Direct Physicians Assistants - Past Questions Solution

DIRECT PHYSICIAN ASSISTANTS – 2015 BATCH: SOLUTION TO MEDICINE/CASE STUDIES PAST
QUESTIONS (2008-JAN 2015) (FINAL QUALIFYING EXAMS)
AUGUST 2008
A child aged 12month and weighs 10kg was rushed to your health centre
with diarrhoea and classified as severe dehydration. He has no other
severe classification. You can give IV fluids in your health centre and you
have ringers lactate infusion
a. Would you refer this child? Explain your answer

SOLUTION
1. a) No. The treatment for severe dehydration is IV fluids (eg. Ringers
Lactate) which can be given at the facility and available.
b) You are to hydrate this child in 3 hours, the total amount of fluid
to give is 100ml/kg body weight. You are to give 30ml/kg in the first
½ hour and 70ml/kg in the next 2.5hours. Calculate the amount of
fluid to give in the first 0.5 hours and the 2.5 hours
Weight of child = 10 Kg
Amount of fluid to be given in first ½ hr = 30ml/Kg
⇒ Amount = 30 x 10 = 300ml
Amount to be given in the next 2 ½ hrs is 70ml/Kg

⇒ The amount = 70ml x 10 = 700ml
c)Use the fluid monitoring chart below to monitor the fluids to be given for
the 3 hours starting from 11:00am
Time Volume Volume Volume
Time Volume (ml) Volume (ml) Volume (ml)

Set up Set up Remaining Received
11:00 am 1000 1000 0
11:30 am 700 300
12:00 Pm 560 440
12:30 pm 420 580
1:00 pm 280 720
1:30 pm 140 860
2:00 pm 0 1000
After 3 hours you reassessed the child and classified as some
dehydration. You are now manage this child using plan B. the amount of
fluid to give is 75ml/kg body weight in 4 hours
Explanation: 300ml is to be given in the first 30 minutes. Therefore 700ml

will be given in the remaining 2 ½ hrs. Using an interval of 30 minutes,
then the remaining 700ml has to be given in 5 divided doses.
⇒ 700 ÷ 5 = 140ml
Therefore the patient will receive an additional 140ml in every 30 minutes.

To know the amount to be received in the next 30 min just add 140ml to
the previous amount. And subtract 140ml to get the remaining amount.
d) How much ORS will be let the mother give the child every 30 minutes.
Show how you arrive at the answer. How will you show the mother to
prepare and use the ORS at home?
Amount is 75ml/Kg
⇒75 x 10 = 750ml in 4hrs (240 min)
30 min = 0.5 hrs
Number of 30 min in 4 hrs = 4/0.5 = 8
∴ Amount to be given every 30 min = 750/8 = 93.75 ml
4 hr (240 min) = 750 ml
30 min = (30 x 750)/240 = 93.75 = 94 ml
The mother should dissolve 1 satchet of ORS in 600ml of water which is

approximately equal the volume of a beer bottle. She should give the child
as much as he wants. If the child vomits she must wait for 10 min and
give again.
2. A 28 years old Medical assistant gave a 10 days history of fever, not

feeling well, nausea and loss of appetite which was of an insidious onset.
Three days later he noticed her eyes were yellow. She denied having
taken any drugs in the previous weeks but admitted she saw many
patients with jaundice, she denied having any blood transfusion or
parental drug therapy. Examination revealed yellow eyes, enlarged soft,
tender liver.
a) Acute hepatitis
b) - Hepatitis A virus
-Hepatitis B virus
-Hepatitis C virus
-Hepatitis D virus
-Hepatitis E virus
-NonA/NonB virus
c) Mode of transmission:
Hepatitis A virus – Faeco-oral
Hepatitis B and C viruses – Contact with infected body fluids such as

blood, saliva, semen, etc.
Hepatitis D virus – Cotransmitted with hepatitis B
d) Sickle cell trait means the person is a carrier (AS) – Heterozygous and
asymptomatic. Whiles in sickle cell disease the person processes the SS
genotype and easily goes into crisis.
e) - Malaria
- Drugs
- Gilbert’s Syndrome
- Cholesistitis
- Hemolytic anaemia
- Obstruction of the bile duct
Obstruction of the bile duct: this causes obstructive jaundice. In this case
the liver is unable to dispose bilirubin as a result of blocking of the bile
duct.
AUGUST 2009
A child aged 13 months and weighs 12kg visited your health facility with
diarrhoea. You assessed and classified as severe dehydration. You are to
treat the dehydration quickly with ringers lactate in three (3hours). You
are to give a total of 100ml/kg body weight; 30ml/kg in the first half ½
hours and 70ml/kg in the next two and a half 2 ½ hours.
Calculate
i. the total amount of ringers lactate to give to the child in 3 hours

SOLUTION
1 a i) Weight of child = 12kg
Amount to be given in 3 hrs = 100ml/kg
Amount = 12 x 100ml = 1200ml
ii. The amount of ringers lactate to give in the first half ½ hour
Solution
ii) Amount to be given in first ½ hour = 30ml/kg
Amount = 30 x 12 = 360ml
iii. The amount of ringers lactate to give in the subsequent 2 ½

hours
solution
iii) Amount to be given in next 2 ½ hr = 70ml/kg
⇒ Amount = 70 x 12 = 840ml
b) how would you monitor the ringers lactate to be given in the three
hours using the sample fluid monitoring chart shown below if the ringers
lactate was set up at 9:00am using a litre bag?
Time set up Volume (mls) set up Volume (mls) remaining Volume

(mls) received
……………….. ……………………………. …………………………………..

