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Group C Answers Cleaned

The document provides detailed clinical cases and management plans for various medical conditions, including ischemic stroke, cerebral malaria, upper gastrointestinal bleeding, acute leukemia, chronic kidney disease, and visceral leishmaniasis. Each case outlines probable diagnoses, investigation methods, complications, and treatment plans. The information is structured in a question-and-answer format, highlighting essential diagnostic and therapeutic approaches.

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Tanveer Shams
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4 views

Group C Answers Cleaned

The document provides detailed clinical cases and management plans for various medical conditions, including ischemic stroke, cerebral malaria, upper gastrointestinal bleeding, acute leukemia, chronic kidney disease, and visceral leishmaniasis. Each case outlines probable diagnoses, investigation methods, complications, and treatment plans. The information is structured in a question-and-answer format, highlighting essential diagnostic and therapeutic approaches.

Uploaded by

Tanveer Shams
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Group C - Detailed Answers

1. A 60-year-old hypertensive male presented with sudden weakness of the left side of his body for

the last 5 days. On examination, plantar reflex is extensor on the left side.

a) Write down the probable diagnosis. (1)

Answer: Right-sided ischemic stroke (involving corticospinal tract).

b) How will you investigate this patient? (1)

Answer:

- CT/MRI of the brain: To confirm ischemic or hemorrhagic stroke.

- Carotid Doppler: To check for carotid artery stenosis.

- Echocardiography: To detect cardioembolic source.

- Lipid profile: To assess dyslipidemia.

- Blood tests: CBC, glucose, and coagulation profile (PT, INR).

c) Write down the complications that might develop in this patient. (1.5)

Answer:

- Hemiplegia or permanent motor deficits.

- Aspiration pneumonia.

- Cognitive impairment or post-stroke dementia.

- Pressure ulcers due to immobility.

- Deep vein thrombosis (DVT).

2. A 50-year-old male from Bandarban with the complaints of high-grade fever, disorientation for the

last 5 days. On examination, he is icteric, GCS 10, bilateral plantar extensor.

a) Name some probable diagnoses. (1)


Answer:

- Cerebral malaria.

- Leptospirosis.

- Viral hepatitis with hepatic encephalopathy.

- Typhoid fever with complications.

b) Write down the principle of management of this patient. (2.5)

Answer:

- Supportive care:

- IV fluids to correct dehydration.

- Maintain electrolyte balance.

- Specific treatment:

- For malaria: Artesunate IV for cerebral malaria.

- For leptospirosis: IV penicillin or ceftriaxone.

- For viral hepatitis: Supportive care with monitoring of liver function.

- Manage complications: Mannitol for raised intracranial pressure (if cerebral involvement).

3. A 45-year-old lady arrived in the Emergency Department due to hematemesis for the last two

days. She is anemic, her BP is 70/50 mmHg, pulse 120/min. Her family members state that she was

taking some painkillers the last few days for her knee pain.

a) Mention the clinical diagnosis. (1)

Answer: Upper gastrointestinal bleeding due to peptic ulcer disease (NSAID-induced).

b) How will you investigate and manage the case? (2.5)

Answer:

- Investigations:

- CBC: To assess hemoglobin and platelet count.


- Upper GI endoscopy: To locate the bleeding site.

- Coagulation profile: PT, INR.

- Serum creatinine and electrolytes.

- Management:

- IV fluids for hemodynamic stabilization.

- Blood transfusion if hemoglobin <7 g/dL.

- Proton pump inhibitors: IV pantoprazole 40 mg twice daily.

- Endoscopic therapy: Injection of adrenaline or hemoclips.

4. A 15-year-old girl presented with progressive pallor, bony tenderness, fever, and multiple purpuric

rashes for the last 3 weeks.

a) What are the differential diagnoses of this case? (0.5)

Answer:

- Acute leukemia (acute lymphoblastic leukemia - ALL).

- Aplastic anemia.

- Thrombocytopenic purpura.

b) Write down the investigations with findings for the diagnosis. (1.5)

Answer:

- CBC: Anemia, thrombocytopenia, and leukopenia.

- Peripheral blood smear: Blast cells (in leukemia).

- Bone marrow aspiration/biopsy: To confirm leukemia or aplastic anemia.

- Coagulation profile: Rule out coagulopathy.

c) Write down the management plan. (1)

Answer:

- For leukemia: Chemotherapy (e.g., vincristine, prednisolone).


- Supportive care: Blood transfusions, antibiotics for infections.

- Bone marrow transplant: For aplastic anemia.

5. A 50-year-old diabetic male presented with anorexia, weakness, and gradual swelling of both

legs. On examination, he is anemic, hypertensive, and multiple scratch marks over skin are noted.

a) What is the most likely diagnosis? (0.5)

Answer: Chronic kidney disease (CKD).

b) What investigations will you do for this patient? (1)

Answer:

- Serum creatinine and eGFR: To assess renal function.

- Urinalysis: Proteinuria and hematuria.

- Serum electrolytes: Hyperkalemia, metabolic acidosis.

- Hemoglobin levels: To check for anemia.

- Renal ultrasound: To evaluate kidney size and structure.

c) Outline the treatment plan. (1)

Answer:

- Diet: Low protein, low potassium, and sodium-restricted diet.

- Medications:

- Erythropoiesis-stimulating agents for anemia.

- ACE inhibitors or ARBs to reduce proteinuria.

- Diuretics for volume overload.

- Dialysis: If eGFR is severely reduced.

6. Write short notes on visceral leishmaniasis. (3.5)

Answer:
- Definition: A parasitic disease caused by Leishmania donovani, transmitted by sandflies.

- Clinical features:

- Fever, weight loss, and darkening of skin.

- Hepatosplenomegaly.

- Pancytopenia (anemia, thrombocytopenia, leukopenia).

- Diagnosis:

- Bone marrow/splenic aspirate: Presence of Leishmania amastigotes.

- rK39 antigen test: Rapid diagnostic test.

- Treatment:

- Liposomal amphotericin B: 3-5 mg/kg IV for 5-7 doses.

- Miltefosine: Oral therapy for 28 days.

- Complications: Secondary infections, bleeding disorders, and post-kala-azar dermal leishmaniasis.

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