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NAME: __________________________ CASE 1

SCORE: ___/10

A 27 years old female involve in motor vehicle accident. She develops massive bleeding and the physician in charge was unable to resuscitate her despite intensive care given. She died 3 hours after admission. On autopsy, the pathologist found a pale infarct in this patient left kidney 1. State 3 factors that influence development of infarct (3 marks)

2. What is the cause of pale infarct in this patients kidney? (1 mark)

3. State the pathophysiology of infarction in this patient kidney (3 marks)

4. Explain briefly the acute compensatory mechanism following massive haemorrhage (3 marks)

ONNAZLI0910

NAME: __________________________ CASE 2

SCORE: ___/10

A 23 years old female, who works in the canteen, came to your clinic following a burn injury in her left arm. You notice that there are blisters in the injured area. You then prescribed her with the medication 1. State 4 roles of inflammation (2 marks)

2. List 2 outcomes of acute inflammation (2 marks)

3. State and define 5 cardinal signs of acute inflammation (3 marks)

4. List and explain stages of burn injury (3 marks)

ONNAZLI0910

NAME: __________________________ CASE 3

SCORE: ___/10

A 43 years old male with history of positive HIV infections admitted to HUSM due to high grade fever, breathlessness and coughing up yellowish sputum. Culture reveals a gram negative organism. 24 hours after his admission, he develops respiratory failure 1. State and explain 4 types of respiratory failure (4 marks)

2. State your diagnosis (2 marks)

3. Explain briefly general management of respiratory failure (4 marks)

ONNAZLI0910

NAME: __________________________ CASE 4

SCORE: ___/10

Mr Donald, a 50 year-old businessman from Kubang Kerian came to see general practitioner for the complaints of fever, running nose and cough of three days duration. The general practitioner made a diagnosis of viral upper respiratory tract infection. 1. Explain the histological features of human trachea (2 marks)

2. List 4 common respiratory viruses causing above symptoms (2 marks)

3. Describe 3 defense mechanism of upper respiratory tract against viral infections (3 marks)

4. State 3 general pathogenic organisms that affects human respiratory tract (3 marks)

ONNAZLI0910

NAME: __________________________ CASE 5

SCORE: ___/10

An infant was born to a diabetic mother was found to be weight at 6.2 kilogram. There is no other abnormalities and the baby was appear to be healthy 1. State 3 causes of obesity (3 marks)

2. Explain briefly the neuro-endocrine regulation of hunger and satiety feeling (3 marks)

3. State 2 investigations in this patient and justify (2 marks)

4. State 2 complications which may arise from this child condition (2 marks)

ONNAZLI0910

NAME: __________________________ CASE 6

SCORE: ___/10

A 23 years old male recently went to Thailand came to hospital after he had a fever, malaise and general enlargement of lymph nodes. Physical examinations reveals painful ulcer at his penis and electron microscopy reveals organism below

1. State 3 characteristics of the organism (3 marks)

2. Name the organism above (1 mark)

3. State your provisional diagnosis (1 mark)

4. State 4 risk factors of the disease you stated above (2 marks)

5. State 2 other investigations to diagnosed this patient (2 marks)

6. State 3 treatments in this patient (1 mark)

ONNAZLI0910

NAME: __________________________ CASE 7

SCORE: ___/10

A 35 years old woman presents to your office complaining of palpitations and increased heat intolerance. Upon further questioning, you learn that she has developed an increase appetite and her husband mentioned that she is quite irritable lately. During physical exam, you note that she has protruding eyeball, moist skin, a pulse of 110 and a diffusely enlarged thyroid gland.

1. Explain briefly the metabolism of thyroid hormone (4 marks)

2. State 3 functions of thyroid hormones (1 mark)

3. State 3 diseases associated with hyperthyroidism (3 marks)

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

ONNAZLI0910

NAME: __________________________ CASE 8

SCORE: ___/10

A 6 years old boy presented to your office complaining of fatigue, fever and history of recurrent epistaxis and urinary tract infections. He has an enlarge liver, spleen, swollen testicle and a petechisl rash over his entire body. Blood test reveals pancytopenia and presents of multiple blast. He was diagnosed to have leukaemia

1. Define and classify leukaemia (2 marks)

2. State 4 differences in types of leukaemia based on peripheral blood smear (4 marks)

3. Explain briefly the pathophysiology of swollen testicle in this patient (2 marks)

4. State 2 drugs commonly used in chemotherapy (2 marks)

ONNAZLI0910

NAME: __________________________ CASE 9

SCORE: ___/10

A 51 years old Malay male presents to the clinic with a chief complaint of increasing fatigue over the past 8 months. He claims that he used to be very active, but finds that he tires now from walking up the stairs in his house. Through series of investigations, he was diagnosed to have myelofibrosis 1. Define myelofibrosis (1 mark)

2. State 2 causes of myelofibrosis (2 marks)

3. State 2 possible findings in this patient peripheral blood smear (2 marks)

4. State 2 prognosis in this patient (2 marks)

5. List 3 treatments in this patient (3 marks)

ONNAZLI0910

NAME: __________________________ CASE 10

SCORE: ___/10

A 23 years old man came to emergency department following a pain in his left forearm. Further history reveals that this patient had a diarrhea and vomiting after eating at the local restaurant located near Mydin. Physical examination reveals that this patient had a gangrene in his left forearm. 1. State your diagnosis (1 mark)

2. Classify disease you stated above and state 1 causative organism under each category (4 marks)

3. State 2 risk factors of the disease you stated above (2 marks)

4. List 3 complications of the disease you stated above (3 marks)

ONNAZLI0910

NAME: __________________________ CASE 11

SCORE: ___/10

An 8 years old boy presents to the clinic because his parents have noticed strange, jerky movement and drastic change in his behaviour and personality. On PE, you see a brownish ring around the superior and inferior poles of cornea. He was diagnosed to have Wilsons disease 1. Described briefly the pathogenesis of Wilsons disease (4 marks)

2. What is the medical term of brownish ring around the superior and inferior poles of cornea (1 mark)

3. List 3 investigations and expected findings (3 marks)

4. State 1 treatment and state how it will help this patient (2 marks)

ONNAZLI0910

NAME: __________________________ CASE 12

SCORE: ___/10

You are asked to examine a newborn baby boy when his mother when his mother reports that he instantly regurgitated upon her first attempt to feed the baby. The mother reports that the baby started choking and coughing up breast milk. He was diagnosed to have tracheoesophageal fistula 1. With the aid of diagram, list 5 variant of tracheoesophageal fistula with the frequency of their appearance (8 marks)

2. State 2 abnormalities associated with tracheoesophageal fistula (2 marks)

ONNAZLI0910

NAME: __________________________ CASE 13

SCORE: ___/10

A 2-year-old boy is examined with history of failed to pass meconium. PE reveals mthis child has abdominal distension consistent with an obstruction of bowel. He was diagnosed to have HIrschsprung disease 1. Explain the cause of HIrschsprung disease (2 marks)

2. State 1 genetic disease associated with HIrschsprung disease (1 mark)

3. Give 3 differential diagnosis of abdominal distension (3 marks)

4. You decided to have the patient to undergo surgery, explain how do you take the informed consent from his parents (4 marks)

ONNAZLI0910

NAME: __________________________ CASE 14

SCORE: ___/10

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)

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

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

ONNAZLI0910

NAME: __________________________ CASE 15

SCORE: ___/10

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 clinical anatomy of the prostate (3 marks)

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

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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