MEDICINE

INTERMEDIATE EXAMINATION QUESTIONS

 SECTION A: MCQs

All questions have a main stem and four options. Choose one correct answer

1. Which of the following describe the minimum combination of tests that should be performed
before initiating antiretroviral therapy for HIV?
a. HIV test, CD4 count, alanine aminotransferase, total lymphocyte count
b. CD4 count, Viral load, full blood count, serum glucose
c. HIV test, CD4 count, Full blood count, Creatinine clearance
d. HIV test, CD$ count, viral load, total lymphocyte count, chest x- ray

2. A 53 year old lady who is known to have peptic ulcers for several years present to
the clinic with persistent vomiting. A diagnosis of pyloric stenosis is suspected. The
following findings would support the diagnosis:

a.Recent onset constipation

b.Vomitus containing undigested food particles
c.Bilious vomitus
d.Vomitus containing “coffee grounds”

3. Which one of the following is true of candida infections of the gastrointestinal tract?
a. Use of predinisolone for 5 days is a risk factor
b. Nystatin for 14 days is adequate treatment for oral thrush
c. Oesophagel candidiasis presents as acute onset odynophagia
d. Use of Phynoxymethyl penicillin for 14 days is a risk factor
4. Which one is correct about angular cheilitis
a. Treatment requires topical acyclovir
b. May be found in HIV infected individuals in WHO clinical stage II
c. Maceration of the upper lip is the hallmark presentation
d. Diagnosis requires laboratory confirmation
5. Gonorrhoea mostly affects the following organs except
a) Urethra
b) Coronal sulcus of the penis
c) Rectum
d) Vagina
6. Which one of the following conditions predispose to cancer of the cervix?
a. Syphilis
b. Human papilloma virus
c. Lymphogranuloma venereum
d. donovanosis

7. Which of the following organisms (a – d) correlates with the information given below
 (i-iii):
i. Diagnosis with modified Ziehl-Nielson stain
ii. Commonly cause chronic watery diarrhoea in the immunocomprised
iii. Has no reliable treatment

a. Giardia lamblia
b. Crytococcus neoformans
c. Norwalk virus
d. Cryptosporidium parvum
8. The following are true of the pathogenesis of tuberculosis except:

a. The Ghon complex is found in primary tuberculosis

b. Lung cavitations is likely to happen in secondary tuberculosis
c. Lymphadenitis often present as discrete tender lesions in the neck
d. The majority of individual develop latent tuberculosis after the
primary exposure

9. Which of the following clinical finding correlates with the presence of bronchiolar lumen
obstruction?
a. Bronchial breath sounds
b. Ronchi
c. Stridor
d.Pleural Rub
10. Carbuncles may be an indicator for which of the following conditions?
a. Sarcoidosis
b. Diabettes Mellitus
c. Lupus vulgaris
d. Miliary tuberculosis
11. A 20 years old has a BP reading of 150/105 on two occasions. The following statements
concerning his condition are correct except.
a. It is essential to investigate him for renal insufficiency
b. It is appropriate to commence antihypertensives immediately
c. Diet modification is essential before antihypertensives are commenced
d. The patient maybe taking corticosteroids
12. The following drugs are correctly paired with their mode of action except
a. Calcium channel blockers - Venous and arterial dilators
b. Captopril - Angiotensin Converting Enzyme Inhibition
c. Propranolol – beta blocker
d. Hydralazine-adrenoreceptor blocker

13.The following cardiac changes accompany heart failure. Which one(s) is correctly paired with
the drug likely to reverse the specific change?
 a. decreased end-diastolic pressure – Frusemide
b. decreased ejection fraction- digoxin
c. increased venous pressure – Nifedipine
d. decreased cardiac output – Beta blockers

14. Which of the following conditions predispose to development of right ventricular failure?

a. Uncorrected tricuspid atresia

b. Mitral stenosis
c. Coarctation of the aorta
d. Anaemia
15. Which noninvasive diagnostic test will provide clinically useful information regarding the
structure and movement of heart valves and ventricles.

