Neck Swelling

A 47 years old presented to A&E department because of choking. Apart from the problem, you notice something on her neck in which she defaulted treatment ten years ago. Below is the picture of her neck

1) What is your finding in the picture?

2) What is your differential diagnosis?

3) What further history you would like to obtain to make a provisional diagnosis

4) What investigation you would like to perform to support your provisional diagnosis.

5) What other signs that you would like to look for and why?

A 23 years Old Malay Female with Pancytopenia

A 23 years old Malay female presented with history of difficulty in swelling for three weeks duration and fever with lethargy for 2 weeks duration. On examination, she looks pale with mild dehydration. Full blood counts show pancytopenia with hypochromic microcytic anemia. There is no history of blood loss, heavy menses or hematuria. Below is the picture of her mouth.

a) What is your finding?

b) Give differential diagnosis for hypochromic microcytic anemia

c) What condition can cause pancytopenia?

c) What is your next step in managing this patient?

SOB with noisy sound

60 years old Malay Lady with history of thyroid carcinoma (undergone surgery to remove the gland two years ago) presented to A&E with shortness of breath and noisy sound for one day duration.

1) Describe the finding in the X-Ray
2) Explain the pathophysiology of the noisy sound
3) Outline the management for this patient