Leiomyoma Uterine Fibroids

A 60-year-old woman visits her gynecologist because of a foul-smelling, blood-tinged, purulent vaginal discharge. She has never been married and has never been pregnant. She is hypertensive and takes oral hypoglycemic agents for diabetes mellitus. VS BP normal at present. PE overweight fleshy, bulky, fungating tumor protruding from cervical os on vaginal speculum exam. CT MR large, complex mass arising from uterus. Large, fleshy tumor of myometrium with areas of necrosis and hemorrhage....

Dupuytrens Contracture

ID CC A 2-year-old boy is brought in for a pediatric consultation because his parents are concerned about the child's protruding eyes ( EXOPHTHALMOS) and excessive urine volume ( POLYURIA). HP1 The parents also state that the child has been febrile and has had multiple ear infections. PE Low weight for age bilateral exophthalmos painful swellings over head (due to cystic bony lesions) no icterus no lymphadenopathy mild hepatosplenomegaly. Labs CBC normal blood counts. Increased serum osmolality...

Alports Syndrome

A 56-year-old male complains of urinary frequency and interruption of the urinary stream over the past six months he also complains of having to wake up multiple times during the night to urinate ( NOCTURIA). The patient's history includes one episode of acute urinary retention one month ago that was relieved with catheterization. He denies any history of hematuria (vs. carcinoma of the bladder) or back pain (vs. metastasized prostatic carcinoma). He also admits to having a reduced caliber of...

Pulmonary Embolism

A 56-year-old male presents with progressively increasing dyspnea and dry cough of several years' duration. He is a nonsmoker, but his occupational history includes mining and quarrying. No clubbing, cyanosis, or lymphadenopathy reduced chest expansion on inspiration dry inspiratory crackles auscultated in upper lobes of both lungs. PFTs combined obstructive and restrictive pattern of functional impairment. Bronchoscopically guided lung biopsy establishes diagnosis negative Mantoux test sputum...

Membranous Glomerulonephritis

Imaging Gross Pathology Micro Pathology A 5-year-old white male presents with generalized edema and abdominal distention, producing respiratory embarrassment. VS normotension. PE generalized pitting edema free ascitic fluid in peritoneal cavity shifting dullness and fluid thrill present normal funduscopic exam. UA 4+ proteinuria (> 3 g 24 hours). Hypoalbuminemia hypercholesterolemia hypertriglyceridemia decreased serum ionic calcium normal C3 levels moderately elevated serum creatinine and...

Creutzfeldtjakob Disease

Micro Pathology Treatment Discussion A 19-year-old female Olympic horseback rider is brought into the emergency room with headache, confusion, weakness of the left side of her body, blurred vision, and projectile vomiting. Three hours ago, she hit the right side of her head when she fell from a horse during a training exercise. She lost consciousness for one minute and then appeared to have recovered completely before presenting with the symptomatology ( LUCID INTERVAL). VS BP mildly elevated...

Testicular Torsion

Micro Pathology Treatment Discussion A 3-year-old male is brought to his pediatrician for evaluation of an abdominal mass that his parents noticed. The child has been well all his life. Slight pallor weight and height within normal range nontender, large, firm, and smooth intra-abdominal mass to right of midline right cryptorchidism and aniridia. UA microscopic hematuria urinary vanillylmandelic acid (VMA). Normal BUN increased serum erythropoietin. IVP displacement and distortion of right...

Sjogrens Syndrome

ID CC An 18-year-old white female presents with a malar rash that is exacerbated by sun exposure PHOTOSENSITIVITY) as well as with arthralgias and joint stiffness involving her ankles, wrists, and knee joints she also complains of decreased visual acuity, anorexia, weight loss, malaise, and weakness. HPI She has a history of hematuria and no history of drug intake prior to the onset of symptoms. PE VS hypertension (BP 160 100). PE pallor malar rash painful restriction of movement of wrist,...

Adult Respiratory Distress Syndrome

ID CC A 10-year-old girl is brought into the ER in acute respiratory distress. HPI The patient is known to be allergic to cats and pollen her mother states that she had a recent URI. She also complains of a history of moderate intermittent dyspnea that is exacerbated by exercise. PE VS no fever tachypnea (RR 32) normotension. PE inspiratory and expiratory wheezes (due to bronchoconstriction, small airway inflammation) boggy and pale nasal mucosa accessory muscle use during breathing enlarged...

