Troy Kampira - End of Year Exams-Across Years

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TABLE OF CONTENTS
AUTHOR:
LIST OF FIGURES
Figure 1-Satelite map of Kalang'oma village ..... Error! Bookmark not defined.
MBBS 3 END OF YEAR
Figure 2- A small marsh near Nankhaka river .. Error! Bookmark not defined.
Figure 3- Sketch
EXAMS of village profile .................... Error! Bookmark not defined.
Figure 4- Gule Wamkulu ................................ Error! Bookmark not defined.
ACROSS
Figure YEARS
5-Jehovah's witness church and the village cemeteryError! Bookmark not
defined.
Figure (MCQS
6- Earth road & and SAQS)ox-drawn cart .......... Error! Bookmark not defined.
Figure 7-Grass thatched house ........................ Error! Bookmark not defined.
Figure 8- Boys playing soccer and pool table... Error! Bookmark not defined.
SUBMITTED TO MBBS
Figure 9- Community 3 STUDENTS
members drawing water from a boreholeError! Bookmark
not defined.
Figure 10-Ablution facilities............................. Error! Bookmark not defined.
Figure 11-Inside the ablution facilities and improper waste disposal in the village
TROYnotMADAH
..................................................................... Error! Bookmark defined.
Figure 12- Women preparing vegetables for sale and men doing piece workError!
KAMPIRA
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Figure 13- A man on his way to sale maize and a food standError! Bookmark not
defined.
MBBS 3
201850044596
0994679938
2021 MBBS 3 END OF YEAR EXAMINATION, SAQs
COMMUNITY HEALTH
1. Monitoring and evaluation
a) Define Monitoring
b) Define Evaluation
c) Use A for monitoring and B for evaluation
I. Primary role objective is tracking and oversight
ii. Focusses on effectiveness impact, cost effectiveness, relevance
iii. Data sources include routine surveillance systems, field observations, progress
report, surveys and special studies
iv. Focus is on conformity/fidelity to program guidelines, process, indicators,
goals and work plans
v. conducted by focal persons and program implementers
vi. Local researchers conducted a study to determine if individuals who are
symptomatic for TB are visiting the DOTS clinics after media campaigns
vii. District manager reports how many nurses were trained on interpersonal
communication skills for quarterly donor reports
viii. Based on activities and targets set out during planning of project or program
2. Health status.
a) Mention 5 reasons for measuring health status of a community
b) What information is needed to make a health profile of a
community
3. Health Systems
a) What is a health system?
b) Mention two characteristics of a health system
c) State and describe the 6 building blocks of a health system.
1|Page ...TROY MADAH KAMPIRA...

PAEDIATRICS
4. On Gastroenteritis
a) Describe the mechanism of function of ORS
b) Stat two major deference’s between ORS and RESOMAL
c) What organism is the most common cause of gastroenteritis in
children below 2yrs
d) Mention two drugs that are proven safe and reduce the duration
of diarrhea in GE
e) Mention two common causes of GE that are associated with HUS
f) Mention two causes of GE that can be prevented by vaccination
5. A 4 yr. old with AIDS is admitted to NRU with issues of SAM

a) Mention three ways in which AIDS can cause SAM
b) He was started on F-75 feeding cautiously to avoid refeeding
syndrome. State any two metabolic derangements that happen in
refeeding syndrome.
c) Mention two causes of edema in a patient with SAM
d) Mention any two pathological changes of the gastrointestinal
system
6. A 3-day old is admitted in the neonatal ward with issues of sepsis.

You are asked to get a thorough history from the mother to help
determine the cause of sepsis.
a) Mention any four risk factors you will be looking for
b) Mention any three organisms likely to cause sepsis in the child.
c) State any three investigations you would do to isolate these
organisms

