FMGE/NEXT/NEET-PG preparation

FMG'S YOU STILL HAVE PLENTY OF TIME TO CRACK FMGE, Kick start your preparations now. My PERSONAL HIGHLIGHTED NOTES &(PREPLADDER OR MARROW NOTES) are in the description below of the Youtube video so check it out. I'm sure it'll guide you, All the best!! https://www.youtube.com/watch?v=LjatO6s_dRY&feature=share

Explanation- The correct answer is Autoimmune Haemolytic Anaemia (AHA). More specifically this is a case of 'cold' type AHA secondary to EBV infection. This patient presents with the classical triad of infectious mononucleosis (IM) namely: fever, pharyngitis, and lymphadenopathy. Splenomegaly occurs in 52% of IM cases and is also consistent with haemolysis. The elevated white cell count points toward an infective aetiology and lymphocytosis (> 50%) is typical for EBV infection. Her blood results show a normocytic anaemia. Elevated LDH and reticulocyte count > 2% suggest haemolysis of a hyperproliferative aetiology. The positive direct Coombs test points toward AHA and the fact it is positive with complement alone is consistent with a 'cold' type AHA.  Normocytic anaemias (MCV: 80-100) are classified as hypo-proliferative (reticulocyte count < 2) or hyperproliferative (reticulocyte count > 2). As well as recent or ongoing haemorrhage, the hyperproliferative group includes hereditary, isoimmune, autoimmune and mechanical haemolytic anaemias. The latter group includes microangiopathic, macroangiopathic and malarial anaemias. In Malaria, Plasmodium parasites replicate inside red blood cells. The disease is characterised by periodical febrile attacks corresponding to erythrocytic schizonts rupturing, thereby releasing toxins and trophozoites. Malaria is NOT endemic to Egypt. Direct Coombs' test would be negative. Such an elevated lymphocytosis would be atypical.  Haemolytic uraemic syndrome (HUS) is characterised by microangiopathic haemolytic anaemia, thrombocytopenia, and nephropathy. Most cases are seen in the paediatric population following dysentery usually caused by enterohaemorrhagic E. coli (EHEC). Shiga-toxin produced by EHEC damages endothelial membranes (of glomerular capillary bed) causing microvascular clots; erythrocytes passing through these narrowed vessels are sheered and haemolysed. This diagnosis is made unlikely by demographics, no history of enteric illness and positive Coombs test.  Disseminated intravascular coagulation (DIC) is a life-threatening condition with various aetiologies and causes a microangiopathic anaemia like HUS. In DIC the coagulation pathway is massively activated to form many intravascular thrombi, depleting platelets and coagulation factors. Erythrocytes passing through thrombosed microvasculature are sheered and haemolysed. This diagnosis is made unlikely because, though there is a clear infective component to this patient's presentation she is haemodynamically stable (BP: 120/90). There is no suggestion of septic shock or DIC, also Coombs test would be negative.   Paroxysmal nocturnal haemoglobinuria (PNH) is an acquired haemolytic anaemia where synthesis of GPI by haematopoietic stem cells is impaired. As a result, erythrocytes do not present complement-protective receptors such as DAF and are more susceptible to complement-mediated lysis. The Coombs' test would be negative as haemolysis is not antibody-mediated. The infective picture that this patient presents with is not consistent with PNH.  Join- @booksfmge for more!

Case A 20-year-old female student is referred by her GP to your specialist clinic because she has felt unwell for the past two weeks. She has recently been on holiday to Egypt. She has had a sore throat and felt very fatigued. On examination she seems pale, her throat is inflamed and you palpate tender cervical lymphadenopathy. You examine her abdomen and find a palpable spleen just below the left costal margin. Her temperature is 38.9 C, BP: 120/90 mmHg. The GP did some blood tests, the results of which were the main reason for referral. These are shown below:   MCV: 93 fL Hb: 98 g/L LDH: 600 U/L Reticulocytes: 4% WCC: 13.0 x 109 / L Lymphocytes: 8.0 x 109 / L Neutrophils: 4.7 x 109 / L Direct Coombs test is positive with complement alone found on the surface of the cells. What is the most likely explanation for these blood results?

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Explanation- Membranous nephropathy (MN) is the most likely diagnosis given the patient's age, the presence of oedema, hypoalbuminemia and heavy proteinuria. The patient is presenting with nephrotic syndrome and MN is one of the most common causes of nephrotic syndrome in adults. MN derives its name from its histological pattern on light microscopy: glomerular basement membrane (GBM) thickening with minimal or absence of cellular proliferation. Primary (idiopathic) MN is the most common form and accounts for over two-thirds of biopsy-proven cases of MN. Men are affected more commonly than women (ratio 2:1 to 3:1) with two peaks of incidence between 30-40 years and 50-60 years. Wegener's granulomatosis is a systemic disorder that involves both granulomatosis and polyangiitis. It is a form of vasculitis that affects small and medium size vessels in many organs.  The disease can feature rapid progressive glomerulonephritis leading to chronic kidney disease. The diagnosis would seem unlikely in this scenario given the normal renal function and absence of systemic symptoms and haematuria. Minimal change glomerulonephritis typically affects children between the ages of two and four making it less likely based on the patient's age. The disease typically presents with normal blood pressure, oedema, hypoalbuminemia and proteinuria. Microscopic polyangiitis (MPA) is a vasculitis of small vessels. Patients frequently present with renal manifestations, but systemic manifestations, arthritis, mono-neuritis multiplex, and other signs and symptoms are also common  It can cause rapidly progressive glomerulonephritis and therefore its presentation can be similar to Goodpasture's syndrome. It is less likely in this scenario given the absence other systemic manifestations and the lack of haematuria in addition to normal renal function. Post-infectious glomerulonephritis occurs after a recent infection involving group A beta-hemolytic streptococci. It often presents with nephritic syndrome (rather than nephrotic syndrome in this scenario). Given there is no evidence in the history, examination or blood tests to suggest recent infection it is unlikely to be the diagnosis. Join- @booksfmge

Case A 52-year-old male presents with increasing swelling of his legs over the last three months. He has also noted his face appears swollen at times, more so in the mornings. In addition, he has noticed that his urine is "foamy". He is otherwise well, with no significant past medical history. On examination, you note widespread oedema, worst in the legs and urinalysis reveals significant proteinuria (++++).  Some investigations are performed with the following results: Blood pressure: 160/70 Pulse: 74bpm Haemoglobin: 140 g/L Creatinine: 90 μmol/ L Albumin:  22 g/L CRP: 3 Which of the following is the most likely diagnosis?

Last minute TIPS AND TRICKS for FMGE June 2021(last week strategy and exam day preparation). Those who are writing FMGE June 21 MUST WATCH!! Here's the link https://youtu.be/qoBj3I3zHwU Hope it will help you. All the very best.

Imatinib is a tyrosine kinase inhibitor used in the treatment of chronic myeloid leukaemia (CML). It has revolutionized the management of CML and has increased 5-year survival from 31% in 1993 to 59% in 2003. All other options are not used in the management of CML. The target for infliximab is the cytokine TNF alpha, making it effective for treating certain autoimmune conditions (Crohn's, ulcerative colitis and rheumatoid arthritis among others). Rituximab is also used in the management of autoimmune conditions as well as certain haematological cancers. Its target is CD20 B cells so it has no benefit in malignancies within the myeloid line such as CML. Finally, Vincristine is a chemotherapeutic agent used to promote apoptosis. This is not used in CML either. Join- @booksfmge