UNIVERSITY OF THE WEST INDIES

FACULTY OF MEDICAL SCIENCES

EXAMINATION OF MAY/JUNE 2016
Code and Name of Course:
EXAMINATION Paper: 1

SU

500/MDSC

5555

STAGE

Date and Time: THURSDAY, MAY 5, 2016: 9:00 a.m. -12:00 noon
hrs.

II,

PART

Duration:

IV
3

INSTRUCTIONS TO CANDIDATES:
This examination consists of Two Sections, A & B, and has 38 pages, including the
cover page.
Section A, consist of Two Parts:
Part I contains 90 questions which require a Single Best Answer
Part II contains 25 questions of the extended matching type
DIRECTIONS:
For each of the questions, shade the appropriate box on the appropriate answer
card.
Section B contains 5 questions requiring short written responses
YOUR QUESTION PAPER WILL BE COLLECTED ALONG WITH YOUR
ANSWER CARD AT THE END OF THE EXAMINATION
FAILURE TO RETURN YOUR COMPLETED PAPER WILL INVALIDATE
YOUR MARKS
POINTS WILL NOT BE DEDUCTED FO INCORRECT ANSWERS GIVEN

UWI ID Number: ___ -_________

The University of the West

Indies_______________________________________________________________________
DO NOT WRITE ON THE BACK OF THIS PAPER USE ONE SIDE ONLY
SECTION B
Structured Answer Essay Questions
Instructions: Please write the answer in the space provided only. Note that marks
vary for each response. Correct precise answers gain full marks. Responses that are
close may be given partial marks.
Question 1
A 52-year-old woman presented to her primary health care physician in
the country with a complaint of feeling weak and fatigued for the past (3)
months. She also experienced unintentional weight loss of 10 lbs. over the
same period. Her physical examination is essentially unremarkable. Blood
investigations reveal that she has a microcytic anaemia. She was
subsequently referred to a tertiary care hospital for further management.
a) List three (3) precursor lesions of colon cancer

b) What other specific investigations would you order if you suspected a rightsided colonic malignancy?

c) List four (4) routes of spread of colorectal cancer and give an example of
each:

UWI ID Number: ___ -_________

Diagnostic imaging tests revealed a cauliflower lesion in the ascending
colon. There was no mention of any visible metastatic deposits.
d) The patient undergoes an exploratory laparotomy for resection of the
affected segment of colon. What specific surgical procedure should be done
AND list any five (5) early post-operative complications you could expect:

Microscopic examination of the specimen by the pathologist reveals

tumour invasion through the muscularis propria into peri-colic tissues &
evidence of spread to two (2) regional lymph nodes.
e) Name three (3) pathological staging systems used for colorectal cancer AND
using any (1) system of your choice give the appropriate stage for this
patient?

On routine surveillance imaging one (1) year after surgery, she is found to
have a 2cm lesion in the left lobe of the liver.
f) What are the options for management of liver metastases from colorectal
carcinoma AND list any two (2) criteria that should be fulfilled for this patient
to be considered a candidate for hepatic resection?

g) If any (3) of her siblings or parents had a history of endometrial, ovarian or

colorectal cancer, what familial cancer syndrome would you consider? What
genetic defect is responsible?

UWI ID Number: ___ -_________

Question 2
A 65-year-old bartender is referred to the clinic with a 6-month history of
hoarseness, coughing and unintentional 9 kg weight loss. He is known to
have chronic obstructive pulmonary disease (COPD). Neck examination
demonstrates a 2 cm right-sided mass that is firm and fixed
a) List three (3) differential diagnoses that could account for his persistent
symptoms

b) What other important information would you ask about when ascertaining the
medical history?

Over the past week he has noted progressive difficulty breathing. Cranial
nerve examination is normal. There is mild biphasic stridor with deep
inspiration and expiration, but the patient has no increased work of
breathing at rest, and breath sounds are clear.
c) What is the definition of stridor?

Flexible fibre-optic laryngoscopy demonstrates a necrotic, ulcerating mass

involving the right true and false vocal cords, and extension onto the
epiglottis and aryepiglottic folds. The right true vocal cord is immobile.
The glottic airway is partially obstructed.
d) What further investigations would you request (give reasons for your choice)?

