Name That Diagnosis
A 72-year-old man presents 4 weeks after CABG with fever and chest pain that worsens when lying flat and improves when sitting up. Chest x-ray shows a small pleural effusion.
What is acute pericarditis?
More specifically this is with postpericardiotomy syndrome likely due to surgical damage of the mesothelial pericardial cells with resultant blood in the pericardial space, which causes an autoimmune response against the released cardiac antigens.
The present and are treated like any patient with acute pericarditis.
A 26-year-old man with ulcerative colitis involving the entire colon dx this year is now in remission after treatment. He is up to date on all vaccinations related to his condition.
What is begin colorectal cancer screening with colonoscopy in 8 years?
UC patients should undergo surveillance colonoscopy 8-10 years after diagnosis and every 1-3 years thereafter
An obese patient with moderate to severe obstructive sleep apnea is already using CPAP.
What is Zepbound?
This country won the most recent FIFA World Cup in 2022
What is Argentina?
☀️✨
Golden Weekend
A 67-year-old man with reported well controlled diabetes has progressive anasarca and nephrotic-range proteinuria. Exam shows JVD, hepatomegaly, and an S4. Urinalysis reveals 4+ protein with a bland sediment. ECG shows low-voltage QRS complexes.
What is primary Amyloidosis?
The combination of restrictive cardiomyopathy and Nephrotic syndrome is consistent with amyloidosis, which causes up to 20% of NS in patients age >60
A diabetic patient has a chronic foot ulcer with foul-smelling drainage and visible bone. X-ray shows cortical erosion and periosteal elevation.
What is obtain a bone biopsy for culture?
This is one of the few conditions where antibiotics can be deferred initially. MRI is the most sensitive imaging modality, but the priority is establishing the diagnosis with a bone biopsy.”
A patient develops bilateral DVT 2 weeks after CABG with thrombocytopenia following recent heparin exposure
What is a direct thrombin inhibitor?
Those include argatroban or bival (IV)
Pradaxa (PO)
This is delayed onset HIT that can happen 1-2 weeks after heparin. High suspicion if there are clots and thrombocytopenia.
You can use the 4T tool and HIT antibody testing.
They will need up to 6months of anticoagulation.
This country defeated Brazil 7–1 in one of the most shocking semifinal matches in World Cup history
What is Germany?
🔥😵
Burn out
A 34-year-old woman presents with fatigue, weight loss, and recent viral illness. She is hypotensive (90/60) and tachycardic. Labs show hyponatremia, mild hyperkalemia, hypoglycemia, and normal anion gap metabolic acidosis. She has a history of autoimmune hypothyroidism.
What is Adrenal Insufficiency?
Primary adrenal insufficency chronic s/s can be non specific with fatigue and weight loss.
Triggers can put in overdrive such as infection, hemorrhage or cancer.
Think about is in combo of Hyponatremia, hypotension and acidosis.
A young woman with lifelong heavy menses, normal platelets, and a family history of bleeding presents with heavy vaginal bleeding
What is plasma von Willebrand factor antigen and activity testing?
Any heavy bleeding warrants CBC, PT, PTT and fibronogen testing.
Normal Plts, with nomal PT, aPTT more consistent with von Willebrand disease.
A patient with a known pituitary mass presents with sudden severe headache, hypotension, ophthalmoplegia, and bitemporal visual field loss
What is high-dose IV Hydrocortisone?
Pituitary apoplexy is an endocrine emergency, and more than two-thirds of patients develop acute central adrenal insufficiency. which can be life-threatening due to severe hypotension and hypoglycemia.
Adrenal insufficiency is so common in pituitary apoplexy, empiric steroid therapy should be given even if it has not yet been definitively confirmed.
This country has won the most FIFA World Cups in history
What is Brazil?
🍬🚪
Chief's office
A 64-year-old man with a recent pacemaker lead revision has lightheadedness when leaning forward, worsening headaches, facial plethora, and distended neck and chest veins
What is SVC syndrome?
Mostly caused by cancer but can be caused by such cardiac procedure as it can cause thrombosis and occlusion causing SVC syndrome.
It can happen 1-15months after the procedure.
A 46-year-old man has recurrent palpable, nonblanching purpura with fatigue, arthralgias, and abdominal pain. Urinalysis shows hematuria with RBC casts and proteinuria. Complement levels are normal.
What is a skin biopsy?
This Henoch-Schönlein purpura classic tetrated of arthralgia, palpable purpura, glomerular nephritis and abdominal pain.
Diagnosis renal studies, normal complement levels and biopsy (Skin or Kidney).
A 73-year-old woman has 6 weeks of bilateral shoulder and hip pain with morning stiffness that improves throughout the day. Exam shows limited shoulder abduction without joint swelling. CRP is elevated, and all other labs are normal.
What is low dose prednisone?
This is a classic presentation of polymyalgia rheumatica (PMR).”
Key clues: older patient, proximal stiffness > pain, worse in the morning, improves with activity.
ESR can be elevated over 40.
Treatment can also be diagnostic.
This country won the 2006 World Cup, defeating France in a final remembered for Zidane’s headbutt
What is Italy?
🧑⚕️❓😰
Pimping
An immunosuppressed patient presents with high fever, diarrhea, and headache. Labs show leukocytosis at 14 and thrombocytopenia at 90. Blood cultures grow Gram-positive rods in all bottles.
What is Listeria monocytogenes infection?
febrile gastroenteritis cause by listeria. Risk factor are patients that are advanced in age or immunosuppressed.
Out of all the gram positive rods listeria is more likely to cause bactermia.
treatment is amp
A patient with recurrent respiratory infections is found to have bronchiectasis on CT. Symptoms improve with antibiotics.
What is check immunoglobulin levels?
Patients with suggestive bronchiectasis on high resolution CT should undergo functional assessment by pulmonary function testing. Potential reversible causes should also be investigated. Current guidelines recommend complete blood count with differential, immunoglobulin quantitation (e.g., IgA, IgG, and IgM), and sputum culture and smear (bacteria, fungi, and mycobacteria) as the initial evaluation for bronchiectasis.
CVID can present in adults who did not have childhood infections.
An elderly demented patient presents with abdominal distension. Imaging shows marked colonic and cecal dilation without mechanical obstruction. An NG tube is placed and electrolytes are corrected, but the dilation persists for the next 24hours.
What is neostigmine?
This is Ogilvie syndrome.
Treatment includes conservative measures (PO, NG/Rectal tube decompression)
If that persists than neostigmine up to two doses.
If it fails you will need surgical or endoscopic decompression
This country was the first African nation to reach a World Cup semifinal?
What is Morocco?
🦠📊💊
antibiogram