01

X ray

55 year old male with history of hypertension presents with shortness of breath for 6 hours.

Here is his chest X Ray

1. What are the findings?2. What is the diagnosis?

01 KeyFindings: Cardiomegaly, Upper lobe diversion

A 35 year old male presents with progressive shortness of breath for last 6 month. He also has dry cough and joint pains.

What are the findings in this chest X Ray?What is the diagnosis?List two differentials.

02 - KeyFindings: Bilateral Hilar Lymphadenopathy

Right Paratracheal Strip enlargement

Bilateral infiltrates involving predominantly the mid zones

Diagnosis: Sarcoidosis

DD, TB, Lymphoma

03 - ECG

A 35 year old female presents with sudden onset palpitations. Here is her ECG.a) What are the findings?b) What is the diagnosis?c) If her BP is 80/ 60 mmHg, what immediate step will you take?

04 - ECG

A 55 year old male presents with sudden onset chest pain and vomiting for two hours. Here is her ECG.a) What are the findings?b) What is the diagnosis?c) List immediate management steps.

05 - CTA 30 year old male, IV drug abuser presents with fever, focal fits and altered mentation. On examination, there is left sided weakness.

a) List four possible differential diagnoses.

06 - CTA 55 year old hypertensive male presents with sudden onset of headache and irritibility.

What is the diagnosis?How will you manage?

• A 23 year old female has an impulsion to check the door locks again and again. She checks the locks 6 to 7 times before sleeping but still feels insecure and wants repeated reassurances.

What is the diagnosis?How will you manage?

• A 50 year old female survivor of a bus bomb blast has difficulty sleeping 6 months after the incident. She has frequent flashbacks of the event and avoids public transportation. There are also frequent episodes of weeping.

What is the diagnosis?How will you manage?

Identify the skin lesion.What is the treatment?

Identify the skin lesion.How will you treat?

a) What is the lesion?b) What lab investigation will you

suggest?

An 18 year old girl presents with fever, sore throat and cervical lymphadenopathy.a) Identify the peripheral film.b) What further investigation will

you suggest?

Identify the peripheral filmWhat is the diagnosis?

Identify the peripheral film.What further investigations will you order?

• CSF RE Report– Appearance: Turbid– Xanthrochromia: Nil– TLC: 250– N 95 %– L 05 %– Protein s 78mg/dl– Sugar 27mg/dl (BSR 120

mg/dl)

Interpret the given CSF report

• ABGs– pH 7.31– pCO2 65 mmHg– pO2 47 mmHg– HCO3 30 mEq/L– O2 Sat 76%

Interpret the given Arterial Blood Gases Report.

• A 31 year old female presents with history of fever and jaundice for 7 days, and altered conconciousness for 1 day.

• On exam, she has bruises all over her body.

• Labs reveal– Bilirubin 14 mg/dl– ALT 3327 IU/ml– AST 2980 IU/ml– Alk Phos 380 IU/ml– PT 50/13 sec– aPTT 78/33 sec

What is the diagnosis?What further investigations will you order?How will you manage?

• A 35 year old female presents with worsening fatigue over the past 6 months. On examination she has bilateral partial ptosis. Power 4/5 in all 4 limbs.

What is your diagnosis?List one important differential.How will you investigate?

• Station 3• (3) Instrument • (a) Identify the instrument.• (B) Contraindications for its use.• (c) specific precautions during the procedure.

Identify the rhythmTreatment?

Station 6

Station 9

• A 14 year school girl presents in emergency with 03 days severe abdominal pain and vomiting. On examination she is drowsy, severely dehydrated and has labored breathing. She has a BP of 90/60mm Hg and her temp is 100⁰F. Her blood sugar is 600mg/dl.

• • What is the diagnosis?• How will you investigate?• How will you manage?

Station 10

• Identify this drug.• State the indications and contraindications of

its use.• State the adverse effects.

Station 11

• A 21 year old woman gave birth to a child 2 days ago. After birth she is unable to sleep and reluctant to hold her child or feed him. But she claims of not harming her child.

• Diagnosis • If treatment required? If yes then describe.• Name the other pregnancy related psychiatric

disorder.

Station 13

A 60-year-old male presented at the Emergency Room withsevere chest pain of sudden onset. This was his CXR (Fig. 12.1). What isthe diagnosis?

• (Interactive)• A 23 year old male, known asthmatic for 4

years presents with worsening shortness of breath for 6 hours. On exam, he has Pulse of 140/min, RR of 40/min, and BP 90/60mmHg. He is cyanosed. Chest is bilateral silent.

• How will you manage this patient?

• (Interactive)• A 28 year old female has recently been

diagnosed with HIV while screening at the time of delivery of her first baby. She is worried and apprehensive about the disease.

• How will you counsel her?

• Key of HIV– Validity of Diagnosis, ELISA, Western blot?– History (Needlestick, Blood transfusion, sexual

activity)– Reassurance– Counsel about HAART– Counselling regarding the risk of vertical

transmission and breast feeding.

• BLS – Dummy• A 50 year old male suddenly collapses in the

market. You happen to be at the site. How will you proceed?

Warfarin

What are the indications of this drug?List 3 side effects

Clubbing

Lid Lag