February Diet 2022 (Preview)

 

✅ 32 yrs. Nurse presented in ED following a needle stick injury from an HBs Ag positive pt + Lab test: her anti-HBs ab titer <10 following 3 months her last booster dose + Most appropriate important intervention >> Hepatitis B immunoglobulin.

 

 

 

 

✅ 23 yrs man presented with intermittent diarrhea, bloating, and abdominal pain for 3 weeks following a holiday in vietnam + On exam: Wt loss, mild abdominal tenderness + Lab test: Raised CRP + Most likely Dx >> Giardiasis.

 

 

 

✅ 18 yrs lady show farm worker presented with nausea, vomiting, and diarrhea for a few days + onLab test: Hb%: 82 g/l (Fragmented red cells on film) + Platelet count: 61×10^9/l + Creatinine: RAISED + most likely dx >> Hemolytic Uremic syndrome. 

 

 

 

✅ 74 elderly pt presented with lumbar pain and Rt humerous pain & getting pallor + GP said: his renal function is deteriorating + Lab test: Hb%: 92 gm/l + Creatine raised + with raised Globulin fraction in blood + Most likely diagnosis >> Multiple Myeloma

• Anemia + Back pain + Impaired renal function >> MM

 

 

 

✅ 42 yr. Bar owner presented with confusion, short-term memory loss, and diplopia + On exam: Lateral Gaze palsy, nystagmus, and unsteady gait + Lab test: Anemia; Low platelet count + Most likely Dx >> Wernicke’s encephalopathy.

 

 

 

✅ 45 yr pt known to have cyclical Vomiting syndrome presented with diarrhea following starting an anti-emetic + No other past medical or allergic history + Most likely medication to be causing this pt’s symptoms >> Metoclopramide. 

 

 

 

✅ 45 yrs. Known to have DM, HTN lady now presented with sudden painless visual loss affecting Lt eye + Ophthalmoscopy shows: Multiple Flame shape hemorrhage + Most likely cause of pt’s symptoms >> Central retinal vein occlusion 

Image: CRVO

 

 

✅ 26 yrs heroin addict brought unconscious to ED + On exam: Pinpoint pupil, low BP, RR: 6 br/min + O2 90% on 10 liters oxygen + Most appropriate next step >> Naloxone. 

★ Naloxone is a competitive opioid receptor inhibitor, usually used as an antidote for opioid overdose. 

 

 

 

✅ 21 yrs. PT from a traveling family presented with headache, nosebleed, HTN + Differential BP in 2 arms + Pulse in Foot appears to be diminished + CXR shows: the following + Most likely cause of PT’s symptoms >> Coarctation of the Aorta

 

 Image: Coarctation of Aorta

Interpretation: Rib notching is pointed by red arrows, and Figure “3” is pointed by yellow, blue, and green arrows.

★ Travelling families may fail to engage with medical services accounting for this patient’s delayed presentation.  

 

 

 

✅ 32 yr Pakistani pregnant lady presented with Irregular palpitation, SOB + H/O frequent illness as a child + ECG: Atrial fibrillation, ventricular rate: 110 bpm + Most likely cause of pt’s atrial fibrillation >> Mitral stenosis. (Dx: Rheumatic Heart Disease)

 

 

 

✅ 31 yrs pt presented with erythematous scaling skin rash over the scalp and extensor surface of body + On exam: Nail pitting + Most likely dx >> Psoriasis. 

Image: Psoriasis Rash

 

 

 

✅ 48 YRS lady with Known RA presented with dry mouth, dry eyes, weakness + Lab test: Low K+, Low HCO3-; Urine analysis: (Blood negative, protein positive) + Most likely dx >> Renal Tubular acidosis Type-1. 

★ Pt with autoimmune Rheumatological diseased pt usually presented with RTA type 1

 

 

✅ 73 yr pt known to have chronic stable angina and Class 2 heart failure and Bronchial asthma + Taking GTN for chest pain and salmeterol, fluticasone for Bronchial asthma+ HR: 85 bpm + Most appropriate intervention for this pt’s angina >> Ivabradine.  

★ Beta blocker is contraindicated in asthma pt. 

 

 

✅ Known CKD pt presented with lethargy, bone pain + Lab test: Low Hb%, High Creatinine, and High phosphate + Most likely cause of pt’s presentation >> Secondary Hyperparathyroidism. 