UWI ID Number: ___ -_________

e) List two (2) life-saving surgical procedures that are sometimes performed in
patients with stridor prior to definitive treatment

f) What is the definitive surgical procedure used in the treatment of laryngeal

cancer and list any four (4) complications associated with this procedure

g) What other modalities are available in the treatment of suspected

carcinomas of the larynx:

Six months after surgery the patient returns to the clinic with a painless 5
x 5cm firm fixed mass close to the site of the original neck incision. Repeat
radiological test were done and review of the images determined that he
was not a candidate for surgical neck dissection due to encasement of a
particular structure.
h) What structure is likely to be encased?

1.

UWI ID Number: ___ -_________

Question 3
A 65-year-old woman with a known history of hypertension, presented to
the accident and emergency department with severe sternal chest pain
radiating to the back and a cold pulseless left leg. She describes the pain
as tearing in nature and has no preceding history of trauma. Her blood
pressure on arrival was 195/90mmHg in the right arm and 160/70 in the
left arm.
a) What important clinical diagnoses should be considered in this patient:

b) Name four (4) clinical manifestations associated with further extension or

extravasation of blood into the layers of the affected organ or surrounding
structures

c) What urgent investigations should be requested to aid in the management of

this patient?

d) Name two (2) classification systems used to describe this condition

e) What is the definitive treatment of this condition, and what techniques/

approaches are available to definitively treat this condition if diagnosed
early?

UWI ID Number: ___ -_________

f) List the monitors would you would want to place for the surgical treatment of
this condition and give (1) reason why you would want each monitor you
have listed

g) List four (4) outcomes or complications associated with surgical repair of this
condition

h) Name any three (3) diseases that may be associated with this condition

UWI ID Number: ___ -_________

Question 4
A 25-year-old man is brought to the casualty department, with severe
burns and a grossly deformed, bleeding left leg after a motorcycle
collision. He had become trapped under the motorcycle, which caught on
fire. On physical examination he is awake and alert but in excruciating
pain. In addition he has partial and full thickness burns to the chest, right
upper limb and lower limb. An open 5 cm wound is seen anteriorly in the
mid-tibia.
Dorsalis pedis and posterior tibial pulses are palpable
bilaterally.
a) List four (4) features on clinical examination that would indicate the need for
immediate endotracheal intubation of this patient

b) Outline the steps you would take in the initial resuscitation

management of this patients injuries in the emergency room

c) Name five (5) common complications that are associated with burns

and

UWI ID Number: ___ -_________

Plain radiographs of the left leg reveal an angulated and displaced tibial
shaft fracture. The patient is taken to the operating theater for further
debridement, and fixation of the fracture
d) List three (3) benefits of early fixation in this patient?

Five (2) hours after the procedure, he becomes increasingly confused and
develops a temperature of 38.5 C. His oxygen saturation falls from 97% to
85% on room air.
e) What complication has developed AND how would you manage it?

The patient is admitted to the burn unit for further intensive care and
wound management.
f) What topical antibacterial agents are commonly used for the treatment of
burns?
Name one disadvantage of each

His wounds heal satisfactorily and she is discharged after 3 months in

hospital. 6 months later he returns to the orthopedic clinic with a
complaint of persistent pain, swelling and a discharging sinus from the
left leg. X-rays reveal non-union of the tibial shaft and areas of involucrum
and sequestrum.
g) What complication has developed and how would you manage this
unfortunate complication?

UWI ID Number: ___ -_________

UWI ID Number: ___ -_________

Question 5
A 66-year-old man who recently attended a prostate screening symposium
is referred to the urology clinic after he was found to have a prostatespecific antigen (PSA) level of 8 ng/mL. His physical exam was normal and
the digital rectal examination revealed a slightly enlarged but benignfeeling prostate. His past medical history was unremarkable.
a) What are the criteria necessary to initiate a screening programme for a
particular disease?

b) List four (4) conditions that may cause to an elevated PSA:

c) What voiding or irritable urinary symptoms would you ask this patient if he is
experiencing?

d) If you were concerned about an advanced prostate malignancy what

symptoms might you expect this patient to have?

UWI ID Number: ___ -_________

UWI ID Number: ___ -_________

e) Name two (3) radiologic imaging tests that could be helpful in this patient

f) Briefly outline the steps involved in performing a prostate biopsy

Prostatic biopsy revealed a Gleason score 7 (4 + 3) adenocarcinoma in 6 of

12 specimens.
g) Would you offer a surgical procedure to this patient and if so what
procedure?

h) If the patient declined to have surgery done what treatment options are
available?