1. By Dr. Zahoor 1

2. Question 1: 1.What is shown in the picture? 2.What is most likely cause? 2

3. Answers 1 1.Carpopedal spasm 2. Hypocalcaemia 3

4. Question 2: 1.What abnormality does this chest X-ray show? 2.What is the likely diagnosis? 4

5. Answers 2 1.Bilateral hilar lymphadenopathy 2.Lymphoma Sarcoidosis Leukemia 5

6. Question 3 1.What abnormality is shown? 2.What is the most likely cause? 6

7. Answers 3 1.Haemorrhages - Exudates 2. Diabetic retinopathy 7

8. Question 4 1.What is seen in the picture? 2.What could be the cause? 8

9. Answers 4 1.Petichel Hemorrhages (purpura) 2.Thrombocytopenia - Drugs e.g. Thiazide diuretic, heparin, Quinine, NSAID drugs, Ranitidine 9

10. Question 5 1.What abnormality is shown? 2.What could be the cause? 10

11. Answers 5 1.Mediastinal mass 2.Lymphoma Thymoma Metastatic carcinoma Leukemia 11

12. Question 6 1.What abnormality is shown? 2.What is the most likely cause? 12

13. Answers 6 1.Koilonychia 2.Iron deficiency anaemia 13

14. Question 7 1.What does the X-ray show? 2. What is the diagnosis? This patient had progressive dysphasia. Barium swallow was done. 14

15. Answers 7 1.Narrowing of lower end of Esophagus 2.Achalasia 15

16. Chest X-ray of middle aged man Question 8 1.What does this X-ray show? 2.What is likely diagnosis? 16

17. Answers 8 1.White shadow left apex 2.Most likely left apical carcinoma, Pancoast tumor 17

18. Question 9 1.What is shown in the picture? 2.What could be the cause? This patient was presented with headache. 18

19. Answers 9 1.Papilloedema 2.Raised intracranial pressure e.g. brain tumor, meningitis 19

20. This patient is presented with weight loss. Question 10 1.What this X-ray chest is showing? 2.What is the diagnosis? 20

21. Answers 10 1.Chest X-ray shows multiple rounded shadows in the lung fields 2.Multiple secondaries - cannonball secondaries (primary carcinoma site in kidney or testes) 21

22. Question 11 1.What is the diagnosis? 2.What is the treatment that you would give? 22

23. Answers 11 1.Acute gout 2.Anti-inflammatory drugs e.g. Voltaren, Brufen 23

24. Question 12 1.What does the skull X-ray show? 2.Give two causes. 24

25. Answers 12 1.Multiple lytic lesions in the skull 2. Multiple myeloma Multiple secondaries 25

26. Question 13 1.What is shown in the picture? 2.Give two pulmonary conditions which may cause this appearance. 26

27. Answers 13 1.Finger clubbing 2.Bronchial carcinoma Bronchiectasis Fibrosing alveolitis Empyema 27

28. Question 14 1.What is this skin condition? 2.What disease are associated with it? 28

29. Answers 14 1.Pyoderma gangrenosum (skin ulceration with clear cut margin) 2.Ulcerative colitis Crohn’s diasease 29

30. This patient aged 35 years had diabetes mellitus. Question 15 1.What is this lesion? 30

31. Answers 15 1.Necrobiosis lipoidica It is closely associated with diabetes mellitus. Ulcerated Plaques look yellow because of high lipid content. 31

32. Question 16 1.Give two abnormal physical sign. 2.What is the most likely diagnosis? 32

33. Answers 16 1.Arthritis of proximal interphalangeal and metacarpophalangeal joints Vasculitis 2. Rheumatoid arthritis 33

34. Question 17 1.What this picture is showing? 2.What is likely diagnosis? 34

35. Answers 17 1.Hands are thick 2.Acromegly 35

36. Question 18 1.What physical sign is shown? 2.Give two likely causes. 36

37. Answers 18 1.Erythema nodosum (hypersensitivity vasculites) 2. Sarcoidosis Streptococcal infection Tuberculosis Drugs e.g. oral contraceptives Chronic inflammatory bowel disease 37

38. Question 19 1.What is the abnormality? 2.What could be the cause? 38

39. Answers 19 1.Optic atrophy 2.Glaucoma Multiple sclerosis Methyl alcohol 39

40. Question 20 1.What this picture is showing? 2.What is the differential diagnosis? 40

41. Answers 20 1.Cushingoid appearance with moon face and plethora 2.Cushing syndrome Exogenous Glucocorticoids 41

42. Question 21 1. What is the diagnosis? 42

43. Answer 21 1. Psoriasis 43

44. Question 22 1.What this picture is showing? 2. What is the diagnosis? This boy presented with abdominal pain following upper respiratory tract illness. 44

45. Answers 22 1.Purpuric rash 2.Henoch-Schonlein purpura Aetiology is unknown, precipitating factors include streptococcal infection, drugs e.g. penicillin 45

46. Question 23 1.What is the diagnosis? 2.How will you confirm the diagnosis? 46

47. Answer 23 1.Acromegly 2.Increased level of growth hormone which fails to suppress during oral glucose tolerance test - Lateral skull X-ray - CT 47

48. This is the peripheral blood film. Question 24 1.What does it show? 2.What could be the possible cause? 48

49. Answers 24 1.Lymphocytosis 2.Viral infection Chronic lymphatic leukemia 49

50. Question 25 1.What this picture is showing? 2.What drug causes it? This patient had renal transplant and is on drug therapy 50

51. Answers 25 1.Gingival hyperplasia 2.Cyclosporin Note Other causes of gingival hyperplasia include drugs phenytoin, cyclosporin, oral contraceptives - Pregnancy - Scurvy - Acute monocytic leukemia 51

52. Question 26 1.What physical signs are present? 2.What is the likely diagnosis? This young girl has deep voice and blood pressure 180/105 52

53. Answers 26 1.Cushingoid features and hirsutism 2.Congential adrenal hyperplasia Androgen secreting ovarian neoplasm 53

54. Question 27 1.Give two observations you find in this picture. 2.What is the diagnosis? 54

55. Answers 27 1. Right eye ptosis and meiosis (smaller pupil) 2. Horner syndrome (lesion affecting sympathetic supply to the eye) 55

56. Thank you 56