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Medicine Card Questions 2025

Compiled & Edited by Srijan Sarker (DCIMC 9)
Respiratory System
Case 01
A 35 years old female presented with high grade fever with chills and rigor, right sided chest pain and cough
for 3 days.
a) What is the most likely diagnosis?
b) How will you investigate this case?
c) How will you assess the severity of this case?

Case 02
A 30 years old male presented with high grade fever, cough with rusty sputum and right sided chest pain for
7 days.
a) What is the most likely diagnosis?
b) Mention the findings of chest examination.
c) How will you investigate him?

Case 03
A 30 years old male presented with low grade fever with night sweat, chronic cough and occasional
hemoptysis for 8 weeks. There is also H/O significant weight loss.
a) What is the most likely diagnosis?
b) What are the indicators of activity of this disease.
c) Outline the investigation plan.

Case 04
A 25 years old male presented with low grade fever and cough for 2 months. Examination of chest is
suggestive of left sided pleural effusion.
a) What is the most likely diagnosis?
b) How will you evaluate clinically?
c) Outline the plan of investigations with expected findings.

Case 05
A 50 years old male with diagnosed case of COPD presented with sudden severe right sided chest pain. In
addition, breathlessness for 4 hours. His BP is 80/65 mmHg. On chest examination, trachea shifted to left
side and hyper resonant on percussion with diminished breath sound on right side.
a) What is the most probable diagnosis?
b) Mention immediate management of this case.

Case 06
A 28 years old female has come to you with fever and productive cough with foul smelling sputum for last 2
months with occasional hemoptysis. On examination, there is finger clubbing and coarse crepitation over
lower zone of right lung. She had H/O community acquired pneumonia during her childhood.
a) What is the most probable diagnosis?
b) Outline the management of this case.
c) What are common causes of this disease?

Case 07
A 55 years old male, following a flight from USA to Bangladesh, presented with a sudden onset of severe
breathlessness and right sided chest pain lasting for the past 3 hours.
a) What is the most likely diagnosis?
b) Outline the investigation plan.
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Case 08
A 25 years old man presented with fever, cough & weight loss for l month. His CXR (P/A view) showed -
homogenous opacity with cresentic upper margin in the right side.
a) What the most likely clinical diagnosis?
b) Write down the expected chest findings clinically?
c) How will you investigate this patient further in laboratory?

Case 09
A 40 years old male presented with high fever, cough with rusty sputum for 4 days.
a) What is the most likely diagnosis?
b) Mention expected clinical findings of this case.
c) How will you investigate and treat him?

Case 10
A 20 years old female presented with severe breathlessness, cough & wheezing for 6 hours. On query, she
told that she used inhaler irregularly and more in winter season.
a) What is the most likely clinical diagnosis?
b) How will you investigate this case?
c) Give an outline of management of this case.

Case 11
A 50 years old male presented with recurrent hemoptysis for 2 months.
a) Mention most likely differential diagnoses.
b) Make a checklist of history and physical signs to find out the causes of hemoptysis.
c) Outline the plan of investigations with interpretations.

Case 12
A 35 years old male presented with low grade continuous fever with weight loss, night sweat, abdominal
pain and dry cough for 3 months. On examination, bilateral cervical lymphadenopathy (non tender) &
hepatosplenomegaly are present.
 Hb: 9gm/dL
 TC WBC: 7000/cmm
 ESR: 110 mm in 1st hour
 Eosinophil: 15%
a) What is the most probable diagnosis?
b) How will you further investigate the patient?
c) What are the expected findings in favor of your diagnosis?

Case 13
A 50 years old male presented wih sudden onset right sided chest pain and breathlessness.On examination,
percussion node is resonant and breath sound is absent on the right side.
a) What is your diagnosis?
b) What is the expected radiological finding in favor of your diagnosis?
c) How will you manage the patient?

Q. What is cor pulmonale? Mention some important causes.

Q. Mention the diferences between bronchial asthma & COPD.
Q. What do you mean by?
- Primary Tuberculosis
- Secondary Tuberculosis
- Latent Tuberculosis
Q. How do you interpret Mantoux test?
Q. Name some diseases, where Mantoux test may be 0 mm.
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CVS
Case 01
A 25 years old woman presented with palpitation. On examination, pulse is 77 beats/min and
irregularly irregular. On precordium examination, apex beat is tapping. First heart sound is loud
and a mid diastolic murmur at apical region.
a) What is the most likely diagnosis?
b) Mention some underlying causes.
c) Outline the principal of management.

Case 02
A 15 years old boy was admitted with fever and migratory painful swelling of multiple large
joints for 2 weeks with preceding history of sore throat. Last 1 week he also complained of
chest pain and breathlessness.
a) What is the most likely diagnosis?
b) Mention diagnostic criteria of underlying disease.
c) Mention 4 important investigations.

Case 03
A 50 years old man, diagnosed case of old MI presented with severe breathlessness and cough with frothy
blood stained sputum for 8 hours.
a) What is the most likely diagnosis?
b) Mention further investigations.
c) How will you manage this case?

Case 04
A 55 years old diabetic, hypertensive patient presented with sudden severe compressive central
chest pain radiating to left arm for 6 hours.
a) What is the most likely diagnosis?
b) Mention 2 acute and 2 late complications.
c) Mention the complication that may lead him death.

Case 05
A 25 years old diabetic hypertensive male presented with sudden severe orthopnea for 8 hours.
On examination, BP 210/110 mm Hg and bilateral basal fine crepitation.
a) What is the most likely diagnosis?
b) Mention immediate investigations.
c) How will you manage him immediately?

Case 06
A 55 years old diabetic hypertensive male presented with sudden severe compressive chest pain, which
radiate to neck and left arm for 1 hour.
a) What is the most likely diagnosis?
b) What other investigations you want to do?
c) Outline the principal of management.

Case 07
A 40 years old woman is taking amLodipine (Calcium channel blocker) for hypertension. Recently she
developed bilateral pedal edema.
a) What is the mostly likely diagnosis?
b) How will you investigate her?
c) How will you treat the patient?
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Case 08
A 40 years old asthmatic woman presented recent onset of hypertension. Her BP is 170/100 mmHg.
a) What medication is indicated for underlying diagnosis?
b) Mention different group of anti-hypertensive drug.

