Maheswaran Umakanth

• MBBS(SL),MD(Col),MRCP(UK), MRCP(Lon), FRCP(Edin) FCCP(SL) and Dip in Diabetes Senior Lecturer in medicine
• Consultant at Eastern University, Sri Lanka

I have included 53 common short cases for final year students.I clearly written the examination order and presentation

Melioidosis is a potentially fatal bacterial infection involving multiple organ systems and is increasingly being reported in Sri Lanka in recent times. The clinical presentation of the disease varies from localized cutaneous infections to sepsis and death. Involvement of the heart in melioidosis is rare and only a few cases have been described so...

Rhabdomyolysis is a potentially life-threatening condition characterized by muscle necrosis and the release of muscle constituents into the circulation. Rhabdomyolysis has several causes, however many of them are complex or ambiguous. Rhabdomyolysis can lead to complications such as acute kidney injury AKI), electrolyte abnormalities, compartment s...

Bee stings are one of the common clinical scenarios in day-to-day clinical practice in Sri Lanka. The spectrum of bee sting-related complications can vary from simple allergic reactions to life-threatening conditions and sometimes death. Anaphylaxis, cardiogenic shock, respiratory arrest, acute renal failure, vasospasm-related ischaemia, and acute...

Thyrotoxicosis-induced pancytopenia is a rare manifestation. The practical challenge is to differentiate thyrotoxicosis-induced pancytopenia from the side effects of anti-thyroid treatment following the commencement of treatment. Although some of the possible underlying pathogeneses have been reported, the complete mechanisms remain unclear concern...

Propanil is a widely used herbicide in agriculture and is also an important cause of poisoning in Sri Lanka. Incidence is around 2% and is commonly reported as self-poisoning. Although it is classified as an agent with low to medium toxicity, severe poisoning can cause lethal outcome and death especially when there is a limited medical facility. We...

Melioidosis is a pyogenic infection that is potentially fatal, caused by the bacterium Burkholderia pseudomallei, which is commonly a soilborne pathogen.It is endemic in the Indian subcontinent, northern Australia, and Southeast Asia. Melioidosis has a wide spectrum of clinical manifestations that can mimic various diseases. Septic arthritis is a r...

Idiopathic hypereosinophilic syndrome is a rare entity where the diagnosis is made after all the probable causes of hypereosinophilia are excluded. The characteristic organ involvement includes the heart, nervous system, lung, and gastrointestinal tract. The mainstay of treatment is corticosteroids. Patients who are unresponsive to the steroids req...

Sarcoidosis is a granulomatous disease with multiple system involvement. It is characterized by the presence of non-caseating granulomas in the involved organs. The most commonly affected organ in sarcoidosis is the pulmonary interstitium. However, extra-pulmonary involvement can be manifested in almost any other organ system. Less commonly, sarcoi...

Sinusitis is a common ailment a clinician comes across in their day-to-day practice. Simple as it may sound, it may become a very debilitating condition depending on the comorbidities of the patient and the organism involved. Rhizopus and Escherichia coli are less common organisms to affect the sinuses, but they are more common in immunocompromised...

Dengue virus infection is an arthropod-born infection with high global prevalence. A spectrum of clinical syndromes and complications were recognized following dengue fever that can range from undifferentiated fever to dengue shock syndrome. Neurological complications following dengue fever can extend to various sequelae, including transverse myeli...

Melioidosis is a systemic disease endemic in Southeast Asia and Northern Australia. The spectrum of the disease varies from asymptomatic infection to severe systemic manifestations. Timely diagnosis and treatment of melioidosis is a challenge due to its atypical presentations. We report a case of melioidosis causing cerebral abscesses and cerebral...

Russel’s viper (Daboia russelii) is a highly venomous snake erratically distributed in the South Asia and the Russell’s viper (RV) is responsible for 30–40% of the snake bites in Sri Lanka. Common clinical manifestations of RV bite are platelet dysfunction and coagulopathy, neurotoxicity, haemolysis, rabdomyolysis, nephrotoxicity etc. However incre...

Dengue infection may manifest as dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). The World Health Organization (WHO) came up with the term "expanded dengue syndrome" (EDS) to designate cases which do not fall into either DHF or DSS, with unusual manifestations in other organs such as the cardiovascular system, th...

Dengue infection can cause a wide spectrum of presentations extending from simple self-limiting febrile illness to severe dengue, including dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Dengue associated hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening condition characterized by the uncontrolled activation of m...

