UGANDA HEALTH PROFESSIONS ASSESSMENT BOARD
Tropical Medicine and Surgical Nursing III - Paper Code: CN 311
Certificate in Nursing | Year 3: Semester 1 Examinations
SECTION A: OBJECTIVE QUESTIONS
20 Marks
1. The medical condition that manifests with ulceration of the peyers patches is
Typhoid fever is caused by Salmonella typhi, which aggressively invades and multiplies within the Peyer's patches (lymphoid tissue) of the terminal ileum, leading to necrosis and ulceration.
2. In which of the following conditions does the patient manifest with blindness?
Onchocerciasis is widely known as "River Blindness." The microfilariae migrate to the eyes, triggering severe inflammatory responses that cause corneal scarring and eventual blindness.
3. Which of the following is NOT a prodromal symptom of rabies?
Hydrophobia (fear of water) is a late, classic symptom of the acute neurological phase ("furious rabies"), not an early prodromal symptom like fever or numbness at the bite site.
4. In which of the following communicable diseases do patients suffer from pustules and vesicles?
Chickenpox (Varicella) is characterized by a rapidly progressing pruritic rash that evolves from macules to papules, vesicles ("dew drops"), and eventually pustules and crusts, often existing simultaneously.
5. Preventive measures of brucellosis exclude;
Brucellosis is a zoonotic disease transmitted from animals to humans (via unpasteurized dairy or contact). Direct human-to-human transmission is extremely rare, rendering human quarantine unnecessary.
6. Which of the following is NOT an epidemiological criteria for suspecting COVID 19 in a person?
Simply "travelling from abroad" is too broad unless the specific destination has known community transmission. The other three options represent distinct, high-risk epidemiological exposure pathways.
7. In which stage of measles does desquamation of the skin occur?
During the convalescence (recovery) stage of measles, the maculopapular rash begins to fade, leaving behind a brownish discoloration followed by fine, branny peeling (desquamation) of the skin.
8. Which of the following is NOT an ideal preventive measure for tape worm infestation?
Adult tapeworm infestation (Taeniasis) is strictly contracted by eating undercooked meat/fish containing cysts. Hand hygiene prevents the ingestion of eggs (which causes Cysticercosis), but not the adult tapeworm infestation itself.
9. Which of the following statements is false regarding yellow fever? It is
Yellow fever is caused by an arbovirus (flavivirus). Because it is a viral infection, antibiotic therapy is completely ineffective. Treatment is strictly supportive.
10. Dracunculosis is transmitted by
Dracunculiasis (Guinea worm disease) is transmitted when humans consume stagnant water contaminated with microscopic copepods (water fleas) that harbor the infective larvae.
11. Which of the following is NOT a diagnostic feature of Marburg?
Marburg virus causes a severe viral hemorrhagic fever. Bleeding diathesis and rashes are classic features. Recurrent tenesmus (painful urge to defecate) is associated with dysentery, not hemorrhagic fevers.
12. In which stage of the malaria life cycle do infected red blood cells burst and release merozoites?
The clinical presentation of malaria features paroxysms. The "Cold Stage" (intense rigors and shivering) directly correlates with the synchronized rupture of erythrocytes releasing merozoites and pyrogenic toxins.
13. Children who suffer from chronic mastoiditis are at high risk of
Chronic inflammatory disease of the middle ear and mastoid bone often leads to the development of a cholesteatoma, an abnormal, destructive skin growth that can erode temporal bone structures.
14. Which of the following conditions are indications for tracheostomy?
Diphtheria causes thick pseudomembranes that obstruct the upper airway, requiring immediate tracheostomy. Patients with severe end-stage emphysema often require tracheostomies to facilitate prolonged mechanical ventilation and weaning.
15. A priority nursing assessment following laryngectomy is
Following a total laryngectomy, the patient's airway is permanently altered. Ensuring stomal airway patency is the highest, immediate life-saving priority to prevent asphyxiation from swelling or secretions.
