SECTION A: MULTIPLE CHOICE QUESTIONS (50 Marks)

Choose the most appropriate answer

1. ______________is an x-ray to view bone structures following an injection of a
contrast fluid into a joint area.
a. Arthroplasty
b. Arthropoxy
c. Arthrogram
d. Arthroplexy

2. ______________ refers to a grating or crackling sound or sensation, as that

produced by the fractured ends of a bone moving against each other.
a. Crepitation
b. Wheezing
c. Grafting
d. Somnolence

3. A plaster of paris (POP) has the following uses except:

a. To prevent movement in soft tissue injuries.
b. To prevent immobility of an injured bone
c. To maintain proper alignment and correct deformities.
d. To permit early mobilization

4. ______________ is useful for children younger than 2 years who weigh 10-12 kg
for Fracture shaft of femur (Child must weigh less than 12 kg).
a. Gallows traction
b. Buck's skin traction
c. Thomas splint
d. Fixed traction

5. Risk factors for rheumatoid arthritis include most of the following except:
a. Genetic/family history of the disease
b. Sex/Gender
c. Aging
d. Blood group
6. Bacterial causes of septic arthritis include most of the following except:
a. Staphylococcus aureus
b. Haemophylus influenza
c. Nesseria Gonorrhoeae
d. Influenza type 1 and 2

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7. A ______________ is an injury to the soft tissue, or ligaments, around a joint
usually caused by a wrenching or twisting motion.
a. Strain
b. Sprain
c. Subluxation
d. Fracture

8. A ______________ fracture is a fracture that involves the break across the entire
section of the bone and frequently displaced from its normal position.
a. Complete
b. Green stick
c. Transverse
d. Stable

9. The ability of the eye to change its focus between distant objects and near objects is
known as _________________
a. Visual acuity
b. Perimetry
c. Refraction
d. Accomodation

10. _________________ is Pupillary dilation

a. Myopia
b. Miosis
c. Mydriasis
d. Aphakia

11. Acuteness or clearness of vision is known as _________________

a. Perimetry
b. Visual acuity
c. Refraction
d. Accomodation

12. Osteomyelitis caused by pathogens from outside the body or by the spread of
infection from adjacent soft tissues such as pathogens from open fracture or surgical
procedure is known as _____________________________
a. Intrinsic Osteomyelitis
b. Contiguous Focus Osteomyelitis

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c. Iatrogenic Osteomyelitis
d. Haematogenous Osteomyelitis

13. Partial foot amputation is also known as_____________________________

a. Syme
b. Pyrogoff
c. Chopart
d. Transfemoral
14. _____________________________is the most common primary bone cancer.
a. Ewing's Sarcoma
b. Osteosarcoma
c. Multiple myeloma
d. Chondrosarcoma

15. Bone tumours which originate in bone or from bone-derived cells and tissues are
referred to as _____________________________
a. Benign bone tumors
b. Malignant bone tumours
c. Primary bone tumours
d. Secondary bone tumours

16. Cartilage forming bone tumors include most of the following except:
a. Chondroma
b. Osteochondroma
c. Chondrosarcoma
d. Osteosarcoma

17. Acuteness or clearness of vision is measured by _________________

a. Snellen chart
b. Perimetry
c. Slit lamp examination
d. Opthalmoscope

18. _________________ is a method of measuring intra ocular pressure.

a. Refraction
b. Opthalmoscopy
c. Gonioscopy
d. Tonometry

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19. Loss of peripheral vision is associated with _________________
a. Cataract
b. Glaucoma
c. Trachoma
d. Blindness

20. The removal of the eye leaving the eye muscles and remaining orbital contents
intact is called _________________
a. Enucleation
b. Exenteration
c. Evisceration,
d. Epilation

21. _________________is the separation of the retinal sensory layer from the
underlying pigment epithelium layer with fluid accumulation between the two layers.
a. Glaucoma
b. Uveitis
c. Retinal Detachment
d. Trachoma

22. An ocular condition characterized by inflammation of the eyelid edges or margins is

known as _________________
a. Cataract
b. Glaucoma
c. Trachoma
d. Blepharitis

23. Trachoma transmission is favoured by the following factors except:

a. High humidity
b. Dry environment
c. Dusty areas
d. Dirty places

24. A stye or ___________ is an infection of the sebaceous glands of Zeis at the base
of the eyelashes, or an infection of the apocrine sweat gland of moll
a. Chalazion
b. Hordeolum
c. Meibomian Cyst
d. Tarsal

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25. Dropping of the upper eye lid is known as ___________
a. Tarsal cyst
b. Chalazion
c. Ptosis
d. Entropion

