Name That Object I

I prefer ones made out of glass; the plastic versions just don't feel as slippery. This syringe is normally filled with air or sterile saline.

Challenge: What is this particular type of syringe used for?

Image shown under Fair Use.

Hot Air

Challenge: What is going on here?

Image shown under Creative Commons Attribution Share-Alike License.

Slides

Back to basics! I pulled out Robbins ad Cotran for this one.

Challenge: This is the buzzword for which diseases?

Image is in the public domain.

Kaleidoscope

Sorry I missed Monday's case of the day! It's been really busy!

Here's a procedure I've never heard about!

It is performed several weeks after a traumatic injury to the eye to look for angle recession or a cyclodialysis cleft.

Challenge: What are we doing here?

Image shown under Fair Use.

Toxic

What toxic drug is responsible for the image above? It causes production of superoxide anions, hydroxyl radicals, and hydrogen peroxide. It leads to atelectasis, accentuation of hypercapnia, pulmonary parenchymal injury, and retinopathy. There is even some thought that it can be potentiated by bleomycin.

Challenge: What is it?

Image is in the public domain.

Palliation

You are a pain physician that performs a neurolytic block for a patient with metastatic pancreatic cancer and severe abdominal pain. He gets hypotensive which resolves with a fluid bolus. He also develops transient diarrhea lasting 48 hours. His pain improves, however, as he is transitioned to palliative care.

Challenge: What procedure did you perform?

Image is in the public domain.

Arrow Sign

This is a high resolution CT scan of a healthy 25 year old volunteer.

Challenge: What do the arrows refer to?

Image shown under Fair Use.

Risk Factors

A 60 year old patient with diabetes, COPD, AML s/p chemotherapy with ongoing neutropenia, history of cholecystectomy, and inguinal hernia presents with a COPD exacerbation. He is treated with nebulizers, high dose steroids, and broad spectrum antibiotics. He slowly improves, but then develops a small bowel obstruction. The surgeons recommend nonoperative management; an NG tube is placed. Because he is slow to improve, a PICC line is ordered and total parenteral nutrition is started. On hospital day 7, he becomes febrile, hypotensive, and tachycardic. He complains of chills and blurry vision. His antibiotics are broadened to cover extended spectrum beta lactamase organisms. He continues to deteriorate clinically.

Fundoscopic exam is shown below:

Challenge: What are you worried about?

Images shown under Fair Use.

Attack Plants

Clue: "Leaves of three, let them be."

Clue: The munchies.

Clue: Fuga Demonum.

Challenge: Identify these plants!

First image shown under Creative Commons Attribution Share-Alike License. Second image is in the public domain. Third image shown under GNU Free Documentation License.

*Note: I am out of the country so answers may be later than usual (which I know are pretty late anyway).

Current Events

You are participating in international relief efforts abroad as a result of natural disasters. Patients come in with multiple exposures. Those who've been exposed within several hours present with anorexia, apathy, nausea, vomiting, diarrhea, fever, tachycardia, and headache. Some people die immediately from fever, hypotension, coma, and severe vomiting. Others present with neurologic deficits and have disorientation, confusion, loss of balance, seizures, papilledema, ataxia, and decreased reflexes.

Those who were exposed 5 days ago have crampy abdominal pain, diarrhea, nausea, vomiting, and GI bleed. In weeks to months, patients expect neutropenia, thrombocytopenia, and anemia.

Challenge: What was the exposure?

Image is in the public domain.

Fowl Play

You are the anesthesiologist for a neurosurgery for a patient with cranial synostosis. The patient is in Fowler's position. You DJ the iPad music, glance at the news of the day, and listen to blips of the heart (you can YouTube this). Suddenly the patient becomes immediately hypotensive and tachycardic. You note the patient's JVP suddenly rises. You turn down the music and hear a sucking noise. You send a stat ABG from the radial art line which showed hypoxemia and hypercarbia. The EKG on the monitor shows peaked p waves, non-specific ST changes, and sinus tachycardia. You start fluids wide open, prepare vasopressor support, and ask the neurosurgeon to place the patient into Tredelenberg.

Challenge: What happened?

Image from www.medtrng.com, shown under Fair Use.

Happy Holidays

This is sort of a fun case that's taken from the blog A Cartoon Guide to Being a Doctor. Hope you all have happy holidays! I think there will be no case this Thursday, but I'll plan for a case a week from today.

Challenge: How many diseases can you name?

Image shown under Fair Use.

Case of the Mondays

A century ago, a factory worker related to the above patent might have presented to you complaining of severe headache, dizziness, and flushing every Monday. The symptoms would get better the next few days until they disappeared for the rest of the week. The following Monday, he would go through the same cycle.

Today, you might prescribe a patient the same drug as treatment or prophylaxis for acute onset chest pain.

Challenge: What drug or chemical does this refer to?

Image is in the public domain.

Vegetable

This week focuses on the head, ears, eyes, nose, and mouth exam.

Challenge: What's the diagnosis?

Image shown GNU Free Documentation License.

Lines

You are napping on your radiology elective when your alarm rings. 4:55pm - almost time to go home! You quickly check if there are any new films and you see the one shown above. You're too lazy to read the clinical correlation; there are only 5 minutes before your shift is over.

Challenge: Quick! What's the pathology here?

Image shown under fair use.

Sympathy

In an unfortunate industrial accident, a patient's right eye is lacerated with a sharp instrument. He loses function of that eye, but it is not removed. Several years later, the other eye is diagnosed with uveitis. Weird.

Challenge: What's the diagnosis?

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?

Image shown under fair use.

Typical Case

You are finishing up your family medicine rotation and feeling good about all the typical cases: allergies, URIs, UTIs, asthma, hypertension, diabetes, obesity... Confident you can handle anything, you meet the last patient of the day.

He is a hunter who says that he has nausea, vomiting, vertigo, blurry vision, drowsiness, and malaise following a trip to the Arctic Ocean where he hunted and ate the animal shown above.

Challenge: You must have learned this one in medical school. What's the obvious diagnosis here?

Image is in the public domain.

Count the Ribs

You are doing a newborn exam and find a baby with narrow, sloping, "weird" shoulders. The baby seems unusually flexible; you can bring his shoulders almost together in the midline in front. You identify the abnormality on the CXR above. You remember that this diagnosis often involves delayed closing of the fontanelles (which may remain open to adulthood), defective bone formation, short stature, supernumerary teeth, and abnormal tooth eruption.

Challenge: The defective gene is a transcription factor called what?

Hint: The number of ribs you count isn't important, but you may notice something interesting while counting the ribs.

Image shown under fair use.

Skin Lesions

A young Latin American woman comes into your office for a routine check-up. On physical exam, you find these marks.

Challenge: What's the etiology?

Image shown under GNU Free Documentation License.