Day 28
Diagnose the case, Give the investigations, suggest the management and select the rubrics

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1. You are working in the desk of your hospital when another employee of the hospital asks for information about a patient who was admitted last night with cancer. You know the details of the case . The person is a co-worker of your patient. He show you proper identification proving he really is a coworker of your patient who also works in the hospital.Which of the following is the most appropriate response to his request A. Give him the information the patient B. Give him the information only if he is a relative of the patient C. Inform him you are not at the liberty to give the details without the patients permission D. Have him sign a release or consent form before revealing the information . Why?
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2. Your patient tells you he thinks his boss is persecuting him. The patient had mild schizophrenia. The patient asks you if you can keep a secret and then tell you that he is planning to kill his boss “when the time is right”. You say, “of course, everything you tell me during the session will always be confidential.  What should you do? a. Keep the patient’s session confidential but make attempts to discourage the patient from his plan b. Inform your medical director and let him handle it. c. Inform law enforcement agencies of the threat to the patient's boss. d. Inform the patient's boss that he is in danger. e. Inform both the patient's boss as well as law enforcement of the threat.
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3. A man of 45 consults his general practitioner (GP) with a 6-month history of reduced appetite and weight loss, from 78 to 71kg. During the last 3 months he has had intermittent nausea, especially in the mornings, and in the last 3 months the morning nausea has been accompanied by vomiting on several occasions. For 1 month he has noted swelling of his ankles. Despite his weight loss he has recently noticed his trousers getting tighter. He has had no abdominal pain. He has no relevant past history and knows no family history as he was adopted. He takes no medication. From the age of 18 he has smoked 5–6 cigarettes daily and drunk 15–20 units of alcohol per week. He has been a chef all his working life, without exception in fashionable restaurants. He now lives alone as his wife left him 1 year ago. Examination findings : He has plethoric features. There is pitting oedema of his ankles. He appears to have lost weight from his limbs, but not his trunk. He has nine spider naevi on his upper trunk. His pulse is normal, and the rate is 92/min. His jugular venous pressure (JVP) is not raised, and his blood pressure is 146/84 mmHg. The cardiovascular and respiratory systems are normal. The abdomen is distended. He has no palpable masses, but there is shifting dullness and a fluid thrill.What is the diagnosis? How would you manage this patient?
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4. A 22-year-old man presented with malaise and anorexia for 1 week. He vomited on one occasion, with no blood. He has felt feverish but has not taken his temperature. For 2 weeks he has had aching pains in the knees, elbows and wrists without any obvious swelling of the joints. He has not noticed any change in his urine or bowels.Five years ago he had glandular fever confirmed serologically. He smokes 25 cigarettes per day and drinks 20–40 units of alcohol per week. He has taken marijuana and ecstasy occasionally over the past 2 years and various tablets and mixtures at clubs without being sure of the constituents. He denies any intravenous drug use. He has had irregular homosexual contacts but says that he has always used protection. He claims to have had an HIV test that was negative 6 months earlier. He has not traveled abroad in the last 2 years.He is unemployed and lives in a flat with three other people. There is no relevant family history.Examination findings : He has a temperature of 38.6°C and looks unwell. He looks as if he may be a little jaundiced. He is a little tender in the right upper quadrant of the abdomen. There are no abnormalities to find on examination of the joints or in any other system. What is your interpretation of the findings?What is the likely diagnosis?
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5.  An 85-year-old woman is investigated by her general practitioner for increasing tiredness, which has developed over the past 6 months. She has lost her appetite and feels constantly nauseated. She has lost about 8kg in weight over the past 6 months. For the last 4 weeks she has also complained of generalized itching and cramps. She has been hypertensive for 20 years and has been on antihypertensive medication for that time. She has had two cerebrovascular accidents, which have left her with some left side weakness and reduced mobility.  The elevated urea and creatinine levels are there.
Examination findings : Her conjunctivae are pale. Her pulse is 88/min regular, blood pressure 190/110 mmHg; mild pitting oedema of her ankles is present. Otherwise, examination of her cardiovascular and respiratory systems is normal. Neurological examination shows a left upper motor neurone facial palsy with mild weakness and increased tone and reflexes in the left arm and leg. She is able to walk with a stick. Fundoscopy shows arteriovenous nipping and increased tortuosity of the arteries.What is the diagnosis? Why
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