1. Painful swelling back of leg  28 year old male in his normal state of health presented with acute painful swelling of the back of his right leg. 1.What is the likely diagnosis? ___ 2.What step is advised to confirm diagnosis? ____

2. 46 year old man presented six month history of with fatigue, fever on and off, joint pains and weight loss of 7 Kg. O/E Tender maculopapular rash on his shins, cervical lymphadnopathy. Investigations: CBC: Hb 14.6 g/dl WBC4.7 X 10 /dl U/E’s Sodium136 mmol/l Potassium 4.2 mmol/ Calcium3.4 mmol/l 1.Describe the abnormality of chest x-ray? _______ 2.What is the most likely diagnosis? ______

3. 1.Describe the abnormal ECG finding? ________ 2. What is the diagnosis? ________________

4. Twenty four year old man presented with 2 day H/O:  nausea  myalgia  anorexia  headache. Two days later developed rash all over body 1.Describe characteristics of the rash? ___ 2.What is the clinical diagnosis? ________

5. This man was being investigated in the infertility clinic for hypogonadism Investigations showed: Testosterone 4.6 nmol/l (NR 10 – 30) LH28U/l (NR <6) FSH42 U/l (NR <6) Buccal smear: Positive for Barr bodies A man with gynaecomastia 1.What is the most likely clinical diagnosis? 2.What is most essential laboratory test for working diagnosis?

6.  A 54-year-old female is admitted with chief complaint of neck pain for one month.  The pain is at the back of the neck, excruciating in character, 10/10 on scale,  temporarily relieved by pain medications, exacerbated by movement, and radiating down the left arm..  She has never had similar symptoms before. O/E  No neurological deficits.  Limited range of motion (ROM) in the neck but no true neck rigidity.  Local tenderness at the back of the neck. 1.What are the imaging findings? -- 2.What is the diagnosis? ----

7. 80 year old lady admitted with two month history of fever, weight loss and abdominal distention. There is no other relevant medical history. Examination reveals ascites. The following results were obtained: Hb10.2 g/dl WBC15.2 x 10/l ESR 70 mm in first hour Serum bilirubin30µmol/l(NR 2-17 µ mol) Alk. Phosphatase147 iu/l(NR 44 – 147IU) Aspartate transferase60 iu/l(NR 8-20 U/L) Ascetic fluid:lymphocytes +++, no polymorphs, no organism seen, protein 38g/l 1. Suggest possible diagnosis? _____________________________ 2. Suggest relevant investigation? __________________________

8. 16 year old girl presented with generalized body aches and pains. There was no history of steatorrhoea. She was on nutritious diet. Investigations showed: Serum calcium 1.7 mmol/l Phosphate 0.5 mmol/l Alk. Phosphatase 661 iU/l Parathyroid hormone 250pmol/l (NR 10 – 90) 1,25 hydroxvitamin D10 pg/ml (NR 30 – 75) What is the likely diagnosis? _____ What is the x-ray findings? ______

9.  A 15 year-old boy with a history of first episode generalized tonic- clonic convulsion.  He was afebrile and had GCS 13 (E3 V4 M6) fluctuating for about 4 hours without improvement.  Pupils were equal and reactive  No focal neurological deficits.  His CT head was normal.  After returning from the scan he had another self-limiting seizure that lasted 2 minutes. U/E’s Na 125 mmol/L K 4.1 mmol/L Urea 3.7 mmol/L Cr 49 umol/L  Venous blood gas pH 7.37 PCO2 42 mmol/L HCO3 24 mmol/L Cl 96 mmol/L glucose 7.2 mmol/L lactate 1.9 mmol/L  FBC and LFTs were normal. 1.What are the laboratory abnormalities? ______________ 2.What is the likely cause of his seizure? ______________

10. Thirty year old man presented with sudden chest pain: 1.What is the abnormal chest X-ray finding? __________ 2.What is the next step for treatment ___________