2 4 6 0 1

In multiple studies including a recent JAMA article, I have been shown to reduce the duration of mechanical ventilation and ICU stay compared to my more traditional counterparts. I'm sometimes used in procedural sedation (even as anesthesia for awake craniotomies!). Other times, you might find me hanging with benzos for that drunk patient sobering up. Sometimes, I am given as a loading dose, and I can cause either hypertension or hypotension, to the confusion of many medical students. Avoid me if the patient has heart block or bradycardia, though.

Challenge: Who am I?

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Normal

As you review this EKG, you note the T-wave inversions in leads V1-V3, the vertical QRS axis (+90 degrees), and the early precordial transition.

Challenge: These findings are normal for what kind of patient?

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Aging

A 55 year old woman presents with complaints of pain with sex. She's noticed vaginal dryness, burning, and irritation as well as yellow discharge. In addition, she has dysuria and increased urinary frequency. On exam, you note scarce pubic hair, diminished elasticity and turgor of the skin, and fusion of the labia minora. Vaginal pH is 6.

Challenge: What's your diagnosis?

Kiss and Tell

This is a peripheral blood smear from an adolescent presenting with malaise, headaches, fever, and sore throat.

Challenge: What do you expect to find on the neck exam?

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No Cases this Week

I'm feeling slightly burnt out. I'm going to take this week off for some self-care. I hope you do too. I'll try to get answers up soon for the last several cases. See you next week.

Craig

Refresher IV

This disease represents the rule of 2's: it occurs in 2% of the population, the male:female prevalence is 2:1; it occurs within 2 feet of the ileocecal valve, and it can be two inches in length.

Challenge: What is the diagnosis?

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Refresher III

A 35 year old G1P0 woman who has not received prenatal care presents at 34 weeks of gestation. She has no prior medical history, but she is obese. She presents because of leg swelling, back pain, right upper quadrant abdominal pain, headache, gastroesophageal reflux, and fatigue. Her blood pressure is 150/100. Her labs show a hemoglobin of 10, platelets of 150,000, a normal creatinine, and normal liver function tests.

Challenge: What parts of her presentation makes this disease "severe"?

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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