1.

A 63 year old women suddenly

fainted and became unconscious, and
when consciousness returned she was
unable to move her left arm and left leg.
Examination revealed absence of
plantar reflex, loss of speech and
paralysis of left arm and left leg with
increased muscle tone and
exaggerated tendon reflexes.
Questions:
1.What is your diagnosis?
2.Where is the probable site of the
lesion?
UMN LESIONS., INTERNAL CAPSULE.
 Case study

2. A patient was admitted to the hospital with multiple fractures after minor
injury. The investigations revealed low serum calcium levels.
1. What changes do you expect in x-ray appearance of bones?
2. Which endocrine dysfunction could have lead to this condition?

FRACTURES. . PARATHYROID GLAND

3.An old man Of 45 years noticed difficulty in initiating any movement. His
walking was extremely slow. On examination his face was lacking an
expression.
1.What is your diagnosis?
2.What is the cause for expressionless face?
4. A girl aged 9 years, very short statured for her age.
1.Mention two possible endocrine causes for the same.
2.Mention three signs and symptoms that will help to differentiate between the
two causes

Dwarfism & Thyroid dwarf

GH - SHORT STATURE,MENTALLY NORMAL,

SEXUALLY NORMAL.
T4-SHORT STATURE, MENTALLY RETARDED,
HYPOGONADISM.
5. A young female exhibits abnormal fatigaubility of
muscles, muscular movements though initially
strong, rapidly tires as the day advances or after a
vigorous exercise. The symptoms that appear are
ptosis, weakness of muscles, swallowing and
speaking. She was unable to undertake the work
above the level of the shoulder. The symptoms
showed a remitting course and often were
precipitated by emotions, infections. Normal
remarkable recovery was seen after injection of
Neostigmine intramuscularly.
Question:
1.What is your diagnosis?
2.What is the main cause for this condition?
3.How does injection of Neostigmine improve the
condition?
Myasthenia gravis, lack of ACH receptors, ACH esterase
enzyme improves ACH effect
6. A 69 years old man goes to physician. As he sits in the
waiting room, he is observed to have tremors in his
hands and fingers. His face is unexpressive, and he
makes few movements. When he is invited to enter the
physician's office he has difficulty in standing up. He
walks slowly into the office and his arms do not swing
appreciably. When he talks to the physician, his
speech is monotonous, but he shows no intellectual
deficit. There was no sensory loss. The stretch reflexes
were normal and the muscles exhibit rigidity.
Question:
1.What is your diagnosis?
2.Which part of the nervous system is involved in this
disease?
3.Why are the movements so few and slow?
4.What is the treatment?
PARKINSONS DISEASE, BASAL GANGLIA, RIGIDITY OF
MUSCLES, L-DOPA&CARBI-DOPA
7. A patient comes to a doctor with the history of
swelling of the legs, which increases towards
evening. On examination there was pitting
edema, distension of neck veins, enlargement of
liver, which was soft and tender. Patient also had
oliguria and nocturia. Jugular venous pressure
was raised.
FOLLOWING WERE THE RESULTS OF
INVESTIGATIONS.
1. Urine - Normal.
2. X-ray chest: Rt. Ventricular hypertrophy.
2.ECG: Elevated 'P' wave.
Question:
1.What is your diagnosis?
2.How do you explain dependent oedema and
enlargement of the liver?
CHRONIC RIGHT HEART FAILURE, FLUID
8. An individual was brought to a hospital from the
site of an accident. He showed following signs
and symptoms.
Restlessness
Extreme weakness
Pale, cold, clammy skin
Rapid thready pulse
Hypotension
Oliguria
Questions:
1.What is your diagnosis?
2.How do you explain the signs and symptoms?
3.What immediate treatment do you suggest?
CARDIOGENIC SHOCK, VASOCONSTRICTION
REDUCTION IN GFR. INCREASE IN HEART RATE,.. BLOOD
9. A 35 years old business executive complains
of pain on the upper abdomen, which is
relieved by taking food. His basal secretion of
HCL was 6 meq/L and secretion during
augmented histamine test was 35 meq/L.
Pain is due to sympathetic over stimulation
causing non-secretion of mucous.
a. What is the likely diagnosis in this patient?

b. Mention one other agent that can be used to

provoke gastric secretion?
d. Why is the pain relieved by taking food?
e. What will be the effect of vagotomy in this
patient?
PEPTIC ULCERS, GASTRIN, DUE TO THE POST
PRANDIAL ALKALINE MEDIUM, REGULATION OF
PHASES OF GASTRIC SECRETION IS LOST
10. A women aged 30 years complains of general fatigue,
breathlessness on exertion, giddiness, headache, palpitation
anorexia and dysphagia. On examination the patient showed
pallor of the skin and mucous membranes, tachycardia,
glossitis, spooning of the nails, (some time tingling in the
fingers and toes) and oedema of the dependent parts of the
body.
Investigations revealed:
Hemoglobin: 6g/100 ml
R.B.C count: 3 millions/c. mm of blood
M.C.H.C: 28 gms/100 ml of cells.
M.C.V: 60 cubic microns
Eosinophilia +
Stool exam: Hook worm ova present.
Question:
1.What is the type of anemia in this patient?
2.What is the cause of anemia in this patient?
3.Mention the principles involved in the treatment of this patient

MICROCYTIC HYPOCHRONIC, . IRON DEFICIENCY,

administration of ferrous ion intramuscularly
11. A bar tender received a stab injury in the back which resulted in spastic
paralysis in the right leg. There was loss of sensibility to pain and
temperature on the opposite side of the body, with disturbance of
proprioceptive sensation on same side.
1. What is your diagnosis?
2. Explain the difference in sensory modalities.

BROWN SEQUARD SYNDROME

12. A female aged 55 years comes to a doctor with the
complaint of intermittent soreness of the tongue and periodic
diarrhea in addition to fatigue, breathlessness, anorexia and
pins and needles sensation. On examination the skin and
mucous membranes are pale, the tongue is red and
ulcerated, spleen is not palpable.
Investigation revealed:
1. Histamine-fast achlorhydria
2. RBC Count: 1 million/mm3of blood.
3. RBC’s are irregular in size and shape
4. Occasionally nucleated RBC present in Peripheral blood
5. Thrombocytopenia
Question:
1. What is the type of anaemia in this patient?
2. What is the most probable cause of anaemia this patient?

3. What are the principles involved in the treat

Megaloblastic anaemia (macrocytic normochromic), VIT -
B12 DEFICIENCY, folic acid & vitamin B12 supplied in diet
with B12 THERAPY
13. A patient comes to a doctor with a history of yellow
discolouration of the sclera and skin. The stool was pale or
clay coloured, bulky and foul smelling. He also developed
itching and loss of appetite. On examination there was
bradycardia: the sclera, mucous membranes and skin were
stained yellow.
INVESTIVATIONS REVEALED THE FOLLOWING RESULTS:
Stool: Stercobilinogen - absent
Urine: Bilirubin - Present Blood: Coagulation Prolonged
Serum Albumin- lowered
Serum Bilirubin- 6 mg/100 ml
Liver function test- serum enzyme test elevated Van den Bergh
test: direct +ve.
Question:
1.What is your diagnosis?
2.Why the stool was pale, bulky and foul smelling?
3.Why the Van den Bergh test was direct +ve

Obstructive jaundice, Stercobilinogen absent,

conjungated bilirubin is present.