a. Chest Xray
b. Echocardiogram
c. Electrocardiogram
d. All the above

16. A 25-year-old lady comes to your clinic complaining of easy fatiguability and palpitations of
3 months duration. Physical examination reveals an irregular pulse and a diastolic murmur in the
left 5th intercostals space just lateral to the midclavicular line. Among the complications she is
most likely to suffer are
a. Pulmonary thromboembolism
b. Stroke
c. Right ventricular failure
d. Staphylococcal endocarditis
17. Which of the following is a major symptom of type II diabetes mellitus?
a. Obesity
b. Loss of weight
c. Blurred vision
d. Polyuria
18. In pneumocystis carinii pneumonia
a. Sputum examination is always required before making a diagnosis
b. 50% of the patients present without fever
c. Shortness of breath on walking is common
d. Finding of oral thrush on clinical examination is not a helpful sign

19. The following statement are correct regarding treatment of diabetes mellitus (DM) except
a. Ketoacidosis may requires up to 6 litres of Normal Saline to rehydrate
the patient.
 b. Insulin requirement in the Keto acidotic state is higher than in the non-
Ketotic state.
c. Diet modification should be tried once insulin therapy fails in type 1
DM
d. Metformin is drug of choice for obese type II DM patients.

20. Which of the following statements is correct regarding epilepsy

a. Drug therapy is indicated after the first seizure episode

b. Drug therapy is often started with two anticonvulsant drugs
c. Most commonly used drugs are excreted through the kidney
unchanged
d. Withdrawal of anticonvulsants should be done over 1 week

21. The following are true of rheumatoid arthritis except ?

a. Being female is a risk factor for rheumatoid arthritis
b. It causes a symmetrical large joint polyarthritis
c. May complicate in anaemia
d. Weight loss and fatigue are common

22. Which one is the most common causes of urethral discharge

a. Syphilis and chancroid
b. Syphilis and Chlamydia
c. Gonorrhea and chlamydia
d. Gonorrhoea and chancroid
23. Early and effective treatment of STI’s is important because it:

a. Reduces rates of complications and increases resistance.

b. Reduces period of infectivity
c. Reduces rates of HIV transmission and increase the infectivity rate.
d. Is not cost-effective than treating late disease or complications

24. One of the following conditions does not require symptomatic treatment
a. Elopecia areata
b. Scabies
c. Gullate psoriasis
d. multiforme.
25. Toxoplasmosis is an infection that may be transited by cat contaminating the soil as well as
vegetables. It is also an opportunistic infection in immune-compromised people. What type of
micro organism causes this disease?
a. Virus
b. Parasite
c. Bacteria
d. Reckettsia
27. In the management of communicable diseases, it is also important to carry out laboratory
investigateons. In which condition is it recommended to take the blood sample at night?
a. Measles
b. Yellow fever
c. Trypanosomiasis
d. Filariasis
28. Plague is a bacterial infection which can be transmitted through the following modes except?
(a) Ingestion of contaminated food
(b) Inhalation
(c) Bite by an infected flea
(d) mother-to-child

29. Leprosy is one of an ancient disease causing deformity and disability. The main diagnostic
features of leprosy include the following except?
(a) Hypo pigmented skin lesions
(b) Loss of sensation on the affected
(c) Amputated foot
(d) Thickening/ damage of nerves

30. Which of the following is not a feature of pneumonic plague?

a. Haematemasis
b. Crepitations
c. Haemoptsis
d. Dyspnoea

31. Neuritis is one of the side effects of tuberculosis treatment. Which of the following drugs is
likely to cause neuritis?
a. Streptomycin
b. Isonizide
c. Ethambutal
d. Rifampicin

32. The following drugs are used in the treatment of Trypanosomiasis

except?
a. Suramin
b. Melasorprol
c. Hetrazin
d. Pentamidine

33. Jane Chibale travelled to India in 2008 and she received a Yellow Fever vaccine. When
would she be eligible for another dose if she were to travel to the same country?
a. In 2015
b. In 2020
c. In 2013
d In 2016
34. The most common cause of heart failure in Zambia is:
a. Dilated cardiomyopathy
b. Pericardial diseases
c. Hypertension
d. Rheumatic heart disease

35. The most common cause of pericardial diseases in developing countries like
Zambia is:
a. hypertension
b. idiopathic
c. tuberculosis
d. metastatic carcinomas of the chest

36. Which of the following is not a major manifestation of Jones criteria in the diagnosis of acute
rheumatic fever?
a. Carditis
b. Arthralgia
c. Erythema marginatum
d. St vitus dance

