Ebook Case history and data interpretation in medical practice: Part 2

(BQ) Part 2 book Case history and data interpretation in medical practice has contents: Case history and data interpretation, data interpretation of cardiac catheter, family tree, family tree, pictures of multiple diseases.

I Case History and Data Interpretation (For answers: See page 317-484) “It is impossible for anyone to find the correct function of any part unless he is perfectly acquainted with the action of the whole instrument” — Galen “It is much more important to know what sort of patient has a disease than what sort of disease a patient has” — Sir William Osler Case History and Data Interpretation Case No 001 A man of 63 years presented with the complaints of weakness, dizziness, lethargy, palpitation, breathlessness on mild exertion and weight loss for six months On examination, appearance – pigmented, anemia – moderate, jaundice – nil, edema – mild, pitting BP – 90/60 mm Hg, pulse – 110/min No other physical findings Investigations • Urine • Full blood count • PBF • • • • • • • • Reticulocyte count Bilirubin SGPT Alk phosphatase Serum creatinine S iron TIBC S ferritin - Protein (+) - Hb – 7.2 gm/dl, WBC – 4,000/cmm, poly – 55%, lympho – 45%, platelets – 1,90,000/cmm, ESR – 52 mm in 1st hr - Microcytic, hypochromic, few normocytic and normochromic - 0.8% (normal 0.2 to 2%) - 28 μmol/L (normal to 17) - 39 IU/L (normal 10 to 40) - 110 IU/L (normal 25 to 100) - 1.3 mg/dl (normal 0.5 to 1.13) - 45 μmol/L (normal to 30) - 88 μmol/L (normal 45 to 72) - 550 μgm/L (normal 20 to 300) Questions a What is the likely diagnosis? b Mention investigation to confirm your diagnosis c Suggest single therapeutic advice to the patient Case No 002 A 27-year-old female with eight months pregnancy is referred for jaundice She is admitted in the hospital with suspected pre-eclampsia On examination, the patient is ill looking, anemia – moderate, jaundice – moderate, edema – mild and pitting BP – 150/105 mm Hg Investigations • Urine • Full blood count - Protein (++) - Hb – 8.2 gm/dl, WBC – 15,000/cmm, • • • • • Case History and Data Interpretation in Medical Practice Bilirubin SGPT Alk phosphatase Serum creatinine S electrolytes - poly – 75%, lympho – 25%, platelets – 90,000/cmm, ESR – 62 mm in 1st hr 118 μmol/L (normal to 17) 99 IU/L (normal to 40) 290 IU/L (normal 20 to 100) 1.3 mg/dl (normal 0.5 to 1.13) Sodium 138 mmol/L Chloride 100 mmol/L Potassium 4.6 mmol/L Bicarbonate 23 mmol/L Questions a What is your diagnosis? b What further investigations would you suggest? c What treatment would you give? Case No 003 A 49-year-old lady, nondiabetic and nonhypertensive, presented with frequent attacks of dizziness, vertigo, palpitation, weakness and sweating for ten months Initially, these symptoms were present in the morning after waking from sleep and relieved by breakfast For the last six months, these symptoms are more frequent any time of the day and relieved by taking food Recently, the patient has gained weight of about 12 kg On examination, the patient looks obese, multiple linear striae are present BP – 130/80 mm Hg, pulse – 84/min Examinations of other systems reveal no abnormality Questions a What is b Suggest c Suggest d Suggest your diagnosis? alternative diagnosis other causes of such case investigations Case No 004 A 16-year-old school student has been suffering from weakness, polyuria, nocturia and cramps in legs for three years No history of diarrhea or vomiting Case History and Data Interpretation On examination, the patient looks emaciated, moderately anemic BP – 110/75 mm Hg, pulse – 76/min muscle power and tone – diminished all reflexes – diminished Other systems reveal no abnormality Investigations • Full blood count • • • • RBS Urine Serum creatinine S electrolytes • • USG of abdomen Chest X-ray - Hb – 10.2 gm/dl, WBC – 10,000/cmm, poly – 65%, lympho – 35%, platelets – 2,70,000/cmm, ESR – 42 mm in 1st hr - 6.1 mmol/L - Protein (+) - 1.1 mg/dl - Sodium 