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Exam questionsMEQ:
DKA:
1. Differential diagnosis: hypoglycaemia, eleyctrolets imbalance, AGE, HHS, alcoholic ketosis,
acute pencrtitis
2. Random blood sugar: high, urinalysis ketone +ve, RFT: electrolytes imbalance (low
bicarbonate) and high urea, ABG: PH acidic if not compensated, ECG metabolic syndrom
macrovascular,
3. complication: arrhythmia, hypoglaciema, hypokalimea, cerebral edema and pulmonary
edema,
4. management: Fluid replacement IV 0.9 normal saline, insulin act rapid, monitor Potassium
and sodium levels cause insulin can cause hypokalimea, nasogastric tube if can’t tolerate
orally, I/o chart
5. Signs and symptoms: thirst, polyphasic polyuria, tired, kussmal breathing, acetone
breathing, tachypnea, tachycardia, nausea vomiting abdominal pain, muscle aches,
headachs, acetone breath fruity
,Thyroid:
1. TSH, free T4 and T3 iodine scan 131 FBC anima or infection (subacute decarvian
thyrodidts) or hashmotiisys CRP
2. Complication: arrhythmia AF thyrotoxicosis HF, stroke, myxoedema coma in hypo
3. PTU in pregnancy or carbimazole or if not woking give iodine 123 scan or surgery injury to
RLN, levothyroxine hypo
,Nephrotic syndrome:
1. DXX: Heart failure (if child due to congenital heart disease), kidney failure CKD, liver failure
cirrhosis
2. 24 hours urine protein collection high protein >40mg/m2/hr proturiea, urinalysis dipstick
proteuriea +3 or more, Lipd profile high cholestrol, RFT: electrolytes imbalance
hypontrema due to edema and activation of RAAS, ASO titer to check for post
streptococcal infection (nephritis), complement C3 and C2 for SLE and Anti dnas AB SLE
TRO, LFT for albumin levels low and total protein and ratio albumin/ globulin, CRP
infection? Can cause it, FBC WBC leucocytosis? CXR TRO pneumonia or viral infection that
can cause nephrotic.
3. Complication: renal thrombosis,, hypovolimic shock and primary peritonitis, pulmonary
oedema fluid overload
4. Management: perdonslone, furosemide if high fluid overload, strict I/o chart, broad
spectrum AB prophalyxisis, urine dipstick daily in the morning
Pneumonia with pleural effusion:
1. Inspection: inspection RR tachypnea, palpation non symmetrical chest expansion
decreased tactile fremits , percussion stony dull on the affected side with perular effusion,
decreased air entry on the affected side
2. Give one diagnosis: bacterial viral atypical parapnemonic effusion
3. CRUB65 consusness RR, urea age BP
4. AB based on organism broad spectrum
NSTEMI with pulmonary oedema secondary to mitral regur with signs of LHF mechanism of
SOB and orthopnea?
1. When blood enters to ventricles there will be less blood pumped to the body organs due to
mitral regurgitation thus there will be increase in sympathetic flow which will increase the
pressure systemically and this will effect the pulmonary pressure and will increase it also
activation of RAAS will lead to increase in fluid retention which will lead to increase in
workload of heart as well as will lead to pulmonary oedema all this goes back to the
mistrial regurgitation cause during sytole the mistrial valve should close to not allow blood
to go back to atria, but cause the valve is not closing in a proper way the blood that is
pumped to the body is low thus the sympathetic outflow as well as RAAs will increase
leading to LHF. Ventricular outflow obstruction pressure overload
Pneumonia underlying COPD with metabolic acidosis and respiratory alkalosis:
1. Differential diagnosis: PTB, bronchogenic carcinoma, Acute exasperation of COPD
, 2. CXR: to rule out effusion and other reps causes pneumothorax PE etc. FBC leucocytosis,
CRP= inflammation, RFT for electrolytes imbalance and urea to check osmolarity, ABG for
o2 saturation and CO2 in respiratory failure high or low o2 below 60 o2 with low co2 type
1, suger level (ddx hypoglaciema)
3. Complication: respiratory failure, parpnemonic effusion, empyema, organ failure renal
failure
4. Management: broad spectrum IV AB, SABA Salbtamul nubulized, IV PCM if have fever, 2 IV
canola big
Liver cirrhosis; signs and symptoms, investigation and explanation:
1. Signs: spider nevi, jaundice, anaemia, koliunikea, low albumin leukinnkea, acietits caput
medusa, flapping and fine trumer. Deputrynes contraction, easy brushing, clubbing,
edema leg swelling, yellow skin oesophageal varieses
2. Syptomes, tired headache, lethargy, fatigue, nausea vomiting, weight loss itchy skin
3. ivestigation: LFT: to check albumin low acieties and enzymes if elevated, PT time and INR
to know the severity of liver disease, RFT urea if low that means its very severe cause liver
metabolise ammonia into urea, FBC anemia, vit K serum, other fat soluble vit which
metabolised by the liver, iron profile IDA common, endoscopy if have eosphegial varieses
Congestive cardiac failure
1. Causes: Hypertension, cardiomyopathy, ischemic heart disease
2. Management: +ve introduces debutamine ACEI, ARBs, spironolactone diuréticos
feurosmide
3. Frist Beta blocker and emplgfizone then angiotensin restorer nelupreysine inhibitor ARNI
then sprionlactone
4. Mange DM HTN and Cholesterol
5. Usually give ACEI rather than giving ARNI cause expensive
DDx coeliac disease,symptoms,ix, causes of villous atrophy,Mx
1. DDx: IBD, lactose intolerance, chronic choleysititis malcapsorbtion, IBS
2. Symptoms: diarrhoea watery osmotic sugar pulled water, abdominal pain, ectopic
dermatitis extra abdominal manifestation, nausea vomiting, eczema??? Vitamins
deficiency, anemia macrocytic?? Proximal intestine, nutrients deficency dental problem,
joint pain and muscle pain short stature and growth restriction in child
3. Causes of villous Atrophy: due to antibodies against gluten resptores which binds to the
resptores and attack it which leads to atrophy of villus ??
4. Management: diet modification gluten free diet AB broad spectrum charcoal pills ??
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