Step I Post a clinical picture...
Started by Idiopathic
Not MVP...tricuspid regurgitation.
If you answer, please post.
"52 year old man with cysts on liver containing organisms with phagocytosed RBC's"
If you answer, please post.
"52 year old man with cysts on liver containing organisms with phagocytosed RBC's"
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Primary Biliary Cirrhosis
" 31 year old man with HIV presents with mild jaundice, fever, malaise, and hepatosplenomegaly. Labs show postive Coomb's test and decreased serum haptoglobin levels. No hemozoin seen on peripheral blood smear. Travel history: spent a week in the northeast US about two weeks ago. History of tick bites"
babesiosis
86-year old man with urinary retention and mild back pain. PSA of 3. Most probable diagnosis?
Great thread, btw.
🙂
🙂
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No, I think in that setting BPH is more likely. The low PSA doesn't exactly rule out cancer but since mild back pain is extremely prevalent in the elderly, our most likely diagnosis is BPH.
Next step would be rectal exploration. In a younger person we would go straight to trans-rectal ultrasound and/or biopsi but probably not in a person of this age. Bone scan is a possibility too.
New case:
57-year old female presents with jaundice. She has been an alchoholic for many years. She has diffuse abdominal pain with some radiation to her back. There is palpable, painless distension of the gallbladder.
If she has lost 11 punds over the last 6 months it could be?
If she has had similar episodes int he past it could be?
Lost weight: pancreatic cancer causing obstructive jaundice (Courvoisier sign: palpable gallbladder)
Similar episodes in the past: Cholethisiasis causing recurrent pancreatitis
54 yr old WM with type I DM with poor diabetic control presents with severe maxillary sinus pain, purulent discharge from nasal sinus, and headache.
mucormycosis?
38 yo WM with longstanding h/o chronic sinusitis, reactive airway disease, who now presents with paresthesias in BLE and dysuria.
-s.
38 yo WM with longstanding h/o chronic sinusitis, reactive airway disease, who now presents with paresthesias in BLE and dysuria.
-s.
I was thinking recurrent pancreatitis with biliary obstruction (I think theoretically the gallbladder becomes scarred and non-distendable if there are many stones). Your choice is probably more realistic, though.
Mucormycosis?🙁
You beat me to it, Sanfilippo.🙂
I don't think that chronic pancreatitis is really associated with recurrent cholecystis or obstruction of the bile duct. Mucormycosis is correct for my question though, we had a patient who we thought might have that during my ID service. It turned out not to be mucormycosis. Now that i think about it, most cases that present like the way that I presented my case in the real world probably wouldn't be mucormyosis since it's so rare, but the way that I presented it is probably how it'd show up on the boards(and most ID docs would tell you that you have to cover for mucor or other fungal infections empirically anyways with my case). Sorry sanfillipo, I don't know the answer to your case.
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SLE
45-yo woman with diplopia that gets worse in the evening. Mediastinal mass on CT.
45-yo woman with diplopia that gets worse in the evening. Mediastinal mass on CT.
Scaphoid/navicular fracture. Splint it, check after one week and again after 2. If still painfull, do bone scan.
Young man presents with "a broken hand". He was in a MVA and had his left hand (the "broken" one) on the wheel. There's now indirect tenderness to his wrist. On x-ray, there's palmar dislocation of the distal radius.
Young man presents with "a broken hand". He was in a MVA and had his left hand (the "broken" one) on the wheel. There's now indirect tenderness to his wrist. On x-ray, there's palmar dislocation of the distal radius.
In this case I was pointing to Mallory-Weiss tears of the esophagus due to severe persistent retching. The severe persistent nausea/vomiting indicates possible hyperemesis gravidarum. A pregnancy test should be included in the workup of any female of childbearing age with severe/persistent nausea/vomiting
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Are you talking about glucuronyl transferase? I think Crigler-Najar, but I'm not sure what type.
"A man with multiple gastric, duodenal, and jejunal ulcers. What hormone is most likely to be elevated? What genetic syndrome can predispose this patient to his current problem"
Negative culture for what? I would say chlamydia, in the face of a negative GC culture.
"32-year old male is c-ANCA positive, and is treated with a drug that has a high propensity for causing malignancy.
What is the drug?
What is the most likely malignancy?"
"32-year old male is c-ANCA positive, and is treated with a drug that has a high propensity for causing malignancy.
What is the drug?
What is the most likely malignancy?"
Wegener's Granulomatosis? Is the most common malignancy leukemia? I don't know what the drug is though.
Here ya go: 55 y/o male with elevated alk phos, but normal calcium; pain in right tibia & lumbar spine, and bifrontal headaches. Impaired hearing. Increased warmth on tibia. Right leg 1/2 inch shorter than left.
Wegeners is right. Rx with cyclophosphamide which causes transitional cell CA of the bladder.
heroin?
"A young boy is hypoglycemic, even when given an infusion of glucagon."
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Budd chiari??
10 year old girl having trouble in school and seems to zone out every now and then. Whats the Dx and Drug of choice?
absence seizures; 1st line ethosuximide.
i was going for Churg-Strauss Syndrome in previous post. I'll try to make it clearer:
10 year old boy has h/o photosensitivity, hypohidrosis, and hematuria persistently on repeat U/A's. His older brother, who accompanied him to clinic, has a peculiar rash over his abdomen, genitalia, and legs comprised of myriad dark purple, punctate papules that don't coalesce. There is a family history of male relatives being on dialysis in middle-age or dying of renal failure.
What's the diagnosis? What treatment is now available for this disease?
-s.
i was going for Churg-Strauss Syndrome in previous post. I'll try to make it clearer:
10 year old boy has h/o photosensitivity, hypohidrosis, and hematuria persistently on repeat U/A's. His older brother, who accompanied him to clinic, has a peculiar rash over his abdomen, genitalia, and legs comprised of myriad dark purple, punctate papules that don't coalesce. There is a family history of male relatives being on dialysis in middle-age or dying of renal failure.
What's the diagnosis? What treatment is now available for this disease?
-s.
mental masturbation at its finest. 🙂
