CLINICAL PROBLEMS
1. A 52-year-old woman, Mrs. Mallika presented with
pain, redness and warmth over her first toe.
Laboratory examination of fluid taken from inflamed
joint revealed crystals of uric acid.
a) Identify the diagnosis.
b) Write the management for this case.
a) Diagnosis: Acute Gout
b) Management
Dr. ABC,MBBS
Reg,No:000000
Address
Date :
For,
Mr. XYZ
Age:
Address:
Rx
1.Tab.COLCHICINE 0.5 mg initially followed by 1 tab orally after 30 mins till pain
and swelling subsides , with in1-2 hrs 2-3 tabs can be given
2.Cap.INDOMETHACINE 25mg 2-3 times a day for 3 days
Signature of Docto
2. Adult male patient, 60 kg weight, presented in
causality dept. with rapid Onset of bilateral upper
and lower limb jerking since 40 minutes, frothing
from mouth, urinary incontinence and loss of
consciousness since last 10 minutes.
a) What is the diagnosis.
b) Write suitable General measures and drugs for
the patient.
a) Diagnosis: Status Epilepticus
b) General Measures:
Admit the patient
Lateral supine position
Take i.v. assess
Send blood for investigations.
Clear airway
Administer oxygen 2 L / min. with nasal prongs
Dr. ABC, MBBS
Reg.No.00000
Address
Date:
For,
Mr.XYZ
Age:
Address:
RX
• Injection Lorazepam 6 mg , IV slowly
Direction :- Administer 3 ml ( 6 mg ) diluted in 6 ml distill water , intravenously slowly ( Slow
bolus ) at the rate of 3 ml / minute ( i.e. 2 mg / min ) . Watch for rate and amplitude of respiration
• Injection Fosphenytoin 75 mg / ml , 2 ml Ampoule………...... 8 Ampoules
Direction :- Dilute 1200 mg Fosphenytoin ( Fosphenytoin 75 mg is equal to 50 mg
Phenytoin ) i.e. 16 ml ( 8 ampoules ) in 34 ml normal saline in 50 ml disposable
syringe and administer it intravenously at the rate of 6 ml / minute ( i.e. 150 mg /
minute intravenous infusion ).
• Tablet Phenytoin sodium …………………………….………… 30 Tablets
Direction: Start maintenance dose of phenytoin 12 hours after administering loading
dose - 1 tablet two times a day ( 12 hourly ) , orally for 15 days and follow up.
• Injection 5% Dextose normal saline 500 ml …………………… 1 Infusion
signature of Doctor
3. A 29-year-old man working at a construction site
had a bee sting. He was brought to casualty with
complaints of light headedness, nausea, increasing
weakness and difficulty in breathing. On examination
his pulse rate was 108/min and BP was 90/50mm Hg.
a) Identify the Diagnosis.
b) Write suitable General measures and drugs for the
patient.
a) Diagnosis: Anaphylactic shock
b) General measures:
• Call for help / Lie patient flat / Raise patient’s legs / Establish
airway
• Monitor Pulse, blood pressure and ECG .
• Admit the patient in Intensive care unit.
• Humidified oxygen inhalation 2 liters / minute through nasal
prongs.
Dr. ABC,MBBS
Reg,No:000000
Address
Date :
For,
Mr. XYZ
Age:
Address:
Rx
Inj. ADRENALINE 0.5 ml of a1:1000 solution I.M. or 0.3-0.5 ml of a
1:10,000 solution I.M. or slow I.V.
Inj. CHLORPHENIRAMINE 2ml / slow I.V. - Repeat if
Required
Inj. HYDROCORTISONE HEMISUCCINATE 2ml/ slow I.V.
Inj. 5 % DEXTROSE normal saline 500 ml /I.V. infusion
Signature of
Doctor
4. A 25-year male brought to emergency department,
a farmer by occupation, reports accidental exposure
to heavy amount of an insecticide while working in
the farm. He presents with irritation and watering of
eyes, increased salivation, sweating, blurring of
vision, breathlessness and abdominal pain. On
examination there is bradycardia.
a) Identify the Diagnosis.
b) Write suitable General measures and drugs for
the patient.
a) Diagnosis: Acute organophosphorus poisoning
b) General measures:
• Remove the patient from source of exposure and move
the patient in fresh air.
• Wash whole body with soap and water, specially hair and
eyes.
• Remove contaminated cloths.
• Admit the patient in Intensive care unit.
• Humidified oxygen inhalation 2 liters / minute through
nasal prongs.
• Gastric lavage through nasogastric tube alternate with
activated charcoal 50 gm and 2 % potassium
permanganate in 500 ml of water.
Dr. ABC,MBBS
Reg,No:000000
Address
Date :
For,
Mr. XYZ
Age:
Address:
Rx
Inj. ATROPINE 2 mg /I.V. repeat every 10 mins till Atropinization
Inj. PRALIDOXIME 2 gm /I.V. over 30 mins followed by 1gm of continuous I.V.
infusion every 4hrs ( dissolved in 10-20ml of Normal Saline)
Inj. 5% DEXTROSE normal saline 500 ml I.V. infusion
ACTIVATED CHARCOAL 50gm dissolved in 500ml of drinking water through
Nasogastric tube 4hrly
POTASSIUM PERMANGANATE GRANULES 20 gm (2% solution) through
Nasogastric tube 4hrly for 24 hrs
MAGNESIUM SULPHATE SUSPENSION -30 ml suspension immediately with 200
ml drinking water through nasogastric tube
Signature of Doctor
5. Prescribe an oral hypoglycemic drug for a patient (90 kg)
diagnosed as Type – 2 diabetes. You have decided to start the
therapy with minimum dose and would adjust it as per the
response.