Case 09
A 35 years old, 25 weeks of pregnant woman presented with hypertension. Her BP is 170/100 mmHg.
a) What medication is indicated for the underlying diagnosis?
b) Mention some causes of secondary HTN.

Case 10
A 55 years old diabetic male presented with persistently high blood pressure. On examination, his BP is
165/100 mmHg.
a) What is the most likely diagnosis?
b) What medication is indicated?
c) Mention different group of anti-hypertensive drug.

Case 11
A 55 years old male presented with sudden severe central chest pain for 4 hours. ECG shows - ST segment
elevation in anterior chest lead.
a) What is your most likely diagnosis?
b) What are the points you will consider during history taking to search risk factor?
c) Outline the management of this case.

Case 12
A 60 years old man admitted with long history of uuncontrolled HTN.
a) How will you clinically evaluate the patient to look for target organ damage?
b) Mention the necessary investigations for the patient.

GIT
Case 01
A 25 years old man came with several episodes of vomiting and diarrhea with anuria for 24 hours after
taking food from a roadside hotel.
a) What is the likely clinical diagnosis?
b) How will you investigate and treat the patient?

Case 02
A 50 years old male presented with hematemesis and malena in medicine ward for 2 days.
a) Mention 3 common causes of this scenario.
b) What are the physical findings you will search to differentiate them?
c) How will you investigate and manage this case?

Nephrology
Case 01
A 25 years old woman has been presented with burning micturition with lower abdominal pain for 7 days.
a) What is the most likely diagnosis?
b) Classify this diagnosis.
c) What are the risk factors of this disease?
d) What do you mean by complicated UTI?
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Case 02
A 32 years old woman presents to the emergency department with a 2 days H/O high grade fever (39oC)
with chills and right flank pain. She reports dysuria and increased urinary frequency over the past week. On
examination, she appears ill with tenderness in the right renal angle. Investigations -
 Urine R/E: Pus cell 40-50/HPF, RBC 2-4/HPF and Positive for leukocyte esterase, nitrites
 CBC: Total WBC - 15,000/μL
 CRP: 100 mg/dL
a). What is the most likely diagnosis? What is the most likely causative organism?
b). Mention 3 key clinical features that support your diagnosis.
c). What is the investigation would you order to confirm the diagnosis?

Case 03
A 35 years old male presents to the emergency department with complaints of decreased urine output over
the past 3 days. He also reports fatigue, nausea and mild shortness of breath. On further questioning, he
mentions that he had a fever and diarrhea last week, for which he took over the counter ibuprofen and
loperamide. On examination, BP: 140/90 mmHg, Pulse: 98 bpm, Lungs: Clear.
a) What is the most likely diagnosis in this patient?
b) Classify underlying diagnosis.
c) What are the possible contributing factors to this patient?

Case 04
A 60 years old diabetic male presents with anorexia, nausea and weakness. On examination, patient is
anemic and BP is 160/110 mmHg. Investigation shows -
 S. Creatinine: 6 mg/dL
 USG W/A: Bilateral small echogenic kidneys
a) What is the most likely diagnosis?
b) Outline the plan of investigations.
c) Mention 4 important complications.

Case 05
A 10 years old boy presented with scanty micturition and puffy face. On examination, BP 120/900 mmHg.
Urine R/E shows -
 Color: Smoky
 Albumin: +
 Pus cells: 0-2/HPF
 RBC: 40-50/HPF
 RBC cast: Present
a) What is the probable diagnosis?
b) Mention one history you should take.
c) Write down 3 clinical signs you should look for.
d) What are the further investigations?

Case 06
A 7 years old girl presented with swelling of the whole body with scanty micturition for 10 days.
Her urine examination reveals -
 Color: Straw
 Albumin: +++
 Pus cells: 0-2/HPF
 RBC: Nil
 Hyaline cast: Present
a) What is the likely diagnosis?
b) Mention 3 investigations.
c) Mention 1 drug you think that should be given to this patient.
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Hepatobiliary System
Case 01
A 26 years old man presented with anorexia, nausea and repeated vomiting for 3 days. He also noticed high
colored urine and pain in the right upper abdomen for 2 days. Investigation reveals -
 Hb: 14 g/dL
 WBC: 3900/cmm
 S. bilirubin: 7.2mg/dL (normal up to 1.2 mg/dL)
 SGPT: 1200 IU/L (normal: 20 IU/L)
 S. alkaline phosphatase: 95 IU/L (normal: 20–100 IU/L)
a) What is the most likely diagnosis?
b) Mention 2 physical signs you should look for.
c) Mention 2 complications.

Case 02
A diagnosed case of acute viral hepatitis has been presented with altered sleep pattern and irritability.
Following day of admission his investigation report shows -
 S. bilirubin: 16 mg/dL
 SGPT: 50 IU/L
a) What is the most likely diagnosis?
b) What physical signs should be looked for in favor of diagnosis?
c) How will you interpret this investigation report?
d) Outline the principal of management.

Case 03
A 20 years old male presented with low grade fever, profound anorexia with occasional vomiting and right
upper abdominal pain for 5 days. Last 2 days he noticed gradually increasing yellow coloration of urine and
eyes. On examination, patient is icteric and mild enlarged tender liver.
a) What the most likely diagnosis
b) What are the underlying etiology?
c) Outline the plan of investigations.

Case 04
A 50 years old male presented with tender hepatomegaly for 5 days.
a) Mention 4 causes with clinical presesentations
b) Outline the plan of investigation that hint underlying etiology.

Case 05
A 45 years old male known case of chronic hepatitis B, presented with hematemesis and melena for last 1
day.
a) What is the most likely diagnoses?
b) Mention 2 differential diagnosis.
c) Outline the plan of management.

Case 06
A 55 years old male presents with a history of chronic alcohol use, fatigue, weight loss and abdominal
distension. On examination, he has jaundice, ascites and a palpable mass in the left upper quadrant.
a) What is the most likely diagnoses?
b) Mention 2 further investigations for underlying diagnosis.
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Case 07
A 40 years old male known case of chronic hepatitis B, presented with abdominal distention. On
examination, there is mild jaundice, bilateral gynecomastia and small testis. On abdominal examination,
shifting dullness positive.
a) What is the most likely diagnosis?
b) What are the underlying etiology?
c) Outline the plan of investigations.

