The second edition of AIIMS Medicine Quiz was held on 11th September, 2021. This quiz was for residents currently pursuing MD/DNB in Medicine/ Geriatric Medicine/ Emergency Medicine and Infectious Diseases.
6. Kaposi Sarcoma
(Multicentric Vascular Hyperplasia)
• Pic1: From the movie Philadelphia, Tom hanks is infected with and
shows the lesions in court, Denzel Washington plays the lawyer
• Path- Skin excision, in low power view showing a well defined nodule
of Kaposi Sarcoma at the tumor stage
• Life cycle depicting the latent and lytic phases of most herpes viridae.
• CT findings in Pulmonary Kaposi Sarcoma include interstitial
thickening and pulmonary nodules in a peribronchovascular pattern
8. MERCURY POISONING
• 1. Pink disease
• 2. Ptyalism
• 3. Mad as a hatter- neurological changes due to mercury poisoning
• 4. Swordfish- highest level of mercury among fish
16. Ans. IgG4 disease
• A- B/L submandibular gland enlargement
• B- Histopathology showing storiform fibrosis
• C- left eye proptosis due to lacrimal gland enlargement
• D- CT abdomen showing diffusely enlarged pancreas and an irregular,
low-attenuation area in the left kidney. These radiologic findings
correspond to autoimmune pancreatitis and tubulointerstitial
nephritis.
23. RULES
• Each question carries 20 points.
• There is no negative marking
• It is mandatory for all teams to pounce
• Time for direct team- 1.5 minutes
• Time for all other teams- 1 minute
24. 1.Take the tour….
On board the Maria Pita were an undefined number of crew
members who were responsible for sailing the corvette, lead by
Captain Pedro del Barco , as well as the specific members:
Dr.Francisco Xavier de Balmis, director; Joseph Salvany, deputy
director; 3 assistant surgeons; 2 first aid practitioners; and 4
nurses. The Ship also had on board 22 orphan children form the
La Coruna Orphanage on board to preserve the purpose of this
expedition.
This expedition disembarked from La Coruña, Spain on 30
November 1803 to do what
26. Exporting Vaccines…
• This Spanish Royal Philanthropic Expedition to Bring
Smallpox Vaccination to the New World and Asia in the
19th Century
• The largest philanthropic effort of its time
• The children on board were the store houses for the vaccine, their
skin vesicles were the ILR’s
27. 2.
• Pier Paolo Pandolfi of the Memorial Sloan Kettering Cancer center,
New York, first called this oncogene as_________ at a conference in
2001. When Pandolfi and his colleagues described the gene’s role in
the development of human cancer, the discovery attracted headlines
as “ ‘ s cancer role revealed”. Message boards and blogs picked up
the story, unable to resist the phrase “__________” causes cancer.
• Nintendo didn’t take very kindly to this and threatened to take legal
action against it. Pandolfi then changed the name to a rather boring ‘
ZBTB7’ What was the original name?
29. 3.
• Marty Feldman was a Hollywood actor who had a characteristic ‘
exophthalmos stare’. Which disease in medicine has specific cells that
are named after him/his characteristic stare?
32. 4.
• The X operation was a complete tele surgical operation carried out by
a team of French surgeons located in New York on a patient in
Strasbourg, France across the Atlantic, using telecommunication
solutions based on high speed services and sophisticated Zeus
surgical robot.
• X was arguably the most famous person on the earth during the early
20th century after achieving a feat which was achieved never before.
• Identify X.
34. 5.
• X was an American professional baseball player who played 17
seasons at MLB for New York Yankees. He was renowned for his
prowess as a hitter and for his durability, which earned him the
nickname ‘ The Iron Horse’. His career was cut short at the age of 36
when he was diagnosed with Y. Later on Y was widely recognized as
X’s disease.
• Y was also popularized in social media platform when various
celebrities took the Z challenge to raise awareness and funds for
research into Y.
• Identify X, Y and Z.
36. 6.
