Case Studies: "Reasoning without Resources"

Welcome to CUGH’s monthly clinical case-series, “Reasoning without Resources,” by Prof. Gerald Paccione of the Albert Einstein College of Medicine. These teaching cases are based on Prof. Paccione’s decades of teaching experience on the medical wards of Kisoro District Hospital in Uganda. They are designed for those practicing in low resource settings, Medicine and Family Medicine residents, and senior medical students interested in clinical global health. Each case is presented in two parts. First comes a case vignette (presenting symptoms, history, basic lab and physical exam findings) along with 6-10 discussion questions that direct clinical reasoning and/or highlight diagnostic issues. One month later CUGH will post detailed instructors notes for the case along with a new case vignette/questions. For a more detailed overview to this case-series and the teaching philosophy behind it, see Introduction to “Reasoning without Resources”. Comments or question may be sent to Prof. Paccione at:

N.B. The first part of this series (Cases 1 – 55) ran for a number of years, and 20 of these Cases are still on the website. Others, used in global health courses, have been removed because provision of the instructor notes on the internet interfered with the group problem-solving methods of the course. The second part begins now, thus the numbering of the Cases starts with #56-67. All cases in the series (over 100) will be available in book form (supported by CUGH) in 2020, “Reasoning without Resources.”

About the Author:
Dr. Gerald Paccione is a Professor of Clinical Medicine at the Albert Einstein College of Medicine in the Bronx, New York. His career has centered on medical education for the past 40 years – as a past residency Program Director in Primary Care and Social Internal Medicine at Montefiore Hospital, and global health educational consultant/advisor at the school. He has served on the Boards of Directors of Doctors for Global Health, Doctors of the World USA, and the Global Health Education Consortium. Dr. Paccione spends about 3-4 months a year in Uganda working on the Medicine wards of Kisoro District Hospital where he draws examples for the case studies.

Gerald Paccione, MD Professor of Clinical Medicine Albert Einstein College of Medicine 110 East 210 St., Bronx, NY 10467
Tel: 718-920- 6409

