HCRS MST (9/5/2022)

SECTION A : ONE BEST ANSWERS (10 MARKS)

INSTRUCTIONS : Answer ALL questions.

1. The mechanism of action involved in malarial anaemia include

A. rupture of eosinophils
B. disruption of Plasmodium parasite
C. inhibition of erythropoiesis by cytokines
D. rupture of peripheral blood mononuclear cells
E. removal of infected and altered white blood cells by splenic macrophages

2. The risk factor for respiratory infection is

A. sedentary life
B. sharing of needle
C. contaminated food
D. secondary smoking
E. mosquito's infestation

3. Regarding non Hodgkin lymphoma

A. hyposplenism is the cause of pancytopaenia

B. Reed Sternberg cells are the neoplastic cells
C. Diffuse large B cell lymphoma has aggressive behaviour
D. the most common extranodal involvement is the thymus
E. immunodeficient individuals has lower risk of developing non Hodgkin's lymphoma

4. A blood donor has A positive blood group. Patients that can safely receive this type of blood are
patients with

A. A negative blood group

B. O negative blood group
C. A positive and O negative blood group
D. A positive and AB positive blood group
E. O positive and B positive blood group

5. Regarding vitamin K,

A. clotting factors IX and X do not require vitamin K

B. it is used as antidote for the overdose warfarin
C. It is directly involved in the intrinsic coagulation cascade
D. it is not to be given for patients suffering from cirrhosis of the liver
E. prolonged use of oral antibiotics will not affect its synthesis in the gut

6. Regarding the differences between filariasis caused by Wuchereria bancrofti and Brugian filariasis,

A. hydrocele is common in brugian filariasis

B. Children are rarely affected in brugian filariasis
C. elephantiasis in brugian filariasis affects lower extremities
D. chyluria is rare in filariasis caused by Wuchereria bancrofti
E. patient will have rapid development of signs and symptoms for filariasis caused by Wuchereria
bancrofti
7. The cause of secondary hypertension due to renal disease is

A. Myxedema
B. diabetes insipidus
C. nephrotic syndrome
D. Pheochromocytoma
E. acute glomerulonephritis

8. A 55-year-old male is brought to the Emergency Department in a semi-conscious state. The blood
pressure is 180/110 mm Hg. His last asthmatic attack was a month ago.

The BEST medication to control his blood pressure is intravenous

A. esmolol
B. Labetolol
C. furosemide
D. Hydralazine
E. phentolamine

9. Chronic HIV infection progresses to AIDS (Acquired Immunodeficiency Syndrome) which is

characterized by multiple opportunistic infections.

Select the MOST common opportunistic infections seen globally in HIV-infected patients.

A. Tuberculosis
B. Candidiasis
C. Toxoplasmosis
D. Herpes simplex virus infection
E. Pneumocystis carinii pneumonia

10. Dengue haemoragic fever results from

A. an autoimmune disease
B. the chronic carrier state of the dengue virus
C. hyperimmune response to reinfection of dengue virus
D. an immediate reaction to the initial infection of dengue virus
E. co-infection with the dengue virus and yellow fever virus

END OF SECTION A

EMI 1

Theme: Bleeding disorders

Options

A. Aspirin
B. Heparin
C. Warfarin
D. Haemophilia A
E. Factor VIII inhibitor
F. von Willebrand disease
G. Henoch-Schonlein syndrome
H. Haemorrhagic disease of newborn

Lead in: Match the following statements with above options:

11. A drug causing immune thrombocytopenia
12. An immunoglobulin A (IgA) mediated vasculitis
13. An acquired vitamin K deficiency bleeding disorder
14. A prolonged APTT, normal PT with uncorrected mixing test E H/F
15. A disease caused by defective platelet aggregation by patient plasma in the presence of
ristocetin

EMI 2

Theme: Anaemia

Options

A. Thalassaemia major
B. Myelodysplastic syndrome
C. G6PD deficiency in crisis
D. Megaloblastic anaemia
E. Iron deficiency anaemia
F. Hereditary spherocytosis
G. Microcytic hypochromic anaemia
H. Normochromic normocytic anaemia

Lead in: Match the following statements with above options:

16. Type of anaemia due to strict vegan diet

17. One of the underlying causes of pica syndrome
18. An absolute reticulocytosis is seen in this condition
19. A 45-year-old lady with anaemia due to chronic renal failure
20. The findings of microcytosis, many target cells and nucleated red cells in peripheral blood

END OF SECTION B

SECTION C: MODIFIED ESSAY QUESTIONS (20 MARKS)

INSTRUCTIONS: Answer ALL questions.

MODIFIED ESSAY QUESTION 1 (20 marks)

A 60-year-old patient is brought to the Emergency Department by her son. She complains that she is
having palpitations, chest pain, dizziness and weakness all over the body. ECG is immediately done
after she is seen by the attending doctor. The long lead II is shown below.

a. State the diagnosis from the ECG tracing (2 marks)

Atrial fibrillation
b. With the aid of a diagram, describe the NORMAL electrophysiology of the cardiac conduction
system (6 marks)

c. Causes for the reasons for the abnormality of this patient's ECG. (3 marks)

d. State TWO (2) cardiac causes and TWO (2) non-cardiac cause for the patient's problem (4 marks)

Cardiac cause 1.
2.
Non cardiac cause 1.
2.

e. List THREE (3) medications which may be prescribed for her heart problem (3 marks)

f. Describe the action of one of the drug stated in e