16. In which of the following positions does the nurse place a patient experiencing epistaxis?
Sitting upright decreases vascular pressure in the nasal veins, while leaning slightly forward prevents the blood from draining down the pharynx, which can cause nausea, vomiting, or aspiration.
17. Which of the following pieces of advice is appropriate to share with a patient after administration of an anaesthetic mydriatic drug?
Mydriatic drugs dilate the pupil paralyzing the pupillary sphincter, leading to significant photophobia (sensitivity to bright light). Sunglasses protect the retina until the drug wears off.
18. The primary surgical treatment of glaucoma is
A laser peripheral iridotomy creates a tiny hole in the iris to restore the flow of aqueous humor, resolving the pupillary block that causes acute angle-closure glaucoma.
19. A patient with glaucoma presents with
The most common form, Primary Open-Angle Glaucoma, is insidious and asymptomatic in its early stages, classically presenting as a gradual, painless loss of peripheral vision ("tunnel vision").
20. The surgery performed in corneal ulceration is called
If a severe corneal ulcer results in perforation or heavy scarring, a Keratoplasty (corneal transplant surgery) is performed to replace the damaged tissue and restore vision.
SECTION A: FILL IN THE BLANK SPACES
10 Marks
21. The term used to define a disease that is prevalent in the whole world is
→ PANDEMIC
→ PANDEMIC
22. Restricted movement of infected individuals to other areas is called
→ ISOLATION
→ ISOLATION
23. White patches lining the mucus membrane of the mouth of a measles patient are called
→ KOPLIK'S SPOTS
→ KOPLIK'S SPOTS
24. The most virulent infecting species in bacillary dysentery is called
→ SHIGELLA DYSENTERIAE
→ SHIGELLA DYSENTERIAE
25. The parasitic worm infestation associated with iron deficiency anaemia is called
→ HOOKWORM INFESTATION (Ancylostomiasis)
→ HOOKWORM INFESTATION (Ancylostomiasis)
26. The type of schistosoma that affects the urinary bladder is known as
→ SCHISTOSOMA HAEMATOBIUM
→ SCHISTOSOMA HAEMATOBIUM
27. Infection of the sebaceous gland in the lid margin is called
→ HORDEOLUM (STYE)
→ HORDEOLUM (STYE)
28. The term that denotes pain in the ear is
→ OTALGIA
→ OTALGIA
29. The surgery which is performed to repair tympanic membrane perforation is called
→ TYMPANOPLASTY (MYRINGOPLASTY)
→ TYMPANOPLASTY (MYRINGOPLASTY)
30. Intraocular pressure rises due to impaired drainage of
→ AQUEOUS HUMOR
→ AQUEOUS HUMOR
SECTION B: SHORT ESSAY QUESTIONS
20 Marks
Question 31: Bacterial Conjunctivitis
(10 Marks)
(a) Outline five (5) specific signs and symptoms of bacterial conjunctivitis. (5 marks):
- Purulent Discharge: Thick, copious yellow, white, or greenish discharge coming from the affected eye throughout the day.
- Crusted Eyelids: Eyelids sticking together or being difficult to open, especially upon waking up in the morning due to dried exudate.
- Conjunctival Hyperemia: Noticeable severe redness and inflammation of the sclera (the white part of the eye) and inner eyelids.
- Foreign Body Sensation: A constant gritty, scratching, or burning feeling, as if sand or dirt is trapped beneath the eyelid.
- Periorbital Edema: Mild to moderate swelling and puffiness of the upper and lower eyelids.
(b) Outline five (5) ways of preventing conjunctivitis. (5 marks):
- Hand Hygiene: Performing vigilant and frequent hand washing with soap and warm water, especially after touching the face.
- Avoid Rubbing: Avoiding touching or rubbing the eyes to prevent introducing environmental bacteria or transferring infection from one eye to the other.
- Personal Item Segregation: Strictly avoiding the sharing of personal hygiene items such as towels, face washcloths, or tissues.