MEDICINE
7. A 45yr old lady is suspected to have a UTI. She presents with
dysuria and suprapubic pain. On PE she has suprapubic tenderness.
a) List two common organisms that cause UTI
b) List any two risk factors for UTI in males/females
c) List two local complications of pyelonephritis
d) List four prevention strategies for UTI
e) List two antibiotics for treatment of patients with asymptomatic UTI
8. Case on SEPSIS
a) Define sepsis
b) Mentions three risk factors for sepsis
c) Mention six intervention that you would do in the first hour
d) Apart from ceftriaxone, state any two other types of drugs with
examples that can be used in a patient with sepsis.
9. 48 yr. old man presented with three days of fever, diarrhea and
vomiting followed by low urine output. At the beginning of his
symptoms he took herbal medication to try and alleviate the
symptoms. On physical examination he is dehydrated has a low
blood pressure and has generalized abdominal tenderness. Labs
show
Na 121
K 5.3
BUN 74
Creatinine 3.5
a) How would you categorize causes of AKI?
b) List possible causes of each category in (a)
c) List tests or interventions you would do to establish the cause of
AKI in the patient. Explain how each would help you in confirmation.
d) State any three indications for dialysis.
SURGERY
10. A 76yr old presents to A/E with a history of not passing stool
and flatus for 7 days, vomiting and abdominal distention.
a) Define acute abdomen
b) What features on abdominal exam would you find for peritonitis?
c) Give your differential for peritonitis
d) List any investigations you would do to confirm your diagnosis of
peritonitis
e) What would be your treatment for this condition depending on
your differential. Give both initial and definitive management
11. A 24yr old man was assaulted in the head and presented to
casualty unconscious. He is not talking only extending to pain and is
not opening his yes.
a) What is the severity of the head injury?
b) Which imaging investigation would you order for this patient?
c) How will you manage the patient initially in casualty (ABCDE)?
d) Where will you admit?
12. A Patient presents with a history of vomiting blood twice the

previous night.
a) What are the common causes of hematemesis in Malawi?
b) What are four things you would ask for when taking a history?
c) Which two investigations would you do to confirm your diagnosis?
d) How would you manage the patient medically?

2020 MBBS 3 END OF YEAR EXAMINATION, MCQs

10 | P a g e ...TROY MADAH KAMPIRA...
PEADIATRICS

INTERNAL MEDICINE

SURGERY

COMMUNITY HEALTH

1. Patient with crackles on right lower zone, confusion, respiratory rate of 35,
low blood pressure and 94% saturations in room air.
i. What is the diagnosis (2 marks)
ii. Mention four clinical finding on examination (4 marks)
iii. Grade the severity of the condition (1 mark)
iv. How will you manage this patient according to the score above (3
marks)
2. A 17-year-old girl, had pain and swelling of one of her joints, it resolved
and then another one joint started. She had an episode of fever and sore
throat in the past and it was treated successfully.
She had a murmur on examination
i. What is name of the syndrome? (1 mark )
ii. What other clinical manifestations will she present with except the
ones mentioned above? (3 marks)
iii. What could have prevented the syndrome above? (2 marks) iv.
What is the long-term consequence of the syndrome above? (1
mark)?
v. What advice would you give to the patient to avoid recurrent
episode(disease) (4 marks)
3. i. What is the seizure (1 mark)
ii. List 6 generalized seizures (6 marks)
iii. What is the differential diagnosis of seizures (3 marks)
4. Acute abdomen
i. Definition of acute of abdomen (1 mark)
ii. Clinical presentation of acute abdomen (2 marks)
iii. What is the differential diagnosis (2 marks)
iv. What are the investigations done (2 marks)
v. What is the Management of acute abdomen (3 marks)
5. Radiological interpretation
i. Differentiate features of large bowel distention and small bowel
distention (6 marks)
ii. Define FAST in Trauma and mention it’s components ( 4 marks )
6. Differentials of inguinal swellings (3 marks )

i. Classify hernias according to type & how to differentiate them
(4 marks)
ii. Investigations in Hernia (3 marks)
7. Components of monitoring and evaluation (10 marks)
8. i. Define coverage health indicator (1 mark)

ii. Define health utilization indicator (1 mark)
iii. Label the following indicators as coverage or utilization indicator by
using A for Coverage and B for utilization indicator.
(There was a table with 8 different health indicators) (8 marks)
9. i. Mention 5 reasons for measuring health and disease of a population

