CMT LEVEL 5||INTERNAL MEDICINE BANK OF QUESTIONS || READ FOR FREE

 QUESTION BANK FOR INTERNAL MEDICINE 

   

1. A 47 years old woman with diabetic mellitus for 10 years came to the outpatient clinic for follow up. Her FBG was 16mmol/l and BP 120/70mmHg. Urinalysis revealed protein ++ with no white blood cells in urine. The first thing to control her proteinuria from progressing to chronic renal failure is to:

1. Start ACE inhibitor

2. Decrease protein diet

3. Control her blood pressure

4. Strictly control of glycaemia

5. Counsel on carbohydrate diet

2. A 21 years old female presents at outpatient clinic with four days history of high grade fever, lower abdominal pain and dysuria. On examination, temperature was 390C, abdominal examination reveals severe loin angles tenderness. The most likely diagnosis is:

1. Acute urinary tract obstruction

2. Acute glomerulonephritis

3. Acute pyelonephritis

4. Severe renal stones

5. Cystitis 

3. The diagnosis of rheumatic fever in a patient with an elevated antistreptolysin O titer is confirmed by:

1. Fever with an elevated erythrocyte sedimentation rate

2. Carditis and elevated erythrocyte sedimentation rate

3. Arthralgia and previous history of rheumatic fever

4. Prolonged P-R interval on ECG and fever

5. Erythema nodosum and arthritis

4. A 34 years old female presents with a history of on and off palpitation, headache and sweating for one month. Her blood pressure at home was found to be 190/120mmHg. Three hours later when she arrived at the hospital, her blood pressure was 130/90 mmHg, no treatment was given at home. The most likely diagnosis is:

1. Primary aldosteronism

2. Primary hypertension

3. Phaechromocytoma 

4. Anxiety disorder

5. Renin tumor

5. A middle aged man present with acute onset of high grade fever and pleuritic chest pain. He also complains of productive cough rusty in colour. Physical examination reveals dyspnea, febrile 390C and features of consolidation on left infrascapular. What is the most likely diagnosis?

1. Lung abscess

2. Bronchial asthma

3. Lobar  pneumonia 

4. Bronchopneumonia 

5. Pulmonary Tuberculosis 

6. A young girl comes in the medical clinic with history of breathlessness and palpitations for one year. After auscultation of precordium you make a diagnosis of mitral stenosis. The most important sign on which this diagnosis is based is:

1. Ejection systolic murmur

2. Mid diastolic murmur

3. Pan systolic murmur

4. Third heart sound

5. Mid systolic click

7. An old lady present with history of fever and left sided chest pain for one month. Examination of respiratory system shows decreased chest movements, stony dull percussion note and absent breath sounds on left side. Her chest x-ray is likely to reveal one of the following conditions

1. Pleural effusion 

2. Pneumothorax

3. Consolidation 

4. Collapse

5. Fibrosis

8. Which of the following medication is used in the treatment of hyperkalaemia in acute renal failure 

1. Amlodipine

2. Propranolol

3. Amiloride 

4. Captopril

5. Insulin 

9. A 27 years old HIV patient started ARVs 6 months ago, presents with one month history of easy fatigability and progressive palpitation on exertion. Laboratory investigation revealed Hb 6.5g/dL, with macrocytosis. The most likely offending antiretroviral for this anaemia is:

