Clinical Microvignettes Flashcards by Rd Pingoy

60-year-old woman with long-term estrogen replacement therapy with new onset of vaginal bleeding

Endometrial carcinoma

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8-year-old boy with acute scrotal pain; a small “blue dot” is seen through the scrotal skin

Testicular appendage torsion

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22-year-old woman with acute onset of lower abdominal pain, hypotension, tachycardia, adnexal mass, and free uid on vaginal ultrasound?

Ectopic pregnancy rupture

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70-year-old male retired leather worker, cigarette smoker; presents with painless gross hematuria

Bladder transitional cell carcinoma

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22-year-old male who develops a right scrotal hydrocele with elevated serum β-HCG

Testicular Cancer

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28-year-old woman involved in a high-speed, side-impact motor vehicle collision (MVC); stable vital signs; chest x-ray reveals widened mediastinum

Toracic aortic injury

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55-year-old woman with diabetes, recurrent pyelonephritis, increased creatinine, increased BUN; IVP reveals radiolucent defects in the kidney collecting system

Papillary necrosis

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31-year-old man with right ank pain radiating into

scrotum, gross hematuria, right-sided hydronephrosis, and normal abdominal x-ray

Uric acid kidney stone

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18-year-old women with fever; costovertebral tenderness; flank mass; and WBCs, RBCs, and gram-negative rods in the urine

Kidney (renal) abscess

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65-year-old man with groin pain who goes into septic shock after a rectalprostatic exam

Bacterial prostatitis

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19-year-old man status post (s/p) spinal anesthetic for a groin hernia repair returns to clinic with back pain, fever, and decreased left lower extremity sensation and movement

Epidural Abscess

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30-year-old woman with thoracic back pain, destruction of thoracic vertebral bodies on x-ray, 1 PPD

Pott’s Disease

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22-year-old man s/p MVC with transection of right optic nerve; progresses to blindness in the contralateral le eye 3 weeks later

Sympathetic ophthalmia

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29-year-old diabetic with chronic bacterial sinusitis, new-onset seizures, fever, and right-sided weakness

Brain Abscess

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28-year-old man with intermittent vertigo, intermittent hearing loss, tinnitus, and a subjective feeling of having ear swelling

Ménière’s disease

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16-year-old girl with severe sore throat, lateral uvula displacement, bulging tonsillar pillar, 1 Streptococcus pyogenes

Quinsy’s abscess (peritonsillar abscess)

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60-year-old woman with a thyroidmass,1 follicular cellsonbiopsy,1 capsular invasion,1 vascular invasion

Thyroid Follicular Carcinoma

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42-year-old woman with thyroidmass,1 amyloid on histology, hypercalcemia

Medullary thyroid carcinoma

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25-year-old man with thyroid mass,1 psammomabodies on histology

Papillary thyroid carcinoma

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Hypothyroidism, “woody” hard thyroid, tracheal compression

Riedel’s thyroiditis

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17-year-old woman with upper respiratory tract infection followed by fever, neck pain, dysphagia, tender thyroidgland,1 strep cultures

Acute suppurative thyroiditis

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28-year-old woman

with tender thyroid, hypothyroidism, elevated antimicrosomal antibodies, increased antithyroglobulin antibodies

Hashimoto’s thyroiditis

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45-year-oldwomanwith itching of the right nipple for 6 months and a right breast mass

Paget’sdisease(infilltrating ductal carcinoma with spread to the nipple)

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60-year-old man with nipple discharge

Male breast cancer

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36-year-old woman with arightbreastmassa after hitting her right breast on a door handle

Fat necrosis

39-year-old woman with bilateral milky breast discharge, decreased lateral vision fields, and pituitary mass

Prolactinoma

28-year-old woman with unilateral green-brown nipple discharge increasing immediately before menses?

Fibrocystic disease

WhatistheGCSforan 18-year-old woman s/p MVC in a “coma”?

5-8

28-year-old man involved in high-speed MVC with lower back spine fracture, bladder/ bowel incontinence, decreased lower extremity sensation, and decreased lower extremity strength

Cauda equina syndrome

24-year-old woman with spine fracture; paraplegia but with touch and proprioception intact

Anterior spinal cord syndrome

29-year-old man s/p 45-foot fall with left-sided loss of temperature and pain sensation; right-sided paresis and loss of right-sided proprioception

Brown-Sequard syndrome

18-year-old woman with a cervicalspinalfracturea after diving into a shallow pool; intact perianal sensation and decreased lower extremity sensation and movement

