CASE BASED DISCUSSION NEET MDS INICET MDS WRAPPING UP YOUR PREP WE ARE WITH YOU

hi everyone this is dr g sayeth team mds concur so we have discussed few number of cases in the part one we'll be discussing few more cases now okay so coming to the first one so here a male infant is presented with asymptomatic erythematous discriminative lesions in the hands and feet which were noticed at birth and he was born to a 35 year old mother who had a poor prenatal care because of socio-economic reasons and there was a diffuse arithmetist trans gradient palmer planter keratoderma with discrimination and fissures as you can see in the picture so what are the other findings that you can expect in this baby during the later stage of the disease so here if you see first let's conclude what exactly the disease could be so as per the findings that is being given so it is nothing but congenital syphilis okay so what are the other findings that you can expect now so first yes dwarfed molars with cusps covered with globular enamel growths which is nothing but the mulberry molars right yes even that can be seen which is a part of the hutchinson's triad right next a scapula in which the vertebral broader below the spine presents concavity instead of convexity yes so this is called as caproid scapulae okay yes even this can be seen next eighth cranial nerve deafness yes it's also one of the constant of the huttington's triad even that can be seen next anterior bowing of the middle portion of the tibia even yes this can be seen it's nothing but the shape or shin okay so even this can be observed as a skeletal change in the patient the thickening of the clavicular portion of the clavicle yes this is nothing but the higgo minakis sign even this can be seen in this child in a later stage so yes the answer is all the above so all these signs or all these other features related to the congenital syphilis so which can be seen in this infant okay so what are the features which has been listed out in this table so do go through all the features that have been listed out so facial features like the frontal bossing saddle nose short maxillon protuber and mandible ophthalmic creatures like the interstitial keratitis secondary glaucoma chorioretinitis corneal scarring and optic atrophy ears showing the hearing loss or with such simpson's teeth and mulberry molars cutaneous like the regates cnas like the intellectual disability arrested hydrocephalus caesar's optic atrophy okay and very importantly the skeletal changes so first one shea buchen which is nothing but the anterior bowing of the tibia higuminaki sign wherein there is enlargement of the sternoclavicular portion of the clavicle clattons joint wherein there will be painless arthritis and scaphoid scapulae so all these are the very important features which you need to know regarding the congenital syphilis so if you see this is a pictorial presentation so this is being the scaphoid scapulae here you can see the frontal embossing in the saddle nose and this is being the higgo minaki sign wherein you can see the irregular thickening of the clavicle the sternoclavicular portion of the clavicle and yes here you can see the bowing of the tibia the anterior bowing of the tibia so which is nothing but the shear but shin so all these are the important skeletal or the important features related to the congenital syphilis which you need to know next question the following picture reveals an anomaly which is related to the development of tooth and this anomaly occurs due to interruption of which of the following stage of the development so here if you see there is a tooth within tooth appearance and it is seen involving the lateral incisor so this would have occurred because of a disturbance in the cap stage of the tooth development so answer is pretty clear it is dense invaginates which shows tooth within tooth appearance and it is seen commonly with the lateral incisor so if you see the stages of tooth development we are very well aware of it so the placard stays a butt stage okay wherein there will be like a bud in the butt stage and here the main process is a proliferation okay whereas in the cap stage the process which take a main role as a proliferation differentiation and morphogenesis okay so these are the three main process which occur in the cap stage so if there is a disturbance in the development of tooth like dense indentee gemination like that so these would have occurred because of the disturbance in the pdm that is proliferation differentiation of morphogenesis that would have occurred at the cap stage that occurs at the capsule so if there is an interruption at the cap stage then the dense invaginate is occurs okay so answer for this question is the cap stage next is the bell stage okay so we know the bell stage so these are the stages of the tooth development so mainly remember the pdm occurs at the cap stage and if there is a differentiation in or if there is a disturbance then obviously there is problem or there is a disturbance like the germination or other disturbances like the dense invaginators