Exam paper (Supplementary) for second semester 201

University of Johannesburg

University of Johannesburg Institutional Repository

    PROGRAMME : FURTHER NATIONAL HIGHER DIPLOMA IN PRIMARY HEALTH CARE: CLINICAL NURSING, DIAGNOSIS, TREATMENT AND CARE  SUBJECT : PAPER 2:    MODULE 5: EMERGENCIES AND SURGICAL PROBLEMS AT PRIMARY LEVEL     MODULE 6: DIGESTIVE SYSTEM AND ENDOCRINE SYSTEM  CODE :  GGP 2057    DATE :  SUPPLEMENTARY EXAMINATION JANUARY 2018  DURATION :  3 HOURS  WEIGHT :  50:50  TOTAL MARKS :  100   EXAMINER :  DR NBD MAGOBE     MODERATOR :  MR. V. MOKOKOTLELA (WITS UNIVERSITY – MEDICAL SCHOOL  NUMBER OF PAGES :  THIS PAPER CONSISTS OF FIVE (5) PAGES AND ONE ANNEXURE   INSTRUCTIONS :  PLEASE ANSWER ALL THE QUESTIONS.  ALL MARKS ARE EQUIVALENT TO HALF (½) MARK PER FACT OR MOTIVATION, UNLESS OTHERWISE STATED.   INSTRUCTIONS TO CANDIDATES: This examination paper remains the property of the University of Johannesburg and may not be removed from the examination room.   _____________________________________________________________________________         2/...FACULTY OF HEALTH SCIENCES DEPARTMENT OF NURSING SCIENCE      - 2 - SUPPLEMENTARY EXAMINATION JANUARY 2018 SUBJECT: PRIMARY HEALTH CARE: CLINICAL NURSING, DIAGNOSIS, TREATMENT AND CARE (GGP2057) ______________________________________________________________________________________  QUESTION 1  An 18-year old woman is brought to the clinic by a neighbour as an emergency. She is in a semi-conscious state and has intermittent convulsions. The neighbour is not sure of what has happened.  1.1  List the possible causes/differential diagnoses of her level of consciousness and convulsions and for each cause/condition listed write the following:  one possible symptom and  one possible sign as illustrated in the example below:  Possible cause/condition Possible symptom (on history taking) Possible sign  (on physical examination) Epilepsy  History of defaulting epileptic treatment Evidence of tongue biting                                        (½ x30)=*[15]   QUESTION 2  A 3-year old boy is brought to the clinic by the mother with a history of drinking paraffin.  2.1 Describe the assessment (history and examination) you would do to determine the extent of the paraffin poisoning.                        (½x8)=(40  2.1 Describe the management of this patient.       (½x12)=(6)  One of the most common home accidents is paraffin poisoning (drinking paraffin).   2.2 Discuss the health promotion/education you would give to a group of mothers in your PHC clinic with regard to the prevention of all home accidents. (½x10)=(5)                                                                                                *[15]    3/… - 3 - SUPPLEMENTARY EXAMINATION JANUARY 2018 SUBJECT: PRIMARY HEALTH CARE: CLINICAL NURSING, DIAGNOSIS, TREATMENT AND CARE (GGP2057) ______________________________________________________________________________________  QUESTION 3   A 15-year old boy presents with a history of an injury during a soccer game the previous day. He alleges that an opponent kicked him at the back of his lower leg. He says he continued to play to the end of the game. This morning he walks with a limp and the pain seems to be a bit more severe than the previous day, which is why he decided to come to the clinic.  3.1   Outline the principles of management of trauma to be considered by the PHC nurse. (½x12)=(6)  3.2   Describe the signs you would find on examination if this was a fracture. (½x8)=(4)              *[10]   QUESTION 4   A 52-year old woman comes to your clinic for the first time and complains of tiredness, polyuria, polydipsia and vaginal itchiness.  