JAWAL-3LMNY

 T & F

Seizures may occur with the following metabolic abnormalities:

Hypoglycaemia
Porphyria
Hyponatraemia
Hypocalcaemia
Uraemia

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CASE SCENARIO ,,, A 55 year old man with headache andconfusion. He has a cough and a temperature of 38.2C . He doesnt complain of any other symptoms. On examination he looks thin and unwell and slightly drowsy. His mini mental test  score was 8/10. There were some crackels in upper zones of the chest posteriorly. His respiratory rate was 20/min. There were no neurological sings. Two months  earlier he was admitted with productive cough and acid fast bacilli in his sputum on direct smear. He had weight loss and complained of night sweating. He has a history of head injury. He smokes 15 cigarettes a day and is an alcoholic, he is homeless too. His chest x-ray showed patchy infiltration in the right upper lobe. What might be the cause of his second admission?

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CASE SCENARIO ,,, A 40 year old man with 2 month history of abdominal pain. The pain is epigastric or central and is  intermittent. He had a similar episode a year ago, took some indigestion pils & went after 10 weeks. The pain lasts for 30 to 60 min. It often occurs at night & wakes him up, and seems to improves after meals, but spicey food seems to bring on pain.  He had Smoked 15 cigarettes per day for 25 years. He is not on any medications & no other medical history. Haemoglobin 10.1 g/dl , RCC 6.4 X 10^12/l , MCV 72 fl , Iron 4 umol/l , Ferritin 7 umol/l. What is the likely diagnosis?

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CASE SCENARIO ,,, A 64 year old woman has a 10 year history of retrosternal pain. The pain it often present in bed at night. Occasionally, the pain comes on after eating & sometimes precipitated by exercise. The pain has been described as having a burning and a tight quality. It has no relation with respiration or position. On examination she is 1.64m tall & weighs 82kg. There is no findings. Chest x-ray is normal, exercise ECG is -ve, What is your diagnosis?

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CASE SCENARIO ,,, A 35 year old  man with painful right knee swelling. This has occurred rapidly over the past 36 hours. There is no history of trama or previous joint problems. He feels unwell & has noticed his eyes to be sore. No previous medical illness. He returned 3 weeks ago from a business trip to Thailand. Examination: temperature is 38C. Both eyes red, Brown macular rash on palms & soles. Examination of cardiovascular, respiratory, abdominal & neurology systems is normal. His  right knee is swollen, hot & tender. No other joints appears to be affected. Investigations: WCC 13.6 & ESR 64mm/h. What is your diagnosis?

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T & F

Graves’ Disease:

1. Is the most common cause of hypothyroidism
2. Is the result of an autoimmune process
3. Is associated with TSH receptor antibodies
4. Has a natural history of remissions and relapses
5. Patients may eventually may be hypothyroid

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CASE SCENARIO ,,, A 58 year old man present with 2 weeks of progressive swelling in his legs, no other significant medical illnesses. He smokes 20 cigarettes per day and drinks 15 units of alcohol per week. No medications. on examination, marked pitting edema on both legs till groin. His pulse is 72/min ,regular and blood pressure 140/90. His JVP is not raised and heart sounds are normal. Examination of his respiratory, abdominal & neurological symptoms is normal. Investigations: Albumin18 g/l , 24h urinary protein 12.6g. What is your diagnosis ?

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T & F

Causes of goitre include:

1.Lymphomas
2.Hashimotos Disease
3.Iodine Deficiency
4.Sulphonylureas
5.Sarcoidosis

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T & F

Causes of nephrotic syndrome include:

1. Systemic lupus erythematosus

2. Diabete mellitus

3. Amyloidosis

4. Renal Tuberclosis

5. Polycystic Kidneys

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CASE SCENARIO ,,, A previously healthy 27-year-old man comes to the physician complaining of a cough with
sputum production for the past 3 days. The cough has been keeping him up at night and it is
affecting his job performance. He has no prior history of respiratory disease. His temperature
is 37 C (98.6 F), blood pressure is 130/80, pulse is 70/min, and respirations are 18/min.
Physical examination is unremarkable. Which of the following is the most appropriate next step
in management?

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