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Showing posts with label Medicine. Show all posts
Showing posts with label Medicine. Show all posts
Friday, January 25, 2013
HIV Patient With Confusion and Disorientation
12:56 AM | 
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UnknownClinical Vignette: A 42-year-old HIV-seropositive man presents to Casualty with a two-week history global headache. His partner
says that he has become increasingly confused and disorientated. The patient's latest CD4 count, taken three weeks ago, was 50 cells/mm3. He had chosen not to take antiretroviral therapy, but was taking co-trimoxazole as prophylaxis against Pneumocystis carinii pneumonia.
On examination he had mild weakness of his left arm and leg in all muscle groups and a right homonymous hemianopia. Fundoscopy was normal with no evidence of papilloedema.
A CT scan of his brain showed several areas of low attenuation in both cerebral hemispheres, but there was no enhancement with contrast and no mass effect. What is the most likely diagnosis?
- Cerebral lymphoma
- Cerebral toxoplasmosis
- HIV encephalopathy
- Neurosyphilis
- Progressive multifocal leukoencephalopathy
Thursday, January 24, 2013
Female with papules and vesicles
Clinical Vignette: A 40-year-old female presents with a
six month history of pruritic papules, vesicles and excoriations on the elbows,
knees, buttocks and scalp. Her GP has prescribed topical betamethasone therapy
which has been unhelpful. What is the most likely diagnosis?
- Atopic dermatitis (Eczema)
- Dermatitis herpetiformis
- Hennoch-Schonlein purpura
- Psoriasis
- Scabies
Diabetic male with Erectile dysfunction and decreased libido
Clinical Vignette: A 36-year-old male with
insulin-dependent diabetes mellitus of three years duration presented with
decreased libido and erectile dysfunction since diagnosis. No abnormalities
were noted on genital examination. Investigations revealed:
- plasma testosterone 6.0 nmol/L (9 - 35)
- plasma follicle stimulating hormone 1.0 u/L (1-8)
Which of the following investigations
is most appropriate next step?
- autonomic function testing
- Doppler studies of penile artery
- Nerve conduction studies
- Serum ferritin
- Serum prolactin
Female With Acutely Painful Goiter
Clinical Vignette: A 40-year-old female with no
prior history of thyroid disease, presents with a 5 day history of an acutely
painful, left-sided goitre. Clinically she appeared euthyroid, and was
apyrexial.
Investigations revealed the following:
- Haemoglobin 13.0 g/dL
- White cell count 7.0 x 109/l
- Platelets count 200,000/mm3
- De Quervain's thyroiditis
- Haemorrhage into a cyst
- Hashimoto's thyroiditis
- Staphylococcal abscess
- Thyroid carcinoma
Saturday, December 25, 2010
Clinical Vignette: Young Married Woman With Amenorrhea and Jaundice
Clinical Vignette: A 27-year-old married woman with amenorrhoea of 7 months duration is found to have mild jaundice, hepatosplenomegaly, lymphadenopathy and palmar erythema.
Investigations show:
Investigations show:
- Hb 10.4 g/dL
- WBC 2.8 × 109/L
- Platelets 72 × 109/L
- ESR 29 mm in first hour
- Plasma bilirubin 58 μmol/L
- Plasma AST 190 IU/L (normal range 5–35)
- Plasma ALT 105 IU/L (normal range 2–17)
- Plasma alkaline phosphatase 65 IU/L (normal range 30–100)
- Serum albumin 35 g/L
- Serum globulin 68 g/L
- Hepatitis B surface antigen negative
- Antinuclear factor positive at titre of 1/512
- Anti-smooth muscle antibodies positive
- Anti-mitochondrial antibodies positive at titre of 1/64
1 What is the diagnosis?
(a) Primary biliary cirrhosis
(b) Chronic active hepatitis
(c) Wilson’s disease
(d) Hepatitis C infection
(e) Drug toxicity
(a) Primary biliary cirrhosis
(b) Chronic active hepatitis
(c) Wilson’s disease
(d) Hepatitis C infection
(e) Drug toxicity
Wednesday, December 22, 2010
Clinical Case: Woman With Fevers and Fatigue ........
Clinical Vignette: A 32-year-old African American woman complains of mild fevers and fatigue for the past month. She has no significant past medical history. Her temperature is 38.I C (100.6 F), blood pressure is 115/70 mm Hg, pulse is 75/min, and respirations are 18/min. Nontender, mobile, cervical and axillary lymph nodes are noted. Auscultation of the lungs reveals fine crackles bilaterally. A chest x-ray film shows hilar lymphadenopathy and diffuse interstitial infiltrates. Lymph node biopsy shows noncaseating granulomas. Which of the following is the most appropriate therapy?