Central cord syndrome

50-year-old woman with painless proptosis and a brain tumor stuck to the dura

Meningioma

24-year-old heavy cigarette smoker with initial onset of foot pain followed by digit necrosis

Buerger’s disease

55-year-old woman with calf claudication, “hourglass” stenosis on angiogram of popliteal artery, and cyst on ultrasound of posterior knee

Cystic degeneration of the popliteal artery

65-year-old woman started on Coumadin alone for atrial fibrillation develops acute DVT

Coumadin-induced hypercoagulable state due to decreased protein C & S

56-year-old woman with hemorrhoids that prolapse with defecation but then retract by themselves

2nd-degree internal hemorrhoids

67-year-old male smoker on Coumadin for chronic DVTnoticesLLQpaina after a strenuous coughing spell; LLQ mass detected on physical exam

Rectus sheath hematoma

34-year-old woman with hemorrhoids that prolapse after defecationandthatshe has to “push back in”

3rd-degree internal hemorrhoids

56-year-old woman with hemorrhoids that are “stuckout”a erabowel movement

4th-degree internal hemorrhoid

61-year-old man develops acute onset of pain and “blurry” vision in the right eye; sees “rings” around lights; states that he feels a little nauseated

Open-angle glaucoma

61-year-old woman with history of left-sided headaches, left temporal tenderness with swelling, pain in the left side of her jaw when she eats, elevated ESR

Temporal Arteritis

2-year-old boy with a “lazy” left eye; left eye has decreased vision and lacks “red refkex”onexam

Retinoblastoma

34-year-old male carpenter develops a decrease in coordination in his hammer hand (right hand); he wakes in the middle of the night with right hand pain and “pins and needles” in the right thumb/index/middle fingers

Carpal tunnel Syndrome

16-year-old boy with right knee pain and fevers; x-ray reveals a distal femur lesion with “sunburst” pattern with a triangle of elevated periosteum

Osteosarcoma

72-year-old man with history of hypertension | and tobacco abuse presents with 20 minutes of left eye blindness. Left carotid bruit is detected on exam

TIA-amurosis fugax

67-year-old man with hypotension, abdominal pain, and an abdominal mass that pulsates

Ruptured abdominal aortic aneurysm

67-year-old female smoker with a history of 25-pound weight loss over 3 months duetoabdominalpaina after eating; nontender abdomen on exam

Chronic mesenteric ischemia

45-year-old man with long- term left lower leg swelling develops a nonhealing sore over the left medial malleolus

Venous Stasis Ulcer

6-year-old child with finger clubbing and history of cyanosis as an infant develops anxiety/increase in respiratory rate and cyanosis with strenuous exercise that is relieved by “squatting down”

Tetralogy of Fallot

57-year-old man develops confusion and wide swings in heart rate and systolic blood pressure POD #2 after an appendectomyfora perforated appendix; Sats5 99%,HCTstable, electrolytes normal, chest x-ray normal

Alcohol withdrawal

54-year-old woman with | reflux disease and columnar epithelium on distal esophageal biopsy

Barrett's Esophagus

56-year-old alcoholic woman receives D51/2 NS IV bolus in the ER; she develops confusion, ataxia, and inability of gaze laterally

Wernicke’s encephalopathy

POD #1a erbariatric gastric bypass a 34-year-old woman develops fever and crackles on chest auscultation

Atelectais

24-year-old man with ulcerative colitis receives Lomotil for excessive diarrhea and develops fever, abdominal pain and tenderness, and a massively dilated colon on abdominal x-ray

Toxic Megacolon

28-year-old man with nonbloody diarrhea, low-grade fever, abdominal pain, perirectal abscesses, perianal fistulae

Crohn's disease

45-year-old man back from a visit to South America who was exposed to Trypanosoma cruzi now presents with dysphagia

Chagas disease

54-year-old woman with dysphagia (to both liquid and solids) and intermittent chest pain; food “comes up” after fallingasleepat night; manometry reveals high LES pressures that do not decrease with swallowing; absent esophageal peristalsis

Achalasia

28-year-old man with groin mass,vomiting,air-fluid levels on abdominal x-ray

Incarcerated inguinal hernia

19-year-old woman involved in a high-speed MVC and was thrown unrestrained into the windshield; she has a GCS of 15 at the scene and initially upon admission to the ER; she then becomes comatose with a GCS of 3

Epidural hematoma and “lucid interval”

Patient with head trauma and a peripheral “crescent”-shaped hematoma on CT

Subdural hematoma

Patient with head trauma and a peripheral “lenticular” (lens-like) hematoma on CT