- Cosmetic Hygiene: Discarding old eye makeup, refusing to share makeup brushes, and avoiding sleeping with makeup on.
- Contact Lens Care: Adhering to strict sterilization protocols for contact lenses and avoiding wearing them while swimming or sleeping.
Question 32: Human Trypanosomiasis
(10 Marks)
(a) Outline seven (7) specific signs and symptoms of human trypanosomiasis. (7 marks):
- Trypanosomal Chancre: A large, painful, red, and swollen ulcer that develops directly at the site of the Tsetse fly bite.
- Winterbottom's Sign: Prominent, painless, and rubbery enlargement of the posterior cervical lymph nodes located at the back of the neck.
- Intermittent High Fevers: Recurrent episodes of high-grade fever, chills, and profuse sweating corresponding to parasitemia waves.
- Sleep Cycle Inversion: The hallmark symptom of the meningoencephalitic stage, featuring extreme daytime somnolence and nighttime insomnia.
- Severe Myalgia and Arthralgia: Debilitating muscle aches and joint pains throughout the body.
- Neurological Deterioration: Progressive confusion, tremors, ataxia (unsteady gait), and profound personality or behavioral changes.
- Cachexia: Extreme physical fatigue, severe weight loss, and progressive wasting of the body as the disease advances.
(b) List three (3) specific investigations performed in patients suspected of trypanosomiasis. (3 marks):
- Microscopy of Blood Smears: Examining thick and thin Giemsa-stained blood films to directly visualize the mobile trypomastigotes.
- Cerebrospinal Fluid (CSF) Analysis: Performing a lumbar puncture to look for the parasite in the CSF and count White Blood Cells, critical for disease staging.
- Lymph Node Aspirate: Puncturing enlarged lymph nodes (especially from Winterbottom's sign) to examine the fluid microscopically for parasites.
SECTION C: LONG ESSAY QUESTIONS
60 Marks
Question 33: Bacillary Dysentery (25 Marks)
(a) Outline five (5) specific signs and symptoms of bacillary dysentery (5 marks):
- Frequent Bloody Stools: Passage of low-volume, frequent stools heavily mixed with frank blood and mucus.
- Tenesmus: A distressing, painful, and constant feeling of needing to pass stool even when the bowels are empty.
- Severe Abdominal Cramping: Acute, intense, colicky pain in the lower abdomen that precedes defecation.
- High-grade Fever: Sudden onset of high body temperature, often accompanied by chills and malaise.
- Signs of Dehydration: Sunken eyes, dry mucous membranes, lethargy, and decreased urine output due to fluid loss.
(b) Describe seven (7) specific interventions implemented in management of an adult patient with severe bacillary dysentery for the first 48 hours of admission (14 marks):
- Infection Control & Isolation: Nurse the patient in a separate room using strict contact and enteric precautions (gloves, aprons) to prevent nosocomial transmission of the highly contagious Shigella bacteria.
- Fluid and Electrolyte Resuscitation: Assess the degree of dehydration and rapidly administer prescribed intravenous fluids (e.g., Ringer's Lactate or Normal Saline) to restore circulating volume and stabilize blood pressure.
- Antibiotic Administration: Promptly administer prescribed specific antimicrobial therapy (such as Ceftriaxone or Ciprofloxacin) to reduce the duration of the illness and limit bacterial shedding in the feces.
- Strict Intake and Output Monitoring: Maintain a detailed fluid balance chart, meticulously recording all oral/IV fluids administered and quantifying all urine, vomit, and diarrheal losses to evaluate kidney function.
- Pain and Cramp Management: Provide comfort measures such as warm abdominal compresses and administer prescribed mild antispasmodics, strictly avoiding anti-motility drugs (like Loperamide) which can delay bacterial clearance and worsen the disease.
- Nutritional Support: Once acute vomiting subsides, encourage the intake of Oral Rehydration Salts (ORS) and initiate a bland, low-residue diet (e.g., bananas, rice, toast) to provide energy without irritating the bowel.
