By Dr. Zahoor 1. Question 1 1. What is the diagnosis? 2

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DATA INTERPRETATION 2 By Dr. Zahoor

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Question 1

1. What is the diagnosis?

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Answer 1

1. Acute Anterior Myocardial Infarction (deep Q waves, elevated ST segments and T

wave inversion are seen in V1 – V5)

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Question 2This is the ECG of

55 year old who is drowsy and confused.

1. What abnormalities are present?

2. What is the diagnosis?

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Answer 2

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

2. Hyperkalemia

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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)

1. What is the diagnosis?

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Answer 3

1. 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

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Question 4 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+

1. What is the diagnosis?2. What investigation will confirm the diagnosis?3. What was the rash?

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Answer 4

1. Coeliac Disease He has mixed macrocytic and microcytic anaemia suggesting iron and Folate (possibly B12 deficiency)

2. Jejunal biopsy

3. Dermatitis Herpetiformis (itchy vesicular rash is associated with celiac)

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Question 5 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

1. What is the diagnosis?

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Answer 5

1. Tuberculous Meningitis

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Question 6A man of 55 collapses outside a restaurant. He is on no drug

therapy:

1. What is the underlying endocrine abnormality?

2. 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

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Answer 6

1. Inappropriate ADH secretion

2. Plasma and Urine Osmolality In inappropriate ADH secretion plasma

Osmolality is low and urinary Osmolality is high

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Question 7An 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)

1. What is the most likely diagnosis?2. How can this diagnosis be confirmed?

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Answer 7

1. Sleep apnea

2. Polysomnography

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Question 8A woman with Vitiligo became anemic. MCV 120

fl.

1. What is the diagnosis?

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Answer 8

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

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Question 9A 60 year old man admitted for a hernia repair is found to

have

1. What metabolic derangement is present?

2. Give two possible causes.

Plasma sodium 144

Potassium 2.9

Bicarbonate 35 mmol/L

Blood urea 5.5 mmol/L

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Answer 9

1. Hypokalemic alkalosis with normal renal function

2. Long term diuretic therapy Corticosteroid therapy Conn’s syndrome

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Question 10A 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?

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Answer 10

1. 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

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Question 11

1. What is the diagnosis?

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Answer 11

1. Pleural Effusion

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Question 12

1. What is the diagnosis?

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Answer 12

1. Left sided Pneumothorax

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Question 13

1. What is the diagnosis?

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Answer 13

1. Tension Pneumothorax

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Question 14

1. What is the diagnosis?

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Answer 14

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

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Question 15

1. What is the diagnosis?

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Answer 15

1. Left ventricular aneurysm (there is outward and upward bulge of left

ventricular apex)

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Question 16

1. What is the diagnosis?

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Answer 16

1. Pericardial Effusion Heart shadow is enlarged and globular in

shape and covers both hila

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Question 17

Patient presented with Raynauds PhenomenonWhat do you see in this X Ray Hand?

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Answer 17

Soft Tissue Calcification

Osteolysis

Systemic Sclerosis

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Question 18

1. What will you do?

This is X-ray abdomen of a young child. He swallowed an engagement ring incidentally.

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Answer 18

1. Should pass spontaneously

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Question 19

1. What is heart rate ? 2. See the rhythm strip, what do you find ?

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Answer 19

1. Heart rate 50/minute (Sinus Bradycardia)

2. APCs – Atrial Premature Contractions

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Question 20

1. What is heart rate ? 2. What abnormality do you find?

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Answer 20

1. Heart rate 94/minute

2. Left axis deviation VPC – Ventricular Premature Contraction

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Question 21

1. What is the diagnosis ?

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Answer 21

1. Ventricular Tachycardia – wide complex tachycardia

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Thank you