………………………………….
………………. …………………………….. ………………………………….

…………………………………
SOLUTION:

Set up Set up Remaining Received
9:00 am 1000 1000 0
9:30 am 640 360
10:00 am 472 528

10:30 am 302 696
11:00 am 200 136 864
11:30 am 168 1032
12:00 pm 0 1200
C) If you are using the number of drops/minute to monitor the Ringer’s
Lactate given, calculate:
i. The number of drops/minutes the drip should run in the first half (1/2)
hour.
SOLUTION:
Total fluid ( Tf ) x Drip rate(DR )

c) i. No. of drops per minute (gtt/min) = Total time(T /min)
Tf = 360 ml DR = 20gtt/ml Total time = 30 min
⇒ (360 x 20)/30 = 240 drops per minute
ii. The number of drops/minutes the drip should run in the subsequent two
and a half hours.
SOLUTION:
ii) Tf = 840ml DR = 20gtt/ml T = 150 min
⇒ No. of drops per minute = (840 x 20)/150 = 112 drops per minute
d. After three (3) hours you reassessed the child and classified as some
dehydration . you are to rehydrate this child Oral Rehydration Salt (ORS)
in the clinic in four (4) hour. The volume of ORS to give in four (4) in 75
times the weight in kilograms
i. how much ORS will give this child in four (4) hours?
ii. Show how much ORS to give every fifteen (15) minutes?
SOLUTION
d) Amount of ORS to be given = 75ml/kg
i) Amount to be given in 4hrs = 75 x 12 = 900ml
ii) 4 hrs = 240min = 900ml
15min = (15 x 900)/240 = 56.25ml

A 28 year old young man presented to the hospital with dizziness, upper
abdominal pain and anemia (Hb 8.5gm/dl). He was given fersolate folic
acid and multivite for his anaemia, magnesium and trisilicate and
ibuprofen for the upper abdominal pain. Diazepam was also given for his
dizziness and mebendazole for possible worms.
a. List four (4) wrong treatment that have been done with
explanations
He reported a week later with worse symptoms of the upper
abdominal pain and black tarry stools
b. List two possible causes of the black stools
c. What should have been done for this young man during his first visit
and give reasons for your answer?
d. What would you do for the man now?
2 a) -Multivitamin for anaemia, because it is not indicated in anaemia.
-Ibuprofen for upper abdominal pain, because the most likely diagnosis is
peptic ulcer disease and NSAIDS like ibuprofen are contraindicated.
-Diazepam for dizziness, because the dizziness was most likely caused by
anaemia.
-Mebendazole for possible worms, because the most likely diagnosis for
dizziness, upper abdominal pain and anaemia is bleeding peptic ulcer
disease.
b) -The bleeding peptic ulcer disease
- The iron preparation (the fersolate)
c) The young child should be given be given
-Omeprazole or triple combination therapy (PPI, amoxicillin and

metronidazole or clarithromycin for the treatment of peptic ulcer diseases.
-Iron preparation and folic acid for the anaemia
-Magnisium trisilicate for relief of the pain
d) - Admit
- Establish a large bore cannula and resuscitate with normal saline or

Ringers lactate
- Aspirate blood from the stomach with NG tube
- Transfuse if patient is hypotensive or lost more than 1 litre of blood
- Refer for surgery if bleeding persists
A 52 years old Medical Assistant who was in coma was brought to the
emergency department by the wife. The wife said he had felt weak and
thirty and for the past week has been asking for drinking, water most of
the time. He passed as much uring as he drank and the rate he passes the
urine is likely turning on a tap. He had also lost weight
a. What is the most likely diagnosis of this Medical Assistant? Give

reasons for your answer
b. How would you confirm your diagnosis? Elaborate on your
laboratory findings
c. List three (3) other causes of coma and differentiate between them
clinically
d. How would you manage him (non-pharmacological
management)where he is conscious and stable?
3 a) Diabetic coma
Reasons:
-Polyuria
-Polydypsia
-Loss of weight
-Coma
b) -Random blood sugar (RBS) usually >18mmol/L
-Urine glucose usually > 3+
-Urine ketones > 2+ (if DKA)
c) –Head injury (history of injury and signs of trauma)
- Hypoglyceamia (history of diabetes and/or use of oral antidiabetic or

ingestion of alcohol)
- Hypertensive encephalopathy (patient with hypertension and headache)
- Epilepsy (history of previous fits, sudden onset of convulsion with or

without incontinence)
Hepatic failure (history of heavy alcohol ingestion for many years,

jaundices, gradual onset of changes in sensorium)
- Meningitis (fever, fits, headache, neck stiffness)

d) – Avoid free or refined sugars
- Reduce carbohydrate quantity taken
- Excecise
- Eat complex carbohydrates
A 15 year old school boy was admitted to hospital with a five (5) history of
fever (38oC), chills, sever pains all over the body, especially the arms and
legs, yellow eyes and dark urine. He had had similar episodes since
childhood. He was second of six (6) children to be affected this type of
illness
On examination, he was small for age, thin and in great pain. He was
deeply jaundiced and pale. The spleen was enlarged and non-tender.
Blood film for malaria parasite was positive.
a. What would be your provisional diagnosis? Give reasons for your

answer
b. What crisis is he in now? Explain your answer
c. In your opinion what precipitated the crisis? Give reasons for your
answer
d. How would you treat this schoolboy?
4 a) Severe malaria
Sickle cell disease
Reasons:
- small for age

