Refresher II

I'm not sure if this counts as a refresher type case, but it's an important one nonetheless.

The top two panels of the MRI were taken two days after admission. The lower two panels were taken two weeks after admission.

This patient presents with acute onset focal neurologic deficits. He is altered with hemiparesis, dysphagia, aphasia, ataxia, and seizures. He also has been running a high fever.

Challenge: When you perform the lumbar puncture, what diagnostic test should you order?

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Refresher I

I got a request for a few more basic cases. I'll see what I can do.

Challenge: In a patient with Raynaud phenomenon, thromboembolic disease, and renal insufficiency, what does the rash above signify?

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White Bile

A young woman presents with right upper quadrant abdominal pain. Ultrasound shows a stone in the cystic duct. You take her to the operating room for a cholecystectomy. You find a quite distended gallbladder, but what surprises you is that when you aspirate fluid from the gallbladder, it is colorless and mucoid.

Challenge: What's the diagnosis?

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But Why?

A 30 year old previously healthy woman who is 11 weeks pregnant complains of heat intolerance, sweating, and anxiety. On examination, you note tachycardia and hand tremor. Her pregnancy has been notable for morning sickness and a slower weight gain than expected. A brilliant diagnostician, you send off thyroid function tests. Serum free T4 and T3 are slightly elevated. TSH is reduced.

The next time you see the patient, before you start any therapy, she is 15 weeks gestation. She says her symptoms have completely disappeared.

Challenge: How do you explain this?

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Holy Fire

I apologize there was no Monday case this week.

A 10 year old child with a history of eczema presents with a rash on his leg. He scratches that leg quite a bit and scrapes it like any ten year old does. But this is the first time he's had anything this severe. It developed quite quickly and is accompanied by fevers and chills. Note that the lesion is very well demarcated and it is raised compared to the surrounding skin.

Challenge: What is the diagnosis?

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Chemo II

Three months after finishing this ruby red chemotherapy regimen, a patient develops shortness of breath. He gets tired even after climbing a flight of stairs. He's noticed some swelling of his legs. At night, he props himself up with pillows to avoid waking up gasping for air.

Challenge; What chemotherapeutic agent caused this?

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Chemo I

A patient starts developing numbness and tingling in the fingertips and feet. There isn't much pain, but you do note some mild distal weakness. On exam, you can't really get deep tendon reflexes, not even an ankle jerk. Vibration perception is quite poor. On review of systems, the patient complains of colicky abdominal pain and constipation. You send the patient to nerve conduction studies and electromyography and find that there is a symmetric axonal neuropathy.

Challenge: What chemotherapeutic agent caused this?

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Nails II

Challenge: Tell me about this person's labs.

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