Day-to-day medicine for medical students, interns and enthusiastic doctors!

This 58 years old teacher presented to your PP with a 3 days history of low grade fever one week back. At that time he had only a mild cough. He was treated with some cetirizine and oral azithromycin. A week later he presents to you again saying he still has on and off fever. What is your main concern? Scroll down for the answer. These are Janeway lesions. This patient had infective endocarditis. (Picture from Oxford case reports)

This patient has a long history of taking ayurvedic medications for chronic knee pain. What is the diagnosis? Scroll down for the answer Mee's line in chronic arsenic poisoning. There are many case reports in India describing arsenic poisoning associated with ayurvedic medications. There are several local articles as well!

This elderly lady presented with this itchy skin rash. The rash had been worsening for the last several weeks despite applying a betamethasone cream she found in a cupboard. What is the diagnosis? How would you treat? Scroll down for answer This is extensive scabies (Norwegian)

This kid was brought by a worried mother who thinks the kid has a problem in her neck. You examine the neck but neck looks normal. Where could be the actual problem? Scroll down for the answer She has right-sided trochlear (IV) nerve palsy

This belongs to a 68 years old man being investigated for altered bowel habits. What is abnormal? What is the main concern? Scroll down for the answer The right pedicle of L1 vertebra is missing!!  Suspect malignancy with metastasis or tuberculosis.

A 65 years old man presents with chronic backache. He has some symptoms of bladder outflow obstruction. He has no neurological signs in the lower limbs. DRE shows a moderately enlarged prostate with no suspicious features. How would you proceed? Scroll down for the answer. This shows the wall of a calcified aortic aneurysm. Lateral Xray

This 19 years old netball player came with on and off right sided non specific chest pain. On examination you noted an occassional ectopic beat. The patient is reviewed with this ECG. What would you do? Scroll down for the answer. This ECG features suggest the possibility of arrhythmogenic right ventricular cardiomyopathy . She needs to be seen by a cardiologist. What needs to be remembered is whenever you see a young patient with cardiac complaints, or with any ECG abnormality make sure to ask 1. Family history of cardiac deaths 2. History of syncopal episodes Unless specifically asked, it's unusual for them to come out with such points spontaneously.

This elderly lady from estate sector admitted with exertional shortness of breath. BP 140/90. Lungs clear. What is the cause for SOB? Scroll down for the answer The patient has jaundice, pallor, and pigmentation, suggestive of B12 deficiency. 

Oral hairy leukoplakia. The patient needs to be evaluated for underlying immunodeficiency, mainly HIV/AIDS.

Gottron's sign and Gottron's papules in dermatomyositis

These are only some of the causes of a 'red face'. You might not be expected to know how to differentiate these, but at least learn the differential diagnosis. 1. This girl came with a history of joint pains for 2 months duration. What is the likely diagnosis? This is the malar rash of systemic lupus erythematosus . The clinical history is compatible. Note the sparing of nasolabial folds. 2.  This 58 years old lady presented with a history of bilateral shoulder pain and weakness for 3 weeks duration. What is this physical sign? What is the diagnosis? This is the well known Heliotrope rash of dermatomyositis . Note the characteristic colour and involvement of the eye lids and the nasolabial folds. 3.  This 65 years old lady is under cardiology clinic follow up for chronic shortness of breath. What is the likely diagnosis? This facial flushing is very non-specific. Note that it's just erythema and there's no true 'rash'

This 54 years old patient is under medical clinic follow up for hypertension and diabetes mellitus. Both his blood pressure and blood sugar control are suboptimal. What are the clinical features shown here? Coarse facial features Prominent supraorbital ridges Enlarged lips/ nose - But to confirm has to be compared with old photographs Prognathism Enlarged hands and feet What is the diagnosis? Acromegaly How do you confirm the diagnosis? IGF1 level Oral glucose tolerance test with GH level. GH will not be suppressed. It can even rise. What are the treatment options? The commonest cause is GH secreting pituitary macroadenoma It can be resected through trans-sphenoidal approach or open craniotomy. Medical management (If unresectable or persistent disease after resection) Somatostatin analogues (Octreotide) Dopamine agonists (Cabergoline) GH receptor antagonists (Pegvisomant)