(A) Allopurinol
(B) Angiotensin converting enzyme (ACE) inhibitor
(C) Cyclosporine
(D) Gluoocorliooids
(E) Isoniazid
(A) Allopurinol
(B) Angiotensin converting enzyme (ACE) inhibitor
(C) Cyclosporine
(D) Gluoocorliooids
(E) Isoniazid
Clinical Case: A Young Obese Woman With Irregular Menses Presents With Acne And Hirsutism
Clinical Vignette: A 20-year-old Caucasian woman was referred with persistent severe acne and hirsutism. Her menses were infrequent, irregular and heavy. She was on no medication and used barrier methods of contraception. Her mother also had irregular menses. On examination, she was obese, had moderately severe acne, greasy skin, and excessive amounts of body hair in a male pattern distribution. The distribution of her obesity was uniform. Her visual fields were normal. There were no other abnormalities on examination or urinalysis.
Results of investigations were as follows:
Plasma luteinizing hormone 20 IU/L (normal range 3–8)
Plasma follicle stimulating hormone 6 IU/L (normal range 2–8)
Plasma prolactin 423 IU/L (normal range <600)
Plasma thyroxine 98 nmol/L (normal range 70–140)
Plasma testosterone 11 nmol/L (normal range 1–3)
Dehydroepiandrosterone sulphate(DHAS) 6 μmol/L (normal range 3–7)
Urinary 17-oxosteroids 39 μmol/L (normal range 14–59)
1 What is the diagnosis?
(a) Congenital adrenal hyperplasia
(b) Anabolic steroids
(c) Pituitary adenoma
(d) Polycystic ovary syndrome
(e) Cushing’s syndrome
Results of investigations were as follows:
Plasma luteinizing hormone 20 IU/L (normal range 3–8)
Plasma follicle stimulating hormone 6 IU/L (normal range 2–8)
Plasma prolactin 423 IU/L (normal range <600)
Plasma thyroxine 98 nmol/L (normal range 70–140)
Plasma testosterone 11 nmol/L (normal range 1–3)
Dehydroepiandrosterone sulphate(DHAS) 6 μmol/L (normal range 3–7)
Urinary 17-oxosteroids 39 μmol/L (normal range 14–59)
1 What is the diagnosis?
(a) Congenital adrenal hyperplasia
(b) Anabolic steroids
(c) Pituitary adenoma
(d) Polycystic ovary syndrome
(e) Cushing’s syndrome
Clinical Case: A Child With Swollen Left Knee
Clinical Vignette: A 6-year-old boy was referred with swelling of his left knee. He had played football in his school playground 48 hours before and had not noticed any problems until the morning of referral. He had had no other problems. There was no family or personal history of significance. On examination, an otherwise well-looking boy had a red swollen knee which was warm and moderately painful to move. He was not systemically unwell and had a pyrexia of 37.3°C. Results of investigations were as follows:
Hb 11.8 g/dL
WBC 6.9 × 109/L
Platelets 405 × 109/L
Bleeding time normal
Prothrombin time 13 s (normal range 11–15)
Activated partial thromboplastin time 60 s (control 25–34)
Factor VIII level 123 per cent
What is the diagnosis?
(a) Von Willebrand’s disease
(b) Factor VIII deficiency
(c) Factor V (Leiden) mutation
(d) Factor IX deficiency
(e) Protein C deficiency
Hb 11.8 g/dL
WBC 6.9 × 109/L
Platelets 405 × 109/L
Bleeding time normal
Prothrombin time 13 s (normal range 11–15)
Activated partial thromboplastin time 60 s (control 25–34)
Factor VIII level 123 per cent
What is the diagnosis?
(a) Von Willebrand’s disease
(b) Factor VIII deficiency
(c) Factor V (Leiden) mutation
(d) Factor IX deficiency
(e) Protein C deficiency
Monday, December 20, 2010
Clinical Case: Man With Progressive Low Back Pain And Weakness With Episode Of Loin Pain
Clinical Vignette: A 24-year-old man with progressive low back pain and weakness finally sees his doctor on account of an episode of left loin pain. Investigations show haematuria and a urinary pH of 7.
Other investigations show:
Other investigations show:
- Plasma sodium 135 mmol/L
- Plasma potassium 2.8 mmol/L
- Plasma urea 5.7 mmol/L
- Plasma creatinine 107 μmol/L
- Plasma chloride 115 mmol/L
- Plasma bicarbonate 16 mmol/L
1 What is the diagnosis?
(a) Type I (distal) renal tubular acidosis
(b) Type II (proximal) renal tubular acidosis
(c) Type IV renal tubular acidosis
(d) Bartter’s syndrome
(e) Gittleman’s syndrome
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