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MEDICAL QUIZ
An online quiz conducted as a promotional event for the
Annual Meet of Kerala Chapter
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Q1. Identify this
physician
● A Canadian physician
● Created the first residency
program for specialty
training of physicians
● The first to bring medical
students out of the lecture
hall for bedside clinical
training.
Kerala
Chapter
Answer
Sir William Osler
● One of the "Big Four" founding professors of Johns Hopkins
Hospital
● One of the "greatest diagnosticians ever to wield a
stethoscope".
Q2. Which is this protein ?
● The most abundant protein excreted in ordinary urine
● May act as a constitutive inhibitor of calcium crystallization in
renal fluids.
● May provide defense against urinary tract infections caused
by uropathogenic bacteria
● In the tubular lumen , this protein forms high molecular weight
filaments that constitute the matrix of hyaline casts
Kerala
Chapter
Answer
Tamm Horsfall protein ( Uromodulin )
Q3.
A patient with chronic kidney disease presented with exercise
intolerance.
The physical examination was unremarkable , but the oxygen
saturation was diminished.
An ECG was taken ( image shown in the next slide ).
a. What is the ECG abnormality ?
b. What might be the etiology of this ECG abnormality in this
patient ?
Kerala
Chapter
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Answer
a. Sine wave pattern
b. Hyperkalemia
Classically, the ECG manifestations in hyperkalemia progress from tall
peaked T waves (5.5–6.5 mM), to a loss of P waves (6.5–7.5 mM), to a
widened QRS complex (7.0–8.0 mM), and, ultimately, a to a sine wave
pattern (>8.0 mM).
However, these changes are notoriously insensitive, particularly in
patients with chronic kidney disease or ESRD.
Q4. Four peripheral smears are shown. Identify
the abnormality and mention a cause for the
same.
A B
Kerala
Chapter
C D
Answer
A - Target cells
B - Stomatocytes
C - Tear drop cells , Nucleated RBCs
D - Basophilic stippling
# Target cells are recognized by the bull’s-eye appearance of the cell.
Small numbers of target cells are seen with liver disease and
thalassemia. Larger numbers are typical of hemoglobin C disease.
# Stomatocytes are red cells characterized by a wide transverse slit
or stoma. This often is seen as an artifact in a dehydrated blood
smear. These cells can be seen in hemolytic anemias and in
conditions in which the red cell is over hydrated or dehydrated.
# Teardrop cells and nucleated red blood cells can be seen
together in myelofibrosis.
# The presence of basophilic stippling is attributed to aggregates of
ribosomes or fragments of ribosomal RNA precipitated throughout the
cytoplasm of circulating erythrocytes. The most important etiology is
lead poisoning.
Q5.
A 7 year old child underwent preoperative evaluation
for adenotonsillectomy. He was found to have upper
extremity hypertension and the lower extremity
pulses were feeble. A systolic murmur was
auscultated in the left infrascapular region. What is
the probable diagnosis ?
Kerala
Chapter
Answer
Coarctation of aorta
Q6.
An 85 year old male
presented with fatigue ,
dry cough & dyspnoea.
A chest x ray was taken.
What are the X ray
findings and the probable
diagnosis ?
Kerala
Chapter
Answer
Mediastinal enlargement due to a hiatus hernia with
gastrointestinal protrusion into the mediastinum.
Hiatal hernia is a herniation of viscera, most commonly the stomach, into the
mediastinum through the esophageal hiatus of the diaphragm.
Four types of hiatal hernia are distinguished, with type I, or sliding hiatal hernia,
composing at least 95% of the overall total.
A sliding hiatal hernia is one in which the gastroesophageal junction and gastric
cardia translocate cephalad as a result of weakening of the phrenoesophageal
ligament attaching the gastroesophageal junction to the diaphragm at the hiatus and
dilatation of the diaphragmatic hiatus.
Q7. Connect these images.
What is the most
likely diagnosis ?
Kerala
Chapter
Answer
Dermatomyositis
● Symmetric proximal muscle involvement
● Heliotrope rash
● V sign
● Shawl sign
● Gottron’s papules
Q8.
The image shown is the
mechanism of action of a
protein enterotoxin.
a.Identify the toxin
b.What is the mainstay of
treatment of the disease
caused by this organism ?
Kerala
Chapter
Answer
a. Cholera toxin
b. Fluid therapy
Enterotoxigenic E.coli ( ETEC ) produces a heat labile toxin ( LT ).
