20 - VENEREOLOGY

20 - VENEREOLOGY
(03) MD (Venereology) Examination
01. May 2006 02. May 2007
POSTGRADUATE INSTITUTE OF MEDICINE
UNIVERSITY OF COLOMBO
MD (VENEREOLOGY) EXAMINATION
MAY, 2006
Date : 24th May, 2006 Time :1.30 p.m. - 4.30 p.m.
PAPER I
Answer all questions.
Each question to be answered in a separate book.
1. As the newly appointed venereologist to the STD clinic at Matara, you observe
that the patient attendance is low and that there is a high defaulter rate. In
addition, there are limited resources for the diagnosis and management of sexually
transmitted infections (STI).
1.1. List the possible reasons for the low patient attendance and high defaulter
rate. (25 marks)
1.2. Discuss what action you would take to improve accessibility and enhance
patient retention in your clinic. (75 marks)
2. Describe your first line of antiretroviral therapy of an asymptomatic 28 year old
female with a CD4 count of 80 ceU-s/!-11 and explain your rationale for this
choice including why other agents were not chosen. Assume that all common
antiretroviral therapies are available to you. (100 marks)
3. Write short notes on :
3.1. Male circumcision and risk of sexually transmitted infections.
(25 marks)
3.2. Imaging studies for the diagnosis of pelvic inflammatory disease.
(25 marks)
3.3. The role of direct microscopy as a diagnostic tool for sexually transmitted
infections (illustrate your answer with examples). (25 marks)
3.4. Programme to reduce maternal morbidity, fetal loss and neonatal mortality
and morbidity due to syphilis (list the components) (25 marks)
4. A cohort of HIV infected and non-infected male and female populations are being
followed for more than 10 years. The cohort consists of injecting drug users, men
having sex with men, bisexuals and heterosexuals. Some of them are on
antiretroviral treatment depending on their virological and immunological
markers. The following observations were made in this cohort:
Observation A
After seroconversion, a few of them progressed to AIDS very rapidly (less
than 3 years).
4.1. Outline the viral, immune and host factors important for the rapid
progression. (50 marks)
Observation B
As a result of unprotected sexual relationships some seronegative
members in the cohort became HIV positive.
4.2. Describe the public health measures that could be used to minimize such
outcomes in the future. (50 marks)
5. Discuss briefly:
5.1. Clinical trial (40 marks)
5.2. Meta-analysis (30 marks)
5.3. Parametric tests in statistical analysis (30 marks)
6. A 40 year old married man presents to a STD clinic with a painful perianal
lesions. He admits to having several sexual exposures with casual male partners.
6.1. List the conditions you would consider in the differential diagnosis of the
above. (20 marks)
6.2. Discus the factors you would consider in arriving at a diagnosis.
(80 marks)