What is your diagnosis (3)?


I finished pediatric cycle today with the zachot (credit test). There were 3 teachers; of course the one who considers me as her favorite student still exists, that insufferable monster who wants to eat me alive. She was glaring at me all the time throughout zachot. She definitely has some unfinished business with me. I was her target from the start!

But then, I am one kind of a stupid person. There was definitely a more lenient and kinder teacher whom I can go answer my pediatric stuffs to, but I chose that woman monster instead! What the hell, right? Since she’s got an unfinished business with me, why not I go give her some closure? And to her I went. Everything went fine, fine and fine from Rheumatic Fever to Hydronephrosis to Case Report.

I can tell that she’s proud of me, although I’m always late for her class (but to think back what’s there to be proud of? It’s just rheumatic fever and hydronephrosis!). Whatever. Got my zachot without ОТРАБОТКА she promised to make me do last week… and she’s got her psychological closure! Ngengengenge! 😉

Ok, enough small talk. I would like to honor a request from a dear boss of mine. He wishes to walk an extra mile as well. Let’s start with Biochemistry:

A 48-year-old divorced man presents with shortness of breath. On questioning, the man admits a 20 year history of extensive alcoholism. A systems review reveal that he experiences tingling and burning sensation in his legs for the past few weeks. Physical examination reveals that he is tachycardic (heart rate 122/min), has rales bilaterally and bilateral pitting edema. He also has decreased sensation in his feet and reduced reflexes in his lower extremities. Chest X-ray shows enlarged cardiac silhouette and bilateral pulmonary congestion. The deficient factor in this condition serves as a cofactor to which enzyme?

•A.      Adenosine Deaminase
•B.      Aldolase B
•C.      Transketolase
•D.      Homogentisate oxidase
•E.       Carnitine Acyltransferase

And here’s Endocrine Physiology:

Growth Hormone (GH) is essential for human growth. Which of the following is a stimulus for GH secretion?

•A.      Hypoglycemia
•B.      Obesity
•C.      Dwarfism
•D.      Pregnancy
•E.       Somatostatin
•F.       Tumor Necrosis Factor (TNF)

And here’s my favorite –Pathology:

A 45 year old woman complains of a blurry vision. She says that her eyes have been very dry and itchy and she is unable to make tears. She also states that she has a dry mouth despite drinking adequate fluids. Physical examination reveals bilateral dry, ulcerated corneas and fissures on the sides of her lips. Her knees are swollen and reddened. When asked about her knees, she says that her knees and wrists tend to be swollen and stiff in the morning. The intern in charge runs for test of autoantibodies, which reveals rheumatoid factor positive and also another autoantibody test is positive. What might the other positive autoantibody test be?

•A.      Anti-Jo-1
•B.      Anti-dsDNA
•C.      Antibody-SS-B (La)
•D.      Antihistone antibodies
•E.       HLA-B27

Okay that’s enough I guess. Whoever answers all the three questions correctly, plus explanations, will get a sushi treat from me. Hehe feeling very spring and generous. You can try answer in comment, or simply thru my YM. Final date? Err… one week, two weeks, tomorrow… what the hell right? I’ll decide later. It’s not like everyone loves to read my blog tho… ngengengenge 😉

P/s: I’ve heard that my blog appears a little skewed (senget)/unreadable or something like that from someone’s computer. Is it true? Need some feedbacks pls.

6 thoughts on “What is your diagnosis (3)?

  1. A 48-year-old divorced man presents with shortness of breath. On questioning, the man admits a 20 year history of extensive alcoholism. A systems review reveal that he experiences tingling and burning sensation in his legs for the past few weeks. Physical examination reveals that he is tachycardic (heart rate 122/min), has rales bilaterally and bilateral pitting edema. He also has decreased sensation in his feet and reduced reflexes in his lower extremities. Chest X-ray shows enlarged cardiac silhouette and bilateral pulmonary congestion. The deficient factor in this condition serves as a cofactor to which enzyme?
    •A. Adenosine Deaminase
    •B. Aldolase B
    •C. Transketolase
    •D. Homogentisate oxidase
    •E. Carnitine Acyltransferase

    answer: urgh i so hate biochem.. but the answer is transketolase 😛 the patient has thiamine deficiency due to lack of this enzyme which is caused by chronic alcoholism..

    And here’s Endocrine Physiology:

    Growth Hormone (GH) is essential for human growth. Which of the following is a stimulus for GH secretion?
    •A. Hypoglycemia
    •B. Obesity
    •C. Dwarfism
    •D. Pregnancy
    •E. Somatostatin
    •F. Tumor Necrosis Factor (TNF)

    answer: A. thats why to check the level of GH, the doc do insulin tolerance test.

    And here’s my favorite -Pathology:

    A 45 year old woman complains of a blurry vision. She says that her eyes have been very dry and itchy and she is unable to make tears. She also states that she has a dry mouth despite drinking adequate fluids. Physical examination reveals bilateral dry, ulcerated corneas and fissures on the sides of her lips. Her knees are swollen and reddened. When asked about her knees, she says that her knees and wrists tend to be swollen and stiff in the morning. The intern in charge runs for test of autoantibodies, which reveals rheumatoid factor positive and also another autoantibody test is positive. What might the other positive autoantibody test be?
    •A. Anti-Jo-1
    •B. Anti-dsDNA
    •C. Antibody-SS-B (La)
    •D. Antihistone antibodies
    •E. HLA-B27

    answer: the patient has sjogren syndrome. so check for Antibody-SS-B (La)! 😛

    p/S: yay! im gonna get sushi for my upcoming birthday! muahaha! tp kn faiz… aku x suka sushi a… change it to smth else ok? 😛

  2. 1. Betol thiamine (vit B1) deficiency. But you didnt explain that this patient has wet beriberi as well; manifested by congestive heart failure. Dry beriberi on the other hand presents with peripheral neuropathy.

    2. Betol jugak. Guess that wasnt hard.

    3. Ngehehehe… Walaupun choice Antibody-SS-B (La) tu betol, tapi ejaan diagnosis tu salah. It’s SJÖGREN SYNDROME, with the two dots above letter O, characterized by xerophthalmia, xerostomia and arthritis. Ngengengenge. (No sushi for you?)

    Anyways congratulations on answering everything correctly. Jatdin has definitely raised the bar for Nizhniy’s Malaysian medical students 😉

  3. “Okay that’s enough I guess. Whoever answers all the three questions correctly, plus explanations, will get a sushi treat from me.”

    well, i didnt read the “…plus explanation” part so thats why the explaination was brief.. hehe. n of coz i know how to spell SJÖGREN SYNDROME! except that my keyboard doesnt have the double dots O. 😛

  4. Salam Faiz

    Not answering your questions since Jatdin has already done. Since Faiz is not treating you Sushi, do drop by at our house if you come around here in KL when you are on holidays.

    Now Faiz, your blog is not skewed anymore as it used to be earlier, I think it happened sometimes last few months ago.

    Good bloggers indeed!

    Kudos.

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