2021 November & 2022 June Osce

Question 1

A patient has weakness of his left upper and lower limbs. Perform a lower limb motor examination on him.

Answer 1

Do motor exam

Question 2

A pregnant woman will undergo an elective cesarean section. Counsel her and obtain a signed consent.

Answer 2

Greet the examiner

• Greet the patient

• Confrim identity

• Confirm language of preference

• Establish rapport and introduce yourself

• Assure the patient of confidentiality

• Obtain consent

• Ask what she knows about cesarean section and tell her

• Define C/S: is the delivery of fetus or other products of conception via abdominal and uterine incision after the age of viability.

• Classification based on timingElective
Emergency

• Inform her the indications(usually primigravidas are scheduled for C/s as the pelvis has not been tested yet . We don’t want to risk anything) if known and the possible complications(bleeding, wound infection, Epidural headaches, prolonged recovery time compared to Vaginal delivery)
• Explain to her that it will be performed by highly skilled obstetricians and other people that will be involved in her management such as Nurses, Anaesthetists, Neonatologists and their roles to prevent complications.
• Discuss investigations necessary(group and crossmatching of blood, FBC, Serology, EUCR) and the need for her to get blood ready for the surgery.
• Discuss Cost implications,
Duration of the surgery(1hr usually depends on surgeon skill and intra op evaluations),
Possible length of hospital stay following surgery( 3 to 5days if no complications present)

Pre-op

Admission one day prior to surgery

NPO 8hrs to surgery

Urine catheter and cannula inserted on the day of surgery

patient is put on IV fluid dextrose saline 5%

Intraop

Skin incision Pfenensteil incision (better scar compared to midline)

uterine incision (kerr’s) low

194

transverse incision

• Baby willl be removed and cord clamped, uterus will be sutures and skin will be sutured after hemostasis in ensured

Postoperative care.

Urine catheter is removed in 24hrs

Pain management with pentazocine and pcn/ibuprofen

Oral feeds initiated after 24hr or before if bowel sounds are present.

Wound inspected on day 3 post op.

PCV is checked 48 hrs after surgery

Ask if she understands,if yes ask to repeat.

Encourage her to ask questions and provide honest answers.

Inquire if she wants to go ahead with the surgery and possibly book her for one

Issue her a leaflet to read more about the surgery.

Thank the patient

Question 3

A 6 year old boy with body Itching and yellow sclera. List the systems involved

Answer 3

Hematology and Gastrointestinal systems

Question 4

List 10 symptoms each

Answer 4

Hematology: abnormal bleeding, rashes, epistaxis,purpura, petechia, tiredness,
weakness, fatigability, Malaise, dizziness.

Gastrointestinal:Anorexia, diarrhea, constipation, abdominal pain, abdominal distention, dysphagia, melena, nausea, vomiting, tenesmus.

Question 5

Define epidemic mention 4 examples

Answer 5

Epidemic refers to sudden increase in the number of cases of a disease above what is normally expected in that population in that area which is clearly in excess of the usual expectancy. Examples: Lassa fever, yellow fever, monkeypox, measles, cerebrospinal meningitis, Cholera,Ebola

Question 6

List 8 steps in outbreak investigation

Answer 6

1. Prepararion
   2 establish existence of outbreak
2. Verify the diagnosis
3. Define and identify the cases
4. Perform descriptive epidemiology ( time, place and person )
5. Develop hypothesis
6. Evaluate and refine hypothesis
7. Implement control and prevention measures
8. Reinforce surveillance
9. Communicate findings to the authorities

Question 7

Apply epidemic control of Lassa fever

Answer 7

● Administration of antiviral drugs to confirmed cases and supportive care.
● Isolation of infected individuals.
● Contact tracing to identify people who may have been exposed to the virus.
● Avoiding contact with Mastomys rodents.
● Putting food away in rodent-proof containers.
● Keeping the home clean helps to discourage rodents from entering homes.

