1. DATA INTERPRETATION MED -2
By Dr. Zahoor

2. Question 1
1. What is the diagnosis?

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

4. 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?

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

6. Question 3 A woman of 50 with nausea and anorexia.
Calcium 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?

7. 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

8. 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?

9. 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)

10. 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?

11. Answer 5
Tuberculous Meningitis

12. 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

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

14. 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):
PO kPa (78 mmHg)
PCO kPa (43 mmHg)
What is the most likely diagnosis?
How can this diagnosis be confirmed?

15. Answer 7
Sleep apnea
Polysomnography

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

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

18. 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

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

20. 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
T nmol/L (1.2 – 3 nom/L)
TSH 3mU/l ( 1-6 mU/l)
1. What is the most likely diagnosis?

21. 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

22. X RAYS & ECGs

23. Question 11
1. What is the diagnosis?

24. Answer 11
1. Pleural Effusion left side

25. Question 12
1. What is the diagnosis?

26. Answer 12
1. Left sided Pneumothorax

27. Question 13
1. What is the diagnosis?

28. Answer 13
1. Tension Pneumothorax

29. Question 14
1. What is the diagnosis?

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

31. Question 15
1. What is the diagnosis?

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

33. Question 16
1. What is the diagnosis?

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

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

36. Answer 17
Soft Tissue Calcification
Osteolysis
Systemic Sclerosis

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

38. Answer 18
Should pass spontaneously

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

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

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

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

43. Question 21
What is the diagnosis ?

44. Answer 21
Ventricular Tachycardia – wide complex tachycardia

45. Question 22 Comment on the ECG

46. Answer 22
Hyperkalemia
Tall T waves

47. Question 23 Comment on the ECG

48. Answer 23 LBBB M shaped R-R waves in V5 & V6
Wide QRS complex > 0.12 sec.

49. Question 24 Comment on the ECG

50. Answer 24 RBBB M shaped R-R waves in V1 & V2
Wide QRS complex > 0.12 sec.

51. Question 25 Comment on the ECG

52. Answer 25 Supraventricular tachycardia Narrow QRS complex tachycardia.
P wave is not seen
Heart rate is 190/min.

53. Question 26 Comment on the ECG

54. Answer 26 WPW syndrome Short PR interval
Delta wave (slurring of upstroke of QRS complex).

55. Thank you