(a)Justify the drug you have selected.
(b)What instructions would you like to impart to your patient?
(c)What side effects would you anticipate, if any?
Rx
Tablet METFORMIN 500 mg Dispense such 14 tablets
Take one tablet with breakfast and one tablet with dinner
meal.
Follow up after one week.
Sign
a) Justification:
• Metformin is Biguanide group of drug.
• It has additional anorectic effect which is useful to reduce the
weight.
• Episodes of hypoglycemia are rare Lactic acidosis is not
common with metformin.
(b) Instructions:
• Regular intake of food and drug : Timing of food and drug
must be followed Don’t stop the drug without consultation
Avoid excessive exercise
• Always keep a card with name and dose of drug
(c) Side effects
• Abdominal discomfort Bloating
• Anorexia Metallic taste Mild diarrhoea
• Hypoglycaemia is rare
• VitB12 deficiency
6. An adult female patient, age 18 years, attended
O.P.D. with history of fall to the ground, legs extended
followed by repetitive bilateral lower limb jerking
lasting 20 minutes, frothing from mouth and loss of
consciousness lasting 10 minutes – whole episode
lasts for about 20 – 25 minutes. Various
investigations and EEG done.
a) Identify the diagnosis.
b) Write Suitable drugs and instructions to the
patient.
a) Diagnosis: Grand Mal Epilepsy.
Dr. ABC, MBBS
b)
Reg.No.00000
Address
Date:
For,
Mr.XYZ
Age:
Address:
RX
1 Tablet Carbamazepine 200 mg , TID, orally for 15 days- 45 tablets and follow up.
Instructions-
✓ Patient Education :- Not to conceive during antiepileptic drug therapy
signature of Doctor
7. A 55-year-old male has complained of sudden
severe ache in the eye and diminished visual field
during some activity such as driving. On examination
Intra-ocular pressure is 50 mm Hg at 9 AM and 40
mmHg in evening at 5 pm.
a) Identify the Diagnosis.
b) How do you treat this condition?
a) Diagnosis: Angle closure glaucoma
Dr. ABC,MBBS
b) Management:
Reg,No:000000
Address
Date :
8. A 50-year-old female has complaint of occasional
pain (dull ache in nature), diminished visual field
during some activity such as driving. On examination
IOP is 28 mm Hg.
a) Identify the Diagnosis.
b) How do you treat this condition?
a) Diagnosis: Open angle glaucoma
b) Management
Dr.ABC,MBBS
Reg,No:000000
Address
Date :
For,
Mr. XYZ
Age:
Address:
Rx
LATANOPROST –Drug of Choice starts once daily
dose
TOMOLOL 0,25%-0.5% eyedrops- 1 drop instilled
in lower conjunctival sac 12 hrly
9. A 30-year-old woman presented with recurrent
slurring of speech, difficulty in swallowing, double
vision, difficulty in holding head for last 6 months.
These symptoms worsen on continuing the activities.
She had intermittent weakness in her legs and arms.
She reported a feeling of generalized fatigue and is
occasionally short of breath. On examination there
was drooping of eye lids and decreased muscle tone.
a) What is the diagnosis.
b) Write the management for this condition.
a) Diagnosis: Myasthenia gravis
Dr. ABC,MBBS
b) Management
Reg,No:000000
Address
Date :
For,
Mr. XYZ
Age:
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10. A 78-year-old man presented with a history of
frequent urination during the day, at least three times
during the night, poor urinary stream, hesitancy, post
micturition dribbling and a feeling of incomplete
evacuation of the bladder over last 2 years. Trans-
rectal sonography shows diffuse parenchymal
calcification. no suspicion of malignancy present. The
residual urine volume is 85 ml. A moderate-sized intra
vesical prostatic protrusion is seen.
a) Write the Diagnosis.
b) How do you treat this condition?
a) Diagnosis: Benign prostatic hypertrophy
b) Management
Dr.ABC,MBBS
Reg,No:000000
Address
Date :
For,
Mr. XYZ
Age:
Address:
Rx
Capsule.TAMSULOSIN 0.4 mg –OD, Orally, Morning 30
Capsules for 1 month.
Tablet. FINASTERIDE 5 mg – OD, Orally , 30 Tablets for 1 month
11. A 23-year-old patient, Mrs. Mahalakshmi, in her 1st
trimester was found to be slightly anemic on routine
check-up. Her hemoglobin was found to be 9 g/dl,
blood smear showed macrocytic anemia. Further blood
tests showed a normal serum concentration of vitamin
B12.
a) Identify diagnosis.
b) Write suitable drugs for the patient.
a) Diagnosis: Megaloblastic anemia.
b) Management
Dr.
ABC,MBBS
Reg,No:000000
Address
Date :
For,
Mr. XYZ
Age:
Address:
Rx
1. Tab. FOLIC ACID 5mg/day orally, OD for 30 days and follow up after 30
days.
Signature of Doctor
THANK YOU