- previous history of similar episodes
- splenomegaly
- family history
b) Heamolytic crisis. Because of the presence of jaundice, pallor and

splenomegaly.
Vaso-oclusive crisis. Because of the severe pain all over the body.
c) Malaria, because the malaria parasites invade the red blood cells which
can induce hemolysis.
d) –Admit
- IV DNS
- IV artesunate 120mg st
- IM pethidine
- Check Hb for possible transfusion
5 A 30 years old woman reported to health centre with generalized

abdominal pains of two duration. On examination, she was in pain febrile
(38oC) and the abdomen was diffusely tender on superficial palpitation
a. List five (5) possible causes in the case
She was later reviewed by a senior officer and found to have an

irreducible swelling in the right groin with an additional history of on and
off right groin swelling for the past six 6 months. Bowels sounds were
increased.
b. What would be your definitive diagnosis and why?

c. List four groin swellings and differentiate between them
d. You want to refer this patient for surgical intervention and she is not
ready to go now. How would you manage this case until she is ready
to go to hospital with the referral
a)- Thyphoid perforation
- Appendicitis
- Peritonitis
- Ruptured ectopic gestation
- Pelvic inflammatory disease
- Gastroenterits
- Obstructed hernia
b) Ostructed hernia
Reasons:
-History of on and off groin swelling
-Irreducible right groin swelling
-Increased bowel sounds

c) –Femoral hernia
- Inguinal hernia
- Lymph node
- Undescended testis
- Psoas abcess
For inguinal hernia the swelling is above and medial to the inguinal
ligament and there is visible cough impulse.
For femoral hernia the swelling is below and lateral to the inguinal
ligament and there is visible cough impulse.
Lymph node is rubbery, flactuant and painless.
For undescended testis there is the hernia sac but the testis will not be
present in the scrotum.
For psoas abcess the place is warm, tender, red and flactuant.
d) -Nil per os
-IV fluids (N/S, R/L or D/S)
-Pass NG tube
-Relief pain with diclofenac
-Put patient on input and output chart
-Administer broad spectrum antibiotics like metronidazole + gentamycin

and ciprofloxacin.
6) Not solved
AUGUST 2010
Miss Sawaba Jema is twenty two 22 years old and lives at Alhassan Kuraa
near Kintampo. She is brought to the Kintampo municipal hospital by the
relatives ill and in sever pain
You are the medical assistant at the Kintampo Municipal Hospital OPD
when Sawaba was brought. When you took history from the patient and
relatives , you were told that she was apparently well till about three
weeks previously when she had fever with heandache, body pains, joint
pains and general bodily weakness. She reported at the Kintampo
Municipal Hospital three week ago where she was told she had malaria
and was treated for malaria.
She did not improve so she went to a chemical shop and bought some
tablets which she claimed was also for malaria but she does not know the
name of the tablets. According to the patient and relatives she has
become worse and now diarrhoea, very high fever and sever pain in the
abdomen
On examination you see that the patient has a fever with a temperature of
37.7oC, rapid pulse and blood pressure of 110/60mmHg. She was pale,
febrile and weak. When you examine Sawaba, the abdomen was slightly
distended with tenderness guarding and rebound tenderness
a. What is your initial impression on her diagnosis and why do you

think so?
b. What is your differential diagnosis
c. What further questions would you ask the patient and relatives to
help in your diagnosis
d. How would you manage the patient
1 a) Typhoid perforation
Reasons:
- Previously treated for malaria but not improvement seen

- Sudden onset of severe abdominal pain

- Diarrhoea and very high fever
- Distended abdomen, tenderness and rebound tenderness
b) – Peptic ulcer perforation
- Appendicitis
- Ruptured ectopic gestation
- Pelvic inflammatory disease (PID)
c) –Admit
- Nil per os
- Relief pain with diclofenac
- Pass NG tube
- Broad spectrum antibiotics (ciprofloxacin + metronidazole)
- IV fluids
- labaratomy
A 70kg woman presented to you with signs and symptoms of

umcomplicated malaria
a. How woulkd you manage this woman’s malaria?

b. If after two (2) days treatment the fever persists, what would be
your next line of action?
c. This woman got well and became pregnant for three months and
developed umcomplicated malaria how would you treat her?
d. List three complications of malaria on the pregnant woman
e. List three complications of malaria on the unborn child?
f. How would you prevent this woman’s malaria during her period of
pregnancy
2 a) Tab Arthemeter/Lumefantrine 80/480 mg bd x 3
Tab Paracetamol 1g tid x 3
b) Repeat blood film for malaria parasites. If still positive treat with second
line antimalarial drugs. If negative assess for other differentials of fever
and treat.
c) Tab qunine 600mg tid x 7

