KENYA METHODIST UNIVERSITY

SCHOOL OF MEDICINE AND HEALTH SCIENCES

Department of Clinical Medicine, Surgery & Community Health

FINAL QUALIFYING EXAMINATION

For the Award of

DIPLOMA IN CLINICAL MEDICINE, SURGERY & COMMINITY HEALTH

UNIT:MEDICINE PAPER TWO

DATE:TUESDAY, DECEMBER 6TH, 2011

INSTRUCTIONS

READ THESE INSTRUCTIONS CAREFULLY.

  1. Write your University Number (Not Name)
  2. Number ALL questions CORECTLY.
  3. Attempt all the questions, part 1 & Part 2 separately
  4. Multiple choice questions:

Mark T for True of F for False

You score a mark for every correct response

You do not score or lose any mark for not responding

You will be penalized 1 mark (minus) for every wrong response

  1. Time allowed is 3 hours. (2.30 P.M. - 5.3O P.M)
  2. DO NOT USE A PENCIL

PART A - MCQ’s

  1. Indications of Lumbar Puncture include: -

(a)Meningitis

(b)Transverse intracranial hypertension

(c)Sub Arachnoid Haemmorhage

(d)Thrombocytopenia

(e)Comatose patient

  1. The following statements are True about changes of CSF In pyogenic Meningitis: -

(a)Turbidity

(b)Mononuclear cells <50mm3

(c)Polymorphonuclear cells 200-300/m3

(d)Protein levels of >0.5-2.0g/l

(e)Glucose levels normal to blood glucose levels

  1. The following are psychiatric Disorders Except?

(a)Schizophrenia

(b)Hysteria

(c)Depression

(d)Encephalitis

(e)Epilepsy

  1. The following are Risk Factors for psychological problems associated with medical conditions, except:

(a)Previous history of psychiatric condition

(b)Lack of social support

(c)New diagnosis of serious medical condition

(d)Change in medical care

(e)Impending death

  1. Mental state Examination includes: -

(a)General appearance and behavior

(b)Speech

(c)Mood

(d)Thoughts

(e)Abnormal beliefs

  1. The following are viral infections except?

(a)Herpes Simplex ll

(b)CMV Retinitis

(c)Karposi Sarcoma

(d)Shingles

(e)HIV Encephalitis

  1. Complications of Typhoid Fever include?

(a)Perforation of Gut

(b)Bone and Joint infections

(c)Myocarditis

(d)Meningitis

(e)Cholecystitis

  1. The following drugs are used in management of Congestive Cardiac Failure: -

(a)Spironolactone

(b)Furosemide

(c)Carvedilol

(d)Nifedipine

(e)Lorsatan

  1. Regimes used in management of HIV positive patients include the following except?

(a)Combinations of 2 Nucleoside Reverse Transcriptase inhibitor and 1 Non Nucleoside Reverse Transcriptase inhibitor

(b)Combination of 1 protease inhibitor, 1 Nucleoside R.T Inhibitor and Non-Nucleoside R.T Inhibitor

