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Dicm 333:Medicine Paper Ii Question Paper

Dicm 333:Medicine Paper Ii

Course:Clinical Medicine

Institution: Kenya Methodist University question papers

Exam Year:2013

KENYA METHODIST UNIVERSITY

END OF 1''ST ''TRIMESTER 2013 (FINAL QUALIFYING) EXAMINATIONS
SCHOOL : MEDICINE & HEALTH SCIENCES
DEPARTMENT : CLINICAL MEDICINE
UNIT CODE : DICM 333
UNIT TITLE : MEDICINE PAPER II
TIME : 3 HOURS

Instructions:

Read the instructions carefully
Write your University Number (Not Name)
Number all the questions correctly
Answer all questions on the multiple choice questions paper
Correct response earns 1mark; for every incorrect response you lose 1 mark and you do not a mark if you do not attempt
Do not use a pencil.
Answer Part A and B separately.

PART A

Question One

Causes of chronic diarrhea include

Strongyloidosis
Shigellosis
Tropical sprue
Salmonellosis
HIV enteropathy

Question Two

The following statements are true of scabies

Can be transmitted during sexual intercourse
Intense itching is worse at night.
The lesions are found mostly on the exterior surfaces of the skin.
Secondary infection causes urticarial papules and pustules
25% of Benzyl Benzoate emulsion is the drug of choice

Question Three

The following statements are true

Haemoptysis in cardiac disease is usually due to valvular lesion.
Central cyanosis is best seen under the nails
In central cyanosis the skin of the extremities is warm.
Central cyanosis is due to reduced blood volume.
Cyanosis may be found in a case of congestive cardiac failure.

Question Four

Respond true of false on the following

Frothy sputum is seen in pulmonary Oedema
Cough precipitated by exertion is usually of respiratory system
Fatigue may be due to endomyocardial fibrosis
A patient with anaemia may complain of fatigue
Physiological syncope may be seen in cardiomyopathies

Question Five

The following are the risk factors in hypertension

Family history
Aortic stenosis
Consumption of fatty foods
Chronic respiratory disease
Proteinuria

Question Six

The following findings are matched correctly

Vesicular breathing – Pneumonia
Bronchial breathing – Lung consolidation
Ronchi – normal lung
Crepitations – Bronchial asthma
Pleural rub – pleurisy

Question Seven

A patient who present with purulent sputum may have the following diseases.

Acute Bronchitis
Bronchial Asthma
Bronchiectasis
Chronic obructive pulmonary disease (COPD)
Influenza

Question Eight

The following drugs used in the management of Bronchial asthma are administered correctly

Theophylline - Intravenous route
Adrenaline – subcutaneously
Aminophylline – orally
Hydrocortisone - Intravenously
Sulbutamol – intramusalarly

Question Nine

Concerning the management of COPD

Salbutamol 8mg BD
Paracetamol 2 tablets
Capsule Amoxycillin 500mg TDSX
Breathing exercises are of benefit
Avoidance of cigarette smoking

Question Ten

Concerning Pleurisy

Pleural rub is a finding
Chest pain is retrosternal
Ronchi are present
Chest X-ray confirms this condition
Tuberculosis is a complication

Question Eleven

The following are true of Acute Rheumatic fever

Blood culture will identify the causative organism
The organisms usually respond well to penicillin therapy
Emboli may cause stroke
Hepato-megally is the finding
Erythrocyte sedimentation rate is increased

Question Twelve

The cause of a tender hepatomegally is likely to be

Hepatoma
Congestive cardiac failure
Amoebic hepatitis
Alcoholic hepatitis
Hydatid cyst.

Question Thirteen

The following are true of pneumothorax

The presence of air in the alveoli
Iatrogenic pneumothorax is a complication of percutaneous lung biopsy
The trachea is deviated towards the affected side
There is always an underlying lung disease in the elderly patients
The pleuritic chest pain is of sudden onset.

Question Fourteen

Bradycardia is found in the following conditions

Myocardial infarction
Thyrotoxicosis
Obstructive jaundice
Pregnancy
Brain tumour

Question Fifteen

The following are the clinical features of acute pancreatitis

The pain is more on the right upper quadrant
The pain radiates to the back
Signs of shock may be seen
Serum amylase level is usually decreased from the normal
There is vomiting.