 

 

 

✅ 49 yrs pt presented with sensory loss affecting both feet and frequent tripping + On exam: Loss of fine touch proprioception and vibration sense, loss of ankle jerk + EMG: Positive sharp waves and fibrillation potential + Lab test: Low Hb%, Low platelet count + Most likely cause of pt’s neuropathy >> Alcoholic neuropathy. 

★ Anemia and thrombocytopenia are consistent with Chronic liver disease Due to alcoholism. 

 

 

 

✅ Elderly pt present with worsening confusion and cough for last 5 days + On exam: Crackles in the Rt lung base + Lab test: Raised WBC, Low Sodium: 128 mmol/l + Most appropriate next step >> Fluid restriction. (Pt developed pneumonia induced SIADH )

 

 

 

✅ 19 yr boy presented with evening fever, joint pains erythematous rash on chest and thigh + On exam: Intermittent chest pain + Lab test: Raised WBC, Raised ESR + Most likely dx >> Adult onset still disease. 

 

 

 

20. 67 yrs known COPD pt presented with cough, night sweats, fever + On exam: Coarse crackle over the Rt upper lobe + Lab test: Sputum: Acid and Alcohol fast bacilli positive, PCR: Negative for M. TB +  CXR: Rt upper lobe infiltration and Cavitation + Most likely cause of pt’s symptoms >> Mycobacterium avium. 

★ M. avium usually causes pulmonary infection in pt who has underlying lung disease. 

 

 

 

✅ 22 yr pt brought to ED following PCM overdose of unknown quantity + Feels nauseated, abdominal tenderness + Lab test: Raised ALT: 2732, high Cr, High INR, Low platelet count + Most appropriate intervention >> Acetylcysteine. 

 

 

 

✅ 24 yr ladt present with Lt loin pain and swing fever + On exam: Raised ™, Lt loin tenderness + Lab test: Raised WBC + Most likely dx >> Pyelonephritis. 

 

 

 

✅ 27 27-year-old pt presented with severe headache, myalgia, and fever following. Hiking to northwest Of the USA + On exam: maculopapular rash on the wrist and forearm + Small necrotic insect bite on the left ankle + Most likely dx >> Rocky Mountain spotted fever. 

 

 

 

✅23 yr pt brought to ED following a collapse in a night club + On exam: SOB, chest pain, confusion,  Blue color skin + Oxygen saturation: 86% on 60% inspired oxygen + Lab test: pa(O2): 50 kPa + Most appropriate intervention >> Methylene blue.

★ Methylene Blue is the accepted first-line intervention for the methemoglobinemia 

 

 

 

✅ 49 yrs afro-Caribbean man presented with an average BP 155/92 mmHg on a 24-hr recording + ECG and ECHO normal + Most appropriate treatment for this pt’s Hypertension >> Amlodipine. 

 

 

 

✅ 74 yrs pt now on 60 mg steroid present with severe Bitemporal headache,  jaw pain + H/O intermittent night sweat, one episode of temporarily lost vision on her left eye + On exam: temporal artery tenderness on palpation + Lab test: Raised ESR + Most useful investigation >> Temporal artery biopsy (Dx: Temporal arteritis)

 

 

 

✅ Risk factor for complete /Successful suicide:

★Umeployment

★ Traumatic life event( Divorce, break up)

★Chronic physical pain

★ Mental illness

★Excessive drinking

★Recent admission in prison service. 

 

 

 

✅ 53 yr CKD pt undergoing hemodialysis presented with tiredness + looks pallor despite taking oral iron + Lab test: Low Hb, High creatine + Most appropriate next step >> IV iron infusion. 

 

 

 

✅ 52 yr taxi driver presents with severe daytime sleepiness and nighttime snoring with H/o intermittent apneic spell + On exam: BMI: 35kg/m2, Epworth sleepiness score: 18 + Most appropriate intervention >> Nocturnal continue positive airway pressure.  

 

 

 

✅ 24 yr pt presented with severe unremitting headaches for a few months + On exam: looks Tired, Bitemporal visual field loss + Most likely diagnosis >> Meningioma 

★ MRI T1 reveals homogenous enhancement of a well-circumscribed tumor rising from the dura at the skull base.

 

Image: MRI of Meningioma At the base of Skull

 

 

✅ 32 yr known HIV pt presented with drowsiness, headache, and neck stiffness + On exam: Pt has a cough, Bilateral 6th CN palsy+ Lab test: Raised CSF pressured CSF protein and CSF microscopy: Lymphocytic pleocytosis  + CT head with contrast: Leptomeningeal enhancement + Most likely dx >> Tuberculous meningitis. 