Question 8

A 3 year old with fever, cough, breathlessness and nasal flaring, other findings include bibasal lung crepitations and right upper lobe bronchial breath sounds. Mention systems involved

Answer 8

Respiratory system

Question 9

Likely diagnosis for case 5

Answer 9

Respiratory distress syndrome

Question 10

2 differentials

Answer 10

Chronic obstructive pulmonary disease
Pneumonia

Question 11

A 28 yr old woman para 1+4 with bleeding for 2 weeks.No associated vaginal discharge and abdominal pain. Mention 4 differentials.

Answer 11

Molar pregnancy

Ectopic pregnancy

Abortion

Endometrial cancer

Question 12

A 28 yr old woman para 1+4 with bleeding for 2 weeks.No associated vaginal discharge and abdominal pain List 3 diagnostic tests

Answer 12

Beta HCG test

Ultrasound

Pap smear

Question 13

2 Treatment modalities

Answer 13

Combined oral contraceptives pills

Surgery

Question 14

These 3 patients present with goiter: || MR A T3- High T4- High TSH- low || Mr B T3- low T4- low TSH- high || Mr C T3- normal T4- normal TSH- normal || What are their diagnosis?

Answer 14

A) Diagnosis in Mr A

Primary Hyperthyroidism

B) Diagnosis in Mr B

Primary hypothyroidism

C) Diagnosis in Mr C

Euthyroid

Question 15

3 Symptoms in Mr A

Answer 15

Weight loss, Heat intolerance, Increased sweating

Question 16

2 Symptoms in Mr B

Answer 16

Weight gain, cold intolerance, constipation

Question 17

Which area will you find Mr C

Answer 17

Areas with Iodine deficiency

Question 18

A 56 year old man presents with hematuria. Take a focused history from him.

Answer 18

Introduction: Greet examiner, greet patient, introduce yourself, establish rapport and obtain consent.

Biodata: Name, Age, Occupation, Marital Status, Address, Religion, Tribe, Level of Education.

Presenting Complaints:

Blood in Urine

History of Presenting Complaint

How was it noticed?

Is it painful?

Is the blood seen at the initial or terminal end of the stream? Or is it total?

Irritative symptoms:

Do you notice increased urinary frequency?

Do you urinate more often at night?

Do you notice increased urgency to pass urine?

Are you unable to hold urine once the urge comes?

Obstructive symptoms:

Do you notice hesitancy of your urine?

Do you strain on urinating?

How poor is the stream of your urine?

Does the urine flow stop intermittently?

Do you notice terminal dribbling of your urine flow?

Are you unable to completely empty your bladder when you go to urinate?

Do you have abdominal pain?

Cause:

Any abdominal mass? (?Renal cell carcinoma)

Any weight loss, fatigue or anorexia? (?Renal cell carcinoma, ?bladder cancer)

Any purulent urethral discharge? (Urethritis)

Any history of Abdominopelvic trauma?

Any history of Rifampicin use?

Do you live (or have visited) a riverine area? (Schistosomiasis)

Do you smoke cigarette? If yes, how often?

Do you work in a paint or petrochemical company? (Malignancy)

Complications:

Any fatigue? (From blood loss)

Any cough or difficulty with breathing? (?Chest metastasis)

Any bone pains or lower back pain?

Care:

What have you done since development of symptom?

Drug History:

Are you on any routine medication?

Are you allergic to any drug?

Past Medical History

Are you hypertensive?

Are you Asthmatic?

Do you have peptic Ulcer disease?

Have you been admitted in the hospital before?

If yes, when? Why? And how long did you stay?

Have you had surgery before? If yes, what procedure was that and when?

Have you been transfused with blood before? If yes, when?

Family & Social History

Monogamous or polygamous setting?

What is your level of education?

Do you smoke cigarette?

Do you drink alcohol?

If yes, how often do you take them?