On examination of the patient you find the following;  Vital data: o Blood pressure:  145/98 mmHg o Pulse: 84 beats per minute o Temperature: 37,2ºC o Respiratory rate 18 breaths per minute  Mass 90 kg, Height 165 cm (BMI 33.1 Obese)  Urine Glucose ++ and Nitrites Positive and no other abnormalities  Blood glucose 11mmol/ℓ (random)  Vaginal discharge: Curd-like, thick and white  No abnormalities detected in the rest of the systems.       4/… - 4 - SUPPLEMENTARY EXAMINATION JANUARY 2018 SUBJECT: PRIMARY HEALTH CARE: CLINICAL NURSING, DIAGNOSIS, TREATMENT AND CARE (GGP2057) ______________________________________________________________________________________  4.1  List the differential diagnosis/ses and give motivation/s (give reasons for each diagnosis). (½x14)=(7)  4.2  Describe the goals of treatment in the management of Diabetes Mellitus. (½x10)=(5)  4.3  Hypoglyceamia is one of the common complications in patients with Diabetes Mellitus.  4.3.1 List the clinical features of hypoglyceaemia you would warn and advice the patient about. (½x16)=(8)   *[20]   QUESTION 5  A 12-month-old girl child is brought to your clinic by the mother. She says that the child has had watery stools (diarrhoea) for 2 (two) days, but no vomiting and no fever. This is the first episode. There is history of loss of appetite since the diarrhoea started, but she normally eats well. The mother gives the baby porridge three times per day, with sour milk. She sometimes eats porridge with sugar or cabbage and maybe meat or chicken twice a week. The child is still breastfeeding and the last immunisation was at 14 weeks and the weight was 6kg. Nobody else in the household has the same problem. On review of systems there are no other problems. They share a water tap with other people in the informal settlement and are using bucket system toilets.  The mother is 35 years old and this is her first child; has never been pregnant before, and has never done a Pap smear and was examining her breasts regularly before she became pregnant. She tested HIV negative during pregnancy and last used contraception 10 years ago.   On examination: The child shows signs of mild/some dehydration (5% dehydration) and drinks eagerly. All vital signs are within normal limits. Birth weight was 3,1kg and today the weight is 8,3kg. RTHC – is attached.  5.1 List the most likely differential diagnosis/ses and problem list and give reasons for each. (½x14)=(7)    5/… - 5 - SUPPLEMENTARY EXAMINATION JANUARY 2018 SUBJECT: PRIMARY HEALTH CARE: CLINICAL NURSING, DIAGNOSIS, TREATMENT AND CARE (GGP2057) ______________________________________________________________________________________  5.2  Discuss the management of this baby under the following headings:   5.2.1 Rehydration of the baby at the clinic (includes fluid replacement calculations). (½x14)=(7)  5.2.2 Advice you would give the mother on discharge home. (½x16)=(8)   The Mother comes back with the child after two days with a complaint that the baby is now vomiting the ORS since last night On physical examination of the baby you realise that the baby is now severely dehydrated (10% dehydration).   5.3  Discuss your further management of this child.  (½x6)=(3)    *[25]   QUESTION 6   A 45-year old female complains of an increased appetite, but is losing weight. She also states that she is very emotional lately and very nervous. You suspect a possible thyroid problem.  Compare the clinical features of hypothyroidism and hyperthyroidism (thyrotoxicosis) under the following headings:  Hypothyroidism Hyperthyroidism (Thyrotoxicosis)  Incidence  Symptoms (history)  Signs (physical examination findings)  Incidence  Symptoms (history)  Signs (physical examination findings)     (½x30)=*[15]    ---oOo--- 