( 5 marks )
ii. Mention 5 factors needed to draw a health profile (5 marks)
10. There was a graph on trends of IPTp Malaria in pregnant women, these
women received doses 1, 2 ,3 of SP/FANSIDAR. NB; it was a linear graph
a. Describe the trends

b. According to the trend, what 5 health beliefs are shown?
(Model Answers) (5 marks)
11. What is a bilateral donor (2 marks)
a. Mention 3 examples of multinational health organizations ( 3
marks )
b. 5 key challenges affecting international health organization
performance in Malawi (5 marks )
12. What is health systems ( 2 marks )

a. 2 characters of a health system ( 2 marks )
b. List components of a health system according to World Health
Organization; WHO – ( 6 marks )

2019 MBBS 3 END OF YEAR SUPPLIMENTARY EXAM
INTERNAL MEDICINE
QUESTION 1. A 26-year-old female patient received test HIV positive on 28
august 2018.
a) A clinician started the patient on ARVs according to the Malawi
standard treatment guidelines. Mention the drugs with their full
names (3m)
b) What are the side effects of each drug? (3m)
c) A few weeks later you review the patient and she has right sided
weakness, inability to talk with CD4 count of 20. What are the
possible causes of the above features? (4)
QUESTION 2. A 60-year-old male patient is complaining of abdominal fullness

for 3 days. On examination he has hepatomegaly and jaundice.
a) From the history given, mention 3 clinical features suggestive of
chronic liver disease? (3m)
b) Which two features are consistent hepatic encephalopathy? (2m)
c) Mention clinical features that suspect hepatocellular carcinoma. (3m)
d) The laboratory test for Hepatitis B was done. HBsAg negative, Anti-
HBc positive and Anti-HBs positive. What is the interpretation of the
results? (2m)
QUESTION 3. A 75-year-old male present to you with gradual onset of
symptoms suggestive of heart failure and sinus rhythm and examination confirms
the presence of biventricular failure.
a) What is heart failure? (1m)
b) What are the 3 major causes of heart failure? (3m)
c) Mention major clinical features of heart failure? (3m)
d) Mention 3 investigation that would do? (3m)
SURGERY
QUESTION 4. ACUTE ABDOMEN
a) Define acute abdomen. (2m)
b) Clinical presentation of acute abdomen (2m)
c) What are the investigations done? (2m)
d) What are the differential diagnosis? (2m)
e) Explain your management plan? (2)
QUESTION 5. RADIOLOGICAL INTERPRETATION. (plain radiographs)

a) Differentiate radiological features between large bowel obstruction
and small bowel obstruction. (6m)
b) Define ‘FAST’ in trauma radiography and mention its components.
(4m)
QUESTION6.
PAEDIATRICS
QUESTION7. ABOUT SICKLE CELL DISEASE
a) List 5 indications of blood transfusion in sickle cell disease (5m)
b) What would be your advice to the mother to prevent sickle cell crisis? (3m)
c) How does hydroxyurea decrease the frequency of sickle cell crises? (2m)
QUESTION8.
Andrew, a 3-year-old boy was brought to a clinic because he had been sick with
diarrhea for the last 3 days. He well nourished, and low-grade fever, if this boy
was having severe dehydration which signs would he have? (10m. 2.5m for
each correct answer)
QUESTION9.
A 6-year-old is admitted to the hospital with a diagnosis of DKA. On physical
examination he is found to have fast and deep breathing and is severely
dehydrated.
a) From the history how would differentiate the hydration in DKA and
dehydration in severe gastro-enteritis? (3m)
b) Explain why this child has deep breathing? (3m)
c) In addition to insulin and possible treatment for infections, what
other treatment would you consider? (2m)
d) If the child starts seizing during the treatment, what could be the
possible cause? (1m)
COMMUNITY HEALTH
QUESTION 10. Concerning Health indicators
a) Define coverage health service indicators? (1m)
b) Define utilization health service indicators? (1m)
c) We were given 8 health service indicators on a separate paper and
we were told to mark A for coverage health service indicator and B
for utilization health service indicators (8m). so be familiar with these
service indicators
QUESTION 11. Concerning Decentralization

a. Define Decentralization
b. Outline five challenges facing its implementation
c. Outline three importance of decentralization

QUESTION 12. Concerning Outbreak investigation
a. Define the following terms
i. Endemic
ii. Epidemic
iii. Pandemic
iv. Sporadic
v. Hyper-endemic
b. List five steps in the investigation of an epidemic

