Medicine Sendups 2013- Topic wise sorted out

Medicine Cases and scenarios
UHS Medicine Sendups 2013

INFECTIOUS DISEASES

-A 26 year old male presented in OPD with C/O malaise, generalized body aches, headache, sore throat. Now he also has difficulty in swallowing. On examination pulse 96/min, BP=130/80 mm HG, Temp 103 F, with congestive sore throat, cervical lymph nodes were enlarged and tender, No clubbing, anemia, jaundice or dependent edema. On systemic examination spleen was 2cm enlarged with no other anomaly. Investigations showed Hb:14gm/dl, TLC 14000 with predominant atypical lymphocytes. Urine C/E and serum electrolytes were normal.

   What’s the probable diagnosis?

   What r Differentials

   2 investigations to confirm? Give treatment (IMC) 

A pt. having a 2 day H/O high grade fever, with rigors developed altered consciousness. O/E temperature is 105 F, He’s comatose, neck stiffness is absent.

 What is the most likely diagnosis (cerebral malaria)? How will u confirm diagnosis? Give management(SZMC)

--A 50 yrs. old sewage worker is admitted with high fever, anorexia and severe myalgia. Examination revealed conjunctival hemorrhage, and suffusion and mild hepatomegaly. Few days later his urine output dropped to 200ml/day. There was no history of alcohol or drug intake or accidental ingestion of any topic substances.

Investigations= Hb=11.8gm/dl,  TLC=38000cells/mm3 with 95%polyps,   bilirubin=24mg/dl,  ALT=445 IU/L,  Alkaline Phosphatase=543IU/dl,  blood urea=285mg/dl,  serum creatinine=6.9 mg/dl, hepatitis serology is negative, malarial parasites thick and thin films were negative.

  What is the most likely diagnosis(Weil's disease.. icteric leptospirosis.)?give 3 investigations to confirm it? How will u treat the pt(CPMC)

-A 20 yrs. old male presents with fever for last 10 days .examination reveals splenomegaly.

 U r asked to defend the point that its spleen not kidney, what explanation will u give? Give 3 d/Ds and how will you differentiate them from one another? How will you treat brucellosis? Give drug, dose and duration of treatment (QMC)

-A 19 yrs. old NGO worker returned to Pakistan 2 weeks after working in a refugee camp in sub-Saharan Africa, he was febrile, dyspneic, and widespread inspiratory crackles were present. He had extensive macula papular rash, conjunctivitis, generalized stomatitis and bluish grey spots on buccal mucosa, Give diagnosis, investigations and treatment(PMC)

-A 15 yr old boy presented with 2 week H/O malaise, fatigue and pharyngitis. He has multiple palpable lymph nodes in axilla, groin and neck along with rashes on the body. He gave H/O taking amoxicillin 2 days ago. Hb=12.8, WBC=16000, platelets=160000, lymphocytosis on peripheral film.

 Give diagnosis? Investigations and treatment (PMC)

-A 30 yrs. old man with H/O fever, tiredness, night sweats, weight loss, dyspnea for 1 month. On examination there’s pallor and skin lesions on tips of fingers, splenomegaly, and pan systolic murmur over the pericardium.

 What’s the diagnosis(infectious mononucleosis)?Give investigations, treatment and prophylaxis of this disease(PMC)

-A 15 year old girl presented in OPD with C/O rash over her face, trunk, and both upper and lower limbs for last 2 days..2 days earlier she had high grade fever. She took paracetamol for that, it subsided a little bit followed by irritation of both eyes and non-productive cough. She also told that one of her younger brothers also had the same rash 3 weeks ago. On examination she’s pale pulse=100/mim, BP 110/70,temp=101 F, Her conjunctiva were congested with maculopapular rash with reddish in color over her face, neck, trunk and forearm, Other systemic examinations were normal. Lab tests TLC=4500,  DLC P=76% ,M=4%,  L=18%, E2%, ESR=18mm/1st hour with normal platelet count,

     What’s the diagnosis, pathognomonic lesion and give 3 complications?(IMC)

-Herpes zoster aetiopathogenesis and treatment?(FMH)

-A 30 yr old female presents to u in OPD with complaints of insidious onset of malaise,headache,mild cough,high grade fever with rigors and chills.thers mild jaundice and hepatosplenomegaly.U r suspecting malaria.

   Give investigations to diagnose malaria?Enlist 6 complications to diagnosis malaria?How wil u treat complicated falciparum malaria(CPMC)

-A boy presented with severe watery diarhoe and vomiting for last 2 days.There no fever or rectal bleed.He ahs not passed urine in the past 12 hours.Examination revals dry tongue and sunken eyes.BP was 50/30.ABdomen was non-tender with intact bowel sound.Bladder wasnt palpable.urea78mg/dl,  creatinine=2.6 mg.dl,  Na=124mmol/l,  K=2.8mmol/l   blood sugar=80mg/dl

  Whats the complete diagnosis?whats the manegement(CPMC)

-TB(CMH)

  

-A 34 yr old female was admitted with complaint of alteed bowel habit,low grade fever with evening rise,weight loss for 3 monnths,ultrasound showed iliocecal mass and ascitis.

