This document provides information about sepsis identification, treatment and management. It contains 10 multiple choice questions about signs of sepsis, causative pathogens, appropriate fluid resuscitation and vasopressor use, lactate measurement, and antibiotic administration. The key goals in the first hour of treatment for sepsis are to administer oxygen, collect blood cultures, give broad-spectrum antibiotics, begin fluid resuscitation, measure lactate levels, and monitor urine output closely. Early recognition and treatment following sepsis care bundles can significantly reduce mortality.
1. The child has relapsed acute lymphoblastic leukemia (ALL) and underwent reinduction chemotherapy.
2. Following the first cycle of reinduction therapy, laboratory tests show: a white blood cell count of 21,900, uric acid level of 9, and LDH level elevated.
3. These laboratory abnormalities indicate tumor lysis syndrome, a potential complication of effective chemotherapy in patients with high tumor burden. Urgent intervention is needed to prevent renal failure and other complications.
The patient is a 49-year-old woman with end-stage renal disease and diabetes who presented with altered mental status. She receives hemodialysis three times per week for a few years. Recently, she has been increasingly tired, weak, and unable to perform daily activities with poor appetite and nausea. On examination, she was pale and swollen with low hemoglobin. Tests found elevated creatinine, BUN, and electrolyte abnormalities. The most probable diagnosis is inadequate hemodialysis, as her symptoms and labs are consistent with worsening uremia due to insufficient solute clearance from her dialysis sessions. Kt/V is a measure of dialysis adequacy that accounts for urea clearance and patient
This document provides an overview of acid-base disorders and the approach to interpreting arterial blood gases (ABGs). It begins with a brief preview of the summary and includes expected changes in different acid-base disorders. The document then presents two medical cases involving patients with acid-base abnormalities. It analyzes the lab results and clinical picture for each case and discusses the diagnoses and treatment. Additional topics covered include causes of metabolic alkalosis and acidosis, interpreting urine and serum electrolytes, and the use of diagnostic tests. The document concludes with a quiz case involving a patient with asthma and theophylline toxicity.
1. A 21 year old man presented with pancytopenia with a Hb of 5.0, WBC of 2.6, neutrophils of 1.1, and platelets of 45. His MCV was elevated at 104.
2. Initial tests such as B12, folate, ferritin, LFTs and virology were normal. A bone marrow aspirate and trephine was performed.
3. The bone marrow aspirate and trephine revealed findings consistent with aplastic anemia, explaining the patient's pancytopenia. Further investigation is needed to determine the underlying cause of the aplastic anemia.
This document discusses sepsis, acute kidney injury (AKI), and their recommended treatment. It begins with definitions of sepsis, septic shock, and lactic acidosis. It then discusses recommended treatment for severe sepsis patients, including antimicrobial therapy, fluid therapy, vasopressor therapy, corticosteroids, and managing AKI. Specific goals for fluid resuscitation in the first 6 hours are provided. The document also discusses oliguria, RIFLE criteria, and epidemiology of AKI in critically ill patients.
The document describes a case of acute chest syndrome in a 13-year old male patient with sickle cell anemia. He presented with fever, cough, chest pain, and respiratory distress. Imaging showed infiltrates in both lungs. He required intubation and mechanical ventilation for respiratory failure and developed pneumothoraces requiring chest tubes. After 7 days of intensive treatment his condition was stabilizing.
This document provides information about sepsis identification, treatment and management. It contains 10 multiple choice questions about signs of sepsis, causative pathogens, appropriate fluid resuscitation and vasopressor use, lactate measurement, and antibiotic administration. The key goals in the first hour of treatment for sepsis are to administer oxygen, collect blood cultures, give broad-spectrum antibiotics, begin fluid resuscitation, measure lactate levels, and monitor urine output closely. Early recognition and treatment following sepsis care bundles can significantly reduce mortality.
1. The child has relapsed acute lymphoblastic leukemia (ALL) and underwent reinduction chemotherapy.
2. Following the first cycle of reinduction therapy, laboratory tests show: a white blood cell count of 21,900, uric acid level of 9, and LDH level elevated.