Mixed Connective Tissue Disorder Mctd

Imaging Gross Pathology Micro Pathology An obese 35-year-old male goes to a clinic because of distal muscle weakness in both upper and lower limbs and gradual diminution of vision. His father suffered from a similar muscular weakness. The patient also suffers from mental retardation. Frontal balding typical facial wasting bilateral cataracts distal muscle weakness in both upper and lower limbs difficulty releasing grip after handshake percussion over tongue and thenar eminence reveals myotonia...

Craniopharyngioma

A 62-year-old man is brought to his family doctor because of rapidly progressive loss of cognitive function ( DEMENTIA) and excessive somnolence. Five years ago, he received a corneal transplant. His wife states that she has seen a definite change in his personality over the past year. Dementia myoclonic fasciculations normal funduscopic exam no other focal neurologic signs. LP normal CSF profile. EEG bursts of high-voltage slow-wave activity and slow background. CT-Head ventricular enlargement...

Fibroadenoma Of The Breast

Imaging Gross Pathology Micro Pathology A 20-year-old Asian female visits her family doctor because of chronic, intermittent left lower quadrant pain. The pain is not accompanied by dyspareunia, menstrual irregularity, vaginal discharge, abdominal distention, nausea, vomiting, or diarrhea. It is not correlated with her menstrual periods. Left adnexal mass on bimanual exam uterosacral ligaments normal pouch of Douglas normal McBurney's point nontender no evidence of ascites. Routine lab work on...

Subarachnoid Hemorrhage

A 30-year-old black male complains of constant bifrontal Headache and blurred vision of three weeks' duration. He has had mild intermittent frontal headaches for the past eight months and has become irritable for the past month he has been extremely drowsy and often sleeps for 30 hours at a time. Ten months ago, he fell from a moving vehicle and lacerated his scalp. Bilateral papilledema dilated left pupil right spastic hemiparcsis deep tendon reflexes on right side arc brisk right-sided...

Pleural Effusion

ID CC A 25-year-old white male complains of sudden pleuritic chest pain and shortness of breath that awakens him at night. HPI He smokes one pack of cigarettes a day and states that his paternal uncle once had a similar episode, PE Tall, thin patient diaphoretic and feels weak left chest expands poorly on inspiration trachea and apex beat displaced to right left side hyperresonant to percussion decreased breath sounds decreased tactile fremitus. Labs ABGs decreased PO, elevated PC02. Imaging...

Polymyositis

A 40-year-old white female complains of paleness and bluish discoloration of the hands, mainly upon exposure to cold, with redness upon re-warming ( RAYNAUD'S PHENOMENON) increasing pain in the knees, elbows, and hands over several months and recent difficulty swallowing solid food. She also has masklike facies with a limited range of expression. Smooth, shiny, tight skin over face and fingers edema of hands and feet palpable subcutaneous calcinosis pigmentation and telangiectasias of face. CBC...

Von Hippelundau Disease

A 49-year-old male who is a known chronic alcoholic is brought to the emergency room with dehydration, jaundice, and fever blood is drawn for routine tests, and he is infused with 5 dextrose, after which he becomes stuporous. He had been admitted to the ER several times before for alcoholic gastritis and acute intoxication. Patient confused and stuporous normal fundus nystagmus skin and mucosal icterus spider nevi on neck and upper chest pitting pedal edema abdominal distention with shifting...

Minimal Change Disease

A 47 -year-old black diabetic female complains of weight loss, progressive shortness of breath, and swelling of the lower legs and arms. Her past medical history is unremarkable. Pallor pitting edema in extremities decreased lung sounds with crackles bilaterally in lower lung fields periorbital edema ascites. UA proteinuria (> 3.5 g 24 hr) lipiduria with oval fat bodies and fatty and waxy casts in urinary sediment. Hypoalbuminemia (< 3 g dL) hyperlipidemia (serum cholesterol 250 mg dL)....

Acute Tubular Necrosis

A 47-year-old white male enters the emergency room complaining of a sudden-onset, severe headache that is the worst headache of his life. He also describes slow-onset dull pain in his left flank and blood in his urine. He was recently treated for recurrent UTIs, which were attributed to an enlarged prostate gland. His father died of chronic renal failure, and his paternal grandfather died of cerebral hemorrhage. VS hypertension (BP 170 110). PE palpable, nontender abdominal mass on both flanks...

