SBAQ

40 years old man presented with history of fever and productive cough for 1-week duration. His temperature is 39.7 ̊C, pulse rate 120 bpm, blood pressure 100/50 and oxygen saturation is 90% under room air.

Investigation

Urea 15 mmol/L

Cretinine 150 umol/L

Hb 13.3 mg/dl

WBC 21.8 x 10 ⁹ /L

Platlet 550 x 10 ⁹ /L

Which is the best investigation to confirm the diagnosis?

• Blood Culture and Sensitivity

• Chest Xray

• Aterial Blood Gas

• Sputum Culture and Sensitivity

• Mantoux Test

1. 66 years old woman recently admitted to medical ward and intubated for DKA. She was discharged well but 1 week later, she developed productive cough and fever. His temperature is 39.7 ̊C, pulse rate 90 bpm, blood pressure 135/70 and oxygen saturation is 95% under room air.

Investigation

Urea 15 mmol/L

Cretinine 150 umol/L

Hb 13.3 mg/dl

WBC 21.8 x 10 ⁹ /L

Platlet 550 x 10 ⁹ /L

Chest Xray – Consolidation over right lower zone

What the is the most likely organism cause pneumonia in this patient?

• Staphylococcus Aureus

• Klebsiella Pneumonia

• Pseudomonas Aeruginosa

• Mycoplasma Pneumonia

• Streptococcus Pneumonia

34 years old gentleman presented with history productive cough for 1 week. Chest x-ray was done noted the is pleural effusion on the right side. Pleural tapping was done and sent for investigation.

Hb 13.3 mg/dl

pleural pH 5

WBC 24.5 x 10 9 /L

Pleural Albumin 26 g/dL

Platlet 450 x 10 9 /L

Pleural LDH 1000

Albumin 30 g/dL

Serum LDH 310

What is the best diagnosis?

• Community acquired pneumonia with parapneumonic effusion

• Lung carcinoma

• Lung Empyema

• Congestive cardiac Failure

• Liver Failure

1. 45 years old lady, with history of uncontrolled diabetes mellitus for past 3 years presented to emergency department with history of fever and productive cough for 1 month. Further history she loss of appetite but her weight is maintain at 45 kg. On examination, she is alert conscious, her respiratory rate is 18 breath per minute, SPO2 is 95% under room air, temperature 40.5°C and her right lung is dull on percussion and reduce vocal resonance. Pleural tap was done noted pleural pH 7 and pleural LDH is 1900 u/L.

What is your best next step?

• Chest tube

• Pleuralscopy

• Bronchoscopy

• Pleural decortication

• Pleurodesis

35-years-old man presented with chest pain and he was diagnosed to have myocardiac infraction. He underwent percutaneous intervention and angioplasty was done. Blood investigation was done

Urea 15 mmol/L

HDL 2.6 mmol/L

Cret 550 umol/L

LDL 3.0 mmol/L

Hb 18.0 x 10 ⁹ /L

Calcium 2.0

WBC 6.9 x x 10 ⁹ /L

Phosphate 2.2

What is the most likely predisposing factors lead to MI?

• Atherosclerosis

• Smoking

• Polycythemia

• Hypercalcemia

• Chronic Kidney Disease

35-years-old man presented with chest pain and he was diagnosed to have myocardiac infraction. He underwent percutaneous intervention and angioplasty was done. Blood investigation was done

Urea 15 mmol/L

HDL 1.6 mmol/L

Cret 250 umol/L

LDL 5.0 mmol/L

Hb 18.0 x 10 ⁹ /L

Calcium 2.3

WBC 6.9 x x 10 ⁹ /L

Phosphate 1.4

What is the most likely underlying disease?

• Atherosclerosis

• Polycythemia Rubra Vera

• Polycystic Kidney Disease

• Chronic Obstructive Lung Disease

• Pheochromocytoma

80 years old man was diagnosed with lung carcinoma, presented with weakness and confusion. His hydration is good, blood pressure 135/70 and oxygen saturation is 98% under room air. His blood test revealed

Hemoglobin 11.1 g/dL

Hct 36

Platelet 429 x 109 /L

WBC 5.6 x 109/ L

Creatinine 89 µmol/L

potassium 4 mmol/L,

sodium 110 mmol/L

urea 4 mmol/L

What is the best investigation to differentiate the causes of hyponatremia in this patient?

• Urine Osmolarity

• Serum ADH

• Serum LDH

• Urine Pottasium

• Urine pH

80 years old man was diagnosed with lung carcinoma, presented with diarrhea, vomiting and confusion. His hydration is fair, blood pressure 135/70 and oxygen saturation is 98% under room air. His blood test revealed

Hemoglobin 18.1 g/dL

Hct 50

Platelet 429 x 109 /L

WBC 5.6 x 109/ L

Creatinine 200 µmol/L

potassium 5 mmol/L,

sodium 150 mmol/L

urea 40 mmol/L

What is the mostly causes of confusion in this gentleman?

• Hypernatremia

• Hypovolemia

• Uremia

• Stroke

• increase intracranial pressure

56 years old lady known case of diffuse large B cell Lymphoma. Currently she receives 3^rd cycles of R-CHOP chemotherapy. A week post chemo, she develops a fever associated with productive sputum. Which is the best investigation to determine next step plan of action?

• A. Chest X-ray

• B. Blood cultures and sensitivity

• C. Renal profile

• D. Full blood count

• E. C reactive protein

35 years old lady known case of rheumatoid arthritis. 6 months ago she had flare of rheumatoid arthritis and currently she on methotrexate since then. Recently she was admitted to ward complaint of shortness of breath and reduce effort tolerance. On examination there is crepitation on bilateral lower zone. What is the most likely causes of the respiratory finding?

• A. Pneumonia

• B. Lung fibrosis

• C. Bronchiectasis

• D. Lung abscess

• E. Pulmonary edema