1. AZT

2. 3TC

3. FTC

4. ABC

5. D4T

10. For the patient with history of fever, headache and neck stiffness, the most important investigation is: 

1. Computerized tomography scan brain

2. Magnetic resonance imaging brain 

3. Cerebrospinal fluid examination

4. Complete blood counts

5. Skull x-ray 

11. In the management of type two diabetes mellitus, metformin primarily works by the following mechanism:

1. Decrease postprandial rise of blood glucose and increase glucose uptake by peripheral cells

2. Reduce hepatic gluconeogenesis and promote peripheral glucose utilization

3. Decrease the absorption of carbohydrates from the gastro-intestinal tract

4. Stimulate the release of endogenous insulin from the pancreatic β-cells

5. Increase insulin sensitivity in the peripheral tissues

12. When acute upper gastrointestinal bleeding is suspected:

1. Endoscopy is the investigation of choice in locating the site of bleeding

2. Nasal Gastric Tube aspiration provide an accurate amount of blood loss

3. Hypotension without tachycardia suggests alternative diagnosis

4. A pulse rate of >100b/minute is most likely due to anxiety

5. The absence of anaemia suggest moderate blood loss

13. A 50 years old man with history of hypertension and arteriosclerotic disease presents with acute onset of severe chest pain tearing in nature radiating to the back. On physical examination, he is in pain with BP of 200/100mmHg. Chest X-ray shows widened mediastinum. The most likely diagnosis is:

1. Severe hypertension

2. Myocardial infarction

3. Aortic dissection

4. Congestive cardiac failure

5. Unstable angina

14. The following is the best medicine to eradicate H. pylori in a patient with peptic ulcer disease:

1. Omeprazole alone for six weeks

2. Ranitidine   and amoxicillin   for 1 month

3. Omeprazole for 6 weeks, amoxicillin and clarithromycin 2 weeks

4. Pepto-bismol and metronidazole for 14 days 

5. Sucralfate alone for 6 weeks

15. A 52 years old man is a known hypertensive on treatment for many years. Recently, he has been diagnosed with moderate congestive cardiac failure and has developed cough. The possible cause of the cough is:

1. Isosorbide mononitrate

2. Furosemide

3. Nifedipine 

4. Digoxin

5. Captopril 

16. A 62 years old man HIV negative on Tuberculosis treatment for two months presents with history of worsening numbness and parasthesia of extremities. Which of the following drug is the likely cause of these symptoms:

1. Isoniazid 

2. Rifampicin 

3. Ethambutol 

4. Pyrazinamide 

5. Streptomycin 

17. The following is neurological manifestation of severe vitamin B 12 deficiency:

1. Hemiplegia associated with flaccid paralysis

2. Confusion and dementia

3. Mononeuritis multiplex

4. Optic hypertrophy

5. Cerebral ataxia

18. An epileptic girl is found to have gum hypertrophy, ant epileptic drug which she is modt likely taking is:

1. Sodium valproate 

2. Carbamazepine 

3. Lamotrigine 

4. Gabapentin 

5. Phenytoin 

19. A patient of chronic diarrhoea is having angular stomatitis and glossitis. The most likely cause of these signs is deficiency of:

1. Iron 

2. Proteins

3. Thiamine

4. Folic acid

5. Pyridoxine 

20. A 20 years old is brought to your health facility by his friends, apparently he has ingested unknown drugs in suicidal attempt. On examination he has pinpoint pupils. This findings are most likely due to Intoxication by which of the following:

1. Acetaminophen

2. Benzodiazepine

3. Organophosphate

4. Barbiturate Poisoning

5. Non Steroidal Anti inflammatory Drugs 

21. A 12 yrs old boy comes to your dispensary with complaints of generalized body swelling with foamy urine.  Urinalysis results revealed 5g/24hrs of proteins.  The appropriate combination of drug for this patient will be:

1. Captopril and Furosemide

2. Tolbutamide and Nifedipine

3. Chlopropramide and captopril

4. Furosemide and  Prednisolone

5. Losartan and hydrochlorothiazide

22. Regarding Diabetes Mellitus:

1. Type 2 is more common in children

2. Type 1 is  characterized by insulin deficiency

3. Type 2 is more commonly associated with Ketosis

4. Type 2 results from autoimmune beta cells destruction

5. Type 1 is more common in Patient aged more than 45yrs

23. The following is the common clinical presentation of TB in HIV positive patients with low CD4 count:

1. Weight loss

2. Hemoptysis

3. Smear positive sputum

4. Smear negative sputum

5. Cavitary lesions on X-ray

24. The following are considerer severe forms of Extra pulmonary Tuberculosis:

1. Tuberculosis of Peripheral Joint

2. Tuberculous Lymphadenitis

3. Unilateral Pleural Effusion

4. Tuberculous Meningitis

5. Tuberculosis of skin

25. Cardiogenic shock can results from one of the following conditions:

1. Bee sting

2. Endotoxins

3. Cardiomyopathy

4. Severe haermorrhage

5. Gastro Intestinal haemorrhage

26. Ischaemic stroke differs from haemorrhagic stroke in that:

1. The former results from rupture of an artery supplying part of the brain

2. The later arise from interruption of the blood supply to part of the brain

3. Cholesterol are the known predisposing factors of the former

4. Aspirin are highly encouraged in the management of the later

5. The later can result from a irregularly beating heart

27. A fifteen year old boy who is diabetic presents with abdominal pain, vomiting and shortness of breath. There is a history of fever and sore throat two days back. The most likely cause of his symptoms is:

1. Non ketotic hyperosmolar coma

2. Diabetic ketoacidosis

3. Hypoglycaemia 

4. Gastritis 

5. Renal failure 

28. A forty year old lady gives history of weight gain and hoarsness of voice. On examination her pulse is 64 per minute and skin is pale, coarse and dry. The most important investigation to find diagnosis in this patient is 

1. Adrenocorticotropin hormone (ACTH)

2. Insulin like growth factor 

3. Gonadotrophin levels

4. Thyroid function test

5. Cortisol level

29. A 13 year old boy gives history of swelling of body starting from face and more on getting up in the morning. On examination his blood pressure is normal, pallor is absent and jugular venous pressure is not raised. Signs of ascites and bilateral pleural effusion are found. The first line investigation for this boy is:

1. Chest X-ray

2. Blood urea level

3. Echocardiography

4. Liver function test

5. Urine for albumin

30. During abdominal examination 

1. Pelvic examination is mandatory

2. A patient should be calm in a sitting position

3. Dullness can be audible in patient with gaseous distension 

4. In all conditions auscultation may be performed prior to palpation

5. Abdominal examination is incomplete without digital rectal examination

31. Clinical presentation of the  patient with pneumonia include

1. Apnoea

2. Stridor

3. Wheezing

4. Chest pain

5. Hypothermia

32. A 46 years old man presents with vomiting blood for one day. On examination he was conscious, pale and not jaundiced. The abdomen was distended with caput medusa; fluid thrill was positive, splenomegaly and liver span of 13 cm. The most likely diagnosis

1. Peptic ulcer

2. Mallory weisy tear

3. Esophageal Varices

4. Chronic renal disease

5. Hepatic encephalopathy

33. A 55 years old man present with the history productive cough characterized initially with scanty mucoid sputum, which later become purulent.  This patient had a history of cigarette smoking more than 20 years. The most likely diagnosis:-

1. Pneumonia

2. Bronchiolitis

3. Acute bronchitis

4. Chronic bronchitis

5. Pulmonary Tuberculosis 

34. A 10 years old boy was diagnosed to have rheumatic fever, the attending clinician recommended a monthly dose of long acting antibiotic for a period of 5 years.  The drug of choice is:

1. Penicillin G Benzathine

2. Benzyl penicillin

3. Erythromycin

4. Cephalexin

5. Penicillin

35. A 40 years old man was diagnosed to have sub-acute bacteria endocarditis blood culture and sensitivity reveals Methicillin-resistant Staphylococcus aureus.  The drug of choice will be

1. Cloxacillin

2. Amoxycline

3. Vancomycin

4. Erythromycin

5. Benzy/penicillin

36. Regarding percussion in respiratory system examination:

1. Is done to the anterior only

2. It is done while the patient is lying 

3. A dull percussion notes indicate  pneumothorax

4. Movement of percussion hand should be wrist

5. Examiner should start at the sternum towards the anterior axillary line

37. Which of the following statement suggest the classical triad of foreign body aspiration

1. Crackle, wheezing and decreased breath sounds

2. Cough, wheezing and decreased breath sounds

3. Cough, wheezing and increased breath sounds

4. Cough, crackles and decreased breath sounds

5. Cough, crackle and increased breath sounds

38. Which of the following is one of the cause of cerebral vascular accident (CVA)

1. Diabetes

2. Smoking

3. Thrombosis

4. High blood pressure

5. High blood cholesterol

39. A 44 years old man presents with the history of abdominal distension for 3 weeks. Skin itching, fatigue and vomiting blood for 1 day.  The patient has a history of alcohol consumption for the past 20 years.  On examination he was alert, afebrile, jaundiced liver span was 5cm and positive fluid thrill with no splenomegaly.  The most likely diagnosis