Case 08
A 45 years old male presented with anorexia, nausea for 2 months. He had a h/o of I/V drug abuse. On
examination, there is palmer erythema, leukonychia, bilateral gynecomastia and small testis.
a) What is the most likely diagnosis?
b) What are the underlying causes?
c) How will you investigate him?
d) Mention 2 important complications.

Case 09
A 40 years old male presented with h/o vomiting of blood and black tarry stool for the last 2 days.
a) Mention the focused history that hints underlying etiology.
b) What could be the expected physical findings?
c) Outline the principal of management.

Case 10
A 40 years old women presented with sudden severe upper abdominal pain which radiate to the back. She
had a h/o taking fatty food 6 hours back.
a) What is the most likely diagnoses?
b) Outline the investigations with interpretation.

Case 11
A 50 years old male ex smoker came to you with the complaint of hematemesis for 1 day. He had a h/o
dyspepsia for past 3 months. On examination, there was an epigastric mass.
a) What is the most likely diagnosis?
b) Mention the other physical finding of underlying diagnosis.
c) Mention the single most investigation to confirm your diagnosis.

Case 12
A 45 years old male was found HBSAg positive during his pre anesthetic checkup
before an operation.
a) What further investigations you want to do?
b) What can be the fate of a HBsAg positive patient?
c) What are the points in counselling a Hepatitis B carrier?

Case 13
A 54 years old patient with known chronic liver disease became drowsy and disoriented for 1 day.
a) What is the most likely diagnosis?
b) What factors may precipitate this condition?
b) Give an outline of management of this patient.

Q. What are the outcome of HBV infection

Q. How will you counsel a HBV carrier
Q. How will interpret different serological tests of HBV infection.
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Electrolytes & Acid Base balance

Case 01
A 50 years old man has been suffering from kidney disease for 8 months. S. Bicarbonate shows 12 mmol/L.
a) What is the biochemical diagnosis?
b) Mention 4 causes of metabolic acidosis.
Case 02
A 50 years old male has been presented with palpitation 6 hours. His blood reports shows S. Potassium is 7
mmol/L.
a) What is the biochemical diagnosis?
b) Mention 5 underlying causes.
c) Mention immediate bedside investigations with findings.
d) How will you mange immediately?

Case 03
A 40 years old male presented to you with S. electrolyte reports. His S. Potassium is 2 mmol/L.
a) What could be the presenting complaints?
b) Mention 5 important causes.
c) Mention immediate bedside investigations with findings
d) Outline the principal of management.

Case 04
A 42 years old male presented with vomiting and diarrhea followed by acute confusional state. His S.
Sodium is 110 mmol/L.
a) What is the biochemical diagnosis?
b) What are the causes of underlying diagnosis?
c) Outline the principle of management.

Case 05
A 50 years old man came to you with recurrent vomiting and diarrhea followed by acute confusion state. S.
Sodium level was found 110 mmol/L.
a) What is your diagnosis?
b) What are the causes of hyponatremia?
c) Discuss complications and management.

Endocrinology
Case 01
A 32 years old woman presented with bilateral proptosis, palpitation and weight loss. Investigations reveals
-
 Serum FT3: 9.0mmol/L (normal 1.3–3.5mmol/L)
 Serum FT4: 215mmol/L (normal 70–160mmol/L)
 Thyroid stimulating hormone (TSH): 0.04 IU/L (normal 0.5–5.1 IU/L)
a) What is the most likely clinical diagnosis?
b) Mention 2 other causes of such investigation findings.
c) What is the treatment of primary cause?

Case 02
A 30 years old woman presented with palpitation and weight loss 2 months. On examination, pulse 110 bpm
and diffuse non tender thyromegaly.
a) What is the most likely clinical diagnosis?
b) Mention 3 important investigations.
c) Outline the modalities of treatment.
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Case 03
A 35 years old woman presented with a generalized weakness and weight gain. Her thyroid function test
reveals -
 Serum FT3: 0.5mmol/L (normal 1.3–3.5mmol/L)
 Serum FT4: 30mmol/L (normal 70–160mmol/L)
 TSH: 35mIU/L (normal 0.5–5.1mIU/L)
a) What is the most likely clinical diagnosis?
b) Mention 4 important clinical signs of this patient.
c) What are the ECG changes in hypothyroidism?

Case 04
A 30 years old woman presented with a generalized weakness, menorrhagia and weight gain for 3 months
On examination, pulse 60 bpm and diffuse non tender thyromegaly.
a) What is the most likely clinical diagnosis?
b) Mention 4 important investigations.
c) Outline the modalities of treatment.

Case 05
A young female presented with significant weight gain with hoarse voice and cold intolerance for 3 months
a) What is the most likely clinical diagnosis?
b) Mention the causes of goitre
c) How will differentiate hypothyroidism from hyperthyroidism?

Case 06
A 30 years old woman presented to you with weight loss, palpitation. On examination, pulse 113 bpm and
irregular, diffuse goiter, exophthalmos.
a) What is the most likely diagnosis?
b) What are the differential diagnosis of toxic goiter?
c) Outline the investigations plan.

Case 07
A 25 years old anxious looking lady presented with palpitation sweating and marked
weight loss for 3 months. On examination, there is a goiter.
a) What is the most likely diagnosis?
b) Mention important clinical signs.
c) Outline the investigations plan.

Case 08
A 22 years old man was admitted with the complaints of weakness.weight loss and progressive darkening of
skin for several weeks. His BP was 80/50mm Hg. Investigations reveal -
 Na: 122mmol/L
 K: 6.3mmol/L
 Cl: 98mmol/L
 HCO3: 18mmol/L
a) What are the biochemical abnormalities?
b) What is the likely diagnosis?
c) What are the common causes?
Case 09
This is the oral glucose tolerance test (OGTT) report of a 50 years old male.
 FBS: 8mmol/L
 After 2 hours: 14mmol/L
a) What is the most likely diagnosis ?
b) Mention the acute and chronic complications of underlying diagnosis.
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c) Mention some oral drugs used in this condition.

Case 10
This is the oral glucose tolerance test (OGTT) report of a 40 years old male.
 FBS: 5.1mmol/L
 After 2 hours: 10.1mmol/L
a) What is the most likely diagnosis?
b) What other investigation you want to do?
c) How will you counsel the patient?
d) How will you follow up the patient?

