1. DESCRIBE WHAT YOU CAN SEE?

 UNILATERAL SWELLING OF THE LEFT LEG

 HYPERPIGMENTED MULTIPLE NODULES
2. WHAT IS THE DIAGNOSIS
 KARPOSIS SARCOMA
3. WHAT IS THE CAUSE
 HUMAN HERPES VIRUS TYPE 8 (HHV8)
4. WHAT ARE THE DIFFERENTIALS
 Lymphoma
 Hemangioma
 Erythema nodosum
 LYMPHANGITIS
 CELLULITIS
5. WHAT WHO STAGE IS IT
 WHO STAGE 4
6. WHAT INVESTIGATIONS WOULD YOU DO
• FBC
• CXR
• HIV TEST
• SKIN BIOPSY

7. HOW WOULD YOU MANAGE IT

 CHEMOTHERAPY IE. VINCRISTINE, DOXORUBICINE
 HAART

7. MENTION TWO OTHER SYSTEMS IT MAY AFFECT

 GIT
 RS

8. MENTION ATLEAST THREE TYPES

 CLASSIC (MEDITERANIAN TYPE)
 AFRICAN ENDEMIC
 AIDS RELATED KS
 KS ASSOCIATED TO IMMUNOSUPRESSION THERAPY
1. WHAT CAN YOU SEE
- Whitish plague on endoscopy of oesophageal
2. What is the diagnosis?
• EOSOPHAGEAL CANDIDIASIS

2. WHAT IS THE CAUSE

• CANDIDA ALBICANS

3. LIST 4 RISK FACTOR

• HIV INFECTION
• DIABETES
• STERIOD THERAPY
• MALIGNANCIES/CHEMOTHERAPY

4. HOW WOULD YOU MANAGE IT

• FLUCONAZOLE

5. WHAT WHO STAGING

• WHO STAGE 4
1. WHAT CAN YOU SEE
• Whitish plaque on the soft palate

2.What is the diagnosis?

ORAL CANDIDIASIS

3 WHAT IS THE CAUSE

• CANDIDA ALBICANS

4. LIST 4 RISK FACTOR

• HIV INFECTION
• DIABETES
• STERIOD THERAPY
• MALIGNANCIES

5. HOW WOULD YOU MANAGE IT

• NYSTATIN ORAL SUSPENSION

6. WHAT WHO STAGING

• WHO STAGE 3
1. WHAT DO YOU SEE
• SICKLED RED BLOOD CELLS ON A PERIPHERAL SMEAR
2. WHAT IS THE DIAGNOSIS
• SICKLE CELL ANEMIA
3. What list four precipitating factors
- hypoxia
- dehydration,
- infection,
- acidosis,
- exercise and
- high altitude.
4.Complications of sickle cell aneamia
- stroke
- Retinopathy
- leg ulcer
- renal failure
- Avascular necrosis
- infections pneumonia and osteomyelitis
- gallstones
4. MENTION THREE CRISIS
• VASOOCLUSIVE CRISIS
• HEMOLYTIC CRISIS
• SEQUESTRATION CRISIS
• APLASTIC CRISIS
5. HOW WOULD YOU INVESTIGATE
• HEMOGLOBIN ELECTROPHORESIS
• SICKLING TEST
• SOLUBILITY TEST
• FBC
• Reticulocytes count
6. MANAGEMENT
• DAILY FOLIC ACID
• FLUIDS therapy- normal saline
• BLOOD TRANSFUSION
• ANTIBIOTICS – if there are features of infections
• ANTIMALARIALS - fansider
• Pain killers- morphine.
• Hydroxyurea
• Bone marrow transplant
1. WHAT ABNORMALITIES DO YOU SEE
• RIGHT SIDED UPPER LOBE HOMOGENOUS OPACITIES