26. __________________amputation does not preserve the knee joint.

a. Above Knee
b. Below knee
c. Disarticulation
d. Hemicorporectomy

27. The __________________ ear or labyrinth contains organs of hearing and balance
a. Outer
b. Middle
c. Inner
d. Incus

28. The pinna is also known as the __________________

a. Outer ear
b. Auricle
c. Malleus
d. Stapes

29. The ear receives its nerve supply from __________________

a. Vestibulocochlear nerve
b. Tympanic nerve
c. 2nd cranial nerve
d. Eustachian nerve
30. Deafness caused by impaired transmission of sound through the outer or middle ear
to the fluid in the cochlea is known as __________________
a. Sensorineural deafness
b. Conductive deafness
c. Psychogenic deafness
d. Mixed deafness

31. The most common type of epistaxis is __________________

a. Posterior Epistaxis
b. Anterior Epistaxis
c. Lateral Epistaxis

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d. Superior Epistaxis

32. Otitis media which results from obstruction of the Eustachian tube and causes
buildup of negative pressure in the middle ear, promoting transudation of serous
fluid from blood vessels in the middle ear is known as __________________
a. Suppurative otitis media
b. Acute otits media
c. Secretory otitis media
d. Chronic otitis media

33. Common complications of tonsillitis include most of the following except

a. Peritonsilar abscess
b. Parapharyngeal abscess.
c. Obstructive sleep apnea
d. Paragastric abscess

34. Risk factors for otitis media include most of the following except
a. Young age
b. Gender/sex
c. Recurrent upper tract respiratory infections
d. Season

35. Causes of partial airway obstruction include all of the following except:
a. Aspiration of food
b. Foreign body in the trachea
c. Laryngeal nerve paralysis
d. Extubation

36. The Nose is richly supplied by both the external and internal carotid systems, both
on the septum and the lateral walls. This area is called the__________________
a. Avascular area
b. Vascular area
c. Little's Area.
d. Epistaxis area

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37. ______________ or ulcerative keratitis is a serious inflammatory, infective
condition of the cornea involving disruption of its epithelial layer with involvement of
the corneal stroma.
a. Endothalmitis
b. keratoconjuctivitis
c. Corneal ulceration
d. Cellulitis

38. The causative organism of Trachoma is ______________

a. Chlamydia trachomatis
b. Staphylococcus aureus
c. Staphylococcus Epidermis
d. Streptococus Pyogens

39. The grade or stage of trachoma characterized by presence of at least 5 follicles on

the tarsal plate is called:
a. TI (active trachoma intense)
b. TS (trachomatous scarring)
c. TT (trachomatous trichiasis)
d. TF (active trachoma with follicles)

40. A malignant congenital tumour arising from the retina of one or both eyes usually
common in children is:

a. Retinoblastoma
b. Retinopatholoma
c. Keratoblastoma
d. Kerotopatholoma

41. ______________is a medical condition involving the loss of the surface epithelial
layer of the eye's cornea.
a. Keratomalacia
b. Corneal ulceration
c. Corneal Abrasion
d. Keratitis

42. The type of Uveitis which affects the front of the eye, normally the iris (iritis) or the
ciliary body (iridocyclitis) is referred to as:
a. Anterior Uveitis
b. Posterior Uveitis
c. Capsular Uveitis

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 d. Intermediate Uveitis

43. Visual acuity less than 3/60 in the better eye with the best possible spectacle
correction or a corresponding visual field loss according to WHO (World Health
Organization) is ______________
a. Low Vision
b. Blindness
c. Tunnel Vision.
d. Central Vision
44. The following are types of retinal breaks except:
a. Holes,
b. Lacerations
c. Dialyses
d. Tears

45. A chronic joint disorder in which there is progressive softening and disintegration of
articular cartilage accompanied by new growth of cartilage and bone at the joint
margins (osteophytes) and capsular is known as ______________
a. Septic Arthritis
b. Osteoarthritis
c. Rheumatoid Arthritis
d. Gout
46. Knee disarticulation removes the lower leg through the__________________ joint
a. Knee
b. Wrist
c. Ankle
d. Elbow

47. __________________ is a congenital deformity that develops in the womb during

the first trimester (between 8 to 12 weeks) and causes an abnormal twisting of the
ankles, heels, toes and feet.
a. Talipes
b. Osteoporosis
c. Equinovas
d. Congenital pedis fetalis

48. __________________ is the autoantibody (antibody directed against an organism's

own tissues) against immunoglobulin G.
a. Rheumatism
b. Rheumatoid factor
c. Rheumatic fever