Case 67: The Muffle of an Oft-Forfeited Cure PDF icon Questions 67 The Muffle of an oft-forfeited Cure.pdf, PDF icon Answers 67 The Muffle of an oft-forfeited Cure.pdf
Case 66: Company Dark and Quiet, Suspicion Required PDF icon Questions 66 Company Dark and Quiet.pdf, PDF icon Answers 66 Company Dark and Quiet, Suspicion Required.pdf
Case 65: Getting There Slowly Strategy & Patience PDF icon Questions 65 Getting there Slowly, Strategy and Patience.pdf, PDF icon Answers 65 Getting There Slowly.Strategy and Patience.pdf
Case 64: Finally Fungating PDF icon Questions 64 Finally Fungating.pdf, PDF icon Answers 64 Finally Fungating.pdf
Case 63: Lumps Worse on Treatment PDF icon Questions 63 Lumps Worse on Treatment.pdf, PDF icon Answers 63 Lumps Worse on Treatment.pdf
Case 62: Right, Left or Both PDF icon Questions 62 Right, Left or Both.pdf, PDF icon Answers 62 Right, Left or Both.pdf
Case 61: Collapse in the Field PDF icon Questions 61 Collapse in the Field.pdf, PDF icon Answers 61 Collapse in the Field.pdf
Case 60: Headache in a Healthy Man PDF icon Questions 60 Headache in a Healthy Man.pdf, PDF icon Answers 60 Headache in a Healthy Man.pdf
Case 59: Despite or Due to Kumenesha PDF icon Questions 59 Despite or Due to Kumenesha.pdf, PDF icon Answers 59. Despite or Due To Kumensha.pdf
Case 58: The Slow Decline PDF icon Questions 58 The Slow Decline.pdf, PDF icon Answers 58 The Slow Decline.pdf
Case 57: Vomiting Forever PDF icon Questions 57 Vomiting Forever.pdf, PDF icon Answers 57 Vomiting Forever.pdf
Case 56: Rash in the Way PDF icon Questions 56. Rash in the Way.pdf, PDF icon Answers 56. Rash in the Way.pdf
Case 55: Tragic Connections PDF icon Case_55_Tragic_Connections_Questions.pdf, PDF icon Case 55_ Tragic Connections_Answers.pdf
Case 53: Body Swelling II PDF icon Case_53_Body_Swelling_II_Questions.pdf, PDF icon Case 53_Body Swelling II_Answers.pdf
Case 52: Skin and Bones PDF icon Case_52_Skin_and_Bones_Questions_0.pdf, PDF icon Case 52_Skin and Bones_Answers.pdf
Case 49: Embarrassing and Persistent PDF icon Case_49_Embarrassing_and_Persistent_Questions.pdf, PDF icon Case 49_Embarrassing and Persistent_Answers.pdf
Case 47: 3 Strange Stories PDF icon Case_47_3_Strange_Stories_Questions.pdf, PDF icon Case 47_3 Strange Stories_Answers.pdf
Case 45: Of Course... But Really... PDF icon Case_45_Of_Course..._But_Really..._Questions.pdf, PDF icon Case 45_Of Course... But Really..._Answers.pdf
Case 41: Pumping Fast PDF icon Case_41_Pumping_Fast_Questions.pdf, PDF icon Case 41_Pumping Fast_Answers.pdf
Case 40: Common and Missed x 3 PDF icon Case_40_Common_and_Missed_x_3_Questions.pdf, PDF icon Case 40_Common and Missed x 3_Answers.pdf
Case 39: Fever and Cough PDF icon Case_39_Fever_and_Caugh_Questions.pdf, PDF icon Case 39_Fever and Caugh_Answers.pdf
Case 38: Stiff Stride PDF icon Case_38__Stiff_Stride_Questions.pdf, PDF icon Case 38_ Stiff Stride_Answers.pdf
Case 36: Problems Working, Walking, Speaking PDF icon Case_36_Problems_working,_walking,_speaking_Questions.pdf, PDF icon Case 36_Problems working, walking, speaking_Answers.pdf
Case 35: Platypnea with Sudden SOB PDF icon Questions_Case_35_Platypnea_with_Sudden_SOB.pdf, PDF icon Case 35_Platypnea with Sudden SOB_Answers.pdf
Case 33: Paralyzed Legs PDF icon Questions_CUGH_Case_33_Paralyzed_LEgs.pdf, PDF icon Answers CUGH Case 33_Paralyzed Legs.pdf
Case 28: Chronic Diarrhea x2 Vignettes PDF icon Questions_CUGH_Case_28_Chronic_DIARRHEA_x_2_Vignettes.pdf, PDF icon Answers Case 28_Chronic DIARRHEA x 2 Vign.pdf
Case 27: Diarrhea x2 Vignettes PDF icon Questions_CUGH_Case_27_DIARRHEA_x_2_Vignettes.pdf, PDF icon Answers CUGH Case 27_DIARRHEA x 2 Vignettes.pdf
Case 26: Acute Diarrhea PDF icon Questions_CUGH_Case_26_ACUTE_DIARRHEA_x_2_Vignettes.pdf, PDF icon Answers Case 26_ACUTE DIARRHEA x 2 Vignettes.pdf
Case 25: Persistent Diarrhea PDF icon Questions_CUGH_Case_25_Persistent_Diarrhea.pdf, PDF icon Answers CUGH Case 25_Persistent Diarrhea.pdf
Case 24: Abdominal Pain and Swelling PDF icon Questions_CUGH_Case_24_Abdominal_Pain_and_Swelling.pdf, PDF icon Answers Case 24_Abdominal Pain and Swelling.pdf
Case 22: Abdominal Pain Back in Time PDF icon Questions_CUGH_Case_22.pdf, PDF icon Answers Case 22_ABDOMINAL PAIN BACK IN TIME.pdf
Case 21: Right Abdominal Pain and Fever PDF icon Questions_CUGH_Case_21_fixed.pdf, PDF icon Answers CUGH Case 21_fixed.pdf