1. What are the five (5) Challenges you can encounter during Counseling of Adolescents

A. Silence
B. Crying
C. Threat of Suicide
D. Threat of Suicide
E. Threat of Suicide

2. What are five (5) barriers to adolescents obtaining sexual and reproductive health
information and services
A. Lack of knowledge on the part of the adolescent
B. Legal or cultural restrictions
C. Physical or logistical restrictions
D. Poor quality of clinical services
E. Unwelcoming services

3.Mention three (3) values governing decision making in provision of GBV and VAC
A. Ethnicity:
B. Culture
C. Culture 




4. Mention six (6) recommended laboratory investigations to be done to GBV (gender based
violence) and VAC (violence against children) survivors
A. Urine
ü Pregnancy Test
ü Microscopy

B. Vaginal Swab-Sperm
ü Culture and sensitivity

C. Blood
ü Hepatitis B surface antigen
ü Full blood picture
ü Hemoglobin (HB)
ü X matching
ü Blood chemistry
ü Serological test for HIV

D. Anal Swab
ü Sperm analysis

E. X-ray
ü In case of fractures.

F. Radio-imaging
ü In case of inner pathological conditions.


A. Check the mother’s vital signs
B. Asses the size and tone of the uterus (Check if her uterus is contracting
C. Assess for vaginal bleeding
D. Assess the perineum
E. Help the mother to urinate
F. Provide body bath and change clothing
G. Light diet can be given (e.g. soft drinks and gruel)
H. Medication for pain relief (for after pain and episiotomy)
I. Rooming in the neonate and early breast feeding
J. Administer Anti-D immunoglobulin for Rh negative mothers
K. Offer health education


6. The Guiding Principles on Immunization Services
A. Community Participation, Involvement and Social Mobilization
B. Integrated Approach
C. Accessibility and Equity
D. Quality of Services and Safety Considerations
E. Coordination and Leadership


7. Mention five (5) essential qualities of a supervisor
A. Must be competent in the area they are supervising
B. systematic, thorough, and reliable problem solver
C. Motivates and encourages staff and all members of the team
D. Demonstrates good interpersonal skills
E. Understands and is involved in the planning of the immunization services
F. Is fully knowledgeable of the resources (human and non-human), tasks,
logistics, and all records
G. Has experience in training others
H. Is trustworthy and committed


8. Identify five (5) Risk Factors for Mother to Child Transmission (MTCT) of HIV
A. Viral Factors
à Transmission risk is greatest when the mother’s viral load is high

B. Maternal factors:
à Low Immunity - low CD4+ counts
à Poor nutrition
à Sexual behavior – unprotected sexual intercourse exposes one to different new
types and sub types of HIV.
à Stage of disease – early and late or advanced AIDS stages
à ART reduces the risk of transmission
à Smoking & drug abuse

C. Obstetric factors:
à Prolonged rupture of membranes > 4 hours b4 delivery
à Prolonged or obstructed labor
à Invasive fetal monitoring
à Invasive delivery procedures E.g.: Episiotomy, artificial rupture of membranes,
à Mode of delivery: use of instruments like vacuum extraction enhances MTCT
while Elective C/S is associated with much reduced rates of MTCT than
Vaginal delivery

D. Fetal Factors
à Prematurity
à Twin deliveries: First twins have a higher rate of HIV infection than the
second born twins

E. Infant Factors
à Breastfeeding – especially prolonged breastfeeding
à Mixed feeding
à BF when the baby has oral sores or ulcerations
à Breast conditions e.g. cracked nipples, mastitis, breast abscesses

1. The primary aim of the EPI is to protect children from immunizable killer diseases with
the goal of contributing to the overall reduction of infant and child mortality rates. The
target groups are infants from birth to 11 months and women of child bearing age (15-
49 years).
A. State the main goal of Tanzania Expanded Programme on Immunization (EPI)

