CASE 1 A 9 months old boy presented to you with history of fever and vomiting.

On physical examination, he was moderately dehydrated and had failure to thrive. The result of investigation suggested a urinary tract infection with septicaemia. 1. State the differential diagnosis for this patient (2 marks)

2. Describe briefly 3 defense mechanism of the urinary tract (3 marks)

3. Describe the pathophysiology of each of the symptoms presented above ( 4 marks)

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4. State one treatment for this children (1 mark)

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CASE 2 A 10 years old girl presented complaining of eye swelling. You remember this children from 2 weeks ago when she was seen for pharyngitis. Lab findings include azotemia, hematuria and red cell cast in the urine. 1. State your provisional diagnosis (2 marks)

2. Describe the immunopathogenesis for this disease (3 marks)

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3. Explain the pathophysiology of each of the lab findings in this patient (5 marks)

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CASE 3 A 50 years old man presents to the emergency department because he is unable to urinate. After taking a detailed history, you find that he had increasing urine hesitancy and decreased force of his urine stream for several months. He also complains of a sensation of incomplete bladder emptying. On rectal examination, you find a smooth, firm, elastic enlargement of the prostate. Lab finding shows that he has Acute Renal Failure 1. With the aid of diagram, describe briefly the anatomical structure of the prostate (3 marks)

2. State the aetiology of Acute Renal Failure (3 marks)

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3. Gives 3 lab findings that shows the patient was already having Acute Renal failure (3 marks)

4. State 1 step you should do when the patient came to you with the complaints of unable to urinate (1 mark)

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CASE 4 A 67 years old man presents to the clinic with dark coloured urine and flank pain. After taking a careful history, you find that this man had a low grade fever and has lost 10 pounds over the last month. He is also a chronic smoker. On PE, you find that a large mass in his left kidney. He was diagnosed to have Renal Cell Carcinoma 1. Describe the normal structure of kidney and its relations (5 marks)

2. State 3 histopathological findings of this patient (3 marks)

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3. State 2 complications of Renal Cell Carcinoma (2 marks)

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CASE 5 A 68 years old woman presents to hospital complaining of aching lower back. She also explains that she is getting shorter and you note that she has a slight hunchback. An X-ray reveals a compression fracture of the L4 vertebra while a bone density scan reveals decreased bone mass 1. State your provisional diagnosis (2 marks)

2. State 3 pathological findings in this patients bone (3 marks)

3. Describe briefly how the calcium inside our body is regulated (4 marks)

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

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CASE 6 A 13 years old boy presents to your clinics complaining of pain and swelling in his left knee. He also has trauma in his left knee. Lab investigation reveals that there is increase of number of white cell and reduce in haemoglobin. 1. Describe briefly the blood supply to the bone (3 marks)

2. State 2 the complications arises from bone infections (2 marks)

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3. State 3 relevant investigations you would like to perform to this patient (3 marks)

4. State 2 treatments for this patient (2 marks)

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CASE 7 A 32 year old woman with a history of heavy menses presents to your clinic complaining fatigue upon exertion. You note that she is pale and decide to send her for serum studies. Lab results reveal a low serum iron levels, a high TIBC and mildly decrease serum ferritin levels. 1. State the pathophysiology of the symptom presented (3 marks)

2. Gives 2 microscopic appearance for the patients blood film (2 marks)

3. State 1 suitable treatment for this patient (1 mark)

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4. State the mechanism of iron absorption (4 marks)

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