REPUBLIC OF CAMEROON

REPUBLIQUE DU CAMEROON PEACE-WORK-FATHERLAND

PAIX-TRAVAIL-PATRIE MINISTRY OF HIGHER EDUCATION
MINISTERE DE L’ENSEIGNEMENT SUPERIEUR NATIONAL COMMISSION FOR THE ORGANIZATION
COMMISSION NATIONAL D’ORGANISATION OF EXAMS
DES EXAMENS

HIGHER NATIONAL DIPLOMA EXAMINATIONS

Specialty/Option: Paper: CASE STUDY
BACTERIOLOGY/VIROLOGY
Code Nature of Paper Duration Credit value Total
MLS 14 Written 05hrs 10 100

SECTION A: BACTERIOLOGY/VIROLOGY (20MARKS)

1) A 36-year-old patient presents several hours after eating tinned fish with a sudden onset of
diplopia and dysphagia.

a) How do you make a diagnosis?(1.5 Mark)

b) How is the mode of transmission of the causative agent of botulism? (1.5 Mark)
c) In what other ways does disease occur? (1.5 Mark)
d) How are the symptoms caused? (1Marks)
e) What other diseases do clostridia cause? (1.5 Mark)
f) What other feature is common to these bacteria that contribute to their
epidemiology?(1.5 Mark)
g) How should botulism be treated? (1.5 marks)

1) In 2010 a screening test was carried out at the Bafut district Hospital using the
ELISA Test by the National commission in charge of the fight against HIV/ AIDS
in Collaboration with the Health Club. A student by name Ndifor was diagnosed
HIV positive. In March 2015 Ndifor was sick and started developing signs and
symptoms suspicious of AIDS. He was referred to the General Hospital Bamenda.
In the Hospital he was sent to the serology department for general test for the
following disease causing organisms: Streptococcal bacteria, Salmonella typhi and
Hepatitis B virus. A CD4+ cell count was also carried out and showed a marked
reduction.
a) Describe the general principal and procedure of the ELISA test used in
Screening for HIV/AIDS (5marks)
b) Why was there a reduction in the CD4+ cell count? (2marks).
 SECTION B: PARASITOLOGY/MYCOLOGY (20MARKS)
1) A young farmer from an equatorial rain forest region of Africa reported in a clinic with a kwashiorkor-
like abdomen. His body mass index has dropped drastically in a matter of a year after he returned from
a forest hunting session with his father. He was also diagnosed of several bacterial infections and
before the physician could commence treatment on him, he died. A post-mortem autopsy revealed an
enlarged spleen and liver. From the clinical picture, attending physician conclude that the boy died of a
case of Leishmaniasis

a. What type of the disease did the farmer most like have died of ( 1 mark)
b. What is the causative agent of this disease and what is its most probable vector ( 2marks)
c. Apart from the type of Leishmaniasis above, give 2 other types of leishmaniasis and their
causative agents. (2marks)
d. The parasite in a) above exist in 2 morphological forms, name them (1mark)
e. Discuss the diagnosis and treatment of the above infection. (4marks)
2) A patient who had inhaled aerosols from in an area with pigeon droppings was rushed to a clinic
almost in a comma. A brain scan of the patient revealed an inflammation and lesions in his meninges
with several brain abscesses resembling a brain tumor. His CD4 count was less than 100cells/ul and
the meningitis was a slowly developing one. It was therefore realized that he was suffering from an
opportunistic fungal infection.
(a) Which opportunistic fungal infection is the patient suffering from (1 mark)
(b) What is its causative agent (1 mark)
(c) List two other opportunistic fungal infections (2 marks)
(d) List four systemic fungal infections and their causative agents (2 marks)
(e) All fungi must enter the host in order to successfully establish an infection. Give the 4
portals of entry of fungi into humans (4 marks)

SECTION C: HAEMATOLOGY/ BLOOD TRANSFUSION SCIENCE (20MARKS)

1.An adult lady of about 30 years of age returning from the farm was knocked off by an
oncoming motorbike and she sustained a serious injury with bleeding from both upper and lower
limbs. She was immediately rushed to a nearby District hospital and the attending physician after
consulting her noted that some of her siblings easily bleed without a significant trauma. The
attending physician requested for some laboratory investigations with the following results;
TT 14 seconds (RR 12 – 15 seconds)
 PT = 12 seconds (RR 11 – 16 seconds)

APTT = 70 seconds (RR 35 – 60 seconds)

BT = 6 minutes (RF 3- 5 minutes)

Platelet count = 300 x 109/L (RF 150 – 400 x 109/L)

The physician then provided the victim with some procoagulants that led to the arrest
of the bleeding

a. Which type of haematological condition could this victim be suffering from?