1. A 15 year old secondary school student attends RCH clinic for consultation regarding contraception. She is planning to conceive later after school. List down six(6) methods of contraception suitable for  this student        (6 Marks)



i. Abstinence

ii. Consist and correct condom use,

iii. Combine oral contraceptive pills

iv. DMPA

v. Progrestron only pill

vi. Hormonal implants

vii. Intra uterine contraceptive device

viii. Fertility awareness method


2. Each clinic should have EMERGENCY KIT.  Mention four (4) content of any emergency kit.  (4 Marks)


i. Adrenaline injection

ii. Anticonvulsant drugs

iii. Hydrocortisone injection

iv. Antipyretic drugs

v. Intravenous fluids


3. Outline five (5)  components of immunization service: (5  Marks)


i. Vaccine supply  and quality

ii. Logistics

iii. Service delivery

iv. Surveillance

v. Advocacy &  communication


4. 17 year old girl arrives at the emergency department after an induced abortion. Enumerate five (5) factors that might have predisposed her to induced abortion: (5 Marks)


i. Strictness of parents

ii. Fear of breaking the relationship with the spouse

iii. Peer pressure

iv. Religious reason

v. Fear of been suspended from school

vi. Fear of going into labor and also take care of the newborn.


5. Mention five (5) potential side effects of combined oral contraceptive pills: (5 Marks)


i. Headache

ii. Dizziness

iii. Nausea

iv. Breast tenderness

v. Irregular bleeding or spotting

vi. Weight gain


6. Outline five (5) underlying principals of provision FANC (Focus – Antenatal care) (5 Marks)


i. Creation of a friendly environment

ii. Involvement of woman’s partner or a family member

iii. Respect culture of a client

iv. Services should be Individualized

v. Integration of FANC with other services such STI and HIV testing


7. Enumerate for (4) PILLARS of safe mother hood    (4 Marks)


i. Family planning

ii. Antenatal care

iii. Clean/Safe Delivery, New born care and post natal care

iv. Emergency obstetric care


8. Outline six(6) practices that can increase the risk of condom breaking:      (6 Marks)


i. Unrolling the condom first and then trying to put it on the penis

ii. Using lubricants with an oil base they damage latex

iii. Using a condom if the color is uneven or  changed

iv. Using a condom that feels brittle, dried out or very slickly

v. Using the same condom for more than one sexual act

vi. Re-using condoms

vii. Dry sex.  








· This section consists of two (2) questions which are supposed to be answered in a narrative way

· Write your answer on a separate sheet of paper provided; each question should start on a new page DIRTY WORK IS NOT ALLOWED.

· Write your examination number on each answer sheet you are using.


1.  A 12 month-old infant is brought to the hospital after developing high grade fever and macula-papular rashes, cough, running noses and red eyes. Her mother reports that 3 months ago she received measles vaccine. A clinician assesses this child and comes with a diagnosis of “measles”.

Write an essay which includes; reasons for failure of the previous measles vaccine, explain how presenting features in this case differ from side effects of measles vaccine, and give differential diagnoses for the presenting symptoms. (15 Marks)


Key answers:

Reason for failure of the previous vaccination could be (at least 6 points one ,mark each):

Break of the storage temperature

Wrong diluents,

Over dilution of the vaccine

Vaccine has expired

Wrong vaccine was given

Under dose

May be the child did not get vaccine 3 months ago.


Side effects of measles vaccine (One marks for each point, mention at least 5 points)

Usually the side effects occurs immediately after vaccination and resolve within first two weeks, this includes:


Pain and tenderness at the site of injection

Moderate and not high grade fever

Mild rashes which resolves within 12 days


Occassionally, anaphylactic shock or encephalitis may occur within first two week after vaccination.

Differential diagnoses (at least 4 points, each point 1 mark)

· Malaria

· Pneumonia

· Urinary tract infection

· Septicemia

· Upper respiratory tract

· infection

2. Suppose you are a peer educator from one of the non-government organization and assigned to prepare a session on life skills. Describe the life skills required by the adolescent to prevent and effectively manage sexual and reproductive health problems and its importance.

(15 Marks)

Key answers:

· Life skills are abilities for adaptive and positive behaviours that enable individuals to deal effectively with the demands and challenges of everyday life. (2 marks).


Importance of life skills (3 points, one mark each):

· They help adolescents to clarify their needs and rights.

· They help adolescents to express themselves effectively

· They enable them to decide on course of action


Important life skills  (5 points, 2 marks each)

· Self esteem: the ability to feel confident and self worth

· Assertiveness: Express beliefs, thoughts and feelings in a direct and clear way at an appropriate moment

· Decision making: ability to make their own decision and feel greater commitment to these decisions.

· Interpersonal relations: Ability to distinguish good relationship from risky relationship

· Effective communication: express thoughts, ideas and feelings effectively.

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