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d. Rheumatoid

49. The dead bone resulting from bone infection is called __________________
a. Involucrum
b. Sequestrum
c. Osteophyte
d. Osteonecrotic

50. A protective shell of plaster and bandage molded to protect a broken or fractured
limb as it heals is known as
a. Splint
b. Traction
c. Cast
d. Gypsum

SECTION B: FILLING IN THE BLANKS

51. The RETINA is a thin layer of light sensitive (nerve) tissue on the back wall of the
eye.

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52. A LENSMETER is an instrument that measures the power of a patient's
spectacles during an eye examination.
53. . In the first 24 hours after blunt eye injury, blood may leak into the skin of the eyelid
and surrounding areas, producing swelling and a bruise( contusion), commonly
called a BLACK eye
54. Open or Quillone amputation is the amputation whereby the surgeon does not
close the stump with the skin flap immediately but it is left open allowing the wound
to drain freely.
55. New bone that forms as the body attempts to repair itself following osteomyelitis is
known as INVOLUTION
56. .Soft tissue injury that results from overstretching or overexertion of muscles or
tendons is known as STRAIN
57. SUBLUXATION is an incomplete or partial dislocation.
58. A GREEN fracture occurs when there is twisting around and along the shaft of a
bone.
59. SEPTIC arthritis is the invasion of a joint by an infectious agent which produces
inflammation of the joint structures.
60. A SPLINT is a device or an appliance which is applied to the body to protect and/
or immobilize a body part to restrict movement.
61. The procedure of measuring refractive error is called REFRACTION
62. A REFRACTIVE error is an optical abnormality of the eye in which a corrective
lens is needed for proper focusing.
63. ENTROPION is the turning of the eye lids in wards.
64. The CORNEA is the transparent front part of the eye that covers the iris, pupil,
and anterior chamber.
65. The PALBEBRAL conjunctiva is the part of the conjunctiva that covers the inner
surface of the eyelid
66. TRACHOMA causes bilateral keratoconjunctivitis generally in childhood, that leads
to adulthood corneal scarring which when severe causes blindness.
67. A hole located in the center of the iris of the eye that allows light to enter the retina.
is known as PUPIL
68. Localized swelling and discolouration of the skin which occurs after a fracture due
to trauma and bleeding into the vascular tissue is called ECHYMOSIS

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69. Surgical removal of poorly vascularised tissue and dead bone as part of
management of osteomyelitis is known as SEQUESTRECTOMY
70. A cast that extends from below the knee to the base of the toes is known as
SHORT leg cast.
71. CERUMEN is a brown wax like secretion found in the external auditory canal.
72. SUPPURATIVE otitis media is caused by conditions that allow nasopharyngeal flora
to reflux through the Eustachian tube and colonize the middle ear, such as respiratory
tract infection and allergic reaction.
73. TRACHEOSTOMY is an emergency or elective life saving surgical procedure
where an opening is created in the anterior wall of the trachea between the second and
third tracheal rings for the purpose of establishing an airway to facilitate breathing which
may be either temporary or permanent.
74. Peritonsillar abscess one of the indications for tonsillectomy is also known as
QUINSY
75. Nose bleeding which originates further back and higher up the nose where artery
branches supply blood to the nose is called POSTERIOR epistaxis.
76. Functional or PSYCHOGENIC hearing loss or deafness is non organic and
unrelated to detectable structural changes in the hearing mechanisms, it is usually a
manifestation of an emotional disturbance.
77.MASTOIDECTOMY is a surgical procedure that removes an infected portion of the
mastoid bone when medical treatment is not effective.
78. MASTIODITIS is the infection and inflammation of the mastoid bone of the temporal
bone mostly due to bacterial invasion manifested by pain, tenderness and the auricle is
pushed away from the head.
79. SINUSES are hollow cavities in the facial bones that play the function of reducing
the weight of the bones and phonation.
80. SINUSITITS is the inflammation of the paranasal sinuses which may be acute,
chronic, hyperplastic or allegic resulting from cold or persistant infection characterized
by nasal, discharge, headache and fever.

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SECTION C: CROSSMATCHING ITEMS: - (20 marks)
Match the types of uveitis in column I with their corresponding description in
column II.
COLUMN I COLUMN II
81. __C__ Pan Uveitis A. inflammation of the Cilliary body
82. ___D_ Anterior Uveitis B. Affects the part of the uvea at the back of the
eye,
the choroid

83. ___B_ Posterior Uveitis C. Affects all the layers of the uvea.

84. ___F_ Intermediate Uveitis D. Affects the front of the eye

85. __A__ Iridocyclitis E. inflammation of the uvea.

