MEJOGUE, JED S.

Rotation 5
MLS-Group 4 January 3, 2018
Clinical Microscopy

Case Study

1. What are the evidences in the history, conversations, and scenarios that would help in the diagnosis
of the boy? Explain.

Patient history mentioned by the mother includes normal pregnancy with no reported
complications. However the scenario reported by the mother and the evidences seen were vague and
does not seem to point out what is actually happening. The patient has been reportedly biting his fingers
which could be an indication of Dermatophagia, a compulsion disorder of gnawing or biting one’s own
skin most commonly at the fingers. During the conversations, the doctor noticed that the patient has
poor motor skills, which could be pointing to neurological disorder having mentioned by his mother that
her brother has schizophrenia. Another thing to be considered is the scar of open heniotomy and the
presence of atrophic testis. Although some of these clinical signs and symptoms are hard to correlate at
first glance, these information will be considered to state the initial impression of the patient’s disease.

2. Make a flow chart regarding your approach to solve this case. Explain.

Clinical signs and symptoms, and history should be correlated to all laboratory findings. By this, I
first relay all information gathered by the people involved, the patient itself, the mother’s complaints,
and the doctor’s first impression about the case. This information should be with accordance in the
laboratory result. It must satisfy what was being felt by the patient and at the same time what was
obviously seen.

Based on the clinical manifestations of the patient, Hematology, Clinical Chemistry, Urinalysis,
and Ultrasound requests were interpreted. For hematology, I rule our parasitic and viral infection or
causes. This is because there is a decrease of monocytes and eosinophils detected in blood. Most
prominent result in Hematology is the blood picture and the hypersegmented neutrophils.
Hypersermented neutrophils indicate a folate deficiency that may be an effect because of neural tube
defect. This might have been the cause of the atrophic testis of the patient. If this is the case, due to the
narrowing of the organ, genitourinary abnormalities occur which could be a reason as to why there is
the presence of urinary crystals together with other abnormal results in urinalysis. This would likely
result to the formation of kidney stones. Hence, I considered Megaloblastic anemia as an option.
However, as I have stated, Megaloblastic anemia cannot explain the behavioural abnormalities of the
patient.

Seco

3. What is your diagnosis? Explain why you have come up with such diagnosis.

At first glance
4. What is the pathophysiology of the disease? Explain.

5. What other tests can you recommend to further confirm your diagnosis? Explain test use and
principle.

6. What is the most probable treatment? Explain.

7. What is the prognosis?

8. What is the epidemiology of the disease?

9. Provide recent advances in disease diagnosis and treatment.

10. What happened to the mother? Explain.