P1 CASE SCENARIO

Question 1

Nadia came back from work and found her 3-year-old boy crying and vomiting.
Nearby the container of her iron tablets was empty.
Q1:What clinical findings will be seen if he Ingested more than 40-60 mg of iron
per kg of body weight?

Answer 1

• Vomiting
• Hematemesis
• Diarrhea
• Hypotension
• Metabolic acidosis

Question 2

Nadia came back from work and found her 3-year-old boy crying and vomiting.
Nearby the container of her iron tablets was empty.
Q2-What diagnostic investigations needed?

Answer 2

• serum iron
• plain abdomen radiograph

Question 3

Nadia came back from work and found her 3-year-old boy crying and vomiting.
Nearby the container of her iron tablets was empty
Q3-What specific therapy is available?

Answer 3

deferoxamine by
constant intravenous infusion

Question 4

An 8-year-old boy had a hemoglobin concentration of 7 g/dl with MCV of 72 fl,
and absolute eosinophil count of 1 x 109
/L and reticulocyte count of 0.2 per
cent.
After excluding other causes of his condition, his microscopic stool
examination was diagnostic
Q1:What do you expect to see under the microscope?

Answer 4

. An embryonated hookworm egg.

Question 5

An 8-year-old boy had a hemoglobin concentration of 7 g/dl with MCV of 72 fl,
and absolute eosinophil count of 1 x 109
/L and reticulocyte count of 0.2 per
cent.
After excluding other causes of his condition, his microscopic stool
examination was diagnostic
Q2 : what os diagnosis ?

Answer 5

Anaemia due to hookworm infection

Question 6

An 8-year-old boy had a hemoglobin concentration of 7 g/dl with MCV of 72 fl,
and absolute eosinophil count of 1 x 109
/L and reticulocyte count of 0.2 per
cent.
After excluding other causes of his condition, his microscopic stool
examination was diagnostic
Q3:What are the drugs effective in treating this parasitic infection?

Answer 6

Anthelmintic drugs such as albendazole, mebendazole or pyrantel
pamoate

Question 7

For six months a 52-year-old female has noticed increased weakness,
palpitation, and easy exhaustion. She is on strict vegetarian diet with a sore tongue
for a year. She also was complaining of needle prick like sensations in her lower limbs.
On examination she was extremely pale and mildly jaundiced. Her pulse rate
was 100/min, and she had an ejection systolic murmur. with a red and
beefy tongue . The spleen was palpable . No abnormal neurological signs were found.
Q1: give differential diagnosis ?

Answer 7

• haemolytic anaemia
• liver disease
• B12 or folate deficiency

Question 8

Q2 :What initial investigations would you consider for the previous case ?

Answer 8

CBC ,reticulocyte count, peripheral smear, LFT

Question 9

Investigation Revealed:
Hb : 4.2 g/dL
WBC : 3.1 x 109
/L
Platelet : 107 x 109
/L
MCV : 118 fl
Reticulocyte count : 1.2%
Peripheral Smear : Gross anisopoikilocytosis, oval macrocytes and
hypersegmented neutrophils. Platelets were reduced.
Q3 How would you interpret the CBC results?

Answer 9

The CBC shows pancytopenia , macrocytic anemia with hypersegmented neutrophils
(suggesting vit B12 and/or folate deficiency)

Question 10

Q4 :what is the most likely diagnosis ?

Answer 10

megaloblastic anaemia