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Dimc 221:Medicine Ii Question Paper

Dimc 221:Medicine Ii

Course:Clinical Medicine

Institution: Kenya Methodist University question papers

Exam Year:2012

KENYA METHODIST UNIVERSITY

END OF 2''ND ''TRIMESTER 2012 (DAY) EXAMINATIONS
SCHOOL : MEDICINE & HEALTH SCIENCES
DEPARTMENT : CLINICAL MEDICINE, SURGERY & COMMUNITY

HEALTH
UNIT CODE : DICM 221
UNIT TITLE : MEDICINE 2
TIME : 3HOURS

INSTRUCTIONS: Answer ALL Questions

SECTION A

QUESTION ONE

Burkitt`s lymphoma
A. Associated with cytomegalovirus (CMV) infection
B. Associated with tumour lysis syndrome
C. Endemic type is associated with malaria infection
D. May present with aplastic anaemia
E. Allopurinol may have a role in its management

QUESTION TWO

Macrovascular complications of diabetes include
A. Diabetic retinopathy
B. Cerebro vascular accident
C. Diabetic nephropathy
D. Peripheral arterial disease.
E. Acute myocardial infection

QUESTION THREE

Complications of liver cirrhosis include:
A. Oesophagel varices
B. Gynaecomastia
C. Massive ascites
D. Bleeding disorders
E. Elevated albumin levels

QUESTION FOUR

Management of patient in diabetic ketoacidosis (DKA) includes
A. Rehydration with half strength darrows
B. Use of oral hypoglycaemics
C. Antibiotics play no role in management
D. May require potassium supplementation
E. May require calcium supplementation

QUESTION FIVE

Complications of hypertension include:
A. Hypertensive encephalopathy
B. Chronic renal insufficiency
C. Hypoalbuminaemia
D. Haemorrhagic stroke.
E. Hyperphosphataemia.

QUESTION SIX

Parathyroid hormone
A. Leads to calcium resorption from bone.
B. marketing reduced in chronic renal failure
C. is antagonistic to the activity of vitamin D
D. Produced by the posterior pituitary
E. Stimulates phosphate reabsorption from kidneys

QUESTION SEVEN

Adverse effects of starvadine include:
A. Lipodystrophy
B. Acute pancreatitis
C. Bone marrow failure
D. protease inhibitors are associated with hyperlipidaemia
E. Nevirapine is not known to cause hepatotoxicity

QUESTION EIGHT

Adverse effects of prolonged steroid use include:
A. Thick skin
B. Buffalo hump
C. Psychosis
D. immunosupression
E. All of the above

QUESTION NINE

Nephrotic syndrome is associated with
A. Hyperalbuminaemia
B. Hypercoagulability
C. Pulmonary oedema
D. Immunosupression
E. May occur due to mercury poisoning

QUESTION TEN

Examples of first line anti-TB medication include
A. Isoniazid
B. pyraziamide
C. amikacin
D. Rifamycin
E. Rifabucin

QUESTION ELEVEN

Causes of exudates include:
A. Liver cirrhosis
B. malignancies
C. pulmonary tuberculosis
D. nephritic syndrome
E. Cardiac failure

QUESTION TWELVE

Features of raised intracranial pressure include
A. Double vision
B. projectile vomiting
C. lowered levels of consciousness
D. may lead to increase head circumference in adults
E. sensory and motor neuronal deficiencies.

QUESTION THIRTEEN

Hodgkins lymphonsa
A. Associated with reed stenburg cells
B. Associated with starry sky appearance
C. Main mode of treatment is surgery
D. Lymph node biopsy is the goal standard test
E. Mainly presents with a rapidly growing jaw mass.

QUESTION FOURTEEN

Sickle cell anaemia
A. Underlying genetic defect is a point mutation at the alpha globulin chain
B. causes a prolonged red cell life span.
C. increases susceptibility to infection
D. life long folic acid treatment is recommended.
E. Malaria prophylaxis is recommended as part of the management plan.

QUESTION FIFTEEN

Signs of upper motor neuron lesions include:
A. Flaccid paralysis
B. hyperreflexia
C. muscle wasting
D. increased tone
E. A positive barbinski reflex.

QUESTION SIXTEEN

Concerning follow-up of HIV positive patients
A. Liver function tests should be done on every visit
B. Lipid profiles have no role in a patient taking ritonavir
C. CD4 counts should be taken yearly
D. HAART should be initiated on a patient with history of herpes zoster
E. Kaposi`s sarcoma is a WHO stage 4 symptoms

QUESTION SEVENTEEN

Risk factors for developing peptic ulcer disease (PUD) include
A. Chronic use of asprin
B. Shigellosis infection
C. Helicabator pylori infections
D. Zollingar elision syndrome
E. Steroid overuse

QUESTION EIGHTEEN

Cryptococcal meningitis
A. Drug of choice is chloramphenical
B. Indian ink stain plays a role in diagnosis
C. likely in a HIV infected patient with a CD4 of 400 cell/mls
D. Patients may present with blurred vision
E. CSF biochemistry likely to show elevated sugars and reduced protein levels.

QUESTION NINETEEN

Causes of liver cirrhosis include:
A. Wilson`s disease
B. Hepatitis A infection
C. Hepatitis C infection
D. Haermacchromatosis
E. Chronic alcohol abuse.

QUESTION TWENTY

Investigations in a hypertensive patient
A. microalbuminuria on urinalysis is not significant
B. chest x-ray likely to show cardiomegaly
C. stool examination is a mandatory test
D. urea electrolytes and cretinine play no role in management of the patient
E. Regular monitoring of sugars is not necessary.

SECTION B (SHORT ANSWER QUESTIONS)

QUESTION ONE
Classify hypertension according to the JNC- 7 system. (5marks)

QUESTION TWO
Stage heart failure clinically according to the New York Heart Association (NYHA) system. (5marks)

QUESTION THREE
Briefly discuss the clinical presentation of asthma. (5marks)

QUESTION FOUR
List and discuss expected findings of investigations you would do to a patient with suspected acute leukemia. (5marks)

QUESTION FIVE
Briefly discuss the clinical presentation of a patient with suspected acute pancreatitis. (5marks)

QUESTION SIX
Briefly outline the features of Nephritic syndrome. (5marks)

QUESTION SEVEN
Discuss management of vasooclusive crisis in sickle cell disease. (5marks)

QUESTION EIGHT
Briefly discuss the hormones involved in calcium metabolism. (5marks)

QUESTION NINE
a) Define cor-pulmonale

b) List common causes for cor pulmonale. (5marks)

QUESTION TEN
Briefly discuss the investigations you would do on a patient with suspected ascites. (5marks)

SECTION C (LONG ANSWER QUESTIONS)

QUESTION ONE
Discuss the management (History, investigations, examination and treatment) of a known type 1 diabetic who presents with vomiting, sharp abdominal pain and a fruity odour in his breath. (25marks)

QUESTION TWO

Discuss cerebro vascular accident under the following topics:

Definition
Risk factors
Clinical presentation
Investigations

Treatment

(25marks)

Dimc 221:Medicine Ii Question Paper

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