Question Sixteen

Changes in skin pigmentation may be due to

Race
Exposure to the sun
Albinism
Vitiligo
Leprosy

Question Seventeen

The following are true of hepatoma

His a highly malignant tumour of the liver
Aflotoxin is implicated
90% of patients test HIV positive
Alcohol consumption is associated with it.
Prognosis is good

Question Eighteen

The following statements are true of typhoid fever

It is an infections disease
Constipation may be present
Rose-red spots may be noted on the skin
Haemorrhage may be a complication
Blood culture is the most diagnostic method

Question Nineteen

Concerning ankylostomiasis

The parasite is transmitted through oral route
Haemoptysis may be a symptom
Megaloblastic anaemia may develop
Stool test for occult blood will be positive
Single dose of Albendazole 400mg is the best choice.

Question Twenty

The following statements are true of cancer of oesophagus

It is commonly seen in men
Difficulty in swallowing fluids in the first symptom
Achalasia of the cardia is a complication
Weight loss is a striking feature
Radiotherapy cures the disease

Question Twenty One

A comatose patient is admitted to your ward. No history is available

A positive blood slide for malaria parasite rules out other diseases.
Diabetes mellitus could be a cause.
Lumber puncture required is done at the level of anterior superior iliac
Blood sugar of 6.0 mml/litre signifies hypoglycaemia
Alcohol could be the cause

Question Twenty Two

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

She may be having cellulitis
Filiriasis is the most likely diagnosis
Hypoproteinures is the cause
Elevation of the limb is important management
Recent surgical removal of abdominal malignancy is likely to be the contribution.

Question Twenty Three

The following statements are true of community acquired pneumonia.

The infection is spread through contact
Alcohol drinking may predispose to the condition
One lobe is usually affected in lobar pneumonia
Bronchial breathing is a finding
There is pleuritic pain.

Question Twenty Four

Concerning Syphilis

Treponema pallidum is the bacteria responsible for infection
May be transmitted through kissing
Penicillin remains the drug of choice
Change is a painful ulcer on the penis
Argyll-Robertson is a cardiovascular complication

Question Twenty Five

The following are true of candidiasis.

Is it caused by thrush
It may cause dysphagia
May be found in patients receiving prolonged oral antibiotic drugs
White patches on buccal mucosa are seen
Cyanocobalamin is the drug used for treatment

Question Twenty Six

Regarding fruzemide

It is a potassium sparing diuretic
Decreases renal calcium re-absorption
Reduces the passive re-absorption of water from distal tubule and collecting ducts.
Decreases free water clearance in nephron
Increase sodium excretion by sodium pump in the loop of Henle.

Question Twenty Seven

The following are true of a case of ascites

Hepatic malignancy may be the cause
There is symmetrical abdominal distension
Tympanic note is found on the flanks
Paracentesis abdominis confirms the cause
Increased bowel sound are noted

Question Twenty Eight

The following vitamins are matched correctly with the conditions seen when deficient

Vitamin A – Night blindness
Vitamin B12 – Ricketts
Vitamin C – Beriberi
Niacin – Pellagra
Vitamin K – Haemolytic anaemia

Question Twenty Nine

The following are complications of Gonorrhoea

Prostatitis
Urethral stricture
Male sterility
Blindness of both sexes
Salpingitis

Question Thirty

A 24 year old man presents to your clinic with marked dyspnoea and haemoptysis.

Pulmonary Tuberculosis is definitely the diagnosis
A murmur of mitral stenos is may be present on auscultation
Bronchiectasis could be the cause
Intravenous Aminophylline may be useful.
Franol and haematenic should be sufficient treatment

PART B

Question One

Causes of post renal acute renal failure include:

Renal calculi
Prostate enlargement
Acute glomenlonephritis
Haemorrhage
Congestive cardial failure

Question Two

Indication of dialysis include

Uraemic pericarditis
Pulmonary oedema not responding to treatment
End stage renal disease
Random blood sugar of 20mmol/l
Potassium levels of 5.8mmol/l.

Question Three

Metabolic complications of chronic renal failure include

Megaloblstic anaemia
Bleeding tendancies
Hypercalcaemia
Polyneuropathy
Lowered creatinine levels

Question Four

Extra pulmonary TB may present as

Ascitis
Brain abscess
Pericarditis
Lymphadenitis
Hematuria

Question Five

Chronic complications of Diabetes Mellitus include

Renal insufficiency
Uraemic encephatopathy
Peripheral arterial disease
Hypoglycaemic attacks
Retinopathy

Question Six

Management of diabetic keto acidosis

Potassium should be restricted due to hyperglucaemia
Antibiotics have no role
Ringers lactate is the fluid of choice
Should be started on oral hypoglycemic immediately
Calcium supplementation is necessary