The dengue virus is a mosquito-borne flavivirus that causes dengue fever (DF), dengue hemorrhagic fever, and dengue shock syndrome. DF is characterized by fever, headache, arthralgia, retro-orbital pain, and skin rashes. However, some patients with DF develop post-dengue fatigue syndrome (PDFS) following their initial febrile episode. Fatigue is co...

Methemoglobinemia is a potentially life-threatening manifestation of Dapsone poisoning characterized by functional anemia and tissue hypoxia. With the increasing use of dapsone for various indications, acute poisoning (either accidental ingestion or suicidal) is increasingly recognized. We report a case of twenty year old female presented to the em...

dengue fever and leptospirosis have common clinical presentation and both these conditions are more commoner in rainy season. Differentiating them is a challenge to the clinician and serological diagnosis of dengue fever should not misdirect from diagnosing leptospirosis as a co-infection. WE here report a case of co-infection of dengue haemorrhagi...

Malaria is an infectious disease caused by Plasmodium parasites, mainly P. vivax, P. falciparum, P. ovalae, P. malariae and P. knowlesj which are spread through Anopheles mosquitoes. Disease is not endemic in SriLanka currently, but can be reintroduced from6thercountries,mostlyfromlndia,AfricaandAsia.Themainsignofthediseaseisfeverwithshiversrepeate...

DKA is a cardinal feature of type 1 diabetes, which has led to the widespread errant perception that it is a complication unique to type 1 diabetes due to insulin deficiency.[ ] It can be the first presentation of diabetes. This accounts for about 6% of cases. Diagnostic criteria for DKA include presence of blood glucose >250 mg/dL, arterial pH of...

Dengue fever is one of the most fearful viral infections in Sri Lanka. More than one hundred thousand cases are reported each year. [1] Dengue has various atypical presentations such as polyneuropathies, fulminant hepatic failure, myocarditis and pulmonary hemorrhage. [2] Although the occurrence of renal complications is rare with dengue, acute kid...

Kerala Ganja (KG) is a type of cannabinoid which is becoming an increasingly popular psychoactive substance amongst middle age and& adolescent population in Srilanka.It is used as an extract, by smoking, vaporizing & with the food. This substance have beenit is associated with wide range of side effects. Well known side effects of synthetic cannabi...

suicide behind

β thalassemia major is a common hemoglobinopathy in Sri Lanka. Klebsiella pneumoniae (KP) is a gram-negative capsulated organism responsible for various nosocomial and community-acquired infections. Transfusion-dependent splenectomized thalassemia patients are at risk of infections. Liver abscess is an infection to suspect in such patients, and, am...

Introduction: European cultural norms have influenced physicians' attire in Sri Lanka. The necktie is one such item of clothing which is worn to be recognized and respected as professionals. This study was carried out to assess the perceptions of doctors and patients towards male doctors wearing neckties while providing patient care. Methodology:...

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Background: Organophosphates (OPs) are regularly utilized as pesticides all over the world. Exposures to OPs cause countless cases of poisoning and death annually. Organophosphates inebriation generates a range of muscarinic, nicotinic, and cholinergic side effects including both central and peripheral nervous systems. OP compound’s simple accessib...

Crystal jelly balls are colorful and attractive beads like structures which are used in decorations and has a capacity to absorb water to expand. They are also known as water beads, jelly beads, water jelly balls and water monkey.[ ][2] It is a Superabsobent polymer (SAP), a hydrogel which forms multiple hydrogen bonds in an aqueous solution thus w...

It is a case report on macrophage activation syndrome in a patient with MCTD

Teaching in the clinical environment is a challenging, complex and often frustrating task.There are number of roles have been described for medical teachers, grouped into six major tasks, the information provider, the role model, the facilitator, the assessor, the curriculum and course planner; and the resource material creator.

There are several species of snake present in SriLanka, among that seven species of snakes are medically important poisonous snake such as Russell’s viper, Hump nosed vipers, Cobra, Saw scale viper, Indian Krait, Common Krait and Sea Snake. Snake bite can cause different types of clinical manifestation such as neurological manifestation, clotting a...

Hemophagocystic lymphohistiocytosis is a clinical condition characterized by the activation of either macrophages or histiocytes with a prominent hemophagocytosis feature in the bone marrow and other reticuloendothelial systems. It can be associated to infections, malignancies, autoimmune diseases, drugs and a variety of other medical conditions. W...

Parsonage turner syndrome (also known as neuralgic amyotrophy) (PTS) is an acute brachial neuritis of an unknown origin,first reported by Dreshfeld in 1887 . Patients with Parsonage-Turner Syndrome initially presents with an acute onset of excruciating pain over the shoulder. Lower motor neuron type paralysis with or without sensory impairment deve...

