Thursday, February 17, 2011

MD MAY 2010

MAY 2010
Date :- 10th May 2010 Time : 1.00 p.m. – 4.00 p.m.
Answer all questions.
Each question to be answered in a separate book.
1.1. Discuss the rationale for using targeted interventions approach in
prevention and control of HIV / AIDS in Sri Lanka ? (60 marks)
1.2. Briefly describe the components of the essential prevention
package used in targeted interventions for prevention of sexual
transmission. (40 marks)
2. In May 2007 a 46 year old man presented with ano-genital ulcers at the
Central STD clinic.' He also complained of fever, sore throat and
maculopapular rash of one week duration. He admitted receptive and
insertive anal intercourse with a man two weeks prior to appearance of
these symptoms. His VDRL, TPP A and HIV antibody tests were
negative. He was treated clinically for genital herpes.
After two months, his HIV screening test was positive and confirmed with
Western blot test.
He was lost to follow up for three years and presented again in May 2010
with fever, fatigue, non-productive cough, loss of appetite, oral thrush,
and difficulty in swallowing.
2.1. Discuss the differential diagnosis for his fever and other symptoms at
the initial presentation. (50 marks)
2.2. Outline the management of his current clinical presentation.
(50 marks)
3. A 30 year old homosexual man complained of diarrhoea of 2 weeks
duration following commencing treatment for his HIV infection with
tenofovir, lamivudine and Kaletra (lopinavir/ritonavir). His CD4 count
is 40 cells/mm3 and the HIV viral load is 200,000 copies/ml.
Discuss the causes and management of his diarrhea. (100 marks)
4. Discuss critically the effects of socio-demographic changes on the
prevalence of HIV / AIDS and STIs in Sri Lanka. (100 marks)
5. A 35 year old married woman with a period of amenorrhoea of 10 weeks
presented to the STD clinic with genital ulcers of 8 days duration. She has
returned from Middle East two weeks back. She admitted having sexual
exposures with casual partners while working there.
5.1. List the differential diagnosis of genital ulcers in this patient ?
(20 marks)
5.2. How would you manage her ? (80 marks)
Date : 13th December 2010 Time : 1.00 p.m. -4.00 p.m.
Answer all questions.
Each question to be answered in a separate book.
1. A 30 year old HIV positive woman complained of acute abdominal pain.
Discuss the management of this patient. (100 marks)
2. You are appointed as the Venereologist in charge of a district STD clinic. During the initial assessment, you found that the-clinic services are not adequately utilized by the most at-risk populations (MARPs) living in the area.
Describe the steps you would take to improve this situation. (100 marks)
3.1 Describe the impact of STls (excluding HIV) and bacterial vaginosis on
pregnancy and neonate. (50 marks)
3.2 Outline the steps that can be taken to reduce transmission of STls (excluding HIV) to baby during pregnancy and neonatal period.
(50 marks)
4. Discuss the strengths, weaknesses, opportunities and threats of using the already available services in a Health Unit (MOH unit), in preventing sexually transmitted
infections (STls) and promoting sexual health of a community. (l00 marks)
5. A 40 year old man recently diagnosed with HIV infection was admitted to National Hospital with fever, headache, numbness and weakness of left leg and seizures affecting the left side of the body for one week. His CD4 count was 90 cells/cu mm.
Discuss the management of this patient. (100 marks)

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