Case 11
A 50 years old diabetic male has been brought to the emergency department with sweating and
unconsciousness. He took insulin this morning but missed to have breakfast.
a) What is the most likely clinical diagnosis?
b) Outline the principal of management.

Case 12
A 19 years old woman was presented at emergency department with high grade fever and diffuse abdominal
pain. She used to take insulin. Investigations reveal -
 Blood glucose: 28mmol/L
 Na: 118mmol/L
 Potassium: 4.7mmol/L
a) What is the likely diagnosis?
b) What other biochemical findings?
c) Outline principal of management.
Case 13
A 19 years old woman was suffering from high grade fever, productive cough, shortness of breath, diffuse
abdominal pain and vomiting. She was emaciated and dehydrated. Investigations reveal -
 Blood glucose: 28 mmol/L
 Na: l18 mmol/L
 Bicarbonate: 8.1 mmol/L
a) What is the most likely clinical diagnosis?
b) Outline other important investigations.
c) What is the treatment option?

Rheumatology
Case 01
A 22 years old female presented with alopecia, oral ulcer with pain and swelling of small joints of hands for
2 months.
a) What is the most likely diagnosis?
b) Mention other diagnostic criteria of underlying diagnosis.
c) Mention the difference between seropositive and seronegative arthritis.

Case 02
A 45 years old female presented to you with painful joints swelling involving both hands with morning
stiffness for 2 months.
a) What is the most likely diagnosis?
b) Outline the plan of management
c) Mention 3 synthetic DMARDs and 3 biologics with 2 side effects respectively.
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Case 03
A 20 years old female presented to you with joints pain involving both hands with morning stiffness for 10
days. She had H/O flu 3 weeks ago.
a) What is the most likely diagnosis?
b) Outline the plan of investigations.
c) What are the causes of polyarthritis?
Case 04
A 45 years old male uncontrolled T2DM presented with acute painful left knee for 3 days. On examination,
left knee is swollen hot, tender and there is tenia pedis in right toe cleft.
a) What is the most likely diagnosis?
b) Outline the plan of investigations with expected findings.
c) What are the causes of monoarthritis?

Case 05
A 48 years old male presented with severe pain over root of right great toe for 1 day. Pain is started at mid
night and reached maximum intensity over 4 hours.
a) What is the most likely diagnosis?
b) How will you confirm the diagnosis?
c) Outline the principal of management.

Case 06
A 57 years old obese woman presented with pain in both knee joints for 3 months. Pain is more marked over
left knee and increased after activity. On examination, there is coarse crepitation during passive movement
of knee joints.
a) What is the most likely diagnosis?
b) Outline the plan of investigations.
c) How will you differentiate degenerative arthopathy from inflammatory arthritis?

Case 07
A 20 years old male presented with low back pain with morning stiffness for 2 months. Pain is relieved by
activity. On examination, tenderness over the sacroiliac joint.
a) What is the most likely diagnosis?
b) Outline the plan of investigation.
c) What are the other causes of low back pain?

Case 08
A 20 years old female presented with complaints oi poiy arthritis, photosensitivity and oral ulceration for 4
months and evidence of pleural effusion.
a) What is the most likely diagnosis?
b) Mention the diagnostic criteria.
c) Name 5 important investigations with expected findings.

Case 09
A 28 years old woman presented to you with the complaints of joint pain involving both hands with morning
stiffness for 2 months.
a) What is your diagnosis?
b) Outline the plan of management of this disease
c) Mention 3 DMARDs with 3 side effects of each.

Case 10
A 50 years old male presented with severe pain in the great toe for 2 hours. On examination, joint is swollen,
red and tender.
a) What is your diagnosis?
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b) Outline the specific investigations and mention the drugs used for this disease.

Q. Define seropositive and seronegative arthritis with examples.

Q. How will you differentiate seropositive and seronegative arthritis?

Infectious Disease
Case 01
A 25 years old female presented with fever for 10 days. Initially fever is low grade and last 2 days fever is
high grade associated with loose motion.
a) What is the most likely diagnosis?
b) How will you confirm the diagnosis?
c) How will you interpret WIDAL test?

Case 02
A 20 years old male presented with blood mixed stool with tenesmus for last 2 days.
a) What is the most likely diagnosis?
b) How will you investigate him?
c) Mention the difference between amoebic vs bacillary dysentery.

Case 03
A 25 years old student presented with acute onset of severe upper abdominal pain with vomiting for last 2
hours. He had a h/o taking food at restaurant last night.
a) What are the differential diagnosis?
b) What are the causes of food poisoning?

Case 04
A 30 years old female admitted with complaints of high grade fever followed by drowsiness. He had h/o
recent travel to Bandarban.
a) What is the most likelydiagnosis?
b) How will you investigate him further?
c) Outline the treatment plan.

Case 05
A 55 years old male presented with fever for 2 months. On examination, there is splenomegaly.
a) What are the possibilities?
b) Outline the investigation plan.

Case 06
A 40 years old farmer presented with fever for 2 months. He also complained weight loss despite good
appetite. On examination, generalized hyperpigmentation and a lump over left upper quadrant.
a) What is the most likely diagnosis?
b) How will you investigate him?
c) How will you treat this case?

Case 07
A 42 years old day laborer presented with hypo pigmented anesthetic patch over left arm. On examination,
left ulnar nerve was thickened.
a) What is the most likely diagnosis?
b) What are the types of this disease?
c) How will you differentiate this?
d) Outline the treatment of plan.
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Case 08
A 35 years old male hailing from Mymensing presented with fever for 6 weeks. On examination, there was
moderate splenomegaly.
a) What is the most likely diagnosis?
b) How would you investigate him to confirm the diagnosis?
c) What are the 1st line drugs?
Case 09
A 35 years old truck driver with high grade continued fever and abdominal pain for 10 days. On
examination, there is mild splenomegaly.
a) What is the most likely diagnosis?
b) Outline the 1st line investigation.
c) Mention the drug of choice for this case.

Case 10
A 35 years old male recently returned from Rangamati, presented at emergency department with 2 days h/o
high grade fever with chill and rigor. Subsequently he develops seizure.
a) What is the most likely diagnosis?
b) Outline the 1st line investigation.
c) Mention the drug of choice for this case.

Case 11
A 25 years old male with known case of CSOM has been presented with high grade fever
with acute confusional state for 2 days. On examination, there are signs of meningeal irritation.
a) What is the most likely diagnosis?
b) Outline the plan of investigations.
c) Mention principal of treatment.