• Ruptured Aortic aneurysm causes expanding retroperitoneal
hematoma, which may cause right sided abdominal pain and mimic
right sided renal colic or even acute cholecystitis.
• X, a very famous personality was a case of aortic aneurysm for 10
years, when in 1955 he was admitted to Princeton Hospital as a case
of suspected Cholecystitis, which ultimately resulted into his death.
Later on, he was diagnosed as case of ruptured aortic aneurysm on
autopsy.
• Subsequently, ruptured aortic aneurysm mimicking Acute
cholecystitis was named X’s sign. Identify X.
38. For The Crowd
• X and Y are two very different entities which have been used as
similarly by the medical profession. X is said to be the original entity
but Y got popularized when it was used by US Army Medical Corps in
early 20th century. Popular organizations using X are WHO and MCI
whereas Y is used by US Public Health Service and AIIMS. Identify X
and Y.
41. RULES
• 1 question per team in this round
• Direct team gets 2 minutes to
answer
• Pounce window closes at 1 minute
• Direct team to answer after
pounce window closes
• Correct answer to direct question
to the team will fetch you +20
points
• Correct pounce response gets +10
• Penalty for an incorrect response
will be -10 points for the team(s)
43. • A 12 year old male presented to GE-OPD with complaints of chronic
large-bowel type of diarrhea (8-10 low volume stools per day). There
was no associated history of fever, abdominal distension, vomiting,
hematemesis, malena or hematochezia. There was no significant
finding on examination.
• Routine labs were suggestive of iron deficiency anemia and stool
occult blood was positive. Remaining lab investigations were all
normal.
• Colonoscopy images and rectal mucosal biopsy are shown in the next
slide. What is the diagnosis?
44.
45. EOSINOPHILIC COLITIS
• Eosinophilic colitis in an infant presenting with heme-positive
stools and anemia.
• The endoscopic image of the rectum shows mucosal nodularity
with central umbilication characteristic of nodular lymphoid
hyperplasia, findings often associated with food allergies.
• Rectal mucosal biopsy show increased numbers of eosinophils
in the lamina propria that are forming aggregates and
occasionally encroaching on the epithelium and crypts.
47. • A 38 year old female presents to you with history of sudden onset
vision loss, in the following pattern.
• She also gives history of secondary amenorrhea. On evaluation she
was found to have UPT negative, and normal pituitary hormones.
• An MRI was done which revealed a macroadenoma, and a
transsphenoidal resection was done the biopsy of which revealed
this. Pituitary hormonal IHC and pituitary specific IHC (PIT1, SF1, T-
PIT) are negative.
• What would be the next investigation you would order?
48. Ductal Adenocarcinoma with pituitary
metastasis
• This image shows bitemporal hemianopia, due to a pituitary mass
compressing the chiasma
• Since pituitary hormonal IHC is negative, the lesion is not a primary
pituitary adenoma.
• In females the most common cancer metastasizing to the pituitary is
Breast cancer – as shown in the biopsy – Adenocarcinoma
• SO, the next investigation is mammogram.
50. • A 35 year old female with no prior co-morbidities, presented to
the emergency with complaints of sudden onset right sided
chest pain which was pleuritic in nature. Her family members
also reported that she was complaining of progressively
increasing breathlessness on exertion since the last few
months. There was no H/O fever, cough, any prior history of
chest pain, weight loss or anorexia. Her chest radiograph
showed the presence of right sided hydropneumothorax for
which a chest tube was put. Pleural fluid analysis showed
exudative nature of the fluid. Chest tube was removed once
hydropneumothorax resolved.
• A CT scan of the chest was subsequently done which showed
the following findings. What is the diagnosis?
53. A 46-year-old man presents to the emergency department with a 2-week history
of diarrhea, nausea, abdominal pain, and weakness.
He reported a weight loss of 8 kg in the preceding 2 months and was sexually
active.
Results of laboratory studies showed a serum creatinine level of 2.4 mg per
deciliter and there was no previous measurement to serve as a comparison.