37. The least commonly affected valves in rheumatic heart disease are:
a. Aortic valves
b. Tricuspid valves
c. Mitral valves
d. Pulmonary valves
38. A 55-year-old man is noted to have moderately severe congestive heart failure with impaired
systolic function. Which of the following drugs would most likely lower his risk of mortality?
a. Angiotensin-converting enzyme inhibitors
b. Doop diuretics
c. Digoxin
d. Aspirin
39. A 28-year-old woman has been told she has rheumatic heart disease, specifically Mitral
Stenosis. Which of the following murmurs is most likely present?
a. Diastolic rumble at apex of the heart
b. Early diastolic decrescendo at right upper sternal border
c. Holosystolic murmur at apex
d. Late-peaking systolic murmur at right upper sternal border
40. A 30-year-old woman is noted to have blood pressures in the 160/100 mm Hg range. She
also has increased obesity, especially around her abdomen, with striae. She has been bruising
very easily and has Hirsutism. Which of the following is the most likely diagnosis?
a. Hyperthyroidism
b. Coarctation of the aorta
c. Cushing syndrome
d. Pheochromocytoma
41. A 34-year-old woman is noted to be diagnosed with stage 1 hypertension and after an
evaluation is noted to have no complications. Which of the following antihypertensive agents are
generally considered first line agents for this individual?
a. Thiazide diuretics
b. Angiotensin-receptor blockers
c. Alpha-blocking agents
d. Nitrates
42. A 45-year-old man with type ii diabetes is noted to have blood pressures of 145/90 and
150/96 mm hg on two separate occasions. Which of the following is the best initial therapy for
this patient?
a. Hydrochlorothiazide
b. Ace inhibitor
c. Beta-blocker
d. Beta-blocker and hydrochlorothiazide
43. Which of the following are the most likely physical examination findings in a patient with
emphysema?
a. diffuse expiratory wheezing
b. clubbing of the fingers
c. bibasilar inspiratory crackles with increased jugular venous pressure
(JVP)
d. inspiratory stridor

44. Which of the following features is not consistent with chronic pulmonary obstructive disease?
a. Wheeze
b. Cough
c. Clubbing
d. Cyanosis

45. The disease progression of rabies in man depends on the following except?
 a. Dose if Inoculation
b. Size of the wound
c. Age of the victim
d. Length of neural path

46. A 24-year-old man of Chawama compound has been treated with isoniazid, Rifampin,
Pyrazinamide and Ethambutol for active pulmonary tuberculosis. After 3 months, he states that
he is having numbness and tingling of both feet but no back pain. He denies taking other
medications. Which of the following is the most appropriate next step?

a. Send for a CT scan of the lumbar spine.

b. Initiate Pyridoxine.
c. Continue the tuberculosis agents and monitor for further neurological
problems.
d. Initiate a workup for tuberculosis adenopathy compression on the
femoral nerve

47. Which of the following is the most likely organism to cause pneumonia in a patient with
HIV/Aids?
a. Pneumocystis jirovecii
b. Mycobacterium tuberculosis
c. Histoplasmosiscapsulatum
d. Streptococcus pneumonia
48. Which of the following tests is the most important to follow for a patient receiving Isoniazid
and Rifampin for tuberculosis treatment?
a. Renal function tests
b. Liver function tests
c. Slit-lamp examinations
d. Amylase and lipase tests
49. A 44-year-old woman infected with HIV is noted to have a CD4 count of 180 cells/mm3.
Which of the following is recommended as a useful prophylactic agent in this patient at this point?
a. Fluconazole
b. Azithromycin
c. Trimethoprim-Sulfamethoxazole
d. Ganciclovir
50. A 42-year-old overweight but otherwise healthy woman presents with sudden onset of right
upper abdominal colicky pain 45 minutes after a meal of fried chicken. the pain is associated
with nausea and vomiting, and any attempt to eat since has caused increased pain. Which of the
following is the most likely cause?
a. Gastric ulcer
b. Cholelithiasis
c. Duodenal ulcer
d. Acute hepatitis
51. Which of the following is the most accurate statement regarding h pylori infection?
a. It is more common in developed than underdeveloped countries.
b. It is associated with the development of colon cancer.
c. The route of transmission is believed to be sexually transmitted.
d. It is believed to be a common cause of both duodenal and gastric ulcers.
52. A 32-year-old woman has a history of chronic diarrhea and gallstones and now has
rectovaginal fistula. Which of the following is the most likely diagnosis?
a. Crohn disease
b. Ulcerative colitis
c. Systemic lupus erythematosus
d. Laxative abuse
53. A 35-year-old man has undertaken a self-imposed diet for 3 months. He previously had been
healthy but now complains of fatigue. His hemoglobin level is 10 g/dl, and his mcv is 105 fl.
which of the following is the most likely etiology of his anemia?
a. Iron deficiency
b. Volate deficiency
c. Vitamin b12 deficiency
d. Thalassemia