 Give diagnosis(tb),investigations and treatent?(PMC)

SKIN

-A 70 yr old male presented in opd with chnge in shape and colour of existing mole.(IMC

   How will u examine the lesion and what investigations wil b done to calculate the severity of this lesion.IMC)

 -Scabies confirmation test and management?(FMH)

-Psoriasis(CMH)

-A 16 yr old girl is seen in clinic as shes concerned abt an area of hairloss on scalp,past medical history includes atopic eczema,and she has a number of de pigmentedaead on her hand.Give diagnosis and treatment(PMC)

-A 30 yr old female presented with papules  in finger webs,breasts and abdomen and a H/O severe itching all over the body especially at night.

 What is the probable diagnosis?What important questions wil u ask in history to confirm the diagnosis?(SZMC)

ENDO

-A 28 yr old male presents with complaint of change in facial apearance and increase in size in hands a ring and shoe that dont fit anymore

What other clinical features u wil find in this pt?How wil u investigate this condition?Describe most specific non-radiological test to diagnose this condition.Give treatment.(QMC)

-A 70 yr  old male presented with abdominal pain,muscle cramps,nausea,vomit,diarhoea with fever and night sweats for last 6 months.On examination he was a dark looking male with dark coloured pigmentation of elbow,knee,palmar creases and knuckles.Theres n H/O fluid loss.His BP is 95/60 mmm HG, with postural hypotensionn.Hb=10,platelets=300000, WBC=8000,  Na=128,  K=4.5

   Whats the diagnosis?how will u investigate?give treatment/(IMC)

-A 55yr old female presents with episodic sweating and tremors which r relieved by glucose.she gained 6kg weight of late and drinks 10 units of alcohol weekly.CBC,LFT,urea electrolytes r normal.FBS=4mmol/l(N=3-6mmol/l)

 Give diagnosis(insulinoma0,investigations and management(PMC)

-30 yr old female presents with polyurea and passing 4litre urine per day.She has recently started new medication.Na=144mmol/l,  plasma osmololity=299mmol/l,  urine osmolality=230 mmol/l(N=350-1000mmol/l)

 Give diagnosis(nephrogenic diabetes insipidus),drug causing it(lithium),treatment?(PMC)

-A 34 years old man presents with  tiredness,headache,sweating and increase in size of feet.

 Whats iagnosis?Give 3  investigations to reach diagnosis?Give 3 management steps?(IMC)

-A 25 yr old lady has attacks of headache,nervousness,palpitation,sweating and apprehension.Her BP in these attacks is170-180/110-120mmHg .examination shows black pigmented spots on the skin.

 What is the most likely diagnosis?What investigations wud u like to do?AWhat wil b the menagement?(CPMC)

-Drug innduced hyperthyroidism(CMH)

-A 40 yr old male presented with C/O muscle weaknes and fatigue,He also has H/O polyuria and polydipsia.he has family history of hypertension.O/E his BP is 140/106,  no pallor,jaundice or pedal edema.labs show metabolic alkalosis, blood sugar is 95mg/dl.

  Give the most likely diagnosis?Give 3 d/Ds?Enlist specific investigation to diagnose?Give treatment?(AIMC)

DIABETES MELITUS

-A 38 year old male presented with polyuria and polydipsia.Examination showed weight 80kg and height 150 cm

Give 3 DDs and how will u confirm diagnosis?(IMC)

-DKA management(FMH)

-How wil u treat a drowsy pt with type 1 DM whose serum sugar=375 mg/dl,  arterial ph=7.5, and urinary ketones are positve.(QMC)

PSYCHIATRY

How wil u treat patient of schizophrenia(QMC)

-Define schizophrenia?Give its etiology?How will u diagnose it?Give its management/(IMC)

-A 26yr old known psychiatric pt was brought to ER.He is raising slogans,talking excessively,has torn his clothes and wants to talk to the pesident  immediately.on physical examination he has excessive salivation.torticollis and cogwheel rigidity in all limbs.

  What is the likely psychiatric disorder and D/D?What could b the cause of neuroloical sign in this case?List the drug treatment in this case(CPMC)

 -Bipolar(CMH)

-How wil u manage an acutely aggressive and disturbed patient in a medical emergency ward(PMC)

-A 30 yr old banker presented with recurrent,intrusive and ego dystonic thoughts regarding PAAKI and NAPAAKI(cleanliness and filth)

 Whats the most likely diagnosis?Enumerate the 3 most common psychological intervention techniques for managing this condition?(SZMC)

KIDNEY

-A 20 yr old male,diagnosed case of nephrotic presented in ER with history of abdominal pain and hematuria  for 2 hours.His urinanalysis shows RBC=15-20/hpf,Blood urea=2omg/dl,serum creatinine=0.5mg/dl

