Thursday, December 31, 2015


Here's a different way of looking at a disease. It is the most commonly diagnosed gastrointestinal condition, and direct and indirect costs of this disease can be up to $30 billion dollars a year. This is probably because it is the second highest cause of work absenteeism (behind the common cold). The prevalence in North America is approximately 10 to 15%, yet only 15% of patients seek medical attention. Young patients and women are more likely to have it; there is a 2:1 female to male predominance. This disease makes up 25-50% of referrals to gastroenterologists.

Challenge: What is it?

Monday, December 21, 2015

Are You Serious?

A family comes into urgent care, all complaining of abdominal cramps, nausea, and vomiting. One of them also has diarrhea. Earlier today, they ate fried rice.

Challenge: What's the diagnosis?

Image is in the public domain.

Thursday, December 17, 2015

Well, I Tried

Though not planned, I guess there are no cases this week. Oops! I'll have them over the holiday week next week. Sorry about that. I know I also have to get around to posting answers - it's all on the to-do list.


Thursday, December 10, 2015

Not Seasickness

A 30 year old woman with depression presents with dizziness after being on a boat (or using a flight simulator or being on a water bed). When she's on a boat, she feels a sense of swaying or rocking, like she's walking on uneven ground. She doesn't feel like the room is spinning around her, but rather she just has disequilibrium. She does not feel nauseous. She's never had motion sickness or seasickness. Her physical examination is normal. Vestibular tests are normal. She is treated with benzodiazepines.

Challenge: What's the diagnosis?

Monday, December 7, 2015


Challenge: What category is this tracing?

Image shown under Fair Use.

Thursday, December 3, 2015


Here's a great case! This blood smear is from a patient with massive hemolysis. In fact,the laboratory called because routine chemistries are not working correctly and they cannot cross-match the blood. The patient initially presented with multiple knife wounds in a fight over black tar heroin (he also does skin popping). He had severe pain at the site of the injuries and was admitted to the hospital for monitoring, but over the last 24 hours, has become quite ill. He was transferred to the intensive care unit with tachycardia, fever, and shock. He is developing renal failure. The skin over his injuries has developed a bronze appearance with some red and purple discoloration. The skin is tense and exquisitely tender. There are some bullae present.

Challenge: What's the diagnosis?

Interlude - QuantiaMD

Since readers of this blog might be interested in other websites with "case of the day" type presentations, I wanted to put a plug in for QuantiaMD. It is a community for health care practitioners (requiring an MD, DO, NP, or PA degree to sign up) with focused educational videos on many topics throughout medicine (from basic diagnosis and treatment of diseases to health care policy to physician well-being). Every field from radiology to surgery to oncology is covered. There are lots of "mystery" cases similar to the material I have here. Participating in it leads to rewards, which makes it fun and engaging. The material is pretty solid and it awards CME credits. If you're interested, check it out: QuantiaMD. It does require you to verify your clinician status. Full disclosure - I do get a referral if you sign up.