Quiz time!

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Quiz time!

With all the momentum that continuing medical education is receiving, I feel compelled to do my bit for the benefit of the CMC population. I will be posting a couple of commonly encountered cases, along with a brief management oriented discussion.
so here goes-

A 22 year old medical student from Ernakulum, referred from curriculum to principals office, presents with decreasing attendance.

History of presenting complaint: he has been apparently well till one year ago, roughly about pegasus, when he noticed a decrease in his pharmacology attendance. Loss was gradual, starting initially with pharm, which eventually progressed to involve the path, micro and forensic attendances.
He has had associated altered sleep cycles, along with a progressive decreased clinics performance. His morning waking time has increased over the last 8 months, from an initial 7am at the start of symptoms to currently 10:45am. He gives a positive history of nocturnal movie watching, and multiple episodes of missing the bus.
No history of late night partying,
No history of nocturnal gassing. He takes a mixed hostel diet.
He was treated by local department doctors with extra class supplements for a period of 3 weeks. The treatment did not show positive results and he was referred to princi's office for further evaluation.

Past History: No history of break ups.

Personal history: He has been fixed for the last 1 year, non Mal, non consanguineous fixture.
Was a consumer of alcohol till the passing of the C.M.C. Prohibition Act.
No history of Sick-leave slip abuse.

Family history: No history of alumni. His ammachy's-cheduthis-nathoon-de-moll worked in CMC

Treatment history: 3 weeks of extra class therapy.

On Examinaton,
A well built, young man, in no apparent distress, has headphones connected bilaterally, sleeping comfortably in hostel.
Vitals stable
Clinically Normal examination

Investigations

Attendance TC: 30% Normal: >90%
Attendance DC:
Pharm 40%
Path 33%
Forensic 20%
Micro 33%


What are your differential diagnoses?
How would you manage this?

Straightforward case? Actually, no. Though the diagnosis might be rather obvious, going from the very clear history, it's the pathophysiological basis to this condition that I believe should be stressed on. The presenting complaints strike home an impression of a young medical student with an attendance deficiency disorder. I hope the fact that he is a medical student from CMC has rung a bell in your head- CMCite's have genetic predispositions towards an increased sleep threshold. The history of reduced attendance not relieved on extra lectures, along with the history elicited of nocturnal movies all are all a bit ambiguous, and will not point in any particular direction. The fact that he is on a hostel diet indicates that he will be deficient in almost everything except oil and meat. The clincher is from the personal history- note that he has been fixed for the last 1 year- which tallies with the duration of the disorder. Let's not beat about the bush- the etiology is not fully described, causes are multifactorial, with several theories, including the 12:06 translocation theory, cellular-sms theory, and several others that I don't think are useful from a management point of view.

Our final diagnosis would be:
Uncomplicated CHANDY syndrome Chronic Hereditary AttendaNce DeficiencY Syndrome.
The syndrome is characterized by a triad of
1. Transhostel synechiae
2. Reduced attendance
3. Altered sleep cycles
Treatment must be initiated for both the patient and the partner. Will continue treatment options in the next post. Cheers.