3. These laboratory abnormalities indicate tumor lysis syndrome, a potential complication of effective chemotherapy in patients with high tumor burden. Urgent intervention is needed to prevent renal failure and other complications.
The patient is a 49-year-old woman with end-stage renal disease and diabetes who presented with altered mental status. She receives hemodialysis three times per week for a few years. Recently, she has been increasingly tired, weak, and unable to perform daily activities with poor appetite and nausea. On examination, she was pale and swollen with low hemoglobin. Tests found elevated creatinine, BUN, and electrolyte abnormalities. The most probable diagnosis is inadequate hemodialysis, as her symptoms and labs are consistent with worsening uremia due to insufficient solute clearance from her dialysis sessions. Kt/V is a measure of dialysis adequacy that accounts for urea clearance and patient
This document provides an overview of acid-base disorders and the approach to interpreting arterial blood gases (ABGs). It begins with a brief preview of the summary and includes expected changes in different acid-base disorders. The document then presents two medical cases involving patients with acid-base abnormalities. It analyzes the lab results and clinical picture for each case and discusses the diagnoses and treatment. Additional topics covered include causes of metabolic alkalosis and acidosis, interpreting urine and serum electrolytes, and the use of diagnostic tests. The document concludes with a quiz case involving a patient with asthma and theophylline toxicity.
1. A 21 year old man presented with pancytopenia with a Hb of 5.0, WBC of 2.6, neutrophils of 1.1, and platelets of 45. His MCV was elevated at 104.
2. Initial tests such as B12, folate, ferritin, LFTs and virology were normal. A bone marrow aspirate and trephine was performed.
3. The bone marrow aspirate and trephine revealed findings consistent with aplastic anemia, explaining the patient's pancytopenia. Further investigation is needed to determine the underlying cause of the aplastic anemia.
This document discusses sepsis, acute kidney injury (AKI), and their recommended treatment. It begins with definitions of sepsis, septic shock, and lactic acidosis. It then discusses recommended treatment for severe sepsis patients, including antimicrobial therapy, fluid therapy, vasopressor therapy, corticosteroids, and managing AKI. Specific goals for fluid resuscitation in the first 6 hours are provided. The document also discusses oliguria, RIFLE criteria, and epidemiology of AKI in critically ill patients.
The document describes a case of acute chest syndrome in a 13-year old male patient with sickle cell anemia. He presented with fever, cough, chest pain, and respiratory distress. Imaging showed infiltrates in both lungs. He required intubation and mechanical ventilation for respiratory failure and developed pneumothoraces requiring chest tubes. After 7 days of intensive treatment his condition was stabilizing.
Based on the clinical presentation, the most likely diagnosis is pneumonia. Key findings supporting this include:
- History of smoking and alcohol use, which are risk factors
- Fever, chills, and chest pain on inspiration, which are common symptoms
- Rust-colored sputum, indicating presence of blood
- Tachypnea and inspiratory crackles on exam, localized to the right lower lobe
The immediate treatments that should be initiated are:
1. Supplemental oxygen via nasal cannula or mask to address his hypoxemia
2. IV fluids for hydration
3. Blood cultures to identify causative organism
4. Broad spectrum IV antibiotics to treat presumed community-acquired pneumonia
5. Chest
This document discusses various hematologic and liver function tests that are important for dentistry. It provides normal reference ranges for tests like complete blood count, prothrombin time, partial thromboplastin time, liver enzymes, and describes what abnormalities in these tests may indicate. Several clinical cases are presented and questions are asked about which tests should be ordered and how to manage patients based on abnormal test results.
This document describes the management of a 45-year-old male patient who presented with polytrauma including a head injury from a motor vehicle accident. Initial resuscitation involved administration of fluids and blood products to stabilize vital signs. Investigations revealed a subarachnoid hemorrhage and fractures. The patient underwent surgery and was transferred to the ICU for further care and monitoring. The document discusses important considerations for fluid choice in neurosurgical patients, noting risks of hypotonic, hypertonic and large volumes of non-balanced fluids, and the benefits of balanced salt solutions for maintaining adequate cerebral perfusion pressure and oxygenation without worsening edema or acid-base status.
