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15 Case Scenarios

A 45-year-old male vegetarian presented with fatigue, numbness and tingling in hands and feet. Examination found pallor and macrocytic anemia. This suggests vitamin B12 deficiency which can cause macrocytic anemia and neurological symptoms if untreated. A newborn presented with jaundice immediately after birth. Lab tests found elevated bilirubin and signs of breastmilk jaundice. This is a common condition caused by breastmilk inhibiting the baby's ability to clear bilirubin, which can cause complications if severe or untreated. A 10-year-old boy presented with prolonged bleeding after tooth extraction, similar to family members. Tests found low platelets. This suggests

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71 views5 pages

15 Case Scenarios

A 45-year-old male vegetarian presented with fatigue, numbness and tingling in hands and feet. Examination found pallor and macrocytic anemia. This suggests vitamin B12 deficiency which can cause macrocytic anemia and neurological symptoms if untreated. A newborn presented with jaundice immediately after birth. Lab tests found elevated bilirubin and signs of breastmilk jaundice. This is a common condition caused by breastmilk inhibiting the baby's ability to clear bilirubin, which can cause complications if severe or untreated. A 10-year-old boy presented with prolonged bleeding after tooth extraction, similar to family members. Tests found low platelets. This suggests

Uploaded by

Ramya Kutty
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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A 45 year old male who is a strict vegetarian came to OPD with

complaints of easy fatigability, tingling and numbness in the hands and


feet. On examination there is pallor, red beefy tongue.
Haemoglobin 9.8g/dl
Peripheral blood smear shows macrocytic normochromic RBC.
i. What is the likely diagnosis?
ii. What could be the cause of this clinical condition?
iii. Why RBC are macrocytic in this condition?
iv. What complication can occur if untreated?

A Rh-negative mother delivers a baby who develops jaundice


immediately after birth. General examination of baby revealed Heart
rate: 80 beats/min. Icterus +, Irritability +, Liver palpable
Laboratory investigations:
Serum Bilirubin : Total 10mg% ; Indirect 7mg% ;Direct 3mg%
Alkaline phosphatase 50U/L
Urine Urobilinogen +++
Feces Stercobilinogen +++
i. What is your likely diagnosis?
ii. Identify the type of jaundice in this case.
iii. What other complications that neonate might develop?
iv. How to treat this condition?
v. What could be done to prevent occurence of such condition in
neonate?

A 10 year old boy with no known medical problems has been admitted to
hospital for persistent bleeding after tooth extraction. Hemostasis had
been achieved initially after the extraction but subsequently prolonged
oozing from the tooth socket began. He had similar history in his family
members. Laboratory investigations showed Platelet count - 1.5 lakh
cells/cu.mm. of blood, Bleeding time 2 min, clotting time – 20min.
i. What is the probable diagnosis?
ii. Name similar conditions.
iii. What is the treatment?
A 16 year old boy was brought to the hospital with excessive bleeding
from an injury in his foot. He had past history of similar delayed stoppage
of bleeding associated with swelling of injured parts following blunt
trauma. His maternal uncle had similar history. Investigation revealed Hb
14 g/dl; platelet count 4 lakh/c.mm; BT- 5 min; CT- 12 min.
i. What is the probable diagnosis
ii. What is the type of inheritance of this disorder
iii. What is the treatment for this condition

A 55 year old male known hypertensive rushed to casualty with severe


central chest pain for the past 1 hour duration, associated with profuse
sweating and pain radiating to the medial aspect of left arm. On history
taking he used to smoke 20 cigarettes per day for the past 10 years.
i. What is the probable diagnosis?
ii. What investigations do you undertake to confirm the diagnosis?
iii. What are the ECG changes do you expect in this patient?
iv. What lifestyle modifications do you advice?

A 60 year old male patient from a village, who is a known diabetic since
10 years was brought to OPD with complaints of both right upper limb &
lower limb weakness for the past 10 days. On examination there is
hypertonia, loss of power of muscles in the affected limbs, and Babinski
sign present.
i. What is the probable diagnosis?
ii. What is the site of lesion? Which tract fibers are affected?
iii. What other clinical features can be observed?

