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UNIVERSITY OF LONDON FACULTY OF MEDICINE MSc Examination For Internal Students

MSc Tropical Medicine and International Health PAPER 2 Tuesday, 21 June 2005 10:00am - 1:00pm INSTRUCTIONS Time allowed: 3 hours Answer FIVE (5) of the following TEN (10) questions (35 minutes per question) You must answer: TWO (2) from Section A and ONE (1) from Section B and ONE (1) from Section C and ONE (1) more question from either Section B or Section C Each answer carries the same number of marks. ANSWER EACH QUESTION IN A SEPARATE BOOK Electronic calculators may be used. These should be of a hand-held non-programmable (where relevant) type and the name and model should be stated CLEARLY on the front of your answer book.

Section A 1. You are a District Medical Officer in Northern Nigeria. A mission hospital in your district has reported an increase in the number of cases of meningitis admitted in the past month. Describe the steps you would take to investigate this report, and the action you would take to prepare for a possible meningitis epidemic.

2. Write short notes on: (a) the control of a shigellosis outbreak (b) the use of larvicides for malaria control (c) the elimination of guinea worm

3. Discuss the reasons for the resurgence of human African trypanosomiasis in the past 30 years. How can the disease be controlled?

4. Describe malaria prevention strategies for a non-immune traveller visiting West Africa for a two week period. Please be as specific as possible in discussing your strategies.

Section B 5. A 30 year old man who has been working in rural Colombia attends your clinic in London with an infected ulcer on his face. Outline the process you will go through to establish the diagnosis. You should discuss the differential diagnosis and relevant investigations indicating the reasons for each investigation.

6. A 43 year old Ghanaian woman is brought to hospital in London by her sister. She had been complaining of feeling tired and depressed for some weeks, but the sister became anxious when she was unable to give a clear account of her daily activities over the telephone. The sister then visited the patient and found her to be apathetic, confused and uncooperative and complaining that she had a headache. The patient had lived in the UK for more than 20 years and had last visited her family in Ghana two years previously. Clinical examination reveals a temperature of 38.5OC, pulse 112, blood pressure 130/80. She has probably got a right sided weakness of arm movements (the patient has difficulty cooperating with the examination). She is slow to reply, but gives her correct address, knows the date and that she is in the hospital. Examination of the retina is not possible in the emergency room. Her neck is stiff. No rash is present and the remainder of the examination contributes no other important abnormalities.

1. Describe your immediate management and differential diagnosis. 2. How would you confirm or refute a diagnosis of tuberculous meningitis? 3. Assuming that she does have tuberculous meningitis, outline your subsequent management.

Section C 7. The World Health Organisation has called for trials of the efficacy of a new heatprobe treatment for cutaneous leishmaniasis. Outline a design for such a trial indicating how the influence of bias, chance and confounding will be minimized. Include in your answer a description of where you would conduct the study, and what endpoints you would choose.

8. Write short notes on the following terms used in TB control programmes: 1. 2. 3. 4. Treatment success rate Annual risk of infection Political commitment Fixed dose combinations

9. Write short notes on the epidemiology and treatment of: a) African tick typhus b) Melioidosis c) Plague

10. What is meant by syndromic management? Discuss the advantages and disadvantages of syndromic management for sexually transmitted infections

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