The document discusses evidence-based critical care and updates from 2006. It predicts that the shortage of intensivists will worsen by 2020 as demand increases. It contrasts the old method of teaching based on tradition versus the new evidence-based approach of evaluating the quality and results of clinical studies. Examples discussed include low tidal volume ventilation in ARDS, glucose control in critically ill patients, and use of corticosteroids in septic shock.
The document discusses evidence-based practices in critical care medicine. It describes how evidence-based care focuses on adapting practices based on high-quality clinical studies rather than traditional teachings. Examples discussed include using low tidal volumes for ARDS patients based on randomized trials, the evidence for and against intensive insulin therapy, and use of activated protein C for sepsis. The document advocates applying grading systems to clinical recommendations based on the strength of scientific evidence.
This document discusses several diagnostic challenges in body fluid analysis. It outlines pre-analytic challenges including differences in acceptance criteria across labs and lack of knowledge among clinicians about proper collection procedures. Analytic challenges include lack of trained staff and deviations between manual and automated methods. Post-analytic challenges involve correcting cell counts and protein levels in traumatic taps and distinguishing traumatic taps from CNS hemorrhage based on blood distribution in collection tubes. Proper collection and handling of CSF is also reviewed, highlighting the importance of centrifugation, culture techniques, and microscopic examination of cells and differentials.
Sudden onset shortness of breath in patient with chronic renal failureAR Muhamad Na'im
A 45-year-old man with chronic renal failure presented with sudden onset shortness of breath and chest pain after dialysis. Investigations showed pulmonary edema, sepsis, and severe metabolic acidosis. The provisional diagnosis was acute pulmonary edema and sepsis from his dialysis catheter. Management included oxygen, nitrates, antibiotics, fluid removal, and addressing his acidosis with bicarbonate and urgent dialysis. Pulmonary edema is a complication of dialysis that can be caused by fluid overload from non-adherence to diet or an intercurrent illness exacerbating renal failure.
An Approach to a Case of Severe Pneumonia with Iron Deficiency Anemia KairviRaval
This case discusses a 1 year and 6 month old female child who presented with cough, fever and hurried respiration for 5 days and was admitted to the hospital with a provisional diagnosis of severe pneumonia with right side empyema thoracis and anemia. Over the course of 16 days in the hospital, the child was treated with antibiotics, bronchodilators, steroids and blood transfusions. Laboratory tests showed improvement in hemoglobin levels but persistent consolidation in the lungs. The child was discharged on oral iron supplements and referred to another hospital for further management.
This document discusses the fundamentals of using vasopressors. It outlines the steps to determine when to start vasopressors: 1) Is the patient's blood pressure too low? 2) Why is the blood pressure low? 3) How to raise the blood pressure? Norepinephrine is generally the first-line vasopressor. Adjuncts like vasopressin and steroids may be considered if norepinephrine dose is high. Peripheral intravenous lines can be used for vasopressors in the short term but central lines are preferable at higher doses due to risk of extravasation from peripheral lines.
This document provides information on sepsis for EMS providers, including causes and risk factors, signs and symptoms, treatment guidelines, and case studies. Sepsis is a serious condition that can lead to septic shock and organ failure if not treated quickly. The guidelines describe identifying septic patients in the field using specific criteria and initiating fluid resuscitation and transport to the hospital for early goal directed therapy to improve outcomes. Case studies demonstrate application of the guidelines and emphasize importance of early recognition and treatment.
This document provides an overview of shock and hemodynamic monitoring. It defines shock as inadequate organ perfusion and classifies shock into four categories: hypovolemic, cardiogenic, distributive, and obstructive. For each category, it describes the pathophysiology, signs, and treatment approach. It also discusses goals of fluid resuscitation and introduces concepts of oxygen delivery, consumption, and tools like pulmonary artery catheters that are used to monitor hemodynamics and guide shock management. Vasopressor and inotropic agents commonly used to treat shock like dopamine, norepinephrine, and epinephrine are also outlined.
1. The document discusses various factors that can affect the accuracy of blood cell counts from hematology analyzers, including lipemia, sickle cells, and the presence of nucleated red blood cells.
2. It provides methods for correcting blood count results when issues like lipemia or nucleated red blood cells are present, such as saline replacement or subtracting nucleated red blood cells from the white blood cell count.
