4- A 54 year old male presents with case of

repeated episodes of redness of upper body

specially neck and face which in many
circumstances is associated with diarrhea.
Patient feel warmth and itchiness. He has
noticed that these episodes are precipitated
when he exercises or consume cheese. These
episodes typically last for 15 to 20 minutes.
Flushing of skin upper trunk
On examination, his skin showed dry scaly
lesions.
Plasma and urine investigation revealed raised
serotonin and its metabolite 5-hydroxy-
indoleacetic acid (5-HIAA).
Urinary 5-HIAA = 170 mg/day (normal is <10
mg/day)
QUESTIONS
Carcinoid syndrome.
Q.1. What may be the diagnosis in this case?
Q.2. What is the treatment advised in such
cases?

5- A55 year old male presents with the history

of pain in the right big toe since morning .He is
not a regular alcoholic but gives the history of
consumption of alcohol on previous night in the
party along with nonvegetarian items.
On examination, the affected area was found to
be swollen, tender and warm. Patient had
similar episode of pain 1 year back when pain
started in knee joint and then involved big toe
in the right limb. Patient had consulted general
physician who prescribed certain medications
(allopurinol) and patient improved ni 4 days.
Swollen tender big toe
Biochemical investigation revealed high level of
serum uric acid whichwas 8.6mg/dl. Rest other
routine parameters of KFT, LFT, lipid profile and
serum electrolytes were normal
QUESTIONS GOUT
Q.1. What may be the possible diagnosis in this
case?
Q.2. What is the rationale behind consumption
of alcohol and precipitation of the symptoms?
Alcohol produces NADH which
precipitates Gout attack

6- A 2-year-old child of a poor farmer is brought

to the hospital with history of severe weight
loss, irritability and repeated infection. He is
youngest of 4 siblings. On examination, baby
was emaciated* with dry and shrunken eye.
Bony rib cage was prominent and baby had
labored breathing. His body weight is 6.5 kg
(normal weight of 2-year-old healthy boy is 12
kg). Following are the results of various
laboratory investigations: Blood glucose: 5
mg/dl(normal random = 80-140 mg/dl) Total
protein: 6.5 g/dl (normal = 5.5-8.5 g/dl)
Albumin: 3.2 g/dl (normal = 3.5-5.5 g/dl)
QUESTIONS
Q.1. Comment on the condition baby is
suffering from.
Q.2 What is the plan of management ni this
case
7-a) Comment on this graph
 b) Mention the fasting and post prandial
value of glucose for present condition

Multiple myeloma
8-a)Mention the diagnosis based on the
patients electrophoretic pattern?
b)What is M band in serum electrophoresis?
9-solve the question given below
10- a)which cardiac biomarker shown as arrow
in graph?
b)write the cardiac marker of reinfarction?