Quick Assessment of Data Interpretation Skills ( QADIS ) with Key

1. Quick Assessment of Data Interpretation Skills (QADIS) with Key Instructions: Please read the scenario and data carefully and answers the questions given below each data. Time allocated for each patient is 2 minutes

2. A 63 year-old male presented with history of haemoptysis and cough for the last 02 years. He is a chain smoker (20 cigarettes / day). His biochemical profile is like this: • Ca: 3.20 mmol/L (2.10 – 2.55) • Phosphates: 0.7 mmol/L (0.81-1.45) • Urea: 8.2 mmol/L (3.3 – 6.6) • Creatinine: 102 mol/L (78 – 115) • Plasma PTH: < 2 pmol/L a. What is the most probable diagnosis in this patient? • Name ONE hormone which is leading to HYPERCALCAEMIA Patient No 1 • Humoralhypercalcaemia of malignancy due to Lung Malignancy • PTH-related peptide

3. A 62 year-old-male patient having following arterial blood gas analyses results: • pH : 7.40 (7.35 – 7.45) • Base Excess: 21.8 (<+3 - >-3) • PCO2 : 10.7 (4.7 – 6.0 kPa) • PO2 10.9 (10.7 – 13.3 kPa) • HCO3 51.1 (23 – 33 mmol/L) • Oxygen Sat 95.1 (95-98%) a. Name the ACID BASE Abnormality in this patient? b. Name TWO clinical conditions which can lead to this HCO3 result Patient No 2 • Double opposing disorder i.e. Metabolic Alkalosis and Respiratory acidosis • Upper GI Vomiting and diuretics

4. A 33 year old male had a fasting lipid profile as a part of his regular screening. His past medical history is not significant. Presently he is not on any medications. His lipid profile is as under: • Triglycerides: 1.13 mmol/L (<1.87) • Cholesterol : 4.45 mmol/L(<5.1) • HDL Cholesterol: 0.73 mmol/L(>1.0) • LDL Cholesterol: 3.53 mmol/L(<3.62) • Which lipoprotein is abnormal in this patient? • Name TWO complications (other than atherosclerosis) which can be caused due to this biochemical abnormality Patient No 3 • Low HDL-Cholesterol • Malignancy, poor response to infection and complications in diabetes mellitus

5. A 32 y male has a unilateral swelling of his left testis and symptoms of hyperthyroidism. His thyroid profile was as following: • Serum Free T3 4.12 ng/ml (1.60-4.20) • Serum T4 2.18 pg/ml (0.70-1.68) • Serum TSH 0.14 mIU/L (0.30-4.0) • The most probable testicular tumour you would like to exclude • Would you like give anti-thyroid medicines to this patient? Patient No 4 • Embryonal carcinoma • No

6. A newborn with neurological deterioration with moderate hepatocellular disturbance, hypotonia, seizures and coma. His biochemical findings are:• Alkalosis: +• Ketones : +• NH3: ++++• Lactate: Normal• Glucose: Normala. What is the most probable diagnosis in this patient? b. Name the amino acid metabolism most likely affected in this baby? Patient No 5 • Urea cycle defect • Ornithine

7. A patient presented with vague complaints. He had no tremors or weight loss. His pulse was 82 /minute: • Free T4 : 72 pmol/L (6-21) • Total T3 : 9.2 nmol/L (1.1-2.7) • TSH: >75 mIU/La. What is the most probable diagnosis in this patient? b. Name the pathogenic mechanism causing this disease Patient No 6 • Thyroid resistance syndrome • It is defect of thyroid hormone receptor which are present in the peripheral tissues and in pituitary.

8. A 2 years boy presented with abdominal pain, vomiting; neuropathic pain and neuropathy. His urine tests showed following results: • Total Porphyrin 64.0 nmol/mmol creat (0 - 35 ) • Porphobilinogen 20.2 µmol/mmol creat (0 - 1.5 ) • Delta-Aminolaevulinic Acid 7.2 µmol /mmol creat (0 - 3.8 ) • Creatinine 3.9 mmol/L • Plasma fluorescence peak at 620 nm a. What is the most probable diagnosis in this patient? b. Name the enzyme which is deficient in this patient? Patient No 7 • Acute intermittent porphyria • Porphobilinogen deaminase

9. A female aged 65 years, presented in semi-conscious state Plasma • Na : 153 mmol/L (135–150) • K : 4.5 mmol/L (3.5 – 5.0) • Cl : 118 mmol/L (98-108) • HCO3 : 34 mmol/L (23 – 33) • Urea : 15.2 mmol/L (3.3 – 6.6) • Osmolality: 393 mmol/Kg (275 – 295) • Glucose (R) : 43 mmol/L (3.5 – 11.1) Urine: • Ketones: Trace a. What is the most probable diagnosis in this patient? b. Name the most important treatment to be started immediately in this patient? Patient No 8 • Non-ketotic hyperosmolar diabetic come • Rehydration

10. A 57 y old female admitted for cough and fever of about 4 months duration. Her radiological investigations show evidence of extensive granalumatous involvement of lungs and liver. Treating physician has confidently excluded tuberculosis in this patient. Following are her lab investigations • Ca : 3.44 mmol/L (2.15–2.55) • PO4 : 0.96 mmol/L (0.60 – 1.25) • Albumin : 40 g/L (37-52) a. What is the most probable diagnosis in this patient? b. Name ONE biochemical investigation which can be very helpful in confirmation of the diagnosis. Patient No 9 • Sarcoidosis • Serum ACE levels

11. A 36 years female who is mother of two children has a body mass index (BMI) of 31. She has facial hirsutism and amenorrhoea for the last 2 months. Her routine biochemical profile shows Plasma • Glucose (F) : 6.9 mmol/L (3.3-5.6) • ALT : 21 U/L (< 42) • ALP : 186 U/L (< 306) • Triglycerides : 4.8 mmol/L (<2.83) • HDL-C : 0.7 mmol/L (>1.0) • HbsAg: Negative • Anti-HCV : Negative a. Name ONE HORMONE test you will advise in this patient as a first line test. b. Write TWO possible causes of hirsutism in this patient. Patient No 10 • Urine pregnancy test • PCOS and Cushing Syndrome (CAH is unlikely at this age)

12. Thank You