whereas microdon shear microdonsia if there's such developmental disturbance and that would have occurred at the bell stage okay so this is regarding this particular question now next here there is a 45 year old female who has presented with multiple or numerous raised solid lesions over the neck axilla and ground and forehead since four years and she was born with an extra digit on the right hand and on the left foot okay the former got amputated surgically two decades back and she also underwent subtotal thyroidectomy very important to underline for multinodular goiter two years ago and physical examination has shown pallor macrocephaly syndactyly and polydactyly okay so this is again important and dermatological lesions if you see there is multiple forehead papules skin tags over the neck axilla and the groin and there is a cervical scar of thyroidectomy with and also there is a cobblestone tongue with closed papules okay so what is the inheritance of your diagnosis so first let's decide what is the diagnosis here so if you see there are multiple squamous papillomas right and also the papillomas are seen as well as on the tongue as described in the question so it is nothing but the coward and syndrome the syndrome which is associated with multiple papillomas is nothing but the cowan syndrome and that is autosomal dominant okay so these are the important features of the cowden syndrome so the mucocutaneous manifestations include the trichloromas papillomavirus papules and acural keratosis okay so 99 percent all these are very important manifestation besides that in the breast lesions the patient will have carcinoma like adenocarcinoma and also the patients will have macrocephaly and thyroid abnormalities so here in our patient the patient is having multinodular gauter for which she has underwent thyroidectomy right so this is being given in the question and also the other symptoms like the gastrointestinal lesions and genetic urinary urinary abnormalities so all these are the important features related to the cow and syndrome so in our particular patient there are multiple papillomas there is multi-nodular gauter so which goes in favor of cowden syndrome which is autosomal dominant okay so these are the criteria that is being given so the pathognomic criteria there should be six or more facial papules okay and along with oral mucosa papillomatosis so here even the cobblestone appearance of the tongue says that the oral mucus is also involved and there should be acryl keratosis and palma plantar keratosis so this is a pathognomic criteria besides that breast cancer thyroid cancer macrocephaly okay endometrium cancer and hermity duckloss disease so which is nothing but the dysplastic cerebral cytoma so that is nothing but hermities the closed disease which is different from the hermities sign okay so the hermity duclose disease is dysplastic cerebellar ganglocytoma okay whereas hermetic sign is a shock like sensation which is seen in patients with multiple sclerosis on the flexion of the neck okay so this is regarding the criteria important for the cowden syndrome so just note it down and the other minor criteria just give a glance okay so yes uh the next question and 34 year old man had a non-healing oral ulcer on his left inner commissure and left label vestibule the ulcers were roughly over in shape with irregular placentic borders and the edges were thin and undermined with slight induration at the base and tenderness was also elicited on palpation here the key point is undermined edges underlined that and there was no history of cough or fever or hemoptysis and weight loss and on smear examination of the ulcer acid fast bacilli where identified using the jail nielsen stain so here undermined edges acid fast vaseline so it's a direct question so it is nothing but the tuberculosis ulcer so it can't be squamous cell carcinoma can be fungal ulcer and it even it cannot be hepatic ulcer because the smear has given a pretty clear acid fast bacilli and also the edges are undermined which goes in favor of tuberculosis also without pulmonary involvement why because a patient is not having any symptoms related to the pulmonary involvement like cough or hemoptysis and other symptoms like fever right so it's better you go for tuberculosis also without pulmonary involvement okay so next question a 15 year old male patient was being admitted to the hospital having experienced repeated fractures over a period of three years and the clinical signs and radiographic features has shown recurrent fractures loose clearer with low bone mineral density blue is clear of the eyes was observed okay so there was no hearing loss again and which of the following collagen is affected in this condition so it's again a direct question so blue is clear of the eyes repeated fractures low density or mineral density of the bone you can go for osteogenesis imperfecta where the type one collagen is being affected okay so answer is type one okay so this is regarding few more case based discussions i hope you have got an idea of how to answer in your exam okay thank you