Medical Mystery Solved - A Deficient Diagnosis | NEJM

This Double Take video from the New England Journal of Medicine presents the case
of a toddler with a limp. Based on a Clinical Problem-Solving article published
in the Journal, the video explores the differential diagnosis for a child refusing
to bear weight on his right leg and follows its evolution as new clinical findings
arise from the diagnostic evaluation.

For further reading, the following article, A Deficient Diagnosis (Hafez et al., in the April 7, 2016, issue) referenced in this video, is available
at www.nejm.org/d... .
The New England Journal of Medicine is the world’s leading general medical
journal. Continuously published for over 200 years, NEJM publishes
peer-reviewed research along with interactive clinical content for physicians,
educators, and the global medical community at NEJM.org.
#medicaleducation #clinicalmedicine #growthanddevelopment #pediatrics

[@dr.anuptoshniwal]

I am for India. Fortunately or unfortunately 40-50 seconds in history i suspected scurvy.. It can be a tricky diagnosis.. There is so much pain due to bone changes, that sometimes kids present with pseudo-paralysis. A very good and needed video specially who work in high end hospitals. It is also common in Cancer patients

[@ponsaravanan3749]

Me too sir.. i am also from india.. i am also suspected initially as scurvy only...

[@mrskeptic5274]

Typical neet pg q.. Won't take any avg student to mark scurvy! Good that Indian doctors prescribe multivitamins on any day visit!

[@rahmathullaashraf]

Exactly

[@hibamm7854]

Me too

[@as-sabahossain9099]

Before going through all those invasive procedure, a simple nutritional assessment would have done it. I think more than the diagnosis, the important takeaway for video is to have in depth, detailed history to exclude all possible differentials. Very much grateful for this wonderful presentation 🙏🙏

[@dariuslima]

The "picky eating" had me thinking what it could be...and i was surprised to see that it was scurvy. A thorough Anamnesis can go a long way, but understandable, since nowadays everything is fast...Amazing case! Thanks!

[@srinivasaraghavan_devpaed]

Scurvy must definitely be considered as a differential diagnosis of musculoskeletal symptoms in children with developmental needs. Especially if the child has picky eating, where child avoids fruits and vegetables

[@sahrissa7305]

It is better to aways rule-out the common and simple diagnosis before thinking of complicated ones. Good lesson learnt.

[@uranuss]

Nice OSCE-like demonstration for everyone to brainstorm

[@absurdum-the-artist]

To me the possibility of scurvy felt possible from the very beginning. I and many other people with ASD were far too close to being in the same position

[@vishwakaran9020]

I love my teacher ...dr.Bhose ❤

[@EliaAlmazán]

🎯 Key Takeaways for quick navigation: 00:07 🚑 *Presentación del caso y síntomas iniciales* - Niño sano de dos años y medio con dificultad para cargar peso en la pierna derecha. - Radiografía muestra posible fractura de peroné, preocupación por causas infecciosas, malignas, inflamatorias o neuromusculares. - Desarrollo posterior de dolor en la pierna izquierda y síntomas gingivales, aumentando la preocupación por leucemia. 01:33 🏥 *Evaluación en el departamento de emergencias* - Agitación y dolor en ambas piernas, sospecha de trauma no accidental. - Pruebas muestran bajo nivel de hemoglobina, tamaño reducido de glóbulos rojos, y posible leucemia. - Consideración de anemia por deficiencia de hierro o envenenamiento por plomo. 02:57 🧠 *Evaluación neurológica y complicaciones* - Realización de resonancia magnética de cabeza y columna, descartando Guillain-Barré. - Desarrollo de erupción cutánea y traslado a otro hospital para evaluación adicional. - Exploración de posibles causas de parálisis en las extremidades inferiores, incluyendo la posibilidad de una picadura de garrapata. 04:23 🩹 *Exploración de otras posibles causas* - Estudios serológicos para condiciones reumatológicas y deficiencias nutricionales. - Resultados normales en pruebas de inflamación muscular y niveles de vitaminas. - Reevaluación de radiografías y CT scans revela bandas metafisarias lucentes en el fémur. 05:46 🍊 *Diagnóstico final y tratamiento* - Diagnóstico de escorbuto por deficiencia de vitamina C. - Inicio de suplementos de ácido ascórbico, mejoría en una semana. - Importancia de la historia dietética detallada para un diagnóstico preciso. Made with HARPA AI

[@ajitbirnale1971]

American way of diagnosis 😂

[@maohrtega]

What image and video editing applications did you use?

[@sviaxqu4072]

upload more cases

[@doc9911w]

Very interesting case- thank you so much for highlighting the occurrence of Vit C deficiency even in resource rich settings. However, scurvy should have been in the differential from the beginning and an empiric trial of vitamin C would have spared this child from going through so many expensive and painful investigations. With the advent of iOmics and precision medicine , treatment for even common conditions is likely to get extremely expensive. Maybe case discussions in the future should also pause after H&P, and brainstorm possible treatment options if you had nothing further to go upon- ie. no further information from expensive investigations

[@ashishkatiyar4240]

Detailed dietry history will be beneficial in children

[@sim_aware]

Very interesting case. Thanks!

[@anantasaikia2344]

Thank you for reminding , nutritional deficiencies are very common in new generation, maybe attributable to altered dietary habits .

[@chrislongdc]

No offense but those were highly invasive procedures, and took way too long to come to that diagnosis. I don't see this as a win for medicine. Then again, a good reminder on what the child's diet consisted of was missed during the case history. A simple mistake.

[@hibamm7854]

I agreee

[@scriptorpaulina]

I’ll be honest, my mom came across one of these moms at her on-gyn. It’s so fucking hard to get them to be honest with you about the kid’s diet. I agree that it’s hard to send your kid through all these tests, but it’s also really hard to get your kid to miss a vitamin completely. So we need to consider the deadly diseases before the rare ones first

[@tarunaikrar3383]

D/ Vit C Defiance

[@MyPerennial]

Give him vitamin C from the start! Great lessons at the end, thank you

[@tindrums]

Bleeding gums = scurvy first DD.