3. Normal variations in white blood cell, red blood cell, and platelet counts are discussed for different times of day, during exercise or pregnancy, and with factors like altitude.
This document discusses various hematologic and coagulation laboratory tests that are important for dentistry, including:
- Complete blood count (CBC) to assess red blood cells, white blood cells, platelets
- Erythrocyte sedimentation rate (ESR)
- Prothrombin time (PT) and international normalized ratio (INR) to assess coagulation in patients on oral anticoagulants
- Partial thromboplastin time (PTT) to assess the intrinsic coagulation pathway
It provides normal reference ranges for these tests and discusses how they can help evaluate bleeding risk and identify coagulation disorders prior to dental procedures. Several case examples are presented and analyzed to demonstrate how to interpret lab
Sepsis 4 a to z(u) in sepsis managementashish ranjan
This document provides guidelines for the management of sepsis. It discusses:
- Initial resuscitation with 30 mL/kg of IV fluids within 3 hours and targeting a MAP of 65 mmHg.
- Screening criteria like QSOFA and SOFA scores to help identify sepsis early.
- Diagnosis through appropriate cultures and lactate levels.
- "Bundle" of treatments to administer antibiotics, fluids, and vasopressors within specific timeframes.
- Antimicrobial therapy including broad-spectrum antibiotics within 1 hour, duration of 7-10 days, and use of procalcitonin to determine stop.
- Other treatments like source control, fluid choice, and vasopressor recommendations.
The document provides an overview of anemia and presents several clinical cases involving anemia. It discusses the initial laboratory evaluation of anemia including complete blood count, peripheral smear, and reticulocyte count. Additional tests discussed include iron, B12, folate levels as well as LDH, bilirubin, and Coombs test. Five clinical cases are then presented involving autoimmune hemolytic anemia, iron deficiency anemia, acute myeloid leukemia, thrombotic thrombocytopenic purpura, and anemia related to chronic kidney disease. For each case, laboratory findings, diagnoses, and treatment recommendations are discussed.
This document provides an overview of anemia and presents 5 case studies. The key points are:
1) Anemia is defined as a reduction in red blood cells (RBCs), hemoglobin, or hematocrit. Causes can be classified based on RBC size as microcytic, normocytic, or macrocytic.
2) Case 1 describes an autoimmune hemolytic anemia in a woman with symptoms of jaundice and splenomegaly. Testing confirms a warm antibody hemolytic anemia related to an underlying autoimmune disorder.
3) Case 2 involves a asymptomatic woman with a microcytic anemia and normal iron studies who is found to have alpha thalas
The document provides an overview of anemia and presents several case studies. It defines anemia, discusses initial laboratory evaluation and additional tests. It then describes 5 cases of patients presenting with anemia. Case 1 involves a woman with autoimmune hemolytic anemia. Case 2 is a woman with alpha thalassemia. Case 3 is a woman diagnosed with acute myeloid leukemia. Case 4 is a woman with thrombotic thrombocytopenic purpura. Case 5 is a man with renal failure and anemia of chronic inflammation.
The document provides an overview of anemia and presents several clinical cases involving anemia. It discusses the initial laboratory evaluation of anemia including complete blood count, peripheral smear, and reticulocyte count. Additional tests discussed include iron, B12, folate levels as well as LDH, bilirubin, and Coombs testing. Five clinical cases are then presented involving autoimmune hemolytic anemia, iron deficiency anemia, acute myeloid leukemia, thrombotic thrombocytopenic purpura, and anemia related to chronic kidney disease.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
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Based on the clinical presentation, the most likely diagnosis is pneumonia. Key findings supporting this include:
- History of smoking and alcohol use, which are risk factors
- Fever, chills, and chest pain on inspiration, which are common symptoms
- Rust-colored sputum, indicating presence of blood
- Tachypnea and inspiratory crackles on exam, localized to the right lower lobe
The immediate treatments that should be initiated are:
1. Supplemental oxygen via nasal cannula or mask to address his hypoxemia
2. IV fluids for hydration
3. Blood cultures to identify causative organism
4. Broad spectrum IV antibiotics to treat presumed community-acquired pneumonia
5. Chest
This document discusses various hematologic and liver function tests that are important for dentistry. It provides normal reference ranges for tests like complete blood count, prothrombin time, partial thromboplastin time, liver enzymes, and describes what abnormalities in these tests may indicate. Several clinical cases are presented and questions are asked about which tests should be ordered and how to manage patients based on abnormal test results.