  What is diagnosis?How wil u investigate?briefly discuss management?(IMC)

A 25yr old man developed bilatersal loin pain and frank hematuria,His symptoms started 24 hours afer deelopment of sorethroat,Bp=140/90,   Urine R/E blood(4+) protein(2+)

 Give diagnosis(IgA nephropathy),how wil u confirm diagnosis?What r the chances of developing end satge renal failure in this aptient(PMC)

-A 40 yr old male presented with dyspnea,cough and hemoptysis of 10 days.o/E temp=98,  pulse=110,  BP=170/110,  pitting ankle edema,JVP not raised,b/l basal crepitations,cvs normal,hb=10  WBC=16000,  ESR=85mm/1st hour,  urea 230mg/dl  creatinine=8.8 mg/dl, urine examination showed albumin, RBC and granular casts, Xray shows widespread interstitial shadowing of both lungs. Give d/Ds(ARF,wegeners),investigations(PMC)

-A 20 yr old boy presenter in ER with complaint of abdominal pain and vomit.O/E he was dehydrated and tachypneic.On investigations his oxygen saturation was 98% on ABGs,he had metabolic acidosis.His blood urea was 60mg/dl,and creatinine was 1.2mg?dl.

    Whats D/D?What 3 tests wil u do?Give 3 steps of management?(SZMC)

-Nephrotic syndrome(CMH)

-A young pt with C/O facial puffiness in early hours of morning on getting out of bed,He aloso has C/O smoky urine.On examination his BP is 150/95,He has puffiness of eyes and pedal edema.Urine output is reduced with proteins ++ and RBCs.

 What is likely diagnosis?What investigations wil u advise?Enlist 5 complications of this disease(AIMC)

-What do u mean by polyrea?list common causes of polyuria?give list of investigations to reach final diagnosis?(SMDC)

-A 24 yr old farmer developed high grade fever with rigors and chills which occur on alternative day,He took medication.2 days later he developed red coloured urine along with decreased urine output.he also developed nausea,vomit and drowsiness.Urine complete examination,colour=red, protein=1+, RBC=3+, RBC cast=+ve,  CBC..Hb=10.6 gm/dl, TLC=5700/mm3, platelets=350000/mm3, urea=102 mg/dl, creatinine=3.2 mg/dl, 

 Whats the most likely diagnosis?How wil u investigate?Give steps of management?(SZMC)

-A 45 yr old man s shifted to ER from police custody after developing anorexia,nausea,vomiting,intelectua clouding leading to drowsiness over 3 days.Accompanying guard informs tht he as not passed urine since the previous day.Physical examination reveals a drowsy unwell looking person with facial puffiness,and swollen hands and feet.Skin of extremeties is studded with large ecchymosis,llimbs r tender as well, and neck veins r distended..His serum K=6.8 mEq/l and CPK 1432IU/L.

    What is diagnosis(Rhabdomyolysis.. leading to renal shutdown.?2 investigations to confirm diagnosis?2 therapeutic measures for his serum potassium?(CPMC)

ACID BASE:

A 30 yr old male presented with H/O loose mtion and vomit for 3 days and oliguria for 1 day.On investigation blood urea 170 mg/dl,serum vreatinine=6mg/dl,serum K7mmol/l

 Give diagnsis,manageement and 3 differences b/w heamodialysis and peritonela dialysis?(IMC)

-A 35yr old man who was a chronic alcoholic was found unconscious over the weekend.His lab reports were as follows.Serum glucose random=90mg/dl,ph:7.16, HCO3=10mEq/l ,  PCO2=25mmhg,  Cl=102mEq/l,  Serum Na=147mEq/l,  serum potassium=4.5 mEq/l

    What is the acid base idturbance?What is diagnosis?Give 4 causes of same acid base disturbance?How do u calculate anion gap(CPMC)

GIT

-Ulcerative colitis management and investigations(FMH)

-a 52 yr old man is admited with 10 hour h/o vomiting coffee ground material and passing black tarry stools,hes anxious,pale,pulse+100,BP=105/75, Spider nevi r seen on neck and chest and spleenomegaly is there.

 Give reason of vomitus being coffee ground in this pt?After initial resusitation what 2 drugs maybe helpful?Give 2 endoscopic options likely to b helpful(CMC)

-ZPeptic ulcer(CMH)

-A 24 yr old female presents with diarhoea mixed with mucus and blood for 3 months.

 How wil u diferentiate small and large bowel diarhoa?how wil u asses severity of ulcerative colitis and treat a severe case of UC ? What r extra intestinal manifestations of UC not associated with disease severity.(QMC)

-A 45 yr old male presents with multiple episodes of hematemesis.His pulse i thready120/min and extrmities r cold and clammy,BP=50/30.

 Give imediate management?Give clinical features that wil help u ake a diagnosis of esophageal varices and not bleeding due to peptic ulceration.How wil u investigate this pt to make a diagnosis?(QMC)

-A final yr medical student is repeatedly visiting a gastroenterologist with complain of increased stool frequency over the past 4 months,he feels colicky abdominal pain relieved by defecation,He has past H/O similar complaints wen he had to prepare for professinal exams.

