KOLKATA BCC COLLECTION

1.30yr old gentleman with uncontrolled hypertension.

Uncontrollable BP for 1 year with enalapril, atenolol, water pills. Wt -60kg. No hyperthyroid
symptoms. No renal/CVS/CNS symptoms. Smoked previously for 10yrs. Drink alcohol. Mother
has hypertension.
No AF, murmur. Unequal pulse +. No renal bruit.
Dx… Takayasu's arteritis.

2. 28 yes old lady, regular attender in asthma clinic. Today presented with acute
breathlessness.
Salbutamol inhaler for asthma. Pain in lt calf. Travel to Switzerland 12 hrs flight last week. OC
pills +. DVT + in mother. No history of miscarriage.
Physical examination normal.
Dx.. PE
Ex: dx. Invx. Which blood test will you do in suspected PE? Can you exclude PE if Doppler is
negative.

3.60yr old gentleman had dyspnoea for five months. He had back pain for 3 years.
Ankylosing spondylitis patient taking celecoxib and ibuprofen comes with SOB for 5 months.
Smoking +.
AS features +. Chest wall expansion reduced. Ht and lungs normal.
Concern: what's wrong? Come back to normal?
Dx: chest wall deformity and reduction in chest wall expansion in AS patient
Ex: findings in lungs and heart? Causes of SOB in AS patient? Invx? Mgt?

4. Know RA patient comes with SOB.

RA hand deformity +. Lungs basal crepts +.
Dx: pulmonary fibrosis

5. 23 yrs old lady with weakness of rt side of body.

Weakness of rt side of body and slurred speech comes suddenly while having breakfast. 30
mins last. Blurred vision +. Facial weakness +. Claudication pain + when using arm repeatedly.
BP 140/90 rt arm, 130/80 Lt arm. Taking amlodipine for hypertension.
Dx: Takayasu arteritis.

6. 40 yrs old gentleman comes with sudden weakness of rt half of body.

Transient weakness of rt side of body, cardiac operation done 5 yrs ago for coronary
angioplasty. Very slow AF+.
Dx: TIA.

7. DM patient presenting with Loss of vision and Rt sided weakness.

8. 70yrs old man with Ht problem presenting with weakness of lt side of body with slurred
speech and completely recover at 10 mins. AF+. MDM+.

9. 26 yrs old lady with painful legs.

Wt gain +. Missed period for 2-3 months.
Concern: serious? Curable?
Dx: Meralgia paresthetica

10. 50 yrs old gentleman comes to you with episodic diarrhoea.

Flushing +. Wheezing +. Diarrhoea +.
Dx: Carcinoid syndrome.

11. Know DM patient presenting with weight loss.

Dx: Thyrotoxicosis.

12. Known asthma patient presenting with palpitation.

Rt eye exophthalmos ? Thyrotoxicosis.

13. 57 yrs old lady referred from DM clinic for difficult control of blood sugar level.
Topical steroid use for skin infection. Herbal medicine for 4 months.
Concern: why sugar level difficult to control.
Dx: Cushing syndrome.

14. 54 yrs old gentleman who is a regular attender in diabetes clinic for 20 yrs. He was referred
for tingling sensation of both hands.
Dx: carpal tunnel syndrome with goiter.

15. 38 yrs old lady complaint of painful hands.

Dx: Peripheral neuropathy

16. ℅ Hand Pain

Dx: RA

17. 60 yrs old lady in surgical ward admitted for hemorrhoids now complaining of joint pain of
forehands and back pain.
Deforming polyarthropathy with back pain
No skin rash. Fever present for months.
Concern: infection? Disease activity?

18. Outside. 35 years old female vision problem and headache

Inside. Bumping into Rt side.
No blurring. No double vision
Headache. Generalized. No photpphobia.no lacrimation.no wt changes. No OC pills. No ICP.no
acromegaly feature. No past medical and surgical.no similar attack
No symptom of GCA.no pit tumor
O/E. Pronator normal.v acuity normal. V.field.rt HH .Fundus normal
Ex asked finding and lesion side
I said optic tract. Optic radiation.occipital

19. Outside progressive SOB and swallowing difficulty

Inside . Systemic sclerosis
No LOW.no Loa. No dysphagia. Only got heartburn
Surrogate didn't tell medical history
But i asked medication . She said PPI. Cyclosporin. Prednisolone
Lung .clear

20. sudden loss of vision in rt Eye kco bicuspid aortic valve

21.an elderly gentleman who had sudden loss of vision of his right eye. K/c/o HTn under
Amlodipine. Had CABG scar on chest and leg scars too. Did ask all relevant questions and
examination. Looked at fundus. Found it very red. When I asked ‘Do you have any concerns?’
he didn’t understand. He was an old Bengali man. The examiners gave him some clues and he
asked me “Questions?” I said ‘Yes’. He said ‘Yes Yes. I have questions for you. Number 1.
What is wrong? Number 2 Is it permanent? No 3 What can you do?’ Said Vitreous Hemorrhage
or retinal detachment. Missed to say CRVO. Was so so so tensed there.

22.There was an English patient with swelling of his Left lower limbs. Was a DVT. It was
unprovoked and he was on Aspirin. No h/o any surgeries or travel. No features of malignancies.
He was a priest. They asked normal questions on DVT.

23.MS - rt hemianopia with optic atrophy with h/o rt sided weakness

24.? Ankylosing with ILD/COPD - wheezes as well as crepts - little odd

25.psoriatic arthritis

26.first episode of seizure in 55 years old man.