1. Hepatoma

2. TB peritonitis

3. Liver cirrhosis

4. Portal hypertension

5. Peptic Ulcer Disease

40. Which of the following drugs does NOT cause anaemia:

1. Chloramphenical

2. Methotrexate

3. Zidovudine

4. Vincristine

5. Acyclovir

41. A 60-year-old woman with known alcoholic liver cirrhosis presents with difficulty in breathing, malaise and nausea. On examination she was dyspnoec, massive ascites and generalized abdominal tenderness. The initial management of this patient include

1. Under water seal drainage

2. Abdominal paracentesis

3. High soap enema

4. Induce vomiting

5. Gastric lavage

42. Which of the following is included in the management of heart failure:-

1. Increase of cardiac after load

2. Control of excessive fluids

3. Increase sodium intake

4. High protein diet 

5. Excessive exercise

43. Major duke’s jones criteria for diagnosis of rheumatic fever include:

1. Fever

2. Chorea

3. Arthralgia

4. Prolonged PR interval

5. Raised erythrocyte sedimentation rate 

44. A 30 years old man driver was brought to the emergency department following a motor vehicle accident. On examination has rapid and deep shallow breathing.  He is unable to move all four limbs.  Vital sign heart rate was 54 bpm PB = 70/40 mmHg.  The most likely diagnosis is:

1. Haemorrhagic shock

2. Cardiogenic shock

3. Irreversible shock

4. Neurogenic shock

5. Septic shock

45. A 20 years old female presents with history epigastric pain for and vomiting.  The patient report that the pain gets worse when she takes some food.  On examination alert, afebrile.  What is the most likely diagnosis

1. Typhoid fever

2. Angina

3. PUD

4. Esophagitis

5. Severe malaria

46. A 24 years old man presents with mood swings, irritability, racing thoughts and pressured speech, the most likely diagnosis is:

1. Schizophrenia

2. Major depression disorder

3. Cannabis induced psychosis

4. Bipolar disorder – depression

5. Bipolar disorder – Manic episode

47. Regarding unilateral lower limb edema, the following disease are the commonest causes:

1. Right heart failure, pulmonary embolism and deep venous thrombosis

2. Elephantiasis, deep venous thrombosis, Kaposi sarcoma

3. Liver failure, heart failure, chronic renal failure                   

4. Elephantiasis, cellulitis and pulmonary embolism

5. Cellulitis, deep venous thrombosis, pulmonary oedema

48. Regarding Hookworm infestation 

1. Is usually spread by the faeco-oral route

2. May block the pancreatic duct causing pancreatitis

3. In early stage may present with a dry cough and asthmatic wheezing. 

4. Eggs can be readily distinguished microscopically from those of Strongyloides sp.

5. It is diagnosed by microscopy of adhesive tape prints taken from the perianal area

49. Following an occupation needle stick injury with HIV- infected blood:  

1. Zidovudine and Lamivudine for 28 days reduce the chance of sero- conversion for about 8%

2. Zidovudine and Lamivudine should be started 24 hours post exposure

3. Infection is more likely if the HIV patient is in the window period

4. Monotherapy treatment is as effective as two drugs therapy

5. The risk of HIV transmission is about 30%

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

1. Bronchiectasis

2. Bronchial asthma

3. Chronic bronchitis

4. Pulmonary tuberculosis

5. Bronchogenic carcinoma

      MULTIPLE TRUE/FALSE QUESTIONS         

1.  Regarding the management of a patient admitted in a medical ward with diagnosis of infective endocarditis

1. FALSE Liver function test is used to monitor progress

2. TRUE Treat Dental problem if present 

3. TRUE Success relies on eradication of pathogen

4. FALSE Bacteriostatic regiment should be used

5. TRUE Surgery is used mainly to cope with structural complications

2. Regarding presentation of patient with Peptic Ulcer diseased

1. TRUE Pain-meal relation can be used to differentiate between duodenal and gastric ulcer

2. TRUE Sudden onset of severe, generalized abdominal pain may indicate perforation

3. TRUE Food relieve the pain of duodenal ulcers and minimal relief for gastric ulcer 

4. FALSE Dyspepsia that radiate to the back indicate bleeding peptic ulcer diseases

5. FALSE Pain worsening 2-3 hours after meals suggest gastric ulcer

3. Patient comes to the dispensary with history of exercise intolerance awareness of heartbeat. Haemoglobin level measure is 6 g/dl. Management of this patient include

1. FALSE Broad Spectrum antibiotic

2. TRUE Find the cause and correct

3. FALSE Give blood transfusion

4. TRUE    Give Ferrous Sulphate

5. TRUE Stool analysis 

4. The following are the complication of hook worm infestation

1. FALSE  Rectal Prolapse

2. FALSE Intestinal obstruction

3. TRUE    Malnutrition

4. FALSE Diarrhoea

5. TRUE Anaemia

5. The following are the differential diagnosis of a patient present with crepitations during auscultation of the chest:

1. FALSE Myocardio  Infarction

2. FALSE Acute bronchitis

3. TRUE Pneumonia

4. TRUE Heart failure

5. FALSE Bronchial asthma

6. The following clinical conditions causes normocytic anaemia

1. TRUE Severe blood loss from an accident

2. FALSE Pulmonary TB

3. TRUE Aplastic anaemia

4. TRUE Severe malaria

5. FALSE Hook worm infestation

7. The following are the differential diagnosis with a patient with reduced tactile vocal tremitus during respiratory system examination

1. TRUE    Large Pneumothorax

2. FALSE Labor pneumonia

3. FALSE Cavitations

4. TRUE    Atelectasis

5. TRUE    Pleural effusion

8. The hypertension can damage the following organ

1. TRUE Brain

2. FALSE Liver

3. TRUE Eye

4. TRUE Heart

5. FALSE Lungs

9. 
   

10. The typical features of Gullain- Barre polyneuropathy include:

1. TRUE Severe backache and peripheral parasthesia

2. FALSE Normal CSF protein concentration and cell count

3. FALSE Sparing of respiratory and facial nerves

4. TRUE Ascending flaccid paralysis and areflexia

5. TRUE Sensory disturbance

11. The following is true with regard to hospital acquired pneumonia:

1. TRUE   Of early onset, the causative agent is usually similar to those of community 

2. TRUE   Dental and sinus infections are among the risk factors

3. FALSE Is the first commonest hospital acquired infection

4. FALSE It occurs within 24 hours of hospital admission

5. TRUE    Post- operative patients are at risk

12. A patient suspected of having tuberculosis of adrenal gland may present with the following:

1. TRUE  Nausea and vomiting

2. TRUE  Hypotension

3. FALSE Hypernatremia

4. FALSE Hypokalemia

5. TRUE   Pigmentation of sun-exposed areas

13. The following can precipitate decompensated heart failure in a patient with compensated heart failure:

1. FALSE    Aerobic exercise

2. TRUE    Atrial fibrillation

3. TRUE    Anaemia 

4. TRUE    Poor compliance to treatment

5. FALSE    Oral fluid intake

14. In a patient with peptic ulcer disease, the following are true:

1. FALSE Proton pump inhibitors have no role in chronic users of NSAIDS

2. TRUE Around 90% of duodenal ulcer patients are infected with H. pylori

3. FALSE PUD in developed countries is due to H. pylori infection 

4. TRUE H. pylori exclusively colonize gastric type epithelium

5. TRUE Smoking causes delay in healing  

15. The following are definitive indication of H. Pylori eradication:

1. TRUE Mucosal associated gastric lymphoma

2. FALSE Family history of gastric ulcer

3. FALSE Long term users of NSAID

4. TRUE H. pylori positive dyspepsia

5. TRUE Peptic ulcer disease

16. The following are the differential diagnosis of a patient present with crepitations during auscultation of the chest:

