A 45 years old male patient came to the OPD with H/O weakness,

increased thirst and appetite, frequent micturition.

Fasting plasma glucose = 140 mg/dL

Postprandial plasma glucose = 250 mg/dL
HbA1C = 6.7%

Urine: sugar - positive, ketones - negative.

QUESTONS:
1. What is your probable diagnosis?
2. Write the normal fasting & postprandial plasma glucose levels.
3. What is the normal renal threshold for glucose?
4. Name the qualitative test for urine sugar.
 Following are the biochemical data of two patients.

Investigation Patient – I Patient – II

Blood Sugar 350 mg /dl 45 mg /dl
Urine Sugar ++ Nil
Rotheras test ++ ++

What is the diagnosis in patient I & II based upon above

findings?
 22 year old male was admitted in the coronary care unit with
C/O chest pain was diagnosed as case of acute myocardial infarction
by ECG and Enzyme Studies.

Family H/O coronary artery disease & stroke ++

Xanthoma – Palmar crease +

Biochemical Findings

Serum Total cholesterol - 380 mg / dl

VLDL - 80 mg / dl

HDL - 20 mg / dl

LDL - 280 mg / dl

TGL - 400 mg / dl

Discuss the above case correlating with laboratory findings.

 A 45 year old man was admitted in hospital with acute chest
pain of 8 hours.

His blood investigations shows:-

Trop T - Positive

Questions:

What is your probable diagnosis?

What is the most sensitive & specific marker?

A 3 week old female infant was brought to the pediatric OPD with the
h/o severe vomiting 3 days after birth , usually within 30 min after
breastfeeding . her mother noted that her abdomen became
distended at these times, and she was slightly jaundiced. Her liver was
enlarged , and the possibility of cataract formation was also
questioned.

Biochemical Investigations:-

Fasting Blood Glucose - 45mg / dl

Urine for reducing sugar - Positive

Urine strip test for glucose - negative

What is the probable diagnosis?

An 18-yaer-old girl presented to her physician for a precollege
physical examination. While taking her medical history, the doctor
learned that she carefully avoided eating all fruits and any foods that
contained table sugar. She related that food a very early age, she had
learned that these foods caused severe weakness, tremulousness and
sweating. Her mother described her as having been a very irritable
baby who often cried incessantly especially after meals and vomited
frequently .At these times her abdomen had become distended and
she become drowsy and apathetic. Her mother had intuitively
eliminated certain foods from her diet, after which the severity and
frequency of these symptoms diminished.

Laboratory investigations:

Urine reducing sugar: positive

Urine strip test for glucose: Negative

What is your diagnosis?

One year old boy was brought to the hospital with C/O delayed mile
stones with mental retardation. Patient had few episodes of seizures
in the past.

O/E : hypopigmented patches present all over the body.

Biochemical Investigation revealed that the serum phenyl

alanine was abnormally high. Phenyl acetate, phenyl pyruvate &
phenyl lactate were presenting high levels in Urine.

What is the probable diagnosis?

 A 36 year old female was brought to the hospital for the C/O low
back pain with greenish blue pigmentation in both the palms & pinnae
of ears.

Investigations:-

X – ray Spines – Lesions at L1 inter vertebral disc

Urinary Findings:-

 Darkening or Urine on standing

 Ferric Chloride test – Dark brown ppt.
 Ammoniacal Silver Nitrate test - +

Discuss the case.

A 68 years old male patient came to the OPD with C/0 breathlessness.
He is a known case of T2DM for the past 10 years. He is oral anti-
diabetic drugs.

Random plasma glucose=542 mg/dL

Urine: sugar+++, ketones-positive, albumin-trace

O/E: Breath-fruity odour present

ABG: pH=7.30, pCO2=40mmHg,HCO3-=17meq/L

Anion gap=20meq/L

What is the diagnosis of this patient based on the above findings?

A 28 years old female patient came to the OPD with C/0 severe
diarrhea for past 2 days.

O/E: Dehydration present

ABG: pH=7.31, pCO2=36mmHg, HCO3-=16meq/L

Anion gap=14meq/L, Cl-=128meq/L

What is the diagnosis of this patient based on the above findings?