How many rooms do your apartment have?

How many windows per room and how many occupants in a room?

What’s your source of drinking water? Well, borehole, stream or spring?

What method of refuse disposal do you adopt?

What method of sewage (faecal matter) disposal do you adopt?

Review of Systems

CNS:

✓ Do you have headache?

✓ Any dizziness?

✓ Any hearing or vision imbalance?

CVS:

✓ Do you have difficulty breathing?

✓ Do you find it difficult to sleep without pillows (orthopnea)?

✓ Do you wake up in the middle of the night with chest compression (Paroxysmal Nocturnal dyspnea)?

Respiratory:

✓ Do you have cough?

✓ Any wheezing?

✓ Any chest pain?

✓ Any night sweats?

GIT:

✓ Do you experience vomiting?

✓ Any Diarrhoea?

✓ Constipation?

✓ Any stomach pains?

Urogenital Tract:

✓ Do you experience difficulty passing urine?

✓ Do you urinate more frequently than usual?

✓ Did you notice any change in the colour of your urine?

Question 19

List levels of prevention

Answer 19

Primordial

Primary: General health promotion and specific prophylaxis

Secondary: Early diagnosis and treatment

Tertiary: Limiting disability and

Quantenary: rehabilitation.

Question 20

Explain them briefly LOP

Answer 20

Primordial utilizes government policies

Primary: General health promotion

Target population: entire population with special attention to healthy individuals

Objective: prevent onset of illness

Methods: education, nutrition, sanitation, lifestyle changes, etc.

Specific prophylaxis

Target population: entire population with special attention to healthy individuals

Objective: prevent onset of specific diseases

Methods: education, immunization, nutritional supplement (vitamin A, iodine), chemoprophylaxis

(e.g. against malaria)

Secondary:
Early diagnosis and treatment

Target population: sick individuals

Objective: early diagnosis and treatment to prevent further damage to the individual and in

cases of infectious diseases, spread to the community

Methods: screening of high risk groups e.g. Pap smears, sputum examination for TB, blood test

for HIV; monitoring of vulnerable groups - children, pregnant women

Tertiary:

limiting damage

Target population: sick patients

Objective: limit damage from disease

Methods: skilled clinical care and social support to limit physical and social damage from the disease

Quantenary:

Rehabilitation

Target population: convalescent patients

Objective: restore function and capability Methods: physical and social rehabilitation

Question 21

Apply the levels of prevention to diabetes mellitus.

Answer 21

General health promotion: I will educate the public using TV and radio stations, seminars that diabetes is a group of metabolic disorders of fat, protein and carbohydrate characterize by hyperglycemia. Risk factors - Age, family history, obesity, Pancreatitis and sedentary lifestyle
● Specific prophylaxis: No vaccine
Teach them the use of glucometer, reduce carbs intake, cessation of smoking and exercise for 30mins 5xs a day
● Early diagnosis and treatment: screen for symptoms like polyphagia, polydipsia, polyuria, weight loss /weight gain
Investigations: FBS, RBS, HbA1c, urinalysis, OGTT in pregnant women
Treatment: Insulin, oral hypoglycemic drugs like metformin, exercise, strict diet monitoring
● Limiting disability: complications like DKA, HHS, infertility, foot ulcer, retinopathy, hypoglycemia, lipodystrophy
regular eye examination, proper foot care and using alternate sites of injection
● Rehabilitation: Vocational therapy, psychotherapy and nutritional therapy, Counseling

Question 22

A man present with vomiting for 2 weeks and peri orbital swelling. Normal Na High K Normal Cl High Creatine High Urea. Electrolyte abnormality likely to kill the patient

Answer 22

Hyperkalemia

Question 23

Likely diagnosis ? A man present with vomiting for 2 weeks and peri orbital swelling. Normal Na High K Normal Cl High Creatine High Urea. Electrolyte abnormality likely to kill the patient