Tab Paracetamol 1g tid x 5
d) - Anaemia
- Preterm delivery
-Hypoglyceamia
e) -Still birth
-Low birth weight
-Premature baby
f)-Use of ITN (LLINT)
-Intermittent preventive therapy using sulphadoxine pyramithamine (SP)
A mother brought a child aged six (6) months and weighing 5kg to yours
facility with diarrhoea. You assessed and classified as severe dehydration.
You want to treat the dehydration quickly. You decided to rehydrate this
child using plan C giving intravenous infusions of 100ml/kg weight in six 6
hours. In the first hour want to gice 30ml/kg body weight and 70ml/kg
body weight in the next five (5) hours.
i. What fluids would give in order of preference (list three)

ii. Calculate the amount of fluid to give in the first hours and the
next five (5)
iii. Calculate the number of drops per minute the drip would run in
the first hour and the next five hours
b. After six hours you assessed the child and classified as some
dehydration. You want to rehydrate the child using oral rehydration
salt (ORS) in the clinic for four (4) hours. The volume of ORS to give
in four hours is 75 multiplied by the weight in kilograms
i. How much ORS will give in four 4 hours
ii. Show how much ORS to give every fifteen minutes
3 a i) –Ringers Lactate
-Normal saline
-Cholera replacement fluid (5:4:1)
ii) Weight = 5kg
Amount to be given in first hr is 30ml/kg

⇒ Amount = 5 x 30 = 150ml
Amount to be given in next 5 hrs = 70ml/kg
⇒ 5x70 = 350ml
iii) Number of drops per minute for the 1st hr
Total fluid (Tf) = 150ml Drip rate (DR) = 20gtt/ml Time (T) = 1 hr =
60min
Number of drops per minute = (Tf x DR)/T = (150 x 20)/60 = 50 drops

per minute
Number of drops per minute for the next 5 hrs,
Tf = 350ml DR = 20gtt/ml T = 300 min
⇒ Number of drops per minute = (350 x 20)/300 = 23.33 = 24 drops per

minute
b i) Amount of ORS to be given in 4 hrs is 75ml/kg
= 5 x 75 = 375ml
ii) 4 hrs = 240min = 375ml
15min = (15 x 375)/240 = 23.4 = 24ml
A 50 year old man called at your clinic with the complaints of anorexia and
loss of weight for four months. He has been having sleepness nights due
to polyuria
a. What condition is he suffering from?

b. Give the differential diagnosis
c. What further questions will you ask?
d. What investigations will you carry out?
e. How will you manage the patient?
4 a) Diabetes mellitus
b) - TB
- Hepatitis
c) –Chronic cough, haemoptysis and history of contact with TB patient
-Polydypsia
-Fever, puritus, abdominal pain
d) –FBS
-AFB
-HBsAg
-FBC
e)Glibenclamide 5mg dly
OR
Metformin 500mg bd
OR
Glicazide 40 – 160mg bd
AUGUST 2011
a 20 month old boy weighing 12.6kg is rushed to your clinic because he

has become lethargic. Prior to presentation , he had four episodes of
water stools and vomited several times. He was offered oral rehydration
solution at home, but drinks poorly. On examination, he had a low grade
fever of 38.1C slow skin recoil, dry mouth and sunken eyes.
a. What is the degree of dehydration in this patient and how does it

translate into percentage of body fluids
b. What physical examination will you quickly perform in the first
minute
c. What basic laboratory investigations will you perform?
You decide to hydrate your patient using IV ringers lactate
d. Outline your initial management in the first 30 minutes stating your

fluid volume and the drop rate using a 20-drop/ml giving set
e. How will you proceed after the first 30 minutes
After this the patient is assessed and found to be irritable. He is still

passing watery stools with slightly sunken eyes. He also complains of
thirst and drinks eagerly without vomiting. The skin recoil is still slow
F. what is the degree of dehydration at this point and how does it translate
into percentage of body fluids
Outline your management at this point
On your next review, he is active and playful having passed only one
semi-formed stool overnight. Reports from the laboratory are all normal.
You plan to discharge him home
h. what instructions will you give the mother
1 a) Severe dehydration. More than 10% of the body fluid has been lost.
b) –Check for capillary refill
-Examine the mucus membranes
-Assess the airway
-Assess breathing
c) –FBC
-Blood film for malaria parasites
-Stool R/E
-Stool C/S
d) Weight = 12.6 kg
Amount to be given in first 30 min = 300ml/kg
⇒ Amount to given in first 30 min = 12.6 x 30 = 378ml
Drop rate (in drops per min) = (Tf x DR)/Time = (378 x 20)/30
= 252
drops per minute
e) After the 30 min I will give 70ml/kg of Ringers Lactate within 2 ½ hours
⇒ Fluid to be given = 70 x 12.6 882ml
Drops per minute = (822 x 20)/150 = 117.6 = 118 drops per minute
f) Moderate dehydration. 5-10% of the body fluid has been lost.
g) Give 75ml/kg of ORS within 4 hrs
⇒ Amount of ORS to be given =75 x 126 = 945 ml
Amount to be given in every 30 min = 945/8 = 118.13 = 119ml
h) –Give home-based fluids like rice water
-Continue breast feeding the child if still breastfeeding
-Ask mother to return to the health facility if the child gets worse
-Educate patient on how to prevent diarrhoea like hand washing and use
of clean water in preparing the child’s food.
A 35yrs farmer reports of a 3weeks history of fever, anorexia, dry cough,