2. WHAT IS THE DIAGNOSIS

• RIGHT UPPER LOBE PNEUMONEA

3. WHAT OTHER INVESTIGATIONS COULD YOU DO

• FBC
• SPUTUM FOR MICROSCOPY AND CULTURE
• BLOOD CULTURE
• ABG

4. WHAT WOULD BE YOU MANAGEMENT

• CEPHALOSPORINS IE. CEFTRIAXONE

5. WHAT ARE THE 3 POSSIBLE COMPLICATIONS

LOCAL COMPLICATIONS
SYSTEMIC COMLICATIONS
• PLEURAL EFFUSION • PERICARDITIS
• EMPYEMA • MENINGITIS
• LUNG ABSCESS • ARTHRITIS
• LUNG CANCER • SIADH SECRETION
1.What feature are u seen on the diagram?
- Cryptococcol on Indian ink positive
2. What organisms causes this picture?
- Cryptococcus neoformans
- Cryptococcus. Neoformans gatii
3. What is the diagnosis?
- Cryptococcal Meningitis
4. What features do u expect in the patient?
- headache
- neck stiffness
- Fever vomiting,
- lethargy,
- personality change,
- memory loss
5. What signs are expecting in this patient?
- kerngs sign
- brudiki sign
- photophobia
6. What other investigations will u do?
- do lumber puncture for CSF examination
-Cryptococcal antigen test (CAT)
- Blood culture
-Imaging-CT scan/MRI

7. How would you manage this patient

 The following drugs are used for treatment
 Amphotericin B
 Flucytosine
 The Azoles (Fluconazole,)

8. what are complications of this condition ?

- Raised intracranial pressure
- Visual impairment
- Cerebral Infarction
- cerebral abscess
1. What is the diagnosis of this patient and what WHO stage ?
- herpes zoster and stage 2
2. What are differential diagnosis of this condition?
- allergic contact dermatitis
- chicken pox
- irritant contact dermatitis
3. Describe the features you are seen in this patient?
- Vesicular eruption- on one side of the face
- blister like
4. What is the condition causing this condition?
- Varicellar Zoster Virus
5. How would u manage this patent
-Oral Acyclovir 800mg 5 times /day x 7 days
- give analgesia and anti inflammatory
- antibiotic for secondary infections
6. What are possible complications
- post hepatic neuralgia
- Secondary Bacterial infection
- Ophthalmic zoster
- meningoencephalitis
1. What abnormalities can u see in the picture?
- multiple infiltrates on both lungs (miliary Opacity)
2. What are the differentials?
- Milliary TB
- sarcoidosis
- pneumococoniasis
- aspergillosis
- histoplasmosis
- cryptococcosis
- fibrosing alveolitis
- silicosis
- malignancies e.g. lymphoma,
- KS
What investigation will you do?
– FBC for anaemia, pancytopenia,leukopenia
– ESR -elevated
– ABG
– bronchoscopy
– LFTS –ALT &AST elevated
– Sputum M/C/S and AFB
– Biopsy
– Electrolytes
1. What can you see in the picture?
− Schistosoma mansonai egg( lateral spine)
2. What is your diagnosis
– Schistosomiasis
3. What are the possible complications
– Hepatomegally
– Splenomegaly
– Ascites
– esophageal varices
– Periportal fibrosis
– Portal hypertension
– Schistosoma Col-Pulmonale
–Growth retardation
4. What is pathognomic feature on ultrasound
– Peri-portal fibrosis with splenic enlargement
5. What is the management
– Praziquantel
– Health education
Prevention of
SCHISTOSOMIASIS
1. Snail control and eradication
Molluscides

