PBL

PBL: Gout

Keywords 43 y/o lady Outpatient department pain, swelling and limitation of movement in her right knee awakened from sleep at night due to severe pain paroxysmal nocturnal Aggravating factor high protein meal – red meat, liver, kidney Extending to her ankle and foot Pic: swelling of right foot In the past weeks frequency and severity…

PBL: Osteoporosis

Keywords: 61 y.o lady visited outpatient department for annual checkup menopause – early 50s 5’ 7” & 52 kg BMI: 17 – underweight reduced bone mass? pain over back and hip joints worsening over months reduction in her height compared to previous health checkup reports no history of smoking sister, 60 y.o suffered hip fracture…

PBL: Uterine fibroids/Leiomyoma

Keywords: 36 yo woman married 5 years had oral contraceptives 2 years ago already discontinued fro 2 years infertility menstrual cycles regular and normal length not taking other regular medications not smoking no chronic diseases STD –ve male partner no sexual dysfunction Semen analysis normal Prolactin & TSH levels normal endometrial biopsy normal (rule out…

PBL: Inadequate antenatal care and malnutrition

Keywords: 38 yo Malay woman 6 months pregnant 6 children, 4 school going stays with her children in a village husband is a truck driver and is seldom at home only gone for antenatal check up 2 times unable to follow up her antenatal care anaemic & mild hypertension children are underweight mother believes certain…

PBL: Endometriosis

Keywords: 35 yo nulligravida woman cyclic debilitating pelvic pain realting to menses 3 year history failure to concerive & dyspareunia 2 year history menstrual cycles regular but heavy No history of STD Bimanual examination normal sized immobile retroverted uterus fixed left adnexal mass tenderness on palpation Ultrasound 8×6 cyst in left ovary Laparoscopy performed left…

PBL: Polycystic Ovarian Syndrome (PCOS)

Keywords 27 yo woman 10 year history erratic scanty painful menstruation thinning hair facial hair increasingly prominent intermittently on contraceptive pills without them, menstrual cycle only every 6 months overweight increased fasting insulin increased total testosterone increased cholesterol increased TG increased LDL, decreased HDL TG/HDL ratio increased (insulin resistance) Ultrasound of pelvis normal sized uterus…

PBL: Testicular cancer

Keywords: 16 yo male enlargement of right testes gradually increasing in size – 4 months no pain no trauma firm in consistency, non tender on palpation tumour markers carried out right orchidectomy carried out counselled on future management Hypothesis Testicular cancer Lymphatic blockage filariasis seminoma Hypertrophy Inflammation Hydrocele Extra learning issues Tumour markers AFP, hCG…

PBL: Graves’ Disease

Keywords: 35 y.o female secretary (brought in crying after a fight with her boyfriend, accuse him of hitting her) Fast & loud heartbeat Often anxious, nervous and unable to concentrate on her work (symptoms worsening) Could not tolerate hot temperature BP: 150/80 mmHg Pulse regular, pulse rate: 100 per minute Skin is warm & moist,…

PBL: Iatrogenic Cushing’s Syndrome

Keywords: 40 y.o woman Has diabetes & hypertension for 6 months On oral hypoglycemia & antihypertensive medication Height: 165cm Weight: 85kg BMI: overweight/obese Moon shaped facies Truncal obesity Abdominal striae Diminished motor strength of proximal limb muscles Also on prolonged oral corticosteroid treatment for rheumatoid arthritis for 5 years Wanted to stop the cortocosteroid immediately,…

PBL: Nephrotic syndrome

Keywords 5 y/o boy progressive swelling of lower limbs & puffy face (2 weeks) swelling of abdomen (1 week) Frothy urine easily tired, breathless on exertion examined by doctor: generalised oedema, hydrothorax, ascites, gross pitting pedal oedema CVS normal Hb low Urea & creatinine normal Serum albumin low Alkaline transaminase & alkaline phosphatase normal Urinalysis:…