(c)Combination of protease inhibitor only

(d)None of the above

(e)All of the above

  1. Mode of HIV/AIDS transmission include?

(a)Sexually

(b)Mother to child

(c)Blood transfusion

(d)Needle stick accidents

(e)Kissing

  1. Opportunistic infections in HIV/AIDS includes?

(a)Parkinsonism

(b)Stroke

(c)Pulmonary TB

(d)Karposi Sarcoma

(e)Herpes Zoster

  1. Differential Diagnosis of space occupying lesions are?

(a)Multiple Brain Abscesses

(b)Cryptococcal Meningitis

(c)Tuberculoma

(d)Poliomyelitis

(e)Rabies

  1. All are causes of Upper GIT Bleeding Except?

(a)Chronic Duodenal Ulcer

(b)Ca Stomach

(c)Mallory Weiss Tears

(d)Ca Esophagus

(e)Esophagitis

  1. Factors predisposing to liver cirrhosis include?

(a)Chronic Alcohol Consumption

(b)Viral Hepatitis

(c)Autoimmune Hepatitis

(d)Cardiac failure

(e)Congenital malformation of Biliary Tract

  1. Causes of Ascites include?

(a)Liver Cirrhosis

(b)Meig’s Syndrome

(c)Ca Stomach

(d)Chronic Heart Failure

(e)Hepatitis

  1. Features of Pulmonary Edema include the following Except: -

(a)Wheezing

(b)Haemoptisis

(c)Crepitations and Bilateral Rhonchi

(d)Tachycardia

(e)JVP

  1. Precipitating factors for Hypertension include?

(a)Genetic factors

(b)Obesity

(c)Excessive Alcohol Consumption

(d)Polycythaemia

(e)Insulin Resistance

  1. Causes of pleural Effusion include: -

(a)Congestive Cardiac Failure

(b)Obesity

(c)Excessive Alcohol consumption

(d)Polycythaemia

(e)Insulin Resistance

  1. Causes of pleurisy include?

(a)Pneumonia

(b)Pulmonary edema

(c)Cardiac infarction

(d)Rheumatoid Arthritis

(e)Psoriasis

  1. Chronic obstruction pulmonary diseases include all the following except?

(a)Asthma

(b)Chronic Bronchitis

(c)Emphysema

(d)TB

(e)Pneumonia (Recurrent)

  1. Features of chronic Renal Failure include?

(a)Osteodystrophy

(b)Peripheral Neuropathy

(c)Multiple Myeloma

(d)Anaemia

(e)Normal creatinine levels

  1. The following are diseases of Nervous System: -

(a)Meningitis

(b)Cryptococcosis

(c)Rabies

(d)Psychosis

(e)Mysthemia Gravis

  1. Acute brain Syndromes includes the following except?

(a)Coma

(b)CVA

(c)Parkinsonism

(d)Brain Abcesses

(e)Subdural Haematoma

  1. The following are feature of Parkinsons Disease Except?

(a)Tremors

(b)Rigidity

(c)Hypokinesia

(d)Dysarthria

(e)Depression

  1. Mutwiri, a 25 years old gentleman who presents with WBC 11.9x109 /l, platelets of 600x1012/l, Tender splenomegally and Hb of 6.0 g/dl. The following could be his diagnosis: -

(a)Chronic Myeloid Leukaemia

(b)TB of the spleen

(c)Tropical splenomegally syndrome

(d)Kalazaar

(e)Sickle Cell Anaemia

  1. Causes of Anaemia include?

(a)Chronic Renal Failure

(b)Zidovudine (AZT)

(c)Leukaemia

(d)Malaria

(e)Congestive Cardiac Failure

  1. Connective tissue disorders include?

(a)Leukaemia

(b)Rheumatoid Arthritis

(c)Systemic Lupus Erythematosus

(d)Osteoarthritis

(e)Psoriasis

  1. Adverse effects of Stavudine (d4T) include?

(a)Peripheral Neuropathy

(b)Pancreatitis

(c)Anaemia

(d)Hallucinations

(e)Muscle dystrophy and Atrophy

  1. Differential diagnosis for pneumonia include?

(a)Pulmonary infarction

(b)Pulmonary TB

(c)Bronchiogenic carcinoma

(d)Pulmonary Edema

(e)Bronchiolitis

  1. Causes of increased intracranial pressure include the following except: -

(a)Meningitis

(b)Encephalitis

(c)Poliomyelitis

(d)Meningiomas

(e)Sub Arachnoids Hemorrhage

PART B – MCQ’s

  1. A 50 year old obese woman is admitted with two days history of a lower limb swelling. The leg is warm and tender.

(a)She may be havening cellulites

(b)Filiriasis is the most likely diagnosis

(c)Hypoproteinaemia is the cause

(d)Elevation of the limb is important treatment

(e)Recent surgical removal of abdominal malignancy is the contributing factor

  1. Respond to the following findings elicited on examination of a patient suspected to have lung disease: -

(a)The trachea is shifted away from the affected side in tension pneumothorax.

