Test your might!

[Depakote]

In the same vein as Allo's Name that Pathogen thread, let's get some good review going here. Anything on Step I is fair game.

A 37 year old male presents with a BP of 80/?. PT and PTT are elevated. Fibrinogen and Platelet count are decreased. D-Dimers are present. Peripheral blood smear reveals schistocytes as well as the following pathologic abnormality:

What is this patient's acute illness?
What is this patient's underlying illness?
Is there a specific abnormality associated with the underlying illness?
What must be done to treat this patient's underlying illness as not to aggravate the acute disease?

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[Saladin MD]

Yeah, Trousseu's sign works. I believe any cancer can have that; it's a migratory thrombophlebitis.

I totally forgot what Leser Trelat sign was, but thanks for the reminder.

 

[ENThopeful]

I'm gonna sound like a total n00b, but the stuff you guys are going over is freaking HARD. I just started studying a week or so ago, but am not giving my test for a long time (I'm a recently graduated IMG, so I have some time to study). Are all of these obscure diseases (e.g. Kartagener's) in the commonly used study material? I'm assuming most of this stuff is Path, which I haven't gotten to yet during my step 1 prep, but I don't remember learning any of this crap.

Kartenger's isnt obscure. It is actually emphasized a ton, at least in American medical education. The point of these disease isnt that they are common, cause they are not but because they teach pathophys. Dont worry though it should be in first aid/goljan. you will be exposed to it enough.

 

[ENThopeful]

A 10 year old male is brought to the clinic with a chief complaint of abdominal pain and diarrhea. The parents state that the child has been constantly sick with "colds," and has been been repeatedly sick before with either bloody or watery diarrhea on different occasions, and "pus-filled" skin infections. Analysis of the patient's blood reveals a leukocytic phagocytic abnormality. A specific test (the result of which is negative as predicted by the physician) is carried out to confirm the diagnosis.

What is this?
What is the prototypical cause of the patient's symptoms?
What test will be negative in this patient?

a bit late to the game here, but why cant this be chadiak higashi? thats what I read when i read leukocytic phagocytic abnormality. I dont have enough clinical prowess to know if partial albinism + peripheral neuropathy is common or not.

 

[SomeDoc]

a bit late to the game here, but why cant this be chadiak higashi? thats what I read when i read leukocytic phagocytic abnormality. I dont have enough clinical prowess to know if partial albinism + peripheral neuropathy is common or not.

A negative nitroblue tetrazolium-dye reduction test is diagnostic and specific for chronic granulomatous ds.

 

[Captopril]

Kartagener's on the exam is like free points. You barely need to read the question, hehe, since it will always be a Caucasian kid with respiratory problems and steatorrhea (or something extremely similar)...

Don't worry bro, it will all come to you near the end, God-Willing...I was having a major freak out just four days before the exam, right before I took the NBME and felt better right after it.

Seriously, you will learn so much in the next few months, God-Willing. I remember when I first started studying I was like "Prader-Willi wha!?" But now that's like kid stuff.

I just hope I retain this stuff in the long term...Well, I've finished reading half of the Step 2 book (Secrets), and it seems like the same old stuff, so I guess I'm getting the review I need in order to retain this stuff long-term.

Thanks Saladin, good to know before getting into the thick of it.

 

[Captopril]

Kartenger's isnt obscure. It is actually emphasized a ton, at least in American medical education. The point of these disease isnt that they are common, cause they are not but because they teach pathophys. Dont worry though it should be in first aid/goljan. you will be exposed to it enough.

Good call...I think I'll save my input on this thread until I've read everything at least once so I have some semblance of an idea of what you guys are talking about

 

[SomeDoc]

Kartagener's on the exam is like free points. You barely need to read the question, hehe, since it will always be a Caucasian kid with respiratory problems and steatorrhea (or something extremely similar)...

Steatorrhea=cystic fibrosis (think lack of digestive enzymes from pancreatic fibrosis)

 

[ENThopeful]

A negative nitroblue tetrazolium-dye reduction test is diagnostic and specific for chronic granulomatous ds.

right right. Just playing devils advocate here: but if say there was another negative test for Chadiak Higashi syndrome that we arent aware of, I dont know if this question directly points to chronic granulomatous disease, even though that is the better answer.

