Most Likely Diagnosis

A 65-year-old woman with a seizure disorder controlled with phenytoin presents to your office complaining of muscle cramps, dry skin, and depression. Examination shows carpal-pedal spasms after application of a blood pressure cuff.

Hypocalcemia

A patient diagnosed with sarcoidosis presents with erythema nodosum, hilar adenopathy and migratory polyarthralgia

Lofgren syndrome

A 64-year-old man presents with a headache and cough for the last one week. Physical exam shows facial edema, facial plethora, and prominent venous distention of the chest. History is significant for lung cancer.

Superior vena cava syndrome

Sudden painless vision loss with a cherry red spot seen on fundoscopic exam

central retinal artery occlusion

Pain in elderly that increases with extension (walking downhill and standing upright) and is relieved with flexion at the hips and by leaning forward (sitting, leaning over a shopping cart)

spinal stenosis

A 35-year-old woman with a history of migraines and polycystic kidney disease presents to the Emergency Department with a severe, diffuse headache. The onset was abrupt approximately one hour prior to arrival. Her vital signs are within normal limits. She has photophobia and phonophobia, as well as pain with extraocular movements.

subarachnoid hemorrhage

a 24-year-old sexually active woman complains of a profuse, whitish-gray vaginal discharge with a fishy odor that becomes stronger after intercourse and during menses. She denies any irritation and states that her sexual partner has no symptoms. Microscopic evaluation of the discharge reveals granular-appearing epithelial cells.

Bacterial vaginosis

A 46-year-old woman without significant past medical history presents with drooping of the left side of her face which she noticed this morning when she looked into the mirror. She is unable to completely close her left eye and cannot raise her eyebrows on the left side. Her vision is intact. When asked to puff out her cheeks, air leaks out the left side. The rest of her neurologic exam is normal.

Bell's Palsy

A 58-year-old man presents to your office 4 weeks after being hospitalized for MI. He is complaining of chest pain, fever, and multiple joint pain. Laboratory tests do not show an increase in cardiac enzymes.

Dressler's Syndrome

MC cause of hypothyroidism in the US

Hashimoto's thyroiditis aka auto-immune mediated attack of thyroid tissue

A 15-year-old girl presents with generalized abdominopelvic pain that occurs every month after her regular, nonpainful menses. The pain, which is associated with headaches, bloating, and depressed mood, begins 18 days after the last day of menstruation. She also complains of cyclic ankle swelling but denies a history of increased salt intake.

PMS

A 45-year-old man with a past medical history significant for obesity, status post partial gastrectomy, returns to the clinic following a recent barium swallow study for complaints of abdominal pressure and fullness. Results from the study show displacement of the gastroesophageal junction and herniation of a portion of the gastric fundus into the thoracic cavity.

Paraesophageal hiatal hernia

A 60-year-old woman presents to clinic with complaints of right hand tremor that began 4 months ago. The patient reports the tremor improves with purposeful movements of the hand. She also reports difficulty double clicking a computer mouse and loss of sense of smell. On physical exam, a resting tremor of the right hand is observed. The patient demonstrates a shuffling gait. The patient shows increased resistance with passive range of motion of the right upper extremity compared to the left.

Parkinson's Disease

A full term male infant is delivered by cesarean section because of dystocia due to macrosomia. Apgar scores are 8 and 10. An hour after delivery he begins to have tachypnea without hypoxemia. A chest radiograph shows diffuse parenchymal infiltrates and fluid in the pulmonary fissures. The symptoms resolve without treatment within 24 hours

Transient tachypnea of the newborn

A 64 year-old woman complains of headache and left eye pain for about a day. She says it started yesterday as a dull ache and now is throbbing. She also complains of nausea and vomiting, which she attributes to the popcorn she ate at the movie theater yesterday afternoon. On exam, the left pupil is mid-dilated and nonreactive. The cornea is hazy. A ciliary flush is noted.

acute angle closure glaucoma

You are called to the nursery to see a male infant, born by uncomplicated vaginal delivery. He weighs 2,600 grams and has one deep crease on the anterior third of each foot. Respirations are 88 breaths/minute with expiratory grunting and intercostals retractions. He is cyanotic on room air and becomes pink when placed in 60% oxygen. Chest x-ray shows atelectasis with air bronchograms.

hyaline membrane disease

a 22-year-old nulligravida presents with pelvic pain and irregular menstrual bleeding. She denies sexual activity, and her β-hCG urine test is negative. She has never been on oral contraceptives. On pelvic examination, unilateral tenderness on the left side and a palpable cystic mass approximately 4 to 5 cm in size are present.

