Mesenteric Ischemia

A 45-year-old female presents with pain and complains of heaviness and a tumor in her abdomen she also has a fever. Eight weeks ago she had been hospitalized for epigastric pain, nausea, and vomiting due to acute pancreatitis. VS fever. PE pallor epigastric mass tender to palpation mass not motile and seems to be deep-seated no change of overlying skin no peritoneal signs. CBC elevated WBCs. Amylase and lipase elevated (although not to extent of her first admission) AST and ALT slightly...

Digeorges Syndrome Thymic Aplasia

A 65-year-old Vietnam veteran complains of progressively worsening hoarseness and persistent cough. He has smoked one pack of cigarettes each day for 45 years. He is currently being treated for emphysema. Supraclavicular nodes hard and enlarged (cancer has metastasized to these sentinel nodes) lung fields filled with disseminated crackles and rales chest barrel-shaped (underlying emphysema) clubbing of fingers on both hands patches of velvety hyperpigmentation (- ACANTHOSIS NIGRICANS) of both...

Palsy

A 47-year-old male comes to the clinic for evaluation of loss of sensation in his lower extremities as well as lack of sense of position and vibration he also has difficulty walking normally. He also describes sharp pain and numbness ( PARES' 11 iESLAS) in his lower extremities. On directed questioning, he states that about 20 years ago he had a painless ulcer in the glans penis that disappeared spontaneously ( SYPHILITIC PRIMARY CHANCRE). Gait wide-based hyporeflexia and poor muscle tone left...

Hirschsprungs Disease

A 3-week-old male is brought to the pediatrician for projectile, nonbilious vomiting that began today, shortly after feeding. He has been regurgitating food and has had occasional bouts of vomiting for one week. The child is the first-born son of a 28-year-old white female and is the product of a normal delivery. His mother had hypertrophic pyloric stenosis when she was born. Lethargic, moderately dehydrated baby low weight for age wrinkled, old man appearance visible peristalsis from left...

Dumping Syndrome

Gross Pathology Micro Pathology Treatment A 57-year-old white male complains of deep, burning retrosternal pain ( HEARTBURN) that worsens when he lies down. The patient is a heavy cigarette smoker and alcohol drinker. He also complains of regurgitation of sour material on and off for years. He has been overweight for the past 10 years and has recently experienced insomnia. Obese and moderately nervous slight discomfort on palpation of epigastrium. CBC may show anemia it ulcer is present. UGI...

Erbs Palsy

ID CC An 85-year-old woman is taken to the emergency room after falling while climbing out of the bathtub she has pain in her right groin and cannot move her right leg. HPI She suffers from diabetes, hypertension, and osteoporosis. She is currently being treated with calcium supplements and calcitonin. PE Frail, elderly woman with poor muscle tone and low body weight right leg externally rotated at rest (lateral rotators piriformis, obturator internus and externus, superior and inferior...

Temporomandibular Joint Dislocation

Imaging Gross Pathology Micro Pathology Treatment A mother brings her 3-year-old child to an orthopedic surgeon for evaluation of his gait she says the child waddles when he walks. The child had difficulty learning how to walk and has always been rather unstable in his gait. When patient stands on his left leg, his right buttock sags ( TRENDELENBURG SIGN) no sensory loss noted in gluteal area swing phase of left leg seems most affected to swing left leg, child leans over to right side and then...

Tetralogy Of Fallot

A 2-month-old female presents with dyspnea, feeding difficulties, poor growth, and profuse perspiration. The child had pneumonia when she was seven days old, at which time her parents were informed of a congenital heart 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 across mitral valve)....

Scaphoid Fracture

Gross Pathology Micro Pathology Treatment During anti-Gulf War protests in Ohio, a 23-year-old man was forcefully dragged away by the arm because he was blocking the entrance to the meeting. While in the police car on the way to headquarters, he complained of pain in the shoulder and inability to move his arm. Pain in shoulder, deformity (lack of normal rounded contour of shoulder), and inability to move arm depression easily palpable under acromion humeral head palpable through axilla, After...

Cardiac Tamponade

Micro Pathology Treatment Discussion An 18-year-old white male is found during a military physical to have high blood pressure. The patient denies a history of any major illness. VS BP in arms significantly greater than BP in legs (BP right arm 180 110, left arm 190 110 BP in legs 110 70). PE femoral pulses diminished and delayed harsh systolic ejection murmur heard between shoulder blades. CXR may demonstrate rib notching (due to collateral circulation through intercostal arteries)...

