Holiday Week!

Happy Thanksgiving, everyone! Unfortunately, I am on call this Thursday, but I wish you all a warm and happy holiday. No cases this week; we'll see what I come up with next Monday. Thank you for following along.

Craig

Chicken or the Egg?

A 30 year old adult presents with what he thinks is asthma. He used to think he was allergic to chicken, but has been eating chicken okay. He gets short of breath and wheezy when he encounters bird feathers and eggs.

Challenge: Believe it or not, this syndrome has a name - what is it? What is the causative factor?

Image of chicken and egg illustration from the 14th century is in the public domain, from Wikipedia.

It's Greek to Me

A four year old child presents to your child neurology clinic with vomiting and syncope. The parents say he loses consciousness and muscle tone during these strange episodic events. They generally happen at night and last more than five minutes; some even last more than 30 minutes. His pediatrician's note says that during a witnessed episode, he had pallor, miosis, incontinence, coughing, hypersalivation, and tachycardia. He had some staring and eye deviation.

EEG is shown below (his is the second strip):

MRI of the brain is normal.

Challenge: What syndrome is described?

Image shown under Fair Use.

Collision

A man is brought in by ambulance after a motor vehicle accident with a dramatic open chest wound. The wound is on the left chest. During inspiration, the wound makes a big sucking noise and the mediastinum swings to the right. During expiration, the mediastinum returns to midline. When you look into the wound, during expiration, the injured lung inflates.

Challenge: What's going on here?

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

You Nailed It

Challenge: What is this autosomal dominant disorder?

First three images shown under GNU Free Documentation License, fourth image is in the public domain.

False Positive

A 60 year old man who is several weeks out from a bone marrow transplant for multiple myeloma develops fever, shortness of breath, tachycardia, and hypotension. He is started on vancomycin, levofloxacin, and piperacillin-tazobactam and then admitted to the intensive care unit. His lactate is elevated, and he is fluid resuscitated. A flu test is negative. A diagnostic test is sent to look for a specific polysaccharide in the serum that would change the antibiotic management. It comes back positive, but your infectious disease consultant says, "Wait, that test could be a false positive."

Challenge: What is the test and why is it unreliable here?

Image of bone marrow transplant shown under Creative Commons Attribution Share-Alike License, from Wikipedia.

Also Infects Dolphins

You volunteer with a medical mission to see outpatients in a clinic in Brazil (or Colombia, Suriname, Venezuela, Guyana, French Guiana, Ecuador, Peru, Bolivia, Costa Rica, or Mexico). You get a rash (pun not intended) of forest workers, farmers, hunters, and fishermen between 40 and 70 with the following findings:

The histology is shown below:

Challenge: What's your diagnosis?

First three images shown under Fair Use. Fourth image is in the public domain.