1. Tutorial MED – I 29/01/2016 Dr. M. Sofi MD; FRCP (London); FRCPEdin; FRCSEdin

2. 40 year old man presented with cough and shortness of breath for six months. Six weeks ago he noticed painful lumps on the skin of his legs which had resolved in two weeks Investigation: FBC: normal Sodium 145 mmol/l Potassium 2.8 mmol/l Chloride 100 mmol/l Urea 2.4 mmol/l Serum creatinine 83 µmol/l Calcium 3.4 mmol/l 1.What is the abnormality in CXR? 2.What is the most likely diagnosis?

3. Sarcoidosis Infection – Tuberculosis – Fungal infection – Mycoplasma – Intestinal Lipodystrophy (Whipple's disease) Malignancy – Lymphoma – Carcinoma – Mediastinal tumors In-organic dust disease – Silicosis – Berylliosis Extrinsic allergic alveolitis – Such as bird fancier's lung Less common causes also exist: – Churg-Strauss syndrome – Human immunodeficiency virus – Extrinsic allergic alveolitis – Adult-onset Still's disease Bilateral hilar lymphadenopathy: Causes

4. 28 year old lady presented with sharp chest pain which radiated to trapezius ridge and was worse in supine position lasted for hours 1.What are conspicuous changes in ECG? ------------------- 2.What is the likely diagnosis? --------------------------------

5. Idiopathic causes Infectious conditions: – Viral – Bacterial – TB Inflammatory disorders: – RA – SLE – Scleroderma – Rheumatic fever Metabolic disorders: – Renal failure – Hypothyroidism – Hypercholesterolemia Cardiovascular disorders: – Acute MI – Dressler syndrome – Aortic dissection Miscellaneous causes: – Iatrogenic, – Neoplasms, – Drugs, – Irradiation, – Cardiovascular procedures – Trauma Pericarditis: Causes:

6. 1.Describe the abnormal ECG finding? ________ 2. What is the diagnosis? ________________

7. This 23 year old university student presents to A/E acutely short of breath. 1.Describe your findings on chest X-ray a.------------------------ b.------------------------ 2.List 2 conditions that predispose to this condition? a.------------------------ b.------------------------

8. 40Year man presented with painful lesion on his chest 1.What is anatomical localization of the lesion?-------------- 2.What is diagnosis?-----------------

9. A 40 year old man presented with fatigue, fever and painful goitre. The results of investigations were as follows: Hb 14.3 g/dl WBC 11.2 x 10 9/l ESR 100 mm in the first hour T432.4pmol/l (NR 9.4 – 24.5) TSH ˂ 0.1mU/l (NR 0.5 – 5.5 ) Radio-iodine 131 thyroid scan: uptake at 4 hours ˂ 5% (normal range 6 -18%) 1.What are the lab result abnormalities? 2.What is the most likely diagnosis? 3.What treatment is required? A man with painful goitre

11. A 15 year-old boy with a history of first episode generalized tonic-clonic convulsion. He seemed tired in the morning but still attended his inter- school sports competition. He collapsed and had a self-limiting seizure (5 minutes duration). He was afebrile and had GCS 13 (E3 V4 M6) (fluctuating) for about 4 hours without improvement. Pupils were equal and reactive and he had no focal neurological deficits. He vomited 5 times during this times. His CT head was normal. After returning from the scan he had another self-limiting seizure that lasted 2 minutes. U/E’s Na 125 mmol/L K 4.1 mmol/L Urea 3.7 mmol/L Cr 49 umol/L Venous blood gas pH 7.37 PCO2 42 mmol/L HCO3 24 mmol/L Cl 96 mmol/L glc 7.2 mmol/L lac 1.9 mmol/L FBC and LFTs were normal. 1.What are the laboratory abnormalities? _____________________________ 2.How do they relate to his presentation? ______________________________

12. A 48 year old female is concerned about her several episodes of fainting. Brief clinical examination reveals pallor of her skin. Her blood is: Hb8.7 g/dl MCV64.5 fl Plt556 x 10 9 /l WBC7.7 x 109/l Serum iron6 µmol/l(NR: 65-180 µg/dL ) Ferritin10 µmol/l(NR: 12-300 ng/mL) TIBC90 µmol/l(NR: 45-85 µmol/L) Vitamin B12221 ng/l(NR: 130-700 ng/L) Folate9.2 µgl/l(NR: 7-36 nmol/L How would you interpret these results? a.--------------------------------- How would you proceed with investigations? a.-------------------------------- b.--------------------------------

13. Rheumatoid factor is? A.Cause of rheumatoid arthritis B.Present only in rheumatoid arthritis C.Are autoantibodies D.Disappear with successful treatment of RA The recognized extra-articular features of rheumatoid arthritis include? A.Diarrhea B.Impotence C.Pancreatitis D.Lymphadenopathy Laboratory tests useful in diagnosis if rheumatoid arthritis include? A.CBC B.Anti−cyclic citrullinated peptide (anti-CCP) C.viral screening by serologic testing D.Urine microscopy and culture

14. The inflammatory myopthies include? A.Duchene muscular dystrophy B.Beckers muscular dystrophy C.Polymyosotis and dematomyositis D.Spinal muscular atrophy Characteristic clinical manifestations of inflammatory myopathy include? A.Painful distal muscle weakness B.Throat and esophagus is typically spared C.Interstitial lung disease is not a recognized feature D.Typical presence of rash in patients with dermatomyositis Laboratory findings of inclusion body myositis include? A.Myositis-specific autoantibodies are abnormally high B.ESR and CRP are typically normal C.Antinuclear antibody titers are high D.EMG findings are diagnostic

15. Atypical bacterial pneumonia is caused by? A.Influenza virus B.Mycoplasma pneumoniae C.Respiratory syncytial virus D.Corona virus Viral pneumonia is likely to have? A.Signs of consolidation B.Spleenomegaly C.High WBC count D.Foul-smelling productive cough Type II respiratory failure hypoxemia (PaO2 6.0kPa) is commonly associated with? A.Pulmonary embolism B.Large pulmonary arterio venous shunt C.Acute pulmonary edema D.Chronic obstructive pulmonary disease

16. Most reliable diagnostic test for steatorrhoea is? A.Schilling test B.D-xylose absorption test C.Small intestinal mucosal biopsy D.Faecal fat estimation Characteristics of malabsorption syndrome include? A.Carbohydrate malabsorption typically has bulky malodorous stools B.Abdominal pain is characteristic in the absence of chronic pancreatitis C.Anemia may be the sole initial indication of celiac disease D.The prevalence of celiac disease in patients with type 1 diabetes mellitus is less than the general population Most common cause of fulminant hepatic failure is? A.Chronic active hepatitis B.Alcoholic hepatitis C.Acute viral hepatitis A D.Hepatitis B

17. With regard to migraine headaches? A.Ergotamine is a useful in migraine therapy in pregnant women B.Sumatriptan can be safely given for migraine with ischemic heart disease C.Migraine without aura (common migraine) can last up to three days D.50% of brain tumors present with migraine headaches Migraine headache is characterized by? A.Preceded by sensory aura in more than half of patients B.Frequency of attacks averages ten headache attacks per day C.Over half of all patients have first attack before the age of 30 D.Common underlying cause is intracranial arteriovenous malformation. Medical treatment for Parkinson’s disease includes? A.Dopamine antagonists B.Levodaopa/carbidopa C.Pyridostigmine D.Phenytoin