Digestive System and Endocrine System

       PROGRAMME : FURTHER NATIONAL HIGHER DIPLOMA IN PRIMARY HEALTH CARE: CLINICAL NURSING, DIAGNOSIS, TREATMENT AND CARE  SUBJECT : PAPER 2:    MODULE 5: EMERGENCIES AND SURGICAL PROBLEMS AT PRIMARY LEVEL     MODULE 6: DIGESTIVE SYSTEM AND ENDOCRINE SYSTEM  CODE :  GGP 2057    DATE :  NOVEMBER EXAMINATION 2017  DURATION :  3 HOURS  WEIGHT :  50:50  TOTAL MARKS :  100   EXAMINER :  DR NBD MAGOBE     MODERATOR :  MR V. MOKOKOTLELA (WITS UNIVERSITY MEDICAL SCHOOL)  NUMBER OF PAGES :  THIS PAPER CONSISTS OF FIVE (5) PAGES AND ONE ANNEXURE   INSTRUCTIONS :  PLEASE ANSWER ALL THE QUESTIONS.  ALL MARKS ARE EQUIVALENT TO HALF (½) MARK PER FACT OR MOTIVATION, UNLESS OTHERWISE STATED.   INSTRUCTIONS TO CANDIDATES: This examination paper remains the property of the University of Johannesburg and may not be removed from the examination room.   ______________________________________________________________________________       2/...FACULTY OF HEALTH SCIENCES DEPARTMENT OF NURSING SCIENCE      - 2 - NOVEMBER EXAMINATION 2017          SUBJECT: PRIMARY HEALTH CARE: CLINICAL NURSING, DIAGNOSIS, TREATMENT AND CARE (GGP2057) ______________________________________________________________________________________    QUESTION 1   Bronchial asthma is a chronic respiratory condition which could be fatal if not managed appropriately by Primary Health Care (PHC) nurses. A patient presenting with acute Bronchial Asthma attack in the clinics is to be treated as an emergency.  1.1 Describe the indications for referral of an adult male patient with acute Asthma attack. (½x12)=(6)   1.2 Discuss the emergency management of an adult male patient presenting with acute Bronchial Asthma attack before referral to hospital.  (½x12)=(6)    *[12]  QUESTION 2  A 25-year-old male patient complains of epigastric pain for 2 (two) days with nausea but no vomiting, no diarrhoea and no constipation. This is the second episode. The first episode was a year ago after drinking alcohol heavily at a party. The pain is burning in nature and is aggravated by taking food with spices and drinking alcohol. He smokes daily and drinks alcohol on weekends only. He has never tested for HIV and uses condoms sometimes with the two partners he has. He is employed and stays with the one partner in a flat. No laxatives or emetics or any other medication taken. No fever and no additional complaints.  2.1 List the possible differential diagnosis and the problem list based on the scenario above and give reasons for each diagnosis given. (½x10)=(5)   After history taking and a physical examination of the GIT system, your diagnosis is Gastritis.  2.2    Describe the clinical signs you would have found on physical examination to confirm the diagnosis of Gastritis. (½x20)=(10)  2.3  Discuss the management of this patient at your PHC clinic, including indications for referral.   (½x20)=(10)    * [25]   3/…  - 3 - NOVEMBER EXAMINATION 2017          SUBJECT: PRIMARY HEALTH CARE: CLINICAL NURSING, DIAGNOSIS, TREATMENT AND CARE (GGP2057) ______________________________________________________________________________________   QUESTION 3  A 50 years old woman has been Diabetic for just over one year now and has come for check-up today. On reading her card you find the following as clinical notes for the one previous visit which was three months ago.  Known DM  check-up Take drugs everyday but eats sugar food and still smokes No other complaints, On examination:  looks well but still fat BP 140/90   RBG 10mmol/L  Urine: Glucose +++  Diagnosis: Diabetes Mellitus  Treatment  Gliglazide 80mg bd x1month (Has been on this treatment since the diagnosis of Diabetes)  Repeats x3mths (Dates written out and one of the dates is today).  3.1  Critically analyse the patient’s clinical record above (from “on examination to treatment” given) AND correctly rewrite the above clinical notes (do not include examination of other systems and non-drug management). (½x20)=(100   Today the patient complains of an itchy vaginal discharge. She is not sexually active because her husband died 3years ago and never had a partner since then. Last menstrual period was 3years ago before the husband died. There are no additional problems. The patient is satisfactory but still obese and the blood sugar, urine and BP are also still the same as in your answer in 3.1 above.   