quiz of the week

What Ophthalmologic Feature Is This Child Most Likely To Develop?

February 27, 2019February 15, 2019 by Figure 1

A 5-year-old male presents to his pediatrician for a yearly check-up and immunizations. On examination, … Read more

Which additional CSF finding is most likely?

February 27, 2019January 31, 2019 by Figure 1

An 11-month-old male with a two-day history of irritability and lethargy is brought to the … Read more

What’s Causing These Pruritic Lesions?

February 27, 2019January 24, 2019 by Figure 1

A 38-year-old man presents with itchy, scaly lesions on his elbows and small, erythematous papules … Read more

Which testicular malignancy does this patient most likely have?

February 27, 2019January 11, 2019 by Figure 1

A 28-year-old male presents with a three-month history of a chronic cough and weight loss. … Read more

Which Antibiotic Is Associated With This Presentation?

February 27, 2019December 14, 2018 by Figure 1

A 35-year-old male presents to his family physician with progressive heel pain. He denies any … Read more

Do you recognize this ominous sign?

February 27, 2019December 7, 2018 by Figure 1

What underlying condition is most likely? A 62-year-old female presents with fatigue and innumerable pruritic, … Read more

Why Are These Gallstones Black?

February 27, 2019November 30, 2018 by Figure 1

A 45-year-old female presents to the emergency department with abdominal pain and vomiting. She mentions … Read more

Why does this patient have difficulty walking?

February 27, 2019October 26, 2018 by Figure 1

A 24 year-old female presents with a history of multiple ankle sprains and complains of … Read more

Do you recognize these ring-shaped lesions?

February 27, 2019October 19, 2018 by Figure 1

A 69-year-old woman with a history of hypertension and irritable bowel syndrome presents with multiple … Read more

What will exacerbate this patient’s condition?

February 27, 2019September 22, 2018 by Figure 1

A 70-year-old male with a history of hypertension presents with a fever and severe pain … Read more

What’s causing this patient’s spontaneous laughter?

February 27, 2019September 15, 2018 by Figure 1

A four-year-old girl is referred to a pediatric neurologist with new-onset generalized tonic-clonic seizures. Her father mentions that she has also had sudden episodes of spontaneous unexplained loud laughter for the past year, and they now occur almost daily. Neurological examination is unremarkable. An MRI reveals the findings seen here. Which of the following other clinical features is commonly associated with this patient’s condition?

How would you manage this acute abdominal pain?

February 27, 2019August 25, 2018 by Figure 1

A 24-year-old sexually active female presents with a three-day history of severe right upper quadrant pain that worsens on inhalation. She has a history of multiple sexual partners and does not use contraception. Examination reveals marked tenderness in the right upper quadrant and laparoscopy demonstrates the findings seen here. Based on this patient’s diagnosis, what treatment would address the most likely underlying infection?

How would you manage this patient’s neurologic impairment?

February 27, 2019July 27, 2018 by Figure 1

A 28-year-old female presents to the emergency department with an occipital headache and neck pain. She mentions her symptoms appeared after hyperextending her neck while playing tennis the day before. Examination reveals dysdiadochokinesia and decreased lateral vision. A contrast head and neck CT demonstrate the findings seen here. Based on this patient’s probable diagnosis, which of the following treatments is most appropriate?

Macroglossia and Edema—What Do You Suspect?

February 27, 2019July 20, 2018 by Figure 1

A 65-year-old male presents to his family physician with complaints of increasing fatigue, dyspnea on exertion, and unintentional weight loss within the last six months. On examination, he is noted to have macroglossia and peripheral edema. Crackles are audible bilaterally on chest auscultation. Which of the following tests will help to confirm this patient’s most likely diagnosis?

Why is this urine bag purple?

February 27, 2019July 13, 2018 by Figure 1

An 80-year-old female with a history of diabetes and chronic constipation presents to the emergency department with a purple urine bag. She is currently bedridden and uses an indwelling catheter. On examination, she is hypotensive and confused. Blood cultures are positive for Proteus vulgaris. Based on this patient’s presentation, which of the following antibiotics should be commenced?

Did a drug interaction complicate this injury?

February 27, 2019July 6, 2018 by Figure 1

A 76-year-old male presents with a progressive headache, dizziness, and confusion after falling from his bed the night before. He currently takes warfarin following a mechanical valve replacement 11 years ago, and has been recently diagnosed with depression. A CT scan reveals a subdural hematoma and the patient’s INR measures 7.5. Which of the following is most likely to increase the anticoagulant effect of warfarin?

What’s Causing This Persistent Cough?

February 27, 2019June 29, 2018 by Figure 1

A 75-year-old female presents with a two-year history of a persistent cough and fatigue. The cough is occasionally productive of purulent sputum. She was treated for a community-acquired pneumonia two years earlier and underwent an anterior cervical discectomy and fusion previously, but is otherwise well. On examination, she appears well-groomed, polite, and thin. Chest auscultation reveals wheezing in the mid zones bilaterally and a later chest X-ray and CT scan demonstrate the findings seen here.

Why Is This Patient Profoundly Hypotensive?

February 27, 2019June 22, 2018 by Figure 1

A 70-year-old male is brought to the emergency department with subacute shortness of breath and fatigue. Upon searching her father’s home, his daughter reports she found his medication — a nearly empty bottle of metoprolol, 100 mg bid. She believes her father has coronary artery disease. On examination, the patient is confused. His blood pressure is 69/49 mmHg and he has a heart rate of 48 bpm. An ECG reveals the findings seen here. After initiating oxygen and atropine, which of the following is the best treatment for this patient’s presentation?

What proportion of patients with psoriasis may develop accompanying arthritis?

February 27, 2019June 15, 2018 by Figure 1

A 70-year-old female with psoriasis presents with a four-month history of worsening arthralgia. She mentions she has pain and stiffness in her big toes and most of her fingers. On examination, a telescoping finger deformity is seen on her right second digit.

How would you manage this patient’s reaction?

February 27, 2019June 9, 2018 by Figure 1

A 32-year-old female presents with a headache and a rash on her trunk and extremities. She has had unprotected sex with multiple partners over the last two months, but denies any history of sexually transmitted infections. Examination reveals generalized non-tender lymphadenopathy, a diffuse macular rash on her chest and arms, and patchy hair loss. Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody-absorption (FTA-ABS) tests are both positive, and she is given a single dose of penicillin G benzathine intramuscularly. She returns within a few hours with a worsening rash (seen here), myalgia, and a fever.