(b)Vocal fremitus is increased on the right side in a righted sided pleural effusion.

(c)Finger clubbing occurs in severe cases of lobar pneumonia.

(d)High lymphocyte count and exudative pleural fluid is suggestive of tuberculosis.

(e)Tuberculin test is usually strongly positive in milliary TB

  1. The following are true of a case of ascites: -

(a)Hepatic malignancy may be the cause

(b)There is asymmetrical abdominal distension

(c)Tympanic note is found on the flanks

(d)Paracentesis abdominis confirms the cause

(e)Increased bowel sounds are found on auscultation

  1. The cause of upper gastro-intestinal tract bleeding include?

(a)Mallory Weiss Syndrome

(b)Peptic ulcer

(c)Cancer of the stomach

(d)Hemorrhoids

(e)ulcerative colitis

  1. The following statements ate true: -

(a)Genital Ulcers may be due to scabies

(b)Hepatitis B is a sexually transmitted

(c)Aortic aneurysm is manifestation of syphilis

(d)VDRL blood test is confirmatory of syphilis

(e)Romberg’s sign is positive in the quaternary state of syphilis

  1. Regarding frusemide: -

(a)It is a potassium sparing diuretic

(b)Decrease renal calcium re-absorption

(c)Reduces the passive re-absorption of water from distal tube and collecting ducts.

(d)Decreases free water clearance water in nephron

(e)Increase sodium excretion by sodium pump in the loop on the Henle

  1. The following are the signs of lower motor neuron lesion: -

(a)Muscle weakness

(b)Increased tendon reflexes

(c)Extensor plantar response (Babinski’s sign)

(d)Fasciculation

(e)Hypotonia

  1. Concerning neurogenic shock: -

(a)Cardiac tamponade may be the cause

(b)It may be due to tension pneumothorax

(c)It may be associated with neurogenic pulmonary oedema

(d)Severe burns complicate the condition

(e)Major brain injury is a good example

  1. The cause for a tender hepatomegally is likely to be?

(a)Hepatoma

(b)Congestive Cardiac Failure

(c)Amoebic hepatitis

(d)Alcoholic hepatitis

(e)Hydatid cyst

  1. The following conditions/diseases of the skin are due to Bacterial infection: -

(a)Empetigo

(b)Boils

(c)Pityriasis

(d)Condylomata acuminate

(e)Scabies

  1. Changes in the skin pigmentation may be due to?

(a)Race

(b)Exposure to the sun

(c)Albinism

(d)Vitiligo

(e)Leprosy

  1. Concerning Bacillary Dysentery: -

(a)The causative organism is S. Typhi

(b)It has a chronic onset

(c)The loose stool is mixed with blood and mucous

(d)There is high fever

(e)Tenesmus is hot a feature

  1. The following are true of Typhoid fever: -

(a)It is an infectious disease

(b)Constipation may be a symptom

(c)Rose-red spots may be noted on the skin

(d)Haemorrhage may be a complication

(e)Blood culture is the most diagnostic method

  1. The following statements are true: -

(a)Urethral discharge and dysuria in a male within two days duration may be due to gonorrhea.

(b)Clamydia Trachomatis causes Lymphagranuloma inguinale

(c)Culture and sensitivity of urethral discharge in gonorrhea is the best way of confirming it.

