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1. (a) In a pt. with MS with incompetence, list six clinical findings that you would find if they
develop infective endocarditis.
Clnical finding
fever,
complains of unusual tiredness
night sweats
weight loss
low back pain
petechiae
(b) How would you advise a pt. on SBE prophylaxis who wants to have a tooth extraction?
Prophylaxis = they don’t need it.
2. (a) Describe the common clinical findings of Ulcerative Colitis (UC). Include extracolonic
manifestations.
bloody diarrhea
tenesmus
lower abdominal discomfort
malaise
lethargy
anorexa
weight loss
apthous ulcer
proctitis with blood mix wth stool, urgency and tenesmus
diarrhea at night with urgency and incontinence
In severe cases anorexia, malaise, weight loss and abdominal pain occur, and the patient
is toxic with fever, tachycardia and signs of peritoneal inflammation
Extraintestinal
Uveitis
Pyoderma gangrenosum
Pleuritis
Erythema nodosum
Spondyloarthropathy
Ankylosing spondylitis
Primary sclerosing cholangitis
(b) State the liver complications in a pt. with UC.
Primary sclerosing cholangitis causing jaundice
Fatty liver disease
Chronic active hepatitis
Drug induced liver toxicity- eg azathioprine
Liver cirrhosis
cholangiocarcinoma
6. (a) How would a 75 yrs old female with complete heart block present?
Third-degree atrioventricular (AV) block (ie, complete heart block) has a wide range of clinical
presentations. Occasionally, patients are asymptomatic or have only minimal symptoms related
to hypoperfusion. In these situations, symptoms include the following:
Stokes adam attack- patent fall to the ground, develop a near death appearance, patient
become cyanose then patient recover suddenly.
Fatigue
Dizziness
Impaired exercise tolerance
Chest pain
More commonly, however, patients are profoundly symptomatic, especially if a wide-complex
escape rhythm is present, indicating that the origin of the pacemaker is below the His bundle. In
such cases, symptoms can include the following:
Confusion
Dyspnea
Severe chest pain
Sudden death
Signs of congestive heart failure as a result of decreased cardiac outputmay be present and
may include the following:
7. (a) What is the differential diagnosis in a pt. with sickle cell anemia with acute onset of knee
pain?
1. gout
2. avn
3. septic arthritis
4. osteomyelitis
5. trauma
(b) What would be the indication to do exchange transfusion in this pt.?
1. priapism
2. stroke
3. Acute chest syndrome
4. Multiorgan failure syndrome
8. (a) What are the features of nephrotic syndrome= check paper before.
(b) What complications would you anticipate in a pt. with minimal change type of nephrotic
syndrome?
Malnutrition
Infection
Edema
Complication of steroid-
10. (a) How would you establish the diagnosis of autoimmune hepatitis in a pt.?
Urgent liver biopsy, transjugular if appropriate, may help to confirm the clinical suspicion of acute
autoimmune hepatitis- Biopsies may show evidence for interface hepatitis (ie, piecemeal
necrosis), bridging necrosis, and fibrosis.
16. Outline the mgt. of a delirious elderly pt. with a serum [Ca2+] of 16 mg/dL?