Justify your response (3 marks)
b. List the name of a laboratory assay that could be used to selectively identify this
haematological disorder. (1 mark)
c. So how will you ascertain the definitive diagnosis of this victim? (3 marks)
d. If a blood transfusion was recommended, which blood product(s) will be best
suitable for this disorder? (2 marks)
e. What is a pro-coagulant and of what essence was it to the victim? (2 marks)
f. Briefly describe the sequence of event that led to the arrest of bleeding by the pro-
coagulant. (5 marks)
g. Give the function of theAPTT and PT(2x2marks)
SECTION D: IMMUNOLOGY/ SEROLOGY (20MARKS)

1) While working in a mushroom farm for some weeks, a farmer develops itchy and tearing
eyes, coughing and sneezing. The farmer was suspected of suffering of type I hypersensitivity.

a) What do you understand by the word hypersensitivity? (2marks)

b) Explain the mechanism behind Type I hypersensitivity (8marks)
c) List 4 mediators of type I hypersensitivity (4 marks)
d) What is another name of type I hypersensitivity (1mark)
2) Explain the principle behind the Direct Coomb’s test for ABO blood group typing (5marks)
SECTION E: CHEMICAL PATHOLOGY (20MARKS)
1. A 25 year old man presents to the hospital with a fever, mental status changes and
hypotension. He recently complained of increased thirst and urination. Upon laboratory
examination, the following results were obtained;
Na+ = 143mEq/L K+ = 3.9mEq/L Cl- = 98mEq/L
HCO3- = 22mEq/L Glu = 126g/dL BUN = 95g/dL
 pH = 7.61 pCO2 = 23mmHg pO2 = 95mmHg
pH – 7.35 – 7.44; pCO2 – 45 – 61 mmHg; HCO3- - 22 – 26 mEq/L
Na+ - 135 – 145mEq/L; Cl- - 35 – 45mEq/L
a) Is the patient acidemic or alkalemic? Explain [5mks]
b) What is the patient suffering from? Show all the necessary steps leading to your
answer [5mks]
c) Outline any 5 causes of the above condition [5mks]
d) Explain how the above condition is compensated for [5mks]

MARKING GUIDE

SECTION A: BACTERIOLOGY/ VIROLOGY (20MARKS)

(a) The diagnosis of botulism is principally made clinically in the presence of a history of
suspect-food ingestion. Toxin may be detected in serum and stool but treatment should be
instigated on the basis of clinical features.

b) Botulism is usually a food-borne disease. Clostridium botulinum multiplies in

contaminated food when there is an anaerobic environment (e.g. in canned or
preserved food where there heat treatment has been inadequate). Toxin is produced
and then ingested.
c) There are two other forms of disease – wound botulism, where the organism
multiplies in devitalized tissue, and infant botulism, where the organism multiplies in
the gut of infants usually around the time of weaning. In both cases the elaborated
toxin causes the clinical features of botulism.
d) The symptoms are caused by botulinum toxins A–G. This causes a descending motor
neurone paralysis, which causes respiratory failure that requires ventilation.
e) Clostridium tetani causes tetanus by producing a toxin that causes a spastic paralysis
and reflex muscle spasms leading to respiratory failure; Clostridium difficile produces
enterotoxins that cause pseudomembranous colitis and diarrhoea, which may lead to
 bowel perforation; and Clostridium perfringens cause gas gangrene by producing α-
toxin that leads to muscle destruction.
f) Many are carried harmlessly in the gut of man and animals so are shed into the
environment. They all produce spores that make them resistant to drying and
disinfectants. They are also more resistant to heat and therefore more likely to persist
in the environment or foods.
g) The patient should be given ventilatory support and specific antitoxin. Penicillin
should also be given to prevent the production of more toxins.

2. a)
 Testing for antibodies in serum
 Specific antigen is bound to a microtitre plate
 Serum added to well
 Was out excess antibodies
 Anti- IG conjugated with an enzyme added
 Antigen react shown by colour change (1mark for each correct point)
b) Attack and destruction of CD4 cells by HIV which are receptor proteins of HIV;
 When HIV infects humans, the cells it infects most often are CD4+ cells.
 The virus becomes part of the cells, and when they multiply to fight an infection,
they also make more copies of HIV.
SECTION B: PARASITOLOGY/ MYCOLOGY (20MARKS)
1 a) Visceralleishmaniasis or kala- azar

b) Leishmaniadonovani, its vector is the sandfly

c) Cutaneousleishmaniasis caused by leishmaniatropica and leishmaniamexicana

mucocutaneousleishmaniasis caused by leishmaniabraziliensis

d) amastigote and promastigote

e) Diagnosis can be done by animal inoculation, molecular methods,culture,needle biopsy,

peripheral blood films, immunological tests such as direct agglutination test.

