Real medicine

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