3.2  Outline/list the additional aspects of the check-up history today, you will need to complete in the clinic card. (½x14)=(7)  3.3  Write out a complete drug prescription you would give to the patient today and give reason/s for each drug prescribed. (½x16)=(8)    *[25]  QUESTION 4  A 45-year old female complain of an increased appetite, but is still losing weight. You suspect a possible thyroid problem. 4/… - 4 - NOVEMBER EXAMINATION 2017          SUBJECT: PRIMARY HEALTH CARE: CLINICAL NURSING, DIAGNOSIS, TREATMENT AND CARE (GGP2057) ______________________________________________________________________________________    4.1    Compare the clinical features of hypothyroidism and hyperthyroidism (thyrotoxicosis) under the following headings:  Hypothyroidism Hyperthyroidism (Thyrotoxicosis)  Incidence  Symptoms (history)  Signs (physical examination findings)  Incidence  Symptoms (history)  Signs (physical examination findings)     (½x36)=(18)  This patient has an additional complaint of having sprained her ankle 2days ago, now the swelling is not getting better. This morning the pain seems to be a bit more severe than the previous day.  1.2 Outline the principles of management of trauma to be considered by the PHC nurse. (½x8)=(4) 1.3 Describe the signs you would find on examination if this was a fracture. (½x8)=(4)    *[26]  QUESTION 5 Read the scenarios given below, and for each of the following health problems: (I) give the most appropriate diagnosis, and (ii) State whether you would (write A, B or C -– do not re-write the treatment) A. treat the patient and discharge home (no referral) B. treat the patient and refer to hospital/doctor the same day (urgent referral) C. Treat the patient and refer when convenient/later (non-urgent referral).  5.1 A 54-year old male is brought to the clinic by his wife. He is slightly confused. His random blood glucose is 25 mmol/ℓ. (1)  5.2 A 24-year old male complains of abdominal pain, nausea and blood in the stools. He was treated for the same problem last month with magnesium trisilicate 500 mg orally, 2-4 tablets sucked when necessary. (1)     5/… - 5 - NOVEMBER EXAMINATION 2017          SUBJECT: PRIMARY HEALTH CARE: CLINICAL NURSING, DIAGNOSIS, TREATMENT AND CARE (GGP2057) ______________________________________________________________________________________    5.3 A 60-year old woman complains of ‘something in the anus’. On per rectum (PR) examination there is a mass inside the rectum, which is mildly tender. (1)  5.4 An 18-year old male presents with a human bite wound on the lower lip of the mouth after a fight with his girlfriend the previous night. (1)  5.5 A 10-year old boy has signs of shock and alleges to have fallen from a tree, but did not fall on his head. There are no other injuries except that his genitalia are very painful. (1)  5.6 An elderly man complains of a painful lower back which started while he was working in his garden 2 (two) days ago. The pain became worse today after he drove his Mini car that he has owned and driven for several years. (1)  5.7 A 34-year old woman presents with a painful, swollen and hot left knee. She gives a history of falling on the stairs at her house 3 (three) days ago and thought that it would become better after rubbing it and taking pain tablets. X-rays show no fracture. (1)  5.8 A one-day-old baby girl bleeds mildly from the vagina. On physical examination there is no evidence of interference with the baby’s genitalia, which the mother confirms. (1)  5.9  An alcoholic patient comes to your clinic and presents with the 3Ds, i.e. mild intermitted   Diarrhoea, occasional Dementia and Dermatitis of the sun-exposed areas of the skin. (1)   5.10 An 18-year old complains of a nodular growth behind both of her ear lobes which developed after piercing of her ears 2 (two) years ago. She requests that they be removed. (1)   5.11 A 4-year old presents with a non-painful swollen scrotum that is getting worse. On examination there is trans-illumination (light shines through the scrotum). (1)   5.12  A 12-year old male is brought to the clinic by the father who complains that his Son’s breasts are growing and he is worried that they will be like a girl’s. No history of pain.  Examination of genitalia is NAD. (1)   *[12]  ---oOo--- 

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Digestive System and Endocrine System

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