- Meticulous Perineal Care: Clean the perianal area gently after every bowel movement using mild soap and water, and apply protective barrier creams (like zinc oxide) to prevent severe skin breakdown from highly acidic stools.
(c) Outline six (6) preventive measures against bacillary dysentery (6 marks):
- Water Safety: Ensuring provision of safe, clean drinking water by boiling, chlorinating, or utilizing properly maintained boreholes.
- Proper Excreta Disposal: Constructing and consistently using sanitary latrines or flush toilets to stop open defecation and environmental contamination.
- Hand Hygiene Promotion: Establishing strict habits of washing hands with soap and water after defecation, after changing diapers, and before eating or preparing food.
- Food Hygiene: Washing all raw fruits and vegetables thoroughly, cooking food completely, and keeping cooked food covered and served hot.
- Fly Control: Eliminating breeding grounds for houseflies and using screens, as flies act as mechanical vectors carrying the bacteria from feces to food.
- Health Education: Mobilizing communities through education on recognizing early symptoms, seeking prompt medical care, and adhering to basic sanitation protocols.
Question 34: Tracheostomy Management (25 Marks)
(a) Outline four (4) uses of tracheostomy (4 marks):
- Relieve Airway Obstruction: To bypass life-threatening upper airway obstructions caused by tumors, severe laryngeal edema, foreign bodies, or infections like Diphtheria.
- Facilitate Prolonged Ventilation: To provide a stable, long-term artificial airway for critically ill patients who require prolonged mechanical ventilation (e.g., severe head injuries or end-stage emphysema).
- Enable Secretion Clearance: To allow easy access for suctioning and removing thick tracheobronchial secretions in patients with weak or absent cough reflexes.
- Prevent Aspiration: To protect the lower respiratory tract from aspiration of oral and gastric secretions in patients suffering from bulbar paralysis or profound coma.
(b) Outline sixteen (16) actions performed during nursing management of a patient who has undergone tracheostomy for the first 48 hours (16 marks):
- Keep the patient in a semi-Fowler's position to promote lung expansion and reduce neck edema.
- Continuously monitor respiratory rate, depth, effort, and SpO2 levels.
- Keep emergency equipment (suction apparatus, extra tracheostomy tubes, obturator, ambu bag) at the bedside.
- Perform sterile endotracheal suctioning strictly as needed to remove secretions.
- Pre-oxygenate the patient with 100% oxygen before and after every suctioning attempt.
- Provide warmed, humidified oxygen to prevent drying and crusting of mucosal secretions.
- Perform routine tracheostomy stoma care using aseptic technique to prevent infection.
- Clean or replace the inner cannula regularly according to hospital protocol to prevent mucus plugging.
- Assess and adjust the tracheostomy ties, ensuring they are secure but allow two fingers to slip underneath.
- Regularly check and maintain the cuff pressure (usually 20-25 cm H2O) to prevent tracheal tissue necrosis.
- Monitor the surgical stoma site frequently for signs of bleeding, purulent exudate, or hematoma.
- Palpate the neck and upper chest for crepitus, indicating subcutaneous emphysema.
- Provide meticulous oral care at least 4-hourly to reduce the risk of ventilator-associated pneumonia.
- Establish an alternative communication method (e.g., writing pad, picture board) since vocalization is bypassed.
- Administer prescribed systemic analgesics to relieve post-operative surgical pain.
- Provide continuous psychological reassurance to the patient to reduce severe anxiety and feelings of suffocation.
(c) List five (5) complications of tracheostomy (5 marks):
- Hemorrhage: Bleeding from the stoma or major vessels in the neck.
- Tube Obstruction: Blockage of the airway lumen by thick, dried mucus plugs or blood clots.
- Accidental Decannulation: Unintended dislodgment of the tracheostomy tube out of the trachea.
- Subcutaneous Emphysema: Air leaking into the subcutaneous tissue planes of the neck, face, and chest.
- Infections: Development of stomal infections, severe tracheitis, or secondary pneumonia.