FREE TRIAL MEQ Practice

A 40-year-old man developed pain, swelling and deformity on his right wrist following a fall on his outstretched hand.

What are the possible differential diagnoses?

What does the X-ray below show?

How should this case be managed?

The postoperative period was uneventful with no complications. After 3 months, he presents with numbness in his thumb, index, middle, one half of ring finger and weak grip. The clinical photograph and radiograph of his right hand are shown below.

What are the findings on the clinical photograph and radiograph? What is the most likely reason for his complaint?

How would you confirm your diagnosis?

How would you manage this case?

M is an 8-year-old boy living in Batu Pahat. He was referred from the health clinic after his fever of 5 days failed to subside with antibiotic therapy. He started having abdominal pain and bleeding from the nose one day before admission. His mother also noticed that his face was flushed and there were reddish rashes on his upper and lower limbs.

List FIVE questions that you would like to ask his mother to help you arrive at a provisional diagnosis. Give ONE reason for asking each question.

Upon taking further history from M’s mother, he had no history of passing bloody stools or any other manifestations of bleeding. His fever was not associated with any chills or rigors. He had no joint pain or swelling. There was no coughing, runny nose or shortness of breath. His mother mentioned that there was fogging in their housing area recently and a few children were admitted to the hospital with similar complaints.

On admission, M’s temperature was 38.5°C; blood pressure was 75/55 mmHg; pulse was thready with small volume, with a rate of 142 per minute; respiratory rate was 65 breaths per minute. Liver was 4 cm palpable. His extremities were cold to touch and he was restless.

State the most likely diagnosis.  

What are the features to diagnose dengue fever in children?

Upon taking further history from M’s mother, he had no history of passing bloody stools or any other manifestations of bleeding. His fever was not associated with chills or rigors. He had no joint pain or swelling. There was no coughing, runny nose or shortness of breath. His mother mentioned that there was fogging in their housing area recently and a few children were admitted to the hospital with similar complaints.

On admission, M’s temperature was 38.5°C; blood pressure was 75/55 mmHg, pulse was thready with small volume, with a rate of 142 per minute; respiratory rate was 65 breaths per minute. Liver was 4 cm palpable. His extremities were cold to touch and he was restless.

List THREE laboratory investigations you would perform and give your reasons, whenever you encounter a child suspected of having dengue hemorrhagic fever.

M’s blood pressure was noted to be 62/38 mm Hg on the second day of admission (day 7 of fever). Some of the investigation results on the day are given as follows.

Interpret the results given above.

When should you suspect that there is bleeding?

What are the complications of dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS)?