 

[Teee]

i'm not good at making up questions but let me give this a try

a 50 yr old woman presents with significant facial edema after diagnosis with lung cancer, what is the most likely syndrome?

a 82 yr old man presents with active rectal bleeding and pain in his left lower abdomen, CEA levels are normal, what is the most likely diagnosis? treatment?


a 20 yr old female presents with jaundice, itching skin, and increasing fatigue. At the doctor's office during a physical examination, she points to what she describes as "boils" on her knee. blood tests show increased alkaline phosphatase and anti-mitochondrial anti-body, what is the most likely diagnosis and how could the itching be resolved?

 

[FutureInternist]

i'm not good at making up questions but let me give this a try

a 50 yr old woman presents with significant facial edema after diagnosis with lung cancer, what is the most likely syndrome?

a 82 yr old man presents with active rectal bleeding and pain in his left lower abdomen, CEA levels are normal, what is the most likely diagnosis? treatment?


a 20 yr old female presents with jaundice, itching skin, and increasing fatigue. At the doctor's office during a physical examination, she points to what she describes as "boils" on her knee. blood tests show increased alkaline phosphatase and anti-mitochondrial anti-body, what is the most likely diagnosis and how could the itching be resolved?

Q#1 = Compressions of the SVC --> facial edema (SVC syndrome). You could also get Horner's w/ ipsi miosis, anhydrosis & ptosis with possible loss of arm fxn

Q# 2 = ?

Q#3 = Anti-mitochondrial Abs = Primary Biliary Cirrhosis. Since the itching is caused by excess bile you need to remove it from circulation hence cholestyramine

 

[ENThopeful]

. wrong

 

[bluntdissector]

What about complicated diverticulitis?

 

[Saladin MD]

Steatorrhea=cystic fibrosis (think lack of digestive enzymes from pancreatic fibrosis)

Oh crap, that's what I meant lol. I must have been on crack when I wrote that. I knew that. Seriously. Promise. LOLLLL

Kartagener's is situs inversus (sp?), and cilia disfunction due to dynein defect.

I just group CF and kartagener's together in my brain....

 

[Saladin MD]

i'm not good at making up questions but let me give this a try

a 50 yr old woman presents with significant facial edema after diagnosis with lung cancer, what is the most likely syndrome?

Superior Vena Cava Syndrome

a 82 yr old man presents with active rectal bleeding and pain in his left lower abdomen, CEA levels are normal, what is the most likely diagnosis? treatment?

diverticulitis

treatment: npo, iv fluids, antibiotics

you must do a colonoscopy or barium study but only after the acute episode is over...this is done to rule out cancer

a 20 yr old female presents with jaundice, itching skin, and increasing fatigue. At the doctor's office during a physical examination, she points to what she describes as "boils" on her knee. blood tests show increased alkaline phosphatase and anti-mitochondrial anti-body, what is the most likely diagnosis and how could the itching be resolved?

FutureInternist got this right on the money.

what are the boils on the knee about?

 

[triniman]

Superior Vena Cava Syndrome

diverticulitis

treatment: npo, iv fluids, antibiotics

you must do a colonoscopy or barium study but only after the acute episode is over...this is done to rule out cancer

FutureInternist got this right on the money.

what are the boils on the knee about?

diverticulOSIS

 

[bluntdissector]

No, it is diverticulITIS. Look, they even explain it to the patients on the Mayo website:

"Diverticulitis develops from a condition called diverticulosis. If you're older than age 40, it's common for you to have diverticulosis — small, bulging pouches (diverticula) in your digestive tract. In the United States, more than 50 percent of people older than 60 have diverticula. Although diverticula can form anywhere, including in your esophagus, stomach and small intestine, most occur in your large intestine. Because these pouches seldom cause any problems, you may never know you have them.
Sometimes, however, one or more pouches become inflamed or infected, causing severe abdominal pain, fever, nausea and a marked change in your bowel habits. When diverticula become infected, the condition is called diverticulitis."

 

[Saladin MD]

No, it is diverticulITIS. Look, they even explain it to the patients on the Mayo website:

"Diverticulitis develops from a condition called diverticulosis. If you're older than age 40, it's common for you to have diverticulosis — small, bulging pouches (diverticula) in your digestive tract. In the United States, more than 50 percent of people older than 60 have diverticula. Although diverticula can form anywhere, including in your esophagus, stomach and small intestine, most occur in your large intestine. Because these pouches seldom cause any problems, you may never know you have them.
Sometimes, however, one or more pouches become inflamed or infected, causing severe abdominal pain, fever, nausea and a marked change in your bowel habits. When diverticula become infected, the condition is called diverticulitis."