 Give diagnosis(IBD),investigations,treatment(PMC)

-A 60 yr old lady presents to Er with 12 hour history of severe abdominal pain associated witth vomoiting.Shes sitting in bedand leaning forward.O/E she loooks in agony,bp 90/60,Abdomen is soft with mild tenderness,and nosigns of perotinitis,she has H/O cholilithiasis,her labs after admsiion show normal Cp,slightly deranges LFts,U/S abdomen shows cholilithiasis, with no evidnece of cholysystitis.

 what is the likely diagnosis?what other investigations u wil ask for?give treatment?(WMC)

-A pt presented with H/O diarhoea,sometimes steatorhoea and weight loss.He has H/O some abdominal surgery.Investigations show hb=9.3 g/dl, MCV=107, normal folate,low b12,anti endo mysial antibodies r negative,normal pancreas on CT,duodenal biopsy showed sub total villous atrophy.

  What is the likely diagnosis?Enlist 6 predisposing factors?Which investigations r required for diagnosis?(SZMC)

-A 40 yr old known case of type 1 DM presented with dirhoea without mucus or blood for 2 years and progressive fatigue and pallor for 1 yr.She has difficulty in getting up from sitting position.O/E BP 110/70,afebrile,edema legs.No lymphadenopathy,abdominal examination unremarkable,HB=8.4, TLC=7000,  platelets 185000,  MCV=66,  RBS=120mg/dl,  Albumin=3gm/dl,  bilirubin=0.8mg/dl,  ALT=83 IU/l,  ALP=850 IU/L, LDH=normal,  Stool R/e=normal,  abdominal sonography=normal.

 Whats the most likely diagnosis?Give 2 D/ds?Write 2 investigations for underlying disease?Outline management plan(WMC)

-A 34 yr old man with H/O ulcerative pancolitis for 10years presents with left knee swellinf and pain for 3 weeks,He also relates that he has had mildly increased stool frequency over past 5 days,Hes healthy and afebrile,Knee aspiration reveals sterile fluid with no crystals,Sigmoidoscopy shows acute exacerbation of UC.Give management?cause of knee swelling?what complicattions likely to occur when disease progresses.(CMC)

CVS

-Heart failure management(FMH)

-A 69yr old man with new orthopnea and edema is found to have a non-ischemic,dilated cardiomyopathy,ejection fraction is 20%,  treatment includes IV furosemide,lisinopril and carvedilol.BP 95/60, pulse=70,He has jugular venous distension,clear lungs and displaced apex beat with s3 but no murmurs,and mid lower extremity piting edema.Give treatment?and complications likely to occur(CMC)

-A 68yr old male pesents with STEMI with changes noted in anterior chest leads.thrombolytic therapy was administered imediately.

 What complications r likely to develop durng this.Give longterm mnagement plan(CMC)

-A 50 yr old man presents with chest pain in CCU.

 What r the characteristics of pain to b cardiac in origin?give absolute contraindications to thrombolysis?Give dose,route and rate of streptokinase?Give early complications of acute MI?(QMC)

-A 24 year old male presents with low grade fever and malaise for 4 weeks and now develops SO on exertion.On auscultation u hear amurmur on apex.How wil u diferentiate mitral stenosis and mitral regurg?Which clinical findings point to heart failure in this aptient.How wil u diagnose this patient to have infective endo?give treatment?(QMC)

-Infective endo(CMH)

-ST elevated MI(CMH)

-A 40 yr old man with diseminated tb presented with dyspnea.O/E he has rapid low volume pulse,elevated JVP,hepatomegaly,ascitis and peripheral edema.Give diagnosis(constrictive pericarditis),D/Ds?How wil u confirm the diagnosis?give treatment?(PMC)

-A 22 yr old female who suffered from joint pain in her childhood.Heart was mentiones at that time.She started developing low grade fever which partially responds to antibiotics.How do u co relate joint pain with heart in this case?Enumerate other features of this disease?Give diagnosis?how wil u confirm the diagnosis?SMDC)

- A 30 yr old man presented in ER with H/O chest pain for the past 2 days.Chest pain is sharp in character and more on lying down.CBC+RFTs r normal.ECG shows generalised ST elevation in all leads.

 Give 2 D/Ds?How wil u investigate and treat the most likely cause in this patient(SZMC)

-A 50 yr ols man was admitted with acute central chest pain.Clinical examination revealed normotensive(134/84) individual with normaly heard s1 and s2 and faint s3,ECG showed clasical features of acute anterior wal MI,and he was infused with injection streptokinase without any complications along with supportive treatment.After 1 week he was readmitted with sudden onset of breathlesnes,apprehension and couldnt lie straight in bed.clinical examination reveals BP 96/60,  cyanosis,sweating, respiratory rate 34/min, basal crepitations, and 3-4/6 pansystoic murmur at mid left sternal border, which doesnt radiate to apex with gallop.ECG shows sinus tachycardia with signs of settling acute anterior MI

   Give diagnosis?D/Ds?management?(WMC).

