ECG of mitral regurgitation (left ventricular hypertrophy)

Rx; Diuretics (e.g., furosemide)

ACE inhibitors (e.g., lisinopril)

2. Cbc report was given. Same questions. A farmer, was on ATT looks pale. MCV, MCH, MCHC sb kam tha
. RDW low.

3. Hypothyroid Case

Symptoms related to decreased metabolic rate

Fatigue, decreased physical activity

Cold intolerance

Decreased sweating

Hair loss, brittle nails, and cold, dry skin

Weight gain (despite poor appetite)

Constipation

Bradycardia

Hypothyroid myopathy , myalgia, stiffness, cramps

Neurological sign; Woltman sign: a delayed relaxation of the deep tendon reflexes

diagnosis initial step is to determine TSH level, FT4, Tg Ab (thyroglobulin) and TPO Ab (thyroid
peroxidase)

Rx; L-thyroxine replacement

4. IGA Glomerulonephritis Case

Hx of; Usually during or immediately following a respiratory or gastrointestinal infection

Gross or microscopic hematuria

Flank pain

Low-grade fever

And/or nephritic syndrome (including hypertension)

Dx; Urinalysis, Serum IgA level is elevated,

Renal biopsy

Rx Patients with isolated hematuria

Regularly monitor kidney function and initiate treatment if disease progresses

Patients with proteinuria or hypertension : ACE inhibitors/angiotensin II receptor blockers

For severe/rapidly progressive disease: glucocorticoids PLUS possibly cyclophosphamide/azathioprine

5. Asthma Case environmental allergens: pollen (seasonal), dust mites, domestic animals , mold spores

Allergic occupational asthma: from exposure to allergens in the workplace (e.g., flour dust)

cold air

Physical exertion (laughter, exercise-induced asthma)

Clinical Finding Persistent, dry cough that worsens at night, with exercise, or on exposure to
triggers/irritants (e.g., cold air, allergens, smoke)

End-expiratory wheezes

Dyspnea (shortness of breath)

Chest tightness

Prolonged expiratory phase on auscultation

Dx; First-line: PFTs

Second-line bronchial provocation tests, Allergy workup

Rx initial SABA

Step 2 (mild persistent asthma)

Preferred

Low-dose ICS

SABA

6. Viral Hepatitis (easy)

7. Megaloblastic Anemia (easy)

8. ECG STEMI

- Sinus rhythm with a heart rate of ∼75/min

- Normal cardiac axis

- Normal QRS complex

- ST elevation in II, III, and aVF

C/S Acute retrosternal chest pain

Typical: dull, squeezing pressure and/or tightness

Dyspnea (especially with exertion)

Pallor

Nausea, vomiting
Diaphoresis, anxiety

Dizziness, lightheadedness, syncope

Rx Aspirin, Unfractionated heparin, Immediate revascularization

Emergency coronary angiography with PCI, Fibrinolytic therapy in STEMI

9. GBS Case

Associated pathogens (etiology)

Campylobacter jejuni: campylobacter enteritis is the most common disease associated with GBS.

Zika virus

Cytomegalovirus: most common virus associated with GBS

Epstein-Barr virus

HIV

Influenza

SARS-CoV-2

Mycoplasma pneumoniae

C/S/S; Ascending paralysis

Bilateral flaccid paralysis

Spreads from the lower to the upper limbs in a “stocking-glove” distribution

Landry paralysis: involvement of the respiratory muscles → respiratory failure

Muscle reflexes

Reduced or absent

Commonly beginning in the lower limbs

Paresthesias

Peripheral, symmetric

Usually affecting hands and feet

Dx; Cerebrospinal fluid: albuminocytologic dissociation

↑ Protein levels and normal white blood cell count in cerebrospinal fluid (CSF)

Serological screening
To identify potential pathogens (e.g., Campylobacter jejuni)

Detection of antibodies directed against gangliosides (e.g., anti-GM1 antibodies)

Electroneurography

↓ Nerve conduction velocity (NCV) due to demyelination

↑ F-wave latency

Electromyography

Rx Supportive management

Intravenous immunoglobulins

Plasmapheresis

10. Sickle Cell Case

11. Pneumothorax X ray and Chest tube or true cut biopsy needle

12. Thalessemia

13. Meningitis

14. Nephrotic Syndrome Secondary to Diabetic Nephropathy

15. Canon Body X-ray

16. Heat Stroke

17. UTI Lab Report

18. Parkinson

19. Case of Exacerbation of copd by infection. All qs regarding it like Dx? Investigations? Details of
management. Counselling.

20. Trucut Biopsy Needle- how will u prep the patient a day before, C/i.

CXR of mottled b/l opacities ddx from history was occupational lung disease (specifically Bysinossis as he
was in textile). Questions on complication of occupational lung disease, effects on heart finding on ecg

21. case.. worker in factory for 15 yrs... dry cough progressv sob... investigations... it was sarcoidosis
trucut liver instru... 2 indications 2 contraindi and complications ...

22. EcgAFORSVTunobserved, Findings? Diagnosis? Furthertest? Management.

23. CXR TB

24. CXR Asthma

25. XRninstrument
26.CT scan of hydatid cyst and instrument was lumber puncture

27. Acromegaly

etiology; growth hormone-secreting pituitary adenoma

C/S/S enlarged nose, forehead, and jaw (macrognathia) with diastema

Widened hands, fingers, and feet

Painful arthropathy (ankles, knees, hips, spine)

Dx Serum IGF-1 concentration: the best single test

Elevated IGF-1 level: acromegaly suspected; conduct oral glucose tolerance test (OGTT).

Pituitary MRI

Rx Surgery

Transsphenoidal adenomectomy (preferred method)

Medication

Somatostatin analogs (e.g., octreotide, lanreotide)

28. Hydrothorax XR

29. Gouty Arthritis

C/S/S Acute severe pain with overlying erythema, decreased range of motion, swelling, warmth

Possibly fever

Symptoms are more likely to occur at night, typically waking the patient

location Podagra: metatarsophalangeal joint (MTP joint) inflammation of the big toe (the most common
site)

Gonagra: inflammation of the knee

Chiragra: inflammation of finger joints, especially metacarpophalangeal joint of the thumb

Dx CBC and inflammatory markers: WBC and ESR are typically elevated in an acute gout attack

serum uric acid level

Synovial fluid analysis is the gold standard for diagnosing gout

Ultrasound

X-ray

Rx Lifestyle modifications may help reduce the risk of flares.

Limit alcohol consumption

Limit intake of purines (e.g., red meat and shellfish)

Limit high-fructose corn syrup (e.g., sugary foods, juices, and non-diet sodas)

Weight loss if patient is overweight

glucocorticoids, NSAIDs, or colchicine

30. Bell's Palsy

31. Foley Catheter, Chest Tube