141 mmol/L Chloride 100 mmol/L Potassium 2.6 mmol/L Bicarbonate 32 mmol/L - Normal - Normal Questions a What is your diagnosis? b Suggest further investigations c Suggest differential diagnoses Case No 005 A 35-year-old receptionist is admitted in the surgical unit with severe abdominal pain, frequent vomiting and constipation for nine days On inquiry, it was found that she had similar attack many times since 10 years and she was admitted four times in the hospital Five years back, appendicectomy was done, but her symptoms did not improve For the last six months, she is complaining of insomnia, anxiety and confusion On examination, BP – 160/115 mm Hg, pulse – 124/min, abdomen – diffuse tenderness No other physical findings Investigations • Full blood count - Hb – 12.2 gm/dl, WBC – 13,900/cmm, poly – 62%, lympho – 35%, eosinophil – 3%, platelets – 2,90,000/cmm, ESR – 42 mm in 1st hr Case History and Data Interpretation in Medical Practice • • • • RBS Urine R/E Serum creatinine S electrolytes - • • • • • S bilirubin SGPT USG of abdomen X-ray chest Barium meal and follow through Barium enema - • 7.1 mmol/L Normal 1.2 mg/dl Sodium 131 mmol/L Chloride 98 mmol/L Potassium 4.6 mmol/L Bicarbonate 26 mmol/L 55 μmol/L (normal to 17) 96 IU/L (normal 10 to 40) Normal Normal Normal - Normal Questions a What is your diagnosis? b List investigations for your diagnosis Case No 006 A 30-year-old housewife, living in a slum area, is complaining of severe pain in lower abdomen, high grade, continuous fever, burning micturition and purulent vaginal discharge for two days She was given oral antibiotic and pain killer (indomethacin) as suppository After three days, she is hospitalized, because of severe pain in right hypochondrium, which radiates to the right shoulder, associated with vomiting and dry cough On examination, looks ill, dehydrated BP – 90/60 mm Hg, pulse – 120/min, temperature – 38.9°C Liver – enlarged, cm, tender Hepatic rub – present Stony dull in right lower chest with absent breath sound Questions a What is your diagnosis? b Suggest differential diagnoses c Suggest investigations Case No 007 A 39-year-old school teacher, presented with low grade continuous fever, pain in multiple joints, weight loss and dry cough for six months Case History and Data Interpretation For the last three months, she is also complaining of swelling of both parotid gland and few red lesions in leg On examination, patient is ill looking and emaciated, BP – 95/60 mm Hg, pulse – 106/min, temperature – 37.8°C Both parotid glands are enlarged, one right supraclavicular lymph nodes are palpable and non-tender Spleen – just palpable Questions a Suggest differential diagnoses b What is the likely diagnosis? c Suggest investigations Case No 008 A 20-year-old student, presented with gross hematuria, days after sore throat, fever and headache There is no significant past medical history On examination, no abnormality in general examination Throatcongested with enlarged tonsils BP – 110/70 mm Hg, pulse – 80/min, temperature – 38.2°C Examination of other systems reveal no abnormality Investigations • Full blood count • Urine microscopy • • • • Urinary protein Urea Creatinine S electrolytes • • • • Creatinine clearance Throat swab Chest X-ray USG of abdomen - Hb – 14.3 gm/dl, WBC – 10,900/cmm, poly – 62%, lympho – 38%, platelets – 3,95,000/cmm, ESR – 55 mm in 1st hr - red cell casts (+++) and granular casts (+++) - 0.16 gm/24 hrs - 3.6 mmol/L - 1.2 mg/dl - Sodium 138 mmol/L Potassium 4.2 mmol/L Bicarbonate 26 mmol/L Chloride 101 mmol/L - 68 ml/min (normal 98 to 168) - no growth - Normal - Cortex and medulla of both kidneys are irregular Case History and Data Interpretation in Medical Practice Questions a What is the most likely diagnosis? b Suggest diagnostically helpful investigations c Mention alternative diagnosis Case No 009 A 31-years-old housewife has been suffering from occasional loose motion, weight loss, weakness, palpitation and insomnia for months Three