Pneumothorax

Gross Pathology Micro Pathology Treatment A 50-year-old white male develops a fever 24 hours after surgery. He underwent an emergency laparotomy for a perforated peptic ulcer without any intraoperative or immediate postoperative complications. VS fever normotension tachypnea tachycardia. PE no cyanosis scattered rales and decreased breath sounds no calf tenderness no hematoma or discharge from wound no inflammation of IV line veins no urinary symptoms. ABGs mild hypoxemia. CBC slight...

Seminoma

A 23-year-old white male is seen by his family physician because of dyspnea, bilateral enlargement of the breasts (---GYNECOMASTIA), and a painless lump in the right testis of approximately two months' duration. He denies any history of STDs, genital ulcers, drug use, or trauma. Bilateral nontender gynecomastia (due to increased hCG) left supraclavicular lymphadenopathy 5-cm hard mass palpable on right testis, distorted shape normal rectal exam. Markedly elevated blood hCG and alpha-fetoprotein...

Endometriosis

A 27-year-old woman who is actively training for a marathon notes a painful lump in the upper outer quadrant of her right breast of two days' duration. She has no history of fever and no known family history of breast cancer. Retraction of overlying skin in upper outer quadrant of right breast indurated lesion the size of a lemon in same area axillary lymph nodes not palpable. Mammo irregular mass with focal areas of eggshell calcification. Yellowish, fatty fluid on aspiration. Excisional...

Bronchial Asthma

A 50-year-old white male smoker presents with productive cough, copious sputum, shortness of breath, and fever. The patient has a 40-pack-year smoking history. He has also experienced chronic dyspnea on exertion chronic productive cough, usually in the mornings, for several years and multiple colds each winter. VS fever. PE stocky build with plethora wheezes. CBC elevated WBC count (14,000) neutrophils predominant secondary polycythemia. 5. pneumoniae or H. influenzae on Gram stain of sputum...

Renal Infarction

Gross Pathology Micro Pathology Treatment A 35-year-old white male suddenly develops severe, colicky right flank pain radiating to his right testicle as well as nausea and vomiting. He is admitted to the hospital for evaluation, at which time blood is drawn and a urine sample requested the urine sample turns out to be frankly bloody. VS mild tachycardia. PE pallor sweating acute distress moving from one side of bed to the other right flank tenderness right costovertebral angle tenderness. UA...

Table of Contents

Infiltrating Ductal Breast Carcinoma Inflammatory Carcinoma of the Breast Chronic Obstructive Pulmonary Disease Mixed Connective Tissue Disorder MCTD Progressive Systemic Sclerosis PSS, Adult Polycystic Kidney Disease APKD ACE a ngi ore ns in-con verting enzyme APKD - adult polycystic kidney disease C-ANCA - cytoplasmic antineutrophilic antibodies CBC - complete blood count CHF - congestive hearr failure CK - creatine kinase CN - cranial nerve COPD - chronic obstructive pulmonary disease DIC...

Oligodendroglioma

Labs Imaging Gross Pathology Micro Pathology A 60-year-old male complains of a slow gait and a hand tremor of a few months' duration. His wife also describes postural instability, drooling of saliva, and generalized rigidity. Mask-like facies mild involuntary pill-rolling tremor at rest gait short-stepped and shuffling cogwheel rigidity posture semiflexed deep tendon reflexes normal plantar responses bilaterally flexor. Absence of brown black pigment in substantia nigra. Decreased pigmented...

Wernickes Encephalopathy

A 22-year-old female presents with an abnormal cervical Pap She has no history of irregular menstrual bleeding, postcoital bleeding, intermenstrual bleeding, or vaginal discharge. She delivered her first baby at the age of 18 and has had multiple sexual partners. Colposcopy reveals a suspicious area from which a biopsy is taken. Biopsy shows loss of normal orientation of squamous cells atypical cells seen with wrinkled nuclei and perinuclear halos involving full thickness of squamous epithelium...

Endometrial Carcinoma

A 27-year-old white female is admitted to the infertility clinic for evaluation of her inability to conceive she also complains of pain during intercourse DYSPAREUNIA and pain during menses DYSMENORRHEA . She is nulligravida. She admits to having rectal pain during menstruation she also complains of having an abundant menstrual period MENORRHAGIA OR HYPERMENORRHEA . Bluish spots in posterior fornix on vaginal speculum exam on bimanual exam, fixed, tender bilateral ovarian masses palpable during...