This document describes the management of a 45-year-old male patient who presented with polytrauma including a head injury from a motor vehicle accident. Initial resuscitation involved administration of fluids and blood products to stabilize vital signs. Investigations revealed a subarachnoid hemorrhage and fractures. The patient underwent surgery and was transferred to the ICU for further care and monitoring. The document discusses important considerations for fluid choice in neurosurgical patients, noting risks of hypotonic, hypertonic and large volumes of non-balanced fluids, and the benefits of balanced salt solutions for maintaining adequate cerebral perfusion pressure and oxygenation without worsening edema or acid-base status.
The document discusses evidence-based critical care and updates from 2006. It predicts that the shortage of intensivists will worsen by 2020 as demand increases. It contrasts the old method of teaching based on tradition versus the new evidence-based approach of evaluating the quality and results of clinical studies. Examples discussed include low tidal volume ventilation in ARDS, glucose control in critically ill patients, and use of corticosteroids in septic shock.
The document discusses evidence-based practices in critical care medicine. It describes how evidence-based care focuses on adapting practices based on high-quality clinical studies rather than traditional teachings. Examples discussed include using low tidal volumes for ARDS patients based on randomized trials, the evidence for and against intensive insulin therapy, and use of activated protein C for sepsis. The document advocates applying grading systems to clinical recommendations based on the strength of scientific evidence.
This document discusses several diagnostic challenges in body fluid analysis. It outlines pre-analytic challenges including differences in acceptance criteria across labs and lack of knowledge among clinicians about proper collection procedures. Analytic challenges include lack of trained staff and deviations between manual and automated methods. Post-analytic challenges involve correcting cell counts and protein levels in traumatic taps and distinguishing traumatic taps from CNS hemorrhage based on blood distribution in collection tubes. Proper collection and handling of CSF is also reviewed, highlighting the importance of centrifugation, culture techniques, and microscopic examination of cells and differentials.
Sudden onset shortness of breath in patient with chronic renal failureAR Muhamad Na'im
A 45-year-old man with chronic renal failure presented with sudden onset shortness of breath and chest pain after dialysis. Investigations showed pulmonary edema, sepsis, and severe metabolic acidosis. The provisional diagnosis was acute pulmonary edema and sepsis from his dialysis catheter. Management included oxygen, nitrates, antibiotics, fluid removal, and addressing his acidosis with bicarbonate and urgent dialysis. Pulmonary edema is a complication of dialysis that can be caused by fluid overload from non-adherence to diet or an intercurrent illness exacerbating renal failure.
An Approach to a Case of Severe Pneumonia with Iron Deficiency Anemia KairviRaval
This case discusses a 1 year and 6 month old female child who presented with cough, fever and hurried respiration for 5 days and was admitted to the hospital with a provisional diagnosis of severe pneumonia with right side empyema thoracis and anemia. Over the course of 16 days in the hospital, the child was treated with antibiotics, bronchodilators, steroids and blood transfusions. Laboratory tests showed improvement in hemoglobin levels but persistent consolidation in the lungs. The child was discharged on oral iron supplements and referred to another hospital for further management.
This document discusses the fundamentals of using vasopressors. It outlines the steps to determine when to start vasopressors: 1) Is the patient's blood pressure too low? 2) Why is the blood pressure low? 3) How to raise the blood pressure? Norepinephrine is generally the first-line vasopressor. Adjuncts like vasopressin and steroids may be considered if norepinephrine dose is high. Peripheral intravenous lines can be used for vasopressors in the short term but central lines are preferable at higher doses due to risk of extravasation from peripheral lines.
This document provides information on sepsis for EMS providers, including causes and risk factors, signs and symptoms, treatment guidelines, and case studies. Sepsis is a serious condition that can lead to septic shock and organ failure if not treated quickly. The guidelines describe identifying septic patients in the field using specific criteria and initiating fluid resuscitation and transport to the hospital for early goal directed therapy to improve outcomes. Case studies demonstrate application of the guidelines and emphasize importance of early recognition and treatment.