Case 12
A 20 years old male presented with high grade fever and severe generalized body ache for 2 days. On
examination, BP 100/70 mmHg and diffuse erythema.
a) What is the most likely diagnosis?
b) What are the stages of this case?
c) Outline the 1st line investigation.

Case 13
A 20 years old male with known case of dengue fever presented to you with her investigation report at her
critical phase.
a) How will you interpret CBC report?
b) How will you interpret serological report?
c) What are the features of plasma leakage?

Case 14
A 20 years old male presents with fever & rash for 7 days.
a) Mention common differential diagnosis with clinical features.
b) How will you investigate him?

Case 15
A 20 years old male presented with high grade fever for 3 days and suddenly became unconscious for the
last 2 hours. He has a h/o travelling to Chittagong 2 weeks back.
a) What is the most likely diagnosis?
b) Outline the investigations with expected findings.
c) How will you manage him immediately?
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Case 16
A 27 years old male has come to you with fever for last 13 days and loose motion for last 2 days. On
examination, there is mild splenomegaly.
a) What is the most likely diagnosis?
b) Outline the investigations with expected findings.
c) How will you treat the patient?

Q. What are the types of herpes virus?

Q. Mention the diseases caused by each type of herpes virus.
Q. Classify helminths
Q. What are the common helminths in Bangladesh?
Q. What are the helminths causes anemia?

Haematology
Case 01
A 38 years old women presented with generalized weakness with exertional dyspnea for 1
month. On examination, she is pale. Investigation shows -
 Hb%: 6.2 gm/dL.
 ESR: 70 mm in 1st hour
 MCV: 56 fL
 MCH: 18 pg
a) Mention the morphological types of anemia in this case.
b) Mention 4 underlying causes.
c) Outline 3 investigations with expected findings.

Case 02
A 40 years old woman is admitted with moderate anemia. On examination, she has koilonychia.
a) What is the most likely diagnosis?
b) Mention the clinical information that hints underlying causes.
c) What further investigation will you do?
d) Outline the principal of management.

Case 03
A 42 years old woman is admitted with shortness of breath and lethargy for 2 months. Her blood reports
shows -
 Hb%: 8.5 gm/dL
 ESR: 70 mm in 1 hour
 MCV: 56 fL
 PBF: Target cells
a) What is the most likely diagnosis?
b) What history would you like to take in this female patient?
c) Outline the plan of investigations.

Case 04
A 29 years old woman presented with weakness, palpitation and shortness of breath on exertion. Laboratory
investigation reveals -
 Hb: 8.5 mg/dL
 RBC, WBC and platelet counts are within normal limits
 PBF shows cells are hypochromic and microcytic
a) What is the morphological diagnosis?
b) Mention 4 causes.
c) Which one is the more likely diagnosis in this patient?
 15

d) What is the commonest cause of this disease?

Case 05
A 35 years old female presents with fatigue, pallor and mild jaundice. On examination, she has
splenomegaly. Laboratory investigations reveals -
 Hemoglobin level: 8.5 g/dL
 Elevated reticulocyte count
 PBF shows target cells. pencil cells and tear drop cells
a) What is the most likely diagnosis?
b) Explain the pathophysiology of this condition.
c) How will you confirm diagnosis?
d) Outline the principal of management for this patient.

Case 06
A 50 years old woman presented with weakness and anorexia for 3 months. Her laboratory investigations
reveal -
 Hb: 8%
 WBC: 6700/cmm
 Neutrophil: 65%
 Lymphocyte: 25%
 Platelet: 210,000/cmm
 Reticulocytes: 1%
 MCV: 112 fL (normal up to 96 fL)
 PBF shows macrocytosis and hypersegmented neutrophils
a) What is the morphological diagnosis?
b) What are the causes of macrocytosis?
c) What other investigations do you suggest?

Case 07
A 50 years old man presented with fever for 3 months. On examination, patient is mild to
moderate anemic and there is huge splenomegaly.
a) Mention 3 most important differential diagnosis.
b) Outline the plan of investigations.

Case 08
A 25 years old woman is admitted with purpuric spots in whole body for 15 days.
a) Mention 4 most important differential diagnosis
b) Mention the clinical information that hints underlying causes.
c) How will you proceed to investigate her?

Case 09
A 60 years old man presented with generalized lymphadenopathy involving both axillae and right
cervical region.
a) Mention 3 most important differential diagnosis
b) Outline the clinical information that hints underlying diagnosis
c) How will you investigate him?

Case 10
A 35 years old woman presented with the following blood report -
 Hb: 6 g/dL
 ESR: 100 mm in the 1st hour
 Platelet: 100×109/cmm
 WBC: 50×109/cmm, Neutrophil: 35%, Lymphocyte: 28%, Monocyte: 03%, Eosinophil: 05%
 16

 Atypical WBC: 29%

a) What are the abnormalities in this blood profile?
b) What is the likely diagnosis?
c) Mention 1 further investigation.

Case 11
A 45 years old man presented with weakness, loss of appetite and heaviness in the abdomen for
3 months. Laboratory investigation reveals -
 Hb: 9 g/dL
 Platelet: 210,000/cmm
 ESR: 90 mm in the 1st hour
 WBC: 150,000/cmm, Polymorph 45%, Lymphocyte 8%, Myocyte 22%, Metamyelocyte 14%,
Myoblast 3%, Basophil 8%
 PBF: Normocytic normochromic anemia
a) What are the abnormalities in this blood profile?
b) What is your diagnosis?
c) What is the cause of abdominal discomfort?
d) What investigation do you suggest?

Case 12
A 65 years old man presented with generalized body ache for the last 3 months. Laboratory
investigation reveals -
 Hb: 8 g/dL
 WBC: Normal
 Platelet: 200,000/cmm
 ESR: 115 mm in the 1st hour
 PBF: Normocytic normochromic anemia with increased rouleaux formation
 Serum creatinine: 1.8 mg/dL
 Blood calcium: 12 mg/dL
a) What is the likely diagnosis?
b) Write down 2 important investigations to confirm the diagnosis.
c) Write down 3 complications.

