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 October 2003
| Study 1 |
Acne |
Dermatology |
| Study 2 |
A Patient with Haemoptysis |
Radiodiagnosis |
| Study 3 |
A Baby with leg & foot deformity |
Orthopaedics |
| Study 4 |
The IE that wasn't |
Medicine |
| Study 5 |
Secondary Hypertension in Pregnancy |
Endocrinology |
Study 1: A PATIENT WITH ACNE
A Case from the Department of Dermatology, CMC Hospital, Vellore
1. What is Acne vulgaris?
Answer 1
2. What topical therapy would you use for Acne vulgaris?
Answer 2
3. What systemic therapy is used for acne vulgaris?
Answer 3
4. Name some adjunctive therapies for acne vulgaris?
Answer 4
5. AN ALGORITHM FOR TREATMENT OF ACNE
Acknowledgement: Dr. Dincy Peter, Department of Dermatology, CMC, Vellore.
Study 2: A PATIENT WITH HAEMOPTYSIS RADIODIAGNOSIS
A Case from the Department of Radiodiagnosis, CMC Hospital, Vellore
HISTORY
A 50 year old gentleman, a who has been treated for tuberculosis 4 years ago for 9 months with 2nd line anti - tubercular treatment (ATT), presented with
- episodes of mild haemoptysis,
- occasional black coloured sputum and 2 months duration
- fever on and off
RADIOLOGY
THE CHEST RADIOGRAPH
The Chest radiograph PA view is as below.
1. Describe the findings on the Chest Radiograph?
Answer 1
2. What is your provisional diagnosis?
Answer 2
3. What is the differential diagnosis of this condition?
Answer 3
4. What further radiological procedure would undertake to confirm diagnosis?
Answer 4
5. Describe the findings on the HRCT ?
Answer 5
6. What is your final diagnosis?
Answer 6
7. What is an Aspergilloma?
Answer 7
Acknowledgement: Dr. Sunithi Mani Elizabeth Alexander, Deparment of Radiodiagnosis, CMC, Vellore.
Study 3: A Baby with leg & foot deformity
A Case from the Department of Orthopaedics, CMC Hospital, Vellore
HISTORY
This 2 month old baby was brought with congenital deformity of the leg and foot. The parents are quite worried and would like surgical correction if required.
1. What is your diagnosis?
Answer 1
2. How would you manage this condition?
Answer 2
3. What is the eventual outcome in these patients?
Answer 3
4. What serious condition can this be mistaken for?
Answer 4
Acknowledgement: Dr. Vrisha Madhuri Walter, Professor & H.O.D., Deparment of Orthopedics, CMC, Vellore.
Study 4: The Infective Endocarditis (IE) that wasn't!
A Case from the Department of Medicine III, CMC Hospital, Vellore
HISTORY
- 18 year old student
- Fever, high grade intermittent for 2 months
- Cough and breathlessness for 2 months
- Jaundice, pedal oedema and haemoptysis for 2 weeks
- Was diagnosed pneumonia with sepsis and treated with multiple antibiotics
CLINICAL EXAMINATION
- Thinly built, pale
- Elevated JVP, pedal oedema and hepatomegaly
- No splenomegaly or other features of IE
- CVS: Cardiomegaly. Hyperdynamic apex. Loud S1. Palpable P2. Gr IV PSM at apex with extensive radiation
- RS: Scattered crepitations bilaterally
BASELINE INVESTIGATIONS
| Hb: |
8.8 gm% |
| Blood picture |
Aniso+ Hypo+. Retics: 3.8% MCV: 73.2. Ferritin: 325 |
| LDH |
1440 |
| Total count |
24400, Bf1,N87,L10,M2 |
| Platelets |
276000 |
| Urine microscopy |
Fine and coarse granular casts present. Pus cell and hyaline casts+ WBC 25-30 RBC 45-50 |
| MP*3 |
Negative |
| Liver Function Tests |
1.4/0.7/6.9/2.1/50/20/127 |
| Serum Creat. |
1.1 mg% |
| Chest X Ray at admission |
|
1. What are the differential diagnoses?
Answer 1
2. What further investigations would you ask for?
Answer 2
3. Describe the CT Scan findings.
Answer 3
4. What possibilities would you consider and what further tests would you ask for?
Answer 4
5. What is the final diagnosis?
Answer 5
6. What are the clinical features of Myxoma?
Answer 6
7. What are the conditions that are often confused with Myxoma?
Answer 7
Acknowledgement: Submitted by Dr. Subramanian Swaminathan, Lecturer in Medicine, CMC, Vellore.
Study 5: Secondary Hypertension In Pregnancy
A Case from the Department of Endocrinology, CMC Hospital, Vellore
HISTORY
30 year old housewife from Tripura G2P1L1 at 18 weeks gestation presented with
- Headache, dizziness, left loin pain of 2 months duration
- Hypertension at detection (210/130 mm Hg)
- No history of palpitations, visual disturbances, syncope.
- The loin pain was localized with no history of hematuria/renal stones.
- No proximal myopathy /easy bruisability
- Ultrasound abdomen revealed a large adrenal mass measuring 16x 9.6x8.6 cm pushing the left kidney downwards.
- She was referred to our center as a probable case of Pheochromocytoma complicating pregnancy
CLINICAL FEATURES
- Ht.-155cm ,Wt.-65kg
- No pallor, icterus,LNE
- No Cushingoid features
- Bipedal edema +
- No goiter
- Pulse -80/mt.
- BP-220/140 (supine)
- -174/130 (standing)
- No mucocutaneous neuromas
- CVS- JVP-N , A2 loud
- Abd.-bimanually palpable left loin mass,FH+
- CNS- Gr.II HT changes, prox.myopathy+
- No virilisation
1. What are the investigations you would like to ask for?
Answer 1
2. Describe the CT Findings
Answer 2
3. List the problems that need to sorted out and say how you would proceed?
Answer 3
4. What are your differntial diagnoses?
Answer 4
5. Discuss the epidemiology of Adrenocortical carcinoma
Answer 5
6. How would you stage Adrenocortical carcinoma?
Answer 6
7. Discuss the treatment of Adrenocortical carcinoma
Answer 7
8. Describe the histopathological findings
Answer 8
Acknowledgement: Submitted by Dr. Anjali, Dr. Aravindan Nair, Dr. Nihal Thomas, Dr. Simon Rajaratnam, Dr. M.S. Seshadri, CMC, Vellore.
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