This document provides an overview of shock and hemodynamic monitoring. It defines shock as inadequate organ perfusion and classifies shock into four categories: hypovolemic, cardiogenic, distributive, and obstructive. For each category, it describes the pathophysiology, signs, and treatment approach. It also discusses goals of fluid resuscitation and introduces concepts of oxygen delivery, consumption, and tools like pulmonary artery catheters that are used to monitor hemodynamics and guide shock management. Vasopressor and inotropic agents commonly used to treat shock like dopamine, norepinephrine, and epinephrine are also outlined.
1. The document discusses various factors that can affect the accuracy of blood cell counts from hematology analyzers, including lipemia, sickle cells, and the presence of nucleated red blood cells.
2. It provides methods for correcting blood count results when issues like lipemia or nucleated red blood cells are present, such as saline replacement or subtracting nucleated red blood cells from the white blood cell count.
3. Normal variations in white blood cell, red blood cell, and platelet counts are discussed for different times of day, during exercise or pregnancy, and with factors like altitude.
This document discusses various hematologic and coagulation laboratory tests that are important for dentistry, including:
- Complete blood count (CBC) to assess red blood cells, white blood cells, platelets
- Erythrocyte sedimentation rate (ESR)
- Prothrombin time (PT) and international normalized ratio (INR) to assess coagulation in patients on oral anticoagulants
- Partial thromboplastin time (PTT) to assess the intrinsic coagulation pathway
It provides normal reference ranges for these tests and discusses how they can help evaluate bleeding risk and identify coagulation disorders prior to dental procedures. Several case examples are presented and analyzed to demonstrate how to interpret lab
Sepsis 4 a to z(u) in sepsis managementashish ranjan
This document provides guidelines for the management of sepsis. It discusses:
- Initial resuscitation with 30 mL/kg of IV fluids within 3 hours and targeting a MAP of 65 mmHg.
- Screening criteria like QSOFA and SOFA scores to help identify sepsis early.
- Diagnosis through appropriate cultures and lactate levels.
- "Bundle" of treatments to administer antibiotics, fluids, and vasopressors within specific timeframes.
- Antimicrobial therapy including broad-spectrum antibiotics within 1 hour, duration of 7-10 days, and use of procalcitonin to determine stop.
- Other treatments like source control, fluid choice, and vasopressor recommendations.
The document provides an overview of anemia and presents several clinical cases involving anemia. It discusses the initial laboratory evaluation of anemia including complete blood count, peripheral smear, and reticulocyte count. Additional tests discussed include iron, B12, folate levels as well as LDH, bilirubin, and Coombs test. Five clinical cases are then presented involving autoimmune hemolytic anemia, iron deficiency anemia, acute myeloid leukemia, thrombotic thrombocytopenic purpura, and anemia related to chronic kidney disease. For each case, laboratory findings, diagnoses, and treatment recommendations are discussed.
This document provides an overview of anemia and presents 5 case studies. The key points are:
1) Anemia is defined as a reduction in red blood cells (RBCs), hemoglobin, or hematocrit. Causes can be classified based on RBC size as microcytic, normocytic, or macrocytic.
2) Case 1 describes an autoimmune hemolytic anemia in a woman with symptoms of jaundice and splenomegaly. Testing confirms a warm antibody hemolytic anemia related to an underlying autoimmune disorder.
3) Case 2 involves a asymptomatic woman with a microcytic anemia and normal iron studies who is found to have alpha thalas
The document provides an overview of anemia and presents several case studies. It defines anemia, discusses initial laboratory evaluation and additional tests. It then describes 5 cases of patients presenting with anemia. Case 1 involves a woman with autoimmune hemolytic anemia. Case 2 is a woman with alpha thalassemia. Case 3 is a woman diagnosed with acute myeloid leukemia. Case 4 is a woman with thrombotic thrombocytopenic purpura. Case 5 is a man with renal failure and anemia of chronic inflammation.
