JAWAL-3LMNY

CASE SCENARIO ,,, A 27 year old man presents to the outpatient clinic complaining of 2 days of facial and hand swelling. He first noticed swelling around his eyes 2 days ago, along with difficulty putting on his wedding ring because of swollen fingers. Additionally, he noticed that his urine appears reddish-brown and that he has had less urine output over the last several days. He has no significant medical history. His only medication is ibuprofen that he took 2 weeks ago for fever and sore throat, which have since resolved. On examination, he is afebrila, with heart rate 85 bpm and blood pressure 172/110 mmHg. He has periorbital edema: his funduscopic examination is normal without arteriovenous nicking or papilledema. His chest is clear to auscultation, his heart rhythm is regular with a nondisplaced point of maximal impulse (PMI), and he has no abdominal masses or bruits. He does have edema of his feet, hands, and face. A dipstick urinalysis in the clinic shows specific gravity of 1.025 with 3+ blood and 2+ protein, but it is otherwise negative.

• What is the most likely diagnosis?
• What is your next diagnostic step?

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MCQs on Renal

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MCQs on IBD

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Matching

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CASE SCENARIO ,,, A 27 year old man comes to the emergency room complaining of 2 days of abdominal pain and diarrhea. He describes his stools as frequent, with 10-12 per day, small volume, sometimes with visible blood and mucus, and proceeded by a sudden urge to defecate. The abdominal pain is crampy, diffuse, and moderately severe, and it is not relieved with defecation. In the past 6-8 months, he has experienced similar episodes of abdominal pain and loose mucoid stools, but the episodes were milder and resolved within 24-48 hours. He has no other medical history and takes no medications. He has neither traveled out of the United States nor had contact with anyone with similar symptoms. He works as an accountant and does not smoke or drink alcohol. No member of his family has gastrointestinal problems.

On examination, his temperature is 99F, heart rate 98 bpm, and blood pressure 118/74 mmHg. He appears uncomfortable, is diaphoretic, and is lying still on the stretcher. His sclerae are clear, and his oral mucosa is pink and clear. His chest is clear, and his heart rhythm is regular, without murmurs. His abdomen is soft and mildy distended, with hypoactive bowel sound and moderate diffuse tenderness but no guarding or rebound tenderness.

Laboratory studies are significant for a white blood cell count of 15,800/mm3 with 82% polymorphonuclear leukocytes, hemoglobin 10.3 g/dL, and platelet count 754,000/mm3. the HIV assay is negative. Renal function and liver function tests are normal. A plain film radiograph of the abdomen shows a mildly dilated air-filled colon with a 4.5 cm diameter and no pneumoperitoneum or air/fluid levels.

• What is the most likely diagnosis?
• What is the next step?

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CASE SCENARIO ,,, A 49 year old woman presents to the emergency room complaining of a 4 week history of progressive abdominal swelling and discomfort. She has no other gastrointestinal symptoms, and she has a normal appetite and normal bowel habits. Her medical history is significant only for three pregnancies, one of which was complicated by excessive blood loss, requiring a blood transfusion. She is happily married for 20 years, exercises, does not smoke, and drinks only occasionally. On pointed questioning, however, she does admit that she was wild in her youth, and she had snorted cocaine once or twice at parties many years ago. She does not use drugs now. She was HIV negative at the time of birth of her last child.

On examination, her temperature is 100.3 F, heart rate 88 bpm, and blood pressure 94/60 mmHg. She is thin, her complexion is sallow, her sclerae are icteric, her chest is clear, and her heart rhythm is regular with no murmur. Her abdomen is distended, with mild diffuse tenderness, hypoactive bowel sounds, shifting dullness to percussion, and a fluid wave. She has no peripheral edema. laboratory studies are normal except for Na 129 mEq/L, albumin 2.8 mg/dL, total bilirubin 4 mg/dL, prothrombin time 15 seconds, hemoglobin 12 g/dL with mean call volume 102fL, and platelet count 78,000/mm3.

• What is the most likely diagnosis?
• What is your next step?

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MCQs on hyponatremia

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CASE SCENARIO ,,, A 65 year old white woman is brought to the emergency room by her family for increasing confusion and lethargy over the past week. She was recently diagnosed with small cell cancer of the lung. She has not been febrile or had any other recent illnesses. She is not taking any medications. Her blood pressure is 136/86 mmHg, heart rate 84 bpm, and respiratory rate 14 breaths per minute and unlabored. She is afebrile. On examination she is an elderly appearing woman who is difficult to arouse and reacts only to painful stimuli. She is able to move her extremities without apparent motor deficits, and her deep tendon reflexes are decreased symmetrically. The remainder of her examination is normal, with a normal JVP and no extremity edema. You order some laboratory tests, which reveal the serum sodium level is 108 mmol/L, potassium 3.8 mmol/L, bicarbonate 24 mEq/L, blood urea nitrogen 5 mg/dL, and creatinine 0.5 mg/dL. Serum osmolality is 220 mOsm/kg, and urine osmolality is 400 mOsm/Kg. A CT scan of the brain shows no masses or hydrocephalus.

• What is the most likely diagnosis?
• What is your next step in therapy?
• What are the complications of therapy?

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Strangulation of hernial sac:

1. Is always accompanied by intestinal obstruction.
2. Is more common in direct than indirect inguinal hernia.
3. Is usually irreducible.
4. Produces local pain and tenderness.
5. Demands surgical relief.

Hernia in the umbilical region:

1. Are always acquired in origin.
2. Usually occur in males.
3. Usually require surgical repair in infants.
4. Rarely strangulate.
5. Should be treated by a surgical corset.

Good Luck ALL

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CASE SCENARIO ,,, A 55 year old diabetic woman with end stage renal disease(ESRD),has been treated with peritoneal dialysis (prescription of four echanges,2 L exchange per day for 6 years,She is 80 kg

.The patient complains of nausea fatigue, abdominal discomfort, Medications include Erythropoetin, Calcium carbonate, water soluble vitamins. Lab studies showed hematocrite 38%, blood urea 160 mg/di, Serum creatinine 13 mg/dl, bicarbonate 14 meq/I, Calcium 10 mg/dl, Phosphate 2.3 mg/dl. Thlp most likely dlpgtnosis is:

 a) Mycobacterial peritonitis.
b) Dialysis dysequilibrium.
c) Uremia due to under dialysis,
d) Peritoneal carcinornatosis,
e) Diabetic ketoacidosis

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