F. Affects the area just behind the ciliary body and

also the most forward edge of the retina

Match the types of eye surgery in column I with their best descriptions in
column II.
COLUMN I COLUMN II
86. __F__ Enucleation A. Surgical repair of the eye lid

87. __E__ Evisceration B. Surgical repair of the corneal

88. _D___ Exenteration C. Surgical repair of the lens

89. __A__ Tarsorrhaphy D. Removal of the entire orbital contents, including

the
eye, extraocular muscles, fat, and connective tissues.
90. __B__Keratoplasty E. Removal of the entire intraocular contents of the
eye while leaving the scleral shell and extraocular
muscle attachments intact.

F. Removal of the eye leaving the eye muscles and

remaining orbital contents intact.

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 Match the types of ENT surgical procedures in column I with their
corresponding description in column II.
COLUMN I COLUMN II
91. B Simple Mastoidectomy A. Myringoplasty is combined with
ossicular reconstruction
92. F Radical Mastoidectomy B. The surgeon opens the mastoid bone
and removes the infected air cells.

93. C Myringotomy C. Closure/repair of the perforation of the

tympanic membrane alone.

94. A Tympanoplasty D. Surgical incision of the tympanic

membrane to allow drainage and relieve
pressure.

95. C Myringoplasty E. ENT surgeon passes a narrow tube called

an endoscope into the nose.

F. Involves removal of the mastoid bone,

excision of the posterior wall of the ear
canal, remnants of the tympa membrane,
and the malleus and incus

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Match the types of casts in column I with their best descriptions in column II.
COLUMN I COLUMN II
96. C Long arm cast A. Encases the trunk.

97. D Thumb spica B. A body cast that encases the trunk, shoulder,
and elbow.

98. B Shoulder spica C. Extends from axilla to palm, with the elbow
normally

99. E Walking cast D. Extends from below the elbow to the palm

and includes the thumb.

100. A Body cast E. A short or long leg cast with a rubber or metal
walking device attached to the foot.

F. A body cast that encases the trunk and one

or both lower extremities.

SECTION D: ESSAY QUESTIONS

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There are three (3) questions in this section. Question 1 is compulsory.
Answer only two (2) questions including the compulsory question.

QUESTION 1
Mr. Eaten Handyabantu has sustained major head injury following road traffic accident.
He has been brought to your surgical ward for treatment.
a) i. Define head injury 5%
ii.List five (5) causes of head injury 10%
b) Outline three (3) types of intracranial haemorrhage/heamatoma 15%
c) Identify any (5) five nursing problems that Mr. Handyabantu may present with and
using a nursing care plan describe the nursing management 50%
d) Outline any five (5) members of the rehabilitation team and their roles in the
rehabilitation program for a patient with head injury 20%

QUESTION 2
Mr. Gregory Lungu a 60 year old miner who has been working for a blasting and mining
company for the past 20 years comes to the hospital to see the doctor with history of
inability to appreciate auditory stimuli for some time now. On examination by the doctor,
he is said to have complete hearing loss.

a. I. Define hearing Impairment 5%

ii. Outline five (5) grades of Hearing loss according to World Health Organization
20%

b. Explain four (4) types of Hearing Loss 20%

c. Describe six (6) ways in which deafness can be prevented. 30%
d. Discuss five (5) methods that may be used in the rehabilitation of Mr. Lungu to make
him have a better life with the rest of the community. 25%

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QUESTION 3
Mrs. Angela Lungu has sustained fracture of the right femur while running away from
her violent husband. She has been put on skeletal traction as part of management of
her fracture
a) Draw a well labeled diagram of a femur 15%
b) State any five types of fractures 15%
c) Identify five (5) problems that Mrs. Lungu may present with and using a nursing
care plan describe the nursing management 50%
d) Outline five (5) difference between skeletal traction and skin 20%

MARKING KEY/GUIDE

Mr. Eaten Handyabantu has sustained major head injury following road traffic accident.
He has been brought to your surgical ward for treatment.
e) i. Define head injury 5%
ii.List five (5) causes of head injury 10%
f) Outline three (3) types of intracranial haemorrhage/heamatoma 15%
g) Identify any (5) five nursing problems that Mr. Handyabantu may present with and
using a nursing care plan describe the nursing management 50%
h) Outline any five (5) members of the rehabilitation team and their roles in the
rehabilitation program for a patient with head injury 20%

ANSWERS/DISCUSSION

a) i. Define Head injury 5%

Head injury defined as injury to the scalp, skull, or brain caused by trauma instead of
disease
List five (5) causes of head injury 10%
1. Road traffic accidents involving the head

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 2. Industrial accidents involving the head

3. Falling off from a height

4. Diving or swimming

5. Fighting with blows on the head

6. Military accidents e.g. gun shots involving the head

b) Outline three (3) types of intracranial haemorrhage 15%

1. Epidural (Extra Dural) Haemorrhage/Haematoma
In this type of bleeding haemorrhage occurs between the dura mater and the skull.
It is commonly due to rupture of the meningeal artery which runs beneath and is closer
to the temporal bone of the skull. There being no much space between the bone and
brain, the brain tissue is compressed and this leads to increased intracranial pressure.
The whole brain shifts and this can be seen on an x - ray film.

