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Dicm 220: Medicine 1 Question Paper
Dicm 220: Medicine 1
Course:Clinical Medicine & Surgery
Institution: Kenya Methodist University question papers
Exam Year:2011
KENYA METHODIST UNIVERSITY
END OF 3''RD ''TRIMESTER 2011 EXAMINATIONS
SCHOOL : MEDICINE & HEALTH SCIENCES
DEPARTMENT : CLINICAL MEDICINE & SURGERY
UNIT CODE : DICM 220
UNIT TITLE : MEDICINE 1
TIME : 3 HOURS
Instructions:
Write your Registration Number on each paper
Use a pen not pencil
MCQs
Correct response earns one mark
You lose one mark for every incorrect response
You do not lose a mark if you do not attempt
Answer ALL Questions on the MCQs paper
PART A – ESSAY QUESTIONS
Question One
Mention the types of pneumonia you know.
(b) Describe the clinical features of the most common type
of pneumonia.
(c) List its complications.
Question Two
Discuss infective endocarditis under the following headings.
The cause
Clinical features
Management
PART B: SHORT ANSWER QUESTIONS
Question One
What are the differential diagnosis of influenza (flue)
Question Two
Mention FIVE conditions which present with blood stained sputum
Question Three
Indicate the possible causative organisms of the following diseases:
Rheumatic fever
HINI (Swine flue)
Tuberculosis
Acute Bronchitis
Influenza
Question Four
Indicate whether the fluid in the pleural cavity is an exudates or transudate in each of the following conditions:
Congestive Cardiac Failure
Pulmonary infarction
Malignant disease
Cirrhosis of the liver
Tuberculosis
Question Five
Discuss the symptom "cough"
Question Six
What are the findings on examination of a patient with pleural effusion in regard to the following:
Trachea
Chest movement
Percussion note
Breath sounds
Vocal fremitus
Question Seven
Give TWO differential diagnosis of a swollen, warm and tender leg.
Question Eight
Outline the management of heart failure.
Question Nine
Mention THREE indications of aspirin and two side effects
Question Ten
What is the management of essential hypertension?
PART C: MCQs
Question One
Parulent sputum
Is a clinical feature of coryza
Is a symptom of chronic bronchitis
The organisms responsible are pyogenic
Streptococci may also be responsible
Is a feature of influenza
Question Two
Concerning Kussmauls breathing:
Patients with meningitis have.
Is caused by the stimulation of the respiratory centre
Increased levels of carbon dioxide in the blood is to blame
Drug addicts of narcotic have it
Is a sign of brain injury
Question Three
A patient with congestive cardiac failure:
Has a non tender hepatomagally
Crepitations are found at lung bases
Salt free diet is advisable
Pulse rate is within the normal range
Central cyanosis is a finding
Question Four
True or false
Haemoptysis in cardiac disease is due to valvular lesion
Peripheral cyanosis is best seen under the nails
The skin of the extremities is warm in central cyanosis
Cyanosis may be a feature in severe congestive cardiac failure
Pitting ankle oedema is always present in CCF.
Question Five
Extrapulmonary tuberculosis may cause the following
Brain abscess
Constrictive pericarditis
Lymphaderitis
Ascites
Valvular lesions
Question Six
Regarding pleural effusion
It usually follows pleurisy
The fluid is usually serous
Transudate means the protein content is more than 2.0g/100ml
Turbid colour of the fluid indicates that the cause is tuberculosis
In uraemia, the fluid is usually transudate
Question Seven
Concerning pneumothorax:
The absence of breath sounds and the resonant percussion note is
diagnostic
The percussion note is dull in tension pneumothorax
The chest-X-ray shows homogenous opacity on the affected side.
The underwater seal drain is usually removed even when bubbling has not stopped.
The intercostals tube drainage is usually inserted in the 5th or 6th intercostals space.
Question Eight
A patient who presents with a cardiac conditions:
Complains of tachycardia and fatigue
Presents with a symptom similar to a case of thyrotoxicosis
The true cardiac pain is usually at the precordium area.
The pain is usually aggravated by exertion
Inadequate blood circulation to the brain may cause syncope
Question Nine
Concerning brochial asthma
It may result from mucosal swelling
The difficulty in breathing is usually more on inspiration
Aminophylline is administered subcutaneously
Spongy pillows may aggravate the condition
It is prone to people with allergy
Question Ten
Regarding neurogenic shock
Cardiac tamponade may be the cause
It may be due to tension pneumothorax
It may be associated with neurogenic pulmonary oedema.
Severe burns complicate the condition
Major brain injury is a good example.
Question Eleven
The following anti-hypertensive drugs are correctly matched.
Hydrochlorothiazide _________ Beta Blocker
Atenolol ______________ Angiotensin Receptor Blocker
Captopril ___________ Diuretic
Nifedipine _________ Calcium channel blocker
Lorsatan __________ Angiotensin – converting enzyme inhibitor
Question Twelve
On carcinoma of the bronchus:
It is more common in woman than men
It is slightly higher in rural areas than in urban
Haemoptysis is a characteristic feature
Metastases to other organs may occur
Horner’s syndrome may be a sign in some patients.
Question Thirteen
Investigation of an hypertensive patient:
Urinalysis for blood is to confirm essential hypertension
Presence of proteins in urine indicates the hypertension is due to glomerular nephrits
Chest radiography may detect cardiomegally
Blood glucose test may give a clue
Stool examination for urea can be done
Question Fourteen
Concerning valvular disease:
The valve which is mostly affected is tricuspid
The aortic valve is most affected in syphillis
Two-thirds of men with rheumatic fever have valvular lesions
Pulmonary valve is the least affected
Mitral incompetence is usually due to myocardial information
Question Fifteen
Risk factors in hypertension:
Family history
Aortic stenosis
Consumption of fatty foods
Chronic respiratory disease
Protenuria
Question Sixteen
Acute rheumatic fever:
Blood culture will identify the causative organism
The organisms usually respond to penicillin therapy
Emboli may cause strokes
Hepato-splenomegally is the finding
Erythromycin is the best alternative in case of the patient being allergic to penicillin
Question Seventeen
The finger clubbing is found in the following:
Pericarditis
Bronchial carcinoma
Malabsorption syndrome
Emphysema
Crohn’s disease
Question Eighteen
Management of bronchictasis:
Paracetamol
Postural drainage
Expectorant mixture
Capsule amoxyl
Antisposmadics
Question Nineteen
Diagnosis of pulmonary tuberculosis:
Blood for total white cell count
Sputum for gm.stain
Tuberculin test
Ascitic fluid for specific gravity
Chest X-ray=PA view
Question Twenty
Concerning empyema:
Stony dull percussion n ote is a finding
Vesicular breath sounds are found on the affected side
Bronchial breathing is a feature
Chest X-ray confirms the condition
Surgical intervention may be indicated
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