-Cardiac temponade management options and what wil b change in mangement if pt develops jaundice in few weeks of treatment.(FMH)

-O/E of chest of a young male pt,u find on left side that movements of chest r reduced,trachea is shifted to right side,percussion note is stony dull,on left side and breath sounds r absent on lest side.

  Whats the diagnosis(left sided pleural effusion.. shift of mediastinum to the right.)?What radiological test wil u order?What invasive procedures u wil prefer and which tests u wil ask for?(SZMC)

-

-A 45yr old man presents in ER with complaints of severe headache and vomiting.His pupils were equal and reactive to light,neck stiffness was present.His BP was 160/110.CVS examination reveals ejection systolic murmur best heard at mitral area.Git examination reveals bilateral abdominal fulness.His father died of renal failure 3 months ago.

  Whats the cause of headache(upture of Berry aneurysm leading to SUB ARACHNOID HEMORRHAGE. bilateral abdominal fullness is most likely secondary to polycystic kidneys.)?What is the diagnosis?How wil u manage this patient(CPMC)

RHEUMATOLOGY

-A 28 yr old woman with past history of butterfly rash and polyarthralgia is reffererd by the obstetric dept.Aged 21 she has ad DVT whilst on OCP and since then has had 3 miscarriages at 16-18 weeks and a recent IUD at 30 week.Following IUD she developed an extensive femoral vein thrombosis.

Hb11gm/dl,  WBC=6*10 raised to power 9/l,normal differentiated,  platelets=40*10 raised to power 9/l  ,creatinine clearance=120ml/min,  ANA 1 in 40,  ENA=negative,  DNApositive 1 in 10,  VDRL=positive 1 in 1,  plasma sodium 140mmol/l,  potassium=4.5 mmol/l,  Urea=4mmol/l

  Give diagnosis?what further tests should b done?What precautions shal b taken in subsewuent pregnancies?(CPMC)

-RA flare management,pulmonary complications and significance of CCP antibodies(FMH)

  

-Rheumatoid arthritis(CMH)

-A 38yr old pashtoon lady admitted with 3 day H/O increasing pain and sweling of left leg.Over past 24 hours she has also developed low grade fever,no H/O trauma,immobilization,or prolonged air or land travel.

 She was admited 2 years ago with a similar episode of pain and swelling in rt calf.DVT was confirmed on doppler scanning.Shes otherwise fit and well,married and lives with her husband,shes a non smoker.Her only medication is antidepresant prescribed by GP after she had a miscarriage 6 months ago,Her relationship with previous husband ended after this.Hb=10.5,  MCV=53,  WBC=2.5*10 raised to power 9/l,  platelets=130*10 raised to power 9,  and normal activity of protein c and s.

 What is cause of her recurrent problems?what tests wil u do to confirm diagnosis?(CMC)

-30 yr old woman complains of stiffness of hands in morning along with swelling of small joints of both hands.Whats the most likely diagnosis?How wil u investigate to reach a diagnosis?Give list of drugs used for treatment with mechanism of achtion(SMDC)

-A young male complained of low backache(chronic),generally worse in the morning with multiple joint pain nad swelling.On examination spine is tender over sacral area.Crepitations r there on upper part of chest on auscultation.Xray lumbosacral supine shows fused vertebral bodies vertically.ESR raised.ANA and RA negative.

 Give diagnosis(ankylosing spndylitis).investigations and management plan?(PMC)

-A 70 yr old lady comes with C/O joint and muscle pain for the last 4 weeks.daily self care activities like changing clothes,picking up items like cups and feeeding erself r getting diifficult.Symptoms r progressive.she feels feverish and turning in bed is difficult.She feels stiff in the morning.now shes unable to even  get up from toilet seat.Examination reveals normal vital signs and minimal swelling of interphalangeal and metacarpophalengeal joints.Difficulty in raising arms above head and getting up from chair.CBC reveals normocytic normochromic anaemia,ESR 98, urea 34mg/dl, creatinine 0.8, ALT 30, ALP 101  bilirubin=0.8,  Urine RE=no RBC casts or proteinurea.

