Lecture Notes on Clinical Scenarios and Diagnosis

Question 1: Diagnosis of Tricuspid Stenosis

• Patient Profile: 40-year-old female with palpitations and difficulty in breathing.
• Examination Findings:
  • Mid-diastolic murmur.
  • Jugular Venous Pressure (JVP) shows a prominent "A" wave.
• Diagnosis: Tricuspid stenosis.

Key Features

• Large A Waves: Caused by increased pressure in the right atrium.
• Y Descent: Blunted due to narrowing; significant for exam questions.
• Pulsations in Liver:
  • Pre-systolic Pulsations: During diastole, blood filling against obstruction.
  • Systolic Pulsations: Indicative of tricuspid regurgitation.
• Murmurs: Mid-diastolic murmur increases in intensity on inspiration.

Question 2: Diagnosis of Parkinson's Disease

• Patient Profile: 65-year-old with tremors, rigidity, and smell loss (anosmia).
• Pathological Finding: Presence of Lewy bodies.
• Diagnosis: Parkinson's Disease.

Key Points

• Rock Staging: Non-motor symptoms often precede motor symptoms (constipation, anosmia).
• Motor Symptoms: Bradykinesia is a must-have criterion with tremors and rigidity.
• Cognitive Defects: Involvement of the cerebral hemispheres.
• Micrographia: Change in handwriting is a peculiar manifestation.

Question 3: Diagnosis of Disseminated Cryptococcosis

• Patient Profile: 45-year-old HIV-positive male with a persistent cough, weight loss, and skin lesions.
• Findings: CD4 count of 20; sputum negative for tuberculosis.
• Diagnosis: HIV with disseminated cryptococcosis.

Key Features

• Organism: Cryptococcus neoformans, commonly found in pigeon droppings.
• Transmission: Inhalation leading to meningitis in immunocompromised patients.

Question 4: Management of Diabetes Insipidus Post-Hypophysectomy

• Patient Profile: Post-hypophysectomy with polyuria, sodium 155 mEq/L, urine osmolality 200 mOsm/L.
• Diagnosis: Diabetes insipidus due to ADH deficiency.
• Management: DDAVP supplementation for life.

Key Points

• Urine output > 3L indicates DI; low urine osmolality signifies dilution.
• Water Deprivation Test: Important for diagnosis.

Question 5: Prophylaxis for Rheumatic Heart Disease

• Patient Profile: 11-year-old boy with a history of streptococcal infection.
• Management: Benzathine penicillin G every 4 weeks for 5 years or until age 21.

Key Points

• Importance of test dose before administering penicillin to avoid anaphylaxis.

Question 6: MEN2B Syndrome

• Key Feature: Absence of parathyroid adenoma in MEN2B syndrome.

Question 7: Management of Diabetic Ketoacidosis (DKA)

• Key Point: Intravenous fluids with regular insulin; important for management.

Question 8: Management of Acute Pulmonary Edema

• Management: IV nitroglycerin to reduce preload and afterload.
• Mnemonic: LMNOP (Lasix, Morphine, Nitrates, Oxygen, Positioning).

Question 9: Renal Tubular Acidosis

• Key Finding: Metabolic acidosis due to impaired hydrogen ion excretion.

Question 10: Management of Alcoholic Patient with Abdominal Distension

• Management: Octreotide plus albumin to manage portal hypertension.

Question 11: Management of Mitral Stenosis

• Management: Warfarin to prevent thrombotic events due to arrhythmias.

Question 12: Diagnosis of Systemic Sclerosis (Scleroderma)

• Key Findings: Skin tightening, positive ANA, anti-topoisomerase antibody.

Question 13: Child-Pugh Classification

• Classification: Class C due to elevated bilirubin and INR in liver disease.

Question 14: Management of COPD Exacerbation

• Management: Non-invasive positive pressure ventilation (NPPV).

Question 15: Water-Hammer Pulse

• Condition: Aortic regurgitation leads to water-hammer pulse.

Question 16: Polyarteritis Nodosa (PAN)

• Key Feature: 30% associated with Hepatitis B.

Question 17: Paroxysmal Nocturnal Hemoglobinuria

• Key Features: Deficiency of CD55 and CD59 leading to hemolysis.

Question 18: Crohn's Disease Characteristics

• Key Features: Non-caseating granulomas; lead pipe appearance is not associated.

Question 19: GBS Subtypes

• Common Form: Acute Inflammatory Demyelinating Polyneuropathy (AIDP).

Question 20: Electrolyte Disturbance in Seizure

• Expected: Hypernatremia due to loss of water.