54. Which of the following therapies would most likely decrease the number of sickle cell crises?
a. hydroxyurea
b. folate supplementation
c. prophylactic penicillin
 d. pneumococcal vaccination

55. Which of the following is the most common cause of secondary adrenal insufficiency?
a. Autoimmune process
b. Surgical excision
c. Hemorrhagic shock
d. Exogenous corticosteroids
56. Which of the following is the most important first step in the treatment of diabetic
Ketoacidosis?
a. Replacement of potassium
b. Intravenous fluid replacement
c. Replacement of phosphorus
d. Antibiotic therapy
57. Which of the following distinguishes hyperthyroidism from thyroid storm?
a. Tachycardia to heart rate 120 bpm
b. Weight loss
c. Fever and delirium
d. Large goiter
58. A 57-year-old man is noted to have a blood pressure 68/50 mm hg, heart rate 140 bpm,
elevated jugular venous pressure, inspiratory crackles on examination, and cold clammy
extremities. Which of the following is the most likely etiology?
a. Septic shock
b. Adrenal crisis
c. Cardiogenic shock
d. Hypovolemic shock
59. A 67-year-old woman has diabetes and mild hypertension. she is noted to have some diabetic
retinopathy, and she states that she cannot feel her legs. She has recurrent episodes of
lightheadedness when she gets up in the morning. She comes in now because she had fainted this
morning. Which of the following is the most likely cause of her syncope?
a. Carotid sinus hypersensitivity
b. Pulmonary embolism
 c. Autonomic neuropathy
d. Critical aortic stenosis

60. A 68-year-old man with a history of end-stage renal disease is admitted to the hospital for
chest pain. On examination, a pericardial friction rub is noted. His ECG shows diffuse st segment
elevation. Which of the following is the best definitive treatment?
a. NSAIDS
b. Dialysis
d. Digoxin
c. Steroids
61. Which of the following laboratory findings is most consistent with poststreptococcal
glomerulonephritis?
a. Elevated serum complement levels
b. Positive antinuclear antibody titers
c. Elevated ASO titers
d. Positive blood cultures
62. A 36-year-old woman was seen by her physician due to pain in her hands, wrists, and knees.
She is diagnosed with rheumatoid arthritis. Which of the following treatments will reduce joint
inflammation and slow progression of the disease?
a. NSAIDS
b. Joint aspiration
c. Methotrexate
d. Systemic corticosteroids
63. A 42-year-old man with polycystic kidney disease who complained of a sudden onset of
severe headache and then lost consciousness
a. Common migraine headache
b. Meningitis
c. Cluster headache
d. Subarachnoid hemorrhage
64. A 31-year-old woman with a long history of intermittent severe unilateral headache lasting
hours to days associated with nausea and photophobia, but no preceding symptoms and no visual
disturbance
a. Cluster headache
b. Meningitis
c. Subarachnoid hemorrhage
d. Common migraine headache
65. Which of the following agents most closely resembles the action of alcohol in the brain?
a. Amphetamines
b. Marijuana
c. Cocaine
d. Benzodiazepine
66. Viral encephalitis is most commonly due to:
a. HIV
b. Poliomyelitis
c. Herpes simplex
d. Herpes zoster
67. In T.B meningitis;
a. CSF glucose level is normal
b. It is more frequent in aids patients
c. 3 months anti tuberculous drug regimen is the best treatment
d. Steroids has no therapeutic role
68. The following are characteristics of Guillain Barre Syndrome except:
a. Hyporeflexia
b. Weakness
c. Urinary incontinence
d. Parasthaesia
69. Which of the following anti epileptic drugs worsens absent seizures:
a. Sodium valproate
b. Diazepam
c. Carbamazepine
d. Phenytoin
70. Which of the following diseases has a characteristic feature of “ Pea soup” diarrhea?
a. Toxoplasmosis
b. Cholera
c. Typhoid Fever
d. AIDS
71. The following features are associated with obesity except?
a. Hyperuricaemia
b. Depression
c. Gallstones
d. Type II Diabetes mellitus
72. Which of the following diseases is not usually spread via the faecal oral route
a. Poliomyelitis
b. Cholera
c. Hepatitis E (Non-A, Non-B Hepatitis)
d. Hepatitis B
73. Spread of the following infections is best prevented by all except
a. Use of insecticides in malaria
b. Active immunization in measles
c. Barrier nursing in tuberculosis
d. Quarantine in Diphtheria

