Monday, September 29, 2014

Call It

On this single photon emission computed tomography (SPECT) brain scintography, normal is the top figures and abnormal is the bottom figures. What a hot nose!

Challenge: What does his ancillary test show?

Image is in public domain.

Thursday, September 25, 2014

Reverse Engineering II

A 51 year old woman taking the compound shown above is cautioned not to take it long term because of risks for stroke, venous thromboembolism, breast cancer, and cholecystitis.

Challenge: What is the drug and what is she taking it for?

Image is in the public domain.

Monday, September 22, 2014

Reverse Engineering I

Can you figure out from the treatment what the disease is?

A 20 year old on a liver transplant list is taking the drug above. His parents remind him to take the drug on an empty stomach since absorption can be decreased by as much as 50% if taken with food. He takes 1000mg daily in divided doses. When he first started the medication, a lot of caution was taken because of his penicillin allergy. Luckily, he didn't get early sensitivity reactions which are usually characterized by fever, cutaneous eruptions, lymphadenopathy, neutropenia, and thrombocytopenia. He has had some proteinuria, but luckily, his kidney function has remained stable since the drug is renally metabolized. He gets routine blood counts to monitor for aplastic anemia. He gets 24 hour urine collections with his hepatologist to make sure he is compliant with treatment. His child neurologist and ophthalmologist are optimistic that he will get a liver transplant.

Challenge: What's the drug and what's the disease?

Image is in the public domain.

Thursday, September 18, 2014


An obese 30 year old woman with Type II diabetes presents with groin pain. She had an inguinal hernia repair six months ago, but now regrets it. She has had multiple orthopedic surgeries in the past (the last one a year ago) but never had a problem like this. A few weeks after the hernia repair, she was doing well, but about two months out, she began having symptoms again. The pain is an episodic throbbing and burning sensation that begins with prickling pain. It's worse with activity and hyperextension of the hip. It's relieved by recumbency and hip and thigh flexion. Sometimes even just touching the wound or coughing can trigger pain. She also notices numbness over the thigh.

Challenge: What's your diagnosis?

Image shown under Creative Commons Attribution Share-Alike License, from Wikipedia.

Monday, September 15, 2014

Glassmakers Soap

A 40 year old is referred to you for evaluation of Parkinson's disease. He presents with dyscoordination, loss of balance, and confusion. He is on a fad diet of meat, fish, poultry, dried fruit, and nuts. He works in the steel and welding industry. He is a nonsmoker but does drink occasional alcohol. He uses marijuana as well.

Challenge: This is toxicity of the element shown above: what is it?

Image shown under Creative Commons Attribution Share-Alike License.

Thursday, September 11, 2014

It's Not Easy Being Green


Challenge: What medication has this sedated ICU patient been on?

Image shown under Creative Commons Attribution Share-Alike License.

Monday, September 8, 2014


A 50 year old man presents with shortness of breath and a cough two days after taking the substance above. He also has melanoptysis (that is, black sputum). He has thermal burns on his thumbs. He is hypoxic and a bronchoscopy is performed. The bronch shows bloody lavage. Cell count shows eosinophilia. The CXR and CT are shown below.

Challenge: What's the diagnosis?

First image is in the public domain, second image is shown under Fair Use.

Thursday, September 4, 2014


This young healthy football player sustained a "knee injury." He is supine, hip flexed to 45 degrees, knee flexed to 90 degrees, and foot in neutral position.

Challenge: Where is the lesion?

Image shown under Fair Use.

Monday, September 1, 2014

Labor Day 2014

Happy Labor Day!

A 25 year old G1P0 woman delivers a healthy baby girl at 39 weeks gestation. She has a history of gestational diabetes mellitus, hypothyroidism, and polyhydramnios. She had spontaneous rupture of membranes about a day and a half ago. She receives the drug above after delivery. About half an hour later, she develops shivering, then a fever. She receives acetaminophen and these symptoms abate after three hours.

Challenge: What medication is shown above?

Image is in the public domain.