MD MAY 2008

POSTGRADUATE INSTITUTE OF MEDICINE
UNIVERSITY OF COLOMBO
MD (VENEREOLOGY) EXAMINATION
MAY 2008
Date: 5th May 2008 Time : 1.00 p.m. - 4.00 p.m.
PAPER I
Answer all questions.
Each question to be answered in a separate book.
1. A 30-year-old married man presented to the Central STD Clinic, Colombo with
genital ulcers of 4 days duration. He had unprotected sex with 3 casual female
partners during the last 3 months whilst in India. Last unprotected sexual
exposure with a casual partner was 10 days back. On return he had unprotected
sex with his wife.
List the differential diagnosis and discuss the management of this patient.
(100 marks)
2. Discuss the advantages and disadvantages of initiating antiretroviral therapy
for the following scenarios.
2.1. Primary HIV infection (40 marks)
2.2. Chronic HIV infection with CD4+ T-cell lymphocyte count less
than 200 cells/μl (20 marks)
2.3. Chronic HIV infection with CD4+ T-cell lymphocyte count between
200 and 400 cells/μl (20 marks)
2.4. Chronic HIV infection with CD4+ T-cell lymphocyte count greater
than 400 cells/μl (20 marks)
3.
3.1. Discuss the appropriateness of introducing antenatal screening for
Chlamydia trachomatis infection in Sri Lanka. (60 marks)
3.2 In a European study on the effect of Chlamydial infection on pregnancy
outcome, 800 infected and 3200 uninfected pregnant women were
followed up. The numbers of pre term deliveries among infected and
uninfected women were 80 and 160 respectively. The results of the
significance test was reported as P3.2.1 What type of study is this ? (10 marks)
3.2.2. Explain what is meant by P3.2.3. Calculate and interpret a measure of the strength of association
between Chlamydial infection and preterm delivery.
(20 marks)
4. Since the mid 1980s, a number of steps have been taken to respond to the HIV
epidemic in Sri Lanka.
4.1. List the various stakeholders involved in the national response to
the HIV epidemic in Sri Lanka. (20 marks)
4.2. Describe the steps taken in Sri Lanka in response to the HIV epidemic.
(40 marks)
4.3. Describe the areas which need further improvement.
(40 marks)
5. A 49-year-old married man was admitted to a teaching hospital with a history of
non-productive cough, progressive dyspnoea, fatigue and intermittent fever. His
HlV screening test was positive.
5.1. Discuss in detail the clinical management of this patient. (70 marks)
5.2. Outline the long term comprehensive care plan. (30 marks)