Streaks

This is a 21 year old man with hypertension and glucose intolerance who notices easy bruising, proximal muscle weakness, hirsutism, and impotence.

Challenge: What's the diagnosis?

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Vacation

You are on vacation in Thailand when you meet a diabetic drinker with renal disease. He presents with fever, cough with sputum, chills, rigors, and respiratory distress. Even though you're on vacation, you get interested when you find out the organism that grew out is rarely seen in the U.S. A gram negative bacillus with characteristic bipolar staining looking like a "safety pin" is isolated.

Challenge: The causative organism is a facultative intracellular bacterium called what?

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Behavior

A patient recently diagnosed with HSV-1 encephalitis demonstrates remarkable placidity with loss of normal fear and anger, increased sexual aggression, and increased appetite.

Challenge: What syndrome is this?

Fonder

This EEG is from a child who was referred to you because of declining school performance. The teacher says the child daydreams a lot and seems to zone out during class.

Challenge: What's the diagnosis?

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Neuro Week

This is neuro week! An emaciated homeless man with alcohol on his breath presents to your emergency department confused and unable to walk. On examination, you find profound disorientation and lack of attention. Neuro exam shows horizontal nystagmus, bilateral cranial nerve VI palsy, and sluggish pupils. Unfortunately, he does not survive and an autopsy is done, showing this:

Challenge: What is the importance of the following molecule?
Related Question:
1. What does the pathology specimen show? Where is the lesion?
2. What is the diagnosis? What is the clinical triad here?

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Weaning

At the time of weaning, a 6 month old infant has irritability and vomiting. Studies show recurrent episodes of hypoglycemia after feeding, fructosuria, hepatomegaly, jaundice, aminoaciduria, a metabolic acidosis, and low urine ketones. The child begins to develop failure to thrive. Milk is okay. Sweets and fruits are not. This is not a glycogen- or gluconeogenesis-related problem.

Challenge: This is a recessive disorder caused by deficiency in what enzyme?

Multiple Choice

This is not an artifact.

Challenge: Of the following, which organ system should you investigate - heart, lungs, kidney, or spleen?

Related Question:
1. What is shown in the image?

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Occupational History

A 50 year old male who works in the fluorescent lamp industry presents with nonspecific symptoms of dry cough, shortness of breath, night sweats, fatigue, and weight loss. Examination reveals bibasilar rales and clubbing. Labs show hypercalcemia. CXR is normal. PPD is negative. A methacholine stimulation test is negative. Transbronchial biopsy shows noncaseating granulomas and mononuclear cell infiltrates.

Challenge: Given the occupational history, one diagnosis is a little more likely than sarcoidosis (I know you were thinking it). What is it?

Asymptomatic

Routine blood cultures are drawn on an otherwise healthy 20 year old man enrolled in a research study. Cultures are drawn from 2 sites on different arms. The culture from the left arm is negative. The culture from the right arm shows the above image after 72 hours. The study subject does not have fever, hypotension, leukocytosis, or any other detectable laboratory abnormalities.

Challenge: What antibiotic (or class of antibiotic) would you prescribe?

Related Questions:
1. What is the organism shown above?

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Horticulture

A patient comes in complaining of feeling "terrible," restless, muscle and joint pain, nausea, vomiting, abdominal cramping, and diarrhea. You also notice watery eyes, a watery nose, and constant yawning. On exam, you find mydriasis and piloerection.

Challenge: What is the plant shown above?

Image is in the public domain.