The document provides an overview of anemia and presents several clinical cases involving anemia. It discusses the initial laboratory evaluation of anemia including complete blood count, peripheral smear, and reticulocyte count. Additional tests discussed include iron, B12, folate levels as well as LDH, bilirubin, and Coombs testing. Five clinical cases are then presented involving autoimmune hemolytic anemia, iron deficiency anemia, acute myeloid leukemia, thrombotic thrombocytopenic purpura, and anemia related to chronic kidney disease.
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2. (4X 5 marks = 20 marks)
4 stations
Clinical case scenario
Calculation
Lab value Interpretation
Instrument
3. CLINICAL CASE 1
A 7 year old boy was brought to the hospital with
complaints of excessive bleeding even with minor
trauma and collection of blood in both knees. His
bleeding time was found to be 2minutes and
clotting time was 22 minutes , platelet count – 3
lakh cells/ cu.mm of blood
• Identify the clinical condition.
• What is the cause of bleeding in this case?
• How will you treat this condition?
4. CLINICAL CASE 2
A 24 year old female with blood group of B
negative marries a male with the blood group of B
positive.
• What is the probable complication that can occur
if she becomes pregnant and the fetus is B
positive?
• How will you prevent the complication?
5. CLINICAL CASE 3
A 45yr old lady presented with the complaints of
increased thirst, passing large volume of urine and
increased appetite. Lab investigations revealed,
• Fasting blood sugar – 250mg/dl
• Urine sugar +++
• What is the probable diagnosis?
• What is the pathophysiology of the patient’s
complaints mentioned above?
6. CLINICAL CASE 4
• A patient presented with complaints of increased
thirst and passing large volume of urine. Lab
investigations revealed,
Fasting blood glucose 94 mg%
Urine sugar - nil
Urine specific gravity 1.009
Urine osmolarity 290mosm/L
• What is the probable clinical diagnosis?
• What are the different types of this disorder?
• Write about the management plan.
7. CLINICAL CASE 5
• A 40 year old man was brought to the casualty
with severe bleeding after RTA.
O/E he had cold clammy skin. Pulse was feeble.
BP – 80/60 mmHg.
Identify the clinical condition.
What are the different compensatory
mechanism that come into play?
How will you manage the condition?
8. CLINICAL CASE 6
• A 50 year old female came to the OPD with
C/O intolerance to cold, Constipation,
hoarseness of voice, puffiness of face.
• PR 70/min, BP- 120/80 mmHg, Serum
cholesterol – 300 mg/dl
• What is the probable diagnosis?
• Explain the pathophysiology of the above
condition.
9. CLINICAL CASE 7
A 71 year old male presents with difficulty in
walking and trembling hands. On examination
the muscles were rigid, causing cog wheel
motion during stretching, his facial expressions
were reduced.
• Give the probable diagnosis
• Identify the neural structure involved.
• Name the drugs used to treat the condition.
10. CALCULATION 1
A PATIENT HAS THE FOLLOWING VALUE
Hb = 12 gms %
RBC = 3.6 million cells/cu.mm of blood
PCV = 35 %
CALCULATE THE MCH, MCV , MCHC.
Answer :
MCH = Hb per litre of blood = 33 picograms
RBC in millions/cu.mm
MCV = PCV in 1 litre of blood = 97.2 cu.microns
RBC in millions/cu.mm
MCHC = Hb in 100ml X 100 = 34%
PCV in 100 ml
11. CALCULATION 2
CALCULATE THE TOTAL BODY WATER FROM THE FOLLOWING DATA :
AMOUNT OF D2O INJECTED = 100 ml
AMOUNT OF D2O EXCRETED IN 1 HOUR = 4 ml
PLASMA CONC. OF D2O AT THE END OF ONE HOUR = 0.002 ml/mt.