 Give diagnosis(Rheumatoid arthris)?3 D/Ds?and management?(WMC)

-A 23 yr old femalle presented with C/O fever for last 2 months.She has H/O recurrent oral ulcers,and arthritis,Examination showed temperature 100 F,mild jaundice,pallor,and right sided pleural effusion,hb=8,  biliirubin=2mg/dl,urine examination showed proteinuria,

  Give likely diagnosis?whats the caue of elevated bilirubin?What other investigations wil u advise in this patients?List 4 investigations of steroids in this patient(AIMC)

-A 40 yr old male patient presented with pain in small joints of hands(both) for the past 4 months.Theres H/O morning sickness lasting more than 1 hour.O/E joints of both hands r swollen and tender.CBC shows Hb=8mg/dl,TLC=10,500, platelets=1,50,000.RA factor=+ve

 Which is the most common type of anemia in RA?What wil b the X-ray findings in an RA pts joint?List 4 DMARDS in treatment of RA with atleast 1 important side efect of each.(SZMC)

-A 48yr old lady with longstanding seropositive rheumatoid arthritis contacted her GP complainiong of 2 day H/O increasing shortness of breath.Her medication at the time was indomethacin  75mg BD annd methotraxate 7.g mg once weekly commenced one weeek previously.Prior to this she hadbeen receiving IM gold 50mg six weekly.This hadbeen discontinued due to lack of effect 1 month earlier.On examination her temperature was 36.6 C,BP 110/70 mm Hg,JVP not leevated,mild bilateral ankle edema.There was tachypnea with mild bilateral fine crepitations,An active synovitis  of wrists and knee was  noted.ECG unremarkable.

-Give 3 possible diagnosis(complications of RA.. pleural efffusion, osteoporosis, CCF)?What further investigations wil u advice?(CPMC)

CNS

-A patient presenting with bilateral lower limb weakness for last 3 days which traveled upwards and is now involving the forearms,Theres no involvement of sesory syster,bladder or bowel,however reflexes r absent with bilateral flexor plantar response,Theres H/O bloody diarrhoea 3 weeks ago.Give treatment(QMC)

-A 25 yr old man presented with rapidly progressive paralysis of all 4 limbs over days.Examination reveals hypotonia,grade 0/5 power,and absent reflexes in all 4 limbs,sensations were normal,CSF reveals opening pressure=13cm of water,  cell count=7(all lymphocytes),  protein=175mg/dl,  sugar=70mg/dl,  gram stain and Zn stain=negative,  blood glucose=105mg/dl.

 Give diagnosis,how wil u confirm diagnosis?give management?(CMC)

-Meningitis investigations and steps of management(FMH)

-A 17 yr old students from boarding presented with high grade fever for 1 day.Signs of meningeal irritation r positive.He also complains of severe headache and intolerance to light.(QMC)

 How wil u diferentiate pyogenic,viral and tuberculous meningitis on CSF examination?How wil u treat this pt empiricaly?Gram stain reeals gram negative diplococi,what 3 options of prophylaxis can b offered to room mates.

-A 37 yr old male is brought to ER in a drowsy state.examination reveals signs off cholinergic toxidrome.later his attendents find a canister of malathhion in his room.

 Give possible clinical findings in this patient?treatent?how wil u monitor response to treatment?(QMC)

-A middle aged man has difficulty in walking over a period of 2 years,He has stiffness of muscles and walks with stooping posture.O/E he has coarse tremors of hands which improve when he attempts to use his hand.

 Give diagnosis?common causes of this disease and list of drugs used to treat it(SMDC)

-Myasthenia Gravis(CMh

-Subdural hemorrhage(CMH) 

-Write short notes on chorea,raised intracranial pressure and FEV1(SMDC)

-A 16yr old girl presented with severe headache and vomiting for 2 weeks.O/E temp 100 F, bp 100/70 dehydrated, she has diplopia on left lateral gaze,and marked neck stiffnes with no weakness  of any limb.

 what is most likely diagnosis?why has she developed diplopia?Name 4 investigations and their expected findings which wil help in diagnosis?Outline treatment plan?(WMC)

A 24 year old lady recently diagnosed as a case of Rheumatoid Arthriris developed weakness,tiredness and double vision.bilateral ptosis found on examination.Give diagnosis?investigations and treatment(PMC)

-A 20 yr old lady is admitted with 1 day H/O sudden onset of left sided  weakness.She was fairly well and only complained of SOB in exertion in the past.O/E her BP was 125/75,  pulse 98/min irregular.CNS examination shows left sided dense hemiplegia, with brisk jerks and upgoing plantars on left side.Her chest is clear and CVs examination reveals loud S1 and prominent parasternal heave,

 What is the composite diagnosis?(stroke due to AF) what investigation wil u ask for?write atleast 5.What management wil u give to avoid further strokes in the future.(WMC)

-A 15 yr old boy is brought tot u with progreessive weakness of both lower limbs over a period of 7days.He was previously normal except mild flu prior to present condition.O?E he is alert and afebrileGPE doesnt reveal any abnormality except undescended testes on 1 side.power in upper limd is 5/5 whereas 2/5 in lowr limb.Deep tendon reflexes were absent in both lowr limbs..

 Give most likely diagnosis,investigations to confirm it and tel which investigations can prove fatal and their management(CPMC)

-A young pt was brought to ER with unconsciousness.He has H/O fever for last 3 days.

  List 6 D/Ds?How wil u examine this pt?Enlist in points with expected abnormality?Enlist investigations u wil advise to diagnose?(AIMC)

-A middle aged man of village background has presented with sudden loss of consciousness.He is reported to b in perfect health  before going to fields after a visit to the bank to conduct his routine.Theres no past history of similar such episodes.On examination he is deeply comatosed ,temperature 96.5 F,shallow  slow breathing,pinpoint pupils.No signs of meningeal iritation andplanters are bilateraly extensor.

