DIP JULY 2007

POSTGRADUATE INSTITUTE OF MEDICINE
UNIVERSITY OF COLOMBO
DIPLOMA IN VENEREOLOGY EXAMINATION
JULY 2007
Date: 03rd July 2007 Time: 9.00 a.m. - 12.00 noon
PAPER II
(ESSAY TYPE QUESTIONS)
Answer all Questions.
Each question to be answered in a separate book.
1.
1.1. A teacher wanted to determine whether male babies have a higher
mean birth weight than female babies. In a large random sample of
full term singleton births, he found the mean and standard deviation
of birth weight (in grams) for males to be 2800 and 150 respectively.
The corresponding figures for females were 2700 and 150. A
significance test (Z test) was performed and the p value was found to
be 0.001.
1.1.1 Determine the 95% reference range for birth weights for male
infants and female infants (20 marks)
1.1.2 State the Null hypothesis for the significance test (10 marks)
1.1.3 What is meant by p = 0.001 ? (20 marks)
1.1.4 What other information is needed to perform a Z test on the
data given above ? (10 marks)
1.2 Describe briefly the services provided to pregnant women by the Medical
Officer of Health and hislher team (40 marks)
2. Discuss the following statement of a National AIDS Policy in a country.
"Mandatory HIV testing is an effective measure to prevent the spread of
HIV/AIDS". (100 marks)
3. Hepatitis B surface antigen (HBsAg) was found to be positive in a male STD
patient during the routine screening at the Central STD clinic, Colombo.
3.1 What other laboratory investigations would you request to further clarify
his status, giving reasons for each test you request ? (40 marks)
3.2. What issues would you highlight during the counseling of this patient if he
was found to be a chronic hepatitis B carrier ? (60 marks)
4. A 27 years old male presented to an STD clinic with a complaint of a painless
penile ulcer for five (5) weeks and a lump in the left groin. He has taken self
treatment for the ulcer. He denied having any sexual exposures and admitted
using heroin on a regular basis. He used to be a member of a gang of injecting
drug-users about one (l)year ago.
On examination, patient had an indurated, clean, non-tender penile ulcer with
enlarged lymph-node in left groin.
Day 1 - urethral smear - no abnormalities found
dark-ground examination treponemes not seen
giant cells - not seen
VDRL/TPP A - blood drawn
Day 2 - DG examination - treponemes not seen
VDRL-R(16), TPPA-2+
The patient revealed the following sexual history to doctor on the second day.
Female partners; 25-30 in last one (1) year and more than 100 life-time partners
including foreigners.
Male partners; 1 in last year and 8 life-time partners.
He used condoms occasionally with partners.
4.1 What is your diagnosis ? Give reasons for your diagnosis. (20 marks)
4.2 What are the risk factors for sexually transmitted infections that are given
in the history ? (20 marks)
4.3 Discuss the important aspects of management in this patient.
(60 marks)
5. A 32 year old female domestic worker has brought her one week old son to a
paediatric ward with swelling of both eyes and discharge from left eye. She has
been separated from her husband for the past 3 years and had four casual male
partners during last two years. She attended the antenatal clinic twice during this
pregnancy but did not undergo any tests. Baby and mother were referred to the
Central STD clinic for further management.
5.1 Discuss the possible diagnoses in this baby. (20 marks)
5.2 Briefly outline the steps that could have been taken to prevent conditions
stated above. (30 marks)
5.3 Discuss the comprehensive management of this case. (50 marks)