URO

1. A 50-year-old man presented casualty inability to pas urine for a

day. Discus your approach to this patient under the following
headings.

A. Causes.
B. Investigations.
C. Management.
D. Complications.

2. A15-year-old presented with sudden onset of a painful swollen

scrotum for 2 hours.
A. What is the most likely diagnosis and why? (1)
B. What are the differential diagnoses? (2)
C. What investigations would you do? D. Discuss treatment/
interventions.
E. Discuss complications.

3. A 26 year old man was brought to A&Eafter he was involved ni a

road traffic accident. He was complaining of inability to urinate. On
examination: PB10/60; Pusle: 10pm; Tendernesni hte olwer
abdomen; no rebound tenderness; Non-tender mass in the lower
abdomen; blood in theexternal urethral meatus;
Blood biochemistry: Urea= 4.9 mmol/l; Hb =9g/di; WC =12.40 ;
Abdominal XR: shows an open pelvic fracture.
a). Describe anatomical divisions of the male urethra. (6).
b). Precisely, give the most likely urological injury? (4)
c). What do you expect to find on rectal examination? (2) d). What is
the imaging investigation of choice? (2)
d). Describe emergency management approach for this patient? (4)
e). What is most likely long term complication of this injury? (2)

4. A 54 years old male patient came with a 2 weeks history of total gross
haematuria
with clots and lower abdominal pain, associated to burning micturition. He
gives a history of a similar episode 4 months ago that was relieved by
medication from the GP. The clinical examination was unremarkable.
a)What are the characteristics of haematuria that may be indicative of the
source? (6)
b) Write three causes of red urine/ spurious haematuria. (6)
c) Describe differential diagnoses of true Haematuria (5)
d)Rank the diagnostic investigations you would do to reach the definitive
diagnosis of the underlying cause of haematuria (6)
e) What is the histological classification of urothelial malignancy? (5)
f) Describe the principles of treatment according to your differential
diagnosis. (7)

5.A 30-year-old female presents to the clinic/ SOPD with a 2-day history of
suprapubic pain, dysuria, and urgency. This is her 3rd episode ni hte last
4months.
1. What si the most likely diagnosis and why?
4. .2 What are the risk (predisposing) factors?
5. (5) .3How do you diagnose the above condition?
6. (1) 4.Discuss treatment and complication

6.A 60 year old male cannot urinate. He has a history of hesitancy, pure
urine frequency micturition.

What is the diagnosis.

How do you get the diagnosis.
And Emergency Management

PAEDS
Question 1
A two-weeks old neonate presented with vomiting, and the diagnosis of
Hypertrophic Pyloric Stenosis w a s made.
Write short notes under the following:
a. Three most frequent Clinical features
b. Characteristic of the vomitus.
c. Focus investigations
d. Treatment
e. Most frequent non-surgical complication

Question 2
About a neonate with Oesophageal atresia and trachea-oesophageal
fistula,
list:
A. Three most frequent clinical features
B. Diagnostic investigations.
C. Most frequent complication.

Question 3
In relation to the anterior abdominal wall defects such as omphalocele and
gastroschisis, list the following:
a. Clinical differences.
b. Most frequent associated anomalies ni each of them
c. Immediate management of a neonate with gastroschisis

Question 4
An 8 months old male infant, normal weight, presented with one week of
diarrhoea. The mother reports that during the past 48hrs he started crying
intermittently, irritable, flexing his limbs and vomiting. For the past 24
hours, he has been passing mucoid stools.
A. What is the most likely diagnosis? (5)
B. mention the three most frequent signs on physical examination (5)
C. Mention the diagnostic investigation of choice.
D. Describe with justification how you would treat this patient (5)

Question 5

Infant 8months of age, Male, normal weigh; suffering from diarrheic

episodes
during last week, and according with the mother 48 hours ago started
crying, intermittently, irritable, flexing the limbs on to the abdomen,
occasionally these
symptoms end with vomit; 24hours later the diarrheic became with mucus

1 On physical examination mention the three most frequent signs.

2. Mention and document the most likely diagnose (5)
3. Investigations to be performed and which one si the most probably ot
arrive ot a definitive diagnostic.
4. Most probably treatment to be performed, document why

Question 6:

A three-week male presents with projectile, non bile vomit for one week
we'll stop the vomit was off to eating, now after every food meal. No poo
the last 48 hours. Was dehydrated abdomen is distended in epigastrium
with visible peristalsis. Small mass on right upper quadrant.

