Answer

:No
WHOCr
it
eri
afordi
agnosi
ngDi
abet
esMel
l
itus:
Nor
mal
(mg/
dl) I
mpairedGl
ucose Di
abet
esMel
l
itus
Tol
erance(
mg/dl
)
(
mg/
dl)
Fasti
ngBlood 70-110 110-126 >126
Glucose
PostPrandi
alBl
ood <140 140–199 >200
Glucose

Per
sont
obedi
agnosedasdi
abet
iconl
yifany1oft
hef
oll
owi
ngpar
amet
eri
smat
ched:
1.FBG>126mg/
dl
2.PPBG>200mg/
dl
3.Random BG>200mg/
dl
4.HbA1c>6.
5%
Answer
:Per
sonsuf
fer
ingf
rom RenalGl
ycosur
ia
Bot
hFBGandPPBGi
nthebl
oodi
snor
mal
Nor
mal
Renal
Thr
eshol
dforgl
ucosei
s170–180mg/
dl
Loweri
ngofRenalThr
eshol
dcausesRenalGl
ycosuri
aduet
othedefecti
ntheSGLT
Recept
orsasaresul
tofwhi
chglucoser
eabsorpt
ionint
hePCTisi
mpai r
ed.
Gl
ucosepresenti
nurineaft
erameal,i
tmeansthatgl
ucoseconsumpt
iondur
ingt
he
mealcr
ossestherenalthr
eshol
d,sogl
ucosei
sdetect
edinuri
neonlyi
nPPstate.

Answer
:Pat
ientsuf
fer
ingf
rom Di
abet
esMel
li
tus
Easyf
ati
gabi
l
ity
:Lackofupt
akeofgl
ucosebyt
heper
ipher
alt
issuesduet
oinsul
i
n
def
ici
ency
/resi
stance
Excessivethi
rst
:Hy per
glycemiaandincr
easedexcreti
onofgl
ucoseinuri
necauses
excessiv
ewat erremov al
from thebodyduetohyperosmol
ali
tyofbl
ood.Thi
sresul
tsi
n
dehydrati
onstimulati
ngthirst
.
I
ncreasedfr
equencyofur
inat
ion:
Incr
easedosmol
ali
tyduet
ohy
per
gly
cemi
acauses
osmoticdi
uresi
s.
El
evat
edlevel
sofFBGandPPBGal
soi
ndi
cat
eDi
abet
esMel
l
itus(
Ref
er:
WHOCr
it
eri
a
menti
onedearl
ier
)

Answer
:Di
abet
icKet
oaci
dosi
s
Nor
mal
Par
amet
ers:
1.Pl
asmaGl
ucose:
Ment
ionedear
li
er
2.Bl
oodur
ea:
20–40mg/
dl
3.Ar
ter
ial
pH:
7.35–7.
45
4.Pl
asmaBi
car
bonat
e:23–30mmol
/L
Thi
rstandPol
yur
ia:
Duet
oosmot
icdi
uresi
sduet
ohy
per
gly
cemi
a
Vomi
ti
ng:
Duet
oaci
dosi
s.
Col
dSki
n:Duet
ohy
pov
olemi
cshock
Deepsi
ghi
ngbr
eat
hing:
IsknownasKussumaul
’
sBr
eat
hingduet
oaci
dosi
s
Ur
eai
slev
eli
shi
gh:
Duet
osev
eredehy
drat
ion.
Furt
herExpl
anati
on:
Diabeti
cKet
oaci
dosi
sisof
tenassoci
atedwi
thuncont
rol
l
ed
Type1Diabetesmel
li
tus.
Def
ici
encyofinsul
i
ncausesi
nhi
bit
ionofgl
ycol
ysi
sandi
tst
imul
ates
gl
uconeogenesi
s.
I
nsul
ininhibi
tshor
monesensit
ivel
i
pase.I
nabsenceofi
nsul
inhormonesensi
ti
ve
l
i
pasebr eaksdowndepoti
ntofr
eefat
tyaci
d.Fat
tyaci
disoxi
dizedbyBet
aoxidat
ion
i
ntoAcetyl-
CoA.

