BMJ Elective Case Log

This is a 53-year-old hypertensive/hypothyroidism woman who recently underwent FNAC of the axillary lymph nodes (2 months back) after a follow-up USG showed enlarged lymph nodes and multiple cysts in the right breast. She had been noticing an inverted right breast nipple from the last 4-5 months associated with skin thickening. She had this cyst initially in both right and left breast, detected 5 years (2014) back, in a tertiary care hospital, during routine master health check-up and was reassured as it was thought to be a benign fibrocystic breast disease. However, 2 years later, she started to get on/off galactorrhea associated with intermittent right breast pain for the last 4 years. She was treated with cabergoline for her galactorrhea which used to subside the galactorrhea. She has a history of hysterectomy 3 years back. She does not have parental history of breast or any other cancer. Her grandmother died of non-breast cancer. She was being routinely assessed for the cyst f...

A 29-year-old-male with a strong family history of stroke and renal failure develops a fever of unknown origin for last three months. He has a history of hypertension. The general examination is found to be cachectic with tachypnoea. He also has a raised jugular venous pulse.  He is also found to have severe normocytic normochromic anemia, hypoalbuminemia, proteinuria, raised creatinine. He is put on regular hemodialysis. His previous chest xray showed a large right sided pleural effusion which on aspiration is found to be hemorrhagic and exudative with lymphocytic pleocytosis with normal pleural fluid ADA and negative CBNAAT. His Echocardiography assessments reveal severe concentric left ventricular hypertrophy LVH with preserved ejection fraction.  Which of the following is likely responsible for his severe anemia?  Blood loss during hemodialysis Chronic inflammation Folic acid deficiency Vitamin B12 deficiency Erythropoietin resistence.  ...

A 62-year-old male with a history of long-standing diabetes mellitus and hypertension presented to the outpatient department with complaints of exertional shortness of breath and pedal edema since three years. He also complains of intermittent claudication of both lower limbs after walking for around 250 meters since last three years with improvement upon standing for a few minutes. He also complains of episodes of dizziness after walking and has been noted to have a regular daytime somnolence with nocturnal apneic episodes and snoring. He also complained of sudden diminished vision of one eye three months back.   The general examination reveals a large central obesity and bilateral pedal edema along with hyperpigmentation of the skin and "peau de orange." His BMI is 34 kg/m2.  On investigations, his pulmonary function test and 2D Echo and an adenosine driven thallium perfusion scan turn out to be normal. His Hb is 8g % with microcytic hypochromic anemia with re...

A 35-year-old male, caterer by profession, has presented to the outpatient department with complaints of progressive shortness of breath and leg swelling for 4 weeks. He reports having these started with anorexia. He also reports having been treated with antimalarial drugs for suspected malaria 2 months back. He is a known alcoholic, drinking 250-300 ml thrice a week. The general examination noted normal vitals. Additionally, he has large central obesity with elevated jugular venous pressure and moderate to severe bilateral ankle edema. Cardiovascular examination reveals an apical beat felt at the seventh intercostal space near the anterior axillary line with a doubtful S4 gallop. His respiratory system examination is noncontributory. His laboratory investigations are notable for raised alkaline phosphatase, mildly elevated SGPT, borderline decrease in albumin, and increased glycated hemoglobin. His lipid profile, complete blood count, thyroid and renal function tests are normal. ...