2. Sanitary improvement of the environment

3. Mass Treatment of infected person
1. What can you see in the above picture?
- finger clubbing
2.What are the grades of finger clubbing?
- grade 1- nail bed fluctuation
- grade 2- loss of the angle between the nail bed and
nail folds
- grade 3- increased convexity of the nail folds
- grade 4- thickened of the distal phalanx
- grade 5- color changes. Glossy or shinny appearance
of the nail
 3. what are the possible cause of finger clubbing?
- CVS- infective endocarditis
- congenital cyanotic heart diseases(TOF)
-GIT- inflammatory bowel diseases
- liver cirrhosis
- RS- lung abscess
- lung cancer
- empyema
- pulmonary fibrosis
- Bronchiectasis
- cystic fibrosis
1. What can you see in the picture?
 Bilateral Bulging of eyes
2. What is the diagnosis?
 Hyperthyroidism(thyrotoxicosis)
3. What other ocular features can you expect in the patient?
Eye signs
 Lid lag
 Lid retraction
 Exophthalmos
4. What other clinical features of the condition?
 palpitations, increased appetite
 increased sweating, tremors
 diarrhea, amenorrhea
 weight loss, finger clubbing
 menstrual irregularities,
 insomnia, heat intolerance
 irritability, and emotional lability.
5. What investigation would you do?
 Serum TSH, reduced
 Free T3 and high
 Free T4 high
 Thyroid Ultrasonography
6. How would you manage this patient?
 Provide eye care; eye drops. Dark glasses, eyes patching and asses eye lid closure
 Medication; Antithyroid drug( carbimazole,Methimazole) and
 Beta blocker e.g. propranolol
 Surgical intervention
7. What are complications of this condition?
 Corneal abrasion
 Cardiovascular disease( CHF,HTN ,Angiana)
 Thyroid crisis
8. What are the causes of this condition?
 Toxic Adenoma
 Toxic Nodular Goiter
 Multinodular toxic goitre
 Graves disease
 thyroid carcinoma
 Auto immune glandular stimulation
 Toxic solitary nodular
1. What can you see in the picture?
 Egg and ascaris worms
2. Write the life cycle of these condition?
Unembryonated eggs are passed in stool by infected person; they become fertilized and
develop into an embryonated larval stage; the larva is ingested in undercooked or raw
vegetable reaches the gut and penetrated the duodenal mucosa into the capillaries;
reaches the lungs, is coughed up into the trachea and swallowed reaches the gut and
matures into adult worms that mate and release eggs that are passed in stool.
3. What are complications are you anticipated?
 Pneumonia
 Anaemia
 Intestinal obstruction
 Pancreatitis
 appendicitis
 Portal HTN leading to Ascites
 liver abscess
4. How would you manage this condition?
 Medication ; Mebandozole
 Surgical intervention in case of Intestinal obstruction
 Supportive: antipyretic and antibiotics in case of liver abscess
 Prevention; Health education, Sanitary disposal of human excreta and massive treatment.
5. How would you investigate this condition
Stool microscopy for Eggs
Adult worms in vomitus or feces
Loeffler’s syndrome on X-ray
Sputum microscopy for Larvae
Study the diagram below and answer the
following questions
1. Describe the abnormalities of this ECG?
- Irregular R-R intervals (The QRS rhythm is rapid and irregular) and
- p wave is absent

2. What is the diagnosis ?

- Atrial Fibrillation

3.What are the possible causes of this condition?

CARDIAC NON-CARDIAC
Hypertension - thyrotoxicosis
Congestive heart failure - alcohol
Coronary artery disease - smoking myocardial
infarction - Acute and chronic pulmonary disease
Valvular heart disease - chronic obstructive pulmonary disease
Cardiomyopathy: dilated, hypertrophic -Electrolyte disturbances(hypokalaemia)
Myocarditis and pericarditis - Caffeine
Cardiac tumour
Cardiac surgery
4. What are the suspected features of this condition?
- Shortness of breath
- Dizziness or fainting
- Fatigue,
- chest pains
- palpitations
5.What other investigation will you do?
- echocardiograph (echo),
- Chest X Ray,
- thyroid function test (T3 ,T4 and TSH)
- urea and Electrolytes
- Full blood count
6.What are the complications of this condition?
- Stroke
- Heart failure
7.How would you manage the patient?

