35 years old female presented  with the complaints of fits. On lab examination her Serum sodium was 90 mmol/L and managed with giving 5% NaCl.

So my question is, how much 5% NaCl is required to correct her serum sodium?

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45 years old female presented in OPD  with features of (shown in picture)What is she suffering from ,what is the definite test and and treatment of this condition ?

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2 years old boy taken to hospital with the complaints of fever 38C since 3 days on examination and lab test viral fever is diagnosed.
For above case, which drug should not be used and why?

1. Acetaminophen,
2. Antiviral,
3. Aspirin,
4. Cold sponging

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35 years old female visited her obstetrician/ gynecologist and complained that she was unable to get pregnant. Upon taking a medical history, the physician notes that the patient had regular 28-to-30 day cycles during the past year, during which time she had regular unprotected intercourse. She does not smoke and does not use caffeine, drugs, or alcohol. She appears to be in good health. Her ovaries and uterus appear normal in size for her age. Laboratory tests indicate that her preovulatory (late follicular phase) estradiol in 40 pg/mL (normal, 200 to 500 pg/mL) and midluteal phase progesterone is 3 ng/mL (normal, 4 to 20 ng/mL). Her husband’s sperm count is 30 million/mL.

What is the clinical indication of a fertility problem with this patient and on the clinical signs, what basic physiological principles provide insight into the infertility?

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A 35 years-old-man consulted his family physician because of some recent episodes of what he described as dizziness. He was concerned that this complaint might be related to a fall from a stepladder that had occurred the previous month, although his symptoms did not begin immediately after the incident. At the time of his visit to the doctor, his symptoms are minimal, and he appears to be in good general health. He states that the feeling of dizziness, which also included sensation of nausea (without vomiting) and “ringing in the ears”, makes his feel as though his surroundings were spinning around him. The episodes, which could last for several days at a time, are quote annoying and sufficiently severe to cause him concern for his safely on the job. When questioned, he indicates that he also may not be hearing as well as he should, but at other times he does not notice any hearing problems. He further indicates that he may have had occasional dizzy spells before the ladder incident, but that they now appear to be much more frequent. The only medication he takes is aspirin for an occasional headache. He has no difficulty in following a moving finger with head held stationary, and on the day of the visit he walks with a normal gait. He reports no light- headacheness with moderate and continued exertion.

Gentle irrigation of his external ear canals with warm water produces a feeling of dizziness and nausea accompanied by nystagmus. The subjective sensations appeared to be the same for each ear. He is further evaluated with the Dix-Hallpike maneuver, and no sensations of vertigo are elicited during the positional maneuvers. However, when he is rapidly rotated in a swivel chair, he reports dizziness that was more several that his usual symptoms. Rotation in the opposite direction produced similar symptoms. His physician advises him that may be some appropriate specific medication for his condition, but may would first like him to try a salt restricted diet. He also prescribes mild diuretics.

Upon his return  visit 4 weeks later, the patient reports a gradual lessening of the frequency and duration of his spells of dizziness and accompanying symptoms.

What feature of this case would indicate that trauma from the stepladder incident was not the precipitating cause of the symptoms and what factors would tend to rule out a diagnosis of begin paroxysmal positional vertigo?

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67 years old man was taken to see his physician by his wife. For the preceding 2 days , the patients wife has noticed that he did not seem to make sense when he spoke. She also indicated that he seemed a little disoriented and din not respond appropriately to her question. He has no obvious motor or somatic sensory deficits.

On examination, the physician concludes that the man has a stroke in a region of one of his cerebral hemispheres. As part of the diagnosis, the physician tests the man’s visual fields and notices a decreased awareness of stimuli presented to on visual field.

Which side of the brain most likely suffered the stroke and which regions of the hemisphere suffered the stroke?

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55 years old female patient presented with the history of pain in right upper quadrant of abdomen for last 3 years. Patient has recurrent attacks of colicky pain in right upper quadrant of abdomen of last 3 years. Initially patient had colicky pain in right upper quadrant of abdomen but for 3 months patient is having dull aching continuous pain in the same region. The pain radiates to the back of the chest and the center part of the abdomen. Patient complains of anorexia and marked weight loss for last 6 months (history of jaundice and abdominal lump is present).

On examination: On general examination survey patient had moderate pallor, jaundice, cervical lymph nodes are not palpable. Abdomen examination revealed tenderness in right hypochondriac region. Gall bladder is palpable, firm in consistency moving up and down with respiration, tender. Liver and spleen are not palpable. No other mass is palpable. No free fluid in abdomen. Normal bowel sound.