ovarian cyst

A 55-year-old woman presents with right finger pain. She reports she habitually bites her nails. On examination, the lateral nail fold and cuticle of the right ring finger is erythematous, fluctuant and tender to palpation.

paronychia

A 35-year-old hair stylist presents to her physician for ongoing heel pain that is exacerbated by standing on her feet all day at work. She complains that the pain is worse in the morning upon getting out of bed but subsides within 30-45 minutes. On physical exam, pain is elicited by dorsiflexion of the toes. Which of the following is the most likely diagnosis?

plantar fasciitis

A 17-year-old boy presents to the emergency department after being tackled while playing football. He is unable to bear weight on his left ankle. On physical exam, he is tender to palpation over the anterior tibiofibular ligament. Dorsiflexing while externally rotating the ankle reproduces his pain. Plain radiographs reveals a diastasis between the distal tibia and fibula, but no fractures.

syndesmotic ankle sprain

a 39-year-old man presents with difficulty grasping his golf club. The patient reports difficulty with maintaining a strong grip in various situations. This symptom is accompanied by numbness and tingling. On physical exam, there is atrophy of his intrinsic hand muscles.

thoracic outlet syndrome

A previously healthy 27-year-old man presents to your office with a complaint of cold symptoms. He says that initially he had sinus congestion and a sore throat, which have since resolved, but he has also had a productive cough for approximately 10 days that is keeping him up at night. Physical exam reveals a temperature of 98.6°F and mild, diffuse wheezing on auscultation of the lungs.

Acute bronchitis

a 43-year-old man who comes to the emergency department because of a 3-week history of episodic cutaneous flushing, diarrhea, and wheezing. He has a past medical history of hypertension and type 2 diabetes mellitus. His temperature is 36.6°C (97.9°F), pulse is 125/min, respirations are 30/min, and blood pressure is 90/60 mm Hg. Pulmonary examination shows diffuse wheezes in both lung fields. Abdominal examination shows hyperactive bowel sounds.

Carcinoid tumor

a 65-year-old patient with shaking that occurs with simple tasks such as tying his shoelaces, writing, or shaving. According to his wife, the symptoms are aggravated by stress, fatigue, caffeine, and changes in temperature. The patient reports his dad had the same symptoms. On physical examination, there is a 4-10 Hz tremor elicited when both of his arms are outstretched forward. There is no tremor at rest.

Essential Tremor

a 67-year-old female with a severe throbbing headache and visual impairment in the left eye. The patient describes worsening of pain with chewing or combing her hair. Lately, she reports feeling very weak and tired especially in the mornings. At times she cannot even raise her arms to reach the cabinets in her kitchen. On physical exam, she has decreased visual acuity of the left eye, scalp tenderness on the left, and an absent pulse in the left temporal area.

Giant cell (temporal) arteritis

A 41-year-old G3P1011 woman, who is 12 weeks pregnant, presents to the ED with a chief complaint of vaginal bleeding with passage of clots. She also complains of one week of back and pelvic pain and cramping for which she is taking ibuprofen. A pelvic exam demonstrates an open cervical os. Transvaginal ultrasound reveals particles of conception within the cervical canal.

Incomplete abortion

A 20 year-old male presents with a mass in the groin. On examination with the patient standing, a mass is noted that extends into the scrotum. The patient denies any trauma. The most likely diagnosis is?

Indirect inguinal hernia

A 27-gestational-week-old infant is delivered in the emergency department. The neonate is cyanotic, tachypneic, and shows chest wall retractions. An emergent chest radiograph reveals a diffuse ground-glass appearance. Meconium aspiration is not suspected.

Infant respiratory distress syndrome

A red, swollen, warm, itchy breast often with nipple retraction and peu d'orange

Inflammatory breast CA

A 68-year-old male smoker with a history of peripheral vascular disease and a below the knee amputation presents to the emergency room with excruciating abdominal pain and vomiting for the last 6 hours. Vital signs are T 101.0 F HR 136 BP 150/96 RR 18 Sat 93% on room air. The abdominal exam shows a non-distended, exquisitely tender abdomen which the patient refuses to allow you to examine. While assessing peripheral pulses you note that they are irregular. A digital rectal exam is Guiac positive. Laboratory values are notable for a leukocytosis and a lactic acid of 6.8 mmol/L. An ECG is shown here. What is the next best step in diagnosis?

Mesenteric ischemia

A 15 year-old male was seen last week with complaints of sore throat, headache, and mild cough. A diagnosis of URI was made and supportive treatment was initiated. He returns today with complaints of worsening cough and increasing fatigue. At this time, chest x-ray reveals bilateral hilar infiltrates. A WBC count is normal and a cold hemagglutinin titer is elevated.

