1. A 26  years old man present to the health center 15 min after being involved in motor traffic accident with  complain of wrist pain. On examination not pale, afebrile and dysneic  local examination ; blood on the urethral meatus and per rectal reveal a high riding prostate. Vital signs PR=110, RR=38, BP=90/50mmHg

A) What is mostly diagnosis

B) Outline 5 management plan for this patient


2. Mention four (4) complication of femoral neck fracture in 75 yrs old patient


3. A 13 yrs old boy came to the dispensary with complain of painful swollen thigh for about 3 days. He had a history of minor aceration of the right thigh during climbing a coconut tree 4 days ago. On examination, alert, afebrile. On local examination , swollen right thigh, erythromatous, warm and tender


a) What is diagnosis

b) Outline 4 management of this patient




4. Outline 5 key component of primary In major trauma patient brought to the dispensary

5. A 22 yrs old man come to the dispensary with history of right groin swelling for 4yrs. Abdominal distention and vomiting for 2 days. The swelling was on on and off till 3 days ago when it  fall and disappear. On examination distended abdomen, hyper tympanic with reduced bowel sound. Local examination scrotal mass which cannot get above it with negative cough impulse

a) What is the diagnosis

b) Outline management plan for this patient

6. List 4 urinary obstructive symptoms during history taking from a 64 yrs old man with acute urine retention.

7. A 24 yrs old  motorcyclist was brought to the dispensary involved in an accident about 1 hour and sustain injury to the left leg. On examination there is laceration on the mid-anterior surface of the left leg about 5cm oozing blood and deformed left leg. Outline 5 management plans for the patient


8. A 14 yrs old girl presented to the dispensary with severe abdominal pain. Pain for 2 days and vomiting for 1 day. The pain was around the umbilicus which later shifted to the iliac region. There is no history of abdominal distension, constipation or discomfort during micturition. On examination febrile, tender on the right iliac with exaggerated bowel sound.


a) What is diagnosis

b) State 2 DDX

c) List 2 important investigation which should be performed to this patient at this level


1. A 33 YRS old man was brought to the health center with history of constipation and abdominal pain for 3 days. On examination distended abdomen, tender no rebound tenderness, increase tympanic sound and hyper active bowel sound. Vital signs T=37.2 0c , PR=94, RR=22, BP=110/80mmHg. Describe the management of this patient and complication which may occur due to the patient’s condition.


2. A 20 yrs old woman sustained burn injury following hot water splash. On several examination, conscious, not dyspnoeic, not pale. Local examination, burn wound involving the whole of the anterior chest and abdomen with multiple blisters. Her  body weight is 40 Kg. describe management of this patient

1. A 30 years old woman with history of peptic ulcer disease came to hospital with severe abdominal pain. On Examination she was hypotensive and distressed with rigid, silent abdomen. An Abdominal X ray reveals an abnormal gas shadow under the Right hemi-diaphragm:


A. What is the provisional diagnosis? (1 mark)


Perforated peptic disease


B. How will you manage this condition at the health centre? (4 marks)


NGT for stomach decompression

Use large bore needle for IV fluids

Give normal saline or Ringer’s lactate 3L as fast as quickly as possible

Urethral catheterisation

Monitor vital signs

Urgent referral with blood donors


2. A patient presents with painful swelling of left limb associated with fever. Physical examination the left leg is swollen, warm and tender


A. What is the most likely diagnosis? (1 mark)



B. Give one differential diagnosis (1 mark)


- Deep Vein Thrombosis

      - Pyomyositis

C. Give treatment (3 marks)


    -Ampicloxacillin 1 gm 6 hourly for 72 hours the orally 500 mg 6 hourly for one week


    -Bed rest and elevate the affected limb


3. A 41 year old man presents with gradual onset of painless swelling in the scrotum over the past four years progressively increasing in size. Physical examination scrotal swelling is soft, can get above it and transillumination test is positive

i. What is the provisional diagnosis? (1 mark)


- Hydrocele


ii. Give three reasons why you aspiration is not recommended in the treatment of this patient (4 marks)



             -Introduction of infection

             -Trauma (puncture) to the testis



4. Outline five measures to be taken when rescuing a person who sustained spine injury(5 marks)



I. Do not move the patient unless he is in immediate danger of further injury or you need to open an airway for him to breath

II. If a person is not breathing or showing signs of circulation, begin CPR but do not lift the chin to open an airway. Instead you should pull the jaw forward

III. If the victim must be moved pull them by their clothing. Grab a shirt collar and use your fore arms to support their head while pulling the body in a straight line. This is preferred method as the patient’s head is braced while moving.

