Cardiology
A 60-year-old man with a history of hypertension presents with sudden onset of severe chest pain that radiates to his back. His blood pressure is markedly different in both arms. What is the most likely diagnosis?
What is Aortic Dissection?
A 25-year-old woman with a history of autoimmune thyroiditis presents with amenorrhea, infertility, and galactorrhea. Her prolactin is mildly elevated. MRI of the brain shows a pituitary mass. What is the most likely diagnosis and underlying pathophysiology?
What is Sheehan's Syndrome or Hypopituitarism following pregnancy with anterior pituitary necrosis?
A 45-year-old man with chronic alcohol use presents with upper abdominal pain and nausea. His lipase is 15 times the upper limit of normal. A CT scan shows pancreatic necrosis. What is the most important next step in his management?
What is Supportive care with fluid resuscitation and close monitoring for signs of organ failure?
A 50-year-old woman with a history of diabetes and chronic kidney disease presents with fever, chills, and dysuria. Urinalysis shows leukocyte esterase and nitrites, and a urine culture grows Klebsiella pneumoniae. Her creatinine is 2.5 mg/dL. What is the most appropriate next step in management?
What is Empiric IV antibiotics (e.g., ceftriaxone) pending urine culture results and renal dosing adjustment?
A 70-year-old man with a 40-pack-year smoking history presents with progressive dyspnea, cough, and wheezing. A chest X-ray shows hyperinflation and a flattened diaphragm. What is the most likely diagnosis, and what is the key pathophysiologic change in the lungs?
What is Chronic Obstructive Pulmonary Disease (COPD), characterized by emphysema and chronic bronchitis leading to airflow obstruction?
A 70-year-old woman with a history of atrial fibrillation presents with palpitations, dizziness, and a rapid, irregular heart rate of 150 bpm. Her ECG shows no distinct P waves, and the ventricular rate is irregular. What is the most likely diagnosis?
What is Atrial Fibrillation?
A 40-year-old man with a history of hypertension and obesity presents with severe fatigue, muscle weakness, and bruising. His cortisol is elevated despite a low-dose dexamethasone suppression test. What is the most likely diagnosis?
What is Cushing’s Disease due to an ACTH-secreting pituitary adenoma?
A 60-year-old woman presents with weight loss, jaundice, and a palpable, non-tender mass in the right upper quadrant. A biopsy reveals an adenocarcinoma of the pancreas. What is the most likely etiology of her jaundice?
What is Obstructive jaundice due to the tumor obstructing the common bile duct?
A 28-year-old man with HIV presents with fever, cough, and shortness of breath. His CD4 count is 180/µL, and chest X-ray shows bilateral interstitial infiltrates. What is the most likely diagnosis, and what diagnostic test should be ordered next?
What is Pneumocystis jirovecii pneumonia (PCP), and what is a sputum PCR or bronchoalveolar lavage for Pneumocystis?
A 50-year-old man presents with cough, hemoptysis, and constitutional symptoms. His sputum culture grows Mycobacterium tuberculosis, and a PCR test confirms drug resistance. What is the most likely mechanism behind his drug-resistant TB?
What is Acquired resistance due to prior incomplete treatment or noncompliance with TB regimen?
A 45-year-old man with a history of diabetes and hypertension presents with sudden onset of chest pain that radiates to the back, accompanied by syncope. A CT angiogram reveals aortic dissection. What is the most likely mechanism behind his dissection, given his medical history?
What is Hypertension-induced intimal tear
A 60-year-old man presents with hypercalcemia, polyuria, and constipation. His PTH is elevated, and his vitamin D is normal. A neck ultrasound shows a solitary lesion in the left inferior parathyroid gland. What is the most likely diagnosis?
What is Primary Hyperparathyroidism due to a parathyroid adenoma
A 30-year-old woman presents with chronic diarrhea, weight loss, and a family history of autoimmune disease. Colonoscopy reveals deep, linear ulcers and granulomas in the terminal ileum. What is the most likely diagnosis?
What is Crohn’s Disease, specifically ileitis?
A 40-year-old man with a history of travel to Southeast Asia presents with fever, jaundice, and a positive rapid diagnostic test for Plasmodium falciparum. His hemoglobin is low. What is the most likely mechanism behind his anemia?
What is Hemolysis due to malaria parasitic infection?
A 45-year-old woman presents with pleuritic chest pain and dyspnea. A CT pulmonary angiogram confirms a diagnosis of pulmonary embolism. She has no prior history of deep vein thrombosis. What is the most likely risk factor for her condition?
What is Estrogen therapy (e.g., oral contraceptives) as a prothrombotic risk factor?
A 60-year-old woman presents with exertional dyspnea and pleuritic chest pain. Cardiac MRI reveals an infiltrative process in the myocardium. She has a history of light chain gammopathy. What is the most likely diagnosis?
What is Amyloidosis?
A 22-year-old woman presents with tachycardia, heat intolerance, and exophthalmos. Her TSH is low, and free T4 is elevated. However, her thyroid-stimulating immunoglobulin (TSI) is negative. What is the most likely diagnosis?
What is Thyroiditis (subacute or postpartum) or factitious hyperthyroidism?
A 55-year-old man presents with hematemesis and a history of cirrhosis. His platelet count is low, and his liver function tests are elevated. What is the most likely source of his bleeding?
What is Esophageal varices due to portal hypertension?
A 65-year-old man presents with fever, chills, and severe right lower quadrant abdominal pain. A CT scan shows a thickened appendix with surrounding fat stranding. Blood cultures grow Bacteroides fragilis. What is the most likely underlying cause of his infection?
What is Acute appendicitis complicated by perforation and secondary bacterial peritonitis with Bacteroides overgrowth?
A 60-year-old man with a history of asbestosis presents with increasing dyspnea and a recent weight loss. A chest X-ray shows pleural plaques, and his PFTs show a restrictive pattern. What is the most likely diagnosis?
What is Malignant Mesothelioma secondary to asbestos exposure?
A 55-year-old man presents with hypotension, jugular venous distention, and distant heart sounds. A pericardial effusion is noted on echocardiogram, and there is an elevated right atrial pressure. What is the most likely etiology of this patient's condition?
What is Constrictive Pericarditis or Pericardial Tamponade due to chronic inflammation or malignancy?
A 45-year-old woman presents with new-onset hyperglycemia, unintentional weight loss, and a recent history of chronic gastrointestinal symptoms. Her C-peptide level is elevated, and her insulin levels are high. What is the most likely cause of her condition?
What is Insulinoma (pancreatic tumor)
A 45-year-old woman with a history of chronic diarrhea, abdominal pain, and arthritis presents with weight loss and darkened skin. Her lab work shows increased stool fat content and a positive anti-tissue transglutaminase antibody. What is the most likely diagnosis?
What is Celiac Disease with malabsorption?
A 30-year-old woman presents with fever, a painful, swollen knee joint, and a rash. She was recently treated for a throat infection. Gram-negative diplococci are seen on joint aspiration. What is the most likely diagnosis, and how does it differ from other causes of septic arthritis?
What is Disseminated Gonococcal Infection (DGI), distinguished by positive joint culture, history of pharyngitis, and no underlying joint disease?
A 50-year-old man presents with a chronic cough, weight loss, and hemoptysis. A bronchoscopy reveals a central mass with mucosal ulceration. Biopsy shows squamous cell carcinoma. What is the most likely paraneoplastic syndrome associated with this malignancy?
What is Hypercalcemia due to parathyroid hormone-related peptide (PTHrP)?