Fat
eofAcet
yl-
CoA:
Acet
ylCoAcannotbechannel
i
zedi
ntoTCAcy
cleasOxal
oacet
atei
susedupdur
ing
gl
uconeogenesi
s
Moreveritcannotbeuti
li
zedi
ndenov
osynt
hesisoffat
tyaci
dasAcetyl
CoA
Carboxyl
aseisar at
eli
miti
ngenzy
mewhi
chisinhi
bit
edduetothenegat
ivef
eedback
ofalr
eadyhighFFAl ev
el
HenceAcetylCoAi
susedforthesynthesi
sofKet
onebodi
esli
keAcetoacet
ate
(Pr
imaryket
onebody)andAcetone/Betahydr
oxy
buty
rat
e(Secondar
yKetone
Bodies)
 Answer
:Yes,
hei
ssuf
fer
ingf
rom Di
abet
esMel
l
itus
WHOCr
it
eri
afordi
agnosi
ngDi
abet
esMel
l
itus:
Nor
mal
(mg/
dl) I
mpairedGl
ucose Di
abet
esMel
l
itus
Tol
erance(
mg/dl
)
(
mg/
dl)
Fasti
ngBlood 70-110 110-126 >126
Glucose
PostPrandi
alBl
ood <140 140–199 >200
Glucose

Per
sont
obedi
agnosedasdi
abet
iconl
yifany1oft
hef
oll
owi
ngpar
amet
eri
smat
ched:
1.FBG>126mg/
dl
2.PPBG>200mg/
dl
3.Random BG>200mg/
dl
4.HbA1c>6.
5%
Answer
:Pat
ientsuf
fer
ingf
rom Di
abet
icKet
oaci
dosi
s
Posi
ti
veBenedi
ct’
sTest
:Reduci
ngsugarpr
esenti
nur
ine
Posi
ti
veRot
her
a’sTest
:Ket
oneBodi
espr
esenti
nur
ine
Answer
:Ty
peofOGTT:
Diabet
esMel
li
tus
Atzer
ohour
,Pl
asmaGl
ucosei
sFast
ingBl
oodGl
ucose=136mg/
dl(
cutof
f126
mg/dl
)
Af
ter1hour
,bl
oodgl
ucosecr
ossest
heRenal
Thr
eshol
dandgl
ucoseappear
sin
ur
ine
Af
ter2hour
sofor
algl
ucoseconsumpt
ion,
PPBG=180mg/
dl(
cutof
f=200mg/
dl)
EventhoughPPBGi sbel
owt hecutof
f,howev
erasFBGi
sabov
e126mg/
dl,
per
son
i
st obediagnosedwit
hDiabetesMell
i
tus.
Answer
:1.Vi
tami
nAdef
ici
ency
2.RDAf
orchi
l
dren=400-
600ug/
day
3.Al
l
-tr
ans-
Ret
inol
,Ret
inal
,Al
phacar
otene,
Bet
aCar
otene,
GammaCar
otene.
Dif
ficul
tyofvisi
onatni
ght–Ny
ctal
opi
aduet
odef
ici
encyof11-
cis-
ret
inal
acomponent
ofrhodopsin
Dryandthi
ckenedski
n–Ret i
noi
caci
dcont
rol
sthegenesresponsiblef
ordi
ff
erent
iat
ion
ofkerat
ocy
tes.Def
ici
encyofVit
ami
nAcausesFol
li
cularhy
perkeratosi
s.
Tr
iangul
arspotonconj
unct
iva-Bi
tot
’sSpot
s:Duet
oincr
easet
hicknessofconj
unct
iva
Ot
herSy
mpt
oms:
Xer
opt
hal
mia:
Conj
uct
ivabecomesdr
y,t
hickandwr
inkl
ed.
Keratomalaci
a:Xeropt
hal
miaper
sist
ingf
oral
ongt
imepr
ogr
essest
oKer
atomal
aci
a
(Soft
eningofcornea)
Answer
:a)Vi
tami
nC(
Ascor
bicAci
d)def
ici
ency
b)Ascor
bicAci
d
c)Aml
a(I
ndi
angooseber
ry)
,Lemon,
Orange
Explanati
on:Ascorbi
caci di
sessentialforhydroxyl
ati
onprol
i
neandlysi
ne,whi
chis
requir
edf ort
hecrosslinksincoll
agen.DefeciencyofVit
aminCleadstothef
ormati
on
ofabnor malcol
lagenresult
inginli
tt
leredspot s(pet
echi
e)undert
heskinandbl
eedi
ng
from thegums.
Reasonsf
oranemi
a:
 Lossofbl
oodduet
ohaemor
rhage
 Decr
easedi
ronabsor
pti
onasVi
tami
nCconv
ert
sitf
rom f
err
ict
ofer
rousf
orm
 Decr
easedTet
rahy
drof
oli
caci
d(Responsi
blef
orRBCmat
urat
ion)
 Accumul
ati
onofmet
hemogl
obi
n
Answer
:1.(
B)Ar
ginosucci
nat
ely
ase
Accumulati
onofArgi
nosucci
nat
eisduet
odef
ici
encyofar
ginosucci
nat
ely
asewhi
ch
conver
tsitt
oargi
nine
(
Ref
er:
Ureacy
clef
ormor
edet
ail
s)

