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Problem based learning exercises for students of mbbs 1 st prof.
- 1. Slide 1 Problem Based Exercises
- 2. Slide 2 1 A male aged 40 years complained of severe headache, vertigo and occasional shortness of breath and palpitation. He is obese and a sedentary worker. Family history of hypertension and diabetes mellitus is there. ā¢ What is the probable diagnosis? ā¢ What is meant by essential hypertension and its risk factors? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 3. Slide 3 2 A lady aged 30 years came to OPD with complaints of: fatigue, constipation, dry skin, weight gain, puffy face, pain, stiffness and swelling in joints, coarse and brittle hair, hoarseness of voice. On examination a swelling in the front region of the neck was observed. There was bradycardia too. ā¢ What will be your diagnosis? ā¢ What will be investigation of choice? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 4. Slide 4 3 A female aged 35 years is on thyroxin since 15 years. She came with complaints of severe palpitation, weight loss, restlessness, insomnia and heat intolerance. On examination she had moist palms, irregular heart rate and tremors. ā¢ What is the probable cause? ā¢ What will be the next step of treatment? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 5. Slide 5 4. A male aged 40 years and known case of type I DM, taking insulin as well as antihyperglycemic medicines, was brought to the hospital with complaints of blackout, sweating, excessive hunger, fainting, fatigue, light-headedness, anxiety, blurred vision, headache, irritability, pallor, palpitations, sensation of pins and needles, sleepiness, slurred speech, tremor, and unsteadiness. ā¢ What could be the cause? ā¢ What will be line of treatment? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 6. Slide 6 5. ā¢ A female brought to the hospital unconscious with high grade fever. As per her husband she was out for shopping for 4 to 5 hours daily since last week in hot summer and she complained of severe throbbing headache and muscle cramps. On examination temp was 104oF, rapid and shallow breathing with increased heart rate, red and flushed skin. ā¢ What could be the cause of unconsciousness? ā¢ What should be line of treatment? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 7. Slide 7 6. A 54 years old woman to OPD supported by her son with complaints of tremors in hands and gait disturbance. On examination physician found her with expressionless face, short shuffling gait and coarse tremors which disappeared on voluntary movement. ā¢ What is probable diagnosis? ā¢ Comment on the structure involved. ā¢ Name the drug used for the treatment of this disease. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 8. Slide 8 7. A 45 years old man met with an accident. He was brought to the hospital in unconscious state. He was bleeding profusely. On examination he had a low volume fast pulse with unrecordable blood pressure . ā¢ Give probable diagnosis. ā¢ What should be line of treatment? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 9. Slide 9 8. A 50 years old male was examined by the physician. On examination he found that patient is unable to speak properly, unable to move finger along a drawn straight line and unable to stop at a certain point on that line. Patient was unable to do supination and pronation of hand at a rapid rate. ā¢ Where could be the lesion? ā¢ Name two more examinations which can support the diagnosis. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 10. Slide 10 9 A woman aged 30 years attended OPD with complaints of flatulence, vomiting and pale colored stools. On examination she was having yellow bulbar conjunctiva. Urine examination revealed bile salts and urobilinogen. Her serum bilirubin was 5mg/dl and Vanden Bergh direct test was positive. ā¢ What will be your diagnosis? ā¢ What is the cause of pale stools? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 11. Slide 11 10 A female patient 40 years of age complained of extreme weakness, excessive thirst and hunger. She has disturbed sleep due to excessive urine frequency. On investigation her fasting blood glucose was 220mg/dl. ā¢ What is the probable diagnosis? ā¢ Cause of polyuria. ā¢ What will be the next investigation to confirm the diagnosis? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 12. Slide 12 11 Blood picture of a patient shows: ā¢ Hb = 8 gm% ā¢ PCV = 30% (Normal 45) ā¢ MCV = 68fl (Normal 80-100) ā¢ MCH = 20pg (Normal 27-31) ā¢ MCHC = 22% (Normal 32-36) ā¢ Anisocytosis and increased pallor of RBC. ā¢ What is the type and cause of anemia? ā¢ Suggested treatment of the deficiency. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 13. Slide 13 12 Blood picture of a patient shows: ā¢ RBC count = 1million/mm3 ā¢ MCV= 150fl ā¢ MCH = 50pg ā¢ MCHC= 33% ā¢ Hypersegmentation of neutrophils. ā¢ Red cell inclusions also seen in peripheral smear. ā¢ What is the type of anemia? ā¢ Comment on causes of this type of anemia. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 14. Slide 14 13 A 50 years old female complains that she is not able to thread the needle even though she is not having any difficulty to see distant objects. ā¢ Name the refractive error. ā¢ Which type of lens will correct the error? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 15. Slide 15 14 A boy aged 10 years is brought to the OPD with complaint of bleeding from a minor cut for half an hour. His parents said that he has oozing of blood through nose during summers. Investigation showed: ā¢ Clotting time = 20 min. Using capillary method ā¢ Bleeding time = 5 min. ā¢ Platelet count = 2,00,000/mm3 ā¢ What is probable diagnosis? ā¢ What treatment do you suggest? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 16. Slide 16 15 A young woman consulted a Gynecologist with complaint of repeated abortions after her first child birth. On investigation her blood group was found to be B Rh-ve and her husband ās A Rh+ve. ā¢ What should be the next step of investigation? ā¢ What is physiological basis of the problem? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 17. Slide 17 16 A married couple came for the treatment of primary infertility. On investigation semen analysis of husband revealed: ā¢ Volume=2ml. ā¢ Color= white. ā¢ Specific gravity= 1.025 ā¢ pH= 7.35 ā¢ Sperm count= 20million/ml ā¢ Motility= sluggish. ā¢ Abnormal sperms= a few. ā¢ Comment on findings _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 18. Slide 18 17 A 15 years old school boy consulted an ophthalmologist because he is not able to see the letters written on the blackboard. He is able to read the text book. ā¢ Name the refractive error. ā¢ Which type of lens will be of choice for correction? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 19. Slide 19 18 A recently married couple wants to postpone pregnancy for 1 year. ā¢ What will be your advice for contraception and why? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 20. Slide 20 19 A woman with primary infertility was investigated by taking endometrial biopsy during second half of menstrual period. Histopathology report was showing proliferative changes of endometrium. ā¢ Comment on histopathological finding. ā¢ Name two other tests for ovulation. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 21. Slide 21 20 A lady delivered her second male baby who had severe jaundice and convulsions and died on 7th day after birth. ā¢ What can be the possible cause of severe jaundice and convulsion? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 22. Slide 22 21 A 18 years old boy had fracture of right upper limb. After removal of plaster right limb seems less muscular than left limb. ā¢ What could be the cause of this difference? ā¢ What will your advice to regain the size of upper limb? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 23. Slide 23 22 A premature newborn had difficulty in breathing as expansion of lung was not proper. ā¢ What may be the cause of difficulty in breathing. ā¢ Physiological basis of non-expansion of lungs. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 24. Slide 24 23 A young male complained about respiratory problem especially during change of weather. During lung function test FEV1 is 40%. ā¢ What could be the diagnosis? ā¢ What is difference between restrictive and obstructive lung disease in relation with FEV1. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 25. Slide 25 24 A patient presented with generalized edema, distended neck veins even on standing and sitting position with palpable liver. ā¢ What could be the diagnosis? ā¢ Explain the physiological basis of the signs. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________
- 26. Slide 26 25 A hypertensive 36 years old male was investigated through Doppler test for renal blood flow. Blood flow in right renal artery was found to be low, possibly due to stenosis. Left renal blood flow is normal. ā¢ Does this stenosis affect blood pressure? ā¢ What will be the level of Renin? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________