Answer 23

Acute renal disease

Question 24

Commonest ECG change with the electrolyte abnormality

Answer 24

Tall T wave

Prolonged PR interval

Flattened P wave

Widening of QRS complex

Question 25

Two drugs that will worsen this electrolyte abnormality

Answer 25

ACE inhibitors

Spironolactone

Question 26

Treatment of the emergency electrolyte abnormality

Answer 26

ABC resuscitation

Set double wide bore cannula and quick history to determine cause

Discontinue all potassium containing food and fluids

10m/s of 10% calcium gluconate

If symptoms persist give sodium Bicarbonate

Insulin in 50% dextrose solution

Ion exchange resins like kayexalate can also be used

In severe cases dialysis can be done

Question 27

Perform an abdominal examination on this patient

Answer 27

INTRODUCTION:

• Greet the examiner.

• Greet the patient.

• Introduce yourself and establish rapport.

• Confirm patient’s identity.

• Briefly explain what the examination is about.

• Obtain consent.

• Ask for a chaperone

To the examiner:

I would like to:

• screen my patient for privacy.

• adequately expose my patient (e.g. from nipple line to mid-thigh).

• place my patient in an anatomical position (e.g. with the body supine, the arms at the sides and the palms facing upwards).

• sanitize or wash my hands with running water and soap.

Ask to perform a quick general examination.

Points to note: Sclera jaundice, conjunctival pallor, peripheral cyanosis, finger clubbing, cervical lymphadenopathy, etc.

INSPECTION:

Inspect the abdomen from the side to the foot of the bed.

Points to note:

• Is the abdomen flat, scaphoid or distended?

• Does it move with respiration?

• Is umbilicus everted or inverted?

• Is the patient calm or restless?

• Is the patient obese or wasted?

• Are there scars, lumps, rashes, ulcers, dilated veins, etc.?

• Are there colostomy bags, gastrostomy tubes, Intravenous cannula, catheters, etc.?

• Check for visible cough impulse from hernia orifices (ask the patient to turn head to the left).

PALPATION

Before you proceed to palpate, ask for any area of tenderness. If any, ask patient to point with a finger.

Light palpation: start from the left iliac region, checking for tenderness (if there is pain, start away from the site of pain).

Deep palpation: repeat the same palpation but going deeper this time checking for masses.

Organ palpation:

Liver (hepatomegaly): begin by placing the right hand on the right iliac fossa and palpating upwards as the patient breaths in and out.

Spleen (Splenomegaly): starting from the right iliac fossa, palpate diagonally upwards to the projection of an enlarged spleen.

Kidney (hydronephrosis): ballot the kidney by placing the left hand behind the patient at the level of the 12th rib. Place your right hand on the abdomen at the right or left flank and palpate with these two hands, feeling for an enlarged kidney.

PERCUSSION

Liver span:

• Start from the midclavicular line at the 2nd or 3rd intercostal space and percuss downwards until the point of dullness (upper border).

• Resume percussion from right iliac fossa upwards until the point of dullness (inferior border).

• Measure the liver span in centimeters (with the inch side facing you to avoid bias).

Ascites: Shifting dullness:

• Percuss from the umbilicus to the flank (about 3 zones), checking for dullness.

• Keep your finger on the spot and ask the patient to roll onto the opposite side.

• Keep the patient on this position for about 10seconds (to allow for fluid redistribution).

• Repeat the percussion, but this time towards the umbilicus.

• If the flank becomes resonant after a change in patient’s position, it is positive for ascites.

AUSCULTATION

• Bowel sounds: best heard at the Mcburney’s point.

• Aortic bruits: best heard above the umbilicus.

• Renal bruits: best heard above the umbilicus, slightly lateral to the midline.

• Hepatic bruits: best heard over the right upper quadrant.

Ask to perform a Digital Rectal Examination (DRE)

The abdominal examination is not complete without a DRE.