Epidural hematoma

21-year-old man involved in high-speed MVC with obvious unstable pelvis, gross blood from the urethral meatus, high-riding prostate on rectal exam

Urethral injury

45-year-old woman involved in high-speed MVC complains of abdominal pain and shortness of breath; decreased breath soundsonthe left ;chest x-ray reveals the NGT tube coiled up in the left chest

Ruptured left diaphragm

56-year-old involved in a high-speed motorcycle collision complains of severe shortness of breath. On exam the left chest wall moves inwards not outwards on inhalation

Flail Chest - "paradoxic respirations"

67-year-old involved in a high-speed MVC presents with a GCS of 5, bilateral periorbital ecchymosis, le mastoid ecchymosis, and clear uid draining form the le ear

Basilar skull fracture—Battle’s and raccoon signs

Femur fracture, dyspnea, mental status changes, tachycardia, petechiae

Fat embolism syndrome

Pain over the anatomic "snuffbox"

Scaphoid/navicular fracture

Pain on passive exion/ extension, arm or leg pain “out of proportion to injury”

Extremity compartment syndrome

34-year-old in the ICU s/p Iaparotomy with fascia closed, decreased urine output, increased peak airway pressure, decreased CVP, normal chest x-ray, normal EKG

Abdominal compartment syndrome

Hypoxia after braininjury without lung injury, no fractures, no DVTs

Neurogenic pulmonary edema

Coagulopathy afer isolated brain injury

Brain thromboplastin

Midline laparotomy wound that drains continuous straw-colored fluid

fascial dehiscence

POD #1 with bright red wound infection

Streptococcus infection

POD #1 with painful wound and weeping bronze-colored fluid

Costridial wound infection

8-year-old boy with a history of claudication when running, epistaxis, decreased left extrimity (LE) pulses, and headaches

Aorctic coarctation

6 year old girl with purpuric rash, abdominal pain, hematuria, and joint pain,

Henoch-Schonlein Purpura

Recurrent pneumonias, infiltrate on chest x0ray, no bronchus leading to area of infiltrate

pulmonary sequestration

29-year-old male smoker with necrotic fingers

Buerger's disease

Skier with fingers that go from white to blue to red

Raynaud's phenomenon

LAP chole POD #3, fever, RUQ fluid collection, no biliary dilation

Biloma(MC caus of cysttic duct leak)

POD #7 following laparoscopic cholecystectomy— jaundice and dilated intrahepatic biliary ducts

Clipping or transection of common bile duct

21-year-oldwomanwith fever, leukocytosis, lower abdominal pain, 1 chandeliersign

PID(pelvic inflammatorydisease)

45-year-old female with CHF, diastolic murmur, atrial fibrillation, atrial hypertrophy

Mitral Stenosis

33-year-old old woman with jaundice, fever, RUQ pain, hypotension, and confusion

Suppurative cholangitis

29-year-old woman with a mass below inguinal ligament

Femoral hernia

43-year-old woman with RUQ pain and right subscapular pain for 2 hours intermittently over 4 months

Biliary colic

19-year-old man in motorcycle crash with knee dislocation and loss of pedal pulses

Thrombosed popliteal artery

34-year-old woman POD #2 gastric bypass with tachycardia and vague abdominal discomfort

Anastomotic leak

Elderly man with shortened and inverted LE

Hip dislocation

28-year-old woman on BCPs with abdominal pain “out of proportion to exam”; SMA open on Doppler

SMV thrombosis

Pregnant 22-year-old woman with LUQ pain and hypotension

Ruptured splenic aneurysm

S/P gastrojejunostomy with postprandial tachycardia, diarrhea, and abdominal pain

Dumping syndrome

27-year-old woman who following menses develops rash, hypotension, and fever

Toxic Shock Syndrome

Claudication, impotence, atrophy of thigh

Leriche syndrome

56-year-old man on IV Heparin with atrial | fibrillation develops thrombocytopenia

Heparin induced thrombocytopenia

56-year-old male alcoholic with new-onset NGT feeds develops hypokalemia, hypophosphatemia, and hypomagnesemia

Refeeding syndrome

39-year-old man with caput medusae, hemorrhoids, and splenomegaly

Portal hypertension

58-year-old male smoker with oat cell cancer of the lung and hyponatremia

SIADH

28-year-old woman s/p total abdominal colectomy and ileostomy now with increased ileostomy output and U waves on EKG

Hypokalemia

51-year-old man with alcoholic cirrhosis has a sodium level of 127. The intern corrects the sodium to 140 in 1 hour with hypertonic saline and reveals neurologic signs and symptoms

Central Pontin demyelinosis