2.(B)Glut
ami
ne:I
tisthemainst
orageform ofammoniaandisalso
r
esponsibl
eforammoni
atranspor
tfr
om thebrai
ntoliver
.St
oppageofureacycl
eleads
t
oitsaccumulat
ion
Gl
utami
nesy
that
ase Gl
utami
nase
Gl
utamat
e+NH3→Gl ut
ami
ne→Gl ut
amat
e+NH3
(
Brai
n) (
Liv
er)
Answer
:(E)Pur
inedegr
adat
ion
Pat
ienti
ssuf
fer
ingf
rom Goutduet
oaccumul
ati
onofur
icaci
d.
Suff
eri
ngsecondarygoutasther
eishy
perur
icemi
aduet
owi
despr
eadt
issue
dest
ruct
ioncausedduetoradiot
her
apy.
Accumul
ati
onofur
atecr
yst
alsusual
l
ytakespl
acei
nthemet
atar
so-
phal
angeal
joi
ntof
gr
eattoe
Tr
eat
ment
:Al
l
opur
inol
(
Formor
edet
ail
sref
er: an9thEdi
Vasudev ti
on:
Page583)

Answer
:(B)Homogent
isat
e
Pat
ientsuf
fer
ingf
rom Al
kapt
onur
ia
Met abol
i
cdi sordercausedduet
odefi
ciencyofHomogenti
sateoxi
dase.Def
ici
ency
result
sinconv ersi
onofhomogenti
sat
et obenzoqui
noneacet
atewhichonstandi
ng
becomesbl ack.
I
nt hel
aterl
i
fepatienti
spronetosuff
erf
rom Ochronosis(speci
alt
ypeofar
thr
it
isduet
o
deposi
ti
onofalkaptonbodiesi
nint
er-
ver
tebr
aldiscs,nose,pi
nnaofear
)
Dev
elopmenti
snor
mal

Answer
:Ur
emi
cencephal
opat
hy
Nor
mal
Par
amet
ers:
Bl
oodur
ea:
20–40mg/
dl
Ser
um Cr
eat
ini
ne:
0.7–1.
4mg/
dl
I
nor
gani
cphosphat
e:2.
5–4.
5mg/
dl
Expl
anat
ion:
Bl
oodur
eai
sel
evat
edwhi
chi
ssuggest
iveofur
emi
a
Ser
um Cr
eat
ini
nei
sel
evat
edwhi
chi
ssuggest
iveofi
mpai
redr
enal
funct
ion
El
evat
edi
nor
gani
cphosphat
eindi
cat
esChr
oni
cKi
dneyDi
sease
Semi
consci
ousduet
oencephal
opat
hy
Answer
:Gal
act
osemi
a
Posi
ti
veBenedi
ct’
sTesti
ndi
cat
est
hepr
esenceofr
educi
ngsubst
ance
Neget
iveGl
ucoseoxi
daset
esti
ndi
cat
est
hatr
educi
ngsubst
ancei
snotgl
ucose
Bi
l
ater
alCat
aractduet
oaccumul
ati
onofGal
cit
oli
ntheey
es
Galact
osemiaoccur
sduet
othedef
ici
encyofGal
act
ose-
1-Phosphat
eUr
idy
l
Transf
erase
Vomi
ti
nganddi
arr
headuet
oaccumul
ati
onofGal
act
ose-
1-Phosphat
e
St
unt
edgr
owt
hduet
oreducedconv
ersi
onofGal
act
oset
ogl
ucose
Answer
:(c)Gl
ucose6-
Phosphat
ase
Expl
anat
ion:
Gl
ucose-
6-Phosphat
ase
Gl
ucose6phosphat
e→Gl
ucose
Defi
ciencyofGl
ucose6Phosphat
asecausesdecr
easedav
ail
abl
yofgl
ucosel
eadi
ngt
o
hypoglycemi
a
ExcessGl
ucose-
6-Phosphat
e
↓
Ent
ersHMPShuntPat
hway
↓
Excessi
veRi
bose–5–Phosphat
esy
nthesi
s
↓
Ov
erpr
oducti
onofpur
inenucl
eot
ide
↓(under
goescat
aboli
sm)
Excessi
veur
icaci
dpr
oduct
ion
↓
Hy
per
uri
cemi
a

Gl
ucose-
6-Phosphat
e
↓
Under
goesGlycol
ysi
s
↓
Py
ruvat
e
 ↓
AcetylCoA
↓
Excessi
veFat t
yAci dproduct
ion
↓
Excessiv
eTr igl
yceri
de
↓
Hypert
ri
glyceri
demi a

Py
ruv
atei
sal
soconv
ert
edt
olact
atel
eadi
ngt
olact
icaci
dosi
s
Accumulat
ionofGlucose-
6-Phosphat
ewill
alsocauseproductinhi
bit
ionofGly
cogen
Phosphory
lasel
eadingtoexcessi
vestor
ageofglycogeninli
vercausinghepat
omegaly
.

