Day 18
Diagnose the case, Give the investigations, suggest the management and select the rubrics

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1. A clinic patient who has a diagnosis of polycystic kidney disease has been doing research on the Internet. She is asymptomatic and has no significant family history. She asks you for screening for intracranial aneurysms. You recommend which of the following? A. Head CT scan without contrast B. CT angiogram C. Cerebral angiogram D. Magnetic resonance angiogram E. No further testing. How will you workout this case?
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2. A 76-year-old man complains of frequent small stools that are not abnormally liquid or hard. There is some pain with passing the stool. He has no abdominal pain, nausea, melena, vomiting, or fever. He has approximately eight to ten bowel movements per day, which interferes with his quality of life, though there is no fecal incontinence. What is a possible diagnosis to explain his complaints? A. Hypothyroidism B. Neuromuscular disorder C. Proctitis D. Ulcerative colitis E. Viral gastroenteritis Give rubrics for the choice given.
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3. A 21-year-old female presents with complaints of dysuria for the past 48 h. She denies elevated temperature, chills, or nausea/vomiting. She states she is having some difficulty sleeping at night. She is 28 weeks pregnant with her first child. You note she is wearing long sleeves in warm weather and she has bruising on her forearms and left lateral thoracic area. An appropriate way to explore your concerns with the patient would be to ask which of the following questions? a. “Do you know how you got these bruises?” b. “Who hit you?” c. “How long has your partner been abusing you?” d. “I will have to report these injuries to the appropriate authorities if you can’t explain them.”
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4.  A young woman is referred to you. According to her husband,  she is paying less attention to her appearance. She has become less industrious in keeping the house clean and taking care of her children and seems isolated from the family. She doesn’t get up until the late afternoon. Husband reports that these changes appeared gradually over the last two years and that the patient is showing further deterioration. The patient reports fleeting delusional beliefs and hallucinations. Which of the following is the best diagnosis? A. Paranoid schizophrenia B. Undifferentiated schizophrenia 
 C. Stuporous catatonia D. Simple schizophrenia Justify your answer and give rubrics for each choice.
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5. A woman has a verbal altercation with her boss at work. She meekly accepts his harsh words. That night, she picks a fight with her husband. Which of the following defense mechanisms is being used by this woman? a. Displacement b. Acting out c. Reaction formation d. Projection e. Sublimation Explain
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