SURGERY
1. Concerning Complications of surgery
a. A patient had undergone an uncomplicated elective hernia repair and a day
later during ward round, he was found to be tachycardic, outline four
possible causes of the fever (4 marks)
b. How would you go about managing this patient (6 marks)
2. Concerning Principles of fracture management

a. State the goals of fracture management (3 marks)
b. Differentiate Primary bone healing from Secondary bone healing and how
it affects choice of treatment
c. Differentiate bone healing in adults and children and how it affects choice
of treatment…
3. Concerning Radiological interpretation

a. What do the following mean on the x-ray?
➢ Subdiaphragmatic pneumoperitoneum [2]
➢ Combined distended large bowel and small bowel [1]
➢ Periosteal elevation [1]
b. List differences between large bowel and small bowel obstruction [6]
MEDICINE
Question 4: Concerning CSF analysis and interpretation
a. (There was data on CSF findings which needed students to analyze and to
interpret them whether they were:
i. Bacterial
ii. Mycobacterium tuberculosis
iii. Cryptococcal
b. What is the empirical management of meningitis?
c. How would you change the management if the results came out as they are
shown in the diagram. (There was a diagram; diagram is missing)
Question 5: Concerning Herpes zoster virus

a. Which areas of the body are mostly affected by the virus?
b. Which other disease can be caused by the virus apart from zoster
opthamilcus?
c. What are complications of herpes zoster infection and how you can
manage them?
d. How does a person develop zoster?
QUESTION 6: Concerning Heart Failure

A patient presenting with signs of both right and left heart failure with
generalized swelling
a. What is your differential diagnosis of the generalized swelling?
b. Which Investigations can be done on the patient?
c. What is the most likely diagnosis and how you can manage the patient?
PAEDIATRICS
Question 7: sickle cell disease
d) List 5 indications of blood transfusion in sickle cell disease (5m)
e) What would be your advice to the mother to prevent sickle cell crisis? (3m)
f) How does hydroxyurea decrease the frequency of sickle cell crises? (2m)
QUESTION 8: Concerning Dehydration
Andrew, a 3-year-old boy was brought to a clinic because he had been sick with
diarrhea for the last 3 days. He well nourished, and low-grade fever, if this boy
was having severe dehydration which signs would he have? (10marks)
(2.5marks for each correct answer)
QUESTION 9: Concerning DKA

A 6-year-old is admitted to the hospital with a diagnosis of DKA. On physical
examination he is found to have fast and deep breathing and is severely
dehydrated.
e) From the history how would differentiate the dehydration in DKA
and dehydration in severe gastro-enteritis? (3m)
f) Explain why this child has deep breathing? (3m)
g) In addition to insulin and possible treatment for infections, what

other treatment would you consider? (2m)
h) If the child starts seizing during the treatment, what could be the
possible cause? (1m)
COMMUNITY HEALTH
10. Describe five ethical issues raised in Tuskegee Syphilis study (10 marks)
11. Discuss the following terms:
a. Endemic
b. Epidemic
c. Sporadic
d. Pandemic
e. Hyperendemic
b. State the steps involved in epidemic investigation
12. Concerning Decentralization

d. Define Decentralization
e. Outline five challenges facing its implementation
f. Outline three importance of decentralization

INTERNAL MEDICINE

SURGERY

PAEDIATRICS

COMMUNITY HEALTH

2016 MBBS 3 END OF YEAR EXAMNATION, SAQs
SURGERY

INTERNAL MEDICINE

PAEDIATRICS

COMMUNITY HEALTH

PAEDIATRICS
1. A four-year-old boy presents to A & E. His mother states he thinks he is
having the “same thing he had last year.” You look in his health passport
and see he was diagnosed with nephrotic syndrome at that time and
treated successfully with prednisone
a. List two symptoms that would be consistence with the diagnosis of
nephrotic syndrome (2marks)
b. Describe 4 laboratory test abnormalities seen in nephrotic syndrome
(2marks)
c. Name 2 complications of nephrotic syndrome and explain why each
occurs (4marks)
2. The above diagram shows the pressure measured in the left ventricle (LV),
right ventricle (RV), right atrium (RA), left atrium (LA) and aorta
throughout the cardiac cycle
a.With reference to specific cardiac valves, describe what happens at point:
A, B, C, D (4marks) (missing diagram of a cardiac cycle)
b) A 15-year-old girl develops mitral regurgitation as a result of rheumatic
heart disease. Between which 2 points on the diagram above will the
murmur be heard? (1mark)
c) List 3 characteristics that are typical of mitral regurgitation murmur
(3marks)
d) Briefly describe the pathogenesis of rheumatic heart disease (2marks)