Case 13
A 7 years old male infant is brought to the emergency department with prolonged bleeding from the
circumcision site. The parents report that the bleeding has not stopped for over 24 hours despite appropriate
measures. There is h/o bleeding disorders on materanal side. On examination, the infant is pale and
tachycardia. Laboratory investigations -
 Prolonged activated partial thromboplastin time (aPTT)
 Normal prothrombin time (PT)
 Low factor VIII level
a) What is the most likely diagnosis and why?
b) Explain the pathophysiology of this condition.
c) What immediate steps would you take to manage this patient?
d) How would you counsel the parents regarding future precautions and management?

Case 14
A 40 years old man presented with a generalized weakness and gum bleeding for 1 months.
Investigation reveals -
 Hb: 7 g/dL
 ESR: 70 mm in the 1st hour
 WBC: 3,000/cmm, Neutrophil: 16%, Lymphocyte: 81%
 Platelet: 20,000/cmm
 17

a) What is the hematological diagnosis?

b) Mention 3 causes.
c) Mention 1 investigation to confirm the diagnosis?

Case 15
A 13 years old girl presented with pupura and several small bruises on her arms and legs 9 days
after recovering from a viral fever. Investigations reveal -
 Full blood cell count: Hb- 11.3 g/dL, WBC- 10,700/cmm, ESR- 60 mm in the 1s hour, Platelet
count- 20,000/cmm.
 Blood film: Normocytic and normochromic.
a) What is the likely diagnosis?
b) Suggest 2 diagnostically useful investigations.
c) What disease should be excluded in such a finding?
d) What treatment should be given?

Case 16
A 50 years old male presented with severe low back pain for 1 month. Investigation shows -
 Hb: 8 gm/dL
 WBC: 10000/cmm
 ESR: 110 mm in 1st hour
 PBF: Normocytic normochromic anaemia with marked rouleaux formation.
 S. Creatinine: 2.5 mg/dL
a) What is the most likely diagnosis?.
b) Outline relevant investigations with interpretation.
c) Outline the treatment of this case.

Case 17
Hb Electrophoresis report shows -
 Hb conc. in %: 10.0 gm/dL

Fraction % Ref. Values %

Hb A 0.7 96.1 - 98.5
Hb A2 3.1 2.2 - 4.0
Hb E 96.2 0
a) What is hematological diagnosis?

Case 18
Hb Electrophoresis report shows:
 Hb conc in %: 7.7 gm/dL

Fraction % Ref. Values %

Hb A 94 96.1 - 98.5
Hb A2 5.0 2.2 - 4.0
a) What is hematological diagnosis?

Case 19
Hb Electrophoresis report shows -
 Hb conc. in %: 11 gm/dL

Fraction % Ref. Values %

Hb A 5.2 96.1 - 98.5
Hb A2 3.3 2.2 - 4.0
Hb F 1.8 0.8 - 2.0
 18

Hb E 89.7 0
a) What is hematological diagnosis?

Case 20
Hb Electrophoresis report shows -
 Hb conc. in %: 9.6 gm/dl
 MCV: 65.3 fL
 MCH: 20.3 pg

Fraction % Ref. Values %

Hb A 94.0 96.2 - 97.8
Hb A2 4.97 2.0 - 3.5
Hb F 4.97 0.8 - 2.0
a) What is hematological diagnosis?
b) What is the type of inheritance?

Neurology
Case 01
A 25 years old man presented with fever for 3 weeks and disorientation for 3 days. Cerebrospinalfluid (CSF)
study shows -
 Color: Clear
 Pressure: High
 Cytology: Total WBCs 350/cmm, neutrophils 5%, lymphocytes 95%
 Biochemistry: Protein 70 mg/dL, sugar 50 mg/dL
 Microbiology: No organisms were found on the Gram stain
a) What is the likely diagnosis?
b) Mention other differential diagnoses.
c) Write down the important physical signs.

Case 02
A 19 years old man presented with a high grade fever for 2 days and disorientation for 4 hours.
Neck rigidity and Kernig sign were present. CSF examination shows -
 Colour: Turbid
 Pressure: Increased
 Biochemistry: Protein 190 mg/dL, sugar 16 mg/dL
 Cytology: Total cells 6200/cmm, polymorphs 96%, lymphocytes 4%
a) What is the likely diagnosis?
b) What are the causes of bacterial meningitis?
c) What is the commonest organism?
d) What are the complications?

Case 03
A 20 years old man presented with high grade fever, convulsion and disorientation for 3 days. On
examination, sign of meningeal irritation positive.
a) What is the likely diagnosis?
b) Outline the 1st line investigation.
c) How will you manage this case?

Case 04
A 45 years old man presented with a sudden, severe occipital headache followed by unconsciousness. Neck
rigidity and Kernig sign were present.
a) What is the likely diagnosis?
 19

b) Mention 2 causes?
c) How will you confirm the diagnosis?

Case 05
A 55 years old man presented with band like headache after waking from bed for 3 months
a) What is the likely diagnosis?
b) What are the different types of headache?

Case 06
A 66 years old man presented with sudden onset of right sided hemiparesis for 2 hours.
a) What is the likely diagnosis?
b) Enumerate the risk factors of underlying diagnosis.
c) Outline the 1st line investigation.
d) How will you differentiate ischemic stroke from hemorrhagic stroke?

Case 07
A 60 years old diabetic uncontrolled hypertensive male presented with sudden onset of right sided
hemiplegia. Headache and vomiting for 6 hours
a) What is the likely diagnosis?
b) What further clinical information you want to look for?
c) Mention most important investigations.
d) Outline the management.

Case 08
A 20 years old man with progressive weakness of both lower limbs followed by upper limbs for 3 days. On
examination, muscle power of lower limb is 3/5 and upper limb normal. All jerks are diminished and plantar
is absent.
a) What is the likely diagnosis?
b) Outline the 1st line investigation.

Case 09
A 50 years old man with weakness of both lower limbs. On examination, reflex are exaggerated, plantar are
extensor in lower limbs. But upper limbs are normal.
a) What is the type of weakness?
b) Where is the site of lesion?
c) Enumerate the underlying causes.

Case 10
A 25 years old man presented with weakness of both lower limbs for 2 days.
a) Mention four differential diagnosis.
b) Outline the clinical features that hinted underlying diagnosis.
Case 11
A 35 years old man with fascial deviation to right side but can not close his left eye for 10 hours.
a) What is the likely diagnosis?
b) How will you differentiate UMN fascial palsy from LMN fascial palsy?
c) What is the commonest cause of LMN type fascial palsy?

