DATA INTERPRETATION MED -2 By Dr. Zahoor

Question 1 1. What is the diagnosis?

Answer 1 1. Acute Anterior Myocardial Infarction (deep Q waves, elevated ST segments and T wave inversion are seen in V1 – V5)

55 year old who is drowsy and confused. Question 2 This is the ECG of 55 year old who is drowsy and confused. What abnormalities are present? What is the diagnosis?

Answer 2 1. Bradycardia heart rate of 30/min - Absent P-wave - Tall T wave 2. Hyperkalemia

Question 3 A woman of 50 with nausea and anorexia. Calcium 1.63 mmol/L (N 2.25 – 2.62 mmol/L) Phosphate 2.50 mmol/L (N 0.8 – 1.4 mmol/L) Urate 0.88 mmol/L (N 0.21 – 0.37 mmol/L) What is the diagnosis?

Answer 3 Chronic renal failure High urate and phosphate are due to glomerular failure Hypocalcaemia is common in renal failure cause may be failure of conversion of vitamin D

Question 4 What is the diagnosis? A 35 year old man complains of weight loss and abdominal distention. Three years ago he was treated successfully for an itchy vesicular rash on his buttocks. Hemoglobin 8.3 g/dl MCHC 31 g/dl (N 32 – 36 g/dl) MCV 96fl (N 76 – 98 fl) Blood film : macrocytosis+ microcytosis+ anisocytosis+ poikilocytosis+ What is the diagnosis? What investigation will confirm the diagnosis? What was the rash?

Answer 4 Coeliac Disease He has mixed macrocytic and microcytic anaemia suggesting iron and Folate (possibly B12 deficiency) Jejunal biopsy Dermatitis Herpetiformis (itchy vesicular rash is associated with celiac)

Question 5 CSF findings: Pressure 24 cm water RBC 0 A 25 year old Asian is admitted with headache and neck stiffness. He has been on no treatment. CSF findings: Pressure 24 cm water RBC 0 WBC 275 × 106 (275/mm3) Lymphocyte 8o% Monocyte 10% Neutrophils 10% Protein 0.8 g/L (N 0.15 – 0.4 g/l) Glucose 1.8 mmol/L (N 3.3 – 5 mmol/L) Blood Glucose 5.7 mmol/L What is the diagnosis?

Answer 5 Tuberculous Meningitis

Question 6 What is the underlying endocrine abnormality? A man of 55 collapses outside a restaurant. He is on no drug therapy: What is the underlying endocrine abnormality? What test you will do to confirm the diagnosis? Na 115 mmol/L (N 133 – 145 mmol/L) K 4.2 mmol/L (N 3.5 – 5 mmol/L) Urea 1.8 mmol/L (3.3 – 7 mmol/L) Total protein 52 g/L

Answer 6 Inappropriate ADH secretion Plasma and Urine Osmolality In inappropriate ADH secretion plasma Osmolality is low and urinary Osmolality is high

Question 7 What is the most likely diagnosis? An obese 56 year old woman complains of daytime somnolence. Her husband says that she snores loudly. Investigations showed: Arterial blood (breathing air): PO2 10.4 kPa (78 mmHg) PCO2 5.6 kPa (43 mmHg) What is the most likely diagnosis? How can this diagnosis be confirmed?

Answer 7 Sleep apnea Polysomnography

Question 8 A woman with Vitiligo became anemic. MCV 120 fl. What is the diagnosis?

Answer 8 1. Pernicious anemia (due to anti bodies to intrinsic factor)

Question 9 What metabolic derangement is present? A 60 year old man admitted for a hernia repair is found to have What metabolic derangement is present? Give two possible causes. Plasma sodium 144 Potassium 2.9 Bicarbonate 35 mmol/L Blood urea 5.5 mmol/L

Answer 9 1. Hypokalemic alkalosis with normal renal function 2. Long term diuretic therapy Corticosteroid therapy Conn’s syndrome

Question 10 A 38 year old woman presents with swollen neck. Her blood pressure is 190/115 mmHg. Investigations: Serum Calcium 2.9 mmol/L (N 2.25 – 2.6 mmol/L) Creatinine 130 µmol/L (N 60 – 140 µmol/L ) Resting Calcitonin - normal T3 2.8 nmol/L (1.2 – 3 nom/L) TSH 3mU/l ( 1-6 mU/l) 1. What is the most likely diagnosis?

Answer 10 Multiple Endocrine Neoplasia – MEN IIa or Sipple’s Syndrome Raised calcium – parathyroid adenoma Mass in the neck with normal T3 and TSH – Medullary carcinoma of thyroid Hypertension - Phaeochromocytoma

X RAYS & ECGs

Question 11 1. What is the diagnosis?

Answer 11 1. Pleural Effusion

Question 12 1. What is the diagnosis?

Answer 12 1. Left sided Pneumothorax

Question 13 1. What is the diagnosis?

Answer 13 1. Tension Pneumothorax

Question 14 1. What is the diagnosis?

Answer 14 1. Mitral stenosis (Left border of the heart is straight, there is a loss of concavity in its shape)

Question 15 1. What is the diagnosis?

Answer 15 Left ventricular aneurysm (there is outward and upward bulge of left ventricular apex)

Question 16 1. What is the diagnosis?

Answer 16 Pericardial Effusion Heart shadow is enlarged and globular in shape and covers both hila

Question 17 Patient presented with Raynauds Phenomenon What do you see in this X Ray Hand?

Answer 17 Soft Tissue Calcification Osteolysis Systemic Sclerosis

Question 18 1. What will you do? This is X-ray abdomen of a young child. He swallowed an engagement ring incidentally.

Answer 18 Should pass spontaneously

Question 19 What is heart rate ? See the rhythm strip, what do you find ?

Answer 19 Heart rate 50/minute (Sinus Bradycardia) APCs – Atrial Premature Contractions

Question 20 What is heart rate ? What abnormality do you find?

Answer 20 Heart rate 94/minute Left axis deviation VPC – Ventricular Premature Contraction

Question 21 What is the diagnosis ?

Answer 21 Ventricular Tachycardia – wide complex tachycardia

Thank you