Case Studies

A 24-year-old white male was presented to the hospital with complaints of 2 weeks of progressively worsening pain and inflammation of his right wrist and left ankle joints. He had no medical history and did not report any fevers, chills, night sweats, weight loss or rash.  He also denied smoking cigarettes, alcoholism or any recreational drugs. He has a family history of hypertension in father and ovarian cancer in the mother. The physical examination has reported significant swelling of multiple joints, including right wrist, right elbow and left ankle. The joints were tender and erythematous. He had a limited range of mobility due to severe pain in joints.

 

What will most likely explain the pathogenesis of polyarthralgia in this case?

  • Rheumatological conditions such as Rheumatoid arthritis, Lupus, Lyme, Septic arthritis, Gonorrheal joint arthritis, or Gout
  • Hyperlipasemia, a rare paraneoplastic manifestation of pancreatic acinar cell carcinoma.
24min read    

A healthy 21-year-old white female college student with a visual aura consisting of scintillating scotoma followed by headache onset was presented for treatment. A headache was reported to be severe and throbbing in nature with nausea and mild confusion. She was advised to take NSAIDs during this time. There was no improvement in her symptoms, and a neurologist was consulted, and she was diagnosed with an acute migraine headache. Various nonspecific hyperintensities in the pericortical frontal lobe on T2-weighted images were revealed after an MRI scan with the exclusion of possibilities of stroke, multiple sclerosis, or other neurologic disorders.

 

What will be the most effective treatment for a migraine headache in this case?

  • Ganglioside analog such as Famciclovir
  • Combination of Cyclooxygenase-2 inhibitors (Celecoxib) and Ganglioside analog (Famciclovir)
19min read    

A 59-year-old man and 62-year-old woman were presented with degenerative gonarthritis. They had no issues of breathing, pulse and blood pressure. They also had no consciousness or sensory disorders.

 

Which of the following methods could be the suitable management option for this case?

  • NSAIDs
  • Knee Joint

  • Traction

  • Lateral knee injections

13min read    

A 9-year-old girl with newly diagnosed Type 1 DM, DKA, brain oedema, multifocal vasogenic brain lesions and lower limb paresis was presented for treatment. She had reported polyuria and polydipsia over the past week and a weight loss of 3 kg over the previous month prior to admission. The blood glucose level initially was found to be 1136 mg/dL, and severe acidosis was also present (pH 7.1; BE-25.9). Intravenous fluid therapy and insulin therapy did not show any improvement in her medical and neurological state. Glasgow Coma Scale (GCS) scores depleted from 13 points to 7 points. She experienced agitation and motor restlessness followed by upper limb spasms. Computed tomography scan revealed brain oedema and a hypodense lesion in the left temporal region. An anti-edematous treatment helped improve her medical condition, but she had developed symmetric lower limbs paresis. Brain magnetic resonance imaging (MRI) and nerve conduction studies revealed numerous, diffuse lesions and damaged motor neurons in both lower limbs with dysfunctional both peroneal nerves and the right tibial nerve respectively. She reported improvement in her health after therapeutic regimen intensive physiotherapy.

 

What will most likely explain the pathogenesis of acute neuropathy in this case?

  • Diabetic ketoacidosis

  • Peripheral ischemia

22min read    

A 22-year-old woman was presented with a new onset of seizures after delivering her first child. The headache moderately intense, non-positional, bifrontal, with a throbbing quality after one day. Her pregnancy was unremarkable, and she developed a cough, fever (39.6°) and tachycardia at the time of her delivery. She was also detected with influenza B virus infection on nasopharyngeal swab consistent with respiratory influenza. After seven days, she had generalised convulsions and right elbow flexion and head version to the left.

 

Which of the following syndrome explains the new onset of seizures and respiratory influenza infection?

  • Eclampsia

  • Posterior reversible encephalopathy syndrome (PRES)

  • Cerebral Thrombosis

  • Influenza-associated encephalitis

22min read