bloody diarrhoea and 3 day history of severe abdominal pain. He was
treated in a private clinic the first week for malaria, got better only for the
symptoms to get worse this week. On admission before you were called,
the psychiatric nurse has been called and dose of lagartil has been given
to the patient for abnormal behaviour
a. What is the most likely diagnosis

b. On examination the patient is febrile, looks dehydrated with tender
abdomen. What could account for these findings
c. How would manage this patient and how would you advice the
family
d. List two local causes and two general causes of epistaxis
2 a) Typhoid psychosis
b) Typhoid perforation
c)-Nil per os
-Pass NG tube
-IV fluids ( N/S, R/L)
-Broad spectrum antibiotics (ciprofloxacin + metronidazole)
-Pain relief with IM pethidine or diclofenac
-Put patient on input and output chart
Advice:
-Proper hand washing after toilet, before eating and cooking

-Use water from a clean source
-Eat food whilst hot
d) Local cause:
-Trauma
-Picking of the nose
-Nasal polyp
-Atrophic rhinitis
General cause:
-Hypertension
-Bleeding disorders
-Snake bite
-Drugs (eg. Anticoagulant drug overdose like warfarin)
A 15 years old girl was seen in the clinic with a one week history of aching
pain her bones of the arms and legs and the abdomen. She was admitted
having similar pains intermittently three times a year which were
associated with fever, yellow eyes and dark urine. She had a brother with
similar complaints. On examination was small for age jaundiced, pale
conjunctiva and palms and a fever of 380C
A. What would be your provisional diagnosis

B. What is the basis for your diagnosis
C. Outline the emergency treatment you would give this young girl
before referral
D. List two indications and two contradictions to ear syringing
3 a) Sickle cell crisis secondary to infection
b) –Previous history of similar presentation
-Family history
-Small for age
-Presence of jaundice
-Aching pain in the bones
-Presence of pallor
-Presence of fever
c) -Set I.V line
-IV fluids (DNS)
-Pain relief with IM pethidine
-Broad spectrum antibiotics (ceftriazone or ciprofloxacin)
-Grouping and cross matching
d) Indications:
-Foreign blunt object in the ear
-Impacted wax
-Epithelial debris
-Dried fungal debris
Contraindications:
-Vertigo
-Ear discharge (perforated eardrum)
-Acute inflammation of the middle or outer ear
-hygroscopic objects in the ear
-Sharp foreign objects
Give two (2) examples of each of the following methods of family planning
i. Surgical methods
ii. Hormonal methods
iii. Barrier methods
b. Discuss two advantages of each of the following family planning

methods
i. method condom
ii. Intrauterine device
iii. male sterilization
c.
a. What is post natal care

b. Mention four ways you can reduce maternal morbidity and
mortality
d. Give two contrasting features of acute otitis exterior and acute otitis
media
4 a i) Vasectomy
Tubal ligation
ii) Mini pills
Implants
iii) Condom
IUD
Diaphragm
b i) –Easier to use
-safe to use
-Dual protection (prevents STIs and pregnancy)
-Cheap (affordable)
-Effective
ii) –More than 99% effective
-Cost effective
-Does not require cooperation of the sexual partner
iii) –Highly effective and permanent
-Cheaper and fewer than tubal ligation.
c i) It is the care given to mothers up to six weeks after delivery.
ii) –Family planning
d) –Otitis media is mostly due to infection.
-In acute otitis externa pulling the tragus causes pain.

-The eardrum becomes red in otitis media.
-Otitis media is the inflammation of the middle ear while otitis externa is
the inflammation of the outer ear.
Give two advantages and two disadvantages each of the following routes
of drug administration
i. Oral routes
ii. Intramuscular route
b. state the side effects of penicillin
c. Sulphadoxine-pyrimethamine (SP) is the drug used for the intermittent

preventive treatment (IPT) programme in Ghana
i. to which group of people does this programme target
ii. what is reasons (rationale) for this programme
d. list four complications of acute and chronic otitis media if not treated
5 a i) Advantages:
-It is cheaper
-It is convenient
-No special skill is required for administration
-safer
-Easiest route
-Fear and pain is not encountered
Disadvantages:
-First pass effect
-Drugs interacts with gastric content which can slow absorption
-Some drugs are bitter
-It is not suitable for unconscious patients
-Not suitable in emergencies
-Drugs can be hydrolysed by gastric juice or digested by enzymes. Eg

insulin
ii) Advantages:
-No first pass effect
-Absorption is faster, thus suitable for emergencies
-Suitable for drugs which are hydrolysed and digested in the GIT
-Suitable for patients who cannot tolerate oral medications. Eg. patients
who vomit profusely.
Disadvantages:
-Expensive
-Painful
-Requires a trained personnel to administer
-Requires high standards of sterility
b) –GI disturbance
-Skin rashes and itching
-Light headedness
-Joint pains
-Mouth thrush
-Vaginal discharge
Encephalopathy
c) i. Pregnant women
ii. It prevents malaria in pregnancy.
d) –Meningitis
-Perforation of ear drum
-Mastoidtitis
-Brain abcess
-Labyrinthitis
A mother brings a six year old child to your clinic that you suspect may
have acute necrotizing ulcerative gingivitis (ANUG)
a. List five predisposing factors for ANUG in children