LT consists of an A and a pentameric B subunit and is structurally and
functionally similar to cholera toxin.
Q9.
Lecanemab & Aducanumab
These are two anti amyloid monoclonal antibodies.
These agents are approved for the treatment of __________ .
Kerala
Chapter
Answer
Alzheimer’s disease ( AD )
The management of AD is challenging and gratifying despite the
absence of a cure or a robust pharmacologic treatment.
The primary focus is on long-term amelioration of associated
behavioral and neurologic problems, as well as providing
caregiver support.
Q10. Connect these images
Kerala
Chapter
Answers
POEMS syndrome
P - Polyneuropathy ; O - Organomegaly ; E - Endocrinopathy
M - Monoclonal plasma cell disorder ; S - Skin changes
Q11.
A lady developed erythematous
rashes on her face , trunk and limbs
20 minutes after ingesting fish curry
from a seafood restaurant. Upon
enquiry , the preservation standards
of the restaurant was found to be
poor.
a.What is the likely diagnosis ?
b.What is the treatment of choice ?
Kerala
Chapter
Answer
1.Scombroid fish poisoning
2. Anti histamines
Scombroid poisoning ( aka Histamine fish poisoning ) is not
an allergic reaction !
Q12.
A patient presented with fatigue.
On evaluation, he was found to
have pancytopenia and massive
splenomegaly.Peripheral smear
examination under a phase
contrast microscope is shown.
Bone marrow study was a dry
tap.
What is the likely diagnosis ?
Kerala
Chapter
Answer
Hairy cell leukemia ( Phase-contrast microscopy shows tumor cells
with fine hairlike cytoplasmic projections )
Q13.
A 48-year-old woman scheduled to
receive a laparoscopic cholecystectomy
underwent a preoperative evaluation
that disclosed conjugated
hyperbilirubinemia. A laparoscopic
exploration revealed a smooth liver with
normal consistency and morphologic
features but with a grossly black
appearance.
What is the likely diagnosis ?
Kerala
Chapter
Answer
Dubin Johnson Syndrome ( DJS )
A cardinal feature of DJS is the accumulation of dark, coarsely
granular pigment in the lysosomes of centrilobular hepatocytes. As a
result, the liver may be grossly black in appearance. This pigment is
thought to be derived from epinephrine metabolites that are not
excreted normally. The pigment may disappear during bouts of viral
hepatitis, only to reaccumulate slowly after recovery.
Q14.
A 55 year old woman who is
undergoing chemotherapy for breast
cancer presented with a painful scalp
lesion. Blood investigations showed
that she had neutropenia.
a. What is this lesion known as ?
b. The most frequent organism
responsible for this lesion is
Kerala
Chapter
Answer
a. Ecthyma gangrenosum
b. Pseudomonas aeruginosa
15.Connect these
images. What is the
likely diagnosis ?
Kerala
Chapter
Answer
Behcet’s disease
● Turkey
● Oral ulcers
● Genital ulcers
● Hypopyon
Behçet syndrome is systemic vasculitis, first described by Hulusi Behçet, a Turkish
dermatologist.
Patients are most commonly from the Middle East, the Mediterranean region, and
the Far East; it is most prevalent in Turkey, with a prevalence of 1 in 250 adults.
Q16.
This ECG ( next slide ) was recorded in a patient with subarachnoid
hemorrhage.
1. What is the term used to describe these T waves ?
2. Mention any two ECG abnormalities seen in patients with raised ICP.
Kerala
Chapter
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Answer
Cerebral T waves
Q17.
A 70 year old female presented with sudden onset of pain in left flank, back and
abdomen.
On examination, she appeared in shock with cool extremities. Her abdomen
was soft but tender generally with guarding in the upper left quadrant.
A CECT abdomen was taken ( image in the next slide )
a.What is the likely diagnosis ?
b.What is this syndrome and its clinical triad known as ?
Annual Meet 2024 : June 15 , 16 @
Kollam
Whatsapp your answers to 9496720759
Kerala
Chapter
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Answer
There is a large left retroperitoneal hematoma with active bleeding
from a left renal tumor measuring 9 x 7 x 6.5 cm. The tumor has a
large fatty component with abnormal vascularity,compatible with a
large angiomyolipoma. Hemoperitoneum is also noted adjacent to
spleen.
