Theme 1: Lab investigations

A ALT F Full Blood Count

B AST G Serum Ca+

C Blood glucose H Serum bilirubin

D Blood urea I Serum creatinine

E ESR J Serum K+

1. A 60-year old male was found unconscious. His blood pressure was 130/80mmHg.
There was no needle mark found on his body. No history could be obtained from this
patient.
2. A 50-year old male newly diagnosed with essential hypertension, was recently started
with ACE-I 2 weeks ago. His initial lab investigations are normal.
3. A 23-year old abusive male is highly suspected of chronic alcoholism although he denied
it.
4. A 10-year old boy presented with 2 days history of fever associated with gum bleeding.
5. A 45?-year old female with uncontrolled hypertension and currently on ARB. ECG
showed tall T wave.

Theme 2: Pain on limbs

A Bursitis F Neuropathic Pain

B Cellulitis G Neurogenic claudication

C Deep Vein Thrombosis H Meralgia Parasthetica

D Meniscus tear I Osteoarthritis

E Intermittent Claudication J Osteomalacia

1. 42 year old female presented with pain, swelling and redness at left leg. She is on oral
contraceptive pills
2. 68 years old female with genu varus presented with bilateral knee pain that is worsened
on standing, relieved by rest.
3. 62 years old maid presented with pain and swelling above patella, worsens with
kneeling.
4. 55 years old male complaints of pain on the lateral aspect of right thigh.
Theme 3: fever
Dengue fever Pharyngitis

Meningitis Viral Tonsilitis

Epiglottitis Bacterial tonsilitis

Tracheitis Laryngotracheobronchitis

Laryngitis Leptospirosis
1. A 5 year old boy having headache, neck stiffness and fever. For examination, Kernig’s
sign was positive.
2. A 13 year old female presented with fever, sore throat. Examination revealed anteriror
cervical lymphadenopathy and exudative tonsilitis
3. 3 year old boy, presented with fever, shortness of breathness and inspiratory and
expiratory stridor with drooling of saliva
4. fever and retro-orbital pain for 2 days. Torniquet test positive
5. Barking cough, associated with hoarseness of voice.

Theme ?: Cough

Bronchial asthma Bronchogenic carcinoma

Pulmonary Tuberculosis Pulmonary embolism

Bacterial Pneumonia Cryptogenic fibrosing alveolitis

COPD

Theme 5: Neurological conditions

Syringomyelia T10 compression

Cauda equina syndrome peripheral neuropathy

muscular dystrophy

polyradiculopathy

C5 compression myopathy
 1) a 34 yr old male nurse develops weakness of the upper and lower limb since 3 days
ago. on examination proximal and distal weakness of lower limb, and distal weakness of
upper limb. sensory examination is all normal
2) history of diarrhea for 3 days followed by limb weakness
3) upper abdomen normal, lower abdomen abnormal -lower limb hypotonia, reflex absent
4) 70 year old man with diabetes and hpt has loss of sensation of upper and lower limb,
deep tendon reflex lost for upper and lower limb
5) fasciculations & muscle wasting of shoulder girdle, bicep reflex absent, triceps reflex
exaggerated

Theme 6: Red urine

1)A __ year old female presented with dysuria,

2) 15 years old girls presented with hematuria. She also has puffiness of the face. Her BP is
160/90 mmHg
3) Male complains of dribbling and perianal pain

4) Adolescent (19 y/o male?) presented with recurrent sore throat and passing out red colour
urine on and off for the past 2 years..

5)45 years old man presented with haematuria on and of for 6 months. Father and two paternal
uncle passed away at early fifties. BP 180/110

Acute glomerulonephritis Benign prostate hypertrophy

pyelonephritis Prostate carcinoma

Prostatitis Urinary tract infection

Bladder carcinoma Ureteric stone

Cystitis Polycystic kidney disease

Theme 8: Thyroid

Anaplastic carcinoma Squamous cell carcinoma of thyroid

Sarcoma Follicular carcinoma

Hurthle cell carcinoma of thyroid Papillary carcinoma

Lymphoma Adenocarcinoma of thyroid

Medullary carcinoma Occult Primary

 1. Female, most common, prognosis is good.
2. MEN II syndrome
3. Elderly, rapid progression. Not responsive to treatment
4. Metastasis to bone
5. Elderly, good prognosis

Theme 9 : Abdominal Distension & Constipation

Carcinoma of the colon Obstructed Hernia

Sigmoid volvulus Schistosomiasis

Adhesion obstruction Amoebic Colitis

Paralytic ileus

1. history of cholecystectomy 2 years ago.

2. K+: 2.8
3. Absence of bowel sound
4. A 50-year-old lady presented with pain in the abdomen. She hasn’t passed stool and flatus
one day prior to admission. Abdominal X-ray revealed multiple air fluid level and dilated twisted
loop of bowel in the left iliac fossa.
5. Complain of no bowel output, able to pass flatus. X ray shows mass