b. List the signs and symptoms that will be present to convince you of
your diagnosis
c. How is this condition generally managed
d. List four conditions that can cause sore throat
6 a) –Immuno-suppression
-Malnutrition
-Poor oral hygiene
-Measles
b) –Severe gingival pain
-Severe gingival bleeding that requires little or no provocation
-Interdental papillae are ulcerated with necrotic slough
-Halitosis
-Bad taste (metallic taste)
c) –Irrigation and debridement of necrotic areas
-Pain relief
-Give antibiotics like metronidazole
-Management of underlying cause or predisposing factors
d)- Laryngitis
-Pharyngitis
-Otitis media
-sinusitis
-Tonsilitis
AUGUST 2012
A 14 months old boy weighing 12kg is rushed to your health facility with
diarrhoea and vomiting. He is restless and has sunken eyes. When offered
ORS he drinks eagerly but vomits shortly after:
a. What is the degree of dehydration

b. You decided to rehydrate him with IV ringers lactate
a. Calculate the total amount of fluid required in the first 4 hours
b. Calculate the infusion drop rate using a fluid giving set that
delivers 20 drops per 1ml
c. Indicate how you would monitor the fluid using the sample
fluid monitoring
Time set up volume set-up volume remaining volume
received
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……………….. ………………….. ………………………….
……………………….
……………….. ………………….. ………………………….
……………………….
c. The next morning, your patient is now drinking normally without
vomiting. He looks well with no sunken eyes. He passed two loose
stool over night
a. What is the degree of dehydration
b. How much ORS will you give him and how often
d. You decided to discharge him on ORS give instructions to the mother
on when to come back
1 a) Moderate dehydration
b) i. Amount of fluid to be given in the first 4 hrs is 75ml/kg
weight = 12kg
⇒ Amouunt of fluid = 75 x 12 = 900ml
ii. Total fluid (Tf) = 900ml Drip rate (DR) = 20ggt/ml Time (T) =
4hrs = 240 min
Infusion rate (in drops per min) = (Tf x DR)/T = (900 x 20)/240
= 75 drops per
minute
iii.

Set up Set up Set up Set up
10:00 am 1000 1000 0
12:00 am 550 450
2:00 am 100 900
c) No dehydration. 500ml + 50ml of ORS for every extra stool passed,

given as much as the child wants.
d) If child gets worse, pass more water stools, vomits repeatedly, becomes
very thirsty, eats or drinks poorly or is not better in two days.
2. You are called to the labour ward to attend to a new born delivered
at 32 weeks gestations. She weighed 1.9kg. your initial impressions
are prematurity and low birth weight
a. Define prematurity
b. Define low birth weight
After your initial assessment, you record the following vital signs
Temperature =34.80C
Heart rate = 160beats per minutes
Respiratory rate= 60 cycles per minutes
c. From the above, which problems of prematurity and low birth
weight do you identify
d. Outline measures to address this problem at the primary
health care level
2 a) Prematurity refers to a life born infant before 37 completed weeks of

gestation from the last menstrual period.
b) Birth weight less than 2.5kg regardless of gestational age.
c) Hypothermia
d) Use of incubators or radiant warmers
4.
a. what are the signs and symptoms of ruptured ectopic gestations
b. what are the nursing and definitive management
c. classify antepartum haemorrhage
d. What causes fibroid and how is it managed?
4 a) –Distended abdomen
-Rapid pulse
-Low BP
-Pallor
-Sweating (diaphoresis)
-Sudden stabbing severe abdominal pain in the pelvic region
-syncope
-Dizziness
-Non-clothing blood on paracenthesis
-Lower abdominal tenderness
-History of amenorrhoea
b) Nursing management:
-Call for help
-Set a large bore IV line
-Give infusion
-Do FBC
-Group and cross match
-Transfuse where necessary
Definitive management: SURGERY
c) -Placenta previa
-Vasa previa
-Cervical and lower genital tract bleeding
d) –Hereditary (genetic predisposition)
-Somatic mutations in myometrial cells
Management:
It depends on the reproductive desire of the patient.
Surgical: Hysterectomy, myomectomy
Medical: Add-back regimen, HRIUS
5) REFER TO QUESTION 5 IN 2009
A 17 years old farm assistant presented at the OPD with a ten (10) day
history, loss of appetite, tiredness, bodily pains and joints pains. He had
diarrhoea two (2) prior to the above complaints. His source of drinking
water is a nearby stream and the community uses the nearby bush as
their toilet. He has taken antimalarial with no improvement. On
examination he was toxic, febrile, (380C) with an enlarged spleen. The
chest and heart were normal
a. What is the most probable diagnosis in this case. Give reasons for
your answer
b. What laboratory investigations would you do to confirm your
diagnosis
c. How would you treat this case
d. List four complications of the disease
6 a) Enteric fever
Reasons:
-Fever
-Loss of appetite
-Unclean source of drinking water
-Antimalarial treatment showed no improvement
b) –Stool culture
-Blood culture
-Urine culture
c) IV ciprofloxacin 400mg bd until patient improves and switch to tablets
Tab diclofenac 50mg tid x 5
d) –Myocarditis
-Perforation
-Cholesistitis
-Abscess
-Osteomylitis
-GIT bleeding
-Typhoid psychosis
AUGUST 2013
1) NOT SOLVED
(a) the Ghana Health Service charter was made to protect the rights of the
patient. It address four main cardinal principles. State and explain any two
of these cardinal principles that led to the introduction of the charter
(b) as a physician assistant a patient comes to your consulting room and

while you are taking his history he demands to know who the other health
workers in the room are; how should you respond to this request
according to the GHS patient charter
(c ) quote and explain three patient’s responsibilities under the Ghana