Case 12
A 45 years old man presented with unilateral complete ptosis.
a) What is the likely diagnosis?
b) Enumerate other features that indicate 3rd cranial nerve palsy.
 20

Case 13
A 10 years old boy presented with difficulty in standing from sitting.
a) What is the likely diagnosis?
b) What is the type of inheritance of underlying diagnosis?
c) Outline 1st line investigation

Case 14
A 68 years old man presents to the clinic with a 6 months history of tremors of both hands, which occur at
rest and improve with movement. He also reports difficulty in getting up from a chair or starting to walk.
His wife mentions that he has been moving more slowly and has developed a stooped posture. On
examination, you notice expressionless face.
a) What is the most likely diagnosis?
b) Mention 3 cardinal motor features of this condition.
c) What is the 1st line pharmacological treatment for this condition.
d) Mention some neurodegenerative diseases.

Case 15
A 25 years old male has been presented with experiencing a sudden loss of consciousness, stiffening of the
body and jerky movements of all limbs lasting for about 2 minutes. His family reports that he was confused
and drowsy after regaining from consciousness. He has had similar episodes in the past but has not been on
regular treatment.
a) What is the most likely diagnosis?
b) Mention further investigations plan.
c) Outline the immediate management.
Case 16
A 55 years old male hypertensive patient presented with sudden weakness of one side of the body. On
examination, reflex exaggerated on the right upper and lower limb, planter extensor on right side.
a) What is the most likely diagnosis?
b) How will you investigate and treat this patient?

Case 17
A 70 years old woman with long standing hypertension presents with sudden onset left sided hemiparesis.
On examination, her pulse is irregularly irregular, and BP is 160/90 mmHg.
a) What is your diagnosis?
b) Tell me some cause of this condition.
c) How will you investigate of this case?
d) What will be the management?
e) What are the complications?

Case 18
A 42 year old male presented with sudden severe headache with vomiting for 4
hours. On examination, there is meningeal irritation.
a) What is the most likely diagnosis?
b) What immediate investigations you will do?
c) How you will manage the case?

Case 19
A 20 years old male came to you with sudden onset weakness of both lower limbs for 5 hours. On
examination, jerks and plantar response were absent. There was no sensory impairment or bowel-bladder
involvement.
a) What are the possibilities?
b) What is the first investigation in this patient?
c) What other investigations will you have to perform if the initial investigation is normal?
 21

Psychiatry
Case 01
A 26 years old male is brought to the psychiatry outpatient department by his family. They report that over
the past 6 months, he has been talking to himself, laughing without reason and expressing paranoid beliefs
that people are watching him. He neglects his hygiene and often appears emotionally unresponsive. He
claims that he hears voices talking about him even when no one is around.
a) Identify the most likely diagnosis for this patient.
b) List any 2 positive and 2 negative symptoms observed in this patient.
c) Mention criteria diagnosis.
d) Outline principle of treatment for this condition.

Case 02
A 30 years old female is brought to the psychiatry clinic by her family. They report that for the past 2 weeks,
she has been excessively talkative, sleeping only for 3 hours per night and displaying an unusually high level
of energy. She has been spending large amounts of money impulsively and claims to have special abilities to
controlling other events. This episode follows a previous H/O 2 months of low mood, loss of interest in daily
activities, and suicidal thoughts.
a) What is the most likely diagnosis for this patient?
b) Identify 2 symptoms from the case that indicate a manic episode.
c) List 2 pharmacological treatments for the acute manic phase of this disorder.
d) Name 1 long term mood stabilizer used for maintenance therapy.

Case 03
A 28 years old male presents to the emergency department with sudden onset of intense fear and
discomfort, lasting about 15minutes. He reports experiencing palpitations, sweating, shortness of breath,
chest tightness, dizziness and a fear of dying. He mentions that he has had similar episodes multiple times in
the past months, often occurring unexpectedLy. He has started avoiding public places, fearing another
attack.
a) What is the most likely diagnosis?
b) List 3 key symptoms experienced by this patient during an attack.
c) Mention 1 important differential diagnosis that should be ruled out in such cases.
d) Name one 1st line pharmacological treatment for this condition.

Case 04
A 35 years old female presents to the psychiatry outpatient clinic with complaints of persistent sadness, lack
of interest in daily activities, and fatigue for the past 6 weeks. She reports difficulty sleeping, a significant
loss of appetite, and feelings of worthlessness. She also mentions having frequent thoughts of self harm but
has not attempted suicide. Her symptoms have negatively impacted her work and social life.
a) What is the most likely diagnosis for this patient?
b) List any 4 core symptoms required for the diagnosis of this disorder.
c) Name one 1st line pharmacological treatment for this condition.
d) Suggest 1 non pharmacological therapy that can be beneficial for this patient.

Case 05
A 29 years old female presents to the psychiatry outpatient clinic with complaints of recurrent distressing
thoughts about contamination. He washes his hands excessively, spending hours each day scrubbing them,
even though he knows it is irrational. His compulsive behavior is interfering with his work and social life,
causing significant distress. Despite multiple attempts to stop, he feels an intense urge to continue these
rituals to relieve her anxiety.
a) What is the most likely diagnosis for this patient?
b) List any 4 core symptoms required for the diagnosis of this disorder.
c) Outline principle of treatment for this condition.
 22

Case 06
A 35 years old female presents to the psychiatry clinic with complaints of recurrent nightmares, flashbacks
and severe anxiety for the past 3 months. She reports being involved in a major car accident, after which she
has developed intense fear, avoids driving and feels emotionally numb. She also experiences difficulty
sleeping and is easily startled by loud noises.
a) What is the most likely diagnosis?
b) List 2 core symptom clusters required for the diagnosis .
c) Name 1st line pharmacological treatment for this condition.
d) Suggest 1 psychotherapy technique that is effective for management.

Case 07
A 36 years old lady presented with the complaints of low mood, irritability, lack of enjoyment, insomnia,
guilty feelings and suicidal ideation for the last 3 months.
a) What is the most likely diagnosis?
b) How will you manage this patient?
c) Mention 5 risk factors of suicide.

Q. How will you differentiate psychosis from neurosis?

Q. Define hallucination, delusion, illusion.
Q. Mention 4 antipsychotic drugs and antidepresent drugs.
Q. Mention common adverse effects of each class of drug.