6. FALSE Myocardio  Infarction

7. FALSE Acute bronchitis

8. TRUE Pneumonia

9. TRUE Heart failure

10. FALSE Bronchial asthma

17. Gastric lavage is Indicated in the  following poisonings:

1. FALSE    Acid

2. FALSE    Kerosene

3. TRUE    Mushroom

4. TRUE    Organosphate

5. FALSE    Alkali

18. Concerning status asthmaticus:

1. TRUE    Wheezes may be  heard both during inspiration and expiration

2. FALSE    B2 antagonist is the treatment of choice

3. TRUE    Pneumothorax is among the complications

4. TRUE    Pulmonary hypertension can be one of the differentials

5. FALSE    Oxygen therapy has no role in management

19. Concerning cerebral fluid indices in meningitis the following shows the biochemical analysis and characteristics causative organisms:

1. TRUE    Glucose level is  low in fungal meningitis

2. FALSE     Protein level is low in bacterial meningitis

3. FALSE    Protein level is elevated in viral meningitis

4. TRUE    Glucose level is Normal in viral meningitis

5. TRUE    Protein level is elevated in tuberculous meningitis

20. In patient with chronic kidney disease  urine Dipstick is a quick method to  determine:

1. FALSE Hematuria

2. TRUE      Proteinuria

3. FALSE Gram staining

4. FALSE Serum creatinine

5. TRUE      Specific gravity of urine

21. The following are correct concerning administration of  Cotrimoxazole prophylaxis:

22. TRUE      All patients who are in WHO clinical stage II,III,IV

23. FALSE All asymptomatic HIV infected individual CD4>350

24. FALSE HIV positive patient allergic to sulfur

25. TRUE      All HIV infected pregnant women

26. FALSE   Dosage should be twice dail

22. 
    

COLUMN A ( Medication )	COLUMN B ( Side effect)
E Chloramphenicol	Premature ventricular contraction
A Digoxin	Impotence
D Phenytoin	Peptic ulcer disease
C Aspirin	Gum hypertrophy
F Nifedipine	Idiosyncratic bone marrow suppression
	Severe headache
	Hemoptysis
	Acute renal failure

1. Match the blood presentation from column B with the corresponding type in column A

COLUMN A (Type of blood disorder)	COLUMN B ( Presentation)
F  Chronic lymphocytic leukemia	RBC cast in urine
C  Acute myeloid leukemia	Bimodal distribution
H  Multiple myeloma	More than 80% is monocytes
G  Chronic myeloid leukemia	Macrocytosis
B  Acute lymphoblastic leukemia	Aplastic anaemia
	Mature abnormal lymphocytes
	Myeloid hyperplasia with left shift
	Monoclonal protein spike in urine

1. Match the skin lesions description form column B with corresponding skin lesions in column A     

Column A			Column B
1     E	Macules	A	Solid palpable lesion within the skin
2     D	Papules	B	Pus containing blister
3     A	Nodules	C	Large fluid filled blister
4     F	Vesicles	D	Palpable elevated small area of skin (<0.5cm)
5     B	Pustules	E	Non palpable area of altered colour
		F	Small fluid filled blisters
		G	Pedunculated lesion projecting from skin
		H	Dilated superficial  blood vessels

2. Match the following oral hypoglycemic drugs from column B with their corresponding class in column A.

Column A	Column B
1     G	Biguanides	A: Rosiglitazone
2     F	1st generation Sulfonyl urea	B: Glibenclamide
3     B	2nd generation Sulfonyl urea	C: Methadone
4     A	Thiazolidinediones	D: A-Carbose
5     D	Alpha glycosidase inhibitors	E: Amiodarone
		F: Chlopropramide
		G: Metformin
		H: Chlorpromazine

