Taking Boards!

Hi everyone,

Thanks for participating! I'm taking my board-certification exam next week so I'm going to take a break from cases for a week. We will be back soon!

Craig

Dark

 The patient's fingers are on the right; the control is on the left.

In panel B, the patient's hands are on the left. The control is on the right. Panel C shows the hands after treatment.

Challenge: What disease is shown here?

Images shown under Fair Use.

Skulls and Crossbones II

This patient is found down in a park and brought to the emergency department. He is complaining of headache, nausea, and vomiting. He has hearing loss so otoscopy is performed and shown above.

Challenge: What's the diagnosis?

Images shown under Fair Use.

Skulls and Crossbones I

This patient is found down in a park and brought to the emergency department. He is complaining of headache, nausea, and vomiting. He has a cranial nerve III palsy. A few days after the trauma, this patient develops otorrhea and rhinorrhea.

Challenge: What's the diagnosis?

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Tooth Fairy

A healthy 30 year old woman is getting a root canal at the dentist. At the start of the procedure, she notes a metallic taste in her mouth, ringing in her ears, tinglings of her lips, and feels agitated. She is tachycardic, hypertensive, anxious, and feels like she is going to die.

Challenge: What happened?

Image of root canal shown under GNU Free Documentation License, from Wikipedia.

Medieval Weapons

A 50 year old with a past medical history significant for the pathology shown above presents with sudden onset rapidly progressing shortness of breath. On arrival to the ED, he is noted to be hypotensive in cardiogenic shock. Exam shows peripheral vasoconstriction, pallor, and diaphoresis. The arterial pulse is rapid and thready. JVD is elevated. The cardiac impulse is hyperdynamic and not displaced. You feel a right ventricular heave. There is a soft, low-pitched, decrescendo systolic murmur best heard along the left sternal border.

Surprisingly, EKG is sinus tachycardia with no ischemic changes. CXR shows normal cardiac silhouette but asymmetric pulmonary edema, predominantly in the right upper lobe. Laboratory values are all within normal limits.

Challenge: Although your consultants suggest pneumonia and ARDS, you are smarter! What is your diagnosis?

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Spelunker

Challenge: These images from a 12 year old boy with exercise intolerance, chest pain, poor endurance, and shortness of breath show what?

Image shown under Fair Use.