Question 28

Counsel this mother with a child that has been diagnosed with sickle cell anemia.

Answer 28

Introduction:

• Greet examiner

• Greet patient

• Establish rapport and introduce yourself

• Assure her of confidentiality

• Obtain consent

Ask:

• Language of preference

• Settings

• Quick biodata (confirm name, age, and occupation)

• Relationship to the child (child’s name, age and class)

• Quick history of disease/condition

• Knowledge on sickle-cell disease. What do you know about sickle-cell disease and its implications?

Tell:

Definition: Sickle-cell disease (SCD) is the inheritance of two abnormal hemoglobin, each of which is Hemoglobin S. Hemoglobin is a protein responsible for circulating oxygen in the body. Sickle-cell anemia (SCA) is the homozygous inheritance of Hemoglobin S (one from each parent). It is an autosomal recessive disorder where valine replaces glutamic acid at position 6. Sickle-cell trait is the inheritance of one normal gene and one abnormal Hemoglobin S gene.

Red blood cells in these patients are shaped like crescent moons, rigid and sticky. Therefore, they can block blood vessels. This creates a situation where there is not enough red blood cells to transport oxygen round the body.

Clinical Presentation

It varies and depends on the of level of care for the child. Common presentations of this condition include:

− Frontal bossing

− Depressed nasal bridge

− Gnathopathy

− Hand and foot syndrome in infancy.

− Chronic low-level pain

− Increased risk of infection with encapsulated organisms

− Short staure

− Jaundice

− Pallor

− Protruding abdomen

− Poorly developed external genitalia

Complications:

− Vasocclusive crisis (acute chest syndrome, avasculnar necrosis of femur head, retinopathy).

− Megaloblastic crisis due to folic acid deficiency.

− Aplastic crisis usually caused by parvovirus B19 infection.

− Hyper hemolytic crisis mostly precipitated by malaria infection.

− Acute sequestration crisis which is the trapping of red blood cells in the spleen, resulting in circulatory collapse.

Common triggers of sickle-cell crisis:

− Dehydration

− Infections (malaria, respiratory tract infections, etc.)

− Strenuous physical exercise

− High altitude (decreased oxygen level)

− Extremes of weather (especially cold weather)

− Psychological stress

− Alcohol

− Cigarette smoking (second-hand smoking)

Investigations

Complete Blood Count

− Normocytic anemia

− Thrombocytosis

− Leucocytosis

− Reticulocytosis

Blood film

− Sickle cells

− Target cells

− Howell Jolly bodies

− Malaria parasite

Blood culture

Management:

In steady state, early diagnosis and follow up is the key.

− Health education of parent and child

− Avoid precipitating factors as mentioned above.

− Folate replacement

− Malarial prophylaxis

− Antibiotics

− Vaccination

− Monitor PCV, liver, spleen sizes

In crisis, the treatment goal includes:

− Adequate hydration

− Pain management

− Malaria treatment

− Antibiotics

− Blood transfusions

Give haemophilus influenzae and pneumococcal vaccines

Multidisciplinary

Support group

Help:

Ask the following questions:

• Do you understand everything I have explained?

• Is there any question you may have?

• Would you like to proceed with the test?

Explain/Empathy:

You are to answer in clear terms all questions the patient may have for you. Answering these questions is very important. Be understanding of the patient’s state of mind.

Retell/Return

Ask the patient to repeat in their own words what they understood from all you have told them. Advice patient to maintain regular visits to the clinic. Use of iron-containing drugs should be avoided to prevent iron overload in the child.

Thank the patient and the examiner.

Question 29

Apply the levels of prevention to cholera

Answer 29

Level 1: General Health Promotion

Health education on causes of cholera and mode of transmission (caused by vibro cholerae bacteria, transmitted by drinking contaminated water or eating contaminated food).

