A 70-year-old man presents to the emergency department with history of two episodes of vomiting and delirium for 6 hours. He developed a single episode of tonic clonic seizure at the emergency room. Biochemical reports revealed, serum sodium 112 mmol/l, and RBS 5 mmol/L. Patient's relatives denied any complain to upper GIT.
a) Make a checklist of clinical information to reach the underlying cause of his presentation.
b) Make a plan of relevant investigations with expected findings.
c) How will you manage this patiem?
d) Mention one important pitfall in the management of this patient with explanation.
An 18-year-old girl is taken to your private chamber by her mother who is expressing her concern about the weight of her daughter. The weight is 110 kg with height of 155 cm. How will you classify her obesity and in which class the patient fits in?
ii) Mention additional clinical measurement you will take for this patient to assess her cardiovascular and diabetes risks.
iii) Mention the principles of management of this patient.

b) A 30-year-old woman is admitted with history of acute paracetamol overdose. i) How the timing of ingestion will guide the treatment?
ii) How Paracetamol poisoning nomogram helps in deciding N-Acetyl cysteine use in this situation?
70-year-old man has brought to you with recurrent attacks of acute confusional state. How will you evaluate him clinically?
ii) Mention the non-pharmacological interventions those which can prevent further 2.0 delirium in this patient.
d) A 40-year-old woman has presented to you with a CBC report showing Hb-12gm/dl, total WBC 5.5×10 /L with normal differentials. Platelet coun showed 90x10" L. After reviewing her old papers it was found that she has low platelet counts in few more reports ranging from 70-90x10/L during previous 1 year.
1) How will you evaluate thrombocytopenia of this patient? ii) Give a management plan for this patient.

e)A 70-year-old man presented with recent onset of swelling of the whole left lower limb. The calf muscle is not tender but skin over the limb is reddish.
Write 4 important investigations for this patient to come to a diagnosis. ii) Write down 6 red flag signs and symptoms for other internal malignancy mentioning the site specific tumor.


A 36-year-old woman with 32 weeks pregnancy presented to emergency department with history of headache and impaired consciousness for 2 hours. She was reasonably well throughout her pregnancy. Her BP was 166/104 mmHg with mild pedal edema.
i) What is the most likely diagnosis
ii) Mention the risk factors for this condition.
iii) Mention the immediate management for this patient.
b) A 30-year-old farmer while working in the paddy field, suddenly bitten by something and taken to the hospital. On examination, he had bilateral ptosis with active bleeding from the bitten site.
i) Mention the specific treatment you will offer to this patient.
ii) What precautions will you take for giving specific treatment?
iii) What are the justifications of giving the specific treatment for this type of patients?

c)A 35-year-old woman presented with fever, abdominal pain, diarrhoea and weight loss for 6 months. On examination she had anemia, glossitis, leuconychia and tenderness at right lower abdomen.
What further clinical information will you get from him to reach a diagnosis? ii) Mention investigations with interpretations to establish the diagnosis.

1)A 45-year-old man presented with impaired consciousness developed over last 48 hours, He had loss of appetite with nausea for on: week. On examination he was icteric and drowsy but responded to pain and vocal stimulation.
What is the most likely diagnosis?
ii) What are the investigations you would advise to establish the cause?
iii) Mention 4 poor prognostic features in this patient.

e)A 30-year-old woman presented with shortness of breath on rising from sleep. She had sudden onset of shortness of breath and palpitation and had several times emergency department visits in the last six months. Her vitals normal with normal chest and precordium. Emergency ECG was also normal.
i) What wou'd be the most likely diagnosis?
ii) Mention the differential diagnosis.
iii) How we uld you evaluate this patient?

a) A 34-year-old man presented with low grade fever for 1 month with progressive weakness. He also gave history of swelling of left lower limb for 15 days. On examination he was severely anaemic and moderately jaundiced. He had left ankle edema with extremely tender left culf muscle. Abdominal examination had hepatosplenomegaly. Laboratory reports showed Hb% 7 gm/dl, serum bilirubin 5mg/dl, SGPT 55 U/L, reticulocyte count 7% and
positive direct Comb's test.
Mention the clinical information you need to get from the patient for reaching the diagnosis
How will you manage this patient?

b)A 50-year-old man is being evaluated before the day of operation. His BP is found to be 160/104 mm Hg.
Mention the information you will get to evaluate this patient.
ii) How will you manage this patient?

c)A 50-year-old man presented with low grade fever for 1 month after transfusion of whole blood donated from his son. He also had developed generalized exploitive skin eruptions all over the body for last 15 days. His lab investigations showed Hb 8.5 gm/dl. WBC 3.5x10"/L, platelets 129:109/L and ALT level 120 U/L.
What is the most likely diagnosis? How will you manage this case?

d)A 45-year old woman presented with sudden chest pain and shortness of breath with profuse sweating or last 3 hours. She had no previous history of exertional chest pain and dyspnea. She used to take oral contraceptive pills for quite a long time. On examination pulse 124 beats/min, BP 80/50 mm Hg with cold periphery, lung bases were clear. ECG showed RBBB patternwith strain and troponin-I was mildly elevated.
i) Mention the most likely diagnosis.
ii) low would you confirm the diagnosis?
iii) Jive the management plan for this patient.

e)A 5-year-old woman, a known case of diabetes mellitus, presents with weakness and fatigue. Her blood sugar is well controlled with oral antidiabetic medications. Laboratory investigation revealed Hb 9 gm/dl, serum creatinine 3.5 mg/dl and eGFR 40. Mention the investigations you will advise to evaluate the anaemia in this
i) How will you manage anemia in this patient?
1) correction is done.

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