Squamous Cell Carcinomalip

ID CC A 12-week-old male infant is brought to the hospital for evaluation of recurrent oral thrush and URIs. HPI The child had seizures (due to hypocalcemia) shortly after birth. His mother is an IV drug user. PE Full-term infant jittery increased muscle tone oral thrush midfacial hypoplasia. Labs Hypocalcemia T-cell count markedly low. Treatment Transplant of an immature fetal thymus treat opportunistic infections irradiation of blood products. Discussion DiGeorge's syndrome is due to an...

Coarctation Of The Aorta

A 57-year-old male is seen by the resident on call because he complains of pain in the groin area and coldness in the right foot. HPI He underwent coronary angiography that morning for evaluation of coronary artery disease. PE VS tachycardia (HR 98) hypotension (BP 90 60) no fever. PE pallor right groin examination discloses marked swelling and deformation at site of femoral artery puncture with skin discoloration (ecchymosis) to middle third of thigh anteriorly and posteriorly (patients are...

Patent Ductus Arteriosus

ID CC A 6-year-old child is referred to a pediatric cardiologist for evaluation of dyspnea on exertion. HPI Since birth, he has had several-minute-long blue spells during which he becomes hyperpneic, cyanotic, and restless at times he has also lost consciousness. He has been observed to assume a squatting position in order to relieve dyspnea clue to physical effort (increases venous return to right heart and pulmonary flow). PE Delayed growth central cyanosis grade III clubbing of fingers...

Gartners Duct Cyst

ID CC A 54-year-old nurse complains of a heavy sensation in her lower abdomen that worsens when she lifts heavy objects, together with back pain and increased frequency of urination with a burning sensation (due to altered location of bladder, subsequent stagnation of urine, and thus bacterial proliferation). HPI She has given birth to five children, all by vaginal delivery. She complains of urine leakage while coughing, sneezing, or running (stress incontinence). Her menses are irregular, but...

Hypertrophic Pyloric Stenosis

ID CC A 48-year-old male computer programmer is brought to the emergency room with intermittent, excruciating pain in the right flank the pain radiates to his inner thigh and testicle and is accompanied by nausea and vomiting. HPI Over a period of a few hours, the pain migrated toward his groin. It lasted for 30 minutes and then stopped for another 30 minutes before suddenly recurring (due to periodic peristaltic motion of ureter). PE Abdominal exam shows no rebound tenderness (vs. peritonitis...

Aphasiawernickes

ID CC A 7-year-old girl is brought by her parents to the pediatric emergency department because of a severe headache that does not respond to treatment with analgesics. HPI Her father is concerned about weird movements of the girl's eyes (nystagmus). PE Well developed and nourished but confused with ataxic gait chest and abdominal exams unremarkable funduscopic exam reveals left papilledema (due to increased intracranial pressure) nystagmus also noted patient experienced projectile vomiting...

Wristcarpal Tunnel Syndrome

ID CC A 19-year-old college undergrad comes to an urgent care center at a ski resort because of pain in the wrist. HPI He has suffered repeated falls while snowboarding (falling forward with outstretched palms). PE Hyperesthesia and marked tenderness in anatomical snuff box (C) (bounded by the extensor pollicis longus and the extensor pollicis brevis the scaphoid and trapezium bones lie in the floor). Imaging XR, wrist no definite fracture (a small fracture of the scaphoid may not appear on...

Hip Fracture

A 17-year-old high-school student is brought to the emergency room straight from a football game because of acute, severe pain in the left knee and inability to walk. He could not get back up on his feet after being chop-blocked by a lineman from the side during a football game. Leg slightly flexed marked tenderness on medial aspect of knee (damage to medial collateral ligament) and anterior knee joint space (damage to medial meniscus) positive anterior drawer sign (ruptured anterior cruciate...

