Quick Assessment of Data Interpretation Skills

(QADIS) with KeyInstructions:Please read the scenario and data carefully and answers the questions given below each data.Time allocated for each patient is 2 minutes

Patient No 1 A 63 year-old male presented with history of haemoptysis and

cough for the last 02 years. He is a chain smoker (20 cigarettes / day). His biochemical profile is like this:

• Ca: 3.20 mmol/L (2.10 – 2.55)• Phosphates: 0.7 mmol/L (0.81-1.45)• Urea: 8.2 mmol/L (3.3 – 6.6)• Creatinine: 102 mol/L (78 – 115)• Plasma PTH: < 2 pmol/L

a. What is the most probable diagnosis in this patient?b. Name ONE hormone which is leading to HYPERCALCAEMIA

a. Humoral hypercalcaemia of malignancy due to Lung Malignancy

b. PTH-related peptide

Patient No 2A 62 year-old-male patient having following arterial blood gas analyses

results:• pH : 7.40 (7.35 – 7.45)• Base Excess: 21.8 (<+3 - >-3)• PCO2 : 10.7 (4.7 – 6.0 kPa)• PO2 10.9 (10.7 – 13.3 kPa)• HCO3 51.1 (23 – 33 mmol/L)• Oxygen Sat 95.1 (95-98%)

a. Name the ACID BASE Abnormality in this patient?b. Name TWO clinical conditions which can lead to this HCO3 result

a. Double opposing disorder i.e. Metabolic Alkalosis and Respiratory acidosis

b. Upper GI Vomiting and diuretics

Patient No 3 A 33 year old male had a fasting lipid profile as a part of his regular

screening. His past medical history is not significant. Presently he is not on any medications. His lipid profile is as under:

• Triglycerides: 1.13 mmol/L (<1.87)• Cholesterol : 4.45 mmol/L(<5.1)• HDL Cholesterol: 0.73 mmol/L(>1.0)• LDL Cholesterol: 3.53 mmol/L(<3.62)

• Which lipoprotein is abnormal in this patient?• Name TWO complications (other than atherosclerosis) which can be

caused due to this biochemical abnormality

a. Low HDL-Cholesterolb. Malignancy, poor response to infection and complications in

diabetes mellitus

Patient No 4

A 32 y male has a unilateral swelling of his left testis and symptoms of hyperthyroidism. His thyroid profile was as following:

• Serum Free T3 4.12 ng/ml (1.60-4.20)

• Serum T4 2.18 pg/ml (0.70-1.68)

• Serum TSH 0.14 mIU/L (0.30-4.0)

a.The most probable testicular tumour you would like to excludeb.Would you like give anti-thyroid medicines to this patient?

a. Embryonal carcinomab. No

Patient No 5 A newborn with neurological deterioration with moderate

hepatocellular disturbance, hypotonia, seizures and coma. His biochemical findings are:• Alkalosis: +• Ketones : +• NH3: ++++• Lactate: Normal• Glucose: Normal

a. What is the most probable diagnosis in this patient? b. Name the amino acid metabolism most likely affected in this

baby?

a. Urea cycle defectb. Ornithine

Patient No 6

A patient presented with vague complaints. He had no tremors or weight loss. His pulse was 82 /minute:

• Free T4 : 72 pmol/L (6-21)

• Total T3 : 9.2 nmol/L (1.1-2.7)

• TSH: >75 mIU/La. What is the most probable diagnosis in this patient?

b. Name the pathogenic mechanism causing this disease

a. Thyroid resistance syndromeb. It is defect of thyroid hormone receptor which are present in

the peripheral tissues and in pituitary.

Patient No 7 A 2 years boy presented with abdominal pain, vomiting; neuropathic pain and

neuropathy. His urine tests showed following results: • Total Porphyrin 64.0 nmol/mmol creat (0 - 35 ) • Porphobilinogen 20.2 µmol/mmol creat (0 - 1.5 ) • Delta-Aminolaevulinic Acid 7.2 µmol /mmol creat (0 - 3.8 ) • Creatinine 3.9 mmol/L • Plasma fluorescence peak at 620 nm

a. What is the most probable diagnosis in this patient? b. Name the enzyme which is deficient in this patient?a. Acute intermittent porphyria

b. Porphobilinogen deaminase

Patient No 8 A female aged 65 years, presented in semi-conscious statePlasma• Na : 153 mmol/L (135–150) • K : 4.5 mmol/L (3.5 – 5.0)• Cl : 118 mmol/L (98-108)• HCO3 : 34 mmol/L (23 – 33)• Urea : 15.2 mmol/L (3.3 – 6.6)• Osmolality: 393 mmol/Kg (275 – 295) • Glucose (R) : 43 mmol/L (3.5 – 11.1)Urine:• Ketones: Trace

a. What is the most probable diagnosis in this patient? b. Name the most important treatment to be started immediately in this patient?

a. Non-ketotic hyperosmolar diabetic comeb. Rehydration

Patient No 9 A 57 y old female admitted for cough and fever of about 4 months duration.

Her radiological investigations show evidence of extensive granalumatous involvement of lungs and liver. Treating physician has confidently excluded tuberculosis in this patient. Following are her lab investigations

• Ca : 3.44 mmol/L (2.15–2.55) • PO4 : 0.96 mmol/L (0.60 – 1.25)• Albumin : 40 g/L (37-52)

a. What is the most probable diagnosis in this patient? b. Name ONE biochemical investigation which can be very helpful in

confirmation of the diagnosis.

a. Sarcoidosisb. Serum ACE levels

Patient No 10 A 36 years female who is mother of two children has a body mass index (BMI) of 31. She has facial hirsutism and amenorrhoea for the last 2 months. Her routine biochemical profile showsPlasma•Glucose (F) : 6.9 mmol/L (3.3-5.6) • ALT : 21 U/L (< 42)• ALP : 186 U/L (< 306)•Triglycerides : 4.8 mmol/L (<2.83)•HDL-C : 0.7 mmol/L (>1.0)•HbsAg: Negative•Anti-HCV : Negative

a. Name ONE HORMONE test you will advise in this patient as a first line test.

b. Write TWO possible causes of hirsutism in this patient.

a. Urine pregnancy testb. PCOS and Cushing Syndrome (CAH is unlikely at this age)

Thank You