Real medicine

 A 9 year old girl had developed fever which was high grade associated with joint swellings. She states that all her joints we're swollen small and large joints of both the limbs. She had complaints of generalised weakness for the next 3 months. She was married at the age of 13 years. Even till this age she had the previous complaints of joint swellings. Her husband tells that her joints used to swell intermittently whenever she works and that she always was lethargic and weak. 4 years back she developed blisters on the arms and legs which were filled with fluid and pruritic.. These lesions were sudden in onset preceeded by burning sensation followed by itching sensation. She also had complaints of generalised weakness so much so that she could not get up. This weakness was associated with tingling sensation of the limbs and spasmodic contractions of the muscles. She was diagnosed to be hypocalcemic and was treated accordingly. The husband gives history of skin biopsy but

A lady who was married at the age of 15 years and who conceived 5 children 4 boys and 1 girl, had lost her first 2 children both boys at the age of 6 months to 1 year. Later she lost her husband at the age of 41 years. She was told that her husband had died because of Kidney failure. At the age of 45 she lost her eldest son. She was quiet disturbed with the loss of her husband and eldest son.                                          She had complaints of dizziness on and off since 4 years, she was diagnosed to be having low Blood pressure and was given salt. 3 years back she had developed a wound on the hand which got infected and then she was diagnosed to be having diabetes mellitus and was started on Glycomet M1. She also had complains of generalised weakness and paraesthesia of all the limbs since 1 year. She had complains of generalised weakness , giddiness , parenthesias on and off. She had a hypoglycaemic episode 6 months back for which her oral hypoglycaemic dose had been chan

 A old man of age 70 years presented to the hospital with complaints of generalised weakness and pain the oral cavity since 1 month.                                          The old man was apparently symptomatic when he complained of generalised weakness since 1 month. He states that the weakness is more in the lower limbs than the upper limbs. He describes the weakness as not being able to get up after sitting down. The man states that he finds it difficult to get up from sitting posture since the past 1-2 months. He has no complains of slippage of footwear. no h/o any sensory loss in the foot, no h/o any weakness in the upper limbs, no h/o any difficulty in buttoning the shirt or combing hair. No h/o any sensory loss in the upper limb.                                           The old man also complains f pain in the oral cavity below the tongue since 10 days. Also complains of burning sensation in the epigastric region since 10 days which aggravates on having food.    

A couple who was into agricultural works had 4 children, 2 sons and 2 daughters. The 2 nd son had no visible umbilicus at birth. He also had increased breast tissue mass bilaterally during the childhood.                            He got married at the age of 15 years but he and his wife didn't conceive children for the next 25 years. He married again and with the second wife he had 4 children, all 4 sons.                             He gives h/o fall from a tractor 15 years back after which he tells to have developed a defect in the abdominal wall near the umbilical region and developed a swelling which gradually progressed over the years.                             He later had a thorn prick in the left foot 10 years back which later progressed into swelling and colour change in the left foot. He went to a local hospital where he was diagnosed to be having Diabetes mellitus. His foot had to be amputated because of gangrenous change.                          Gives

A girl was married at the age of 15 years to a man who was marrying for the second time as his first wife had expired. The man had no children with the first wife.                    She had regular menstrual cycles of 30 days with 3 days of moderate blood loss. Inspite of regular cycles she could not conceive for many years. She consulted a doctor who prescribed her medications to conceive but her husband did not want her to take the medications and conceive, so he threw the medications. The couple has no not conceived a child since then.                                         The lady at the age of 45 years developed shortness of breath on exertion for 2 months followed by pain in the ?left hypochondrium ? left thoracic cavity  which was stabbing type for 1 month. The pain aggravated on walking and had no relieving factors. She was taken to a hospital where she was told that she had pericardial effusion and needed to get operated. She was evaaluated, a 2D echo was done which