Wunderlich syndrome
Wunderlich syndrome is a rare condition in which spontaneous
non-traumatic renal hemorrhage occurs into the subcapsular and perirenal
spaces.
Wunderlich syndrome is clinically characterized by Lenk's triad:
● acute flank pain
● flank mass
● hypovolemic shock
Neoplasms are the most common cause
Among benign neoplasms, angiomyolipoma is the commonest, while among
malignancies, renal cell carcinoma is the commonest.
Q18.
An alcohol user presented to the emergency department in an acute confusional
state. On examination , he was found to have ophthalmoplegia and ataxia.
An MRI brain was taken ( image shown in the next slide )
a. What is the likely diagnosis ?
b. What is the arrow marked structure that shows abnormal enhancement in
the MRI ?
c. What is the treatment of choice ?
Kerala
Chapter
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Answer
a.Wernicke’s encephalopathy
b.Mammillary bodies
c.Thiamine
Q19.
_______ was first approved for its usage by US FDA in 2013. Later, it was
recommended by WHO in 2019 and NACO Technical Resource Group
approved its usage since July 2020. NACO recommends ___________ as
the preferred drug for treatment of HIV-positive adults, adolescents and
children (aged more than 6 years with bodyweight more than 20 kg) under
the National AIDS Control Program.
a. About which drug is this description ?
b. What is its mechanism of action ?
Kerala
Chapter
Answer
a. Dolutegravir
b. Integrase
inhibitor
Q20. What do these
images show ?
Kerala
Chapter
A B
C D
Answer
Medical devices for treating obesity
A - Intragastric balloons
B - vBloc Maestro system
C - AspireAssist aspiration therapy system
D - Endobarrier device
Q23. Shown is the mechanism of action of ?
Kerala
Chapter
Answer
Inclisiran
The PCSK9 mAb inhibitors (evolocumab and alirocumab) reduce LDL-C by ~60%
and are administered either once or twice monthly by subcutaneous injection.
Inclisiran is a novel small interfering RNA (siRNA) therapy that inhibits the
production of the PCSK9 protein. It is administered by subcutaneous injection twice
a year, after the initial baseline and 3 month doses, and can reduce LDL-C by
~50%.
Inclisiran is a useful adjunct to maximally tolerated statin therapy in patients with
clinical ASCVD or heterozygous familial hypercholesterolemia (HeFH) who require
additional LDL-lowering, as an alternative to treatment with PCSK9 mAb therapy.
Q22.
A 31 year old male presented with fever of 3 days duration , associated
with headache and altered behaviour. He had an episode of generalised
tonic clonic seizure after admission. On examination , he was confused
and there was neck stiffness.
The white cell count , electrolytes and CT brain were within normal limits.
A CSF study was done , which showed lymphocytic pleocytosis with
normal protein & glucose. MRI brain of the patient was done ( shown in
the next slide )
a.What is the MRI finding ?
b.Which organism is the most common cause of this presentation ?
Kerala
Chapter
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Answer
a. Fluid-attenuated inversion recovery (FLAIR) MRI coronal view
shows hyperintensity in the left temporal lobe
b. Herpes Simplex Virus
Q21.
A 48 year old man presented with recent onset diabetes and
significant weight loss. Shown are images of a rash he had and his
CT abdomen.The probable diagnosis is ?
Kerala
Chapter
Answer
a. Necrolytic migratory erythema
b. Glucagonoma
Q24. Connect these images
Kerala
Chapter
Answer
Hyperparathyroidism
● Rugger Jersey Spine
● Sestamibi scan showing parathyroid adenoma
● Medullary nephrocalcinosis
● Brown tumor
Q25.
A 26-year-old man from Somalia presented with a 5-month history of dry
cough, night sweats, and unintentional weight loss of 18 kg. During this
During this period, epigastric pain and postprandial vomiting had also
developed. His BMI was 11. On examination, he was cachectic with
abdominal distention and diffuse tenderness to palpation. On the basis of
chest imaging and sputum studies, a diagnosis of pulmonary tuberculosis
was made, and intravenous antituberculous treatment was initiated.
However, he continued to have postprandial vomiting. Contrast-enhanced
CT of the abdomen was obtained ( image in the next slide ).
What is the cause of his abdominal symptoms?
Annual Meet 2024 : June 15 , 16 @
Kollam
Kerala
Chapter
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Answer
Superior mesenteric artery syndrome ( Wilkie’s syndrome )
Because of the significant loss of mesenteric fat , the 3rd part of
duodenum gets compressed between aorta and the superior
mesenteric artery. This leads to gastric outlet obstruction and
postprandial vomiting.

