Take a Break

Challenge: What is the radiologic finding here?

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Where?

An elderly man with hypertension, hyperlipidemia, coronary artery disease, atrial fibrillation, and dementia falls out of bed and is brought in with low back and leg pain. There are no fractures on radiographs. The CT is shown above.

Challenge: Where's the bleeding?

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Challenge

Here's a challenging case of a disease first described in 1972.

A 30 year old previously healthy woman presents with a low grade fever and fatigue for a week. Physical exam shows posterior cervical lymphadenopathy localized to one side and the rash shown above. The lymph nodes are 1-2cm in diameter, firm, smooth, discrete, and mobile. Labs show leukopenia and an elevated ESR. The following tests are negative: ANA, RF, EBV, CMV, HIV, and toxoplasmosis. She has no cat contact and has not been scratched (I knew you were thinking it). A biopsy of a lymph node is shown below.

Challenge: Luckily, this diagnosis is benign and resolves after 1-4 months. What is it?

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Peas in a Pod

A husband and wife come to you for an infertility work-up. They have two healthy children already (and parentage is confirmed) and would like to have a third child, but have been trying for a year and been unsuccessful. The husband says, "I think it all happened after I got this infection. You see, a year ago, I had a fever to 40 degrees, severe testicular pain, and a rash on my scrotum." On exam, you note testicular atrophy.

Challenge: What happened?

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What Do You See?

Hello! Again, I apologize for the delay in cases; things have been awfully busy and I simply didn't have time to write. Here's a case I saw this week though, and I think the next case will probably be next Monday.

Thanks for understanding, and I appreciate your following along,

Craig

A 55 year old hypertensive smoker presents with an abrupt onset 10/10 headache, confusion, and vomiting. His main concern, however, is his vision; he has trouble seeing. A dilated eye exam is shown above. Panel A shows the right fundus, panel B the left fundus, panel C a week after laser treatment, and panel D two weeks after treatment. A non-contrast CT head from the ED is shown below.

Challenge: What diagnosis and syndrome are described here?

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Clear, Colorless, Odorless

A patient is found with a suicide note in a car and brought in by ambulance. He complains of headache, malaise, nausea, and dizziness. He is too altered to give much more history. His skin looks a little red. Vital signs are: HR 70, BP 110/60, RR 16, O2 saturation 99% on room air, temperature 37. Cardiac biomarkers (CKMB and troponin) are elevated. A CT of the head, taken 16 hours later, is shown above. Weeks later, the patient still has some cognitive deficits, personality changes, and neurologic defects.

Challenge: What diagnostic test should the emergency department order?

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The Foot's Corollary

A 50 year old woman with rheumatoid arthritis presents with unilateral aching, burning, numbness, and tingling at the sole of her foot, the distal foot, and the toes. This discomfort is worst at night and after standing a while, and she often needs to remove her shoes. Tapping over the area posterior to the medial malleolus leads to distal tingling. Sensory loss is over the plantar but not dorsal foot. Muscles do not appear to be very atrophied. The patient's past medical history includes trauma to that foot years ago when she fractured her talus and calcaneus. This helps you make the diagnosis as idiopathic causes of this syndrome are rare.

Challenge: What's the diagnosis?

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