74. Typical features of HIV infection at presentation include

Hairy leucoplakia
a. Atypical pneumonia
b. Thrombocytopenic purpura
c. Candidasis and cryptosporidiosis
d. All of the above
75. The following are characteristic complications of measles except?
a. Pneumonia
b. Post-viral encephalitis
c. Myocarditis
d. Otitis media

76. The clinical features of herpes simplex virus infections include all except
a. Recurrent labial or genital ulcers
b. Shingles
c. Acute gingisostomatitis
d. Encephalitis

77. The characteristic features of secondary syphilis include all except

a. Fever and a macular rash occurring 8 weeks after the chancre
b. Codylomata lata in the moist areas as flat papules
c. Soft early diastolic murmur on cardiac auscultation
d. Generalised lymadenopathy and orogenital mucous ulceration

78. The typical features of lymphogranuloma venereum include

 a. Donovan bodies within mononuclear cell on histology of the lesion
b. Transient genital ulceration 1-5 week after chlamydial infection
c. Fever weight loss and inguinal lymphadenopathy
d. All of the above

79. The typical features of typhoid fever include all except

a. Faecal – oral spread of salmonella typhi by food handlers
b. An incubation period of 3-7 days
c. Onset with fever, myalgia, headache and septicaemia
d. Rose spots on the trunk

80. The characteristic features of untreated cholera include all except

a. The recent ingestion of contaminated water or shelfish
b. An incubation period of 5-10 days
c. Sudden onset of profuse waterly diarrhea followed by vomiting
d. Acute circulatory failure developing within 12 hours of onset

81. Finger clubbing is a typical finding in all except

a. Chronic Bronchitis
b. Bronchiectasis
c. Primary biliary cirrhosis
d. Fibrosing alveolitis

82. Orthopnoea is an expected finding in

a. Chronic anaemia
b. Chronic Bronchitis and emphysema
c. Spontaneous pneumothorax
d. Pulmonary embolism

83. Typical features of peptic ulcer dyspepsia include all except

a. Sharp stabbing epigastric pain
b. Well-localised pain relieved by vomiting
c. Pain-free remissions lasting many weeks
d. Nocturnal pain causing frequent night waking

83. In the management of patients with acute viral hepatitis

a. Dietary protein and calorie intake should be unrestricted
b. Alcohol should be avoided until the anorexia resolves
c. Bed rest is mandatory until the jaundice resolves
d. Corticosteroid therapy should never be administered

84. Typical features of the Nephrotic Syndrome include

a. Bilateral renal angle pain
b. Hypoalbuminuria and proteinuria > 3gm/day
c. Hypertension and polyuria
d. Urinary sodium concentration > 20 mmol/L
85. Which of the description is correct concerning stroke:
a. Ischaemic stroke is the most common type
b. Is preceded by a headache
c. If blood pressure is high then it is haemorrhagic stroke
d. More common in males after 60 years
86. The typical clinical features of sickle-cell anaemia include all except
a. Haemolytic and aplastic crises
b. Renal, papillary, pulmonary and mesenteric infarction
c. Splenomegaly with hyper splenism
d. Bone necrosis and salmonella osteomyelitis

87. The typical features of bell’s facial nerve palsy include

a. Impairment of the orbicularis oculi on the affected side
b. Preservation of forehead wrinkling on the affected side
c. Loss of taste sensation on the posterior tongue
d. Loss of skin sensation on the affected side of the face

88. Factors likely to reactivate herpes zoster include

a. Stress
b. Immunosuppressive drugs
c. Fatigue
d. Smoking

89. The most common causes of vaginal discharge are:

a. Gonorrhoea and chlamydia
b. Syphilis and chlamydia
c. Syphilis and chancroid
d. Gonorrhoea and Anaerobic bacteria