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Medical Quiz ( Online Quiz for API Meet 2024 ).pdf

  • 1. MEDICAL QUIZ An online quiz conducted as a promotional event for the Annual Meet of Kerala Chapter
  • 3. Q1. Identify this physician ● A Canadian physician ● Created the first residency program for specialty training of physicians ● The first to bring medical students out of the lecture hall for bedside clinical training. Kerala Chapter
  • 4. Answer Sir William Osler ● One of the "Big Four" founding professors of Johns Hopkins Hospital ● One of the "greatest diagnosticians ever to wield a stethoscope".
  • 5. Q2. Which is this protein ? ● The most abundant protein excreted in ordinary urine ● May act as a constitutive inhibitor of calcium crystallization in renal fluids. ● May provide defense against urinary tract infections caused by uropathogenic bacteria ● In the tubular lumen , this protein forms high molecular weight filaments that constitute the matrix of hyaline casts Kerala Chapter
  • 7. Q3. A patient with chronic kidney disease presented with exercise intolerance. The physical examination was unremarkable , but the oxygen saturation was diminished. An ECG was taken ( image shown in the next slide ). a. What is the ECG abnormality ? b. What might be the etiology of this ECG abnormality in this patient ? Kerala Chapter
  • 9. Answer a. Sine wave pattern b. Hyperkalemia Classically, the ECG manifestations in hyperkalemia progress from tall peaked T waves (5.5–6.5 mM), to a loss of P waves (6.5–7.5 mM), to a widened QRS complex (7.0–8.0 mM), and, ultimately, a to a sine wave pattern (>8.0 mM). However, these changes are notoriously insensitive, particularly in patients with chronic kidney disease or ESRD.
  • 10. Q4. Four peripheral smears are shown. Identify the abnormality and mention a cause for the same. A B Kerala Chapter
  • 11. C D
  • 12. Answer A - Target cells B - Stomatocytes C - Tear drop cells , Nucleated RBCs D - Basophilic stippling
  • 13. # Target cells are recognized by the bull’s-eye appearance of the cell. Small numbers of target cells are seen with liver disease and thalassemia. Larger numbers are typical of hemoglobin C disease. # Stomatocytes are red cells characterized by a wide transverse slit or stoma. This often is seen as an artifact in a dehydrated blood smear. These cells can be seen in hemolytic anemias and in conditions in which the red cell is over hydrated or dehydrated.
  • 14. # Teardrop cells and nucleated red blood cells can be seen together in myelofibrosis. # The presence of basophilic stippling is attributed to aggregates of ribosomes or fragments of ribosomal RNA precipitated throughout the cytoplasm of circulating erythrocytes. The most important etiology is lead poisoning.
  • 15. Q5. A 7 year old child underwent preoperative evaluation for adenotonsillectomy. He was found to have upper extremity hypertension and the lower extremity pulses were feeble. A systolic murmur was auscultated in the left infrascapular region. What is the probable diagnosis ? Kerala Chapter
  • 17. Q6. An 85 year old male presented with fatigue , dry cough & dyspnoea. A chest x ray was taken. What are the X ray findings and the probable diagnosis ? Kerala Chapter
  • 18. Answer Mediastinal enlargement due to a hiatus hernia with gastrointestinal protrusion into the mediastinum. Hiatal hernia is a herniation of viscera, most commonly the stomach, into the mediastinum through the esophageal hiatus of the diaphragm. Four types of hiatal hernia are distinguished, with type I, or sliding hiatal hernia, composing at least 95% of the overall total. A sliding hiatal hernia is one in which the gastroesophageal junction and gastric cardia translocate cephalad as a result of weakening of the phrenoesophageal ligament attaching the gastroesophageal junction to the diaphragm at the hiatus and dilatation of the diaphragmatic hiatus.
  • 19. Q7. Connect these images. What is the most likely diagnosis ? Kerala Chapter
  • 20. Answer Dermatomyositis ● Symmetric proximal muscle involvement ● Heliotrope rash ● V sign ● Shawl sign ● Gottron’s papules
  • 21. Q8. The image shown is the mechanism of action of a protein enterotoxin. a.Identify the toxin b.What is the mainstay of treatment of the disease caused by this organism ? Kerala Chapter
  • 22. Answer a. Cholera toxin b. Fluid therapy Enterotoxigenic E.coli ( ETEC ) produces a heat labile toxin ( LT ). LT consists of an A and a pentameric B subunit and is structurally and functionally similar to cholera toxin.
