Joint Ventures
45/female with symmetrical polyarthritis, prolonged morning stiffness and positive anti-CCP.
Rheumatoid arthritis
38/female on birth control pills presents with unexplained breathlessness, hypoxemia, with normal CXR and sinus tachycardia on ECG.
Pulmonary Thromboembolism
Hypertension resulting from genetic overactivity of ENaC, causing excessive Na reabsorption
Liddle Syndrome
34/male with jaundice, fever, chills, conjunctival suffusion, calf myalgias, and oliguria.
LEPTOSPIROSIS
23/female 8 weeks pregnant with intractable vomiting (hyperemesis gravidarum)
Metabolic alkalosis
Hyperkalemia, gynecomastia, hypotension
SPIRONOLACTONE
27/male with persistent low back pain, stiffness, with "bamboo spine" on Xray and (+) HLAB27
Ankylosing spondylitis
47/male with exertional dyspnea, neck vein distention, pedal edema and S3 gallop on exam.
Congestive heart failure
17/male with chronic hypokalemia, normotension, urinary K wasting, metabolic alkalosis, hypomagnesemia, and hypocalciuria.
Gitelman Syndrome
45/male OFW returning from Nigeria with remittent fever, chills, jaundice, and hepatospenomegaly
Malaria
36/female cancer patient on maintenance oral morphine found somnolent with shallow respirations
Respiratory acidosis
Abnormal liver function tests, prolonged QT interval, thyroid dysfunction
AMIODARONE
34/male develops polyarthritis after a diarrheal illness, associated with fever and rash called keratoderma blenorrhagica
Reactive arthritis
54/female with recurrent productive cough, dyspnea, with "tram tracks" on CXR and "signet ring" sign on chest CT.
Bronchiectasis
54/female with hypertension, hypokalemia, metabolic alkalosis and a left adrenal nodule on CT.
Conn's Syndrome
18/female with jaundice, fever, vague abdominal pain, anorexia with ALT 1500
ACUTE VIRAL HEPATITIS
43/male with chronic hypokalemia, hypertension and an adrenal nodule on CT
METABOLIC ALKALOSIS
Abnormal LFTs, peripheral neuropathy, lupus-like syndrome
ISONIAZID
56/male with recurrent inflammatory arthritis, normal uric acid and finding of soft tissue calcification or chondrocalcinosis on Xray
CPPD DEPOSITION DISEASE (PSEUDOGOUT)
52/male with fulminant sepsis develops severe dyspnea, hypoxemia, diffuse pulmonary infiltrates, and arterial pO2/ FIO2 ratio of <200 mmHg.
Acute Respiratory Distress Syndrome
45/male with iron deficiency anemia, chronic dysphagia, and esophageal webs.
Plummer Vinson or Paterson Kelly syndrome
54/female with obstructive jaundice develops high grade fever, chills, and clinical deterioration
ASCENDING CHOLANGITIS
42/female with persistent watery diarrhea for 3 weeks
NORMAL AG METABOLIC ACIDOSIS
Allergic cough, hypotension, hyperkalemia
ACE INHIBITOR
56/female with polyarthralgias, asthma, fever, anorexia, palpable purpura, eosinophilia and (+) ANCA
Churg Strauss vasculitis
52/male with exertional shortness of breath, easy fatigability, cardiomegaly with diffusely thinned out myocardium and EF 30% on 2Dechocardiography
Dilated Cardiomyopathy
56/female with RUQ pain and jaundice; ultrasound reveals gallstone impacted at junction of cystic and common bile ducts
MIRIZZI'S SYNDROME
64/female with chronic hepatitis B develops jaundice, anorexia, progressive weight loss, and RUQ mass
Hepatocellular carcinoma
35/male brought to the ER after alleged suicidal attempt, found unresponsive with Kussmaul's breathing
HIGH AG METABOLIC ACIDOSIS
Abnormal LFTs, myalgias or myopathy, exacerbation of proteinuria
ROSUVASTATIN
70/male with polyarthralgias, fever, weight loss, necrotizing sinusitis, and (+) ANCA
Granulomatosis with angiitis (Wegener's)
32/male non-smoker with progressive exertional shortness of breath and wheezing, "tripod posture", barrel chest, and bilateral diffuse hyperaeration on CXR.
