MD MAY 2009

POSTGRADUATE INSTITUTE OF MEDICINE
UNIVERSITY OF COLOMBO
MD (VENEREOLOGY) EXAMINATION
MAY 2009
Date: 25th 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. It has been suggested that antenatal VDRL screening in Sri Lanka can
be discontinued as the number of positive cases of syphilis found for
the year 2006 was less than 50.
1.1. Discuss the advantages and disadvantages of the VDRL test as
an antenatal screening test for syphilis. (40 marks)
1.2. How do you justify continuation of current antenatal syphilis
screening programme in Sri Lanka ? (60 marks)
2. A 44 year old HIV positive woman is on zidovudine, lamivudine and
nevirapine for 3 months. She is feeling weak and is found to have a
haemoglobin of 8 g/l. Her current CD4 count is 90 cells/mm3.
2.1. List the causes of her anaemia. (30 marks)
2.2. Discuss her management. (70 marks)
3. A man presents with the first episode of genital herpes. His partner is
30 weeks pregnant. Discuss the management of this couple. (100 marks)
4. HIV epidemic in Sri Lanka
4.1. List the gaps in the national response to HIV epidemic in
Sri Lanka which were identified in the external review carried
out in 2006. (20 marks)
4.2. Explain the effective measures that can be taken to improve
the situation. (80 marks)
5. A 40 year old man with fever for 2 months was admitted to National
Hospital of Sri Lanka. His HIV antibody test was positive and AST
and ALT showed a five-fold rise with CD4 count of 22 cells/mm3.
Investigations revealed HBsAg and HCV-Ab tests negative.
5.1. What differential diagnosis would you consider in this case ?
(30 marks)
5.2. Discuss the management of this patient. (70 marks)