Transcript Presentation

Quick Assessment of
Data Interpretation Skills
(QADIS) with Key
Instructions:
Please read the scenario and data carefully and answers the questions given below each data.
Time allocated for each patient is 2 minutes
Patient No 1
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A 63 year-old male presented with history of haemoptysis and cough
for the last 02 years. He is a chain smoker (20 cigarettes / day). His
biochemical profile is like this:
Ca:
3.20 mmol/L (2.10 – 2.55)
Phosphates:
0.7 mmol/L (0.81-1.45)
Urea:
8.2 mmol/L (3.3 – 6.6)
Creatinine:
102 mol/L (78 – 115)
Plasma PTH:
< 2 pmol/L
a. What is the most probable diagnosis in this patient?
b. Name ONE hormone which is leading to HYPERCALCAEMIA
a. Humoral hypercalcaemia of malignancy due to Lung
Malignancy
b. PTH-related peptide
Patient No 2
A 62 year-old-male patient having following arterial blood gas analyses
results:
• pH :
7.40
(7.35 – 7.45)
• Base Excess:
21.8
(<+3 - >-3)
• PCO2 :
10.7
(4.7 – 6.0 kPa)
• PO2
10.9
(10.7 – 13.3 kPa)
• HCO3
51.1
(23 – 33 mmol/L)
• Oxygen Sat
95.1
(95-98%)
a. Name the ACID BASE Abnormality in this patient?
b. Name TWO clinical conditions which can lead to this HCO3 result
a. Double opposing disorder i.e. Metabolic Alkalosis and
Respiratory acidosis
b. Upper GI Vomiting and diuretics
Patient No 3
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a.
b.
A 33 year old male had a fasting lipid profile as a part of his regular
screening. His past medical history is not significant. Presently he is
not on any medications. His lipid profile is as under:
Triglycerides: 1.13 mmol/L (<1.87)
Cholesterol : 4.45 mmol/L(<5.1)
HDL Cholesterol: 0.73 mmol/L(>1.0)
LDL Cholesterol: 3.53 mmol/L(<3.62)
Which lipoprotein is abnormal in this patient?
Name TWO complications (other than atherosclerosis) which can
be caused due to this biochemical abnormality
a. Low HDL-Cholesterol
b. Malignancy, poor response to infection and complications in
diabetes mellitus
Patient No 4
A 32 y male has a unilateral swelling of his left testis and symptoms
of hyperthyroidism. His thyroid profile was as following:
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Serum Free T3
4.12 ng/ml
(1.60-4.20)
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Serum T4
2.18 pg/ml
(0.70-1.68)
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Serum TSH
0.14 mIU/L (0.30-4.0)
a.The most probable testicular tumour you would like to exclude
b.Would you like give anti-thyroid medicines to this patient?
a. Embryonal carcinoma
b. No
Patient No 5
A newborn with neurological deterioration with moderate
hepatocellular disturbance, hypotonia, seizures and coma. His
biochemical findings are:
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Alkalosis:
+
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Ketones :
+
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NH3:
++++
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Lactate:
Normal
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Glucose:
Normal
a. What is the most probable diagnosis in this patient?
b. Name the amino acid metabolism most likely affected in this baby?
a. Urea cycle defect
b. Ornithine
Patient No 6
A patient presented with vague complaints. He had no
tremors or weight loss. His pulse was 82 /minute:
• Free T4 :
72 pmol/L
(6-21)
• Total T3 :
9.2 nmol/L
(1.1-2.7)
• TSH:
>75 mIU/L
a. What is the most probable diagnosis in this patient?
b. Name the pathogenic mechanism causing this disease
a. Thyroid resistance syndrome
b. It is defect of thyroid hormone receptor which are present in
the peripheral tissues and in pituitary.
Patient No 7
A 2 years boy presented with abdominal pain, vomiting; neuropathic pain and
neuropathy. His urine tests showed following results:
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Total Porphyrin
64.0 nmol/mmol creat (0 - 35 )
Porphobilinogen
20.2 µmol/mmol creat (0 - 1.5 )
Delta-Aminolaevulinic Acid
7.2 µmol /mmol creat (0 - 3.8 )
Creatinine
3.9 mmol/L
Plasma fluorescence peak at 620 nm
a. What is the most probable diagnosis in this patient?
b. Name the enzyme which is deficient in this patient?
a. Acute intermittent porphyria
b. Porphobilinogen deaminase
Patient No 8
A female aged 65 years, presented in semi-conscious state
Plasma
• Na :
153 mmol/L (135–150)
• K :
4.5 mmol/L (3.5 – 5.0)
• Cl :
118 mmol/L (98-108)
• HCO3 :
34 mmol/L
(23 – 33)
• Urea :
15.2 mmol/L
(3.3 – 6.6)
• Osmolality:
393 mmol/Kg
(275 – 295)
• Glucose (R) :
43
mmol/L
(3.5 – 11.1)
Urine:
• Ketones:
Trace
a. What is the most probable diagnosis in this patient?
b. Name the most important treatment to be started immediately in this patient?
a. Non-ketotic hyperosmolar diabetic come
b. Rehydration
Patient No 9
A 57 y old female admitted for cough and fever of about 4 months duration.
Her radiological investigations show evidence of extensive granalumatous
involvement of lungs and liver. Treating physician has confidently excluded
tuberculosis in this patient. Following are her lab investigations
• Ca :
• PO4 :
• Albumin :
3.44 mmol/L
0.96 mmol/L
40 g/L
(2.15–2.55)
(0.60 – 1.25)
(37-52)
a. What is the most probable diagnosis in this patient?
b. Name ONE biochemical investigation which can be very helpful in
confirmation of the diagnosis.
a. Sarcoidosis
b. Serum ACE levels
Patient No 10
A 36 years female who is mother of two children has a body mass index (BMI) of 31.
She has facial hirsutism and amenorrhoea for the last 2 months. Her routine biochemical
profile shows
Plasma
• Glucose (F) :
6.9
mmol/L
(3.3-5.6)
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ALT
:
21
U/L
(< 42)
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ALP
:
186 U/L
(< 306)
• Triglycerides :
4.8
mmol/L
(<2.83)
• HDL-C :
0.7 mmol/L
(>1.0)
• HbsAg:
Negative
• Anti-HCV :
Negative
a. Name ONE HORMONE test you will advise in this patient as a
first line test.
b. Write TWO possible causes of hirsutism in this patient.
a. Urine pregnancy test
b. PCOS and Cushing Syndrome (CAH is unlikely at this age)
Thank You