2. Subdural Haemorrhage/Haematoma
This is bleeding below the dura mater (i.e. between the dura mater and arachnoid mater
– subdural space). The bleeding is usually venous in nature and mostly involves the
cerebral vein. There is slow development of the haematoma.
However, after a period of time, the bleeding eventually causes increased intracranial
pressure and leads to symptoms similar to those seen in an epidural haematoma.

3. Subarachnoid haemorrhage/Haematoma
This is bleeding of cerebral vessels into the space beneath the arachnoid mater.
This is rarely seen in trauma and is more likely to be due to cerebral aneurysms.
It may occur in combination with other types of bleeding stated above. Bleeding is
usually associated with spillage of cerebral spinal fluid as this space connects with the
spinal canal and hence even pressure does not commonly occur.
4. Intracerebral Haemorrhage/Haematoma
Intracerebral haemorrhage occurs within the brain tissue itself. The bleeding may be

17 | P a g e
 small but like bruising in any other part of the body, swelling or oedema may occur over
a period of time causing progressive decrease in the level of consciousness and other
symptoms of head injury in the patient.

c) Identify any five (5) nursing problems that Mr. Handyabantu may present with and
using a nursing care plan describe the nursing management 50%
Nursing care plan for Mr. Handyabantu

Nursing Nursing Goal/objective Intervention and Evaluation

Problem Diagnosis rationale
Ineffective Ineffective Patient will I will position patient in Patient had normal
breathing breathing related have normal semi prone position or breathing within 2
pattern to compression of breathing recumbent position with hours of
the respiration within 2 hours head turned to one side hospitalization
Centre evidenced of to promote drainage of evidenced by normal
by rapid hospitalization oral secretions. respirations of 14
respirations of 22 I will insert an oral breaths per minute.
breaths per minute pharyngeal airway to
prevent the tongue from
falling backward
I will administer
supplemental oxygen at
the rate of 4-
5/litres/minute to improve

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 tissue oxygenation
I will do pulse oximetry to
assess oxygen saturation
and monitor patient’s
response to oxygen
therapy

Risk for Risk for Patient will I will insert a nasogastric Patient nutritional
Imbalanced Imbalanced have adequate tube to provide an status was
nutrition less nutrition less than nutrition alternative way of feeding. maintained within
than body body requirements throughout I will provide nutritious normal throughout
requirements due to decreased hospitalization fluid based feeds via hospitalization
alertness, chewing nasogastric tube to meet evidenced by
and swallowing the patient’s daily absence of signs of
difficulties nutritional requirements. malnutrition.
resulting from I will administer
altered level of prescribed intravenous
consciousness. fluids to replace lost fluids
and electrolytes.
I will record intake and
output on a fluid balance
chart to prevent fluid
overload which may
worsen cerebral oedema
and rise the intracranial

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 pressure.
Self care Self care deficit Patient will I will bath the patient in Patient had
deficit related to altered have improved bed to remove dead improved comfort
consciousness comfort epithelial tissue throughout
evidenced by through out I will do oral care to hospitalization.
patient’s inability hospitalization. prevent halitosis
to do self care I will do nail care to
activities. prevent harboring of
bacteria in the nails.
I will change soiled linen
to promote patient’s
comfort

Risk of Risk of pressure Patient will be I will turn the patient 2 Patient was
pressure sore formation prevented from hourly to prevent prevented from
sore related to developing prolonged pressure on developing pressure
formation prolonged pressure sores bony prominences. sores through out
immobility through out I will do pressure area hospitalization
hospitlization care to increase blood evidenced by an
flow to bony prominences intact skin.
I will change soiled linen
to maintain skin integrity
I will put an air ring below
the patient’s buttocks to
relieve sacral pressure.