A 50 year old man was admitted to hospital with a c/o persistent
vomiting. On examination , he was found dehydrated and his
respiration was shallow. He gave a past h/o dyspepsia. The result of
the lab investigations are as follows :

Parameter obtained value

Blood pH 7.58

Plasma Hco3- 45 mmol/L

P CO2 60 mm Hg

Na+ 140 mEq/L

K+ 2.5 mEql/L

How can the interpretation of the above laboratory data aid you in
your diagnosis?
A young man was brought to the casualty ward after he had met with
a road traffic accident that causes injury to his chest wall. The result of
the laboratory investigations were as fallows.

Parameter Obtained value

Blood pH 7.2

Plasma Hco3- 26 mmol/L

p CO2 60 mm Hg

Interpret the laboratory data and diagnosis.

A medical student volunteered a sample of arterial blood for a
hematology experiment in the physiology lab. The tutor took some
time to explain the procedure to the class, during this time the
student became increasingly anxious and started complaining of a
tingling feeling and numbness in his fingers and toes while the blood
was being drawn. The result of the investigation of the arterial blood
is as follows.

Parameter Obtained value

Blood pH 7.5

Plasma Hco3- 24 mmol/L

p CO2 25 mm Hg

What is your comment?

A 5 yr old boy was brought to the pediatric OPD with deformities of
bones like bow legs and knock knee. His mother reported that he
started walking during his 2 nd year of life.
O/E
Stunted growth +
Malnourished, Pigeon chest, Beading of ribs
Investigations:-
Serum Calcium - 8.2 mg /dl
Phosphate - 2.8 mg / dl
Alkaline Phosphatase - 720 U/L
What is the probable diagnosis?
A 30 year old female had neck swelling which moves with deglutition,
intolerance to cold, hoarseness of voice, dry scaly skin with lethargy.

Following are the Biochemical parameters of the above said patient:-

Serum FT4 - 0.3 ng / dl

Serum FT3 - 0.6 pg / ml

Serum TSH - 13 IU / ml

Discuss the diagnosis

23 year old female is brought to hospital with neck swelling which
moves with deglutition, loss of appetite, loss of weight, palpitation,
intolerance to heat, diarrhea, fine tremors and exophthalmos.

Investigations:-

Serum T4 - 13 g / dl

Serum T3 - 300 ng / dl

Serum TSH - 0.1  IU / ml

What is probable diagnosis?

 A 56 – year old woman underwent sub-total thyroidectomy, in
the immediate postoperative period she developed muscle cramps,
tingling of hands and feet, stiffness, recurrent carpopedal spasm.

0/E : Trousseau’s sign +

Chvostek’s sign +

Investigations:-

Serum Calcium - 6.4 mg /dl

Phosphate - 7.0 mg / dl

Albumin - 4.4 g/dl

Alkaline Phosphatase - 76 U/L

What is the probable diagnosis?

A 30 years old woman presented at clinical with history of
intermittent abdominal pain and episodes of confusion and
psychiatric problems. Lab test revealed increase of urinary
porphobilinogen (PBG) and aminolevulinate (ALA).

1. what is your probable diagnosis?

2. What is the cause for abdominal pain and psychiatric symptoms?

3. Name some other disorders in the same pathway

A 50-year –old male business executive was admitted to hospital at
midnight with a complaint of excruciating pain in his right first
metatarsophalangeal joint and inability to keep his foot on the floor.
On examination, the joint was found to be swollen, red and extremely
tender. The doctor on duty treated him with an anti-inflammatory
drug (indomethacin) and that gave some relief. The patient also gave
a history of a previous attack of renal colic an year earlier, which had
not been investigated then. Regular business dinners and alcohol
consumption was part of his lifestyle. What is your probable diagnosis
and how would you manage this case?
 A middle age male with H/O alcoholism is admitted in the
hospital with severe abdominal pain of acute onset.

Investigations:-

Serum Amylase - 1400 U/ L

Serum lipase - 400 U/L

Serum Calcium - 8.8 mg / dl

What is your probable diagnosis based upon the above finding?

A new born baby born to a 22 year old female is icteric from day1
after birth.

Investigations:-

Total Bilirubin - 15mg/dl

Indirect Bilirubin - 14mg/dl

Direct bilirubin - 1mg/dl

Liver enzymes - ALT, AST, ALP (Normal)

RBC Count - Decreased

Direct Coomb’s Test - +

Blood Group Rh Typing

Mother A1 Negative
Infant A1 Positive

What is your probable Diagnosis?

