Interactive station This gentleman is recently diagnosed as Essential Hypertension. Please answer his questions. Q1. Q2.

How long I have to take anti-hypertensive? Why should I take the drugs, I have no problems?

Q3. What will happen if I do not take the treatment?

Static station

Q1. What are the ECG findings?

Static station

This 12 lead EKG was obtained from 55 year old female who brought to ER with severe retrosternal chest pain radiating to both arms for four hour duration associated with profuse sweating, nausea and vomiting. A. What is the diagnosis? B. What further investigations are required in this patient? C. How will you manage this patient? Static station

A 50 year old female known case of Hypertension brought to ER with sudden onset of head ache and loss of consciousness and fits. Q1. Q2. Q3. What is the diagnosis? What are the risk factors associated with this condition? How will you treat this patient?

Static station

A 22 year old male is admitted to ICU with head ache, fever and altered behavior and fits one day duration. On examination patient appears confused, irritable and smacking his lips, neck stiffness and kernings sign positive. CSF: Protein 178 mg/dl (15-45), glucose 70 mg, blood glucose 135 mg/dl, WBCS 200/cumm predominantly (90%) lymphocytes 1. What is the diagnosis? 2. What further tests you would do to confirm your diagnosis? 3. How will you treat this patient?

Interactive station

Inhaler technique Q1. How to use inhalers? Q2. What are the advantages of inhalers? Q3. What is alternative to inhaler, when difficult to use inhaler?

Static station

A 50 years old man, life long smoker presented to ER with fever, cough and hemopytsis for three days Q1. What is the likely diagnosis? Q2. What is the differential diagnosis? Q3. How will you treat this? Static station

This chest X Ray was taken from a 35 year old tall man, who presented with left sided chest pain and severe dyspnea of sudden onset. On examination tachypnic, chest movements reduced, percussion note hyper resonant and diminished breath sounds on the left side.
Q1. What is the diagnosis? Q2. What are the causes leading to this condition? Q3. How will you manage this case?

Static station ABG analysis

Ph patient 7.1
68 60 37

pCO2
pO2 HCO3 O2 Sat %

81

Arterial (Normal) 7.35 - 7.45 35 45mmHg 80 100mmHg 22 26mmol/L 94 - 98

Venous (Normal) 7.32 7.42 38 52mmHg 28 48mmHg 22 26mmol/L 40 - 70

This ABG is obtained from a 55 year old man known to have chronic obstructive airway disease, admitted with worsening of shortness of breath. Q1. What are the ABG findings? Q2. What is this type of respiratory failure? Q3. What are the initial management steps in this patient?

Static station Pleural fluid analysis Appearance Color Coagulum Fluid sugar Fluid Albumin Cell count

Turbid Yellowish Positive 38 mg /dl, blood 130mg 2.2 g/dl, serum 3.4g/dl 200/cumm, 90% Lymphocytes

This pleural fluid analysis was obtained from a 25 year old female who presented with three weeks history of cough, fever and shortness of breath. Q1. What are the pleural fluid findings? Q2. What is the likely diagnosis? Q2. What further tests you would do to confirm your diagnosis?

Interactive This gentleman presents to out patient with heart burning and regurgitation on lying down for two month duration. He smokes 40 cigarettes per day for 15 years. His BMI is 38kg/m. He is diagnosed as GERD. Please answer his questions Q1. Am I having heart problem? Q2. What precautions do I have to take? Q3. How long I have to take drugs?

Static station A 30 year old male presents to out patient with heart burning and regurgitation on lying down for two month duration. He smokes 40 cigarettes per day for 15 years. His BMI is 38kg/m2. Q1. What is the diagnosis? Q2. What is the pharmacological treatment for this gentleman? Q3. What non - pharmacological measures are required for the management of this patient?

Static station

A 24 year old gentleman, he is diagnosed case of cirrhosis of liver with ascites. Recently he developed abdominal pain and fever. Blood CP revealed leukocytes with neutrophilia
Q1. What is the most probable diagnosis? Q2. What is the single test by which you confirm your diagnosis? Q3. What is the drug of choice for this patient?

Interactive This 25 years old apparently healthy pregnant lady is found to be Anti HCV reactive on routine ante natal screening. She is worried about her lab report and wants to ask you more questions. Q1.

Q2.

Q3.

Static station A 36 year old staff nurse visited your clinic with jaundice of three days. Similar illness was seen in other two staff nurses 10 days earlier. She is pregnant, her LFTS are as under: Total bilirubin= 13.0 mg/dl, direct 8, indirect 5, SGPT (ALT) = 1450 IU/L, Alkaline phosphatase = 189 (N<168), PT = 26 seconds, HAV IgM = Non - reactive, HBsAg = Non - reactive and HCV = Non - reactive Q1. What is the most probable cause of this acute hepatitis? Q2. What single investigation you will do? Q3. What is the prognosis (risk of death)?

Static station A 57 year old gentleman, admitted with altered mental status for one day. He was found be drowsy and stuperous. On clinical examination he has had palmar erythema, generalized wasting, leukonychia and ascites. Q1. What are your three differential diagnoses? Q2. What are the precipitating factors for this? Q3, Write three steps of management

Interactive This young obese male is recently diagnosed as diabetes mellitus type 2, kindly counsel her about: Q1. Q2. Q3. Diet Weight management How to initiate therapy

Interactive This young female is recently diagnosed as type 1 DM, counsel her regarding insulin therapy Q1. Why I should take insulin, when my ante takes tablets for her DM? Q2. What will happen if I would not take insulin? Q3. What dietary measures should I adopt?

