Currant Jelly

This is the last case involving a specific association between a "Boards-useful" catch-phrase and a disease. The next few cases will be a little wacky, then back to your regularly scheduled programming.

Looks delicious yes?

Challenge: If a patient's sputum was this color, what would be the causative organism of the pneumonia?

Image shown under fair use.

Blister

A middle age person reported flaccid bullae that began in the oropharynx and then spread to the skin. Since the bullae rupture easily, this image shows only erosions. The lesions are painful and there is a fear of secondary infection.

Challenge: What's the disease? What's the cause? What's the treatment?

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3C's

Note the buccal mucosa.

Challenge: On a test, this disease appears with symptoms of fever plus 3C's. What are they?

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Lumpy Jaw

So when I think of "lumpy jaw" I think of Burkitt's lymphoma. But what if the "lumpy jaw" question came with this:

Challenge: What's the causative organism?

Related Questions:
1. This organism is always paired with another organism that looks just like it on gram stain but stains weakly acid fast. What is that organism?
2. What is the organism that causes Burkitt's lymphoma?
3. Sorry, I know this question sucks. What is the chromosomal mutation involved in Burkitt's lymphoma? What is the resulting protein?

Image is shown under fair use.

Dubious D's

Here are two separate cases.

A chronic alcoholic stumbles into your emergency room, but as you take a history, you realize he has no idea who he is or where he is. He can't do serial 7's, doesn't remember any of three objects after a few minutes, can't copy a figure. His MMSE is pretty bad. On exam, you notice this:

He suddenly says, "Oh I remember what's been bothering me. I have to keep going to the bathroom. Must be something I ate."

Challenge 1: Is it something he ate? Or something he didn't eat? What's the diagnosis?

-You can see the changing posture of this boy over time. On exam, you notice he has huge calves. These days, though, he has to use his arms to push himself up from a sitting position.

Challenge 2: What's the mutated gene?

First image is in the public domain, second image shown under fair use.

I Never Really Learned This Disease

So I'm reviewing it now. This is not infectious.


Challenge: This disease is associated with a specific histopathological finding. What is it?

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Benedict

Most cases of this are discovered in infants and children with stridor and swallowing difficulties. But this MRI is of a woman in her forties with headache. You notice her gait is somewhat clumsy, there is diminished upward gaze, truncal instability, and bilateral increased reflexes.

Challenge: What's the diagnosis?

This image and case are from a www.urmc.rochester.edu website, shown under Fair Use. This is because I couldn't find a great UpToDate article.

Spiders

Interesting, huh? (Try it at home!). Upon further examination, this boy's arm span exceeds his height, he has severe scoliosis, and the lens of his eyes are displaced upward.

Challenge: What's the main cause of morbidity and mortality in these patients?

Related Questions:
1. What's shown on the image?
2. What's the diagnosis?

Image shown under fair use.

Question Stem

You're all fired up to take the USMLE and turn to the first question.

A forty-year old fat fertile female presents with..."

You don't read another word and quickly bubble A.

Challenge: What was the diagnosis?

Neurons That Fire Together, Wire Together

Here's a collection of quick cases.

"Worst headache ever."
Challenge 1: What are you looking at?

Related Questions:
1. What happened?
2. What's the cause?
3. What are the risk factors?
4. What is the initial work-up?

Young adult, low back pain, limited spinal mobility, with acute anterior uveitis.
Challenge 2: This is associated with a specific genotype. What is it?

Fatigue, infection, gingival bleeding.
Challenge 3: Diagnosis?

All images shown under Fair Use.

Skin Review

Here's the histology (click to read the labels):
Note the lesions are found on the hand, an often sunlight-exposed area.

Challenge: What is concerning about these lesions?

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Students of Hookers

This was done in Dr. Josephson's BMB Case of the Day, but deserves a rerun for USMLE review.

A 60 year old man presents with sudden, brief, severe stabs of pain affecting the limbs lasting for minutes. He also has an ataxic gait. His pupils are small, do not respond to light, but contract normally to accommodation and convergence.

Challenge: What's the diagnosis?

Star Light, Star...

A six year old girl begins to develop breast buds and menstrual periods. You note ovarian cysts as well as these findings.

Challenge: What's the diagnosis?

First image is in the public domain, second image shown under fair use.

Renal Review

Parents bring their 5-year-old son in because they noticed blood in his urine without history of trauma or infection. He is also deaf. The parents say that several other members in the family have this disease too, but they forget what it's called.

Challenge: What is it called?

This Was Not Photoshopped

After finishing medical school, you decide to squander your education and abandon your kind-hearted nature to pursue law school. As the district attorney, you get called to evaluate this case of potential child abuse. This child presented with multiple fractures. You take one look at his eyes and remember fondly back to your medical school days and realize that this disease is...

Challenge: What?

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For Whom the Bell Tolls

A diabetic and pregnant patient presents with the above finding with an onset of a day or two. She has trouble closing her eyes. She looks funny when she wrinkles her forehead. Oh, oh, oh!

Challenge: What's the diagnosis?

Image shown under fair use.

Private Practice

A 30 year old woman presents to your clinic because she's lost her appetite recently. She feels really tired all the time; the fatigue gets better when she rests, but it's like she has no energy. She has general weakness and has had some weight loss. You assess for depression, but it seems to be more than that. She has nausea and occasional vomiting, abdominal pain, diarrhea, and constipation. She's felt dizzy on occasion. She says she enjoys laying out in the sun cause she tans really easily. On exam, you find orthostatic hypotension and notice this:

Challenge: What's the diagnosis?

Related Question:
1. What's seen on the image?

Image shown under fair use.

The Answer is Stroke

A forty year old woman presents with a stroke, but doesn't have the traditional risk factors (smoking, hypertension, or hypercholesterolemia). Instead, she presents with a swollen tender right calf after an 18 hour plane ride. She is currently on oral contraceptives. When you look at her hands, you notice cyanosis and the following finding:

Challenge: What's the cause of the stroke? What's the status of her lungs? What's the physiology of her heart?

Related Questions:
1. What is shown on the image?

This case idea contributed by Alex Penn.
Image is in the public domain.

All That and a Bag of Chips

A 60 year old smoker presents with right shoulder pain that radiates up his neck and down the ipsilateral arm. He complains of dyspnea, non-productive cough, and facial swelling (worse when he bends forward or lies down). Here's another picture:

Here is a CXR of a similar patient (not the same because the finding is on a opposite side).

Challenge: This case has so many random syndromes, it seems almost artificial; it'd be such a good teaching case, you think. What's the final diagnosis? (Be specific - it's named after a Quaker who was, according to Wikipedia, the first professor of radiology).

Related Questions:
1. What's seen on the first image?
2. What's seen on the second image?
3. What's seen on the CXR?
4. Why the shoulder pain?

Images are all shown under fair use.

History Lesson

It is 1985. An 18 year old woman presents to your office with a diagnosis of adenocarcinoma of the vagina. There is no family history of any cancers.

Challenge: Tell me about her mother.