Risk of Risk of hypostatic Patient will be I will turn the patient 2 Patient was

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hypostatic pneumonia related prevented from hourly to prevent stasis of prevented from
pneumonia to prolonged developing tracheobronchial developing
immobility hypostatic secretions. hypostatic
pneumonia I will involve pneumonia through
throughout physiotherapist in out hospitalization.
hospitalization. performing chest
exercises to mobilize
trachea bronchial
secretions for suctioning
I will gently suction out
bronchial secretions to
prevent their
accumulation

d) Outline any five (5) members of the rehabilitation team and their roles in the
rehabilitation program for a patient with head injury 20%

Occupational therapist

He/she helps the patient learn, relearn or improve skills to perform everyday activities

Physical therapist

He/she helps with mobility and relearning movement patterns, balance and walking

Speech and language pathologist

He/she helps the person improve communication skills and use assistive
communication devices if necessary

Neuropsychologist or psychiatrist

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 He/she helps the patient manage behaviors or learn coping strategies, provides talk
therapy as needed for emotional and psychological well-being, and prescribes
medication as needed

Social worker

He/she facilitates access to service agencies, assists with care decisions and planning,
and facilitates communication among various professionals, care providers and family
members

Rehabilitation nurse

He/she provides ongoing rehabilitation care and services and who helps with discharge
planning from the hospital or rehabilitation facility

Vocational counselor

He/she assesses the ability to return to work and appropriate vocational opportunities,
and provides resources for addressing common challenges in the workplace

QUESTION 2
ANSWERS
a) i. Define hearing Impairment 5%
• This refers to partial or complete loss of the ability to hear from one or both ears.

ii. Outline five (5) grades of Hearing loss according to World Health Organization
20%

GRADE 0

There is no or very slight hearing problems.

Patient able to hear whispers and sound at 25 decibels (dB) in the better ear and does not
require any assistance to improve hearing

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GRADE 1
There is Slight hearing Impairment
Patient is able to hear and repeat spoken words in a normal voice at 1 metre.
Patient is able to hear sound at 26 – 40 decibels in the better ear and requires counseling, and
hearing Aids where easily available

GRADE 2
There is Moderate hearing Impairment
Patient is able to hear words and repeat spoken words in a raised voice at 1 metre
Patient is able to hear sound at 41 – 60 decibels in the better ear and requires hearing aids.

GRADE 3
There is severe hearing Impairment.
Patient is able to hear some words when shouted into the better ear.
Patient is able to hear sound at 61 – 80 decibels in the better ear and requires hearing aids and
if not available Lip Reading and Sign Language should be taught

GRADE 4

There is profound hearing Impairment including Deafness.

Patient is unable to hear or understand even a shouted voice in the nearest ear
Patient may hear sound at 81 or greater decibels in the better ear and requires Hearing aids ,
Rehabilitation , Lip Reading, signs and sign Language training

b) Explain four (4) types of Hearing Loss 20%

1. CONDUCTIVE DEAFNESS/CONDUCTIVE HEARING IMPAIRMENT
It occurs when there is impaired transmission of sound through the outer or middle
ear to the fluid in the cochlea. The sound is quieter but not distorted.
It is caused by impaction of cerumen or a foreign object in the external ear canal,
fluid in the middle ear cavity or scaring of the tympanic membrane blocking the
passage of sound waves to the tympanic membrane from the external ear canal
2. SENSORINEURAL DEAFNESS/HEARING LOSS

It is caused by a defect of the cochlea or its connecting nerves. The sound heard is
quieter and also distorted. It results from lesions of the cochlea (sensory type) or 8th
nerve and its central connections (neural type). Damage to the auditory nerve prevents
transmission of sound impulses or waves to the brain for interpretation. In severe cases,
the patient may not be able to hear the sound of his voice.
3. MIXED HEARING LOSS.

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 In this type of hearing loss, both conductive and sensorineural hearing loss coexist
in the same ear. There is air-bone gap indicating conductive element, and
impairment of bone conduction indicating sensorineural loss. Mixed hearing loss is
seen in some cases of otosclerosis and chronic suppurative otitis media
4. PSYCHOGENIC HEARING LOSS OR AFUNCTIONAL

It is non organic and not related to detectable structural changes in the hearing
mechanisms, it is usually a manifestation of an emotional disturbance.There is often
total hearing loss which may suddenly recover.
c) Describe six (6) ways in which deafness can be prevented 30%
PROPER CARE OF THE HEALTHY EAR
Wax should not be cleaned out of the ear routinely as it acts as a protective mechanism.
It lubricates the skin and traps foreign material that enters the ear canal.
Applicators should be moistened with alcohol and inserted into the canal only the length
of the cotton.

EARLY AND ADEQUATE TREATMENT OF EAR INFECTIONS

Any disease that causes prolonged symptoms of the ear such as pain, swelling,
drainage (plagued feeling) or decreased hearing should be promptly assessed and
treated appropriately by the physician. Many chronic problems such as perforation and
necrotic ossicles should be prevented with prompt and adequate medical attention.