Promote good sewage disposal, adequate faecal sludge management (use of latrines or bury poops), avoid undercooked food, good personal hygiene and sanitation (wash hands and environmental clean-up), water purification (boiling/chlorination/ozone, etc.)

• Level 2: Specific Prophylaxis

Cholera vaccine: Vaxchora (single dose, oral live vaccine), dukoral, ShanChol, and euvichol-plus/euvichol. Vaccination does not offer complete protection. Isolate sick individuals, source decontamination.

• Level 3: Early Diagnosis and Treatment

Screen for symptoms such as watery diarrhoea (rice-water stool), vomiting, stomach pain and weakness. Investigations include full blood count, stool examination, microscopy and culture, serotyping, electrolytes, urea and creatinine examination

Treatment – Rehydration, Lactate ringer solution, replace ongoing fluid losses.

• Level 4: Limited Disability

Replace lost fluid and electrolytes (prevents dehydration, acute tubular necrosis and renal failure), fluid administered intravenously. Give antibiotics in severe cases (single dose tetracycline, doxycycline or ciprofloxacin) to reduce volume and duration of diarrhoea.

• Level 5: Rehabilitation

Start patient on normal diet once vomiting stops (continue breastfeeding for children). Aid recovery from disease using physiotherapy, vocational therapy (help patient return to job by providing letter of recovery), social support.

Question 30

Apply the levels of prevention to cervical cancer

Answer 30

Level 1: General Health Promotion

Educate the public about risk factors of cervical factors such as early age of first coitus, excessive smoking, multiple sexual partners. The public should also be aware of symptoms of cervical cancer such as abnormal vaginal bleeding (in between periods, after sex and after menopause) and dyspareunia.

• Level 2: Specific Prophylaxis

Use of human papillomavirus (HPV) vaccine. Gardasil (against HPV 6, 11, 16, and 18), cervarix (against HPV 16 and 18).

• Level 3: Early Diagnosis and Treatment

Identify symptoms such as dyspareunia, post-coital bleeding, intermenstrual bleeding, etc. Papanicolaou (pap) smear test should be done for women of reproductive age (from 21years old), at least once every 3 years and once after menopause, in addition to colposcopy test. In HIV-positive patients, pap smear should be done every year. Biopsy, CT scan and MRI of pelvis, full blood count, electrolyte, urea and creatinine test, urine microscopy and culture, blood grouping and crossmatching

Treatment – Surgery, radiotherapy, chemotherapy

• Level 4: Limiting Disability

Preventing metastasis of cancer and multiple organ failure by prompt diagnosis and treatment of cancer

Conservative – Good diet, exercise, smoking and alcohol cessation.

• Level 5: Rehabilitation

Physiotherapy, psychotherapy, counselling, family support and care.

Question 31

A 27 year old diabetic presented with complaints of fever of 38 degrees and cough with productive purulent sputum. He had polyuria and polydipsia, he was also feeling dizzy with labored breathing. He has altered mental status, dehydrated and with ketone breath. Random blood sugar was 24mmol/l, urinalysis shows 3+ ketone and Glucose. Likely diagnosis?

Answer 31

Diabetic ketoacidosis

Question 32

What other investigations will aid your diagnosis?

Answer 32

Arterial blood gas, serum uric acid, fating lipid profile, chest x-ray, sputum m/c/s

Question 33

Management of the patient?

Answer 33

ABCD of resuscitation

Fluid therapy with strict input and output monitoring: IV 0.9% normal saline

Electrolyte replacement: K levels need to be monitored, though initial level might not be

low, insulin lead to K uptake.

Insulin therapy:loading dose of 10IU IV, 10IU IM stat

Maintain at 6IU IV or IM hourly

Treat underlying cause

Treat complications

Question 34

Identify the X ray

Answer 34

Alveolar edema (Bat wings)
Kerley B lines
Cardiomegaly (cardiothoracic ratio>0.5)
Dilated prominent upper lobe vessels
Pulmonary effusion

Question 35

Risk factors of X ray

Answer 35

Uncontrolled hypertension

Diabetes

Coronary artery disease

Obesity

COPD

Question 36

What is frank starling law?