Answer
:My
ocar
diali
nfar
cti
on
Expl
anat
ion:
Heav
ysmoker
:Smoki
ngcausescar
diov
ascul
ardi
sor
der
s
BPel
evat
ed,
Pul
sei
slowi
ndi
cat
ingbr
ady
car
dia
Damaget ot
hecar
diacmy
ocytesr
esul
tsint
heliber
ati
onofTroponi
nTi
nbl
ood.
Troponi
nTisaver
yimpor
tantmar
kerformyocardi
ali
nfar
cti
on
CK-
MBisanisoenzy
meofCr eat
ineKi
nasepresenti
nthehear
tmuscl
es.I
ncr
easeofCK-
MBisal
soanimportantmar
kerformyocar
diali
nfar
cti
on
ECGmaydet
ectt
hesi
teofi
nfar
cti
on.
Answer
:Pat
ientsuf
fer
ingf
rom Hemol
yti
cJaundi
ce
Nor
mal
Par
amet
ers:
Tot
alBi
l
irubi
n<1.
2mg/
dl
Conj
ugat
edBi
l
irubi
n:0.
2–0.
4mg/
dl
Unconj
ugat
edBi
l
irubi
n:0.
2–0.
6mg/
dl
ALT:
5–40U/
L
AST:
5–35U/
L
ALP:
3–13KA/
dl

Expl
anat
ion:
Mal
ari
acancausewi
despr
eadHemol
ysi
s
Severeri
sei
nthelevel
ofUnconj
ugat
edBil
i
rubi
nandrel
ati
vel
ynor
mal
lev
elof
conjugat
edbi
li
rubi
nisasi
gnofHemolyt
icJaundi
ce.
Mor
everpr
esenceUr
obi
l
inogeni
nur
inei
sal
soachar
act
eri
sti
cfeat
ureofhemol
yti
c
j
aundi
ce

Answer
:Obst
ruct
iveJaundi
ce
Nor
mal
Par
amet
ershasal
readybeenment
ionedabov
e
Expl
anat
ion:
Rel
ati
vel
ynor
mal
lev
elofALTandASTr
ulesoutt
hepossi
bil
i
tyofl
i
verdamage
ALP(Alkal
inePhosphatase):Ectoenzymeofthebil
iarycanali
culi
presentwit
hinthe
bi
li
aryepit
helium.Regurgi
tati
onofbi l
eduetobil
iar
yobst ruct
ioncausesir
ri
tati
onof
bi
li
aryepit
helium r
esult
inginrel
easeofALPi nbl
ood.Bi l
iaryobst
ructi
oncauses20t o
25ti
mesi ncreaseinthebloodlevelofALP(Normal l
evel3–13KA/ dl
)
ConjugatedBil
ir
ubin:
Incr
easesmarkedl
yduetoobst
ruct
ivej
aundi
cewher
eas
unconjugatedbi
li
rubi
nremainsr
elat
ivel
ynor
mal
Answer
:Ri
cketduet
oVi
tami
nDdef
ici
ency
Nor
mal
Par
amet
ers:
1.Bl
oodur
ea:
20–40mg/
dl
2.Ser
um Cr
eat
ini
ne:
0.7–1.
4mg/
dl
3.Ser
um Cal
cium:
9–11mg/
dl
4.I
nor
gani
cPhosphat
e:3–4.
5mg/
dl
5.ALP:
3–13KA/
dl
Expl
anat
ion:
Bonepai
nisachar
act
eri
sti
csy
mpt
om ofRi
cket
.
Ri
cketcausesbndi
ngofwei
ghtbear
ingbonesi
nthebody
Ricket
yRosar
y:Enl
argementofepi
phy
sisatcost
ochondr
alj
unct
ioncausesbendi
ngof
ri
bs
Pl
asmaCal
cium andPhosphor
usl
evel
sar
esl
i
ght
lyl
owerwi
thmar
kedi
ncr
easei
nALP
Answer
:Met
abol
icAl
kal
osi
s
Nor
mal
Par
amet
ers
1.pH:
7.35–7.
45
2.Bi
car
bonat
e:22–26meq/
L
3.pCO2:
35–45mm Hg
4.pO2:
85–100mm Hg
Expl
anat
ion:
pHi
sel
evat
edi
ndi
cat
ingal
kal
osi
s
Riseinthelevelofbi
car
bonatei
sacharact
eri
sti
csi
gnofmetabol
i
calkalosi
s, wher
eas
falli
nthelevelt
helevel
carboni
caci
dandcarbondioxi
dei
sasignofrespir
atory
alkal
osis
Vomi
ti
ngcauseswashoutofaci
dandchl
ori
de,
ther
efor
ecausi
ngmet
abol
i
cal
kal
osi
s.
Answer
:Respi
rat
oryAci
dosi
s
Nor
mal
Par
amet
ershav
eal
readybeenment
ionedi
nthel
astcase
Expl
anat
ion:
Fal
li
nbl
oodpHi
ndi
cat
iveofAci
dosi
s
I
nRespi
rat
oryaci
dosi
s,thereisriseint
hel
evel
car
boni
caci
dandCO2whi
l
ethe
bi
car
bonat
elevel
remainsrelat
ivelynor
mal
Hyper
vent
il
ati
oni
soneoft hecompensat
orymechanism i
nordert
oremov
eexcessCO2
f
rom t
hebody.Sothepat
ientcompl
ainsofrespi
rat
orydi
str
ess

