TRIGGER 1

Forty two year old male, Amit, presented to Orthopedics OPD with pain in left arm
following a fall due to slipping in his bathroom. He was diagnosed as a fracture of left
Humerus. He was also visiting Medicine OPD with weakness, letharginess for last 1 month
since he was not keeping well for last 2- 3 months. Three months back he developed fever
lasting for 10 days when he was labelled as Typhoid by his GP. For last 20 days he was
having pain on right side of abdomen.
On interrogation, he told the Intern that he suffered from jaundice at the age of 22 years
which persisted for almost 1 month but had poor appetite for the next 6 months. He did not
had any record of diagnosis, prescription or investigations of this illness.
On deep enquiry, he confirmed of similar type of jaundice in about 10-15 people in his
locality who all use to receive injections by a well-known compounder of the area. However,
his clinic had been sealed by health administration few years later.
Amit also became used to alcohol for last 10 years after a loss of job and family problems.
He started gaining weight since then despite avoiding fatty and fast food.
On examination, Amit appears obese with a weight of 121 KG and was 168 cm tall.
He was mildly anaemic and but had no icterus, lymphnodes, etc.
He was wearing POP over left arm and forearm.
On abdominal examination, Senior resident noted prominent tummy with stria and had
difficulty doing palpation for internal organs and percussion for any free fluid. He could
make out some fullness on right hypo-chondrium with tenderness on deep palpation.
Amit was evaluated by a Faculty member and was asked for certain investigations including
an USG of abdomen.
He was advised to come on Tuesday morning with investigations reports along with his
parents or siblings.
Notes:












Session Objectives
At the end of this first session student will be able to:
1. Make a hypothesis about diagnosis
2. Identify gaps in the clinical evaluation of Mr Amit
3. Identify their own knowledge deficit in working up the case of Amit
4. Discuss and Plan further workup
5. Assess socio-cultural factors adding to problems of Mr Amit



Group tasks:
Group A: Clinical/ Diagnostic workup on Medical problem
Group B: Clinical workup on Orthopaedic/surgical problem
Group C: Defining various terms used/ to be used in relation to Amits disease/disorder
Group D: How the symptom complex can be interwoven together keeping in mind various
pathologies
Group E: How his condition will impact his family and community psychosocially.

Resources:
1. Faculty members: Medicine, Surgery, Orthopaedic, Psychiatry, Pathology
2. Textbooks: Robbins Pathology, 8
th
Edn, Bailey & Love 26
th
Edition, S Das Clinical Methods
3. Internet- Glossary of terms used during discussion today.
4. Medscape: www.medscape.com

Next Trigger will be presented on Tuesday morning once Amit attend OPD again at 8.30 AM