PREVENTION OF TRAUMA TO THE EAR

People should be taught to avoid inserting hard objects into the ear canal.
Ear obstruction with any object, insertion of unclean articles or solutions in the ear and
swimming in water identified as being polluted with particles can lead to damage of the
tympanic membrane or to ear infection. Adults often traumatize the ear by inserting hard
articles into the outer or an attempt to remove cerumen or scratch the ear.
EARLY DETECTION OF HEARING LOSS

Because hearing sense does not regain function, early detection of hearing loss is
important so that the cause of the loss can be diagnosed and hopefully the problem can
be corrected and arrested. The earlier the problem is diagnosed the easier it may be to
treat.
MONITORING SIDE EFFECTS OF OTOTOXIC DRUGS

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Some drugs may affect the cochlear and vestibule of the ear or 8 th cranial nerve.
Persons taking ototoxic drugs need to know the side effects and signs and symptoms of
these drugs to prevent the loss of hearing from developing.
If these symptoms (dizziness, decreased hearing acuity, tinnitus etc) occur, the next
dose of the drug is omitted and physician consulted. The most common type of
occupational hearing loss in our society is caused by loud noise. Exposure to noise
levels of excess of 90 decibels over an eight hour period should be avoided.

MONITORING NOISE POLLUTION

Exposure to levels greater than 85 – 90 decibels for months or years can cause
cochlear damage. Persons working in areas of high decibel noises must wear sound
proof ear plugs.
OTHER PREVENTIVE MEASURES
• Immunizing children against childhood illnesses including meningitis and mumps
• Immunizing women of child bearing age 915 – 45 years) against rubella before
pregnancy.
• Testing for and treating syphilis and certain other infections in pregnant women

d) Discuss five (5) methods that may be used in the rehabilitation of Mr. Lungu to
make him have a better life with the rest of the community. 25%

SPEECH OR LIP READING

This is the ability to understand speech through observation of the lip and tongue
movements, facial expression, gestures and body movements. This is the purpose of
providing effective communication.
SIGN LANGUAGE TRAINING

This is the ability to make communication possible by means of hand signals. Various
hand signals represent different letters of the alphabet and words which are taught by
specialists.
SPEECH THERAPY

This is the correction of speech by speech teaching. This is done when the patient
cannot hear his own voice or other people’s voices. It is directed at people who are deaf
with speech problems and also towards counseling of developing speech or both. It
prevents possible deterioration of speech skill related to impaired hearing.
AUDITORY TRAINING

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Any hearing ability which is capitalized upon in the rehabilitative process therefore
auditory training is also another aspect of rehabilitation which emphasizes on speech
discrimination and listening skills and use residual hearing.
HEARING GUIDE DOGS

Specially trained dogs are available to assist a person with a hearing loss. People who
live alone are eligible to apply for a trained dog. At home the dog reacts to a sound of
telephone, a door bell, a small alarm or an intruder.

USE OF HRARING AIDS

These help in amplifying sound e.g. COCHLEA IMPLANT: It is a device that emits
auditory signals for profoundly deaf people. The single electrode system bypasses the
damaged cochlea system and stimulates the remaining auditory nerve fibres.
This results in the perception of sound.

Mrs. Angela Lungu has sustained fracture of the right femur while running away from
her violent husband. She has been put on skeletal traction as part of management of
her fracture
e) Draw a well labeled diagram of a femur 15%
f) State any five types of fractures 15%
g) Identify five (5) problems that Mrs. Lungu may present with and using a nursing
care plan describe the nursing management 50%
h) Outline five (5) difference between skeletal traction and skin 20%

ANSWERS/DISCUSSION

a) Draw a well labeled diagram of a femur 15%

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b. State any five types of fractures 15%

Open Fracture:
• This is a fracture in which the skin or mucous membrane are pierced by the
broken pieces of the bone.

Closed Fracture
• This is a fracture in which the broken pieces of the bone do not protrude through
the skin or mucous membrane.

Incomplete Fracture:
• This is a fracture in which the break of a bone occurs through only a part of the
cross of a bone.

Complete Fracture:

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 • This is a fracture that involves the break across the entire section of the bone
and frequently displaced from its normal position.

Comminuted/Compound Fracture:
• This is a fracture in which more than one line of broken bone resulting into
several bone fragments.

Green Stick Fracture:

• This is a type of fracture in which one side of the bone is broken while the other
is bent (commonly seen in children).

Complicated Fracture:
• This is a fracture in which the extensively broken bone pieces cause damage to
surrounding soft tissues.

