Clinical Conundrums to Practice Diagnostic Reasoning
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Part ?: Clinical conundrums.- 1. Reversible cause of coma in a previously healthy adult : The miraculous recovery.- 2. A Group of People Presenting with Gastrointestinal Symptoms and Blurring of Vision: Mass Casualty.- 3. Patient presenting with vomiting, hypovolemia, Kussmaul’s breathing and normal blood sugars – Pratik decides to party!.- 4. Sudden Death in Polar Climes : The Arctic Trek.- 5. Rash and neuropathy in an adult male: The retreat by the Ganges.- 6. Fatigue and gait disturbance: The failed assassination.- 7. Cluster of Unexplainable Symptoms: The Hysterical Wife.- 8. Adult male with muscle ache& difficulty in moving - Heavy Fuel.- 9. Young woman with agoraphobia, anxiety and difficulty in ambulation: Frankenstein’s sister.- 10. Dysphagia in a young male with no pallor or lymphadenopathy – Hard to Swallow.- 11. Adult male presenting with anxiety, palpitations and diaphoresis - Anxious Allen.- 12. Cluster of Patients with Unexplained Jaundice : The Great Indian Wedding.- 13. Adult Male Presenting with Left Foot Drop and Tingling Numbness both Feet: Nervous Norman.- 14. Sudden loss of consciousness in a fit, young patient: The cricketer who collapsed.- 15. Tachycardia, Hypotension and Agitation in A Post-Partum Mother: The Mother in Distress.- 16. Young lady with abdominal cramps and difficulty in breathing : The shy bride.- 17. Adult male admitted to intensive care unit with tachycardia, hypertension and agitation : It’s where my demons hide.- 18. Fever, rash and arthritis in a young female: Andrea is angry!.- 19. Young female with polyuria: The painful co-passenger.- 20. Disproportionate Fatigue and Abdominal Pain in An Adult Male with Cirrhosis and Portal Hypertension - Sometimes The Hoofbeats Are Zebras.- 21. Subacute onset of Apathy and fatigue in a previously well male: The apathetic attender.- 22. Hirsutism in women : Hairy Harini.- 23. Commonly Missed Diagnoses in The Elderly : The Quiet Grandma.- 24. Dizziness, Blurred Vison and Slurred Speech : The Depressed Decorator.- 25. Middle aged male with burning sensation at fingertips and rash – The Alpha gal and her husband.- 26. Bone, skin and GI symptoms in a young female : The bachelorette party.- 27. Fever and rash in a traveller: The catastrophic rash.- 28. Loose Stools, Breathlessness and Blurring of Vision in a Previously Healthy Person: The Girl who Felt Guilty.- 29. Face swelling and abdominal pain in a young female – Anagha’s absenteeism.- 30. Family clustering of vague symptoms and neurological signs : The depressed worker.- 31. Blurring of Vision and Eye Pain in A Young Male: The Man from Myanmar.- 32. Loose Stools and Constipation in a Stressed Executive – cut it out.- 33. Daytime sleepiness , anemia and hepatomegaly in a middle aged female : Shauli’s somnolence.- 34. Loss of Libido in a Previously Healthy Male : The Unfulfilled Wife.- 35. Elderly male with backache & restricted movement :The Security Guard Who Always Stood Straight.- 36. Polydipsia, polyuria and pruritus – the paan chewing Babu.- 37. Gum bleeding, tinnitus and fatigue: The bloody apple.- 38. Elderly Patient with Pruritus, Splenomegaly and Constitutional Symptoms: Itchy Ignatius.- 39. Low mood and multiple disparate somatic complaints : Morose Monroe.- 40. An adult male with diverse haematological, skeletal and skin anomalies - Thimma with thrombocytopenia.- 41. Life threatening disease acquired in the wilderness : the sick spelunker.- 42. Collapse while standing at a live performance – the deadly laugh.- 43. Acneiform Eruptions and oral ulcers in a Young Adult Male - Acne Angst.- 44. Elderly male with difficulty in swallowing, unsteadiness of gait and slurred speech : The sad reunion.- 45. Headache, Diplopia and Drowsiness in a previously Healthy Young Female: The Pernicious Pimple.- 46. Post Coital headache - Not tonight, John.- 47. Subacute confusion in the previously well : the muddled model.- 48. Acute confusion in an elderly gentleman : Grandad in the department store.- 49. Headache and seizures in a previously healthy female: The Sceptical Husband.- 50. Complicated course of an adult patient admitted with hiccup, vomiting, and altered sensorium - Pass the salt please.- Part ?I: Call the Lab.- 51. Monitoring glycemic status in patients with end stage renal disease.- 52. High Creatinine and Very High Urea : The Risk of Roadside Munchies.- 53. Fatigue & hiccup in an elderly lady : weakness is not a symptom of normal aging!.- 54. Patient on regular MHD presents with carpopedal spasm : Post-holiday blues.- 55. Fever, Body Ache And Decreased Urine Output : The Flu That Wasn’t A Flu.- 56. Young Lady With Possible Drug Overdose Admitted With High Anion Gap Metabolic Acidosis : Danger in the dormitory.- 57. Sudden deterioration in malnourished female : The Peril of Good Intentions.- 58. Anemia , rash and jaundice in a young woman.- 59. Patient admitted with exacerbation of bronchial asthma does not improve : lab report trends are more important than numbers.- 60. Lung cancer with bone metastasis : unexpectedly normal calcium values.- Part ?II: Short Puzzles.- 61. Fluctuating somatic and psychological complaints in a new mother - The Worried Grandmom.- 62. Hypoglycemia not reverting with sugar: The unexplained hypos.- 63. Ascending weakness with no sensory signs in a 5 year old girl – Holiday blues.- 64. Middle aged male meets with an accident while driving on a straight well-lit empty road : The improbable accident.- 65. Middle aged male concerned about verruca - Just a wart?.- 66. Transfusion dependent adolescent presents with rhinorrhoea and epistaxis : The Troubled teen.- 67. Weakness of limbs and difficulty in swallowing after an attack of gastroenteritis : Supercilious Sanjay.- 68. Cardiovascular deterioration after sexual intercourse : The happy couple.- 69. Middle aged male with varicocele – The bag of worms.- 70. Altered Behaviour and Agitation in a Post Operative Patient : The Bike accident.- 71. Refractory shock after trauma – the bloody biker.
Dr. Smitha Bhat holds the positions of Consultant Physician and Professor of Medicine at a medical college in Mangalore. With expertise as both an undergraduate and postgraduate teacher, she also serves as an examiner for medical undergraduates, postgraduates, and MRCP PACES candidates.
In her former role as the Convener of the Medical Education Unit at her institute, Dr. Bhat has organized numerous workshops aimed at enhancing teaching, learning, research, and leadership skills. She is recognized for her innovative teaching and assessment methods, particularly in the realms of clinical skills and diagnostic reasoning.Dr. Bhat's primary areas of interest lie in non-communicable diseases and medical education. She has delivered numerous conference presentations on these topics and authored articles in both national and international journals. Additionally, she has contributed to Cochrane clinical answers, further establishing her expertise in the field.
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