INTERNAL MEDICINE
3. A 16-year-old girl with Asthma is admitted to hospital. She is short of
breath, and tells you she has had a number of attacks in the last week
a. Which clinical markers of severity would you look for (without
electronic equipment)? Name 4 (2 marks)
b. Complete the table for at least three drugs for acute asthma below
(6marks)
Drug Route Side effects
1
2
3
c. You need to describe to her how to take an inhaler for mild attacks at
home. She has a metered-dose inhaler (MDI) of salbutamol. Outline
the procedure (without a spacer) in a list (2marks)
d. What clinical features distinguish between COPD and Asthma
bronchiale (2marks)
4. A 40-year-old man presented with ascending weakness and numbness of

both his legs over 2 days. He had problems passing urine and complained
of pain across his chest. On examination he had weak flexors in both legs
and loss of sensation to pain and vibration up to his umbilicus. You note a
vascular rash in the left T4 dermatome
a. Where is the lesion (2marks)
b. What area of the body would you request an MRI scan for? (2marks)
c. What is the cause of his rash and what further test (which will have
an impact on his long-term survival) would you like to do? (2marks)
d. Give 4 differentials for this patient’s condition (4marks)

5. Heart failure
a. Name 2 clinical findings of isolated left cardiac failure (2marks)
b. Name 2 clinical findings of isolated right cardiac failure (2marks)
c. Name 4 causes of heart failure (2marks)
d. Name four classes of drugs used to treat heart failure (4marks)
Class of drug Side effects
1
2
3
4
6. A 56-year-old man presents to the emergency room with a 5-day history of

abdominal distension, not passing stool for 3 days, vomiting and pain. His
blood pressure is 90/50, heart rate is 125 beats/min
a. What is your differential diagnosis (2 marks)
b. What would be your initial management in emergency room
(3marks)
c. What would your investigation (2 1/2 marks)
d. List 5 complications post laparotomy (2 1/2 marks)
SURGERY
7. A 48-year-old Caucasian lady presents to the emergency unit with right
upper quadrat pain, vomiting and yellow conjunctiva
a. What is your differential diagnosis (2marks)
b. List four risk factors (2marks)
c. List other clinical presentations (2marks)
d. How else would you investigate the pathology (2marks)
e. How would you manage the patient (2marks)
8. Radiological interpretation (plain radiographs)

a. Differentiate radiological features between large bowel and small
bowel obstruction (3 marks)
b. What does sub diaphragmatic air suggest on erect chest radiograph
(1mark)
c. What does combined small bowel and large bowel distension suggest
on supine films (1mark)
d. What views suffice a good x-ray for suspected tibia and fibula fracture
(2marks)
e. What does inverted “U” sign suggest on supine abdominal radiograph
(1/2 mark)
f. What does periosteal reaction suggest on long bone radiograph
(1mark)
g. List the trauma series radiograph in a poly trauma patient (11/2marks)
COMMUNITY HEALTH
9. Outline and describe the Bradford Hill criteria of disease causation (10
marks)
10.Explain your understanding of the following

a. Essential health package (EHP) (5marks)
b. Service level agreement (SLA) (5marks)
11. Epidemiological distribution vary among infectious diseases

a. Describe the following terms: endemic, epidemic, pandemic, hyper
endemic, sporadic (5marks)
b. Give 5 stages involved in epidemic investigation (5marks)