I think Triniman is right. It is diverticulosis. I distinctly remember in medical school my surgical attending told me that bleeding PR is from diverticulosis, not diverticulitis. Shrug.

 

[bluntdissector]

Nope...i dont think so...In FA (p309) it has diverticulosis as "Often assymptomatic or associated with vague discomfort and/or rectal bleeding", whilst it has diverticulitis as LLQ pain and "may cause bright rectal bleeding".

So LLQ pain + active bleeding in a old guy with a reason to suspect it's not cancer = diverticulitis.

What do you think? or

 

[Saladin MD]

Nope...i dont think so...In FA (p309) it has diverticulosis as "Often assymptomatic or associated with vague discomfort and/or rectal bleeding", whilst it has diverticulitis as LLQ pain and "may cause bright rectal bleeding".

So LLQ pain + active bleeding in a old guy with a reason to suspect it's not cancer = diverticulitis.

What do you think? or

I know FA says that, because I remember pondering over it when I read it....but I am pretty sure it's an error. The surgeon who told me this was an expert in her field. She specifically told me that even though it seems counter-intuitive, it is -osis and not -itis that causes bleeding PR.

But then again, who knows. I wasn't sure about it so that's why I initially replied with -itis, but then when Triniman came in and said that, I felt more confident in relaying what that surgeon said.

Anyways, don't take offense...you might be right, who knows. Either way, I don't think both answer choices would come up on the day of the exam, so just click the one they give!

 

[bluntdissector]

Anyways, don't take offense...you might be right, who knows. Either way, I don't think both answer choices would come up on the day of the exam, so just click the one they give!

I was just thinking that! Not to make an issue out of this, because the review books might be wrong, but I checked some other books and the BRS Path also states that -itis frequently causes bleeding. As far as I remember from surgery last year both could bleed, but its the pain that points to -itis. The point is that an old guy without cancer has diverticular disease, which often bleeds. Whether it is -osis or -itis will mean almost nothin from the Step 1 perspective (or at least I don't htink it will) and hece we will all pick the diverticul--- option!

 

[bluntdissector]

Here are two cases we had in some sort of tutorial some time ago. Please note that gradually more information was provided so that we could DDx, plan Ix and then Dx. However, I'm just pasting the history, some examinations and some Ix. They are supposed to be easy, but this might make it VERY easy (or very confusing) but lets see!

Case 1:
4 year old previously healthy girl presents to your outpatient department with several bruises on her arms and legs. She has received a vaccination for Varicella two weeks earlier. She has no lymphadenopathy or hepatosplenomegaly.
Relevant laboratory investigations:
WCC: 7 Hb: 12,5 PLT: 5 INR: Normal PTT: Normal

Most likely Dx?
Pathogenesis?
Tx?

Case 2:
You are seeing a 2 year old boy and his mom. The mother is concerned about swollen glands in the neck that she has noticed since a week ago. The boy seem listless and is pale…History also reveals a persisting fever for which the boy has already completed a course of antibiotics 2 weeks ago. On examination you note several ecchymoses and hepatosplenomegaly.
Relevant laboratory investigations:
FBC: wcc 20 Hb 5 MCV 80 MCV 35 Pl 25 Reticulocyte count = 0,2%

Most likely Dx?
How would you confirm it?

 

[Mortal_Lessons]

I was just thinking that! Not to make an issue out of this, because the review books might be wrong, but I checked some other books and the BRS Path also states that -itis frequently causes bleeding. As far as I remember from surgery last year both could bleed, but its the pain that points to -itis. The point is that an old guy without cancer has diverticular disease, which often bleeds. Whether it is -osis or -itis will mean almost nothin from the Step 1 perspective (or at least I don't htink it will) and hece we will all pick the diverticul--- option!

We could always ask the patient about fever, chills, shakes, and recent fatigue to see if there's active inflammation taking place in their body. Perhaps this could help differentiate diverticulitis from diverticulosis.