An enzyme-linked immunosorbent assay for the human immunodeficiency virus
was positive; the viral load was 114,121 copies per millimeter, and the CD4+
count was 2 cells per cubic millimeter.
Despite fluid resuscitation, the patient’s renal function worsened, and a renal
biopsy was performed.
a. An image of the kidney biopsy is shown on the next slide. Which
microorganism is responsible for the condition?
b. What would you treat the patient with ?
57. • A 23 year old man presented with two-month history of nausea and
pain abdomen and yellowish discoloration of entire body. He also
developed high grade fever with chills and worsening pruritus over the
past 5 days.
• O/E- He was noted to be febrile with bilateral scleral icterus. Epigastric
tenderness was noted. There was no guarding or organomegaly.
• Labs:
• ALP- 818 U/L
• AST/ALT- 144/146 U/L
• T Bil/ D Bil- 6.2/3.9 mg/dL
• INR- 2.23
• Viral hep panel, ANA- Neg
• CECT Chest+ Abdomen done were suggestive of hilar and
retroperitoneal lymphadenopathy
• Biopsy from these nodes was suggestive of Hodgkin’s Lymphoma.
58. • An image of the liver biopsy is shown. What is the diagnosis?
62. • A 26 year old male presented with complaints of worsening shortness
of breath and hemoptysis. He is an occasional alcoholic and non-
smoker. He reports some change in the timber of his voice over the
same duration. CT films done as part of the evaluation are shown
below. What is the most likely diagnosis?
• What is the next blood test that you will order?
65. • A 45 year old male with no previous comorbidities presented to ER
with C/O severe retrosternal chest pain since the last 10 hours. He
described the chest pain as a feeling of tightness and it was
associated with diaphoresis. There was no H/O fever, cough or SOB.
• Examination was normal except for the presence of tachycardia.
• Lab parameters were as follows:
Hb 13
TLC 5600
Platelet 2.4L
Urea/Creat 34/0.7
Na/K 136/4.2
ALT/AST 23/24
Bil (T/D) 0.8/0.2
Trop I 0.01 (<0.02)
66. ECG was as shown below. Identify the ECG finding and explain its significance.
69. Q1.
• A 30 yr old male patient presented with a history of severe bleeding
from gums, as well as and easy fatiguability.
• On the way to the emergency, he developed sudden onset dyspnea
and cough with severe hemoptysis.
• On evaluation he was found to have severe anemia and
thrombocytopenia. A CXR done revealed this picture.
• A flow cytometry was ordered keeping in mind a particular diagnosis
given the presentation, and this was found.
70.
71. • What is the most probable diagnosis?
• What is the next line of management?
72. • Acute promyelocytic leukemia
• The blasts are negative for CD34 and HLA-DR, highly suggestive of APL
• Next Rx- ATRA
73. Q2.
A 45 year old male presented with C/O B/L pedal edema since the last 2 months
along with a dragging sensation in the RUQ. The patient also had C/O SOB
associated with orthopnoea and PND since the last 1 month.
O/E B/L pedal edema and basal crepitations were present along with raised JVP
and hepatomegaly.
Lab parameters wise his Pro-BNP levels were elevated.
2D ECHO showed LV hypertrophy, with reduction in global longitudinal strain, with
the ratio of apical longitudinal strain to avg of mid and basal longitudinal strain =
1.4.
75. • What is the most likely diagnosis?
• What would be the next investigation you order?
• What is the classical ECHO appearance of this disease?
76. • Cardiac amyloidosis
• 2D ECHO- longitudinal strain (LS) in the left ventricle is impairment
more pronounced at the base and mid-ventricular regions compared
to the apex
• MRI- highly characteristic appearance on late gadolinium
enhancement (LGE) imaging kinetics; there is early subendocardial
LGE and later transmural LGE
• Sparkling/speckled appearance of myocardium, biventricular
hypertrophy, thickening of IVS, bi-atrial enlargement.