SURGERY
1. Concerning obstructive jaundice
a. Sketch anatomy of the biliary tree (from liver to ampulla/duodenum). (4
marks)
b. List four causes of obstructive jaundice. (2 marks)
c. List four clinical presentations. (2 marks)
d. How would you investigate obstructive jaundice? (2 marks)
2. Concerning breast disease

a. List four differential diagnoses for breast disease. (2 marks)
b. List four risk factors for developing breast disease. (2 marks)
c. List four investigations for breast lump. (2 marks)
d. List four treatment modalities for breast lump. (2 marks)
e. List four post-operative complications for malignant breast disease. (2
marks)
3. A 45 years old man presents to an emergency room complaining of

abdominal pain, vomiting severely, not passing stool and abdominal
distension, for 2 days prior to presentation. Your assessment reveals dry
mucous membranes, gross abdominal distention, and vital signs: B.P 90/45,
pulse rate 112, temp 38 degree Celsius.
a. What is your differential diagnosis? (2 marks)
b. What investigations are you going to carry out? (2 marks)
c. What would you do as initial management? (3 marks)
d. What would be your definitive management? (3 marks)

PEADIATRICS
4. You see a 1-year-old child in clinic because of developmental delay. For
each of the following domains, state one developmental milestone that you
would expect a child to attain at around 12 months. (4 marks)
a. On examination, the tone is increased and tendon jerks are brisk on the
right side. State 2 other signs of an upper motor neuron lesion that
would expect to find in the right leg of the Child. (2 marks)
b. What is the motor root value of the tendon reflexes? (2 marks)
i. Biceps
ii. Triceps
iii. Knee
iv. Ankle
c. A diagnosis of cerebral palsy is made. List 4 common causes of cerebral

palsy in Malawi. (2 marks)
5. An 18-month-old child is admitted because of cough and fever. On

examination, the doctor recognizes tachypnea, intercostal and sternal
recessions, and bronchial breathing on the left lung. The diagnosis of
pneumonia is made.
a. Define bronchial breathing. (3 marks)
b. What is the upper limit of respiratory rate for a child of this age? (1
marks)
c. The oxygen saturation is low. The doctor examining the child knows
that the oxygen dissociation curve will be shifted to right. List three
factors that will shift this curve to the right? (3 marks)
d. Suggest three other clinical signs that you would expect to find on
examination of this child’s respiratory system on the left side. (3 marks)

6. A 4-year-old girl is admitted because of acute gastroenteritis. The intern
recognizes that the child is severely dehydrated, and has a 6 cm spleen.
a. List four features of dehydration that you would expect to find on
examination? (4 marks)
b. The diarrhea is watery. List three organisms that commonly cause watery
diarrhea in children in Malawi. (3 marks)
c. List three signs that will differentiate a kidney from a spleen on
abdominal palpation. (3 marks)
COMMUNITY HEALTH
7. Describe five Bradford hill criteria of disease causation. (10 marks)
8. Explain your understanding of the following

a. Essential health package (EHP): In relation to its history, aims objectives,
and components. (5 marks)
b. Service level agreement. (5 marks)
9. Epidemiological distribution varies among infectious disease

a. Describe the following terms: endemic, epidemic, pandemic, hyper-
endemic, sporadic
b. List five stages involved in epidemic investigation
INTERNAL MEDICINE
10.A 34-year patient presents for evaluation of a headache.
a. When taking a history from the patient, list 5 features of headache from
the history (not examination) that would concern you for serious
underlying etiology. (3 marks)

Case continuation:
The patient reports that he is HIV positive, and that the headaches have
been going on for several weeks.
b. What is the differential diagnosis of concerning etiologies of headache in
HIV patients? (3 marks)
Case continuation:
On examination, the patient has focal weakness of the left arm and leg.
Reflexes are brisk on the left arm and leg, and the left big toe is up going
when bottom of the foot is scratched. There is subtle weakness of the
left side of the mouth, with preserved eye closure.
c. Where do the findings localize in the nervous system? Please list both the
general location of the nervous system (brain hemisphere, brain stem,
spinal cord, nerve roots, peripheral nerves, muscles) and which side. (2
marks)
Case continuation:
CD4 count is 86. Lumbar puncture is normal. CT shows a circular lesion
in the location expected to explain the patient’s deficits as well as other
similar lesions elsewhere.
d. What are the two most likely diagnoses? (2 marks)
11. Diabetes
a. Explain in one sentence the pathophysiology of diabetes type 1. (2
marks)
b. Explain in one sentence the pathophysiology of diabetes type 2. (2
marks)
c. Name two other types of diabetes. (2 marks)
d. A patient requires oral drug to treat his type 2 diabetes. Which two oral
antidiabetic drugs are currently recommended in the Malawi National