Brain abscess is a focal intracranial infection characterized as an area of cerebritis that evolves in a collection of pus surrounded by a vascularized capsule. Intracranial cerebral abscess is a potentially fatal neurosurgical emergency. bacterial species represent the most common etiology in immunocompetent individuals. The incidence of brain abs...

Abstract : Methotrexate is a disease modifying anti rheumatoid drug commonly used in treatment of rheumatoid arthritis and in many other inflammatory conditions. This is a case of methotrexate(MTX) induced hypersensitive pneumonitis in a patient with rheumatoid arthritis describes, clinical presentation, investigation findings and management princi...

Venous thromboembolism (VTE) that includes deep vein thrombosis and/or pulmonary embolism is a frequent, severe, and potentially lethal disease. After a first episode, VTE has a strong tendency to recur1. Deep-vein thrombosis (DVT) is regarded a chronic disease as it often recurs. DVT affects most frequently the lower limbs2.Furthermore, the incide...

Miller fisher (MF) is an atypical variant of Guillain-Barre syndrome(GBS) which consists triad of symptoms: ataxia, areflexia and ophthalmoplegia. It is a monophasic paralyzing illness which some symptoms and course of the disease is similar to GBS. Though it is a clinical diagnosis, can be confirmed with presence of anti GQ1 b-anti bodies in serum...

There are pros and cons doing fasting and random non-fasting lipid profile test. However, when we consider cardio vascular risk, non-fasting lipid test more reliable than fasting test. In current practice, using fasting lipid profile was challenged in 2007 by two studies that showed that random non-fasting triglyceride (TG) could be superior than f...

Chronic kidney disease (CKD) is major public health problems in SriLanka. Furthermore, it is often shared with poor health outcomes and high economical cost to patient, family and national health system. However, we don’t have exact incidental or prevalence report in a regional or national level. We conducted descriptive prospective study on end st...

Background: Organophosphate (OP) poisoning is a global issue, causing over 200,000 deaths annually especially in developing countries, such as Sri Lanka and India. Clinical presentation of a typical OP poisoning may follow three well-defined phases. The initial phase is an acute cholinergic crisis, after that Intermediate Syndrome (IMS) may develop...

Patients with serious mental illness have an increased prevalence of the metabolic syndrome in comparison to the general population. Metabolic syndrome is a constellation of cardiovascular risk factors including diabetes, hypertension, obesity and dyslipidemia. It is potentially reversible and may explain the higher incidence of cardiovascular dise...

Dengue viral fever is an acute febrile illness which is transmitted by Aedes mosquitoes. It presented with body aches, rash, nausea, fever, headache, pain behind the eyes, and vomiting which are common symptoms of dengue. Dengue infections can result in a wide spectrum of disease severity ranging from an influenza-like illness such as dengue fever...

Requesting patients to come with long fasting state (12 - 14 hours) for lipid profile measurements are a major inconvenience. However, most blood tests, even glycemic management, can be done in a non-fasting state, for example by requesting an HbA1C. It is understandable that when we order lipid profile test, laboratories are very rigid on fasting...

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a unique entity precipitated by a variety of drugs and often presents with variable clinical manifestations. It is also known as drug-induced hypersensitivity (DIHS) reactions, which leads to life-threatening anaphylaxis and rare cutaneous reactions. Most of the literature mentioned t...

Stroke as a disease entity has significantly increased the morbidity, incapacity, and mortality in Sri Lanka. In the west, it is the 3rd most common cause of death. In addition to that, it is a disturbing and restricting cerebrovascular disease with a substantial amount of remaining shortage leading on to emotional and financial burden on the famil...

Background: Deliberate self-harm (DSH) is a global problem which has steadily increased over the past few years in developing countries and has become as one of the major causes of morbidity and mortality in these countries. The aim of this prospective study was to analyze the prevalence of organophosphate poisoning among other acute DSH cases admi...

Dengue is viral infection, not only threat to SriLanka but also threat to the world. It belongs to family Flaviviridae and it responsible for nearly 100 million cases of dengue fever. It affects almost all the systems in our body including, heart, brain, liver, blood and kidney. Dengue fever, affects kidney in various manner, it ranges from glomeru...

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by low platelet count and skin-mucosal bleeding. It commonly affects adult female in an idiopathic and chronic manner. Thrombocytopenia associated with dengue viral infection seems to result in both from a reduction in the production of platelets from megakaryocytes and f...

