Betablocker Overdose
ID CC A 62-year-old female is referred to a pulmonary medicine specialist by her family physician because of a chronic dry cough that has been unresponsive to medications. HPI On careful, directed questioning, the specialist discovers that she had been taking captopril for hypertension for 3 years. She also complains of taste changes and a rash on her chest and lower legs. PE VS normal. PE no lymphadenopathy funduscopic exam reveals grade I hypertensive retinopathy discrete nonpruritic...
Malignant Hyperthermia
ID CC A 32-year-old male is brought by his wife to the family care center of the community because of increasing tremors, slowing of movements (bkadykinksia), and postural instability. HPI The patient works as a chemist at a leading pharmaceutical research company in Northern California and has a longstanding history of drug abuse requiring hospitalization. PE VS normal. PE flat facies resting tremor cogwheel rigidity impaired capacity for voluntary motor activity speech slow, as are voluntary...
Tardive Dyskinesia
A 26-year-old female is brought to the ER by her boss after fainting at work. The day before she had complained of a dry mouth along with constipation and urinary retention. HPI She had a major manic episode of hyperactivity and productivity at work 2 months ago as well as auditory hallucinations, for which she was diagnosed with a schizoaffective disorder and has been undergoing treatment with the antipsychotic drug thioridazine. PE VS orthostatic hypotension tachycardia (HR 108). PE acute...
Captopril Side Effects
ID CC A 54-year-old white female complains of intermittent nausea and vomiting, headaches, fatigue, and blurred vision over the past 3 months. HPI She describes objects as appearing yellow to her. She has a history of heart failure with chronic digoxin use as well as diuretics (may induce hypokalemia). PE VS bradycardia (HR 48) BP normal no fever. PE in no acute distress slight increase inJVP S3 present rales at lung bases mild hepatomegaly ankle edema. Labs CBC normal. Lytes hypokalemia....
Stevensjohnson Syndrome
ID CC A 26-year-old obsessive-compulsive female comes to the family medicine clinic to have her 5-year-old daughter checked by a dermatologist because of itching and scaling of her skin. HPI The mother is very thin and fears that her daughter will not gain enough weight, so she has given her cod-liver oil (rich in vitamin A) four times a day for the past nine months The child complains of fatigue, headaches, and bone pain. PE Funduscopic exam reveals papilledema (pseudotumor cerebri) localized...
Nitrate Exposure
ID CC A 58-year-old man comes to see his cardiologist because of an increased need for nitroglycerin patches in order to control his oppressive exercise-induced chest pain (angina). HPI In the past, taking one tablet five minutes before physical activity controlled his symptoms now he has to take two tablets. The patient has continued to smoke two packs of cigarettes each day and is concerned that his cardiac condition is worsening because of this increased need for medication. PE VS BP normal....
Penicillin Allergic Reaction
A 19-year-old military recruit comes to his medical officer complaining of red urine and orange-colored staining of his T-shirt he also complains that every time he lakes rifampin, he feels as if he has the flu (flulike response). He underwent a routine physical exam and laboratory tests prior to joining the military camp and was started on rifampin at that time (meningococcus was found in nasopharyngeal secretions, indicating a meningococcal carrier state). VS normal. PE muscular male in no...
Cisplatin Side Effects
ID CC A 40-year-old male who has been diagnosed with pemphigus vulgaris complains of dysuria and increased urinary frequency. HPI The patient has no history of fever or gross hematuria. He is receiving monthly dexametliasone-cyclophosphamide pulse therapy. PE VS normal. PE no pallor lungs clear to auscultation cardiac exam normal abdomen soft and nontender no suprapubic masses no peritoneal signs no tenderness in costovertebral angle. Labs CBG normocytic, normochromic anemia mild leukopenia and...
Vitamin A Toxicity
A 32-year-old male who works as a professional weight lifter comes to the family medicine clinic for evaluation of impotence for the past 4 months. HPI His girlfriend reports increasingly aggressive and labile behavior. He has a history of multiple cycles of oral and injectable anabolic steroid abuse. PE VS borderline hypertension. PE young, muscular male androgenic alopecia acne gynecomastia testicular atrophy. Labs CBC Lytes normal. AST and ALT normal hyperglycemia (145 mg dL) BUN and...
Oral Contraceptive Side Effects
ID CC A 55-year-old, postmenopausal white female complains of nausea, headaches, weight gain, and breast tenderness. HPI She was placed on estrogen 6 months ago and is also taking calcium and vitamin D. There is no history of breast, uterine, or ovarian cancer in her family. PE VS normal. PE mild tenderness to palpation over lumbar vertebrae breast exam reveals diffuse tenderness without any palpable masses no axillary lymphadenopathy. Labs Lipid profile reveals decreased LDL, increased HDL,...
X
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...
