Peptic ulcer disease/upper gastrointestinal bleeding (2marks)

• Peptic ulcer disease is a circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by Helicobacter pylori infection.(1mark)

• Supportive features include epigastric pain, vomiting blood and passage of black stool(@0.5=1.5)

Management of this patient includes:

Investigations (any 5@1 mark)

• Stool for fecal occult blood

• pylori stool antigen test (HpSA)

• Urea breathe test, blood test (H. pylori in the serum)

• Rapid urease test (RUT)

• Bacterial culture H. pylori

• Histologic detection of H. pylori in the biopsy specimen

• Oesophagogastroduodenoscopy.

Treatment:

Peptic ulcer disease is treated by triple therapy which includes two antibiotics for 14 days and an anti-acid for 4 to 6 weeks.(1mark)

• Amoxicillin 500 mg PO every 8 hours

• Metronidazole 400 mg PO every 8 hours

• Omeprazole 20 mg once a day.            

2. MPEMBA is a clinician at Mvumi hospital attended a 33 years old semi counsious man. His relative reported that few hours past he had been involved in agricultural activities (spraying the crops) but you observed that the patient has increased rate of salivation, urination, has fecal incontinence then on investigation you observed that the patient has BP  of (99/52 mmHg), and he is sweating. What is the Diagnosis and management of the patient.

Answer 

The diagnosis is ORGANOPHOSPHATE POISONING. (2mark)

• Supportive features includes (1mark)

•   increased rate of salivation, fecal incontinence, urination, Sweating and BP of 99/52

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