Health service patients charter
(d) Quote and explain three patient’s responsibilities under the Ghana
Health Service patient’s charter
A woman aged 30 years was rushed into Akuma Health Centre with fever
of 390C severe headache and neck stiffness. She came down from the
upper west region recently
a. What would be your provisional diagnosis and the most likely

causative organism
b. List and explain the signs you would elicit to confirm your diagnosis
c. What test would you do to confirm the diagnosis
d. Outline your line of treatment
e. How do you prevent an outbreak of the disease
2 a) Cerebrospinal meningitis
The most likely causative organism is Neisseria meningitidis
b) –Brudzinski’s sign: Flexion of the neck causes the knees to flex.
-Kernigs’s sign: Pain felt on attempting to straighten the patient’s leg with
the hip flexed and knee bent.
-Stiff neck: Patient cannot flex or extend the neck but may be able to turn
it.
c) Lumber puncture to tab CSF for C/S
d) –IV ceftriazone 2-4g dly for 7 days followed by oral amoxicillin 500mg
tid x7
IM diclofenac 75mg stat then oral diclofenac.
e) –Immunization
-Prophylaxis treatment of close contacts – ciprofloxacin 500mg single dose

or IV ceftriazone 250mg single dose.
-Prevent overcrowding
-Sleeping in a highly ventilated room
3 (a) List any five types of generalized seizures disorders you know
b. Define” Status epilepticus”
c. How do you manage it?
3 a) – Gandmal seizures (Tonic clonic)
-Petitmal seizures
-Myoclonic seizures
-Clonic seizures
-Tonic seizures
-Atonic seizures
b) When a series of seizures occur without the patient regaining

consciousness between attack for more than 5 minutes or seizures lasting
for more than 30 minutes.
c) IV diazepam or phenobarbitone. If after 1hr the seizures are not

controlled contact anaesthetist for GA and ventilate or refer.
A lady walked into your clinic with a 5 month history of pain in the
epigastrium. He noticed that his stools have been. He also takes alcohol.
You examined and found out that there was tenderness in the epigastrium
a. What would be your diagnosis in this case

b. How would you treat this condition?
c. A week after she rushed into your clinic with severe abdominal
pains, looked pale with abdominal distension, and weak and rapid
pulse
a. What has happened to her
b. What action would you take at your level?
d. List the complications of the diagnosis above.
4 a) Peptic ulcer disease
b) – Cap omeprazole 20mg bd x 7
-Cap amoxycillin 500mg tid x 7

-Tab metronidazole 400mg tid x 7
-Stop alcohol
c i) Peptic ulcer perforation
ii) -Nil per os
-Set IV line
-Give IV fluids (N/S or R/L)
-Give broad spectrum antibiotics
-Pass NG tube and catheterise
-Do Hb/Grouping and cross matching
-Relief pain with analgesics such as pethidine
d) –Pyloric stenosis
-Hour-glass deformity
-Perforation
-Bleeding
5) REFER TO QUESTION 3 IN AUGUST 2009
50 years old Physician Assistant who was in coma was brought to the
emergency department by the husband. The husband said he she had felt
weak and thirsty for the past week and has been asking for drinking water
most of the time. She passed as much urine as she drink and the rate she
passes the urine is like turning on a tap. She has also lost weight
a. What is the most likely diagnosis? Give reasons for your answer
b. How would you confirm your diagnosis? Elaborate on your
laboratory findings
c. List three other causes of coma and differentiate between them
clinically
d. How would you manage her (non-pharmacological) when she is
conscious and stable?
A 2 years old girl who weighs 15kg develops fever and soon has brief
convulsion. She lives in a remote community away from Kumasi. Initially
the mother gave her a teaspoonful of herbal preparation. Later, in the
evening of the same day, the childs speech became less comprehensible
and shortly afterwards was no longer responding to any call. It looks the
mother 4 hours to get to the nearest hospital and the on examination to
be severely pale with temperature of 38.5oC
(a) What signs of severe disease can you identify

(b)How this child illness should be classified
(c) Mention four important laboratory tests to be done
(d)What urgent management steps would you carry out
(e) What specific treatment and dose will you give to the child?
SOLUTION
6 a) –Unconsciousness
-Pyrexia
-Pallor
b) Very severe disease
c) –Blood film for malaria parasites
-FBC
-Grouping and cross matching
-RBS
d) –Assess airway, if obstructed open the airwawy and ensure that it is

clear.
-Check breathing, if no breathing or severe airway or severe respiration

distress ventilate with ambu-bag.
-Give oxygen 1-2L/min
-Check circulation (capillary refill, pulse, cold extremeties).
-Give IV fluids if there is circulation impairment.
-Test blood sugar, if hypoglyceamic give dextrose saline.
-Put the child in unconscious position.
d)IV artesunate 36mg stat, then at 12 hours and 24 hours
IV ceftriazone750mg bbd
Supp Paracetamol 500mg st