Treatment Guidelines? How do you decide which drug to start the
patient on? (4 marks)
12.A 16-year-old girl is admitted to the hospital. She is short of breath, and
tells you she has had a number of attacks in the last week.
a. Which clinical markers of severity would you look for (without any
electronic equipment) Name four markers? (2 marks)
b. Complete the table. Choose three possible drugs for acute asthma
below. (6 marks)
1.
2.
3.
c. You need to describe to her how to take an inhaler for mild attacks at
home. She has a metered-dose-inhaler (MDI) of salbutamol. Outline the
procedure (without a spacer) in a list. (2 marks)

SURGERY
1. A patient comes to you with an open fracture of the right leg. D
Describe how you would go about managing him?
2) A patient comes to the A &E with limb ischaemia.

Discuss how you would assess and manage this patient?
3) Write short notes on the complications of blood transfusion
INTERNAL MEDICINE
4) A 16-year-old girl is admitted to the hospital. She is short of breath,
and tells you she has had a number of attacks in the last week.
d. Which clinical markers of severity would you look for (without any
electronic equipment) Name four markers? (2 marks)
e. Complete the table. Choose three possible drugs for acute asthma
below. (6 marks)
1.
2.
3.
f. You need to describe to her how to take an inhaler for mild attacks at
home. She has a metered-dose-inhaler (MDI) of salbutamol. Outline the
procedure (without a spacer) in a list. (2 marks)

5) a. List five ways how you would identify a spinal cord lesion.
b. List five differences between upper and lower motor neurons
6) SIRS and SEPSIS

a. How would you recognize septic inflammatory
response syndrome – five ways
b. What is the difference between sepsis and SIRS?
c. What are the two common causes of sepsis in Malawi?
d. Outline three things you would do to manage the patient with sepsis
COMMUNITY HEALTH
7) Concerning Health promotion
a. Discuss five problems which change agents meet in the
implementation of health promotion
b. Discuss the Bradford Hill criteria for disease causation
8) Concerning Health management

a. Discuss three principles of ethics and how they apply in human
resource management
b. Explain the following;
i. Planning
ii. Organisation
iii. Management
iv. Leadership/directing
v. Controlling
9) Concerning Outbreak investigation

a. Define the following terms
i. Endemic
ii. Epidemic
iii. Pandemic
iv. Sporadic
v. Hyper-endemic
b. List five steps in the investigation of an epidemic
PAEDIATRICS
10. A five-year-old girl is admitted to special care ward with fever, vomiting and
lethargy. On examination she has a temperature of 38.5, a BCS of 3/5; she looks
pale, has a mild jaundice and has tachypnoea and tachycardia. Chest,
cardiovascular and abdominal examination is otherwise normal. She has a blood
glucose of 4mmol/l, MP’s 4+, and PCV of 10%.
a. What is the diagnosis? (2 marks)
b. How would you treat the condition in ‘a’ at Queen Elizabeth Central Hospital?
(2 marks)
c. Two days later, despite appropriate treatment, the patient looks much more
lethargic and her temperature is above 40 degrees Celsius. She is still
tachypnoeic, has cool peripherals and has capillary refill time of 5 seconds. The
Registrar now suspects that the patient has developed septicaemia. What is the
most likely causative organism for the sepsis in view of the information so far
given? (1)
d. If the patient has Meningitis from the same organism as above, what would be
the positive result on Gram staining of the CSF? (2)
The patient’s condition progressively deteriorates. On further examination she
withdraws on painful stimulation, opens eyes but does not follow objects and she
cries inappropriately when stimulated. She has laboured breathing and posturing
movements.
e. What is her Blantyre Coma Score? (1)