90. Women with Pelvic Inflammatory Disease can be treated

a. As inpatients
b. As outpatient
c. With combination regimens with broad spectrum antibiotics
d. Using doxycycline as a single dose

91. Painless, indurated ulcers with firm, non tender inguinal adenopathy suggest
a. Chancroi d
b. Syphilis
 c. Gonorrhea
d. Herpes Genitalis

92. Which of the following is the most common clinical manifestation of Gonorrhea in males
a. Abdominal pains
b. Paraphimosis
c. Urethritis
d. Backache

93. A patient diagnosed with syphilis and hypersensity to penicillins can be treated with
a. Erythromycin
b. Chrolamphenicol
c. Doxycycline
d. Cotrimoxazole

94. The following are primary skin lesionsexcep?

a. Abscess
b. Pustule
c. Keloid
d. Lichenification

95. The following are the severe complications of Chlamydia

a. Abortion
b. Arthritis
c. Anemia
d. Amnesia

96. During physical examination of the patient, mental status examination should be done
at

a. Beginning of the examination

b. At the end of the examination
c. Either at the beginning or end of the examination
 d. Simultaneously as you do other examinations

98. Which of the following applies to Glomerulonephritis

a. Proteinuria is not a common feature.
b. May be associated with haematuria
c. Is a disease of autoimmune reaction
d. Streptococcol sore throat often precedes the onset of acute disease

97. Following a Mosquito bite, Malaria sporozoites enter the liver within minutes. After a
few weeks they emerge as …………………………to invade the red blood cells
a. Schizonts
b.Trophozoites
c. Merozoites
d. Hypnozoites

98. During Epileptic seizure, the period when the patient falls asleep, the brain is
considered to reboot. This period is known as
a. Pre – ictal
b. Ictal
c. Post ictal
d. Myoclonic

99. A 70 year old man is brought to your clinic with the following clinical features;
aphasia, loss of gag reflex, nystagmus and apraxia. The features developed rapidly.
What is the probable diagnosis?
a. Meningitis
b. Cerebral Vascular Syndrome
c. Encephalitis
d. Neurosyphilis

Section B: short note questions. Answer three questions (15 marks)

1. Outline major differences between hypo and hyperglycaemic coma

2. Outline the classification of antiretroviral drugs which are currently recommended in
Zambia. Include common group side effects.
3. Outline the current recommended treatment protocol for tuberculosis
4. Compare and contrast Cerebral Spinal Fluid (CSF) findings in Bacterial and Viral
Meningitis
5. List two major possible complications of Typhoid fever
6. Describe Congenital Rubella Syndrome and its clinical features.
8. A patient presents to you complaining of passing blood in urine
a. What is this condition called and what are the causes of this state?
b. What points in history and examination will support your causes stated in (a)?
c. What test will you carry out in a patient passing blood in urine?
d. How will you manage such a case?

9. A patient presents to you with cough on and off fever on and off breathing difficult, history of
loosing weight.
a. What are the causes of breathing difficult or dyspnoea
b. What could be/are the likely causes in the above patient?
c. What is PCP? What are the sign/symptoms? And discuss on the investigations
and management of PCP.

SECTION C

1. Malaria is one of the major health problems in the tropical areas.

Discuss how best you can manage a case of malaria that presents with
hyperparasiteamia, convulsions and unconsciousness in an adult.

2. You are the Clinical Officer on duty when a patient arrives at the OPD with history of taking
same insecticide a few hours ago.
a. What are the general principals of managements of poisoning?
b. What are the indications/contra indications of gastric lavage?
c. Describe the clinical features of organophosphorous insecticide poisoning?
d. How will you manage such a case?

3. Pulmonary Tuberculosis is one of the common opportunistic infections in

imunocompromised patients.

Discuss the WHO protocol management of the first case of PTB including the
appropriate health education that may be needed.
SECTION C: ESSAY

Answer only two questions (20 marks)

1) Discuss epilepsy under the following headings;

a) definition
b) classification according to 1981 international league against epilepsy
c) pathophysiology
d) treatment

2) Discuss stroke under following headings;

a) definition
b) pathophysiology (both ischemic and hematological stroke)
c) basic investigations
d) state four differential diagnoses for the same.

3) Discuss pneumonia under the following headings

a) definition and causes
b) classification
c) basic investigations
d) treatment