1. A 32 years old male present at OPD with history of severe difficult in breathing, wheezing, talking with difficulties for 1 day,  he reports to have similar symptoms especially in cold season, On examination BP 110/70mmHg, Pulse 100, T-37oC, RR 30c/min. Examination of respiratory  system revealed;  Barrel chest with rhonchi on auscultation.


(a) What is your diagnosis  (1Mark)

· Asthma

(b) Mention 2 differential diagnoses (2 Marks)

· Pulmonary edema,

· Pneumonia,

· Allergic rhinitis,

· Bronchitis


(c) How  will you manage this patient (2 mark)

· Salbutamol,

· Hydrocortisone,

· Aminophylline


2. A 30 years old male presents with history of high grade fever, headache, nausea, vomiting and abdominal distension for 2 weeks.  On examination the BP was 100/70 mmHg, Pulse rate of 110 b/m, RR 35 c/m, Temperature of 40oC and palpable lymph nodes. Per abdominal examination spleen and liver were enlarged. Full blood picture revealed low haemoglobin, neutropenia and thrombocytosis with increased number of immature white blood cells.

(a) What is most likely diagnosis (1 mark)



(b) What are the two differential diagnoses (1 mark)

· lymphoma

· septicaemia

· secondary malignancies

· malaria


(c) What treatment will you give at dispensary level (3 mark)

· IV fluids, RL/NS

· Antibiotics -ampicillin, ceftriaxone

· Antipyretic -paracetamol

· Refer the patient



3. List down four types of leukemia (4 Marks)

· Acute lymphoblastic leukaemia (ALL)

· Chronic lymphocytic leukaemia (CLL)

· Acute myeloblastic leukaemia (AML)

· Chronic myeloid leukaemia (CML)


4. A 18 year female student from Kilakala High School, is admitted to the medical ward, screaming from pains in knee joints, ankles, phalanges. On examination, she is pale, aphthous ulcers are remarkable. Chelitis is seen from a distance. Purpuric rashes are more on the lower extremities. There is marked hepatospleenomegaly,  frontal bossing is focused.  Her Hemoglobin is 4.5 gm/dl. Mean cell volume is 60 FL.  Erythrocyte sedimentation rate is 60mm/hour. She has a history of frequent blood transfusion. Her cousin brother is also suffering from the same pathology.

(a) What is most likely diagnosis (1 mark)

Sickle cell disease in painful crises


(b) What treatment will you give (4 mark)

· Hydration with i.v fluids

· Analgesics e.g diclofenac

· Antibiotic(s) if the crises is due to infection

· Regular folic acid supplementation (5mg daily) to support the greatly increased

Erythropoietin activity.

· Prophylaxis of malaria using chloroquine



5. A 60 years old man was diagnosed to have Non-lymphoma 2 years ago he presented with lymph node swelling on two sites, one above and another one below the diaphragm and B symptoms

a) How will you stage the patient (2 Marks)

Stage III

b) List down four (4) B symptoms of lymphomas (4 marks)

· Fever

· Drenching night sweat

· Weight loss in excess of 10% of body weight in 6 months

· Anorexia, lassitude, anaemia, pruritis

· Hepatomegally or splenomegaly


6. A 32 years old comes to your health centre complaining of headaches blurred vision. A full blood picture was ordered which revealed Hb of 4g/dl, MCH of 24 pg and MCV OF 70 FL

a) What is the most likely diagnosis (1 Mark)

Microcytic hypochromic anemia

b) List down four possible causes of the above conditions (4 marks)

· Nutritional causes

· Bleeding from GUT, GIT

· Hookworms

· malaria


7. A 60 years old man presents to your dispensary with history of yellowish dicslouration of eyes and abdominal distension for three weeks. He denies history of fever but he is a chronic alcoholic. On examination you find distended abdomen with positive fluid thrill and dull percussion note all over the abdomen with no organomegally.

a) What is the most likely diagnosis (1 Mark)

· Liver cirrhosis

b) List down four possible complications of the above conditions (4 marks)

· Portal Hypertension - Gastroesophageal varices, Portohypertensive gastropathy,

· Spleenomegally and hyperspleenism, Ascites, Spontaneous bacterial endocarditis.

· Hepatorenal Syndrome

· Hepatic Encephalopathy

· Hepatopulmonary Syndrome


8. List down five (5) ways by which microorganism enter the lungs (5 Marks)

· Inhalation

· Aspiration

· Haematogenous spread

· Direct spread

· Reactivation of latent infection


SECTION E: Guided Essay Questions (30 marks)

· Write your answer in the space provided

1. A 16 years old boy attended at your hospital with main complaints of blurred vision, headache, reduced urine output for 1 week, on physical examination BP was 190/120mmHg, Pulse rate 76b/m, T-37oC, RR – 20c/Min. Explain the management of above patient and complications which may arise.

Provisional diagnosis:

· Hypertension (1 mark)

Differential diagnosis (2 Marks)

· Hyperthyroidism

· Hyperaldosteronism

· Renal Artery Stenosis

Investigations (5 Marks)

· CBC count

· Serum electrolytes

· Serum creatinine

· Serum glucose or fasting glucose

· Urinalysis

· Lipid profile


· Echo

Treatment (3 Marks)

· Pharmacological measures

· Non pharmacological measures


Complications (4 Marks)

· Hypertensive retinopathy

· Hypertensive nephropathy,

· Left ventricular hypertrophy,

· Aortic defection,

· Congestive heart failure,

· Angina pectoris

· Myocardial infarction

2. A 50 years old known hypertensive patient presents to you with complaints of lowerlimb swelling easy fatigability and difficulty in breathing on lying flat for 1 month. On examination he is alert, afebrile with BP of 110/60 mmHg with bilateral pitting lower limb oedema. Explain the management of this patient.           

Provisional diagnosis:

· CCF (1 mark)

Differential diagnosis (5 Marks)

· Anaemia

· Protein loosing enteropathy

· Nephrotic syndrome

· Chronic renal insufficiency

· Pneumonia

· Acute respiratory distress syndrome

· Asthma

· Myocardial infarction or pericardial diseases

· Pulmonary edema


Investigations (5 Marks)

· CBC count

· Serum electrolytes

· Serum creatinine

· Serum glucose or fasting glucose

· Urinalysis

· Lipid profile


· Echo


Treatment (4 Marks)

· Pharmacological measures




· Non pharmacological measures


Salt restriction

Fluid restriction

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