 Give diagnosis  and an outline of management plan (CPMC)

-A 30 yr old male prested to ER with C/O numbness and weakness in lower limb followed by upper limbs.He has a H/O diarhoea 2 weeks ago..O/E he ahs tachycardia and tachypnea.Bulk in upper and lower limbs is normal with reduced power and tone and absent reflexes.Plantars r downgoing.

  What is likely diagnosis?Give 2 d/Ds?What investigations wil u advise?give management(AIMC)

-A 27 yr old male came to ER with 3 day H/O high grade fever,headache,vomiting and generalized tonic clonic seizures.O?E hes running high fever of 102 f,drowsy,and has neck stiffness,Thers no focal neurological defecit.

 Give 3 D/Ds?outline management plan?Which neurological complications can occur(SZMC)

-A 28 yr old female presents with weakness of both lower limbs for the past 3 weeks.Shes unable to stand and walk without support.Examination reveals upper motor neuron type weakness of lower limbs with sensory loss at xiphistenum.

 Give 3 D/Ds?whats the spinal cord and vertebral sensory level in this case?What tests wil u do to reach the diagnosis?(SZMC)

BLOOD

-Microcytic anaemia(CMH)

-A 25 yr old unmarried lady presents with mild SOB for 1 month,Shes pale nad hb is 9.

 Give 10 clinical findings u need to proceed for further labs?give investigations in a schematic manner to reach diagnosis(CMC)

-A young man from a remote rural village of punjab gradually developed SOB.He loooks pale and has Hb of 5gm/l,What further investigations u wil ask for to reach a diagnosis?how wil u manage to cure him permanently(SMDC)

- A 35 yr old  male presented with C/O shortness of breath,numbness,tingling in limbs and memory loss for the past 6 months.O?E he is pale,has angular chelosis,smooth tongue,and ocasional generalized bruises over the body.JVP is normal,normal vesicular breathing with no sound in chest.He also has loss of vibration and joint position sense with reduced ankle reflexes and upgoing plantars.CBC shows Hb=7,WBC 5500,and platelets 65000.What is the likely diagnosis?What r investigations to manage this patient?list 5 causes of this disease?Whats treatment(AIMC)

-A 25yr old female pesented in ER with complaint of bleeding from multiple sites 2 days after delivery,investigations showed prolonged PT and APTT and low platelets.

 Whats the diagnosis?what r the different causes of this in this kind of pt?Outline management?(SZMC)

-A 56 yr old female presented with 3 month H/O malaise,sweat,weight loss,cough and hemoptysis.She also has H/O left sided facial palsy of lower motor neuron type in the past.she was treated with antibiotics for pneumonia recently but responded poorly and she remained unwell with low grade fever.Shes mildly anemic  ESR=120, urine RE shows numerous RBCs, and proteins ++, urea 72mg/dl  creatinine=2.2 mg/dl.

 Whats the most likely diagnosis(wegeners granulomatosis)?Give atleast 2 D/ds?How wud u investigate?treatment plan?(WMC)

-A 60 yr old smoker has presented with sudden onset blindness in left eye which recovered in next 6 hours.he also gives H/O dragging sensation on left side of abdomen,He has no H/O previous CVS or respitatory disease.Clinically he has congested face and a mass palpable in left upper abdomen.CVS and Respiratory examinations r normal. Hb=16.9gm/l,  MC=68 fl,  WBC=16*10 raised to power 9/l,  platelet cpunt=450*10 raised to power 9 and increased serum uric acid and normal biochemical profile,

  Whats ur composite diagnosis?What r other diseases which can result in similar hematological picture?What investigations wud u order?(WMC)

RESPIRATORY

-A 55yr old man presented with cough,fever and hemoptysis of 2 months duration.he has lost 10kg weight.He left smoking 6months ago.He had pulmonaary tb 5 months ago which was treated with ATT for 9 months.His chest Xray shows opacity in right upper zone with blunting of right costophrenic angle.

 Give 4 D/Ds and enumerate 6 investigations(CPMC)

-A 55 yr old smoker presents with high grade fever,cough and pleuritic chest pain for the past 2 days.he has now developes scanty rusty sputum  and SOB,He looks distressed with an RR of 38/min.How wil u diferentiate b/w right pnemothorax and pneumonia?How wil u treat pneumonia in this aptient?give indications for tranfer to ICU in this pt.(QMC)

-A42 yr old smoker presents in clinic with productive cough,and foul smelling sputum,patient feels unwell, and feels that he is able to cough out more sputum in a particular posture,Hes febrile,has bilateral clubbing and b/l chest crepitations.