77. Q3.
• A 58-year-old man, non smoker, with history of pain involving
polyarthritis involving wrists and ankles since the last 10 years, which
had now progressed to residual joint deformity. He works at a glass
industry since 5 years.
• He now developed dyspnea on exertion and non productive cough.
There is no h/o fever.
• Chest auscultation revealed diffuse crepitations.
• PFT showed mild restrictive pattern.
• Chest X-ray revealed the pattern as shown in the next slide.
• Due to unclear diagnosis, a lung biopsy was done, the image of which
is shown in the next slide. What is the diagnosis?
78.
79. • Caplan syndrome
• Lung biopsy - palisading of fibroblasts with the presence of an
acute or chronic inflammatory infiltrate (macrophages are most
characteristic) with necrotic changes.
80. Q4.
• A 50 year old gentleman presented to AIIMS with C/O acute onset nausea,
vomiting and abdominal pain starting 2 weeks back.
• 3-4 days later, he also developed severe pain, numbness and tingling
starting from his hands and feet and progressing rapidly to involve all four
extremities, along with motor weakness that started from the lower limbs
and eventually progressed to involve the upper limbs.
• He also complained of painless visual blurring.
• Since the last 3-4 days he is complaining of excessive hair loss and has
developed several bald patches on his scalp.
• O/E he had a BP of 146/94 and a PR of 122/min. His skin was extremely
tender to touch which precluded any further examination. His visual acuity
6/24 in both eyes and he failed to identify the numbers correctly on Ishihara
charts.
• What is the most likely diagnosis?
81.
82. • Thallium poisoning
• Initial GI symptoms followed by neurologic symptoms and alopecia
• Extremely painful sensorimotor neuropathy
• Optic neuritis with blue colour defect
83. Q5.
• A 34 year old male, a chronic IV drug abuser, with history of IV
cocaine use, came with complaints of fever, arthralgias, night sweats
and weight loss.
• 2 days back he developed these
lesions on his body.
84. • On evaluation he was found to be both C and P ANCA positive.
• What is the most likely diagnosis given the drug exposure history ?
86. Q6.
• This 25 year old man presents to us with
complaints of swelling in the front, on the
left side of the neck since the last 6
months.
• Since the last 1 month the patient also
developed episodes of attacks of anxiety,
headache, diaphoresis, palpitations, or
tachycardia.
87. • An ophthalmological evaluation and oral cavity
examination done revealed this.
• What is the most likely diagnosis and why?
• What finding would you expect in the GI tract of
this patient?
90. Q3.
• Mr A is a 73 year old male who presented with H/O multiple falls. He
also complained that his thighs had become much thinner than
before and that he was facing difficulty in gripping, lifting, and using
handheld tools or household implements. These complaints started
around 2 years back and have continued to slowly worsen since then.
• O/E there was marked weakness and severe wasting of forearm
muscles (Flexors> Extensors, L>R) and Quadriceps femoris. Tone and
reflexes were normal.
91. • Lab parameters were all normal except for mildly elevated CPK levels.
• An EMG was done for the patient and showed the following findings:
•
92. • What is the likely diagnosis and why?
• What is the EMG finding?
• What would u find if you biopsy his muscle?
93. • Inclusion body myositis
• EMG- Abundant short-small motor unit potentials (MUP) with
fibrillations and positive sharp waves
94. • A 75 year old male presented to the ER with complaints of fever since the
last 5-6 days. Around 1-2 days after the onset of fever, he developed non
productive cough associated with shortness of breath and pleuritic type of
chest pain. The patient also complained of GI symptoms in the form of
nausea, vomiting and watery diarrhea. His attendants also complained of
diminished responsiveness since the last 2-3 days. His lab parameters are
as shown below: (1)
Hb 13.0g/dl
TLC 13,000
Platelet count 2.4 L
Urea/Creatinine 45/0.8
Sodium/Potassium 123/4.5
ALT/AST 200/187
Bilirubin(T/D) 0.7/0.2
T Protein 5.9 g/dl
Albumin 3.5 g/dL
ESR 65mm
CRP 124 mg/L
Diagnosis?