(d)Chancre is a painful lucre on the penis

(e)Argyl Robertson is a cardiovascular complication

  1. These are true definitions of the following: -

(a)A vesicle is a small, superficial collection of pus

(b)A crust or scab is the dried exudates formed over an oozing surface

(c)An ulcer is a superficial loss of the skin produced by scratching

(d)Hyper pigmentation means an increase in melanin pigmentation

(e)A fissure is a circumscribed loss of the whole thickness of the skin

  1. The treatment of Herpes Simples: -

(a)Zovirax is useful

(b)Pregnant women should be delivered caesarean section

(c)Paracetamol may be given

(d)Caps tetracyclines are of value

(e)Wash with soap

  1. Concerning essential hypertension: -

(a)The cause is known

(b)Blood pressure of 150/90 mm.Hg at 45 years is normal

(c)Stress has been implicated

(d)It is most likely for an elder person to die of another disease than it

(e)Heavy consumption of alcohol can worsen

  1. The following are true of Acute Cholecystitis: -

(a)The pain is on the left upper guadrant

(b)Murphy’s signs is an important finding

(c)Fever is present but rigors unusual

(d)Plasma amylase levels should be measured

(e)Morphine is needed t relieve pain

  1. Pulse paradoxine is associated with?

(a)Aortic stenosis

(b)Pericardial effusion

(c)Constrictive pericarditis

(d)Severe asthma

(e)Rheumatic Heart Disease

  1. These are true symptoms of organic psychosis: -

(a)Delirium

(b)Severe depression

(c)Malaria

(d)Schizophreria

(e)Dementia

  1. A fisherman from Lake Victoria presents with progressive weight loss, skin rash, dysphagia and local oral thrush: -

(a)HIV counseling and testing is necessary

(b)He has carcinoma of the oesophagus definitely

(c)A Chest X-Ray is relevant

(d)Flagyl should treat the oral thrush

(e)Dysphagia may respond to fluconazole

  1. Concerning Nephrotic Syndrome: -

(a)May follow diabetic kidney disease

(b)Is charactrised by hypoalbuminaemia and oedema

(c)Should be treated with low protein, high carbohydrate diet

(d)Frusemide and spironolactone are not useful in the management

(e)Pero-orbital oedema on waking up in early morning is a common feature.

  1. Peripheral neruropathy may be a complication of the following: -

(a)Leprosy

(b)HIV Infection

(c)Alchoholism

(d)Diabetes Mellitus

(e)Hypoglycaemia

  1. Concerning Osteoarthritis: -

(a)It is an infective arthritis

(b)It is degenerative arthritis

(c)It is an acute inflammatory arthritis

(d)Osteophytes are a typical radiological finding

(e)It mainly affect weight bearing joints

  1. A comatose patient is admitted to your ware. No history is available as he was found in the house alone.

(a)A positive slide for Malaria rule out other diseases

(b)Diabetes could be a cause

(c)Lumbar puncture if required is done at the level of anterior superior iliac

(d)Blood sugar of 6.0 mmol/litre signifies hypoglycemia.

(e)Alcohol could be the cause.

  1. The following anti-hypertensive drugs correctly matched: -

(a)Hydrochlorothiazide - Beta Blocker

(b)Atenolol- Angiotensin Receptor

(c)Captopril - Diuretic

(d)Nifedripine-Calciuim channel Blocker

(e)Lorsatan-angiotesin-converterting Enzyme inhibitor

  1. Concerning cancer of the esophagus: -

(a)It is commonly seen in women

(b)Difficulty in swallowing fluids is the first symptom

(c)Achalasia of the cardia is a complication

(d)Weight loss is a striking feature

(e)Radiotherapy cures the patient

  1. The causes of hepatic jaundice include the following: -

(a)Spherocytosis

(b)Glucose-6-phospphatase Dehydrogenes deficiency

(c)Aldomet

(d)Viral hepatitis

(e)Sickle Cell Disease

  1. Complications of myocardrial infarction include the following: -

(a)Arythmias

(b)Embolism

(c)Acute Pulmonary Oedema

(d)Hypertension

(e)Tachypnoea

  1. The following drugs are indicated in the treatment of the corresponding condition/diseases: -

(a)Benzathine Penicilline - Pneumonia

(b)Cloxacilin - Empetigo

(c)Digoxin - Pericarditis

(d)Acetylsalicylic Acid - Angina Pectoris

(e)Heparin - Thrombophlebitis

!!!!!!!!!!!!!………………………….Best of Luck……………………..!!!!!!!!!!!!!!