1. What is the diagnosis.

2. What confirmatory tests will you do.
3. Common complications.
4. And your pre op management.
Neuro:

Question 1
A 30 year old man fell of the motor-bike while racing not wearing a
helmet. On examination at the emergency department was found to not
have sustained torso injuries. On neurological examination was found to
be: localising pain; opening the eyes no command; his verbal response
was inappropriate; left hemi-paresis.
Answer the following questions.

1 What are the components of GCS? (5)

2. What is this patient's GCS? (5)
3. Describe how you wil investigate this patient. (2)
4. Give the possible intracranial injuries sustained by this patient. (5)
5. List the possible causes of secondary brain injury ni a trauma situation.
(5)
6. Describe how you would manage this patient to prevent secondary
brain injury.(8)

Question 2
A 50 year old man presented at the Trauma and Emergency Department
after falling from a bicycle. On physical examination he had a haematoma
over his right temporo- parietal region. His BP was 180/110, pulse 50
b/min, Left pupil was dilated, He withdraws from painful stimuli. His
speech was inappropriate and opens his eyes to painful stimulus.
(a) What is the GCS of this patient? (5)
(b) Give explanation for high BP and slow Pulse rate? (5)
(c) Describe radiological investigations you would do. (5)
(d) Before definitive management, how would you manage this patient in
order to prevent secondary brain injury? (5)
(e) What are causes of secondary brain injury in a head trauma patient?
(5)

Question 3
PVA. BP: 170/80; Pulse 68; Saturation 98%; He si intubated with size 7.5
EeT,tonlig40h%t; oxygen via a T-piece. He opens eyes to pain; pupils
equal and reactive. moving all limbs and flexes to pain. You are called to
casualty to rev
a ) What is the GCS of this patient? (6)
b ) Explain the elements of GCS? (10)
c ) Classify traumatic brain injury according to is GCS. (6)
d) Based on the classification given in (c) above, what is the degree of
severity of this patient's brain injury?
e) What is your understanding of Cushing's triad? (3)
f ) What is Monro Kely Doctrine? (3)

Question 4
A30-year-old man was found unconscious after he was assaulted on the
head
with rusty iron rod. On examination he had a dirty, rugged laceration in
the left parieto-temporal region; weakness of the right upper and lower
limbs. His GCS
was 7/15; PB90/50, pulse 120bpm; snoring breathing.

a) Discuss the emergency management and (10)

i. Monitoring of this patient. (5)
b) Give diagnostic investigation(s) of choice (4)
c) and the most possible underlying injuries. (5)
d ) fI this patient survives this ordeal mention the most likely long-term
sequelae/complication and its management. (6)

Question 5

A26-Year-old male was hit with beer bottle on the left region of his head.
He fell to the ground, vomited, and had a fit.
He was brought out to the Accident and Emergency Room.
1)Describe how you would assess this patient and explain rationale for
each step taken.
ii.) Which general and neurological examination would you carry? (2)
iti.) What is your diagnosis at this stage? (1)

During the examination, he was unable to open his eyes, making

incomprehensible sounds and was unable to localize painful stimuli.
iv.) Calculate the Glasgow coma score. (3)
v.) What localizing neurological signs would you look /examine for.
vi)Describe and discuss the Monro Kely Doctrine of raised intracranial
pressure. (5)

During your examination, the patient had another major epileptic fit. vi.
What would be your response? (1)

After a complete examination and stabilizing of the patient, you decide to

investigate the patient.
viii.) Discuss and describe the general and specific investigation(s) and
possible findings. (5) ix.) Classify Traumatic Brain Injury. (5)
xii.) Based on your findings above, how would you manage this patient
Medically and Surgically.
The patient on day 5 improved, however, he had persistent right
hemiparesis and dysphasia.
xiii.) Localize the les and explain the anatomic - pathological basis