 

[bluntdissector]

We could always ask the patient about fever, chills, shakes, and recent fatigue to see if there's active inflammation taking place in their body. Perhaps this could help differentiate diverticulitis from diverticulosis.

4Shizz, in a clinical setting, but on step 1 you'll just pick diverticulosis/itis, whichever they give you...

 

[Steiner]

Here are two cases we had in some sort of tutorial some time ago. Please note that gradually more information was provided so that we could DDx, plan Ix and then Dx. However, I'm just pasting the history, some examinations and some Ix. They are supposed to be easy, but this might make it VERY easy (or very confusing) but lets see!

Case 1:
4 year old previously healthy girl presents to your outpatient department with several bruises on her arms and legs. She has received a vaccination for Varicella two weeks earlier. She has no lymphadenopathy or hepatosplenomegaly.
Relevant laboratory investigations:
WCC: 7 Hb: 12,5 PLT: 5 INR: Normal PTT: Normal

Most likely Dx?
Pathogenesis?
Tx?

Dx: Child Abuse

Tx: Call CPS

or Thrombocytopenic Purpura

 

[ENThopeful]

Case 2:
You are seeing a 2 year old boy and his mom. The mother is concerned about swollen glands in the neck that she has noticed since a week ago. The boy seem listless and is pale…History also reveals a persisting fever for which the boy has already completed a course of antibiotics 2 weeks ago. On examination you note several ecchymoses and hepatosplenomegaly.
Relevant laboratory investigations:
FBC: wcc 20 Hb 5 MCV 80 MCV 35 Pl 25 Reticulocyte count = 0,2%

Most likely Dx?
How would you confirm it?

EBV? monospot/serology

 

[44466]

Boils are the xanthomas from hypercholesterolemia that form on extensor surfaces methinks.

Isn't the treatment for PBC ursodeoxycholic acid?

 

[Saladin MD]

I was just thinking that! Not to make an issue out of this, because the review books might be wrong, but I checked some other books and the BRS Path also states that -itis frequently causes bleeding. As far as I remember from surgery last year both could bleed, but its the pain that points to -itis. The point is that an old guy without cancer has diverticular disease, which often bleeds. Whether it is -osis or -itis will mean almost nothin from the Step 1 perspective (or at least I don't htink it will) and hece we will all pick the diverticul--- option!

Agreed!

Case 1:
4 year old previously healthy girl presents to your outpatient department with several bruises on her arms and legs. She has received a vaccination for Varicella two weeks earlier. She has no lymphadenopathy or hepatosplenomegaly.
Relevant laboratory investigations:
WCC: 7 Hb: 12,5 PLT: 5 INR: Normal PTT: Normal

Most likely Dx?
Pathogenesis?
Tx?

I think we should provide normal values, since those appear on the test. Anyways, the platelet count is 5, which I am assuming means 5,000? That's EXTREMELY low (unless I am interpreting it incorrectly.)

So diagnosis: ITP
Pathogenesis: Unknown, but likely molecular mimicry
Treatment: In a child, will resolve on its own (hopefully)

Case 2:
You are seeing a 2 year old boy and his mom. The mother is concerned about swollen glands in the neck that she has noticed since a week ago. The boy seem listless and is pale…History also reveals a persisting fever for which the boy has already completed a course of antibiotics 2 weeks ago. On examination you note several ecchymoses and hepatosplenomegaly.
Relevant laboratory investigations:
FBC: wcc 20 Hb 5 MCV 80 MCV 35 Pl 25 Reticulocyte count = 0,2%

Most likely Dx?
How would you confirm it?

Can you give normal values?

This one needs more blue's clues!

 

[NJMD]

Black dude goes into mexican restaurant comes out looking chinese...What does he have?

**Hightlight below to find answer**

G-6-P DH deficiency causing hemolytic anemia due to eating fava beans.






**Disclaimer-- Not intended to be racist or offensive to anyone.

 

[FutureInternist]

That is awesome

 

[Steiner]

Black dude goes into mexican restaurant comes out looking chinese...What does he have?


**Disclaimer-- Not intended to be racist or offensive to anyone.

Shouldn't it be an Italian Restaurant

 

[Instatewaiter]

Here are two cases we had in some sort of tutorial some time ago. Please note that gradually more information was provided so that we could DDx, plan Ix and then Dx. However, I'm just pasting the history, some examinations and some Ix. They are supposed to be easy, but this might make it VERY easy (or very confusing) but lets see!