Answer
:Nor
malel
ect
rophor
etogr
am
+ -
Nor
mal
Par
amet
ers:
Al
bumi
n:3.
5–5mg/
dl
Gl
obul
i
n:2.
5–3.
5mg/
dl
Al
bumi
n/Gl
obul
i
nRat
io=1.
5–2:
1
Al
bumi
nhast
hemaxi
mum andgammagl
obul
i
nhast
hel
eastmobi
l
ityi
nel
ect
ri
cfi
eld.
Const
it
uentofeachband:
GammaGl
obul
i
n:I
mmunogl
obul
i
n
Al
pha1:
Alpha1Ant
i-
tr
ypsi
n
Al
pha2:
Alpha2Macr
ogl
obul
i
n
Bet
a:Li
popr
otei
n
Answer
:Abnor
malEl
ect
rophor
etogr
am

+ -
M Bandi
spresentwhichcoi
nci
deswi
thGammagl
obul
i
n,t
her
efor
eel
evat
edl
evel
of
gammaglobuli
nisseen
Ty
pical
l
yseeni
nMul
ti
pleMy
elomaduet
othepr
esenceofBenceJonesPr
otei
n
Ot
herabnor
mal
i
ties:
(Notpr
esenti
nthi
scar
d)
1.Pr
imar
yImmunedef
ici
ency
:Gammagl
obul
i
nfr
act
ionwi
l
lber
educed
2.Nephr
oti
cdisease:
Alpha2fract
ionwi
l
lbeel
evat
edast
her
emai
ningmi
cro
pr
otei
nswil
lbelostinur
ine
3.Li
verci
rr
hosi
s:Al
buminl
evel
isdecr
easedandcompensat
oryi
ncr
easei
ngl
obul
i
n
l
evel(
widebet
afr
acti
on)
 4.Al
pha1Ant
it
rypsi
ndef
ici
ency
:Al
pha1bandi
snar
row
N.
B:I
fpl
asmaisusedi
nst
eadofserum,Fi
bri
nogenf
ormsabandi
nthegammar
egi
on
t
hatmaybeconf
usedwi
ththeM Band

Answer
:RF=D1/
D2
Expl
anat
ion:
Di
stancetr
avel
ledbythesol
utefr
ont
RF(Retenti
onFact
or)= (
From t
hepoi
ntof
Di
stancetr
avell
edbysol
ventfr
ont
appl
icati
on)
Answer
:(
A)Chy
lomi
crons
Expl
anat
ion:
Medium chainfat
tyaci
daredirect
lyabsor
bedandaretr
ansportedtol
iv
erforbeta
oxi
dati
ont hr
oughportalv
ein.I
tdir
ectl
yenter
shepat
icmitochondr
iabybypassi
ng
car
niti
neshut t
le
Butdiet
aryf
at,
whichmainl
ycont
ainsl
ongchainf
att
yacids,
absor
bedbyly
mphati
c
channel
s→ Thoraci
cductandt
henpouredi
ntosyst
emiccir
cul
ati
onaschyl
omi
cron