Dilated Cardiomyopathy

ID CC A. 21-year-old white male presents with anginal chest pain, dyspnea on exertion, and an episode of syncope while playing basketball. HPI The patient has no history of blue spells, squatting for relief, or rheumatic fever in childhood. PE VS pulse bisferious ( DOUBLE PEAKED). PE JVP normal cardiac apex forceful with strong presystolic impulse ( DOUBLE APICAL IMPULSE) systolic thrill palpable over left sternal border S4 ejection systolic murmur over left third intercostal space radiating to...

Hypoparathyroidism

Micro Pathology Treatment Discussion A 46-year-old white male visits his family doctor complaining of impotence and fatigue over the past year along with decreased peripheral vision. He also complains of decreased appetite and cold intolerance. Last week, he scratched both sides of his car while driving through an alley. VS hypotension (due to decreased ACTH). PE pallor bitemporal hemianopsia on visual field testing optic atrophy loss of axillary and pubic hair increasingly sparse beard smooth,...

Hpi Pe

A 29-year-old female who recently gave birth to a healthy infant develops dyspnea and swelling of her feet toward the end of the day. She is nursing her six-week-old child. VS BP mildly elevated. PE JVP raised with prominent a and v waves tender, mild hcpatosplenomegaly cardiac apex heaving and displaced outside midclavicular line pansystolic apical murmur (due to mitral insufficiency) and systolic murmur increasing with inspiration heard in tricuspid area (due to tricuspid insufficiency) loud...

Pe

Imaging Gross Pathology Micro Pathology A 12-year-old white female, the daughter of Norwegian immigrants, complains of diarrhea and flatulence. Her parents say she has suffered from weight loss despite the fact that she cats well. Her mother adds that her stool is foul-smelling and greasy ( steatorrhea) with no blood or mucus. Pale and thin xerosis ( DRYNESS) and hyperkeratosis of skin (due to vitamin A malabsorption) vesicular rash on knees, elbows, and neck pruritus with erythematous base (...

Gastric Leiomyoma

A 35-year-old male chronic smoker presents with heartburn. His heartburn worsens when bending and lying down at night, preventing him from sleeping it is promptly relieved with antacids. Continuous esophageal pH monitoring correlates symptoms with posture, meals, and reflux. UGI small hiatal hernia spontaneous reflux to mid-esophagus. EGD erythema, friability, and erosions over esophageal mucosa. Evidence of inflammation on biopsy no malignant change noted. Cessation of smoking H2 receptor...

Diverticulitis

Gross Pathology Micro Pathology Treatment A 68-year-old black male presents with anorexia, progressive dysphagia, odynophagia, and weight loss. The patient has been drinking very hot tea since he was 11 years old and smokes one pack of cigarettes per day. His history also reveals heavy alcohol intake occasional cough, vomiting, and regurgitation and severe dysphagia with solids, progressing to liquids. Emaciation fixed, nonpainfiil supraclavicular node pale conjunctiva. CBC PBS hypochromic,...

Primary Hyperparathyroidism

ID CC A 33-year-old white female presents with menstrual cycle irregularity with long periods of amenorrhea and milky nipple discharge ( GALACTORRHEA). HPI Further questioning discloses that she has also been unable to conceive. PE VS normotension. PE no gynecological masses palpable pelvic exam normal. Labs Hyperprolactincmia reduced LH and estradiol. Imaging MR enhancing pituitary microadenoma (< 10 mm) deviation of pituitary stalk. Gross Pathology N A Micro Pathology N A Treatment...

Hemochromatosis

ID CC A 50-year-old male with a history of alcoholism is unresponsive to stimuli when brought by a neighbor to the emergency room. HPI His neighbor states that he had vomited blood three months ago but had received no treatment. The neighbor also says that the patient got drunk three times a week for four years until approximately one year ago. PE Muscle wasting icteric sclera spider angiomata (due to increased levels of estrogen) nodular, hard hepatomegaly caput medusae loss of hair on chest...

Hpi

Imaging Gross Pathology Micro Pathology A 1-year-old white girl is brought into the emergency room because of sudden weakness, apathy, easy bruisability, and periorbital edema with low urinary volumes. The infant experienced diarrhea and had vomited for two days, but her condition resolved spontaneously four days before admission. Pallor listlessness hepatomegaly ankle and periorbital edema purpuric rash on chest and limbs. CBC PBS severe anemia low platelet count RBC fragmentation (burr-shaped...

Renovascular Hypertension

A 50-year-old male presents with complaints of palpitations and chest pain. The pain increases with physical activity and is relieved by rest. He has multiple sexual partners. VS high-volume, collapsing pulse ( water-hammer pul.se) wide pulse pressure. PE pistol shots heard over brachial artery to-and-fro murmur heard over femoral artery ( duroziez's murmur) cardiomegaly loud aortic component of S2 grade III early diastolic murmur heard radiating down right sternal edge (murmur of aortic...

Primary Hyperaldosteronism

Imaging Gross Pathology Micro Pathology A 56-year-old white female complains of severe, colicky left flank pain radiating to the groin and inner thigh and associated with nausea, vomiting, and bloody urine. She has a history of burning epigastric pain that is relieved by food. Her history also reveals anorexia, confusion, irritability, constipation, easy fatigability, excessive thirst, and polyuria. Calcium deposits in cornea ( BAND KERATOPATHY) left flank tenderness thick fingernails decreased...

Ischemic Bowel Disease

Gross Pathology Micro Pathology Treatment Discussion A 65-year-old male with unresectable carcinoma of the sigmoid colon is evaluated for hepatomegaly that was detected on a follow-up exam. The patient is undergoing chemotherapy and underwent palliative surgery one month ago. Marked pallor large nodular liver palpable colostomy bag noted. Markedly elevated carcinoembryonic antigen CEA levels markedly raised alkaline phosphatase other LFTs normal. CT US-Abdomen multiple enhancing hepatic...

Mitral Stenosis

ID CC A 78-year-old white male is brought into the emergency room with nausea, dyspnea, and a crushing substernal chest pain that radiates to his left arm and jaw, the pain has lasted for about 30 minutes and is not relieved with rest. HPI One sublingual tablet did not relieve his pain. His history reveals a sedentary lifestyle, moderate hypercholesterolemia, and obesity. The patient is also a diabetic and smokes. PE VS hypotension. PE diaphoresis. Labs ECG ST elevation following peaking of T...

Hemolyticuremic Syndrome

Imaging Gross Pathology Micro Pathology An 8-year-old white male presents with an erythematous skin rash over the buttocks and legs coupled with joint pains and hematuria. Three days before he had complained of cough, coryza, low-grade fever, and sore throat. He has a history of allergy to dust and pollen. VS hypertension. PE palpable purpuric skin lesions over buttocks and legs painful restriction of knee and ankle joint movement with swelling. CBC normal platelet count normal coagulation...

Menopause

Imaging Gross Pathology Micro Pathology A 42-year-old female is discovered co have hypertension on a routine physical exam. She had been suffering from headaches, weakness, and leg cramps. A careful history discloses that she has also had increased urinary volume. VS hypertension BP 165 110 . PE diminished deep tendon reflexes. Lytes hypokalemic alkalosis high serum sodium 154 low serum potassium 2.4 . ECG flattened T waves, long Q-T, U waves. Increased urinary aldosterone low plasma renin. CT...