A fifty year old lady presented with one day history of left sided chest pain on inspiration and shortness of breath. She was tachycardia, tachypnoeic with raised JVP and clear lungs. Pulse oxymetry showed oxygen saturation of 90% on room air. Her ECG showed sinus tachycardia and a tall R wave in lead V1.
Q1) What is the most likely diagnosis?
- Right ventricular infarction
- Pulmonary embolism
- Atypical pneumonia
Q2) Which of the following investigations is most helpful in confirming your diagnosis?
- Right sided ECG leads
- Ultra sound chest
- Chest x-ray
- Ventilation perfusion scanning
- Arterial blood gases
Patient was started on appropriate treatment, however twenty four hours later patient became unwell, distressed, sweaty with cold extremities and severe hypotension.
Q3) Which of the following would be the desirable intervention?
- Pericardiocentesis to relieve temponade
- Thrombolysis with tissue plasminogen activator
- Broaden Antibiotic therapy with Imipenem
- Intercostal chest tube insertion
A forty year old municipality labourer got admitted with fever, jaundice and systemically very unwell. Clinically he has no rash or lymphadenopathy and there is no history of travel abroad. However he was found to be jaundiced with haematuria, mild renal impairment and signs of meningism.
Q4) Which of the following is the most likely diagnosis?
- Infectious mononucleosis
- Hepatitis B infection
- Typhoid fever
Q5) Which of the following conditions is typically associated with alveolar hypoventilation?
- Pulmonary embolism
- Chest wall deformity
- Salicylate intoxication
- Pulmonary fibrosis
- Diabetic ketoacidosis
Match the following scenarios with the appropriate diagnoses from the list below:
Q6) A forty year old Bangladeshi presented with fever, diarrhoea, and toxic confusional state and examination showed temp:39 degrees; pulse of 80/minuteand coated tongue.
Q7) A sixteen year old girl presented with fever and cervical lymphadenopathy and found to have mild splenomegaly.
Q8) A thirteen year old girl presented with fever and cough for >two weeks and examination showed raised bluish tender nodular rash over the shins and Chest X-ray showed right hilar lymphadenopathy.
Q9) A thirty five year old man, recently returned from an east African holiday and without regular antimalarial prophylaxis, presenting with fever, malaise, mild diarrhoea, heptosplenomegaly and eosinophilia.
|C. Enteric fever
|E. Primary TB
||F. Mycoplasma pneumonia
|G. Infectious mononucleosis