1. Mention six (6) skin conditions associated with HIV infection         (3 Marks)
   

1. Herpes simplex infection

2. Herpes zoster

3. Kaposi’s sarcoma

4. Norwegian scabies

5. Molluscum contigiosum 

6. Bacteria skin infection e.g impetigo

7. Serborrhoeic dermatitis 

8. Warts 
   

2. Outline eight (8) neurological symptoms associated with hypoglycemia    (4 Marks)
   

1. Confusion

2. Irritability and anger

3. Speech difficulty

4. Inability to concentrate

5. Incoordination

6. Drowsiness

7. Tachycardia

8. Sweating and trembling

9. Anxiety 

10. Irritability and anger

11. Trembling 
    

3. Outline the Treatment of acute severe pulmonary oedema             (5 Marks)

1. Positioned the patient at cardiac position (450)

2. Give oxygen therapy

3. Give I.V loop diuretic (furosemide 1mg/kg 8-12hrly)

4. Give I.V morphine 4-6hourly

5. Nitrates e.g Isosorbide mononitrate

4. Mention five (5) poor prognostic indicators for a patient presenting with acute stroke                                                (2.5 Marks)

1. Presence of infection/aspiration pneumonia

2. Presence of uncontrolled diabetic mellitus

3. Hemorrhagic stroke carries poor prognosis than Ischemic stroke

4. Extent of stroke,  stroke involving large area carries poor prognosis than the one involving small area

5. Area of stroke, brain stem strokes carries poor prognosis

6. Presence of fever

7. Low level of consciousness at presentation

 

5. Outline  five (5) differential Diagnoses of a 40 years old male who is brought to you  because of convulsions:                                    (2.5 marks)

Answers:

• Epilepsy

• Viral encephalitis

• Severe  Malaria

• Meningitis

• Electrolyte imbalance

• Hypoglycemia

• Space occupying lesions

6. An eighteen year old young man gives history of swelling of body starting from face and more on getting up in the morning. On examination his blood pressure is normal, pallor is absent and jugular venous pressure is not raised. Signs of ascites and bilateral pleural effusion are found.  

1. What is the most likely diagnosis of this patient?                    ( 1 Mark)

Nephrotic syndrome  

2. Outline four (4) secondary causes the condition                   ( 2 Mark)
   

1. Hepatitis B and C  

2. Rheumatism 

3. Syphilis   

4. HIV  

5. Malaria 

6. Diabetes mellitus 

7. Systemic lupus erythematosus

8. Amyloidosis

9. Multiple myeloma
   

1. 
   

2. List down five (5) Risk factors for developing Type II Diabetes Mellitus:

(5 k)

Answers:

• Family history of diabetes

• Obesity (BMI > 27kg/m2)

• Age >45 years

• Hypertension

• History of gestational diabetes mellitus

• High cholesterol level

3. A 30 years old long distance truck driver who is HIV positive came to the health facility complaining of Painless swelling on his neck and armpits for 5 months. On examination he has generalized lymphadenopathy:

What is the WHO clinical stage of the patient                 (1 Mark)

• WHO clinical stage 1

Outline for (4) Possible causes of the above condition:                               (4 Mark)

• HIV

• Mycobacterium TB infection

• Kaposis Sarcoma

• Lymphoma

• Pyogenic bacterial infection

4. A22 years old Musician attended the health centre with complaints of fever and skin lesions on the Perineum.  On examination, small tender vesicles were found on the genitalia and bilateral enlarged Inguinal Lymphnodes.

What is the most likely diagnosis?                                                                      (1 Mark)

Answers:

Genital herpes

List down two important investigations                            (2 Marks)

• HIV test

• VDRL

How will you treat this patient                              (2 Marks)

• Oral acyclovir

• Analgesics

• Bring  sexual partner(s) for testing

5. A 40 years old man always has alcohol and frequent falls, he moved into the suburb few months ago and is well known for habitual drinking mostly drinking spirit, he presents to you with tremors, sweating profusely and vomiting.  What is the possible diagnosis:

What is the possible diagnosis                            (1 Mark)

Answers:

• Alcohol withdrawal syndrome

List dawn 2 Differential diagnosis                             (2 Marks)

Answers:

• Alcohol Abuse

• Alcohol Dependence

             How are you going to treat the patient?                          (2 Marks)

Answers:

• Treat using Diazepam protocol

• Refer to speliazed care

6. Amida is a 60years HIV positive female who attended Misungwi hospital with history of severe headache and disorganized behavior. Mention five (5) investigations that should be done to Amida.                                       (5 Marks)

Answer:

• Blood sugar

• Bs for MPs

• LP for CSF analysis

• Blood C/S

• Serum Biochemistry

• Cryptococcus antigen test

7. (a) List down Four (4 )Fungal infection commonly associated with HIV/AIDS 

 s)

Answers:

• Cryptococcus Neutamans

• Pneumocystu Jensen Pneumonia

• Candidiasis

• Histoplasmosis

8. A 24 years old young was brought to your dispensary with his relatives saying that the he was found in his room lost conscious. No previous history of any illness. On assessment was found in deep coma. Mention six (6) differential diagnoses for his condition                                                              (6 Marks)   

                                       

Causes of Coma

• Metabolic Disturbances

• Drug overdose 

• Diabetes mellitus 

• Hypoglycaemia 

• Ketoacidosis 

• Hyperosmolar coma 

• Hyponatraemia 

• Uraemia 

• Hypothermia 

• Hypothyroidism

• Trauma

• Cerebral contusion 

• Extradural haematoma 

• Subdural haematoma

• Cerebrovascular Disease 

• Subarachnoid haemorrhage 

• Intracerebral haemorrhage 

• Brain-stem infarction/haemorrhage 

• Cerebral venous sinus thrombosis

• Infections 

• Meningitis 

• Encephalitis 

• Cerebral abscess 

• Others 

• Epilepsy 

• Brain tumour 

• Alcohol intoxication
  

9. A patient present to the health centre with history of fever with severe headache associated with neck pain and stiffness. On examination kerning sign was positive. 

1. What is the working diagnosis of this patient                            (1Mark)

Meningitis

2. List down four (4) pre-disposing factors of the above condition    (4 Marks)

Predisposing factors of meningitis

• Ear infections (Otitis media, mastoiditis)

• Sinusitis

• Respiratory infections

• Malnutrition

• Head injuries

• Septicaemia and Diarrhea especially in the new-borns

• Immune suppression e.g. HIV

1. A 38 years man fisherman presents at emergence department complaining of abdominal discomfort and vomiting of fresh blood mixed with clots three episodes and followed with symptoms of dizziness and awareness of heart beats. On examination, he is severely pale, not jaundiced. PR is 115bpm. BP is 100/60mmHg in supine and 80/50mmHg on erect position. Describe the cause and the management of this patient.

2. A 32 years old female presents at causality with acute onset of cough, chest tightness and wheezing.  She has not taken any medication for two weeks. She is unable to complete a sentence in one breath and she is confused.  On physical examination, she is dyspnoeic with respiratory rate of 38bpm, PR is 120bpm and blood pressure is 90/60mmHg. Lung auscultation scattered wheezes all over. Describe the management of this patient. 

1. A 64 years old male, cigarette smoker reports to you with history of sudden onset of weakness on the right side of the body for one day.  He is a known Hypertensive patient for the last 10 years not on regular medication. On examination: Glasgow coma scale was 8/15, BP 150/100mmHg, Pulse 80b/m, RR 20c/min, T 37oC, mouth deviated to the left and power grade 2 on right lower and upper limbs.

From this information discuss the possible diagnosis, types, risk factors, investigations, treatment and prevention of this condition at health centre level.           

Answer:

Stroke                                               (1 Mark)

2. A 12 years old boy was admitted at Songambele hospital with complaints of recurrent fever for 4 weeks and swelling which  started on the face and later progressed to the  Abdomen and both limbs for 3 weeks. On examination he had generalized body swelling with pitting edema, same Palmar Pallor and bilateral tenderness in Lumbar region. Urinalysis was done and revealed protein of 5g/L and 6 RBCs per high Power field. Write an essay of the most likely Diagnosis basing on differential diagnosis, investigation of choice, treatment plan and complications.