Nephrolithiasis

ID CC A 45-year-old man, the father of seven children, comes to a family planning clinic for advice regarding birth control. HPI After carefully weighing all possible alternatives with the doctor, he decides to have a vasectomy. PE Physical exam unremarkable except for an old McBurney appendectomy scar no contraindications for surgery. Imaging CXR within normal limits for age. Treatment Vasectomy (complications include scrotal hematoma, infection, spermatic granuloma, spermatocele, and...

Thoraxcervical

ID CC A 46-year-old woman comes to her family physician complaining of pain, numbness, and a tingling sensation (paresthesias) on the palmar aspect of her right thumb, her second and third fingers, and the radial side of her fourth finger (fifth finger is always spared) her attacks occur primarily at night. HPI She has worked for several years in the data entry department of a computer firm (an activity associated with prolonged, repetitive movements of the wrist). PE Wasting of thenar eminence...

Tetralogy Of Fallot

ID CC A 2-month-old female presents with dyspnea, feeding difficulties, poor growth, and profuse perspiration. HPI The child had pneumonia when she was 7 days old, at which time her parents were informed of a congenital heart murmur. PE VS pulse normal. PE no edema, cyanosis, or clubbing palpable parasternal heave apical thrust and systolic thrill loud P2 component of S2 harsh pansystolic murmur heard best over left lower sternal border short apical diastolic rumble (due to increased flow...

Arteriovenous Fistula

ID CC A 42-year-old female presents with progressive shortness of breath on exertion and palpitations. HPI The patient has been symptom free until now. PE VS irregularly irregular pulse. PE left parasternal heave grade III VI systolic ejection flow murmur in left second intercostal space widely split, fixed S2 (does not change with breathing). Labs ECG atrial fibrillation RSR pattern in right precordial leads right-axis deviation (right ventricular hypertrophy). Imaging CXR dilated proximal...

Acute Torticollis

A 57-year-old right-handed male is brought to the emergency room by his relatives because they noticed that although he speaks fluently, he has begun to use inappropriate words and phrases to refer to ordinary objects and events in his daily life. He suffers from chronic hypertension that has been treated with calcium channel blockers. VS hypertension (BP 170 120). PE confusion constructional neurologic deficit Babinski's reflex present. EEC abnormal brain activity in left temporal lobe over...

Cavernous Sinus Thrombosis

A 34-year-old construction worker is brought to a clinic after a flying piece of shrapnel cut his leg just below the lateral surface of the head of the fibula the patient also complains of numbness and tingling along the dorsum of his foot and the lateral surface of his leg. He complains of loss of stability when walking and inability to dorsiflex his foot foot drop . He must raise his injured leg higher than normal during walking to prevent his toes from hitting the ground, and his foot slaps...

Thyroglossal Duct Cyst

ID CC A 10-year-old boy is brought to the pediatrician complaining of high fever, sore throat, earache, swollen glands, and productive, greenish-white, blood-tinged sputum. H PI His mother states that the boy has had recurrent bouts of sore throat several times a year for the past 5 years, each time treated effectively with antibiotics. PE Mouth partially open swollen pharyngeal tonsil obstructs nasopharyngeal isthmus tonsils markedly enlarged, hyperemic, and cryptic with spotted areas of pus...

Petits Triangle Hernia

ID CC A 33-year-old gas station attendant is brought to the emergency room after sustaining a bullet wound on the back of his leg. HPI He panicked and ran when confronted by two muggers on a dark, deserted street shot from behind . PE Left foot is cold inability to dorsiflex foot overlying skin cyanotic no dorsalis pedis pulse palpable artery lies between tendons of extensor hallucis longus and extensor digitorum longus entry wound located on popliteal fossa and exit wound on anterolateral...

Inguinal Herniadirect

A 28-year-old male weight lifter comes to the emergency room because of a painful lump in the right scrotal area that began earlier in the morning. HPI He is healthy with an unremarkable past medical history he frequently engages in strenuous physical labor. PE VS tachycardia. PE abdomen distended and tympanic with increased peristaltic movements tender to palpation with no rebound tenderness intestine is obstructed with backward accumulation of gas and feces tender, tense, and painful mass in...