Static station

This photograph was obtained from a patient known to have long standing diabetes mellitus Q1. What is the likely diagnosis? Q2. What are the factors contributing in this problem? Q3. How will you manage this patient?

Static station A 15 year old female is admitted to ER with Diabetic Ketoacidosis which is treated. She is not known to have diabetes prior to the admission. Q1. Q2. Q3. What are the treatment options? What are the complications of the disease? What are the complications of the treatment?

Static station

This photograph is obtained from lady who has heat intolerance and loss of weight despite good appetite. On examination she has fine tremors in hands, sweaty and warm hands.
Q1. What is the likely diagnosis?

Q2. What investigation you would like to do to confirm your diagnosis? Q3. What are the treatment options?

Static station

This lady presented to out patient clinic with weight gain difficulty in rising from chair. On examination she has central obesity and purple striae over the trunk. Q1. What is the likely diagnosis?

Q2. What further investigation you would do to support your diagnosis? Q3. What are the causes of this disease?

Static station

A 50 year old man admitted to the medical ward with three weeks history of anorexia, nausea, hiccup, and shortness of breath Blood urea ( 10 50 ) 165 mg/dl S. Creatnine ( < 1.2 ) 8.5mg/dl Na ( 134 148) 145 mmol/L K ( 3.5 5.0) 6.5 mmol/L CL ( 98 114 ) 110 mmol/L HCO3 ( 17.5 27.5 ) 08 mmol/L Hb 08 g/dl, normocytic normochromic anemia Q1 Q2. Q3. What is the diagnosis? What further investigations are required for the management and diagnosis? What are the causes of this problem?

Static Station
Urine Examination

Color Appearance Chemical Examination pH Specific Gravity Protein Urine Sugar Ketone Bodies Blood Bilirubin Urobilinogen Nitrate Microscopy WBC RBC Epithelial Cast Crystal Others

Yellow-red Reddish 6.0 1010 ++ Nil Nil +++ Nil Nil Nil 3-4/HPF Plenty Granular

This urinalysis taken from a 24 year old lady presented with periorbital puffiness in the morning. On examination she has butterfly rash over the face, alopecia, periorbital swelling, BP 160/110.
Q1. What is the likely diagnosis? Q2. What further investigation you need to do to confirm your diagnosis? Q3. What other systems may be involved in this condition?

Static Station

A 35 years male was admitted with severe watery diarrhea and vomiting one day duration. On examination patient was found be dehydrated with postural hypotension. The lab results are as under: Na = 158mmol/L, K = 5.3, Cl = 120, HCO3 = 10
Urea = 120 mg/dl, Creatnine = 2.3 mg/dl.
Q1. Q2. What are the electrolyte abnormalities? What type of fluid you will give and how much?

Q3. What complication would occur if not treated properly?

Static Station A 42 years of male complaints of fatigue, muscle aches and low grade fever of 1000F for 3 weeks. On examination vitals are stable and patient is anemic with massive splenomegaly. His blood CP shows: Hb=8.5g/dl, TLC=6000/cumm, PLT=55000/cumm
Q1. What is the diagnosis?

Q2. What further tests you would to do confirm your diagnosis? Q3. Give three management steps.

Static Station

Blood CP
Erythrocytes(RBCs) (4.8-701) Hemoglobin (13.5-19.5) MCV (96-108) MCH 32-34 MCHC 27-33 ESR LEUKOC0YTES (WBCs) (4-11) Neutrophils Lymphocytes Monocytes Eosinophils Basophils Platelets count (150-400) 3.2X10 12/L 7g/dl 115 ft 10 mm/1hr 4.5X10 9/L

230X10 9/L

A 12 year old boy strict vegetarian presented with easy tiredness and palpitation. His full blood counts shown above:
Q1 What is the likely diagnosis? Q2. What further investigations you need to confirm the diagnosis? Q3 How will you treat this patient?

Static Station

This clinical image was taken from a 55 year old male who presented to out patient clinic with pain and swelling of small joints of hands and feet for two years duration.
Q1. What is the likely diagnosis? Q2. What other systems are likely to be involved in this patient? Q3. Name the drugs that can modify the natural course of this disease

Static Station

25 years old male presented with fever for 10 days, high grade, continuous in nature. His Temp: 103F on pulse 90 beats/ min. His blood CBC shows Hb: 10 g/dl, TLC count 2300/cumm and platelet count 250000/cumm. Q1: What is the diagnosis?

Q2: What is the investigation of choice? Q3. What other clinical signs you might find?

Static Station

This image was obtained from a 20 years old male who was admitted with H/O fever, headache, vomiting and collapse at home for one day. He has skin rash over limbs. His CSF report shows: Protein: 100 mg/dl Glucose: 15mg/dl TLC: 200/cumm Lymphocytes: 20% Neutrophils: 80% Gram-ve diplococci on Gram staining Q1. What is the diagnosis? Q2. What is treatment of choice? Q3. What precaution you will advise to his households?