S001

1. S001 QUESTION NUMBER 1 The Road to Health Card on the next slide belongs to Johanna Smuts, a 5-year-old child, who presents to the local clinic for routine immunisation. Johanna is well and has no clinical abnormalities Answer the questions that follow in relation to this Road to Health Card. • Describe the pattern of growth seen on this card (1) • Classify Johanna’s nutritional status. (½) • What further measurement/investigation would you consider doing to better classify Johanna’s nutritional status? Why? (1) • List two factors which might explain this growth pattern (1) • List three pieces of general advice and counselling which you offer to Johanna’s mother. (1½)

2. QUESTION NUMBER 1 continued

3. S004 QUESTION NUMBER 2 This is a chest X-Ray of Mr. T. Ndlovu, a 45 year old who presents in respiratory distress with distended neck veins. He has had constitutional symptoms for 2 months. • Given the clinical and radiological features, what is his diagnosis most likely to be? (2) • What other clinical signs would you look for to confirm your diagnosis? List two signs. (2) • Considering a South African population, what is the cause of his presenting problem most likely to be? (2) • What four ECG abnormalities might be present in this patient? (2) • What management would be appropriate in this patient, at this stage? (2)

4. QUESTION NUMBER 3 Sipho Ndlela, 35 year old presents to you in OPD, and complains of pain in his right hypochondrium and jaundice for about a week. You notice fresh traditional scarification marks on his trunk. On the right is his liver function test results • True or false – An abdominal ultrasound is likely to be useful diagnostically in this case. Motivate your answer. (2) • What is the most likely cause of the abnormal liver function tests? Motivate your answer. (2) • What would be the significance of an elevated INR? (1) • What further blood tests would be useful in this patient? (2) • List three important things you should tell this patient (including follow up)? (3) Total bilirubin 150umol/lDirect bilirubin 80umol/lAlbumin 33 g/LALP 140 U/LGGT 55 U/LAST 986 U/LALT 1250 U/L

5. QUESTION NUMBER 4 • On the next slide is the partogram of Janet, a 26 year old pregnant woman who is HIV positive with a CD4 count of 525. She is in labour at a midwife obstetric unit. • Comment on her maternal condition. (1) • b) Comment on the fetal condition. (1) • c) What is the most likely cause of poor labour progress in this patient? Motivate your answer. (3) • d) Describe how Janet’s labour should be managed further. List at least five things your management should include (5)

6. QUESTION NUMBER 4 continued Use arrows keys to move between slides.

7. QUESTION NUMBER 5 Study the antenatal card on the next slide, of this pregnant woman, Dawn Simpson, who has just booked for antenatal care at your clinic. a) List at least five problems you would need to deal with in Dawn’s antenatal management. (5) b) What would your management plan for today be? List at least five things you would do, including counselling, advice and treatment. (5)

9. QUESTION NUMBER 6 This 27 year-old man, Jonas Mosupi, injured his ankle this morning. It is swollen, and the skin is intact. An x-ray has already been done. You are in a rural hospital. • What is the full diagnosis? (3) • Describe the features on the x-ray that support your diagnosis (2) • Name 2 essential things you would check for in your immediate examination.(3) • How would you proceed with managing Jonas, prior to referring him? (2)

10. QUESTION NUMBER 7 It is estimated that about 1000 of every 100 000 people in South Africa have TB. Not all people with TB are diagnosed and treated.

11. QUESTION NUMBER 7 continued • Describe 5 feasible ways that health workers and health managers can be sure to identify people in the community that have TB (5)

12. QUESTION NUMBER 8 This 36 year-old woman, Emma Jones, presents to you in OPD with a 8mm pigmented lesion on her chin. • What is the most likely diagnosis? (2) • Name five clinical features to support your diagnosis. (5) • Name three other sites on the body where these lesions commonly occur? (3)

13. QUESTION NUMBER 9 The attached is a prescription for Mrs Feroza Desai, aged 56 who has hypertension, rheumatoid arthritis and asthma. She also takes Rennies tablets daily. Her blood tests have shown the following: Hb 12.6 WBC 8,900 Sodium 134 mmol/l Potassium 3.2 mmol/l Urea 18.4 mmol/l Creatinine 210 umol/l List 10 clinical and/or legal irregularities in the prescription. (5)

14. QUESTION NUMBER 10 Jeff, a 22 year old male student presents to you in the clinic on a Thursday with a complaint of a thick yellowish discharge for the past 2 days. The previous weekend he spent with his new girlfriend. After examining him you confirm his symptoms. There are no other pathological findings. • What would be the most likely clinical assessment? (2) • b) How would you manage this patient? Mention four important parts! (2 marks each). (8)

15. QUESTION NUMBER 11 The ECG on the next slide is taken in casualty from Mr. Johannes Botha, 63 year old man who complains of palpitations and breathlessness for 3 days. His blood pressure is 110/60. He has bibasal crackles on examination • What rhythm disturbance is present on this ECG? (2) • What three underlying cardiac conditions would be important to exclude in this patient? (3) • True or False. Electrical cardioversion is a safe and appropriate therapy for this patient. Motivate your answer with two reasons. (3) • Which two drug agents would be safe therapy for this patient, at this stage? (2)

16. QUESTION NUMBER 11 cont.

17. QUESTION NUMBER 12 Mr Jacobus Swanepoel is a 69 year old man who presents to you in OPD with this painless subcutaneous lump on his neck, which has been getting bigger for the past 2 years. The lump is soft and mobile on examination. a) What is the most likely diagnosis in this man? (2) b) If this lesion occurred in the colon, what complication may occur as a result? (1) c) If this lump was compressible, but not reducible, what diagnosis would you consider? (1) d) If this lump had a black spot on the surface, what diagnosis would you consider? (1)