CME INDIA Case Presentation by Admin.
CME INDIA Case Study:
Developed Pyrexia, 5 days back. Took antibiotics and vitamins. Noticed yellow colour of urine after taking drugs…. Village practitioner thought yellow colour of urine as jaundice…. went for further treatment of jaundice.
After getting these lesions, came to me…
What could be these lesions?
Tests…. Malaria; Dengue…negative; Platelet count – Normal; FT – Normal.
CME INDIA Discussion
(Comments made before knowing full history of the case)
Dr Gajanan Repal, DNB General Medicine, Dharwad, Karnataka: ITP?
Dr Shashikant Nigam, MD Med., Ahmadabad: Fulminant hepatic failure.
Dr Manoj Saini, MD Medicine & Dy Physician to President: DD – Severe Malaria, Leptospirosis, Meningococcaemia.
Dr S K Goenka, Begusarai: Is its Obstructive jaundice?
Dr N K Singh: No.
Dr B K Shukla, Bihar: LFT PT/INR/ SER ALBUMIN, CBC, PRIPHERAL SMEAR
Dr N K Singh: Well… It is not a mystery.
See the TWIST in the Case
Dr N K Singh: Thanks for comments. But history solved the problem. It is not a mystery. Someone told that he has developed jaundice in village as there is anorexia and yellow urine. So, went to village jaundice remover. In many parts of India there are so called jaundice removers who use traditional methods. One such unscientific method is applying heat and herbal root over forehead. He applied some herbal root over fore head, leading to lesion. Chin lesions are due to nail bite.
Dr. Abhishek physician at Central jail hospital, Varanasi: 🤔😃
Dr Rajesh naik, Internist, Goa: In Goa people used to brand the forearm for any jaundice earlier when I was medical student in 1980. Now it not seen mainly in south Goa.
Dr B K Shukla, Bihar: 😊😇
CME INDIA Learning Points
Dr. Rajeev Kumar Gupta, MD Medicine, IMS BHU, Varanasi:
- That’s why in our medical teaching history taking was given prime importance 😆
CME INDIA Tail Piece
- A doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving bad treatment.
- A physician’s subject of study is necessarily the patient, and his first field for observation is the hospital. But if clinical observation teaches him to know the form and course of diseases, it cannot suffice to make him understand their nature; to this end he must penetrate into the body to find which of the internal parts are injured in their functions. That is why dissection of cadavers and microscopic study of diseases were soon added to clinical observation. But today these various methods no longer suffice; we must push investigation further and, in analyzing the elementary phenomena of organic bodies, must compare normal with abnormal states. We showed elsewhere how incapable is anatomy alone to take account of vital phenomena, and we saw that we must add study of all physico-chemical conditions which contribute necessary elements to normal or pathological manifestations of life. This simple suggestion already makes us feel that the laboratory of a physiologist-physician must be the most complicated of all laboratories, because he has to experiment with phenomena of life which are the most complex of all natural phenomena. – Claude Bernard
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Sir! Good case.
Branding was a traditional practice in many small interior villages in South India for chr. Abdominal pain, jaundice , porphyrias, etc.
Have seen multiple branding marks in & around the umbilicus.
They are linear & in zig Zag fashion.