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Question 1 A 35 years old lady admitted with the history of acute abdominal pain associated with vomiting which persist for 48 hours. The pain was severe, colicky and localized at the centre of abdomen. Physical examination reveals sign of dehydration. Through series of investigations, she was diagnosed to have intestinal obstruction

1. Give 3 signs of dehydration and explain briefly how dehydration cause the signs (3 marks)

2. List 3 investigations and justify the relevant of each investigations (3 marks)

3. With the aid of diagram, name the types of intestinal obstruction (4 marks)

Question 2 A newborn boy, born to a diabetic mother is found to be blue. Chest X-ray reveals a boot shaped heart and diagnosis of Tetralogy of Fallot is made

1. With the aid of diagram, explain briefly the fetal circulation (4 marks)

2. List 4 signs of right heart failure (2 marks)

3. Classify congenital heart disease, give 2 example of disease each (4 marks)

Question 3 A 58-year-old man presents to the emergency department complaining of fever and productive cough. Physical examination reveals bronchial breath sound and dullness to percussion over the right lower lung lobe. Chest X-ray reveals radioopacity of region in his right lower lung lobe. He was diagnosed to have Community Acquired Pneumonia 1. State 3 most common causative organism that can cause Community Acquired Pneumonia (3 marks)

2. State 3 defense mechanism of human respiratory tract (3 marks)

3. Explain the pathogenesis of disease you stated in question 1 (4 marks)

Question 4 A 35 years old HIV-positive man presents to the clinic with a 10 pounds weight loss and widely disseminated, painless, reddish purple skin lesion on his face, arm and trunk. The physician than order a CT scan of chest and abdomen and diagnosis of Kaposi Sarcoma was made 1. How do you differentiate malignancy and benign tumor, state 4 differences (2 marks)

2. Define carcinogenesis and explain briefly the pathogenesis (5 marks)

3. Explain the pathogenesis of weight loss in this patient (3 marks)

Question 5 A 55 years old man presents to clinic complaining of weakness, fatigability, weight loss and anorexia. He notes that he is more thirsty and is urinating more frequently than usual. Physical examinations reveal sclera icterus, jaundice, gynaecomastia and hyperpigmentation of skin, trunk and extremities. From series of investigations, patient was diagnosed to have Haemochromatosis

1. Classify and define haemochromatosis (2 marks)

2. Describe briefly the iron metabolism (3 marks)

3. State 2 pathological findings that can be seen on this patients liver (2 marks)

4. List 2 complications that can arise in this patient (2 marks)

5. State 1 treatment for this patient (1 mark)

Question 6 A 60 years old Malay woman presented to the clinic with severe Right upper quadrant pain and fever. On history, you learn that she has given birth to 5 children, is postmenopausal and is currently taking Hormone replacement therapy. She claims the pain exacerbated after she eats fast food and indulges in greasy food. Physical examination reveals sclera icterus. Radiological findings confirm that this patient had bile stone

1. With the aid of diagram, described briefly the anatomy of bile system (3 marks)

2. State 2 types of stone and their radiological characteristic (2 marks)

3. Classify jaundice and give 1 example of disease under each category (3 marks)

4. Define Charcot triad (2 marks)

Question 7 A 10 years old girl presents to the clinic with fever, malaise, migratory polyarthritis and a blanching erythematous ring-shaped rash over her proximal extremities. On further questioning, you found out that she suffered from a severe sore throat 2-3 weeks ago. You worry that she may suffer from valvular heart disease during her adult years 1. State your provisional diagnosis (1 mark)

2. Explain briefly the pathogenesis of the disease you state on question 1 (3 marks)

3. List 4 theories of autoimmunity (2 marks)

4. What are the criteria used to diagnosed disease you stated in question 1, name and list the criteria (4 marks)

Question 8 A 45 years old lady had an operation to remove her gall bladder. One and a half month later, her wound still not heals. A part of the incision becomes ulcer with necrotic tissue on surface. It also smells bad.

1. Define necrosis and briefly describe 2 mechanism of necrosis (4 marks)

2. State 4 differences between necrosis from apoptosis (2 marks)

3. State 4 factors that aid the process of tissue healing (2 marks)

4. Briefly describe stages of simple wound healing (2 marks)

Question 9 A neonates was born to a diabetic mother was found to be tachypnoea and cyanosis. The premature baby was born via C-section then was unconscious. CT scan reveals intraventricular haemorrhage and the infant was death 24 hours after delivery

1. Define and classify cyanosis (4 marks)

2. What is your provisional diagnosis (1 mark)

3. State the pathophysiology of cyanosis and tachypnoea in this patient (5 marks)

Question 10 A 56 years old Chinese presents to the clinic with decreased ability to swallow solid foods even with extensive chewing. Based on history, you learn that he has been avoiding large meals and has lost nearly 30 pounds over the last 6 months. He smoked a pack of cigarettes a day for 20 years and drink heavily on weekend. Esophageal biopsy reveals glandular formation with mucin-producing cells

1. State your provisional diagnosis (1 mark)

2. State 6 risk factors of disease you state above (3 marks)

3. Explain steps taken in getting consent to do esophageal biopsy (4 marks)

4. Explain why this patient develops loss of appetite based on your diagnosis in question 1 (2 marks)

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