case scenarios for PMDC Exam

SALAM SIR
I AM HAVING DIFFICULTY IN THESE SCENARIOS KINDLY WRITE THE DIAGNOSIS ONLY
HIGHLY OBLGIED TO YOU FOR THE FAVOUR


10) A 30 years old sportsman has come with ring shaped lesions on his back with well defined margins.
a) What is the diagnosis?
b) How would you confirm the diagnosis on clinic and lab?
c) How will you treat him?

11) a) What are the Non-pharmacological interventions of behavioral changes?
b) Write down the DON'Ts of communication skills.

12) A 3 days old child presents with high grade fever, irritability and reluctant to feed.
a) What are the risk factors of neonatal sepsis?
b) How would you investigate a case of neonatal sepsis?


13) A patient with history of proteinurea ++, BP 130/90, TLC 25000, Glycocylated Hb 9.
a) What is the most likely diagnosis?
b) What is the treatment to reduce the proteinurea?
IS THIS NEPHROTIC SYND

6)A 2 year old girl who has cough and difficulty in breathing is brought to a basic Health Unit. On examination her respiratory rate is 65 breaths / min and she has chest In-drawing.

 

Re: can anyone please help regarding the imp case scenarios

a= Ringworm
b= skin scrapings for microscopic examination and a culture of the affected skin can establish the diagnosis of ringworm.
c= Antifungals

a=Standard therapies
Behavioural therapy
Reality orientation
Validation therapy
Reminiscence therapy
Alternative therapies
Art therapy
Music therapy
Activity therapy
Complementary therapy
Aromatherapy
Bright-light therapy
Multisensory approaches
Brief psychotherapies
Cognitive–behavioural therapy
Interpersonal therapy
b=Don’ts
1. Look down or off into space (make meaningful eye contact)
2. Begin speaking before you’ve reached the front of the room
3. Play with your hair (facial or on top of your head)
4. Lean on one hip
5. Point with a finger (use an open palm)
6. Fold your arms
7. Cross your legs
8. Sway from side to side
9. Plant your feet
10. Turn your back to the audience

a= Evidence of maternal chorioamnionitis.
> Preterm labour at less than 37+0 weeks gestation
> Preterm prelabour rupture of membranes
> Prolonged rupture of membranes greater than 18 hours at term (greater than 36 completed weeks gestation) with or without labour, irrespective of GBS status
> Mother is GBS positive, defined as:
> Maternal GBS vaginal colonisation during this pregnancy based on a swab taken less than 5 weeks before labour
> Maternal GBS bacteriuria in the current pregnancy
> Early onset neonatal GBS sepsis in a previous pregnancy
b=Neonatal sepsis screening:
DLC showing increased numbers of polymorphs.
DLC: band cells > 20%.
increased haptoglobins.
micro ESR (Erythrocyte Sedimentation Rate) titer > 55mm.
gastric aspirate showing > 5 polymorphs per high power field.
newborn CSF (CerebroSpinal Fluid) screen: showing increased cells and proteins.
suggestive history of chorioamnionitis, PROM (Premature Rupture Of Membranes), etc...
Culturing for microorganisms from a sample of CSF, blood or urine, is the gold standard test for definitive diagnosis of neonatal sepsis.
Lumbar punctures should be done when possible as 10-15% presenting with sepsis also have meningitis, which warrants an antibiotic with a high CSF penetration.

In question, its Glycosylated Hb 9%, must mention units always.
a=to me its nephrotic syndrome, with diabetes. (As Glycosylated Hb is higher)
b= please study Treatment of proteinuria and Nephrotic syndrome treatment

Clearly a Pneumonia case, please study Pnemonia

 

thankyou sir for the precious time and the speciall attention to my questions ,

but sir thora confusion hay case sportssman waly case main ,lesion is on the back of chest ,thatss a confusion point,i also wrote ringworm ,according to case history of sportsman ,but sir ,ringwrom infction in sports man is likely in toes and fingers hota hay ,aur capitis scalp per hota hay aur ,cruris groin per hota hay ,i have studied these topics in first aid USMLE step 2,
lesion on the back ka concept bilkiul samag nahe aya,
aur mughy lesion on back per , mughy laga SLE hota hay ,but wahan per multiple organ involvment hoti hay , idont know yeh case galat hay ,ya mera knowledge weak hay.

aur sir case no 13 main ,diabetic nephropathy nahe ho sakti kya ? ,app senior hain ,app zayada behtar samjh saktay hain , i hope app mind nahe karain gay ,kyuin i am repeatingly ,asking yourr help ,

 

A 2 year old girl who has cough and difficulty in breathing is brought to a basic Health Unit. On examination her respiratory rate is 65 breaths / min and she has chest In-drawing.

sir is case main , accordingly my knowledge ,4 things hain
acute epiglottis ---- give respiratory difficulty + chest indrwaing -----2--7 years of age
viral croupe---------- same------------------------+-same ----6months-3 years age
bronchilotitis -------same------------------------ + same----------------2 years of age
app nay pnuemonia ka kaha hay i think woh bhe accurate hay
but sir humain case kis tarah exact samag aye ga ,jubkay is main koi diagnostic feature he nahe daitay

 

well, the differential diagnosis of ring worm is lyme disease, due to same appearance, but on back it may be lyme disease
and yes it can be EARLY diabetic nephropathy, i wrote nephrotic syndrome with diabetes coz in diabetic nephropathy the BP should have been increased too. In early stage, there may not be hypertension.

no i dont mind, i do answer whenever i have time

 

thankyou sir thanks

 

Ringworm: Fungal infection of the skin affecting trunk, limbs and non-hairy parts of the face.
So that sportman is having ring-shaped lesions o his back.....so the diiagnosis wil be ringworm.

the thing u r talking about is "Athletes foot" in which sportsmen get fungal infection on feet, toes and interdigital clefts. but there is no ring shaped lesions in athlete foot.

Case 13: its diabetic nephropathy as dr. Watson told u

 

thankyou very much dr xavier for answering ,

 

welcome buddy