  • 23. Q9. Lecanemab & Aducanumab These are two anti amyloid monoclonal antibodies. These agents are approved for the treatment of __________ . Kerala Chapter
  • 24. Answer Alzheimer’s disease ( AD ) The management of AD is challenging and gratifying despite the absence of a cure or a robust pharmacologic treatment. The primary focus is on long-term amelioration of associated behavioral and neurologic problems, as well as providing caregiver support.
  • 25. Q10. Connect these images Kerala Chapter
  • 26. Answers POEMS syndrome P - Polyneuropathy ; O - Organomegaly ; E - Endocrinopathy M - Monoclonal plasma cell disorder ; S - Skin changes
  • 27. Q11. A lady developed erythematous rashes on her face , trunk and limbs 20 minutes after ingesting fish curry from a seafood restaurant. Upon enquiry , the preservation standards of the restaurant was found to be poor. a.What is the likely diagnosis ? b.What is the treatment of choice ? Kerala Chapter
  • 28. Answer 1.Scombroid fish poisoning 2. Anti histamines Scombroid poisoning ( aka Histamine fish poisoning ) is not an allergic reaction !
  • 29. Q12. A patient presented with fatigue. On evaluation, he was found to have pancytopenia and massive splenomegaly.Peripheral smear examination under a phase contrast microscope is shown. Bone marrow study was a dry tap. What is the likely diagnosis ? Kerala Chapter
  • 30. Answer Hairy cell leukemia ( Phase-contrast microscopy shows tumor cells with fine hairlike cytoplasmic projections )
  • 31. Q13. A 48-year-old woman scheduled to receive a laparoscopic cholecystectomy underwent a preoperative evaluation that disclosed conjugated hyperbilirubinemia. A laparoscopic exploration revealed a smooth liver with normal consistency and morphologic features but with a grossly black appearance. What is the likely diagnosis ? Kerala Chapter
  • 32. Answer Dubin Johnson Syndrome ( DJS ) A cardinal feature of DJS is the accumulation of dark, coarsely granular pigment in the lysosomes of centrilobular hepatocytes. As a result, the liver may be grossly black in appearance. This pigment is thought to be derived from epinephrine metabolites that are not excreted normally. The pigment may disappear during bouts of viral hepatitis, only to reaccumulate slowly after recovery.
  • 33. Q14. A 55 year old woman who is undergoing chemotherapy for breast cancer presented with a painful scalp lesion. Blood investigations showed that she had neutropenia. a. What is this lesion known as ? b. The most frequent organism responsible for this lesion is Kerala Chapter
  • 34. Answer a. Ecthyma gangrenosum b. Pseudomonas aeruginosa
  • 35. 15.Connect these images. What is the likely diagnosis ? Kerala Chapter
  • 36. Answer Behcet’s disease ● Turkey ● Oral ulcers ● Genital ulcers ● Hypopyon Behçet syndrome is systemic vasculitis, first described by Hulusi Behçet, a Turkish dermatologist. Patients are most commonly from the Middle East, the Mediterranean region, and the Far East; it is most prevalent in Turkey, with a prevalence of 1 in 250 adults.
  • 37. Q16. This ECG ( next slide ) was recorded in a patient with subarachnoid hemorrhage. 1. What is the term used to describe these T waves ? 2. Mention any two ECG abnormalities seen in patients with raised ICP. Kerala Chapter
  • 40. Q17. A 70 year old female presented with sudden onset of pain in left flank, back and abdomen. On examination, she appeared in shock with cool extremities. Her abdomen was soft but tender generally with guarding in the upper left quadrant. A CECT abdomen was taken ( image in the next slide ) a.What is the likely diagnosis ? b.What is this syndrome and its clinical triad known as ? Annual Meet 2024 : June 15 , 16 @ Kollam Whatsapp your answers to 9496720759 Kerala Chapter
  • 42. Answer There is a large left retroperitoneal hematoma with active bleeding from a left renal tumor measuring 9 x 7 x 6.5 cm. The tumor has a large fatty component with abnormal vascularity,compatible with a large angiomyolipoma. Hemoperitoneum is also noted adjacent to spleen. Wunderlich syndrome
  • 43. Wunderlich syndrome is a rare condition in which spontaneous non-traumatic renal hemorrhage occurs into the subcapsular and perirenal spaces. Wunderlich syndrome is clinically characterized by Lenk's triad: ● acute flank pain ● flank mass ● hypovolemic shock Neoplasms are the most common cause Among benign neoplasms, angiomyolipoma is the commonest, while among malignancies, renal cell carcinoma is the commonest.