days before admission, she has been suffering from high grade, continuous fever, cough with yellow sputum, right sided chest pain, nausea and vomiting On the 3rd day, she feels drowsiness, dizziness, followed by confusion, incoherent talk and delirium On examination, looks very anxious and emaciated Anemia-mild, few submandibular lymph nodes palpable, small smooth goiter is present, temperature – 40°C, BP – 160/70 mm Hg, pulse – 140/min, irregularly irregular Heart – systolic murmur in pulmonary area Investigations • Full blood count • Chest X-ray • • • ECG RBS S electrolytes • • Urea Creatinine - Hb – 10.5 gm/dl, WBC – 23,540/cmm, poly – 88%, lympho – 12%, platelets – 1,80,000/cmm, ESR – 49 mm in 1st hr - Homogeneous opacity in the left upper zone - Atrial fibrillation - 12.1 mmol/L - Sodium 128 mmol/L Potassium 4.1 mmol/L Bicarbonate 21.8 mmol/L Chloride 105 mmol/L - 45 mg/dl - 1.2 mg/dl Questions a What is the likely diagnosis? b What investigation should be done to confirm your diagnosis? Case History and Data Interpretation Case No 010 A 70-year-old lady is suffering from fever, frequency of micturition and feeling unwell for 10 days She is hospitalized, because of confusion, drowsiness, followed by unconsciousness There was no history of diabetes mellitus, hypertension or any drug intake On examination, the patient is semiconscious, response to painful stimulus tongue – dry, skin turgor – reduced, BP – 90/60 mm Hg, pulse – 110/min, low volume Temperature – 39.2ºC Neck rigidity – slightly present Plantar- extensor on both sides Lower abdomen – very tender Investigations • Full blood count • S electrolytes • • • • • • Bilirubin SGPT Alk phosphatase Serum creatinine Serum urea Urine • • Chest X-ray CT scan of brain - Hb – 11.2 gm/dl, WBC – 17,000/cmm, poly – 85%, lympho – 15%, platelets – 2,10,000/cmm, ESR – 12 mm in 1st hr - Sodium 158 mmol/L Chloride 110 mmol/L Potassium 4.6 mmol/L Bicarbonate 19 mmol/L - 18 μmol/L - 29 IU/L - 90 IU/L - 1.4 mg/dl - 38 mg/dl - Plenty of pus cells, albumin (++), glucose (+++) - Normal - Diffuse age-related cerebral atrophy Questions a What is the likely diagnosis? b Suggest investigations c What immediate therapeutic measures would you start? Case No 011 A 59-year-old man, smoker, diabetic, had an attack of acute myocardial infarction During recovery, he developed sudden blindness 10 Case History and Data Interpretation in Medical Practice On examination, there is no significant finding on general examination BP – 100/60 mm Hg, pulse – 82/min, irregular Heart – pansystolic murmur in mitral area Lungs and abdomen – no abnormality Pupil – normal in size and shape, equally reactive to light and accommodation No other neurological finding Fundoscopy – normal Questions a Where is the site of lesion? b What is the likely cause? c Suggest investigation to confirm your diagnosis d What is the prognosis? e Mention causes of murmur Case No 012 A 29-year-old clerk is hospitalized with the complaints of high grade, continuous fever, polyarthritis involving all the joints, generalized bodyache, right sided chest pain, abdominal pain, nausea and occasional vomiting for weeks She also lost weight about kg within this period There is no history of cough, chest pain or hemoptysis On examination, looks unwell, anemia – moderate, cervical and inguinal lymphadenopathy, which are soft, discrete and non-tender Liver – enlarged, cm, non-tender Spleen – just palpable Pleural rub – present on right lower chest Abdomen – diffusely tender and slightly rigid Both knee joints – swollen and tender Cervical spine – painful restricted movement Left shoulder and both wrist joints are tender Investigations • Full blood count • • • • • • - Hb – 8.5 gm/dl, WBC – 33, 540/cmm, poly – 81%, lympho – 19%, platelets – 1,88,000/cmm, ESR – 138 mm in 1st hr Chest X-ray - Consolidation in right lower zone with small pleural effusion on left RBS - 8.1 mmol/L Blood and urine C/S - No growth RA test and ANA - Negative CRP - 54 g/L (normal