Friday, November 28, 2008


This is modeled after a case presented in resident report and one described in an American Family Physician 1998 article.

A man in his 20s is brought into your ER from prison because he was found seizing in his cell. He seized again in the ambulance and despite IV diazepam, he seized once more in the ER. Temperature is 38.0, pulse 105, blood pressure 170/80, respiratory rate 28. Neuro exam showed no focal abnormalities and the rest of the exam was unremarkable.

An ABG showed pH 7.03, PO2 298, PCO2 37, HCO3 9.3. Electrolytes were Na 144, Cl 104, K 3.5, CO2 10, glucose 150. CBC showed white count 18,000 (68% neutrophils). A serum and urine tox screen was negative, LFTs were normal, U/A was negative, EKG was normal. The CXR is shown below.

Upon seeing the CXR, your attending makes the diagnosis, administers one drug that reverses the seizures and corrects the metabolic acidosis.

Challenge: What's the diagnosis? What's the cure?

Image is in the public domain.

Wednesday, November 26, 2008

A Chicken Ain't Nothing But a Bird

Happy Thanksgiving! I was again hard-pressed to come up with a somewhat Thanksgiving related case. This one comes from a Warren Levinson lecture one year ago and I have to give thanks to him for the idea.

A medical student with known egg allergy presents with the following after receiving a vaccine.

Challenge: What vaccine was the culprit and why?

Related Questions:
1. What's shown in the image?

Image shown under fair use.

Monday, November 24, 2008

Sudden Cardiac Death

An 18 year old baseball player is hit in the chest by a regulation baseball at around 40 miles per hour and suffered cardiac arrest. He had no underlying heart disease and there was no structural damage to the chest wall, thoracic cavity, or heart itself.

Challenge: What happened?

Friday, November 21, 2008

Shades of Violet

A 45 year old female presents to your clinic complaining of weakness. She has trouble getting out of a chair or reaching for books on high shelves. She cannot identify when it started, but the weakness has been getting worse over the last few months. The weakness is symmetric and associated with mild muscle tenderness. On exam, you do not find any signs of muscle atrophy. Instead, you note the following:

Challenge: What's your diagnosis?

First two images are in the public domain; last two images shown under fair use.

Wednesday, November 19, 2008

The Spy Who Loved Me

This gentleman is a remarkable 7 feet, 2 inches tall. Note his facial features.

Challenge: What is the cause of this gentleman's condition?

Related Questions:
1. Who is this man and what is he known for?

Image shown under GNU Free Documentation License.

Monday, November 17, 2008

Hard to Pronounce

A five year old child presents with the finding shown above as well as several days complaint of colicky abdominal as well as hip and knee pain. You notice edema in the lower extremities, periarticular swelling and tenderness of the joints without effusion, erythema, or warmth. The stool is guaiac positive; there is also isolated microscopic hematuria.

Challenge: What's the diagnosis?

Image is in the public domain.

Friday, November 14, 2008

Identity, Supremacy, Ultimatum

You're a big fan of Matt Damon and buy the super deluxe froo-froo special collector's DVD version of The Bourne Identity. The opening scene cuts to a stormy night on an Italian fishing boat where one of the crew members pulls a body out of the water. In a scene omitted from the movie version, the medic puts on some EKG leads. With your ultra high definition Blu-Ray-Blue-Tooth TV, you can make this out:

Challenge: What's the abnormality, and what does it mean?

Image shown under fair use.

Wednesday, November 12, 2008

Localize the Lesion

Challenge: Where's the infarct?

Image shown under fair use.

Monday, November 10, 2008


This is EKG week!
A hospitalized patient with known renal failure develops progressive lower extremity muscle weakness. The EKG is shown above.

Challenge: What is the abnormality seen and what is its significance?

Image shown under fair use.

Friday, November 7, 2008

The Sport of Kings

This patient presents with persistent rhinorrhea, oral ulcers, polyarthralgias, myalgias, and cough. A urinalysis shows microscopic hematuria.

Challenge: What's the diagnosis here?

Related Questions:
1. What's the finding shown here?
2. What's the sport of kings?

Image shown under fair use.

Wednesday, November 5, 2008


Challenge: This man recently completed a course of antibiotics. What's the diagnosis?

Image is in the public domain.

Monday, November 3, 2008


This week focuses on the head, ears, eyes, nose, and mouth exam.

Challenge: What's the diagnosis?

Image shown GNU Free Documentation License.