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By Dr. Zahoor 1

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Question 1: 1.What is shown in the picture? 2.What is most likely cause? 2

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Answers 1 1.Carpopedal spasm 2. Hypocalcaemia 3

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Question 2: 1.What abnormality does this chest X-ray show? 2.What is the likely diagnosis? 4

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Answers 2 1.Bilateral hilar lymphadenopathy 2.Lymphoma Sarcoidosis Leukemia 5

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Question 3 1.What abnormality is shown? 2.What is the most likely cause? 6

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Answers 3 1.Haemorrhages - Exudates 2. Diabetic retinopathy 7

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Question 4 1.What is seen in the picture? 2.What could be the cause? 8

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Answers 4 1.Petichel Hemorrhages (purpura) 2.Thrombocytopenia - Drugs e.g. Thiazide diuretic, heparin, Quinine, NSAID drugs, Ranitidine 9

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Question 5 1.What abnormality is shown? 2.What could be the cause? 10

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Answers 5 1.Mediastinal mass 2.Lymphoma Thymoma Metastatic carcinoma Leukemia 11

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Question 6 1.What abnormality is shown? 2.What is the most likely cause? 12

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Answers 6 1.Koilonychia 2.Iron deficiency anaemia 13

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Question 7 1.What does the X-ray show? 2. What is the diagnosis? This patient had progressive dysphasia. Barium swallow was done. 14

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Answers 7 1.Narrowing of lower end of Esophagus 2.Achalasia 15

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Chest X-ray of middle aged man Question 8 1.What does this X-ray show? 2.What is likely diagnosis? 16

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Answers 8 1.White shadow left apex 2.Most likely left apical carcinoma, Pancoast tumor 17

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Question 9 1.What is shown in the picture? 2.What could be the cause? This patient was presented with headache. 18

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Answers 9 1.Papilloedema 2.Raised intracranial pressure e.g. brain tumor, meningitis 19

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This patient is presented with weight loss. Question 10 1.What this X-ray chest is showing? 2.What is the diagnosis? 20

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Answers 10 1.Chest X-ray shows multiple rounded shadows in the lung fields 2.Multiple secondaries - cannonball secondaries (primary carcinoma site in kidney or testes) 21

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Question 11 1.What is the diagnosis? 2.What is the treatment that you would give? 22

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Answers 11 1.Acute gout 2.Anti-inflammatory drugs e.g. Voltaren, Brufen 23

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Question 12 1.What does the skull X-ray show? 2.Give two causes. 24

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Answers 12 1.Multiple lytic lesions in the skull 2. Multiple myeloma Multiple secondaries 25

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Question 13 1.What is shown in the picture? 2.Give two pulmonary conditions which may cause this appearance. 26

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Answers 13 1.Finger clubbing 2.Bronchial carcinoma Bronchiectasis Fibrosing alveolitis Empyema 27

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Question 14 1.What is this skin condition? 2.What disease are associated with it? 28

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Answers 14 1.Pyoderma gangrenosum (skin ulceration with clear cut margin) 2.Ulcerative colitis Crohns diasease 29

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This patient aged 35 years had diabetes mellitus. Question 15 1.What is this lesion? 30

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Answers 15 1.Necrobiosis lipoidica It is closely associated with diabetes mellitus. Ulcerated Plaques look yellow because of high lipid content. 31

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Question 16 1.Give two abnormal physical sign. 2.What is the most likely diagnosis? 32

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Answers 16 1.Arthritis of proximal interphalangeal and metacarpophalangeal joints Vasculitis 2. Rheumatoid arthritis 33

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Question 17 1.What this picture is showing? 2.What is likely diagnosis? 34

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Answers 17 1.Hands are thick 2.Acromegly 35

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Question 18 1.What physical sign is shown? 2.Give two likely causes. 36

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Answers 18 1.Erythema nodosum (hypersensitivity vasculites) 2. Sarcoidosis Streptococcal infection Tuberculosis Drugs e.g. oral contraceptives Chronic inflammatory bowel disease 37

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Question 19 1.What is the abnormality? 2.What could be the cause? 38

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Answers 19 1.Optic atrophy 2.Glaucoma Multiple sclerosis Methyl alcohol 39

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Question 20 1.What this picture is showing? 2.What is the differential diagnosis? 40

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Answers 20 1.Cushingoid appearance with moon face and plethora 2.Cushing syndrome Exogenous Glucocorticoids 41

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Question 21 1. What is the diagnosis? 42

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Answer 21 1. Psoriasis 43

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Question 22 1.What this picture is showing? 2. What is the diagnosis? This boy presented with abdominal pain following upper respiratory tract illness. 44

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Answers 22 1.Purpuric rash 2.Henoch-Schonlein purpura Aetiology is unknown, precipitating factors include streptococcal infection, drugs e.g. penicillin 45

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Question 23 1.What is the diagnosis? 2.How will you confirm the diagnosis? 46

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Answer 23 1.Acromegly 2.Increased level of growth hormone which fails to suppress during oral glucose tolerance test - Lateral skull X-ray - CT 47

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This is the peripheral blood film. Question 24 1.What does it show? 2.What could be the possible cause? 48

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Answers 24 1.Lymphocytosis 2.Viral infection Chronic lymphatic leukemia 49

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Question 25 1.What this picture is showing? 2.What drug causes it? This patient had renal transplant and is on drug therapy 50

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Answers 25 1.Gingival hyperplasia 2.Cyclosporin Note Other causes of gingival hyperplasia include drugs phenytoin, cyclosporin, oral contraceptives - Pregnancy - Scurvy - Acute monocytic leukemia 51

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Question 26 1.What physical signs are present? 2.What is the likely diagnosis? This young girl has deep voice and blood pressure 180/105 52

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Answers 26 1.Cushingoid features and hirsutism 2.Congential adrenal hyperplasia Androgen secreting ovarian neoplasm 53

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Question 27 1.Give two observations you find in this picture. 2.What is the diagnosis? 54

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Answers 27 1. Right eye ptosis and meiosis (smaller pupil) 2. Horner syndrome (lesion affecting sympathetic supply to the eye) 55

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Thank you 56