This older gentleman was working out when he noted a "pop" and pain in his shoulder. He's been having moderate anterior shoulder pain with radiation over the anterior upper arm. He noted bruising and swelling after the incident. The pain is worse with lifting, pulling, and doing overhead arm motions.
You're taking home call as the cardiology fellow when your sleep is interrupted by beeping of your fax machine. You get the EKG shown above; darn the quality of those faxed copies! The resident calls with the story: a fifty year old gentleman with hypertension, diabetes, dyslipidemia, and gout presents with several minutes of substernal crushing chest pain radiating to the jaw and left arm. This pain is accompanied by dyspnea, nausea, and diaphoresis. Troponins are negative. The EKG is shown above. Apparently, this man had a perfectly normal EKG one year ago.
The newborn shown above is being treated for a rare genetic disorder. He was the product of a normal spontaneous vaginal delivery at 38 weeks to a 30 year old G1P1 mother with no medical problems. He presented at 2 days of life with jaundice. Blood tests showed a total bilirubin of 25mg/dL (direct bilirubin of 0.1). Liver function tests were all within normal limits. Coombs test is negative. Stool color is normal. In social/family history, you learn that there's consanguinity in the parents.
Challenge: What's your diagnosis?
A 40 year old dentist presents with the skin lesion shown above, pain, and low grade fever. To make the diagnosis, you remove the blister roof with a no. 15 blade, blot excess fluid, then scrape the base with a scalpel blade. You spread the material on a slide, add 95% methanol for 5 seconds, air dry for 1-2 minutes, then add a nuclear stain for 30-60 seconds. Finally, you wash with distilled water and restain with methanol. Here is what you see:
Challenge: What's the diagnosis?
Challenge: What's the initial disease? What antibiotic did he take?
This is a T2 weighted MR image of a patient with bilateral loss of pain and temperature sensation in his hands and fingers. His upper arms have preserved pain and temperature sensation. He has no deficits in light touch, vibration, or proprioception. Good thing you tested all the sensory modalities!
This is an incidental finding in a patient with a ball-cage prosthetic valve for a remote history of refractory endocarditis.
A 25 year old man presents to your clinic with low back pain that improves with exercise but not rest. It had an insidious onset and occurs at night. He also has buttock, hip, shoulder, TMJ, and posterior thigh pain. He had an episode of anterior uveitis a month ago. Review of systems is notable for fatigue.
A 20 year old man is brought in by police with agitation and combativeness. On exam, he is tachycardic, hypertensive, and hyperthermic. In general, he is a diaphoretic, flushed man. Neuro exam shows vertical nystagmus even while the patient is awake as well as hyperreflexia. HEENT exam shows miosis and hypersalivation. Psych exam reveals he has acute new-onset schizophrenia, psychosis, audio-visual hallucinations, and paranoid delusions.
Challenge: What is the diagnosis and the cause?
30 year old G1P0 at 38+2 weeks gestation, contractions began 5 hours ago, ROM 1 hour ago.
Ah, yes, the ever important arrow and circle sign. This might help orient you: the blue line on the lateral view is drawn from the carina to the junction of the diaphragm with the anterior chest wall.
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