Day 26
Diagnose the case, Give the investigations, suggest the management and select the rubrics

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1.  A 25 years old healthy male dies in a fatal road traffic accident; he has advance directives about his organ donations. Health care rationing of organs take multiple factors into account for deciding of who will be recipient of organ. Social utility, equity, equality, distributive justice, beneficence and expected life expectancy after organ transplantation ,all perspectives play roles in allocating of scarce organs to recipients, as waiting lists are lengthy and decision is tough.The most likely recipient of organ will be: A. 45 years alcoholic with irreversible liver failure. B. 75 years old female with extreme form of dementia and end stage renal failure. C. 35 years young entrepreneur with acute renal failure. D. 10 years old male with multi organ failure and brain death.E. 40 years old female with heart failure and HIV positive.
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2. A middle aged woman has numbness and tingling in her feet. On examination, there are signs of involvement of the peripheral nerves in the form of decreased sensation, motor weakness, and distal reflex loss. The findings are symmetric. Which of the following medical conditions is most likely to explain her peripheral nerve findings? 
(A) heart disease
(B) dermatomyositis (C) hypothyroidism 
(D) diabetes mellitus (E) adrenal insufficiency. Why ?
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3. A old man presents with progressive headaches, light-headedness, drowsiness, and unsteady gait over 6 weeks. On examination, his blood pressure is 160/90 mm Hg, pulse 70/min, lungs clear, and he has no focal weakness. His gait is unsteady but sensation in the feet is normal. A CT scan reveals a hyperintense clot over the left cerebral cortex. Which of the following is the most likely cause for this clot? 
(A) is venous in origin 
(B) is arterial in origin 
(C) is from injury to the middle meningeal artery 
(D) is from a subarachnoid hemorrhage 
(E) is from injury to the middle cerebral artery. 
Explain
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4. A middle aged woman presents to the emergency department complaining of abdominal pain. Twenty-four hours previously she developed a continuous pain in the upper abdomen that has become progressively more severe. The pain radiates into the back. She feels nauseated and alternately hot and cold. Her past medical history is notable for a duodenal ulcer, which was successfully treated 5 years earlier. She smokes 15 cigarettes a day and shares a bottle of wine each evening with her husband.ExaminationThe patient looks unwell and dehydrated. She weighs 115 kg. She is febrile, 38.5°C; her pulse is 108/min, and blood pressure is 124/76 mmHg. Cardiovascular and respiratory system examination is normal. She is tender in the right upper quadrant and epigastrium, with guarding and rebound tenderness. Bowel sounds are sparse.What is the most likely diagnosis? Give the rationale.
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5. A 63-year-old woman develops symptoms of nausea, vomiting, and dizziness, which she describes as a to-and-fro movement of the room like as if she is on a boat. Which of the following findings suggests the vertigo is central in origin? 
(A)  deafness 
(B)  symptoms are more protracted but less severe 
(C)  unidirectional nystagmus 
(D)  visual fixation inhibits vertigo and nystagmus 
(E)  spinning sensation is toward the fast phase of nystagmus 

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