CME Learning Cases February 2004

CONTINUING MEDICAL EDUCATION,
CMC, VELLORE

© Department of Continuing Medical Education, Christian Medical College, Vellore
For more information please email: cme@cmcvellore.ac.in

Learning Cases February 2004

Study 1
Lady with Rash and Loose stools Medicine

Study 2
A Child with Movement Disorder Neurology

Study 3
An elderly gentleman with pain in the hip Radiodiagnosis

Study 4
A gentleman with Recurrent Staring Spells Endocrinology

Study 1	Lady with Rash and Loose stools	Medicine
Study 2	A Child with Movement Disorder	Neurology
Study 3	An elderly gentleman with pain in the hip	Radiodiagnosis
Study 4	A gentleman with Recurrent Staring Spells	Endocrinology

Study 1: MEDICINE

Lady with Rash and Loose stools

Courtesy: Department of Medicine, CMC, Vellore.

HISTORY

21 year old unmarried lady from an underprivileged background
Loose stools x 6 months
Rash over the hands and legs x 4 months
Fluctuating altered behaviour x 2 months
Difficulty in walking x 2months

ON EXAMINATION

Pallor, glossitis and angular stomatitis
Skin lesions as depicted
No dysmorphic features or evidence of deficiencies
Bilateral hypertonia with brisk reflexes without clonus
Hoffman and Tromner- positive Abdominal reflexes absent
Plantars downgoing bilaterally
Spastic broad based gait

1. Describe the lesions.

INVESTIGATIONS

Hb - 8.9 gm% Retics - 1.2% MCV - 71.1
White cells and Platelets normal
Total protein - 7.9, Albumin - 3.9
Calcium - 8.9, Phosphorus - 3.4
Vitamin B12 and Folate - Normal

2. What is your diagnosis?

3. What further investigation would you like to ask for?

4. What is the aetiology of pellagra?

5. What historical facts do you know about pellagra?

6. What relation does pellagra have to diet patterns?

7. Describe the clinical features of pellagra?

8. What are the risk factors for pellagra?

9. What is the treatment and prognosis of theis condition?

Acknowledgement: Submitted by Dr. Subramaniam, Department of Medicine, CMC, Vellore.

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Study 2: NEUROLOGY

A Child with Movement Disorder

Courtesy: Department of Neurology, CMC, Vellore.

HISTORY

9 year old boy with history of abnormal movements withpart of which are shown. Apart from that he also hascognitive impairment. He has this movements of thejaws with difficulty to close it. There is history of jaundice.

Observe the movements in the video clipping.

Click here to observe

1. What would be your probable diagnosis?

2. What would you expect in the examination of his eye?

3. In metabolism of which substance in the body is thebasic defect?

4. What is the diagnostic confirmatory test?

Acknowledgement: Submitted by Dr. Joe Jacob, Department of Neurology, CMC, Vellore.

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Study 3: RADIODIAGNOSIS

An elderly gentleman with pain in the hip

Courtesy: Department of Radiodiagnosis, CMC, Vellore.

HISTORY

An elderly gentleman, diagnosed to have carcinoma of the prostate, presented with hip pain and painful restriction of movements. Plain radiograph of the pelvis is shown below.

1. What are the X-ray findings?

2. What is your diagnosis?

3. Discuss the etiology of this lesion?

Acknowledgement: Submitted by Dr. Divyan Paul Pancharatnam, Dr. George Koshi, Dr. Shyamkumar NK, Department of Radiodiagnosis, CMC, Vellore.

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Study 4: ENDOCRINOLOGY

A gentleman with Recurrent Staring Spells

Courtesy: Department of Endocrinology, CMC, Vellore.

HISTORY

A 40-year-old gentleman with recurrent staring spells and progressive weight gain over 6months.

INVESTIGATIONS

An EEG reveals abnormal wave patterns over the right temporal lobe. The MRI findings are depicted below.

1. Describe the lesion

2. The most likely diagnosis is

3. What complications may arise in this patients?

REFERENCES

Newton DR, Larson TC, Dillon WP et al. Magnetic resonance characteristics of cranial epidermoid and teratomatous tumours. In: ASNR Abstracts, University of California, San Francisco, 1987, 945.

Grabb PA, Albright AL. Brain tumours of Congenital and developmental origin in infants and children: Clinical features and natural history.In: Tindall GT, Cooper PR, Barrow DL (eds): The Practice of neurosurgery, vol.I Baltimore, William and Wilkins, 1996, 822.

Acknowledgement: Submitted by Dr. Nihal Thomas, Department of Endocrinology, CMC, Vellore, from Pituitary passions by Nihal Thomas, Chrisopher White.

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