97. • Questions from 6 super-specialities
• Each team gets to answer questions of one super-speciality
• Each team will be asked 3 questions from the chosen field
• The team at the bottom of the points table gets to choose first
• The questions each carry 20 marks (10 marks each for pounce)
• -10 for pounce
• The team will get to answer the next question only if they have answered
the previous questions correctly or have passed the previous questions.
• In case a team answers a question incorrectly, they will loose all the points
which they have earned in the round so far and shall not be eligible to
answer the subsequent questions. These remaining questions however will
be open for pounce. The direct team can answer but they shall not get
points.
98. • You will get a total of 1.5 minutes per question
• Pounce window 1 minute
101. • 20 year old gentleman with no prior co-morbid illnesses presents with a history
of syncope while going for a jog in the morning. Further probing reveals a history
significant for sudden death in his maternal uncle at 27 years of age.
• General physical and systemic examination is unremarkable
104. • Apical HCM
• Ventriculography showing spade like configuration and marked apical
obliteration
• Giant negative T waves in infero-lateral leads and large QRS voltages
105. • 40 year old gentleman presents to the emergency department with the
chief complaint of palpitations.
106. • Future recurrences of this arrhythmia may be prevented by catheter ablation at which of the following
sites.
A
A
B
C
D
108. • 32-year old lady with no prior known co-morbid illnesses presented to the
emergency department with complaints of one episode of syncope while sitting
at home and reading the newspaper.
• General physical examination was unremarkable. Systemic examination was
significant for the presence of a late systolic murmur best heard at the apex with
radiation to the axilla.
114. • 1. A 40 years old lady presents
with intermittent diarrhea of 4
years duration with progressive
weight loss, and progressive
ascites with bilateral pleural
effusion. Echo shows only mild
pericardial effusion. Ascitic tap
shows this appearance of fluid.
Ascitic fluid cell count is 50
cells/mm3. What’s the diagnosis?
116. • 2. A 50 years old male with history of
chronic alcohol abuse presents with
intermittent drowsiness associated with
subacute onset bilateral lower limb
weakness with urinary incontinence.
Examination reveals clonus in both lower
limbs with decreased sensations, with
normal strength in bilateral upper limbs.
Rest of CNS examination is normal. MRI
screening of spine, MRI brain and MR LS
spine are normal. Vitamin B12 levels and
detailed neurological workup are all
normal, and there is no response to
empirical B12 supplementation, steroids
and ATT. Serum ammonia levels are
elevated at 130 U, and CT venography
reveals this finding. What’s the diagnosis?
118. • 3. A 30 years lady presents to you for a
routine health checkup. She had a birth
defect with cloacal exostrophy, for which
she underwent ureterosigmoidostomy.
She has no specific complaints at
present. In addition to general health
advice, what specific regular health
checkup would you advise to this
patient?
121. 1. A 63-year-old woman presented after having a seizure. Her family said that she
had been confused recently and had progressive cognitive decline such that she
was unable to take care of her activities of daily living. An MRI revealed white
matter hyperintensities, primarily in the temporal and occipital lobes as shown in
the image. Cerebrospinal fluid analysis revealed a protein of 100 mg/dL and 20
WBC/μL. She was sent for a brain biopsy, which is shown. Diagnosis?
123. 2. A previously healthy, intelligent 16-year-old male is brought to the attention of the
school guidance counselor for behavioral problems. He is getting into fights and his
grades decline from As to Cs over the course of a year. Over the next several years, the
patient becomes involved in multiple illicit substances, including marijuana, ecstasy,
and cocaine. After five years, he is brought to the attention of a neurologist for
cognitive problems by his parents, whom he lives with.
