Slipped Capital Femoral Epiphysis

Labs Imaging Gross Pathology Micro Pathology Treatment A 35-year-old male seen after a roadside accident presents with a persistent bloody but thin nasal discharge. Directed questioning reveals that he has also lost his sense of smell since the accident. Watery nasal discharge noted bilateral periorbital hematomas (black eye) seen anosmia found on neurologic exam remainder of physical exam normal on placing a drop of nasal discharge on clean white gauze, spreading yellow halo noted in addition...

Chronic Pulmonary Emphysema

A 50-year-old fanner presents with severe shortness of breath ( DYSPNEA) and fatigue. He also complains of a dry cough and mild fever. His symptoms are exacerbated when he works in the fields, especially when he comes into contact with moldy hay. He does not smoke and drinks alcohol occasionally. VS tachycardia tachypnea mild fever. PE moderate respiratory distress scattered rhonchi and bilateral fine rales. CBC leukocytosis with shift to left. Elevated ESR serum antibodies against thermophilic...

Pe

Imaging Gross Pathology Micro Pathology An 18-year-old white male complains of gradually progressing shortness of breath and ankle swelling. His symptoms started following a URL He also complains of excessive fatigue and frequent chest pain. He has no history of joint pains, skin rash, or involuntary movements (vs. rheumatic fever) and is neither hypertensive nor diabetic. VS tachycardia hypotension no fever. PE elevated JVP pitting pedal edema fine inspiratory rales at both lung bases mild...

Hpi Pe

Imaging Gross Pathology Micro Pathology Treatment Discussion A 15-year-old male presents with fever of three days' duration, headache, fleeting joint pains, and a reddish rash on the trunk and left arm of two weeks' duration. VS fever. PE regional lymphadenopathy (axillary lymph nodes enlarged) mild neck stiffness neurologic exam normal large (6- to 8-cm), annular, erythematous lesions with central blanching seen over left arm and trunk ( ERYTHEMACHRON1CUM MIGRANS) no enanthema. ASO titer...

Chronic Atrophic Gastritis

A 21-year-old female complains of intermittent abdominal pain, mild, nonbloody diarrhea, and anorexia of two years' duration. During these episodes, she describes that she also has a fever and that the pain is almost always confined to the right lower abdomen and is cramping in nature. Pallor weight loss abdominal mass in right iliac fossa (thickened bowel loop) perianal fistulas. CBC megaloblastic anemia leukocytosis. Positive stool guaiac test stool exam reveals no parasites. BE granulomatous...

Meningioma

ID CC A 20-year-old woman complains of recurrent headaches associated with profound nausea and light sensitivity. HPI She has had similar headaches several times each year since the onset of her menstrual periods. The headaches occur on one side of her head. She also reports seeing flashing lights like lightning moving across her field of vision. Stress, sleeplessness, and anxiety usually precipitate these headaches. VS normal. PE funduscopic exam and visual field testing normal neurologic exam...

Hpi

A 31-year-old male complains of having more than five bowel movements a day together with cramping abdominal pain and tenesmus. The patient adds that his stools consist of watery or pasty material with mucus and gross quantities of blood. He also complains of intermittent fatigue, fever, and an increased need for sleep. VS mild fever. PE localized tenderness over distal colon. CBC anemia leukocytosis. Elevated ESR stool exam reveals no parasites no bacterial pathogen isolated in culture. BE...

Osteopetrosis

ID CC A 60-year-old woman visits her physician complaining of severe low back pain after a fall from her bed. HPI Onset of menopause was at 48 years. The patient is not receiving hormone replacement therapy, she suffered a Colles' fracture last year thai is malunited. Directed history reveals loss of height and a mild hunchback deformity. PE Patient thin kyphosis noted percussion over dorsolumbar spine exquisitely tender right wrist malunited Colles* fracture. Labs Serum calcium, phosphates and...

Erythema Migrans

Imaging Gross Pathology Micro Pathology A 4-year-old Japanese male presents with fever and an extensive skin rash. A primary care physician had previously found the patient to have cervical adenitis antibiotics were administered but achieved no response. VS fever. PE conjunctival congestion dry, red lips erythematous palms and soles indurative edema of peripheral extremities desquamation of fingertips various rashes of trunk cervical lymph adenopathy > 1.5 cm. Throat swab and culture sterile....

De Quervains Thyroiditis

ID CC A 30-year-old woman presents with complaints of excessive anxiety, tremors, bulging of the eyeballs ( EXOPHTHALMOS), and a progressively increasing neck mass ( GOITER). HPI She has had significant weight loss over the past few months despite an increased appetite. She also reports excessive bleeding during menses ( MENORRHAGIA). PE VS tachycardia. PE anxious Eye exam reveals bilateral exophthalmos, lid lag, stare (due to lid retraction), and convergence weakness smooth, nontender diffuse...

Hypersensitivity Pneumonitis

ID CC A 65-year-old male complains of progressive shortness of breath on exertion. HPI The patient has never smoked cigarettes and has no history of exposure to occupational dusts or fumes he has not had a productive cough or hemoptysis. PE VS warm but cyanosed tachycardia (HR 88) normotension. PE clubbing present JVP not elevated heart sounds normal with no additional sounds or murmurs respiratory examination reveals presence of bilateral basal fine inspiratory crepitations. Labs PFTs...