Mention the normal range of total ,direct and indirect bilirubin.

What is vandenberg reaction?

The following LFT values are those of a 35 – year old man who is a
known alcoholic for the past 3 years came with a history of fever,
malaise, anorexia and upper abdominal pain. O/E he was jaundiced
with tenderness over right hypochondrium . His urine was noticed to
be high colored.

Investigations:-

Plasma Bilirubin Total - 7.4 mg /dl

Direct Bilirubin - 6.4 mg/dl

ALP - 200 U/L

ALT - 2090 U/L

AST - 1788 U/L

Total Proteins - 7.1 g/dl

Albumin - 4.2 g/dl

Urine Bile pigments & Bile salts - Positive

Urine Urobilinogen - decreased

What is the patient suffering from?

Mention the normal range of AST, ALT & ALP.

 A 40 year old woman presented with yellowish discolouration of
the sclera. She had been well in the past but had suffered from
increasingly intense pruritus during the previous 18 months. She had
h/o passing high colored urine and clay colored stools.

Investigations:-

Serum Bilirubin Total - 20mg/dl

Direct Bilirubin - 17 mg/ dl

AST - 98 U / L

ALT - 106 U/L

ALP - 522 U/ L

Total Protein - 8.5 g/dl

Albumin - 2.8 g / dl

Urine Bile Pigments - +

Bile Salt - +

Urobilinogen - -

What is the woman suffering from?

Name the qualitative test for urine bilirubin?

Name the qualitative test for urobilinogen?

Name the qualitative test for bile salts.

A 45 year old woman who had a H/O of hypertension for more than
15 years came to the hospital with anemia, weight loss, apathy and
muscle weakness. Two weeks prior to admission she had increasing
lethargy, vomiting, and diarrhoea and presented in semi-coma.

Investigations:-

Plasma urea - 330mg/dl

Creatinine - 14.0 mg/ dl

Sodium - 133mmol / L

potassium - 5.5mmol/L

Chloride - 99mmol/ L

Bicarbonate - 15mmol/L

Calcium - 7.8mg / dl

Inorganic phosphate - 6.2mg/dl

What is the person suffering from?

A 10 year old boy was brought to the hospital with Anasarca.

Biochemical Investigations as follows:-

Urine Albumin - +++

Epithelial casts - +++

Blood Parameters:-

Serum Total Protein - 4.0 gm /dl

Serum Albumin - 1.8 gm / dl

Serum Globulin - 2.2 gm /dl

A/G Ratio - Reversed

Serum Total Cholesterol - 500mg /dl

Blood Urea - 40 mg /dl

Serum Creatinine - 1 mg/dl

Discuss the diagnosis

A 10 year old female with H/O puffiness of face, scanty micturition,
passing smoky urine reported to OPD

H/O Antecedant skin infection +

O/E

BP - 160 / 110 MM Hg

Dependant pitting oedema +

Biochemical Investigations:-

Urine Benzidine Test - +

Urine Protein - ++

Blood Parameters:-

Blood Urea - 90 mg /dl

Serum Creatinine - 2.5 mg /dl

Serum Total Cholesterol - 200mg /dl

Serum Total Protein - 5.5 gm/dl

Serum Albumin - 3.2 gm/dl

What is your diagnosis?

A 15-year-old boy was brought to the emergency department in a

comatose state with cyanosis. He was found at home with reduced

consciousness at about 6:30 am. According to his parents’ statement, he

had slept in his room, which is next to the room containing the home

water heater. His father had taken a bath at 11:00 pm. Investigations

revealed PaO2 of 40.9 mmHg and SaO2 of 72%. His spontaneous

breathing was shallow and weak. Blood drawn for investigations had a

cherry red colour.

What is the probable diagnosis?

A 30 year old male diagnosed with right lower lobe pneumonia due to
a gram –negative bacillus was started on a course of the antibiotic
combination of trimethoprim and sulfamethoxazole ( TMP/Sulfa). On
the third day of therapy the patient became jaundiced and his urine
became red brown in color.

Lab investigations:

Total bilirubin : 4.3 mg/dl

Indirect bilirubin : 4.0 mg/dl

Hemoglobin : 11.8 g/dl

Reticulocytes : 8%

Serum glucose -6- phosphate dehydrogenase : 0.278 U/g Hb

(ref range: 4.6 -13.5 U/g Hb)

What is your probable diagnosis?