1.control of the heart rate with

beta blockers
calcium channel blockers
8. Name the types of this condition

- Paroxysmal,
- persistent longstanding,
- persistent continuous
- permanent and
- non vavular
HEMOGRAM
WBC - 8.27(10-3/UL) ………… normal; 5-11
RBC - 2.58 (10-3/UL) …………. ; 4- 6
HB - 5 g/dl………………………… ;12- 17
MCV – 70.9 (FL) ……………………… ;80- 100
MCH – 22. 1 (pg) ……………………. ;28-32
MCHC………………………………. 32 -36
PLT – 503 (10-3/UL)………………….. ;350- 450

Study the above hemogram and answer the following

questions
1.What abnormalities can you see?
 low HB
 Low MCV
 Low MCH
 High PLTs
2. What is the diagnosis of the above hemogram?
- Hypochromic Microcytic Aneamia with thrombocytosis
3. What are the differentials of this hemogram?
 Iron deficiency anemia
 Thalassemia
 Sideroblastic anemia
 Lead poisoning
 Aneamia of chronic disease
4. what other investigations will you do?
Peripheral blood smear
Reticulocytes count
Iron studies for
- total iron binding capacity (TIBC)
High
- Low ferritin
- serum iron low
- High transferitin
Bone marrow biopsy and aspiration
HEMOGRAM
WBC - 6.09 (10-3/UL)
RBC - 4.55 (10-3/UL)
HB - 4.5g/dl
MCV - 89.0 (FL)
MCHC – 32.6 (pg)
MCH – 28
PLTs - 450 (10-3/UL)

Study the above hemogram and answer the following

questions
1.What abnormalities can you see?
- low Hb( aneamia)
2. What is the diagnosis of the above hemogram?
-Normocytic normochromic Aneamia
3. What are the differentials of this hemogram?
- Anaemia of chronic disease
- acute blood loss
- Aplastic Aneamia
- Hypoadrenalism
- Bone marrow infiltration; leukemia
- Endocrine disorders ;
1. Hypopituitarism,
2. hypothyroidism,
-Haemolytic aneamia
- Increased plasma volume ; pregnancy ,over hydration
4. what other investigations will you do?

Bone marrow aspiration

Bone marrow biopsy
Peripheral blood smear;
 Reticulocytes count
Renal function tests
TSH
Free T 3 and T 4
Liver function tests
Serology tests; Hepatitis
HEMOGRAM
WBC – 1.9 (10-3/UL)
RBC - 2.72 (10-3/UL)
HB - 6.6g/dl
MCV - 80.0 (FL)
MCHC – 30.1 (pg)
PLTs - 60 (10-3/UL)

Study the above hemogram and answer the following

questions
1.What abnormalities can you see?
- Reduced WBC,RBC,Hb and PLTs
2. What is the diagnosis of the above hemogram?
- Pancytopenia
3. What are the differentials of this hemogram?
-megaloblastic aneamia
-iron deficiency aneamia
-aplastic aneamia
-lymphoma
- Acute leukemias
- Liver disease
- Milliary TB
- HIV infection
- Bone marrow carcinoma
- chemotherapy
- Radiation therapy
4. what other investigations will you do?

Peripheral blood smear

Reticulocyte count
Bone marrow aspiration
Bone marrow biopsy
Blood culture
Serology tests e.g. HIV,Hepatitis EBV
Liver function tests
A 18YR OLD GIRL WITH HISTORY OF FEVER AND
MODERATE ANEMIA. EXAMINATION OF OTHER SYSTEMS
WAS OTHERWISE UNREMARKABLE

1. WHAT DO YOU SEE

RING FORMS OF MALARIA PARASITES
(TROPHOZOITES)