Case 1:
4 year old previously healthy girl presents to your outpatient department with several bruises on her arms and legs. She has received a vaccination for Varicella two weeks earlier. She has no lymphadenopathy or hepatosplenomegaly.
Relevant laboratory investigations:
WCC: 7 Hb: 12,5 PLT: 5 INR: Normal PTT: Normal

Most likely Dx?
Pathogenesis?
Tx?

Case 2:
You are seeing a 2 year old boy and his mom. The mother is concerned about swollen glands in the neck that she has noticed since a week ago. The boy seem listless and is pale…History also reveals a persisting fever for which the boy has already completed a course of antibiotics 2 weeks ago. On examination you note several ecchymoses and hepatosplenomegaly.
Relevant laboratory investigations:
FBC: wcc 20 Hb 5 MCV 80 MCV 35 Pl 25 Reticulocyte count = 0,2%

Most likely Dx?
How would you confirm it?

1) Child abuse was my knee jerk reaction after seeing bruises but given the lab values I'm gonna go with ITP

give steriods.

2) Acute leukemia. Most likely ALL given age: Bone marrow creates too many abnl WBC (high WBC) that crowd out the red blood cell and platelet production (low Hb and Plt)

you first need a smear to determine whether AML/ALL.

 

[FutureInternist]

Boils are the xanthomas from hypercholesterolemia that form on extensor surfaces methinks.

Isn't the treatment for PBC ursodeoxycholic acid?

That is the tx but it does not help with the symptoms. So the tx for the "itch" part is cholestyramine.

 

[Teee]

4Shizz, in a clinical setting, but on step 1 you'll just pick diverticulosis/itis, whichever they give you...

Lol. for a minute there, I got lost. Yeah I dont know if it is -isis or olitis or whatever , as long as it started with diver... that was the answer.

the first one was SVC syndrome

and the last one was primary Biliary cirrhosis, treatment for itching is cholestymine, treatment for the disease is ursodol (not the correct spelling)

 

[PeepshowJohnny]

A step 1 favorite:

A 23 year old man is brought to see his family doctor by his parents. The man walks into the office clumsily. He states he has, over the last six months, developed an uncontrollable "tremor" of his arms and his feet, and feels clumsy. It is getting worse, He is able to converse, but his mental processes do not seem completely appropriate. His parents add that he has not seemed himself, has become more and more depressed, and sometimes does not speak logically. His mother is especially worried, and tearfully described how she was told her father died young "in a mental institution". The couple have three other younger children, who are healthy.

When asking about past history, patients state that the patient has had "bad liver enzymes" when tested two years ago for a prework physical. They wonder if his state is caused by drugs or alcohol. Physical exam is unremarkable except for the neurological symptoms the patient described, and something seems unusual about his iris...

What is the dx?
What is the pathophysiology?
What is the name of the patient's eye findings?
What is the first diagnostic test?
What else should be done?
What is the treatment?

 

[SomeDoc]

A step 1 favorite:

A 23 year old man is brought to see his family doctor by his parents. The man walks into the office clumsily. He states he has, over the last six months, developed an uncontrollable "tremor" of his arms and his feet, and feels clumsy. It is getting worse, He is able to converse, but his mental processes do not seem completely appropriate. His parents add that he has not seemed himself, has become more and more depressed, and sometimes does not speak logically. His mother is especially worried, and tearfully described how she was told her father died young "in a mental institution". The couple have three other younger children, who are healthy.

When asking about past history, patients state that the patient has had "bad liver enzymes" when tested two years ago for a prework physical. They wonder if his state is caused by drugs or alcohol. Physical exam is unremarkable except for the neurological symptoms the patient described, and something seems unusual about his iris...

What is the dx?
What is the pathophysiology?
What is the name of the patient's eye findings?
What is the first diagnostic test?
What else should be done?
What is the treatment?

Wilson's Ds.
Low ceruloplasmin, high serum copper--> deposits in basal ganglia
Kayser Fleischer rings
Serum copper levels/ceruloplasmin
Can result from alcohol abuse and resultant cirrhosis- alcohol counseling
Penicillamine

 

[Redrox]

Crazy bonus worthless point if you can name the membrane of the cornea that is the site of copper deposition.