JANUARY 2015
1) PAST QUESTION 2008 Q2
A 20 year old girl is brought to your Health Centre in a semi-comatose

state. The mother gives a history of her daughter having her LMP two
months age
On examination, she is sem-conscious. Her pulse is feeble but rapid. Her

conjunctiva is pale. The Bp is very low. The abdomen is slightly distended
and does not move with respiration. There is tenderness, rebound
tenderness and guarding. There is no bleeding from vagina
a. What is your provisional diagnosis

b. Give differential diagnosis
c. What laboratory investigations will you carry out?
d. How will you manage the case?
SOLUTION
4 a) Ruptured ectopic gestation
b)-Peritonitis
-Ovarian torsion
-Ruptured spleen
-Appendicitis
-Salpingitis
-Ruptured corpus luteum cyst or ovarian follicle
-Degenerative fibroid
-Spontaneous abortion
c) –UPT
-FBC
d) Management:
-Call for help
-Set a large bore IV line
-Give infusion
-Monitor vials
-Do Hb, grouping and cross and matching
-Transfuse if Hb is low transfuse
-Refer for surgery
6) (a) provide brief notes on three (3) types of analgesics
(b) in the management of childhood diarrhoea antibacterial agents are not

necessary. Is this statement true? Explain your answer
(c ) Provide three (3) examples of contradicted in breastfeeding
( d) in pregnancy how are the following medical problems treated?
a. Infection
b. hypertension
NOT SOLVED

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DIRECT PHYSICIAN ASSISTANTS – 2015 BATCH: SOLUTION TO MEDICINE/CASE STUDIES PAST

QUESTIONS (2008-JAN 2015) (FINAL QUALIFYING EXAMS)

a. Would you refer this child? Explain your answer

Amount to be given in the next 2 ½ hrs is 70ml/Kg

Time Volume Volume Volume

Time Volume (ml) Volume (ml) Volume (ml)

Explanation: 300ml is to be given in the first 30 minutes. Therefore 700ml

Therefore the patient will receive an additional 140ml in every 30 minutes.

⇒75 x 10 = 750ml in 4hrs (240 min)

30 min = 0.5 hrs

Number of 30 min in 4 hrs = 4/0.5 = 8

∴ Amount to be given every 30 min = 750/8 = 93.75 ml

4 hr (240 min) = 750 ml

30 min = (30 x 750)/240 = 93.75 = 94 ml

The mother should dissolve 1 satchet of ORS in 600ml of water which is

2. A 28 years old Medical assistant gave a 10 days history of fever, not

Hepatitis A virus – Faeco-oral

Hepatitis B and C viruses – Contact with infected body fluids such as

Hepatitis D virus – Cotransmitted with hepatitis B

- Obstruction of the bile duct

i. the total amount of ringers lactate to give to the child in 3 hours

1 a i) Weight of child = 12kg

Amount to be given in 3 hrs = 100ml/kg

Amount = 12 x 100ml = 1200ml

ii) Amount to be given in first ½ hour = 30ml/kg

iii. The amount of ringers lactate to give in the subsequent 2 ½

iii) Amount to be given in next 2 ½ hr = 70ml/kg

Time set up Volume (mls) set up Volume (mls) remaining Volume

……………….. ……………………………. …………………………………..

………………. …………………………….. ………………………………….

Time Volume (ml) Volume (ml) Volume (ml)

10:00 am 472 528

Total fluid ( Tf ) x Drip rate(DR )

Tf = 360 ml DR = 20gtt/ml Total time = 30 min

⇒ (360 x 20)/30 = 240 drops per minute

ii) Tf = 840ml DR = 20gtt/ml T = 150 min

d) Amount of ORS to be given = 75ml/kg

i) Amount to be given in 4hrs = 75 x 12 = 900ml

ii) 4 hrs = 240min = 900ml

15min = (15 x 900)/240 = 56.25ml

2 a) -Multivitamin for anaemia, because it is not indicated in anaemia.

b) -The bleeding peptic ulcer disease

- The iron preparation (the fersolate)

c) The young child should be given be given

-Omeprazole or triple combination therapy (PPI, amoxicillin and

-Iron preparation and folic acid for the anaemia

-Magnisium trisilicate for relief of the pain

- Establish a large bore cannula and resuscitate with normal saline or

- Aspirate blood from the stomach with NG tube

- Transfuse if patient is hypotensive or lost more than 1 litre of blood

- Refer for surgery if bleeding persists

a. What is the most likely diagnosis of this Medical Assistant? Give

b) -Random blood sugar (RBS) usually >18mmol/L

-Urine glucose usually > 3+

-Urine ketones > 2+ (if DKA)

c) –Head injury (history of injury and signs of trauma)

- Hypoglyceamia (history of diabetes and/or use of oral antidiabetic or

- Hypertensive encephalopathy (patient with hypertension and headache)

- Epilepsy (history of previous fits, sudden onset of convulsion with or

Hepatic failure (history of heavy alcohol ingestion for many years,

- Meningitis (fever, fits, headache, neck stiffness)

a. What would be your provisional diagnosis? Give reasons for your