2. WHAT IS YOUR DIAGNOSIS

MALARIA WITH MODERATE ANEMIA

3. WHAT IS YOUR TREATMENT?

- Artesunate i.v. or i.m
- quinine
- HAEMATINICS
4. what other complications of malaria would you
expect in this patient?
- Cerebral malaria
- Metabolic acidosis
- Hypoglycaemia
- Acute renal failure
- Acute pulmonary oedema
- Circulatory collapse(algid malaria”).
- DIC
- Water black fever
4. what other complications of malaria would you
expect in this patient?
- Cerebral malaria
- Metabolic acidosis
- Hypoglycaemia
- Acute renal failure
- Acute pulmonary oedema
- Circulatory collapse(algid malaria”).
- DIC
- Water black fever
RDT +VE
1. What is your diagnosis
Complicated malaria (water black fever)
2.What other forms of complications would you expect in this
patient
- Cerebral malaria
- Metabolic acidosis
- Hypoglycaemia
- Acute renal failure
- Acute pulmonary oedema
- Circulatory collapse(algid malaria”).
- DIC
- Water black fever
1. WHAT CAN YOU SEE ON THE X-RAY
• RIGHT SIDED OBLITERATION OF COASTAL PHRENIC ANGLE
• DENSE HOMOGENOUS OPACITY IN THE RIGHT LOWER LUNG FIELD

2. WHAT IS YOUR DIAGNOSIS

• RIGHT SIDED PLEURAL EFFUSION

3. WAT ARE YOU DIFFERENTIAL DIAGNOSIS

• PNEUMONEA
• TUBERCULOSIS
• PULMONARY EMBOLISM
• CONSTRICTIVE PERICARDITIS
• NEPHROTIC SYNDROME
• Liver cirrhosis
• sarcoidosis
• Bronchial carcinoid
• Congestive heart failure
4. WHAT INVESTIGATIONS WOULD YOU DO
• DIAGNOSTIC PLEURAL TAP
• SPUTUM FOR M/C/S AND AAFB
• FBC & DC
• Cytology
1.What can you see in the above picture
A patient with Massive abdominal distention
Prominent abdominal blood vessels
2. what questions would you ask in this patient?
About chronic heavy alcohol drinking
About drug history such as paracetamol ,Pyrazinamide
About history blood transfusion
Multiple sexual partners
Intravenous drug use
3. state 5 differentials of this patient?
Liver cirrhosis
Congestive cardiac failure
Alcohol hepatitis
Nephrotic syndrome
Peritoneal tuberculosis
Peritoneal carcinoma
Hepatocellular carcinoma
Protein losing enteropathy
Bacterial peritonitis
Constrictive pericardititis
4. How would you investigate this patient?
Radiology
 Abdominal scan
 CT of abdomen
 Chest and abdominal plain x-ray
Ascitic fluid
 For biochemistry
 For cytology
 For Gramm staining
 For culture and sensitivity
 For acid fast bacilli
 FBC/Differentials
 LFTs ,RFTs and urinalysis
 Serology tests; HBsAg,
 Peritoneal biopsy
5.How would you manage this patient?
Restricting of fluids and sodium

MEDICAL CARE
Diuretics
SPIRONOLACTONE 25-20mg
FUROSEMIDE:20-80 m
Paracentesis
Start 3-5 L/24hrs removal
Albumin replacement
Surgical therapy
LEE VEEN SHUNT
What are the complications this patient?
Spontaneous Bacterial Peritonitis
Study the diagram below and answer the
following questions
1. What can you see in the above picture?
Peripheral smear stained with giemsa showing trypanosomes
2. What is the diagnosis?
trypanosomiasis
3. How is it transmitted?
Through the bite by tsetse fly
4. What are organisms responsible this disease?
Trypanosome brucei gambiense (‘Gambian sleeping
sickness’), and
 Trypanosome brucei rhodesiense ( Rhodesian sleeping
sickness’).
5. What are clinical features?
fever and lymphadenophathy
Hepatosplenomegaly
headache
behavioral changes,
confusion and daytime somnolence.
tremors, ataxia, convulsions and hemiplegias

6. What is the treatment of this condition?

- Suramin 20 mg/kg Bwt IV
Study the diagram below and answer the
following questions
1. What is this abnormality ?
Craw hand
2. What is the diagnosis?
Rheumatoid arthritis
3. What 2 deformities would you expect?
Swan-neck deformity
Ulnar deviation
Boutonnière deformity
4. Extra-articular features
Subcutaneous nodules and
 tendon ruptures
5. How would you investigate this patient?
Rheumatoid factor
X-ray
FBC
Aspiration of the joint