Answer 36

The law states that the stroke volume of the heart increases in response to an increase in the volume of blood in the ventricles before contraction (the end diastolic volume), when all other factors remain constant

Question 37

8. A 45 years old man, present to your clinic, complaining of breathlessness and easy tiredness, take a full focus history.

Answer 37

Presenting complaint;

• Breathlessness
• Easy tiredness

GRIP

G-Greet Examiner and patient

R- Create Rapport

I – Introduction

P – Ask permission

BIODATA

Using NASOMART

Name

Age

Sex

Occupation

Marital status

Address

Religion

Tribe

Why are you here?

If the presenting complaints is more than 2, ask which one started first?

History of presenting complaint; 5Cs

1/2 COMPLAINT/COURSE; using DOCTOR for analysis

a. BREATHLESSNESS;

Duration: How long has this been for

Onset: when did it start, was it sudden or gradual

Course: has it gotten better, worse or has it remained the same

Character: is this breathlessness present at all times or is it intermittent

Timing: is it worse at any particular time of the day, is there anything that makes it worse, do you

feel breathless during any physical activities or at rest

Other symptoms: Any bluish discolouration, noisy breathing

Related phenomenon: Leg swelling, fever, headache

b. EASY TIREDNESS;

Duration: How long have you been experiencing this

Onset: when did it start, was it sudden or gradual

Course: Has it gotten better, worse or has it remained the same

Character: is it present at all times, is it intermittent. Do you get easily tired during ordinary physical

activities, or during strenuous exercise. How many minutes can you walk before you get tired

Timing: At what time of the day do you usually experience this, Do you feel tired even at rest or

when lying down

3. CAUSES
4. Previous history; is this the first time you are presenting with this
5. Family history; Anyone in your family experiencing the same thing
6. Are you a known diabetic patient and are you compliant with your medications
7. Do you have chest pain that radiates to the jaw or shoulder (Myocardial Infarction)
8. Are you a known Hypertensive patient and are you compliant with your medications
9. Any history of sore throat or kin infection , Joint pain (Rheumatic Heart Disease)
10. Any history of heat intolerance, do you excessively feel hot and sweat a lot (rule out

Thyrotoxicosis)

8. Any history of facial swelling and decrease in urine output (chronic renal failure)
9. Any history of jaundice, abnormal swelling (Chronic liver disease)
10. Any history of paleness, body weakness, fainting (Anemia)
11. Do you use intravenous drugs, have you had any tooth removal (infective endocarditis)
12. COMPLICATIONS
13. Any history of headache, loss of consciousness, convulsions, blurry visions (encephalopathy)
14. Weakness on one side of your body ( stroke)
15. Do you feel pain when walking that get relived upon rest (intermittent claudication)
16. Feeling like you are drowning (pulmonary edema)
17. History of coughing up blood and difficulty breathing
18. Any history of prominent or distended neck vein, abnormal swelling (Right sided heart

failure)

5. CARE SO FAR
6. What have you done since this started
7. Have you taken any herbal medications, have you bought any drugs from the pharmacy
8. Have you visited the hospital, did they carry out any investigations on you such as Chest Xray,

ECG, FBC, E/U/Cr. Was any drug prescribed to you? Such as Diuretics, beta blockers

PAST MEDICAL HISTORY ;

• Using HEADS

H- Hypertension

E- Epilepsy

A -Asthmatic

D- Diabetes

S- sickle cell

Are you a known Hypertensive, Epileptic, Asthmatic, Diabetic, Sickle cell disease patient

• Have you been hospitalized before
• Any past surgery
• Any history of blood transfusion

PAST FAMILY HISTORY;

