MEQ by wehloong

1. Part 1 : A patient is presented with fasting glucose level 8.0 mmol/L.

a. State four causes of hyperglycemia besides diabetes mellitus. [ 2 m ]
b. State the investigations you would carry out to rule out the causes mentioned above. [ 4 m ]
c. Describe the structure of insulin. [ 2 m ]
d. Describe the mechanism of action of insulin. [ 3 m ]

Part 2 : On physical examination, the patient has coarse facial features and prognathism. His stature is
taller than the average man of his age.

a. State two possible causes for the disorder in this case. [ 2 m ]

b. Describe the regulation of growth hormone in our body. [ 2 m ]

Part 3 : After a few days, the patient develops paraesthesia and numbness on the lateral three and a half
fingers.

a. Explain the condition in this patient. [ 2 m ]

b. List all the components which make up the carpal tunnel. [ 3 m ]

2. Part I : A patient is presented with polydipsia and polyuria.

a. State two disorders which are associated with this patient’s presentation. [ 1 m ]
b. State the criteria for diagnosis of diabetes mellitus. [ 2 m ]
c. State three differences between type I and type II diabetes mellitus. [ 3 m ]

Part II : After a few months, the patient complaints of passing foamy urine.

a. State the five stages of diabetic nephropathy. [ 3 m ]

b. Describe the pathophysiology of diabetic nephropathy. [ 3 m ]
c. State two characteristic feature of diabetic nephropathy under microscope. [ 2 m ]

Part III : The patient develops into chronic renal failure after few years with complications of renal
osteodystrophy.

a. State the benchmark for diagnosis of chronic renal failure. [ 1 m ]

b. Explain the pathogenesis of osteomalacia in this patient. [ 3 m ]
c. State two clinical presentations of rickets in children. [ 2 m ]

3. Part I : A patient with history of sickle cell anemia presented with fatigue, bone pain and skin ulceration.
a. Describe the pathogenesis of sickle cell anemia. [ 3 m ]
b. Describe three features you would observe in peripheral blood smear of this patient. [ 3 m ]

Part II : The patient develops osteomyelitis as complication.

a. Name the most possible causative microorganism for this osteomyelitis. [ 1 m ]

b. Describe briefly the pathogenesis and course of osteomyelitis. [ 4 m ]

Part III : Most of the indigenous inhabitants of Sub-Saharan Africa carry the sickle cell trait and they are
resistant to malaria.

a. Name four malaria species. [ 2 m ]

b. Describe briefly the life cycle of malaria species in the human body. [ 5 m ]
c. Describe the treatment therapy for malaria. [ 2 m ]
4. Part I : A young male is presented with bloody diarrhoea, cramping abdominal pain, fever and weight
loss.

a. State three investigations for this patient. [ 3m ]

b. Name three microorganisms which can cause bloody diarrhoea. [ 3m ]
c. Name the main three branches of celiac trunk. [ 3m ]

Part II : The diagnosis of ulcerative colitis is confirmed in this patient. He also complains of low back
pain with morning stiffness recently.

a. State four causes of low back pain. [ 2m ]

b. State two other extraintestinal manifestations of ulcerative colitis. [ 2m ]
c. Describe two changes you would observe in X ray of the spine for this patient. [ 2m ]

Part III : After a few years, the patient develops complications from the ulcerative colitis.

d. State two complications for ulcerative colitis. [ 2m ]

e. State three differences between ulcerative colitis and Crohn disease. [ 3m ]

5. Part I : Patient is presented with sudden onset of tenderness, warmth and swelling in his toes. Serum uric
acid is found to be elevated in this patient.

a. State the provisional diagnosis for this patient. [ 1m ]

b. State the investigations you would carry out to confirm the diagnosis. [ 2m ]
c. State three causes for the disorder. [ 3m ]
d. Describe two pathways for synthesis of nucleotides from purine. [ 4m ]

Part II : The diagnosis of acute gout has been made in this case.

a. Outline the treatment and management for this patient with the goals of
i. termination of acute attack [ 2m ]
ii. lowering of serum uric acid [ 2m ]
b. State four features of synovial joint. [ 2m ]

Part III : Patient develops complication from untreated chronic gout after a few years. He experiences loin
pain radiating to the groin with nausea and vomiting.

a. State the most likely complication of untreated chronic gout in this case. [ 1m ]
b. Describe struvite stone and its formation. [ 3m ]

wehloong
6. Part I : A 47 year old man presents to the emergency department after experiencing substernal chest pain.
The pain is worsened with inspiration and is relived only when he leans forward.

a. State four causes of chest pain. [ 2m ]

b. State three investigations you would carry out for this patient. [ 3m ]
c. Name the branches of right coronary artery and the areas supplied by each branch. [ 3m ]

Part II : Cardiac examination reveals a friction rub. An ECG and chest X ray are done for this patient.

a. State the provisional diagnosis. [ 1m ]

b. Describe the findings you would expect in the
i. ECG [ 2m ]
ii. Chest X ray [ 1m ]
c. Explain cardiac tamponade. What is Beck triad ? [ 4m ]

Part III : The patient had a myocardial infarction two weeks earlier.

a. State your final diagnosis for this case. [ 1m ]

b. State three other complications of myocardial infarction. [ 3m ]