The ophthalmologist is called in to do fundoscopy for features of cerebral
malaria.
f. List two features of malaria retinopathy (2)
11. A seven-year-old boy presents with recurrent history of cough and shortness of
breath for a period of three months. He reports sweating profusely at night and
easily getting tired. In the few days preceding his admission, his parents had been
very worried about his fast breathing and therefore decided to bring him to
hospital. He recently tested HIV positive but has not yet started on ARV’s. On
examination he is alert and pink. He has diffuse umbilicated papules on his
forehead and cheeks. He is in obvious respiratory distress with nasal flaring and
mild sub costal indrawing. His temperature is 37.5; his heart rate is 160 and is
breathing at 40 cycles per minute.
a. Basing on these findings, what WHO HIV stage is this patient? (1)
If this patient had a symptomatic pericardial effusion; what would be the

expected findings;
b. On inspection? (2)
c. On palpation? (4)
d. On auscultation? (1)
e. How would you confirm your diagnosis of a pericardial effusion? (1)
f. What would be the most likely cause of the pericardial effusion in this
patient? (1)
12. A baby boy is brought in for a six-month review. He was born vaginally at
term from a diabetic mother, with APGAR scores of 2/10 and 5/10 and a birth
weight of 4500g and presentation is said to have been hand prolapse (Hand
coming out first). After the initial resuscitation in labour ward, the baby had been
immediately transferred to Chatinkha nursery where she stayed for a week on
treatment before discharge.
You are asked to make a problem list for this baby during the perinatal period.
a. List three issues that would be on your problem list (3)
You are further informed that the baby now has occasional convulsions. The
mother explains that during the seizure, the baby has twitching of the mouth and
fingers on the right side for about 1 minute with drooling from the mouth.
However, the baby remains alert during the episodes.
b. What type of seizure does this baby have (1)
c. If you had seen this baby in Chatinkha nursery soon after birth, what simple
crucial investigation would you have done? (1)
The mother further explains that now the baby has difficulties in feeding. He is
able to receive feeds by mouth but has explosive coughs with choking as soon as
he attempts to swallow. As a result, he only takes in very small amounts at a
time. You think the child has a poor gag reflex.
d. Which cranial nerves are involved? (2)
As part of examination, you find the following on anthropometry: weight for

height 60%; height for age 90%.
e. Interpret these findings (2)
You are asked to examine the right hand. You find that the arm is held in
extension, slightly adducted and internally rotated. The wrist is in flexion and the
forearm in pronation.
f. In view of the signs, what is the diagnosis? (1)

Troy Kampira - End of Year Exams-Across Years

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1|Page ...TROY MADAH KAMPIRA...

5. A 4 yr. old with AIDS is admitted to NRU with issues of SAM

6. A 3-day old is admitted in the neonatal ward with issues of sepsis.

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12. A Patient presents with a history of vomiting blood twice the

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6. Differentials of inguinal swellings (3 marks )

7. Components of monitoring and evaluation (10 marks)

8. i. Define coverage health indicator (1 mark)

9. i. Mention 5 reasons for measuring health and disease of a population

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12. What is health systems ( 2 marks )

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QUESTION 2. A 60-year-old male patient is complaining of abdominal fullness

QUESTION 5. RADIOLOGICAL INTERPRETATION. (plain radiographs)

QUESTION 11. Concerning Decentralization

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2. Concerning Principles of fracture management

3. Concerning Radiological interpretation

Question 5: Concerning Herpes zoster virus

QUESTION 6: Concerning Heart Failure

QUESTION 9: Concerning DKA

f) Explain why this child has deep breathing? (3m)

g) In addition to insulin and possible treatment for infections, what

12. Concerning Decentralization

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4. A 40-year-old man presented with ascending weakness and numbness of

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6. A 56-year-old man presents to the emergency room with a 5-day history of

8. Radiological interpretation (plain radiographs)

10.Explain your understanding of the following

11. Epidemiological distribution vary among infectious diseases

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2. Concerning breast disease

3. A 45 years old man presents to an emergency room complaining of

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c. A diagnosis of cerebral palsy is made. List 4 common causes of cerebral

5. An 18-month-old child is admitted because of cough and fever. On

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8. Explain your understanding of the following

9. Epidemiological distribution varies among infectious disease

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Describe how you would go about managing him?

2) A patient comes to the A &E with limb ischaemia.

3) Write short notes on the complications of blood transfusion