COPD/Pulmonary Emphysema (Alpha-1- antitrypsin deficiency)
70/male with renal cell carcinoma found to have abnormal liver function tests but no evidence of hepatic metastases
STAUFFER SYNDROME
45/female develops jaundice, oliguria, anemia and thrombocytopenia following a severe diarrheal illness with E.coli O157:H7.
HEMOLYTIC- UREMIC SYNDROME
24/female Type 1 diabetic with severe weakness and obtundation after missing her Insulin maintenance for 1 week
HIGH AG METABOLIC ACIDOSIS (DIABETIC KETOACIDOSIS)
Bone marrow suppression, folate deficiency, abnormal LFTs
Methotrexate
70/female with non-inflammatory polyarthritis and Heberden's nodes on PE
Osteoarthritis
57/male sugar cane farmer with progressive shortness of breath, dry cough, easy fatigability, and diffuse reticular to reticulonodular infiltrates on CXR
INTERSTITIAL LUNG DISEASE (or Hypersensitivity pneumonitis)
21/male with recurrent hypokalemia, salt-craving, normotension, metabolic alkalosis, and hypercalciuria.
BARTTER'S syndrome
45/male Type 2 diabetic presents with fever, chills, RUQ pain and jaundice, with multiple hypoechoic hepatic lesions seen on ultrasound
PYOGENIC HEPATIC ABSCESSES
37/female with refractory hypertension, truncal obesity, buffalo hump, abdominal striae, and hypokalemia
METABOLIC ALKALOSIS of Cushing's Syndrome
Nausea and vomiting, hair loss, cardiotoxicity,
DOXORUBICIN
17/male with migratory polyarthritis, fever, chorea, and erythema marginatum
Rheumatic fever
27/male IV drug abuser with spiking fevers, productive cough, shortness of breath, and bilateral parenchymal infiltrates with pneumatocoeles on CXR
Staphylococcus aureus penumonia
23/male with arachnodatyly, pectus excavatum, ectopia lentis, and aortic aneurysm.
MARFAN Syndrome
56/female with jaundice, intractable pruritus, hepatomegaly and positive antimitochondrial antibody
PRIMARY BILIARY CIRRHOSIS
50/male farmer admitted with severe body weakness and stupor after 3-day binging with "lambanog"
HIGH AG METABOLIC ACIDOSIS (Methanol poisoning)
Hypotension, headache, cyanopsia or blue vision
SILDENAFIL
37/male with polysrthralgias, oral mucosal and genital lesions and a positive pathergy test
Behçet's Syndrome
54/female with exertional shortness of breath, easy fatigability and pallor, found to have a white count of 130,000 in varying degrees of maturation, and marked splenomegaly.
CHRONIC MYELOGENOUS LEUKEMIA
24/male with sensorineural deafness, proteinuria, microhematuria, and renal insufficiency
ALPORT Syndrome
34/female with polyarthritis, recurrent fever, anorexia, jaundice and abnormal LFTs tests positive for ANA, anti SM and anti LKM1 antibodies
AUTOIMMUNE HEPATITIS
56/male brought in to the ER in full arrest, after complaining of severe chest pain
MIXED METABOLIC AND RESPIRATORY ACIDOSIS
Paroxysmal SVT with block, nausea and vomiting, xanthopsia or green vision
DIGOXIN
55/male with 3-year history of miliary tuberculosis presents with symmetric polyarthrtis of his knee and ankle joints
Poncet's disease
56/female with new onset episodic shortness of breath and wheezing, also presents with palpable purpura, arthralgias, fever, weight loss and eosinophilia.
EOSINOPHILIC GRANULOMATOSIS (Churg Strauss vasculitis)
23/male with uncorrected VSD develops cyanosis, exertional shortness of breath, and easy fatigability
EISENMENGER syndrome
54/female presents with recurrent fever, oliguria, anemia, thrombocytopenia, jaundice with indirect hyperbilirubinemia, and mental status change.
THROMBOTIC THHROBOCYTOPENIC PURPURA (TTP)
27/female with Sjögren's Syndrome presents with hypokalemia, persistently alkaline urine, and nephrocalcinosis
NORMAL AG METABOLIC ACIDOSIS (DISTAL RTA OR RTA TYPE 1)
Brownish black skin discoloration, nausea and vomiting, abnormal LFTs in a patient being treated for leprosy
CLOFAZIMINE