SECTION D: SHORT ANSWER QUESTIONS (40 marks)

INSTRUCTIONS:

 This section consists of eight (8) questions.

Page | 1
 Write your answer in the space provide

 Marks to be awarded for each correct response are shown to specific question

1. Mention five characteristics of true labour ( 5 marks)

i. Regular contractions
ii. Progressive stronger contractions
iii. Presence of bloody show
iv. Cervix effaced and dilated
v. Head is fixed
vi. Sedation does not stop true labour
vii. Cephalic presentation.
viii. Pain is felt in the abdomen and radiating to the back
ix. Unassisted vaginal delivery
x. End with delivery of baby and other product of conception.

2. A 39-year-old woman G6P4+1L4 with GA 34 weeks came to the health centre complaining
of increasing tiredness and shortness of breath for 3 months, with frequent headaches and
palpitations. She had no previous gynecological problems and takes no medication. On
examination the woman is slim with pale conjunctivae and palm.
a. What is the likely diagnosis? ( 2 mark)
Anemia in pregnancy

b. Mention three complications if the above condition remains untreated (3

marks)

Answer
i. Prematurity
ii. Abortion
iii. Heart failure
iv. Post-partum hemorrhage
v. Uterine inertia
vi. Shock
vii. Failing lactation
viii. Sub involution
ix. Puerperal sepsis
3. Mention 5 common organisms that cause Genital infections in pregnancy
(5marks)
i. E coli
ii. Klebsiella
iii. Proteus spp Page | 2
iv. Pseudomonas
v. Enterococcus faecalis
vi. Staphylococcus aureus
vii. Staphylococcus saprophyticus

4. What are five (5) laboratory investigations you would order to an epileptic pregnant patient
presents with Loss of Consciousness( 5marks)
i. FULL BLOOD PICTURE
ii. RANDOM BLOOD GLUCOSE
iii. LIVER FUNCTION TESTS
iv. RENAL FUNCTION TESTS
v. BLOOD SLIDE FOR MALARIA PARASITES
vi. SERUM ELECTROLYTES

5. Samira is a 27 years old pregnant woman with GA of 35 weeks came to the hospital
after having 2 episodes of convulsions, she reported that before the attacks she always
experience unpleasant smell, she also reported that this condition started when she was
10 years old. Her cousin has a similar condition. On examination she has stable vital
signs.
a. What is the likely diagnosis? (2 mark)
Answer
 Epilepsy

b. Mention two investigations that can be ordered to confirm the diagnosis? (2

marks)
i. Electroencephalogram
ii. Magnetic resonance imaging

c) What is the drug of choice can be given to the above diagnosis (1 mark)
 Phenobarbitone
6. A Pregnant mother presented at the clinic at gestation age of 37 weeks, with
tiredness/general body weakness, headache, dizziness blood pressure of 100/60 mmHg,
haemoglobin 6.2 gm/dl and palpitations.
a. What is the likely diagnosis? (1 mark)
 Severe anemia in pregnancy Page | 3

b. Mention three investigations that can be order( 3marks)

i) Full blood picture to determine the cause and type of anemia

ii) Blood grouping and cross matching

iii) Serum iron concentration

iv) Iron binding capacity

v) Transferrin saturation

c. How are you going to treat the above patient? ( 1 mark)

 Admit the patient and transfuse the patient whole blood or packed red blood cells

7. A 35 year old primegravida arrives at Buguruni RCH for first antenatal visit. The
gestation age is 16 weeks. Outline FIVE important investigations which are needed in
this case: (5 marks).
Answer
a. Hemoglobin level
b. Urine for protein
c. Malaria
d. VDRL
e. HIV screening
f. Radom blood glucose
8. Mention five (5) clinical features of obstructed labour ( 5 marks)
Answer
 Delayed/ no descent of the presenting part
 Moulding
 Caput formation
 Increasing lower abdominal pain and contrations
 Abnormal fetal heart rate
 Band’s ring
 Saucer shaped abdomen, very tender
 Cessation of contractions Page | 4
 Easily palpable fetal parts per abdomen
 Per vaginal bleeding
 Shock due to internal bleeding
SECTION E: ESSAY QUESTIONS (30 marks)

INSTRUCTIONS

 This section consists of two (2) questions which are supposed to be answered in a
narrative way Page | 5
 Answer both questions.

 Each question must start on a new page

1. 29 years old prime gravida at a gestation age of 24 weeks presents at the dispensary with
history of vomiting everything, fever and muscle ache. On examination she is ill looking,
febrile, lethargic, cannot sit without support and jaundiced. MRDT test is done and was
positive. Discuss the management of this patient in terms of diagnosis, differential
diagnosis, investigations, treatment and complications.
Answer
Provisional diagnosis (2 marks)
Complicated malaria
Differential diagnosis (3 marks) - mark any 3 @ 1 mark
 Septicemia
 Enteric fever
 Urinary tract infection
 Meningitis
 Dengue

Investigation (4 marks) - mark any 4 @ 1 mark

 Blood slide for malaria parasites- will help to see the degree of parasitemia
 Full blood picture / hemoglobin level - to check hemoglobin level, White blood cell
and platelets
 Serum electrolytes such as potassium, sodium, chlorine to rule out electrolyte
imbalance
 Random blood glucose to check and treat hypoglycemia
 Renal function tests such as blood urea nitrogen and serum creatinine to rule out renal
failure
 Liver function tests
 Urinalysis to rule out urinarly tract infection
 Widal test to rule enteric fever
 Treatment- 4 marks
 Intravenous artesunate 2.4 mg/kg at 0, 12 and 24 hour then continue with tablets
ALU.
 Paractetamol 500 mg 8hly to control fever.
 Continue with feeding Page | 6

Complications – (2 marks) mark any 2 @ 1 mark

 Coma, convulsions
 Anemia
 Acute renal failure
 Pulmonary edema
 Disseminated intravascular coagulopathy
 Hypoglycemia
 Metabolic acidosis

2. Discuss mastitis based on definition, risk factors, clinical features, management and
complications ( 15 marks)
Introduction ( 2 marks)
• Mastitis is the inflammation of the breast tissue. It is common in the first 3 months breast
feeding. Breast becomes painful, swollen and red.

Risk factors- 3 marks (mark any 3 @ 1 mark)

 Previous history of mastitis
 Partial blockage of milk duct
 Over supply of milk
 Infrequent feedings
 Nipple cracking or excoriation
 Rapid weaning
 Illness in mother or baby

Clinical features- 4 marks (mark any 4 @ 1 mark)

 Breast pain
  Swelling
 Erythematous
 Fever
 Myalgia
 Chills Page | 7
 Malaise
 Axillary lymphadenopathy associated with axillary pain and swelling

Management -3 marks
 Stop lactation: from the affected breast and breast is emptied manually or by an
electric pump.
 When the acute phase is over breast feeding can be resumed. Support the breast:
over a pad of cotton wool.
 Antibiotic therapy: A sample of milk is sent for culture and sensitivity then antibiotic
started. Flucloxacillin 500 mg/6 hours is suitable for 10-14 days. If allergic to
penicillin: Erythromycin tab 500mg qdsx10-14 days.

 Analgesics – A: Ibuprofen500mg 8 hourly for 5 days OR Paracetamol 500-1000mg

8 hourly for 5 days

Complications- 3 marks (any three complications)

 Breast abscess
 Inflammatory breast cancer
 Systemic symptoms e.g. fever, myalgia
 Inability to use the affected breast in case
 Recurrence mastitis