They report his memory is quite poor, and recently he has been getting lost on the
way from his house to the grocery market where he works. His family history is
significant for an aunt who died of "some sort of dementia" in her 30s, but further
details are unavailable. HIV, VDRL- non reactive. On physical exam, he is well
nourished without any craniofacial abnormalities. The mental status exam reveals
poor memory registration and recall at 5 minutes. He has mildly diminished vibration
and proprioception at the toes and ankles, with 1+ reflex at the ankles. The rest of his
neurologic exam is unremarkable.
MRI shows bilateral diffuse white matter hyperintensities on T2- weighted imaging,
predominantly in the frontal lobes. There is no contrast enhancement and there is
sparing of subcortical U-fibers. EMG showed diminished conduction velocity but
normal amplitudes at the sural nerves. Diagnosis?
124. METACHROMATIC LEUKODYSTROPHY
• Anti VGKC Ab (CASPr2)
antibody
• Auto-immune encephalitis
• cognitive changes,
cerebellar symptoms,
peripheral nerve
hyperexcitability,
autonomic dysfunction,
insomnia, neuropathic
pain, and weight loss
125.
126. • 3. A previously healthy 64–year-old man presented with
pain in both lower limbs with excessive sweating over the
palms and soles. He also complained of painful muscle
cramps, insomnia and involuntary muscle contractions over
the deltoid and calf muscles (video shown). His condition
got progressively worse over the next few months. During
his inpatient stay, he had episodes of intermittent
encephalopathy characterized by confusion, severe
insomnia, auditory and visual hallucinations, and
aggressive behaviour. Motor, sensory, gait, and cerebellar
examinations were unremarkable.
• Diagnosis?
• Which auto-antibody will be positive in this case?
127. MORVAN SYNDROME
• Anti VGKC Ab (CASPr2)
antibody
• Auto-immune encephalitis
• cognitive changes,
cerebellar symptoms,
peripheral nerve
hyperexcitability,
autonomic dysfunction,
insomnia, neuropathic
pain, and weight loss
130. Question 1
• A 30-year-old male construction worker presents few hours
after a fall from a ladder. He complained of right-sided chest
pain. A chest X-ray was performed following which a chest
tube was placed in the right hemithorax. About 100 mL of
serosanguineous fluid was aspirated and sent for analysis.
The fluid was exudative with 20% eosinophils.
• He has no previous illness and was otherwise well prior to
the fall. He admits to smoking 5 bidis a day for the past 5
years. Peripheral blood count was 8000/mm3 with 1%
eosinophils.
• What is the likely cause of eosinophilic pleural effusion?
132. Question 2
A 27-year-old male was found to have an abnormal chest
radiograph during an occupational health check-up. He
denied any respiratory or other systemic complains. He
denies smoking cigarettes but admits to smoking two or
three joints of marijuana per day since he was in college.
On spirometry, The patient had a normal FVC and FEV1.
Investigation revealed a normal α1-antitrypsin level. An
HRCT of the chest was performed.
What is the likely diagnosis? What is the prominent
finding on CT chest?
133. Cannabis related bullous lung disease
Vanishing lung syndrome
Bullae occupies at least one-third of hemithorax
Upper lobe bullae
Asymmetric
Smokers
134. Question 3
The accompanying chest radiograph
shows one treatment modality for a
chronic, progressive disease. About 45%
patients suffering from this disease also
experience the symptoms of a particular
sleep disorder. In fact 75% of patients
who exhibit this sleep disorder in the
absence of the said chronic disease, go on
to develop this disease. Hence, this
particular sleep disorder is most
commonly seen in patients with this
chronic disease. Name the sleep disorder.
137. 1. A 48 year old female presented with a 2-day history of fever,
arthralgia, diarrhea, and headache. She recently returned from an eco-
tour in tropical sub-Saharan Africa where she went swimming in inland
rivers. On examination her temperature was 101.7, 2 cm tender mobile
lymph nodes in axilla, cervical and femoral regions and a palpable
spleen. Her WBC is 15,000 with 50% eosinophils. She had also noticed
a pruritic papular rash on her left leg
138.