(And yes the answer can be found in Goljan, I checked.)

 

[Richspiders07]

Um... starts with D... D. membrane. ha

 

[44466]

I think it's Descemet's membrane

 

[Saladin MD]

K here is one:

On a routine check-up visit, a 45 year old man complains of excessive farting. On physical exam, the abdomen is soft, non-tender, with no visceromegaly. Whiff test is positive: the gaseous substance released from the patient's rectum is malodorous and smells four days old. Rest of exam is unremarkable. The patient explains that his diet consists of reheated rice and beans. The patient lives with his wife and four children, all of whom are healthy but perturbed by his excessive farting. The patient's lab values are as follows:

Hb: 15
Plt: 200,000
WBC: normal

What is the dx?
What is the pathophysiology?
What is the treatment?

 

[bluntdissector]

1) Child abuse was my knee jerk reaction after seeing bruises but given the lab values I'm gonna go with ITP

give steriods.

2) Acute leukemia. Most likely ALL given age: Bone marrow creates too many abnl WBC (high WBC) that crowd out the red blood cell and platelet production (low Hb and Plt)

you first need a smear to determine whether AML/ALL.

hi

sorry for not providing normals! I'm at a massive rock festival so only checked on my phone now. But you got both of them spot on, ITP and ALL.

The flava beans joke killed me, so funny...

 

[Steiner]

K here is one:

On a routine check-up visit, a 45 year old man complains of excessive farting. On physical exam, the abdomen is soft, non-tender, with no visceromegaly. Whiff test is positive: the gaseous substance released from the patient's rectum is malodorous and smells four days old. Rest of exam is unremarkable. The patient explains that his diet consists of reheated rice and beans. The patient lives with his wife and four children, all of whom are healthy but perturbed by his excessive farting. The patient's lab values are as follows:

Hb: 15
Plt: 200,000
WBC: normal

What is the dx?
What is the pathophysiology?
What is the treatment?

Dx: He's on acarbose for his dabetes and ripping nasty ass all day long.
Pathophys: enzymes are blocked so carbs make it to large intestines where normal flora of the gut have a buffet.
Treatment: Switch drugs

Or he's just a normal 45 year old guy who eats rice and beans a lot.

 

[SomeDoc]

K here is one:

On a routine check-up visit, a 45 year old man complains of excessive farting. On physical exam, the abdomen is soft, non-tender, with no visceromegaly. Whiff test is positive: the gaseous substance released from the patient's rectum is malodorous and smells four days old. Rest of exam is unremarkable. The patient explains that his diet consists of reheated rice and beans. The patient lives with his wife and four children, all of whom are healthy but perturbed by his excessive farting. The patient's lab values are as follows:

Hb: 15
Plt: 200,000
WBC: normal

What is the dx?
What is the pathophysiology?
What is the treatment?

-Normal gas production from diet (R/O bacillus cereus from reheated rice with WBC count, non-tender abdomen)
-Beans=cellulose. Bacteria in gut digest cellulose from beans-->end product=methane.
-Change diet or limit consumption.

 

[Instatewaiter]

On a yearly physical, a 20 year old female c/o cramping bilateraly lower abdominal pain that has been going on for years and are debilitating. The pain begins about a week and a half before her period and then goes away when her menses come. She has tried NSAIDs without much help. Her menses are regular. She has no other symptoms. On bimanual vaginal exam, she has no adnexal masses, uterus is normal size and has some nodularity in the cul-de-sac.

Lab Wbc: 6.0 Hgb:11.8, Plt 232


- What is the most likely diagnosis?
- How do you confirm the diagnosis?
- What is the pathophys?
- What is the treatment?
- What assocaited defects are seen in 15-20% of people with this disorder?

 

[Instatewaiter]

28 year old man presents to the emergency room comatose at 8pm and unable to be roused by deep sternal rub. The friends that brought him in said that he was fine yesterday at their lake house. He even showed them some tricks he had been practicing on his wake board which were "Crazy Wicked". As the afternoon came he developed a headache and became less responsive. He has no past medical history, takes no medicines and up until incident was completely healthy. Drug screen was negative. CT negative. No history of trauma

Most likely diagnosis?
Cause?
Prognosis?