Answer:
Total body water = D2O injected - D2O excreted
Plasma concentration
= 100 – 4 = 48000 ml = 48 litres
0.002
12. CALCULATION 3
CALCULATE THE CARDIAC OUTPUT FROM THE FOLLOWING
DATA :
O2 UPTAKE / MIN = 240 ml
O2 CONTENT OF ARTERIAL BLOOD = 20 ml %
O2 CONTENT OF VENOUS BLOOD = 15 mL %
Answer:
Cardiac output = O2 uptake/min
(arterial O2 – venous O2)/ 100 ml
= 4.8 litres/min
13. CALCULATION 4
CALCULATE THE RENAL BLOOD FLOW FROM THE FOLLOWING DATA :
PARA AMINO HIPPURIC ACID IN URINE= 15 mg %
CONCENTRATION OF PAH IN PLASMA = 0.03 mg %
AVERAGE PAH EXTRACTION RATIO = 0.9
HEMATOCRIT = 45 %
URINE FLOW RATE = 0.9 ml /min
Answer:
Effective renal plasma flow = UV/P = 15 X 0.9/0.03 = 450ml/min
Actual renal plasma flow = ERPF / Extraction ratio = 500ml/min
Renal blood flow = ARPF/1-Hematocrit = 909ml/min
14. CALCULATION 5
Calculate the Alveolar Ventilation from the
following data.
• Tidal Volume – 600 ml
• Respiratory rate – 12/ min
• Dead space air – 200 ml
Answer:
AV = (TV- DS) x RR = ( 600 – 200) x 12
= 4800 ml/min
15. CALCULATION 6
• Calculate the Respiratory Minute Volume from
the given data.
• Respiratory Rate – 14/min
• Tidal volume – 500 ml
• Dead space air – 150 ml
Answer:
RMV = 500 x 14 = 7000 ml/min
16. CALCULATION 7
• Calculate the Ventilation – Perfusion ratio from the given
data
• Pulmonary blood flow = 5 L/min
• Respiratory Rate = 10/min
• Tidal volume = 600 ml/min
• Dead space volume = 200 ml/min
Answer:
V/Q ratio = Alveolar ventilation
Pulmonary perfusion
Alveolar ventilation = (TV- DS) x RR = (600-200) x 10
= 4000 ml/min
V/Q ratio = 4000/ 5000 = 0.8
17. INTERPRETATION 1
Read the following biochemical values and
interpret your findings for the diagnosis.
pH = 7.2
HCO3 = 8 mmol/L
H+ = 0.72 X 10-7 mol/L
1.Comment on the above lab investigations of the patient
2.Give the normal values
3.Name 1 condition where you get the above picture
18. INTERPRETATION 2
Blood investigation of a 40 year old female shows the
following results
• Hb – 6.8 gm/dl
• MCV – 56 femtolitres
• MCH – 20 picograms
• MCHC – 26 gms/dl
1. Interpret the given values and comment on them
2. Write the normal values of all the above parameters
3. Name any two conditions with the above lab picture
19. INTERPRETATION 3
Serum electrolyte for a given subject is the following,
Na+ = 136 meq/L
K+ = 6.6 meq/L
Ca2+ = 9.5 mg/dl
ECG shows tall slender peaked “T” waves
1.Comment on the above lab investigations of the
patient
2.Give the normal values
3.Name 1 condition where you get the above picture
20. INTERPRETATION 4
Blood investigations of a 60 year old male shows the
following
values .
Hb – 7gm /dl
Creatinine - 2.6 mg/dl
Blood Urea Nitrogen (BUN) - 40 mg/dl
Questions
Comment on the above lab investigations of the patient
Write the normal values of the above lab parameters
What is the probable diagnosis
21. INTERPRETATION 5
Lab results of a 7 year old boy shows the following results
Total WBC count – 65000/cumm
DC- Lymphocytes- 84, Neutrophils -15, Eosinophil-1
Hb – 7.2gm/dl
Bone marrow biopsy shows >30% lymphoid blast cells.
Give the probable diagnosis
Give the normal WBC Count and Differential Count
What is leucocytosis? Write any 2 causes for leucocytosis.
22. INSTRUMENT 1 – Neubauer chamber
• Identify.
• Mention its use .
1. Identify the apparatus
2. Write its uses
3. What are the precautions
to be followed while charging
the apparatus?
23. INSTRUMENT 2 – Mosso’s ergograph
• Identify.
• Mention its use .
24. INSTRUMENT 3 – Wright’s Peak
Expiratory Flow meter
• Identify.
• Mention its use .
• Give the normal values recorded by this apparatus
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