139. a. What is your clinical diagnosis ?
b. What medication would you prescribe to treat her condition ?
c. What is the infective stage and mode of infection of this pathogen ?
141. 2. A 51-year-old woman with a history of acute lymphoblastic leukemia
presented to the emergency department with cough and pleuritic pain
in the left side of the chest that had persisted for 3 days; she had no
fever. She had undergone bone marrow transplantation 3 months
previously, and graft-versus-host disease had developed, for which she
had been receiving treatment with cyclosporine and high doses of
glucocorticoids. LPCB mount of a BAL sample was done.
142.
143. a. LPCB mount of the BAL specimen is shown. What is your diagnosis ?
b. Name the classical radiological sign seen in chest CT in these
patients.
145. 3. An 8-year-old boy presented with subcutaneous nodules associated
with a 1-week history of fever 2 months after starting treatment for
relapsing B-cell leukemia. He had had pancytopenia for 57 days, and
laboratory studies showed a hemoglobin level of 7.5 g per deciliter , a
white-cell count of 200 per cubic millimeter , and a platelet count of
12,000 per cubic millimeter. Fever persisted despite the initiation of
broad-spectrum intravenous antibiotic treatment, and 1 week later, the
subcutaneous nodules developed. Physical examination revealed
nodules ranging from 5 to 18 mm in diameter on the chest, back, arms,
and legs.
146.
147. a. Name the organism responsible for this clinical presentation ?
b. How would you treat this infection ?
c. Name two more moulds which can cause fungaemia and be isolated
from blood culture?
150. 1. An 18/M with h/o osteosarcoma at age 11
(cured with chemotherapy) presents to you with
fever for the last 1 month with generalized bony
pain.
CBC showed Hb 10; TLC 4000 and PLT 70000 with
peripheral smear showing normocytic
normochromic cells. PET-CT showed multiple
bone lytic lesions.
Bone marrow aspirate is shown in the image.
What are the two possible causes for this
presentation in the patient?
(Points only for both)
151. • Blasts in peripheral smear
• Secondary AML due to chemotherapy/ li Fraumeni Syndrome
152. • 2. A 45/F case of metastatic lung adenocarcinoma was started on
immunotherapy with single agent pembrolizumab to which she had a good
partial response.
• On follow up at 7 months, she complained of excessive fatigue and swelling of
the body. He also had shortness of breath on exertion. Her daughter said that
she was losing interest in her hobbies.
• On examination, she had a heart rate of 55/min. Chest was clear on auscultation.
ABG showed type 2 respiratory failure (pH 7.35; pCO2 60; bicarb 28). Routine
investigations showed hyponatremia (Na=125). Chest Xray and 2D echo were
normal.
• What is your clinical diagnosis?
154. • 3. A 16/F with Burkitt’s lymphoma presenting with an abdominal
mass and multiple enlarged abdominal and mediastinal lymph
nodes.
• You start the patient on steroids and TLS prphylaxis. Two days later,
the patient develops sudden onset shortness of breath.
• PR 130/min; BP 120/80; RR 40/min; SpO2 75% on room air; Chest:
clear on auscultation.
• CXR is normal; ABG on room air:PaO2 75 mm Hg; PaCO2 20 mm Hg;
Lac 3.0 mg/dL; Bicarb 22 mg/dL; ECG-sinus tachycardia
• What is the cause for her presentation?
157. Rules:
• 6 teams
• 5 questions will be read out
• 30 seconds to answer
• You can answer or pass the question
• At the end of five questions, passed questions shall be repeated
(subject to 30 second time limit)
• Correct answer gives you +5 points
• Incorrect answer makes you lose 5 hard-earned points
• Passing is safe!
158. Rules:
• Please discuss and answer
• Only one person per team can be nominated to answer
• Answers from other two team members shall be invalid
• Decision of quizmasters and experts shall be final and binding