treatment can be achieved by administration of stigbogluconate

2). a) Cryptococcosis
 b) Cryptococcus neoformans
c) Candidiasis, Aspergillosis, Mucormycosis
d) Histoplasmosis – Histoplasmacapsulatum
Coccidioidomycosis- Coccidioidesimmitis
Paracoccidioidomycosis – Paracoccidioidesbrasiliense
Blastomycosis- Blastomycesdermatitidis
a) Inhalation, skin trauma, inhalation, sharing of clothing

SECTION C: HAEMATOLOGY/ BLOOD TRANSFUSION SCIENCE (20MARKS)

a. Coagulation disorder. This is because the child suffered from profuse

bleeding/prolonged APTT and it is hereditary science one of his cousins presented
with it and most like to be Haemophila. (2 marks)
b. Single factor assay
c. This is because the child suffered from profuse bleeding/prolonged APTT and it is
hereditary science one of his cousins presented with it and most like to be
Haemophila. (2 marks)
The definitive diagnosis is the prolong APTT which is a screening test for the
intrinsic coagulation system and will detect deficiency in FVIII, FXII, fibrinogen. Or
using the single factor assay to screen for FVIII deficiency and then running the
APTT which will be prolonged. (3 marks)
d. Transfusing the patient with whole blood or cryoprecipitate. FVIII should be
administered to immediately arrest the bleeding. (2 marks)
e. To prevent further bleeding leading to severe anaemia or death. To rejuvenate the
function of the body’s organs. Restore a normal health of the boy. (2 marks)
f. Injury to blood vessel exposesvWF which attracts platelets that bind to collagen and
one another. Platelet are then activated that will degranulates and release content of
granules that wi;; attract more platelets that will bind to one another and lead to
platelet plug
g. PT is a screening test for the extrinsic clotting system and will detect deficiency in
factor VII, V, X, fibrinogen and prothrombin. Use to monitor individual on warfarin
oral anticoagulant. APTT is a screening test for the intrinsic clotting system. It will
detect deficiency in FXII, FVIII, fibrinogen and prothrombin. Use to monitor patients
treated with heparin.

SECTION D: IMMUNOLOGY/SEROLOGY (20MARKS)

 1) a) it is an exaggerated response of the immune system (2marks)
b) - When you are exposed to the allergen the first time Ig E is produced and this is
known as the sensitizing dose
-This molecule binds to the surface of the mast cell
- When you are exposed to the same allergen a subsequent time another IgE molecule is
produced
- This 2 molecules crosslink on mast cell and this leads to degranulation
each correct step explained properly is (1 mark for each correct point
c) Histamine, serotonin, slow reacting substance of anaphylaxis, eosinophil chemotactic
factor ( 1mark for each 4 correct mediator)
d) Anaphylactic hypersensitivity or immediate hypersensitivity (1 mark for any 1 correct
name)
2) This detects the presence of antibodies on red blood cells or red blood cells sensitization.
ABO BLOOD GROUP TYPING
 The human blood is grouped according to the presence or absence of specific
chemical structures called blood group antigens.
 These substances are found on red blood cells and can induce the body to produce
antibodies.
 There are two major antigens forming the ABO blood group system ie A and B
The antigens of ABO system consist of core glycolipids called substance H or O antigen
SECTION E: CHEMICAL PATHOLOGY (20MARKS)
1. a) Alkalemic
Normal pH range is 7.35 – 7.45 any value above 7.45 is considered alkalemic while any
value below 7.35 is considered acidemic and since the patient’s pH value 7.61 which is
greater than 7.45, he is considered alkalemic
b) Patient has an increased pH or a decreased [H +] and from the formula below, one
could deduce what the patient is suffering from
[H+] α pCO2
[HCO3-]
A decrease in [H+] will lead to a decrease in pCO 2 and an increase in [HCO3-] and
from the results of the patient pCO 2 is decreased which indicates respiratory and since
pH is decreased, the patient is thus suffering from respiratory alkalosis
c) Direct stimulation of the respiratory center
CNS causes like stroke
 Drug use e.g. caffeine
Pregnancy
Moving into high altitude areas
Fever
As a result of medical treatment during excessive mechanical ventilation
d) In respiratory alkalosis, less H+ is excreted and less HCO3- is generated by the
kidneys decreasing blood bicarbonate