  Give diagnosis?investigations and treatment(CMC)

-A 49 yr old male presented with green coloured sputum in cough for last 5 days.He has passed large volume of urine in the past 2 days..Now he presented with altereed consciousnes,O/E hes drowsy,has upgoing plantars,Hb=10,  WBC=13000,  urea=88mmol/l (N=20-40), RBS=31mmol/l,  xray chest opacity in left upper lobe of chest.

  give diagnosis(klebsiella pneuoniae infection.. pulmonary and urinary tract involvement, plus signs of meningitis)?treatment?(PMC)

-40 yr old male is admited with altered conscious level,fever and cough for last 4 days.On clinical examination theers pyrexia,tachycardia and tachypnea,Chest examinations reveal crepitations in mid and lower zones.investigations show serum urea=3.5mmol/l,  Na=120mmol/l,  k=3mmol/l.

Give diagnosis(atypical pneumonia),what complication has occured,how wil u diagnose and steps of management.(PMC)

-A young man of 25yr old has had cough in sputum for the past 5 years.Name physical signs u wil look for to reach the diagnosis?Name 2 key investigations.Name drugs used in tb treatment with their sideefects and dosages(SMDC)

-Interstitial lung disease(CMH)

-A 45 yr old ale farmer by ocupation,was brought to ER with complaint of shortness of breath,fever,dry cough,myalgia for last 12 hrs,he is tachypneic,has tachycardia,cyanosis.On auscultation he has bilateral bibasilar crepitus.HE HAS h/o SUCH EPISODES before.

 What is the most likely diagnosis?Give 2 D/Ds?What investigations wil u advise?Give treatment(AIMC)

-A medical registrar hasbeen calledto c a 30yr old lady who was operated for acute apendicitis.She has developed marked breathlessness.and cannot lie straight in bed since last night.On exam BP 160/90,  pulse 126/min regular, cyanosis,loud S1, respiratory rate 28/min, and bi-basal crepitus, X-ray shows cardiomegaly with prominent pulmonary conus,and double shadow of atria,

 Whats the composite diagnosis?(pulmonary embolism) what r the D/Ds?Give 4 inveestigations u wil do and what do u expect to find?(WMC)

-A 70 yr old male complained of low back pain,fatigue,dyspnea,and blurring of vision.O?e he had pain over several vertebrae and his hb was 8,ESR=100mm/1st hr.

  Give diagnosis(multiple myeloma).Give 3 investigations and management?(PMC)

LIVER

-A middle aged lady has prestented with pain RUQ/right uper quadrant),fever and jaundice,On examination shes healthy looking with yellownes of eyebals.there r marks of itching on her trunk.Liver is 3cm enlarged with sharp and regular edgeUSG shows dilated biliary channels.

 Give 4 D/Ds in order of likelikhoood,Enlist 3 specific tests u wil do to confirm diagnosis(CPMC)

-A middle aged lady over a period of 2 weeks has developed yellowness of eyes and pain in right hypochondrium(rt)..O/E theres globular mass in right hypochondrium which moves with  respiration and also side to side.

 Give a list od D/Ds?how wil u investigate this case?(SMDC)

-A 35 yr old woman presented in ER with abdominal distension.What r possible causes?how wil u investigate?How wil u differentiate b/w ascitis and a large ovarian cyst(SMDC)

-A 22 yr olf female was admited with complaint of tiredness,anorexia,nausea,jaundice,On examination deep jaundice.palmar erythema,spider nevi,hepatosplenomegaly.labs show markedly elevated AST+ALT,high imunoglobulins,viral seerology for hepatitis b n C is negative.

  what is the likely diagnosis?what investigations wil u advise to reach the diagnsis?Give management(AIMC)

-A cirrhotic pt whose ascitis was well controlled with diuretics,presented with progressive abdominal distension,On examination shifting dullness and fluid thrill r present.

 What causes could b responsible for his worsening ascitis?How wud u investigate him?(SZMC)

-A 20 yr old presented in ER with gradual deterioratin of consciousness.His mother gave past H/O jaundice,abdominal distension and tremors for the past 2 years.Give provisional diagnosis(wilsons)?steps of management and investigations to reach the diagnosis?(PMC)

-A middle aged overweight man has 2 finger enlarged liver.His ALT is 66 IU/L.with negative serology for hepititis markers.BSF is 124mg/dl.Theres strong famly history of type 2 diabetes mellitus and early coronary artery disease.

  Give diagnosis(NAFLD.. non alcoholic fatty liver disease.)?3 investigations to confirm the diagnosis?give management in this case(CPMC)

-Liver abcess(CMH)

-A 60 yr old man is admited to ICU via ER with acute GIT bleed due to esophageal varices,his BP on arrival 80/45 and hb has decreased from 11 to 6 gm/dl,he has receives 3 units of RBCs in Er,he appears to b chronicaly ill with icteric sclere and marked asccitis, His past medical history is significant for chronic liver disease with cirrhosis, patients urine output since admission is less than 30ml/h. Na=128,  K=3.7,  creatinine=2.8,  urine analysis was rare except for rare epithelia cells.

 what complications have developed? Give management and prognosis? (CMC)

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