MedTutor is an online tutoring site for medical students and young doctors in Internal Medicine. Write to MedTutor at: <moc.liamg|todikiwrotutdem#moc.liamg|todikiwrotutdem>.
August to December 2015
A sample of the questions asked to students in the final examination at the end of Semester 10 in August 2015.
- A patient has cirrhosis liver. But the liver is enlarged and palpable. Is this possible?
- What will be the abnormalities seen, if any, in the LFT of patients with cirrhosis?
- What are the tumour markers relevant to patients with cirrhosis liver?
- What is the biochemical abnormality that leads to hepatic encephalopathy?
- What kind of antibiotics are used in patients with hepatic encephalopathy?
- What can be done to limit upper GI bleeding (before endoscopy is done) in patients with cirrhosis liver?
- When one lower limb is shorter than the other, how do you know if the shortening is due to a problem above or below the greater trochanter?
- How can you demonstrate the presence or absence of fixed flexion deformity of the hip?
- Why should the knee be examined in patients with long standing hip joint problems?
- How do you test the motor function of the sciatic nerve in a patient who has pain in the lower limb?
- What is the significance when an abdominal mass becomes more prominent on tensing the abdominal wall?
- What is the criteria for saying that a stroke is a lacunar stroke?
- Some strokes can be caused by space occupying lesions in the brain. Explain how that happens.
- When you are faced with an elevated serum creatinine in a patient, how do you go about determining whether it represents acute kidney injury or chronic kidney disease?
- What precautions will you observe when treating diabetes in patients with chronic renal failure?
- Why do some people with inferior wall myocardial infarctions have a transient period of hypotension?
- When will you prescribe thiamine to a patient with congestive cardiac failure?
- What is the rationale of prescribing spironolactone to a patient with congestive cardiac failure?
- How do you diagnose diabetes mellitus?
- What is the risk of prescribing high doses of inhaled corticosteroids?
- When is the ideal time for surgical closure of atrial septal defect?
- Why does pulmonary hypertension develop in patients with atrial septal defect?
A 59 year old woman presented to the hospital with these investigations. Your task is to analyse these results and discuss the various things that might be wrong with her.
|Item||Patient's value||unit of measurement||normal value/range|
|Blood urea||26.8||mmol/L||2.8 - 7.8|
|Serum creatinine||773||umol/L||61 -124|
|Serum sodium||138||mmol/L||135 -148|
|Serum potassium||4.9||mmol/L||3.5 - 5.1|
|Serum chloride||107||mmol/L||93 - 108|
|Total serum protein||62||Gram/L||60 -83|
|Serum Albumin||36||Gram/L||35 - 48|
|Serum Globulin||27||Gram/L||28 - 36|
|Total Bilirubin||5.8||umol/L||0 -25|
|Alk. Phosphatase||120||U/L||36 -92|
|Alanine transaminase (ALT)||15||U/L||< 40|
|Total Cholesterol||3.8||mmol/L||< 5.7|
|HDL C||1.0||mmol/L||> 1.7|
|LDL C||1.9||mmol/L||< 3.3|
|Serum Calcium||1.95||mmol/L||2.2 - 2.65|
|Serum Phosphate||1.82||mmol/L||0.81 - 1.45|
|Fasting plasma glucose||4.2||mmol/L||3.9 - 6.6|
|24 hours urine protein||7.6||Grams||Less than 150mg|
|Urine examination||SG 1.010||protein 5G/L||glucose +||nitrite nil|
Urine WBC: 5 to 10 / HPF (500/uL; normal less than 10/uL)
Urine RBC: 1 to 3 / HPF ; (50/uL; normal less than 5/uL)
- The discharge diagnosis is: "Chronic liver disease with thrombocytopenia". How are these two things linked?
- From clinical notes: "The patient has fluid overload. His x-ray chest shows congestive pattern and cardiomegaly." What exactly are we dealing with here?
- A woman has hypertension and a serum creatinine of 171umol/L. What do you think may be the cause of the hypertension?
- An 85 year old man has CKD. His fasting plasma glucose is 5.3mmol/L. Is it possible that he has diabetes?
- The renal profile of a patient: Blood urea 14.3mmol/L; Serum creatinine 156umol/L; Serum Na 140mmol/L; Serum K 3.2mmol/L. Question: Why is the K low when the urea and creatinine are raised?
- A 69 year old man has COPD and was diagnosed recently as having decompensated CCF. His ECHO showed LVEF of 60 percent. What are we dealing with here?
- How do you treat a patient who has chronic renal failure?
- What are the advantages and disadvantages of using Frusemide in chronic renal failure?
Dr Velayudhan Menon, MD
Clinical Associate Professor of Medicine
International Medical University, Malaysia