 

[SomeDoc]

On a yearly physical, a 20 year old female c/o cramping bilateraly lower abdominal pain that has been going on for years and are debilitating. The pain begins about a week and a half before her period and then goes away when her menses come. She has tried NSAIDs without much help. Her menses are regular. She has no other symptoms. On bimanual vaginal exam, she has no adnexal masses, uterus is normal size and has some nodularity in the cul-de-sac.

Lab Wbc: 6.0 Hgb:11.8, Plt 232


- What is the most likely diagnosis?
- How do you confirm the diagnosis?
- What is the pathophys?
- What is the treatment?
- What assocaited defects are seen in 15-20% of people with this disorder?

-Sounds like a bicornuate uterus
-U/S
-Incomplete fusion of paramesonephric (mullerian) cords
-Sx
-Improper vaginal development (partial), possible impaired fallopian tube development.

I could be wrong though- looks like it's time to look up uterine anatomy.

 

[werd]

On a yearly physical, a 20 year old female c/o cramping bilateraly lower abdominal pain that has been going on for years and are debilitating. The pain begins about a week and a half before her period and then goes away when her menses come. She has tried NSAIDs without much help. Her menses are regular. She has no other symptoms. On bimanual vaginal exam, she has no adnexal masses, uterus is normal size and has some nodularity in the cul-de-sac.

Lab Wbc: 6.0 Hgb:11.8, Plt 232


- What is the most likely diagnosis?
- How do you confirm the diagnosis?
- What is the pathophys?
- What is the treatment?
- What assocaited defects are seen in 15-20% of people with this disorder?

sounds like endometriosis, could be fibroids or bicornate uterus
confirm with US, but direct visualization is gold standard
pathophys is endometrial tissue outside the uterus, often around ovaries, cycles like regular endometrium during the month and the growth/degredation causes pain
treat with OCP's, consider surgical removal if it's causing infertility and want kids

 

[SomeDoc]

28 year old man presents to the emergency room comatose at 8pm and unable to be roused by deep sternal rub. The friends that brought him in said that he was fine yesterday at their lake house. He even showed them some tricks he had been practicing on his wake board which were "Crazy Wicked". As the afternoon came he developed a headache and became less responsive. He has no past medical history, takes no medicines and up until incident was completely healthy. Drug screen was negative. CT negative. No history of trauma

Most likely diagnosis?
Cause?
Prognosis?

-Subdural hemorrhage
-rapid angular velocity changes ripping cerebral veins
-poor

 

[Depakote]

28 year old man presents to the emergency room comatose at 8pm and unable to be roused by deep sternal rub. The friends that brought him in said that he was fine yesterday at their lake house. He even showed them some tricks he had been practicing on his wake board which were "Crazy Wicked". As the afternoon came he developed a headache and became less responsive. He has no past medical history, takes no medicines and up until incident was completely healthy. Drug screen was negative. CT negative. No history of trauma

Most likely diagnosis?
Cause?
Prognosis?

Headache progressing to coma in an otherwise healthy young man would make me thing aneurysm or subarachnoid hemorrhage if we had something on CT.

Given the negative CT, I'm going to guess meningitis. If I had my micro notes I could look it up, but I know there's some atypical bug that gets swimmers.

Prognosis isn't too hot, IIRC when it was discovered it killed like 50% of a group of triathletes.

 

[SomeDoc]

Headache progressing to coma in an otherwise healthy young man would make me thing aneurysm or subarachnoid hemorrhage if we had something on CT.

Given the negative CT, I'm going to guess meningitis. If I had my micro notes I could look it up, but I know there's some atypical bug that gets swimmers.

Prognosis isn't too hot, IIRC when it was discovered it killed like 50% of a group of triathletes.

Good point, DDx should also include naegleria fowleri.

Edit: oops... missed the negative CT

 

[Depakote]

Headache progressing to coma in an otherwise healthy young man would make me thing aneurysm or subarachnoid hemorrhage if we had something on CT.

Given the negative CT, I'm going to guess meningitis. If I had my micro notes I could look it up, but I know there's some atypical bug that gets swimmers.

Prognosis isn't too hot, IIRC when it was discovered it killed like 50% of a group of triathletes.

Naegleria fowleri, yup. Amebic Meningoencephalitis was what I was thinking of... just found it on Access Medicine.