Poisoning
Case 01
A 35 years old unconscious male is brought to the emergency department by his family. They found an
empty bottle of Benzodiazepines (diazepam) near him. Vital signs: BP 90/60 mmHg, HR 52 bpm, RR 8/min,
SpO₂ 88% on room air, GCS 6/15.
a) Mention 3 immediate life threatening complications of sedative poisoning.
b) Outline your 1st 3 steps in managing this patient.

Case 02
A 20 years old village girl has been presented diarrhoea with vomiting and disorientation for 4 hours. She
had H/O of unknown poisoning. On examination, profuse sweating, pulse is 50 bpm, pupil is pin point.
a) What is the most likely diagnosis?
b) Mention other physical findings.
c) Outline the principal of management.

Case 03
A 30 years old male presents to the emergency department with severe oral pain and difficulty swallowing
after accidentally ingesting a cleaning agent.
a) What is the most likely diagnosis?
b) Outline the principal of management.

Case 04
A 28 years old woman is brought to the emergency department by her roommate. She is drowsy and found
with an empty pill bottle labeled "Amitriptyline".
a) Mention the signs which consistent with amitriptyline poisoning.
b) Mention 3 urgent investigations.
c) Outline the principal of management.
 23

Case 05
A 22 years old male is brought to the emergency department with agitation, confusion, and chest pain. His
friends mentioned that he took a "Party drug" at a club.
a) Mention the signs which consistent with amphetamine overdose.
b) Mention 3 urgent investigations.
c) Outline the principal of management.

Dermatology
Case 01
A 27 years old male presents to the dermatology clinic with complaints of intensely itchy, raised, red
wheals on his arms and torso. He reports that the lesions appear suddenly and fade within a few hours, only
to reappear at different sites. He recalls eating seafood the night before the this episode. There is no H/O
similar skin rashes in the past.
a) What is the most likely diagnosis for this patient?
b) Describe 2 characteristic features of the skin lesions in this condition.
c) Mention 2 common triggers for this condition.
d) Outline the principle of treatment.

Case 02
A 45 years old male presents to the dermatology outpatient clinic with complaints of generalized itching for
the past 1 month. He reports no visible skin rashes. But mentions that the itching worsens at night. He has a
H/O chronic kidney disease and is on regular dialysis. There is no H/O allergies, new medications or insect
bites.
a) What is the most likely diagnosis for this patient’s generalized itching?
b) List 4 possible systemic causes of generalized pruritus.

Case 03
A 20 years old male presents with intensely pruritic, dry and scaly lesions on his hands and behind the
knees. The lesions worsen in winter and improve in summer.
a) What is the most likely diagnosis?
b) List three hallmark features of eczema.
c) Mention two complications of chronic eczema.
d) Outline principle of treatment.

Case 04
A 25 years old male presents with pruritic papules in the interdigital spaces, wrists and genital region. The
itching worsens at night.
a) What is the most likely diagnosis?
b) List three common sites of involvement of this disease.
c) Outline the treatment of this patient.
d) Mention two complication if this disease is untreated.

Case 05
A 25 years old male presents with an itchy, circular rash with central clearing on his groin. That has been
slowly expanding over the past 2 weeks.
a) What is the most likely diagnosis?
b) Mention other common clinical presentations of this disease according to sites.
c) Outline principle of treatment.
Case 06
A 28 years old woman presented with multiple circular dry, scaly patch specially near the waist line. She is
obese and diabetic. On examination, there is an active border with central clearing.
 24

a) What is your probable diagnosis?

b) How will you diagnosis this case?
c) How will treat such case?
d) Mention the local and systemic causes of itching.

Case 07
A young adolescent male presents with dystrophic nails, with yellowish debris on the under surface of the
nails and elevated distal end of nail plate. On examination, he has silvery scaly lesions on both knees.
a) What is the likely diagnosis?
b) Name 1 important differential diagnosis?
c) How to confirm the diagnosis?
d) How will you treat the likely diagnosis?

Genetic Disorders
Case 01
A 20 years old male presents with multiple café-au-lait spots, axillary freckling and two neurofibromas. His
mother has similar skin findings.
a) What is the most likely diagnosis?
b) What is the inheritance pattern?
c) What is the percentage of an offspring to be affected from the parents?

Case 02
A 35 years old male presents with progressive muscle weakness, cognitive decline and involuntary
movements. His father had similar symptoms and died at age 50. Genetic testing reveals a trinucleotide
repeat expansion in the HTT gene.
a) What is the most likely diagnosis?
b) What is the inheritance pattern?

Case 03
A 25 years old male presents with tall stature, long limbs, lens dislocation and aortic regurgitation.
a) What is the most likely diagnosis?
b) What is the inheritance pattern?

Case 04
A 5 years old boy presents with frequent falls, difficulty standing from a sitting position and calf muscle
hypertrophy. His maternal uncle had similar symptoms and died at age 20.
a) What is the most likely diagnosis?
b) How is this disorder inherited?

Case 05
A 25 years old male presents with mild anemia detected on routine blood test. Her father had similar
findings but was never diagnosed with any severe anemia. Blood test results -
 Hb: 9.5 g/dL
 MCV: 65 fL
 MCH: 21 pg
 Serum ferritin: 120 ng/mL (Normal)
 Hb Electrophoresis: HbA2 - 5.2%
a) What is the most likely diagnosis?
b) What type of inheritance is seen in this disorder?
c) Why is it important to test the patient's partner for this condition?
 25

Case 06
A young boy presents with prolonged bleeding after minor injuries. His factor VIII levels are very low, but
platelet count and PT (prothrombin time) are normal.
a) What is the most likely diagnosis?
b) How is this disorder inherited?
c) How can this condition be differentiated from iron deficiency anemia?

STD
Case 01
A 25 years old male presented with genital ulcer.
a) What are the differential diagnosis?
b) Mention the clinical features that hints underlying etiology.

Case 02
A 25 years old male presented with urethral discharge.
a) What are the differential diagnosis?
b) What are the presentations of STD.

Case 03
A 30 years old male garments worker presented with purulent urethral discharge for 2 weeks
a) What is the most likely diagnosis?
b) How will you investigate and manage this case?
c) Mention the complications of both sexes in this case.