Mycoplasma pneumoniae

a 49-year-old computer programmer with right elbow swelling for the past few months. The swelling has worsened and became more painful over the last week. He works 12 hours a day and spends a lot of time at his desk keyboarding and working with his mouse. On examination, he has no fever. There is a red and tender swelling of the left posterior elbow.

Olecranon bursitis

a 63-year-old male complaining of bilateral leg pain, which has been increasing gradually over the past several months. It worsens when he walks but improves with rest. Past medical and surgical history is significant for hypertension, hyperlipidemia, and coronary artery bypass graft (5 years ago). He has a 60-pack-year smoking history. Physical exam of the lower extremities reveals palpable but weak posterior tibial and dorsalis pedis pulses bilaterally

Peripheral arterial disease

A 20-year-old man presents to the clinic with dyspnea and chest pain that began spontaneously six hours ago while playing basketball. He has never smoked, takes no medications, and has no family history of cardiovascular or pulmonary diseases. His vital signs are as follows: heart rate 112 beats per minute, respiratory rate 24 breaths per minute, blood pressure 114/68 mm Hg. He is six feet tall and weighs 165 pounds. On physical exam, the left upper lung field has diminished breath sounds and is hyperresonant to percussion.

Pneumothorax

A 24-year-old woman presents to the clinic complaining of chest pain. Review of systems is positive for a chronic nonproductive cough, chest pain, fatigue, and weight loss. She denies any history of tobacco use. A chest radiograph reveals bilateral hilar adenopathy with symmetric enlargement of the hila

Sarcoidosis

describe both the serum and urine osmolality in a patient with diabetes insipidus

Serum osmolality is high (unable to stop the secretion of water into the kidneys so blood becomes more concentrated) and urine osmolality is low because it is so dilute

A 73-year-old man presents with vomiting and abdominal pain for 2 days. The patient has a remote history of cholecystectomy and appendectomy. Examination reveals a markedly distended abdomen and absent bowel sounds. Lab studies show an elevated WBC count and lactate of 4.3 mmol/L

Small Bowel Obstruction

A 46-year-old man presents to the emergency department reporting abdominal pain, bloating, nausea, anorexia, and vomiting. His symptoms have been worsening since onset three days ago. His last bowel movement was four days ago, but he continues to pass flatus.

Small bowel obstruction

Non-pulsatile, bilateral headache in a band-like distribution. Often occurring at work. Associated with neck muscle tenderness

Tension Headache

An 18-year-old man is brought into the emergency room for evaluation after being the restrained passenger in a motor vehicle collision. He is alert and complains of severe right lower extremity pain. He was unable to bear weight on the extremity at the scene. On exam, there is presence of a transverse groove at the medial knee joint line. The extremity is pale and cold. Popliteal pulses are not palpable in the right lower extremity and 2 in the left lower extremity.

Tibiofemoral dislocation

a 23-year-old G1P0 at 20 weeks gestation presents for a routine obstetric visit and complains of vaginal discharge for one week. She describes the discharge as watery and yellow, and she has had an associated burning sensation on urination. Her pregnancy has been uncomplicated. She denies new sexual partners or previous history of sexually transmitted diseases. On pelvic exam, there is a foul odor. You note red punctate lesions and inflammation of her cervix.

Trichomoniasis

A 28-year-old woman presents with intense pain, tearing, and ocular foreign body sensation in both eyes that began yesterday. She denies any trauma, past medical problems, or contact lens use and reports that she works as ski patrol for a local resort. Her physical examination is significant for bilateral decreased visual acuity, injected conjunctiva, and diffuse punctuate corneal lesions with a discrete superior border. Her pupils are equal, round, and reactive to light.

Ultraviolet keratitis

A 15 year-old male presents with a 1 week history of hacking non-productive cough, low grade fever, malaise and myalgias. Examination is unremarkable except for a few scattered rhonchi and rales upon auscultation of the chest. The chest x-ray reveals interstitial infiltrates and a cold agglutinin titer was negative.

Viral pneumonia

The parents of a 16 year-old male presents to the clinic with their son asking that you examine him. Over the past 9-12 months he has developed behavioral problems and emotional lability. Physical examination reveals a well-developed male who is cooperative with exam but tends to be easily distracted. It is noteworthy for dysarthria, a resting tremor and the presence of gray-green pigmentation surrounding each pupil. The most likely diagnosis is

Wilson's Disease

What diagnosis should be expected in a patient with recurrent diarrhea and peptic ulcer disease that is refractory to adequate standard therapy

Zollinger-Ellison Syndrome