Depressed Fracture:
• This is a type of fracture in which broken pieces of a bone are driven inwards
(common in skull or facial bones).

Traumatic fractures
• Fractures that are caused by physical injury

Pathological Fracture:
• This is a fracture that occurs in an area of a diseased bone tissue as occurs in
Osteomyelitis and osteosarcoma, can also occur in elderly people especially post
menopausal women etc.

c. Identify five (5) problems that Mrs. Lungu may present with and using a nursing
care plan describe the nursing management 50%
Nursing care plan for Mrs. Lungu

Nursing Nursing Goal/objective Intervention and Evaluation

Problem Diagnosis rationale
Pain on pin Pain on pin site Patient will be I will ensure that the Patient was relived
related to surgical
site. relieved of pain patient is correctly of pin site pain
trauma during pin
insertion within two positioned in proper body within 2 hours of
evidenced by hours of alignment in bed to interventions
patient’s
verbalization of intervention prevent limb movement evidenced by

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 pain. which may worsen the verbalization of pain
pain. relief.
I will provide emotional
support to enable the
patient cope with the pain.
I will use diversional
therapy to divert the
patient’s mind away from
pain
I will administer
prescribed analgesics to
block pain sensation
hence relieve pain.

Self care Self care deficit Patient will I will facilitate bathing Patient had
deficit related to have improved while patient is in bed to improved comfort
restricted mobility comfort remove dead epithelial throughout
evidenced by through out tissue hospitalization.
patient’s inability hospitalization. I will assist the patient in
to do self care performing oral care to
activities. prevent halitosis
I will do nail care to

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 prevent harboring of
bacteria in the nails.
I will change soiled linen
to promote patient’s
comfort
Anxiety Anxiety related to Patient will be I will explain to the patient Patient was relieved
long period of relieved of the need for of anxiety within one
immobilization and anxiety within immobilization as part of hour evidenced by
unfamiliar hospital one hour of treatment to gain his patient being calm
environment and hospitalization cooperation.
people evidenced I will encourage the
by patient’s patient to verbalize his
verbalization of fears and concerns to
worry. relive psychological
tension
I will explain all medical
and nursing procedures
done on the patient to
gain his cooperation and
prevent unnecessary
anxiety.
I will introduce patient to
all staff participating in his
care to reduce fear and
anxiety.

Risk for pin Risk for pin site Patient will be I will cover pin site with Patient remained
site infection infection related to free from pin sterile dressing free from pin site
a break in the
protective barrier site infection immediately after skeletal infection throughout
of the skin throughout traction to prevent hospitalization
hospitalization. contamination. evidenced by
I will advise the patient absence of signs of

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 not to be touching the pin infection
site to prevent
contamination
I will do daily cleaning and
dressing of the pin site
using aseptic techniques
to prevent contamination
I will assess the pin site
and drainage for signs of
infection to early identify
infection and take
corrective measures.

Risk of Risk of pressure Patient will be I will examine bony Patient was
pressure sore formation prevented from prominences frequently prevented from
sore related to developing for evidence of pressure developing pressure
formation prolonged pressure sores so that corrective sores throughout

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 immobility through out interventions can be put in hospitalization
hospitalization place. evidenced by an
intact skin in
I will reposition the patient
pressure points.
frequently to avoid
prolonged pressure on
bony prominences.

I will do pressure area

care to increase blood
flow to bony prominences
I will use wool pads to
protect bony prominences
from excessive pressure
I will change soiled linen
to maintain skin integrity
I will put an air ring below
the patient’s buttocks to
relieve sacral pressure.

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d. Outline five (5) difference between skeletal traction and skin 20%

1. Comfort

Skeletal traction more comfortable than skin traction because of the pressure on the skin,
muscles or tendons in skin traction.

2. Liability to Disturbance

Skeletal traction is less liable to disturbance than skin traction because of the skin
irritation and loosening of stirrups in skin traction
3. Risk of Bone infection

Skeletal traction has higher risk of bone infection than skin traction because skeletal traction
involves breaking the skin and inserting pins, wires or screws are surgically implanted into
the bone.

4. Traction Weight

Skeletal traction uses more weight of about 7-12kg or 5-10% of the patient’s body weight
while skin traction uses less traction weight of between 2-3 kgs

5. Effectiveness

Skeletal traction is more effective than skin traction because skeletal traction provides
direct pull to the bone while skin traction provides indirect pull to the bone.
6. Duration of Traction

Skeletal traction is recommended for long periods of bone immobilization (8-12 weeks)
mostly in adults while skin traction is for short immobilization of bone immobilization (6-8
weeks) mostly in children.

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