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A 61-year-old male is admitted to the internal medicine ward for evaluation of weight loss and an increase in abdominal girth. He is the father of an African student who is currently studying in the United States. His son brought him here from Central Africa for treatment of his disease. Thin, emaciated male marked jaundice abdomen markedly enlarged due to ascitic fluid hepatomegaly pitting edema in both lower legs. CBC anemia (Hb 6.3) (sometimes there may be polycythemia due to ectopic...
Cocaine Withdrawal
ID CC A 35-year-old plastic surgeon is rushed to the hospital by his wife after he is found lying comatose in his bed with a couple of syringes lying on the floor and his sleeve rolled up. HPI His wrife states that her husband had been having serious financial problems she has suspected drug use in light of recent personality and mood changes. PE On admission to ER, patient had a tonic-clonic seizure respiratory depression bradycardia stupor pupils very constricted (pinpoint pupils) cold skin...
Pseudomembranous Colitis
ID CC A 6-year-old boy is brought by his parents to the emergency room in a comatose state. HPI The child had been suffering from chickenpox and had been given aspirin by the family physician for fever. PE VS fever. PE comatose child with papulovesicular rash all over body fundus shows marked papilledema no icterus moderate hepatomegaly asterixis. Labs Marked hypoglycemia increased blood ammonia concentration elevated AST and ALT prolonged FT serum bilirubin normal. LP (done after lowering...
Nicotine Withdrawal
ID CC A 32-year-old male, the lead drummer of a popular rock band, presents to the emergency room with high fever, a running nose, and severe diarrhea as well as abdominal pain. HPI He is a chronic user of multiple drugs and had been a heroin addict for 2 years until two days ago, when he decided to quit. PE VS tachycardia (HR 165) hypertension (BP 160 90). PE patient has lacrimation and rhinorrhea and is thin, anxious, malnourished, and sweating profusely generalized piloerection (goosebump )...
Ketamine Side Effects
ID CC Aji 82-year-old male complains to his doctor about chronic nausea and vomiting, loss of appetite, and altered taste perception as well as involuntary tremors, chewing, and grimacing movements (dyskinesia). HPI The patient also states he has been having palpitations and insomnia He suffers from Parkinson's disease and has been taking levodopa for a long time. PE VS tachycardia (HR 1 15) postural hypotension. PE patient thin typical parkinsonian gait masklike fades pill-rolling tremor of...
Zidovudine Toxicity
ID CC A 59-year-old female visits her family doctor complaining of chronic fatigue, muscle weakness, and cramps. H PI She has been receiving furosemide for the treatment of essential hypertension for more than 1 year. PE VS tachycardia. PE dehydration somnolence muscle weakness deep tendon reflexes slow. Labs Elevated uric acid. Lytes decreased potassium and magnesium. EGG flattened T waves and prominent U waves (due to hypokalemia). Treatment Treatment consists of replacement of fluid and...
Alternative Pharmacotherapy
ID CC A 36-year-old white morbidly obese woman presents to her primary care physician, seeking help with losing weight. H PI She has tried various diets and exercise programs with no success. Labs CBC Lytes normal. Lipid panel, LFTs, TSH normal. Treatment Orlistat or sibutramine in combination with a structured diet and exercise program. Discussion Obesity contributes to atherosclerosis, CAD, hyperlipidemia, hypertension, and type II diabetes. Anti-obesity drugs currently on the market include...
Lidocaine Toxicity
ID CC A 52-year-old man visits his physician complaining of extreme tiredness, dry mouth, and easy fatigability he states that he has never experienced symptoms such as these before. HPI He was started on hydrochlorothiazide for treatment of hypertension, but it did not control his hypertension, so a-methyldopa was added approximately 2 months ago. On directed questioning, he states that he has been suffering from sexual dysfunction (impotence and inability to ejaculate) for the past several...
Tricyclic Antidepressant Overdose
A 5-year-old male becomes cyanotic and has a cardiorespiratory arrest in the ER. HPI The child, a known asthmatic, had come to the hospital by ambulance 15 minutes earlier with severe wheezing, intercostal retractions, nasal flaring, and marked dyspnea. He was given inhaled corticosteroids. PE Immediate CPR was given, the patient was intubated, and assisted ventilation was administered. The patient came out of the arrest but then returned to his preadmission state of wheezing and respiratory...
Protease Inhibitor Side Effects
ID CC A 5-year-old female is brought by her parents to the pediatric ER with severe nausea, hematemesis, and abdominal pain. HPI She had been playing candy maker in her parents' room, and an open aspirin botde was found on the floor. The child is otherwise healthy. PE VS marked increase in respiratory frequency hyperventiiation fever BP normal. PE flushed face lethargy disorientation dehydration generalized petechiae abdominal pain. Labs CBC thrombocytopenia. Elevated PT. Lytes normal. ABGs...
Pi Pe
A 43-year-old art consultant in an advertising agency is brought to the emergency room with severe headache, palpitations, ringing in her ears, and sweating she had been drinking and dining at a French restaurant. Over the past several months she had seen several physicians for a variety of complaints before finally being diagnosed with hypochondriasis and given medication for it tranylcypromine . VS tachycardia hypertension BP 180 120 no fever. PE pupils dilated no papilledema no signs of...