A 55 year old male came to OPD with history of tingling sensation and
numbness in both hands and feet and he says that he becomes tired even
on mild exertion. On examination he was having pallor, sensory
dysfunction in both hands and feet. Blood investigations revealed
anaemia, MCV: 120µ3 and MCH: normal value.
i. What is the probable diagnosis?
ii. What other investigations he has to undergo?
iii. What is the treatment?
A 45 year old female came to OPD with complaints of passing of yellow
coloured urine, pain in the abdomen for the past one week. She also
gives history of passing greasy, clay coloured stools. On examination she
was found to have yellowish discoloration of sclerae and her serum
bilirubin was 6mg/dl.
i. What is the probable diagnosis?
ii. What is normal serum bilirubin level?
iii. What are the types of jaundice?
iv. What are the investigations she has to undergo and treatment?

A 48 year old woman came to medicine OPD with complaints of passing


large volumes of urine and excessive thirst since few days. She neither
had history of excessive eating nor associated with recurrent infections.
These symptoms started after she recovered from one episode of severe
meningitis.
i. What is the probable diagnosis?
ii. What is the cause of the disease?
iii. How do you differentiate between the two types of this clinical
condition?
iv. What investigations done to confirm the diagnosis?
v. What is the treatment?

A 25 year old man had developed change in behavior like decreased fear
and anger, increased curiosity, hyperphagia and hypersexuality. These
changes have started few days after he had undergone neurosurgery for
head injury.
i. What is the likely diagnosis?
ii. What is the cause of the disease?
iii. What are the functions of the structure that is involved?

A 25 year old male patient was brought to emergency OPD with history of
road traffic accident. His clothes are very bloody. On examination he is
pale with cold extremities. HR: 120bpm, BP: 70/50 mmHg, RR : 30/min.
i. Identify the clinical diagnosis.
ii. What are the types of this clinical condition?
iii. What is the treatment protocol?
A 62 year old male patient was brought to neurology OPD by his daughter
because of increasing difficulty in walking. On physical examination, his
facial expression was mask like with few eye blinks. His speech was soft,
monotonous. He had slow, resting tremor and pill rolling tremor in both
of his hands. When the neurologist tried to flex his arm, he felt many
catches, similar to a cogwheel.
i. What is your probable diagnosis?
ii. What other clinical findings can be observed during physical
examination?
iii. What is the cause of this clinical condition?
iv. How do you treat this condition?

A 30-year-old female demonstrated a subtle onset of the following


symptoms: dull facial expression; droopy eyelids; puffiness of the face
and periorbital swelling; hoarseness of the voice; sparse, dry hair; dry,
scaly skin; evidence of intellectual impairment; lethargy; a change of
personality; increased sleepiness. She also had history of weight gain of
10kgs in 6 months and menorrhagia.
i. What is the likely diagnosis?
ii. What endocrine organ is involved here?
iii. What investigations to be done to diagnose the condition?
iv. What are the other features of this condition?

A 50-year-old male had a total thyroidectomy followed by thyroid


hormone-replacement therapy. Thirty-six hours later he developed
laryngeal spasms, a mild tetany, and cramps in the muscles of the hands
and arms. The following tests were performed:
Plasma calcium 7.0 mg/dL
Plasma phosphorus 5.0 mg/dL
i. What endocrine disorder is present in this person?
ii. What caused the tetany and laryngeal spasms?
iii. How blood calcium is normally maintained at its physiological level?
A 45 year old man came to neurology OPD with the complaint of
clumsiness of right arm since 6 months which is getting worse. He noticed
increased clumsiness when trying to reach an object, during eating and
drinking. When he walks, he notices that now and again he tends to reel
over to the right, "as If he had too much alcohol to drink."
i. What is the probable diagnosis?
ii. What other clinical features can be observed?
iii. What is the cause of his problem?

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