What is your diagnosis and what are the other possibilities ?

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30 years male patient presented with a swelling in the left side of the scrotum for last 4 years. The selling started in the lower part of the scrotum and subsequently the swelling is slowly increasing in size and grown upto the root or the scrotum. The swelling disappears on lying sown position and reappears on standing and walking. Patient complains of dull aching pain in the left side of the scrotum for last 6 months. The pain is more towards the evening when the swelling is larger. There is no pain abdomen. No urinary complaints.

On examination: On inspection the left testis in lying at a lower level that the right .Multiple dilated veins are seen on the left side of the scrotum. No expansile impulse on cough is seen. On palpation a mass of dilated vein feeling like a bag of worms is palpable on the left side of the scrotum along the left spermatic cord extending from the upper pole of the testis upto the superficial inguinal ring. No expansile impulse on cough in palpable, instead a thrill is palpable. On stand up the dilated vein reappeared. The left testicular volume is smaller than the right one.Abdominal examination is normal.

Based on the above case, what is your diagnosis and what is your management ?

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35 year old female patient presented with a swelling in right side of upper abdomen for last 5 years which is gradually increasing in size for last 5 years. There is no history of rapid increase in size of the swelling. Patient complains of occasional dull aching pain over the right upper of abdomen for last 2 years. No history of fever and no other systemic symptoms .There is no history of major ailment in the past. Patient used to keep pet dogs at home for long time.

On examination Patent looks healthy .On local examination of abdomen liver is enlarged 9 cm below the right costal margin in the right midclavicular line and a cystic swelling is palpable in relation to the liver 7cm ×5cm in size, non tender .No other mass is palpable. No free fluid in the abdomen and normal bowel sounds are audible.

Based on the above case, what is your differential diagnosis and diagnosis?

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40 years old alcoholic male presented at OPD, with the complaints of vomiting, Diarrhea, abdomen pain and abdominal fullness since 1 day, Physical examination shows normal finding. Routine stool test shows present of amoeba for that physician prescribed him metronidazole for 5 days but the very next  day this patient returns at emergency room with the chief complaints of nausea, vomiting, flushing of the skin, tachycardia (accelerated heart rate), and shortness of breath.

Based on the above case, what would be a reasonable initial hypothesis?

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3 years old female child comes to ED with abdominal pain, nausea, vomiting and hypotension. She has severe weight loss since 1 year of duration.Previously she was diagnose as transient hypoparathyrodism.

Her lab investigation shows Hb decreased ,cortisol <495nmol/L,Bp <110/70mmHg .Her thyroid function test –T3 & T4 increased TSH decreased  & TPO and TMO  is positive. fasting blood glucose is elevated.

On PE  her thyroid is 3degree enlarged .

What would be ur further investigation & wt is ur diagnosis ?????

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58 years old woman arrived in the emergency department complaining of sudden onset of palpations, lightheadedness, and shortness of breath. These symptoms began approximately 2 hours previously. On examination, her blood pressure is 95/70 mmHg, and heart rate is 140 beats /min .An ECG demonstrates atrial fibrillation. The physical examination is otherwise unremarkable.

Explain why the patient has these symptoms and how medications could be useful in this setting?

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57 year old man experienced several months of vague pains in his left chest and shoulder when climbing stair. During a touch football game at a family gathering, he had much more intense pain and had to rest. After 45 minutes of intermittent pain, his family brought him to a emergency department.

His heart rate is 105 beats/min, his Bp is 105/85 mmHg, and his hands and feet are cool to touch and somewhat bluish. His is sweating and is short of breath. An ECG indicates an elevated ST segment, which is most noticeable in leads V4 to V6 .The attending cardiologist administers streptokinase intravenously. One hour later, the ST segment abnormality is less noticeable. The heart rate 87 bmp, Bp is 120/85 mmHg and patient’s hands are pink and warm and not complain of chest pain and shortness of breath.

During a 4 day stay in the hospital, percutaneous angioplasty is performed to open several partially blocked coronary arteries. The patient is told to take half of an adult aspirin every day and is given a prescription of a statin drug to lower blood lipids. In addition, he is assigned to a cardiac rehabilitation program designed to teach proper dietary habits and improve exercise performance and, together, to lower body fat gradually.

How did the left chest pain during stair climbing predict some abnormality of coronary artery function?

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