Avogadro

This 40 year old woman presented with severe nausea and vomiting. She also notes pelvic discomfort and vaginal bleeding the color of "prune juice." Her heart rate is 104, blood pressure is 152/91. She has a mild tremor. Her urine dipstick shows 1+ protein. Her hCG is quite elevated. Her TSH is low.

Challenge: What is this disease, first described by Hippocrates in 400BC?

Teenagers (Sigh)

A high school football player gets in trouble for tackling players head-on. On lateral view of the neck in neutral alignment, you note developmental narrowing of the cervical spine canal as well as straightening of the normal cervical lordotic curve.

Challenge: What is this injury, first described in 1993?

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Board Exam this Week

The next in a never-ending series of tests happens this week for me. I'm going to be out of town taking my oral board exams, so next case will be a week for now. Thanks for reading.

Craig

Glow in the Dark

You are in a emergency exploratory laparotomy for a patient who developed peritonitis. Half way through running the bowel, the surgeon asks the anesthesiologist to give fluorescein. He then asks the circulator to pull this device out of the closet.

Challenge: What is it and what's he looking for?

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Hang Ten

A young otherwise-healthy man is learning to surf for the first time. After his first lesson, he begins to develop progressively worsening low back pain, followed by lower extremity paresthesias. On arrival to urgent care, he has normal vital signs, normal cardiopulmonary exam, no spinal deformity, and a neurologic exam significant for decreased sensation and strength in the lower extremities. Two hours later, he lost complete sensation and motor function of his legs as well as rectal tone. Labs and CSF are unremarkable. Lumbar spine films are unremarkable. CT of the lumbar spine showed no evidence of spondylolysis, spondylisthesis, fracture, or soft tissue abnormalities. Brain MRI is normal. A non-contrast spine MRI (T1w sagittal image) four weeks later shows this:

Challenge: What happened?

Axis of Awesome

Challenge: What does the echo show?

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Burrito

Challenge: What's being shown here?

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Everything but the Kitchen Sink

This is a poor child in a developing country. He gets recurrent infections because of a depressed immune system. He has impaired taste and smell as well as diarrhea. He has a bullous pustular rash. If untreated, he may develop night blindness, alopecia, and decreased spermatogenesis. The treatment, though, is fairly easy.

Challenge: What's he missing?

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Taking a Break

Hi everyone,

Thanks for following along Case of the Day. I'm going to take a break this week. I have my oral board exams coming up in a month so things are looking quite busy; I'll probably take a breather then as well. I feel a little like a hamster running on a wheel, always playing catch-up so hopefully this will give me a chance to get on top of things.

Craig

Names

This rash begins in the second or third trimester. The erythematous excoriated nodules or papules are seen on the extensor surfaces of limbs and the trunk. It should resolve in the immediate postpartum period. Labs are unrevealing.

Challenge: What is one of the many names for this disease?

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