  • 44. Q18. An alcohol user presented to the emergency department in an acute confusional state. On examination , he was found to have ophthalmoplegia and ataxia. An MRI brain was taken ( image shown in the next slide ) a. What is the likely diagnosis ? b. What is the arrow marked structure that shows abnormal enhancement in the MRI ? c. What is the treatment of choice ? Kerala Chapter
  • 47. Q19. _______ was first approved for its usage by US FDA in 2013. Later, it was recommended by WHO in 2019 and NACO Technical Resource Group approved its usage since July 2020. NACO recommends ___________ as the preferred drug for treatment of HIV-positive adults, adolescents and children (aged more than 6 years with bodyweight more than 20 kg) under the National AIDS Control Program. a. About which drug is this description ? b. What is its mechanism of action ? Kerala Chapter
  • 49. Q20. What do these images show ? Kerala Chapter A B
  • 50. C D
  • 51. Answer Medical devices for treating obesity A - Intragastric balloons B - vBloc Maestro system C - AspireAssist aspiration therapy system D - Endobarrier device
  • 52. Q23. Shown is the mechanism of action of ? Kerala Chapter
  • 53. Answer Inclisiran The PCSK9 mAb inhibitors (evolocumab and alirocumab) reduce LDL-C by ~60% and are administered either once or twice monthly by subcutaneous injection. Inclisiran is a novel small interfering RNA (siRNA) therapy that inhibits the production of the PCSK9 protein. It is administered by subcutaneous injection twice a year, after the initial baseline and 3 month doses, and can reduce LDL-C by ~50%. Inclisiran is a useful adjunct to maximally tolerated statin therapy in patients with clinical ASCVD or heterozygous familial hypercholesterolemia (HeFH) who require additional LDL-lowering, as an alternative to treatment with PCSK9 mAb therapy.
  • 54. Q22. A 31 year old male presented with fever of 3 days duration , associated with headache and altered behaviour. He had an episode of generalised tonic clonic seizure after admission. On examination , he was confused and there was neck stiffness. The white cell count , electrolytes and CT brain were within normal limits. A CSF study was done , which showed lymphocytic pleocytosis with normal protein & glucose. MRI brain of the patient was done ( shown in the next slide ) a.What is the MRI finding ? b.Which organism is the most common cause of this presentation ? Kerala Chapter
  • 56. Answer a. Fluid-attenuated inversion recovery (FLAIR) MRI coronal view shows hyperintensity in the left temporal lobe b. Herpes Simplex Virus
  • 57. Q21. A 48 year old man presented with recent onset diabetes and significant weight loss. Shown are images of a rash he had and his CT abdomen.The probable diagnosis is ? Kerala Chapter
  • 58. Answer a. Necrolytic migratory erythema b. Glucagonoma
  • 59. Q24. Connect these images Kerala Chapter
  • 60. Answer Hyperparathyroidism ● Rugger Jersey Spine ● Sestamibi scan showing parathyroid adenoma ● Medullary nephrocalcinosis ● Brown tumor
  • 61. Q25. A 26-year-old man from Somalia presented with a 5-month history of dry cough, night sweats, and unintentional weight loss of 18 kg. During this During this period, epigastric pain and postprandial vomiting had also developed. His BMI was 11. On examination, he was cachectic with abdominal distention and diffuse tenderness to palpation. On the basis of chest imaging and sputum studies, a diagnosis of pulmonary tuberculosis was made, and intravenous antituberculous treatment was initiated. However, he continued to have postprandial vomiting. Contrast-enhanced CT of the abdomen was obtained ( image in the next slide ). What is the cause of his abdominal symptoms? Annual Meet 2024 : June 15 , 16 @ Kollam Kerala Chapter
  • 63. Answer Superior mesenteric artery syndrome ( Wilkie’s syndrome ) Because of the significant loss of mesenteric fat , the 3rd part of duodenum gets compressed between aorta and the superior mesenteric artery. This leads to gastric outlet obstruction and postprandial vomiting.