Using HEADS

Is there anyone in your family who is a known Hypertensive, Epileptic, Asthmatic, Diabetic patient,

anyone who is a sickle cell disease patient

SOCIAL HISTORY;

• Do you smoke, if yes, what do you smoke and how much do you smoke in a day
• Do you take alcohol, what kind of alcohol do you take, and how many bottles in a day

DRUG HISTORY;

• Are you on any current medications
• Any past medications
• Any negative reactions to any drugs

REVIEW OF SYSTEMS

Central nervous System: Blurry vision, Headache, Dizziness

Cardiovascular System: Chest pain, Difficulty breathing

Respiratory System: Catarrh, cough, sneezing

Endocrine System; Heat intolerance, Cold intolerance, excessive weight gain/loss

Digestive System ; Abdominal pain, Diarrhea

Urinary System; painful urination, groin pain

Musculoskeletal System: difficulty walking, Joint pain

Hematological System; Rashes, Abnormal bleeding, easy bruising

Question 38

Define epidemic;

Answer 38

Epidemic: is a sudden outbreak of a disease which spreads rapidly to a large number of people in a given population over a short period of time in a given region.

Question 39

Mention five epidemic diseases currently in Nigeria;

Answer 39

Measles

• Lassa fever
• Yellow fever
• Cholera
• Ebola Virus Disease
• Bacterial Meningitis

Question 40

Levels of prevention, apply it to Lassa fever

Answer 40

Level 1: Primordial – General Health education and promotion

Level 2: Primary – Specific prophylaxis

Level 3: Secondary – Early diagnosis and prompt treatment

Level 4: Tertiary – Limiting disabilities

Level 5: Quaternary – Rehabilitation

Applying it to Lassa fever

Level 1

Definition: Lassa fever is a viral hemorrhagic fever caused by the Lassa virus.

It source of infection is the multimammate rat (mastomy Natalensis)

Mode your transmission; Direct contact with items contaminated with infected rat feces or urine,

person to person contact

Symptoms;

• Fever
• Weakness
• Headache
• Malaise
• Muscle pain
• Nausea
• Vomiting
• Bleeding from different orifices

Prevention;

• Avoid eating bush meat
• Avoid direct contact with rodent
• Stop bush burning
• Clear refuses in the house
• Avoid contact with infected corpse
• Use rodent proof containers to store your food items
• Cover open spaces and crack walls
• Wash kitchen utensils properly
• Avoid contact with bodily fluid of infected individuals

Level 2:

• No available vaccines
• Chemoprophylaxis: Ribavirin
• Use of Personal protective equipment (PPE); like gloves, gowns, mask, boots, google, proper

hand washing

Level 3:

Isolate sick individuals

Investigations; RT-PCR, ELISA, culture from blood, urine.

Treatment; IV or oral Ribavirin

Supportive treatment; IV fluids, Antipyretics, Antibiotic for secondary infections, analgesic

Level 4:

• Maintenance of fluid and electrolyte
• Blood transfusion if anemic
• Dialysis in case of renal failure

Level 5:

Family support, social support, vocational therapy, counsel individuals to wait for atleast 3 month

after resolution of Lassa fever infection before unprotected sexual intercourse

In case of deafness give hearing aids

Question 41

10. A 47 year old woman presents with easy fatiguability and shortness of breath especially while climbing stairs. She complains of suddenly waking up at night with paroxysm of cough. List two systems affected?

Answer 41

Respiratory system

Cardiovascular system

Question 42

List 10 symptoms for each system

Answer 42

A) Respiratory system

Runny nose, breathlessness, cough, snoring, sore throat, Wheezing, hemoptysis, chest pain, sputum, fast breathing.

B) Cardiovascular system
Cyanosis, dyspnea, bradycardia, tachycardia, dyspnea on exertion, orthopnea, edema,syncope, palpitation, paroxysmal nocturnal dyspnea

Question 43

What is the likely diagnosis?

Answer 43

Congestive Heart Failure