Day 30
Diagnose the case, Give the investigations, suggest the management and select the rubrics

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1. You are invited to a dinner by a pharmaceutical company. In addition to the dinner theres is lecture given on a medical subject as well as a gift of Rs. 2000 and certificate from the counter of venue.  Which of the following is the most appropriate action in this case. A. It is entirely unethical to accept any of it, refuse every thing B. It is only ethical to attend lecture C. Do not accept the money, but dinner and lecture are ethically acceptable D. You may accept all three components E. Cash payments are acceptable as long as they are not tied to prescribing specific medicines . Justify your answer
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2.  A 44-year-old woman present with headaches. These headaches have been present in previous years but have now become more intense. She describes the headaches as severe and present on both sides of her head. They tend to worsen during the course of the day. There is no associated visual disturbance or vomiting. She also complains of loss of appetite and difficulty sleeping, with early morning waking. She has had eczema and irritable bowel syndrome diagnosed in the past, but these are not giving her problems at the moment. She is divorced with two children, aged 10 and 12 years, whom she looks after. She has a part-time job as an office cleaner. Her mother has recently died of a brain tumour. She smokes about 20 cigarettes per day and drinks 15 units of alcohol per week. She takes regular paracetamol or ibuprofen for her headaches.
Examination findings : She looks withdrawn. Her pulse is 74/min and regular; blood pressure is 118/76mmHg. Examination of the cardiovascular, respiratory and gastrointestinal systems, breasts and reticuloendothelial system is normal. There are no abnormal neurological signs, and funduscopy is normal.
What is the diagnosis?What are the major differential diagnoses?How would you manage this patient. Give related rubrics
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3.  A patient of yours has gone to the hospital to obtain a copy of her medial records for her own review. The hospital refuses to release them to her on the ground that she must provide an adequate reason for wishing to see the records. She has come to see you to ask if this is true and how can she get her records. What should you tell her? A. You as the physician, can get the records for yourself to view, but she cannot B. The hospital will give her the records as long as you ask C. She has the right to have her own records as long as she has a legitimate reason D. She has the right to have her own records even without giving a reason E. Only another physician or insurance company can have free access to her records F. She can have the records as long as she has fully paid her hospital bills. Justify your answer
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4. A 23-year-old actress presents to her general practitioner complaining that she has not had a menstrual period for 5 months. She started having periods aged 13 years, and previously they had been regular. On direct questioning she states that she has lost 8 kg in weight over the past year, although she says her appetite is good. She has had no serious medical illnesses. Currently she is out of work. She split up from her boyfriend 1 year ago. She drinks 10 units of alcohol per week and is a non-smoker. She is taking no regular medication.
Examination findings : She has lost muscle mass, especially on her limbs and buttocks. She is 1.7 m (5 ft 9 in.) tall and weighs only 41kg. She has excessive hair growth over her cheeks, neck and forearms. Her pulse rate is 52/min and regular; blood pressure is 96/60mmHg. Examination is otherwise normal. What is the clinical diagnosis?How should this patient be investigated and managed?
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5. A 76-year-old woman presents to the emergency department complaining of an episode of weakness in her right arm and leg. She was sitting down with her husband when the weakness came on, and her husband noticed that she slurred her speech. All of the symptoms resolved within 10 min. Her husband has noticed two to three episodes of a slurred speech lasting a few minutes over the last 6 months but had thought nothing of it. Two months earlier she had a sensation of darkness coming down over her left eye, lasting for a few minutes. She has had type 2 diabetes mellitus for 6 years, controlled on diet. She is hypertensive and suffered a myocardial infarction 3 years previously. She smokes about 10 cigarettes per day and drinks alcohol rarely. Her only medication is enalapril for her blood pressure.Examination findings : She looks frail. Her pulse rate is 88/min and irregular, and blood pressure is 172/94mmHg. The apex beat is displaced to the sixth intercostal space, midaxillary line. Her heart sounds are normal, and a grade 3/6 pansystolic murmur is audible. A soft bruit is audible on auscultation over the left carotid artery. Her dorsalis pedis pulses are not palpable bilaterally, and her posterior tibial is weak on the left and absent on the right. Examination of her chest and abdomen is normal. Neurological examination demonstrates normal tone, power, and reflexes. There is no sensory loss. Funduscopy is normal. What is the diagnosis?• How would you manage this patient?
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