IV. Then following first aid  principle which include

A- Airway maintenance with care and control of a possible injury to the cervical spine

B- Breathing control or support

C- Circulation control and blood pressure monitoring

              D- Disability the observation of neurological damage and state of consciousness

              E- Exposure of the patient to assess skin injuries and peripheral limb damage


V. Refer the patient to hospital for definitive treatment


5. A 25 year-old-man presents to you at district hospital with burn injury to different parts of the body. Which criteria will you use to transfer the patient to burn center?(5marks)


i. 2nd and 3rd degree burns more than 25% of BSA in adults or more than 20% of BSA in children

ii. 3rd degree burns more than 10% of BSA

iii. 3rd degree burns to hands, feet, face and perineum

iv. Major chemical or electrical burns

v. Respiratory tract injury

vi. Associated major trauma

vii. Circumferential burns


6. A -32 –year-old female comes to dispensary with heavy bleeding from left leg followed road traffic accident; she is confused, severe pallor, dynoic with cold and clammy skin. How will you manage this patient?(5marks)



ii. Oxygen therapy if available(option)

iii. Stop bleeding

iv. Insert large bore cannula(double line)

v. Administer intravenous fluid(crystalloids)

vi. Hb level, grouping and cross matching

vii. Conduct serial measurement of vital signs.

viii. Refer the patient with blood donors.


7. A 54 year-old-man was admitted to surgical ward with diagnosis of spreading ulcer. List five (5) physical findings that can be obtained on local examination.


i. Surrounding skin is inflamed

ii. Floor is covered by profuse offensive slough

iii. No evidence of granulation tissue

iv. The ulcer is inflammed, oedematous and ragged edges; it is a painful ulcer.

v.  Draining lymphnodes are inflamed, enlarged and tender and may be suppurated with abscess formation.

vi. Purulent discharge



8. A 56 year-old -man, known patient with diabetic mellitus on irregular medications presents to you at district hospital with history of swelling, pain and purulent discharge on left foot for one month, no history of trauma. List five investigations will your order to confirm your diagnosis


i. FBP & ESR

ii. Gram staining

iii. Cultural and sensitivity


v. Serum glucose

vi. X-ray of affected foot

vii. Doppler US if available



This section consists of two (2) that are supposed to answered in a narrative way

Write your answer on the empty pages of this question paper however each question should start on a new page. There will be a penalty of 3 marks from score attained in this section if questions are not answered in essay form


1. Explain the clinical features and management of intestinal obstruction


Clinical Features (6 marks)

1.Abdominal pain 

In mechanic obstruction pain is the first symptom; it occurs suddenly and is usually severe

It is colicky in nature and is usually centred around umbilicus (small bowel) and lower abdomen (large bowel)

In paralytic ileus pain is due to the cause (e.g. peritonitis) or due to grass abdominal distension

The development of severe pain is indicative of the presence of strangulation in mechanical obstruction or possibly due to ischaemia of the intestines.



2.Projectile Vomiting

3.Absolute constipation

4.Abdominal distension


6.Dehydration: Seen more in small bowel obstruction due to repeated vomiting and fluid loss


7.Pyrexia in obstruction may indicate :

     -The onset of ischaemia

     -Intestinal perforation

     -Inflammation association with the obstructing disease


Investigations (3 marks)

    -Plain, erective and supine abdominal X-ray

    -Full blood picture

   - Blood grouping and cross match

   -Serum electrolyte


Treatment (6 marks)

NGT to decompress the distension

Intravenous Antibiotics

Catheterisation for monitoring output

Refer patient


2. A 60-year-old man, with a 70 kg body weight, sustained burn injuries while preparing

charcoal in the forest. On arriving to the health centre his entire lower left limb has a blister

and oedematous.

His upper right limb from the shoulder joint towards the palm had superficial burns.

Describe the management of this patient



-A, B, C (Airway maintenance, Breathing and ventilation, Circulation)(0.5marks)

-Check for disability and neurological status (0.5mark)

-Exposure and environment control; keep warm (0.5mark)



Fluid resuscitation:

Using Parkland formula: Body weight × 4 mls × % burns surface area(1marks)

Estimate the percentage of burns .

     -Lower Limb = 18 %( 0.5 marks)

     -Upper Limb = 9 %( 0.5 marks)

     -Total Surface Area Burns = 18 % + 9% = 24%(0.5marks)

60 kgs × 4 mls × 24% = 5760 mls of crystalloids , half of this volume(2880mls) is given in the first 8 hours and the rest in the next 16 hours.(4marks)

· Monitor urine output by catheterization (1marks)

· Analgesic (inj diclofenac/tramadol)(1mark)

· Tetanus Toxoid 0.5 mls S/C(1marks)

· Clean wounds (social and surgical toilet)(1marks)

· Local antiseptics (Silverex cream, Povidine iodine)(1mark)

· Blood for grouping and cross-matching (1mark)

· Dress toes and fingers separately if involved in burns to avoid contractures (1mark)

· Refers the patient if complications arise or anticipated(1mark)

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