Lymphatic Metastasis Of Lung Cancer

A 63-year-old woman who is a heavy smoker comes to the emergency room with severe swelling on the right side of the neck, arm, and face (compression of superior vena cava) together with severe pain in the right arm. The swelling has gotten progressively worse over the past several months. In addition, her voice has become hoarse over the same period of time (the recurrent laryngeal nerve is paralyzed due to compression by the tumor). Reduced radial pulse on right side (arterial flow is blocked...

Portal Hypertension

ID CC A 58-year-old obese man presents for an evaluation of a lump in the anal area of tbree days' duration, causing acute, constant pain that increases during dcfccation. HPI He is a smoker with a chronic cough and is overweight. He also .suffers from prostatic hyperplasia that forccs him to strain in order to initiate micturition. PE Patient walks very slowly with both legs apart and sits down in chair sideways external rectal exam reveals presence of a rounded, 3-cm, purple mass in the anal...

Astrocytoma

Micro Pathology Treatment Discussion A 45-year-old diabetic male comes to the emergency room fearing that he has had a stroke he complains of inability to move the right side of his lace and cannot blink his right eye or seal his lips (lesion of C.N VII - facial nerve). The previous night, his wife noticed that he was sleeping with his right eye open and that the right side of his face was drooping. That morning, the patient could not stop drooling on the right side of his mouth. He has not...

Tracheoesophageal Fistula

Labs Imaging Gross Pathology Micro Pathology Treatment A 12-week-old male infant is brought to the hospital for evaluation of recurrent oral thrush and URIs. The child had seizures (due to hypocalcemia) shortly after birth. His mother is an IV drug user. Full-term infant jittery increased muscle tone oral thrush midfacial hypoplasia. Hypocalcemia T-cell count markedly low. CXR absent thymic shadow. Transplant of an immature fetal thymus treat opportunistic infections irradiation of blood...

Perforated Gastric Ulcer

A 47-year-old male is brought by ambulance to the emergency room vomiting copious amounts of blood ( He has a history of heavy alcoholism he has gotten drunk at least three times a week for many years. VS tachycardia (HR 103) hypotension (BP 90 40) (due to hypovolemia) no fever. PE marked pallor thin, wasted, delirious man with strong alcohol smell on breath pupils reactive and equal enlargement of parotid glands no focal neurologic signs abdomen enlarged due to ascitic fluid spider angiomas...

Tonsillitis

Micro Pathology Treatment Discussion A 35-year-old woman is brought to the emergency room by ambulance because of the sudden appcarancc of severe retrosternal pain with radiation to the back and abdomen along with dyspnea the pain appeared after vigorous vomiting. She suffers from episodes of binge eating and self-induced vomiting ( BULIMIA). VS tachycardia (HR 110) mild hypotension (BP 100 65) no fever. PE in acute distress complains of severe chest pain no heart murmurs left lung field...

Tabes Dorsalis

Gross Pathology Micro Pathology Treatment A 55-year-old woman complains of intermittent bouts of excruciating stabbing pain on the left side of her face between the upper lip and lower eyelid region covered by the maxillary branch of CN V the pain is so severe that the patient has considered suicide. She first experienced this pain two months ago, while she was chewing gum. She also reports that cold drafts trigger the attacks. HEENT exam normal no lymphadenopathy found no neurologic...

Thyroglossal Duct Cyst

Gross Pathology Micro Pathology Treatment 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. His mother states that the boy has had recurrent bouts of sore throat several times a year for the past five years, each time treated effectively with antibiotics. Mouth partially open swollen pharyngeal tonsil obstructs nasopharyngeal isthmus tonsils markedly enlarged, hyperemic, and...

Trendelenburg Gait

Labs Imaging Gross Pathology Micro Pathology Treatment A 73-year-old male is referred to a surgeon because of a painful mass in the left inguinal area the mass protrudes with straining and disappears at rest. The patient has frequent bouts of constipation resulting in increased intra-abdominal pressure . Rectal exam shows marked prostatic enlargement straining at micturition is predisposing factor in supine position, left inguinal region does not disclose any apparent pathology, but when...

Straddle Injury

Gross Paitioiogy Micro Pathology Treatment A 42-year-old female on the gynecology ward complains of a dull, aching pain on her left flank as well as nausea and vomiting on her third postoperative day the intern notices that the patient has also been oliguric overnight. She recently underwent a total abdominal hysterectomy due to large uterine fibroids. VS low-grade fever normotension. PE patient well hydrated no pallor noted surgical wound is midline infraumbilical dressing noted to be wet with...