7. Part I : A 50 year old woman is presented with 1-month history of productive cough with yellow sputum.
She has had several periods of cough lasting 4 to 6 consecutive months each year for the past 5 years. She
has been smoking for the past 30 years.

a. State your provisional diagnosis. Give the reasons from the history to support your diagnosis. [ 2m ]
b. State the abnormalities you would expect on pulmonary function test of this patient. [ 2m ]
c. Describe the pathogenesis of this disorder. [ 3m ]

Part II : Her jugular venous pressure is elevated and there is pitting edema noted up to her knees.

d. What complication of this condition do the patient’s enlarged neck veins, hepatomegaly and edema
suggest ? [ 3m ]
e. State two other causes of elevated jugular venous pressure. [ 2m ]
f. State all the segments of right lower lobe of the lung. [ 2m ]

Part III : Antibiotics and ipratropium bromide are given for this patient as treatment.

g. State three differences between emphysema and chronic bronchitis. [ 3m ]

h. State the mechanism of action of ipratropium bromide and state two side effects. [ 3m ]

wehloong
8. Part I : A 27 year old man complains of blood in his urine over the past week.

a. State four causes of hematuria. [ 2m ]

b. State three investigations you would carry out for this patient. [ 3m ]
c. State three sites where constriction of ureter occur. [ 3m ]

Part II : Ultrasound shows massively enlarged kidneys bilaterally. The surface of both kidneys is covered with
well circumscribed cysts.

d. State the provisional diagnosis. [ 1m ]

e. Describe micturition reflex. [ 3m ]
f. Describe the development of nephron. [ 2m ]

Part III : After a few years, the patient is presented with sudden, severe headache described as the worst
headache his life.

g. Explain the patient’s condition. [ 2m ]

h. State the arteries which form the circle of Willis. [ 3m ]
i. State the significance of circle of Willis. [ 1m ]

9. Part I : A 30 year old patient is admitted into the hospital with severe epigastric pain radiating to the back.
Pain is relieved by leaning forward. He also complains of nausea and vomiting.

a. State two possible causes of severe epigastric pain radiating to the back. [ 2m ]
b. Define acute abdomen. [ 1m ]
c. State three indications for endoscopic retrograde cholangiopancreatography ( ERCP ). [ 3m ]

Part II : Physical examination shows guarding and presence of rebound tenderness in the epigastric region.
Cullen and Grey Turner signs are positive.

d. State three laboratory findings to support your diagnosis. [ 3m ]

e. State four causes of the disorder. [ 2m ]
f. State two complications of the disorder. [ 2m ]

Part III : The patient develops dyspnea, tachypnea and cyanosis after several days. Bilateral fine inspiratory
crackles are heard upon auscultation of the chest. He is diagnosed with adult respiratory distress syndrome.

g. State the four criteria for diagnosis of adult respiratory distress syndrome. [ 4m ]
h. Describe the clinical course of adult respiratory distress syndrome. [ 3m ]

wehloong
10. Part I : A 25 year old patient is presented with fever, chills, headache and nuchal rigidity. He also
complains on photophobia and vomiting.

a. What is meningism ? State two causes of meningism. [ 3m ]

b. State two investigations you would carry out for this patient. [ 2m ]
c. Name two bacteria which commonly cause meningitis in young adults. [ 2m ]

Part II : Blood culture of the patient shows encapsulated gram-negative diplococcus. Petechial rash is
found to be present in this patient. Persistent bleeding occurs at the skin puncture sites for intravenous
injection. The patient has developed disseminated intravascular coagulation.

d. Describe the pathophysiology of disseminated intravascular coagulation in this patient. [ 3m ]

e. State four other causes of disseminated intravascular coagulation. [ 2m ]
f. Define primary and secondary phase of hemostasis. [ 2m ]

Part III : The coagulation profile of the patient confirmed the diagnosis and appropriate treatment is given
promptly.

g. State the findings you would expect in the following [ 3m ]

- Fibrin degradation products ( D dimers )
- Partial thromboplastin time (PTT)
- Platelet count
- Prothrombin time (PT)
- Bleeding time
- Serum fibrinogen

h. State another condition when D dimers test is ordered. [ 1m ]

i. Suggest two treatment and management for this patient. [ 2m ]

11. Part I : A 30 year old female is presented with amenorrhoea for the past three months. Diagnosis of
pregnancy is ruled out in this patient.

i. Define anovulatory amenorrhoea. [ 1m ]

ii. State three causes of anovulatory amenorrhoea. [ 3 m ]
iii. Outline the process in oogenesis. [ 3m ]

Part II : The patient has been having palpitations and weight loss despite increase in appetite. A thyroid
function test is carried out.

i. State the probable diagnosis and the findings you would obtain in the thyroid function test. [ 3m ]
ii. State two other investigations to be carried out in this patient to rule out malignancy. [ 1m ]
iii. Explain the pathogenesis of palpitations, weight loss and amenorrhoea in this patient. [ 3m ]

Part III : The diagnosis of hyperthyroidism has been made. Anti thyroid drug therapy is given.
i. Name one antithyroid drug and describe its mechanism of action. [ 1m ]
ii. Outline the synthesis of thyroid hormone. [ 4m ]
iii. State two organs which are not affected by thyroid hormones. [ 1m ]

wehloong