 

 

 

✅ 39 yr lady presented with hemoptysis + Has sinusitis,  HTN + On exam: Inspiratory crackles + Lab test: CXR: Patchy interstitial shadowing through both lungs; Urine: (Blood 3+, protein 2+) + Autoantibody most likely to be found >> Classic C-Anca (Dx: Granulomatosis and polyangiitis)

 

 

 

✅ 59 yr pt presented with Rt-sided dull chest pain and SOB + CT chest: Accumulation of fluid on rt side of Chest + Most likely dx >> Rt pleural effusion.

Image: Ct chest: Rt sided Pleural effusion (Pointed By arrow)

 

 

✅ 71 yr pt presented with a H/O 30 mins episode of Lt sided facial weakness, weight loss, night sweat, intermittent fever + On exam: Moderate splenomegaly + Lab test: raised Creatinine, Immunoglobulin electrophoresis: Immunoglobulin (IgM) paraprotein band + Most likely dx >> Waldenstrom macroglobulinemia. 

 

 

 

✅ 34 pt presented with wt gain, HTN and DM + Lab test: Low K+, High HCO3-, High 24-hrs urinary cortisol + MRI: no pitytary adenoma seen + Most likely cause of pt’s biochemistry results >> Bronchial Carcinoid.

★ Bronchial carcinoid tumors are known to secrete ACTH and May lead to the development of Cushing syndrome. 

 

 

 

✅ 27 yr pt presented with a rapidly enlarging mole on the left forearm + Pt said: it’s painful and itchy + Most likely dx >> Malignant Melanoma.

Image: Malignant Melanoma

 

 

 

✅ 35 yr pt presented with loss of appetite, early satiety, dyspepsia following small bowel resection for Crohn’s disease + On exam: Abdomen is mildly distended + Hydrogen breath test: positive + Most appropriate intervention >> Rifaximin. (Dx: Bacterial Overgrowth syndrome)

 

 

 

✅ 31 yrs drug abuser presented with fever, facial spasms, neck stiffness, and unable to swallow + On exam: injection wound noted on her left foot surrounded by erythema + Lab tests: Raised WBC count + Most likely dx >> Botulism. 

★Early dx is crucial for the administration of tetanus antitoxin 

★Most pt are considered for prophylactic sedation, intubation, and ventilation. 

 

 

 

✅ 28 yr man presented with H/O recurrent lower RTI + CT chest: Thickened dilated bronchi with some displaying the signet ring + Most likely cause of pt’s symptoms >> Pertussis infection as a child. 

★ 40% Cases of bronchiectasis are said to be following viral infection:            

• 🔸Pertussis                                                                                                           
• 🔸herpws zoster
• 🔸Influenza

Image: CT chest shows: Cystic lesion and Signet ring lesion

 

 

✅ 27 yrs pt presented with central chest pain worsened by lying down following a cold flu + ECG: Concave ST-elevation + Most likely dx >> Acute pericarditis 

• Respiratory virus cause: Coxsackie, Influenzae
• NSAIDs are the TX of choice
• Colchicine is potentially indicated to reduce the risk of chronic pericarditis 

 

 

 

✅ 45 lady presented with weight gain, lethargy, menorrhagia + On exam: BP: 150/90 mmHg + Lab test: High TSH with and High triglyceride level + Most appropriate next step for managing this pt’s lipid level >> Thyroxine, then review lipids in 3 months. 

 

 

 

✅ 72 yr previously independent pt presented with fractured femur neck + Now confused and deemed not to have capacity + Most important with respect to proceeding to surgery >> Proceeding in the best interests of the pt. 

★Unless the advance directive has been issued, the treating team decides to proceed with therapy according to the patient’s best interest.

 

 

 

✅ 54 yrs pt referred by GP due to worsening renal function following taking chinses herbal xi Xin + Lab test: Low HB, Raised Creatinine, and high Urine protein: creatinine ratio + Most likely dx >> Chronic interstitial nephritis. 

★Other causes of interstitial nephritis: 

• 5- amino salicylic acid
• Phenacetin
• Allopurinol
• Acyclovir

 

 

 

✅ 24 yr pt presented with a painless ulcer on the glans penis following unprotected sex in Thailand trip + Most likely dx >> Syphilis. 

★ A single dose of IM penicillin is the recommended treatment.