Diabetes mellitus is a chronic, progressive disease with potentially serious consequences. Treatment for type 2diabetes often begins lifestyle modification with oral agents and ultimately requires insulin therapy. As the disease progresses, drug therapies are often intensified and rarely reduced to control glycemia. The incidence rates of remission...

At last, by the grace of Almighty God, I have succeeded in bringing out the first edition of “Emergency Concepts for Nursing Students”. The idea behind the preparation of the book is to give proper, concise, comprehensive and complete picture of basic concepts of emergencies in medicine. I try to cover the most of objectives in emergency concepts m...

Snake bite is an imperative cause of mortality and morbidity in SriLanka. The Russell's viper (Daboia russelii) is responsible for 30-40% of all snakebites and the most number of life-threatening bites of any snake in Sri Lanka. The neurological consequences of snake bite are predominantly the result of inhibition of neuromuscular transmission. We...

Dengue encephalitis is a different entity, which possibly occurs due to direct neuronal infiltration by the dengue virus. Encephalopathy is a rare though well-known neurological complication of dengue infection. These two different cases, therefore, highlight the lack of a definite scientific explanation of the exact pathogenesis behind neurologica...

Abstract: Dengue fever is endemic in countries of south and south-east Asia. Dengue fever may be complicated with dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Owing to the increase in dengue cases, atypical manifestations are also on the rise. The dengue virus, a member of flavivirus group in the family Flaviviridae, is a single-...

Abstract: Dengue fever is caused by infection with any of four mosquito-transmitted dengue viruses (DENV-1–4) and is characterized by fever, headache, myalgia, and leukopenia. Hemophagocytic lymphohistiocytosis (HLH) is a potentially lethal hyperinflammatory syndrome. HLH is characterized by a constant activation of CD8+ T lymphocytes and natural k...

Background: Anaemia is one of the common complications associated with Chronic Kidney Disease (CKD) liable for the increase in the morbidity and mortality in such patients. Numerous factors have been attributed to cause renal anemia, amongst which hyperparathyroidism is one of the less recognized reasons. The excess amount of Parathyroid Hormone (P...

Abstract Background: Deliberate self-harm (DSH) is a global problem which has steadily increased over the past few years in developing countries and has become as one of the major causes of morbidity and mortality in these countries. The aim of this prospective study was to analyze the prevalence of organophosphate poisoning among other acute DSH c...

It’s a great pleasure for me to write this foreword for the wonderful book on “Acute Medicine for medical Professional, A Symptom-based Approach” being published by my colleague Dr.M.Umakanth, MBBS, MD, MRCP(UK), MRCP(Lon), Senior lecturer in Medicine, Faculty of health care Sciences-Eastern University SriLanka.I have known him for couple of decade...

Peritoneal Tuberculosis is a rare extra-pulmonary presentation of tuberculosis. It caused by strains of mycobacterium, usually mycobacterium tuberculosis. Even though TB has been declining in incidence in the developing country like SriLanka, it remains a main problem in endemic areas of the developing world. A wide spectrum of clinical presentatio...

FOREWORD It is with a great pleasure to write a foreword message “MCQ and BOF for Medical Students’ written by my colleague Dr M Umakanth MBBS, MD, MRCP (UK), MRCP (Lon), Senior lecturer in Medicine. Multiple Choice Questions (MCQs) are generally recognized as the most widely applicable and useful type of objective test items. They could be used t...

Acute pancreatitis is defined as an acute inflammation of the pancreas that may also involve peripancreatic tissues and/or remote organ systems. Although the common causes of acute pancreatitis are gallstones and alcohol consumption, drug-induced cases are also reported frequently. While disease-modifying anti-rheumatic drugs (DMARDs) induced pancr...

There are numerous kinds of centipedes present across the world. All species hold venom in their glands. However, a bite of each kind has its reactions. According to researchers, it has not been that bites of centipede killed people or pets. The symptoms of centipede stings vary depending on the degree of allergic reaction and the size of the centi...

The rate of non-fatal deliberate self-harm (DSH) in Sri Lanka has increased in recent years, with associated morbidity and economic cost to the country. Pesticide ingestion is the commonest mode of suicide in Asia with an estimated loss of around 300,000 lives every year. We conducted a cross-sectional observational study in patients with 12 years...

: Tuberculosis (TB) is commonly associated with poverty and undernutrition in both developed and developing countries. Being underweight has been associated with a higher risk of tuberculosis in several studies. A retrospective descriptive study was conducted to analyze TB surveillance data from the chest clinic teaching hospital Batticaloa, in Sri...

It is a case report on Melioidosis patient with multiple skin and splenic abscesses complicated with sepsis

It is a case report on microscopic polyantiitis with nasal septal perforation