Question Seven

Tumours associated with HIV include

Leukaemias
Brain lymphomas
Cancer of the cervix
Kaposi’s sarcoma
Astrocytomas

Question Eight

The following are clinical features of Acute Pancreatitis

The pain is more to the right upper quadrant
The pain can radiate to the back
Signs of shock may be seen
Serum amylase level is usually decreased from the normal range
There is vomiting

Question Nine

Features of stage 4 HIV include

TB peritonitis
Oral thrash
Herpes roster encephalitis
HIV associated nephropathy
Cryptococcal meningitis

Question Ten

Features of Cushings syndrome include

Thin skin with striae
Immunosupression
Fat redistribution
Glucose intolerance
Salt and fluid retention

Question Eleven

Hormones associated with hyperglycemia include

Growth hormone
Glucagon
Anti diuretic hormone
Glucocorticoids
Vitamin D

Question Twelve

Features of hyperthyroidism include

Cold intolerance
Oligomenorrhoea
Fine tremors
Exoptualmons
Palpitations

Question Thirteen

Signs and symptoms of meningitis in adults include

Anisochorea
Increased head circumference
Neck stiffness
Rhinorrhea
Raccoon eyes

Question Fourteen

A Lumbar puncture from a patient with suspected bacterial meningitis include

Clear colourless sample
Sugar levels of 8mmol/L
Prominent monocuclear lymphocytes
High calcium levels
Elevated platelet count

Question Fifteen

Features of lower Motor Neuron Lesions include

Hypotonicity
Low muscle bulk
Hyper reflexia
Associated with a meningioma
Muscle fasciculation

Question Sixteen

Trigger factors of a sickling crisis include

Infections
Acidosis
Dehydration
Associated with use of analgesics
Hypocalcaemia

Question Seventeen

Causes of polycythaemia include

Cigarette smoking
Chronic bronchitis
Gastric carcinoma
Living at high altitude areas
None of the above

Question Eighteen

Pernicious anaemia

Due to folate deficiency
Intrinsic factor has no role in its management
Associated with microcytic anaemia
May occur following gastrectomy
The pathogenisis is due to an autoimmune disease

Question Nineteen

Causes of Normocytic Normochronic anaemia include

Leukaemia
Erythropoietin deficiency
Chronic kidney disease
Diphylobothrium latum
Necator americanus

Question Twenty

Important in management of sickle cell anaemia

Routine vaccinations
Antibiotic prophylaxis
Transfusion when haemoglobin levels reach 8g/dl
Routine folate supplementation
Hydroxyurea

Question Twenty One

Burkitts lymphoma

Associated with malaria prevalence
Endemic type more common in the tropics
Sporadic type present mainly with a neck mass
Main form of management is chemotherapy
Treatment associated with tumour lysis syndrome

Question Twenty Two

True concerning Hodgkin’s lymphoma

Associated with reed stenburg cells
Cytology shows a starry sky appearance
Most commonly affects the T-lymphocites
Management is mainly by surgery
Patients may present with a widened mediastinum

Question Twenty Three

Complications of acute leukaemia include

Thrombocytes
Recurrent bacterial infections
Bleeding disorders
Microcytic anaemia
May present with convulsions.

Question Twenty Four

Investigations in suspected chronic leukaemia include

Bone marrow aspirate
Chest X-ray
Peripheral blood films
Chromosomal studies
Immunocyto chemistry

Question Twenty Five

Acute Glomerulnephritis is associated with

Hypertension
Microscopic haematuria
Thrombotic episodes
Oliguria
Associated with pre-renal Acute Renal failure

Question Twenty Six

Indicatins of initiatitng Highly Active Anti-Retroviral Treatment (HAART) include

CD4 of 360 cells /ml
History of cytomegalovirus Retinitus
History of HIV wasting syndrome
WHO stage 2 HIV
Kaposi’s sarcoma

Question Twenty Seven

Causes of macrocytic anaemia include

Alcohol abuse
Chronic Renal Failure
Folate deficiency
Resection of the Terminal Ileum
Resection of the Jejunum

Question Twenty Eight

Features of Tumour Lysis Syndrome

Hyperkalemia
Hypophosphataemia
Increased uric acid levels
Allopurinol has no role in management
Rehydration plays a major role in management.

Question Twenty Nine

Examples of Autoimmune Diseases include:

Osteoartatisis
Septic arthritis
Rheumatoid Arthritis
Systemic lupus erythematosis
Dermatomyositis

Question Thirty

Features of Rheumatoid Arthritis

Mainly affects the large joints
Associated with morning stiffness
May lead to renal failure
Affects only one side of the joints
All the above are true.

Dicm 333:Medicine Paper Ii Question Paper

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