Yr 1 Diagnoses/Medications

A 30-year-old man presents with fever and sore throat of 2 days' duration. He reports several months of increasing fatigue and exertional dyspnoea, as well as easy bruising. Examination reveals tachycardia, evidence of tonsillopharyngitis, and scattered ecchymoses. (4 differentials)

1 - Aplastic anaemia 2 - Myelodysplastic syndrome 3 - Myelofibrosis 4 - Leukemia

A 74 year old man presents to his GP complaining of feeling increasingly dizzy and short of breath when he exerts himself. On auscultation of his heart, a crescendo-decrescendo murmur is heard in the right second intercostal space, with radiation to the carotids. (top differential)

1 - Aortic stenosis

A 50-year-old man presents to his primary care physician for a routine physical examination. He is asymptomatic at the time of the visit and the physical examination is normal. Routine baseline bloods showed elevated WBC and platelet counts. (4 differentials)

1 - Chronic myeloid leukemia 2 - Essential thrombocytosis 3 - Polycythemia vera 4 - Myelofibrosis

An 18-month-old boy presents with left ankle swelling and pain. He has limited range of motion at the ankle and has difficulty walking. Over the last year, he has presented with significant haematomas at immunisation sites. He also had prolonged bleeding after heel prick for neonatal screening tests. (4 differentials)

1 - Haemophilia 2 - Acute myeloblastic leukemia 3 - Von Willebrands Disease 4 - Rheumatioid Arthritis

Ramipril, Perindopril

ACE-Inhibitors -> Blocking the ACE enzyme = decrease conversion of angiotensin I into angiotensin II = decrease angiotensin II = decrease vasoconstriction + decrease Na+/water reabsorption = decrease blood volume = decrease BP

A 59-year-old man presents to the accident and emergency department with a sudden onset of excruciating chest pain, which he describes as tearing. He has a history of hypertension. On physical examination, his heart rate is 95 beats per minute. Blood pressure is 195/90 mmHg in the right arm and 160/80 mmHg in the left arm. Pulses are absent in the right leg and diminished in the left. (4 differentials)

1 - Aortic dissection 2 - Unstable angina 3 - Pericarditis 4 - Congestive Heart Failure

A 55-year-old white man presents with weakness, palpitations, and dyspnoea on exertion. On physical examination, his blood pressure is 148/50 mmHg with a bounding pulse and an early diastolic murmur over the left sternal border. He denies any history of drug abuse, rheumatic fever, or connective tissue disorder. The patient is taking hydrochlorothiazide for high blood pressure.

1 - Aortic regurgitation 2 - Mitral stenosis 3 - Atrial fibrillation 4 - Supra-ventricular tachycardia

A 34-year-old woman with no known underlying lung disease has had a 12-day history of cough that has become productive of sputum. Initially she was not short of breath, but now she becomes short of breath with exertion. She initially had nasal congestion and a mild sore throat, but now her symptoms are all related to a productive cough without paroxysms. She denies any sick contacts. On physical examination she is not in respiratory distress and is afebrile with normal vital signs. No signs of upper respiratory tract infection are noted. Scattered wheezes are present diffusely on lung auscultation. (4 differentials)

1 - Acute bronchitis 2 - LRTI 3 - COVID-19 4 - Pneumonia

A 69-year-old man develops worsening substernal chest pressure after shovelling snow in the morning before work. He tells his wife he feels a squeezing pain that is radiating to his jaw and left shoulder. He appears anxious and his wife calls for an ambulance, as he is distressed and sweating profusely. Past medical history is significant for hypertension and he has been told by his doctor that he has borderline diabetes. On examination in the accident and emergency department he is very anxious and diaphoretic. His heart rate is 112 bpm and blood pressure is 159/93 mmHg. (4 differentials)

1 - Acute coronary syndrome (NSTEMI/STEMI/Unstable Angina) 2 - Stress Caridomyopathy (severe stress event) 2 - Aortic dissection (radiate to back, sharp/tearing quality) 3 - Acute pericarditis (relieved sitting forward, sharp, pleuritic)

A 38-year-old man presents to his primary care physician complaining of generalised weakness, epistaxis, mouth ulcers, and weight loss. He has unremarkable past medical history and takes no medications. Physical examination reveals mild pallor and petechial haemorrhages over his lower limbs. He has multiple widespread small lymph nodes that are palpable, and mild splenomegaly. (4 differentials)

1 - Acute lymphocytic leukemia 2 - Myelodysplastic syndrome 3 - Myelofibrosis 4 - Lymphoma

A 54-year-old man presents to his primary care physician with a 2-month history of fever, malaise, and weight loss. He also reports frequent epistaxis, abdominal fullness, and early satiety. On examination, he is found to have splenomegaly. (4 differentials)

1 - Chronic myeloid leukemia 2 - Chronic lymphocytic leukemia 3 - Acute myeloblastic leukemia 4 - TB

An 8-year-old boy presents with intermittent wheeze and cough. Over recent months he has had problems with night-time wheeze and shortness of breath. He is waking at least 3 or 4 nights per week since recovering from an upper respiratory tract infection. He has also noted more problems with wheeze and shortness of breath on minimal playing at school. (4 differentials)

1 - Asthma 2 - Cystic fibrosis 3 - Bronchiolitis/Bronchiectasis 4 - Aspiration

A 52-year-old woman presents with gradually increasing dyspnoea on exertion over the past 2 years. Recently she has required 2 pillows at night to alleviate recumbent dyspnoea. On examination, she has an apical diastolic murmur.

1 - Mitral stenosis 2 - Aortic regurgitation 3 - Congestive heart failure (other cause) 4 - Obstructive sleep apnoea

A 77-year-old man presents with complaints of palpitations and new shortness of breath, especially with exertion. He has a history of rheumatic fever in childhood. He has been told he has a murmur but does not recall having had an echocardiogram. He is otherwise healthy. (4 differentials)

1 - Atrial flutter 2 - Atrial fibrillation 3 - Rheumatic heart disease 4 - Stable angina

A patient presents with shortness of breath. She has marked dullness to percussion in the right lower chest posteriorly. On auscultation, she has decreased breath sounds and decreased vocal resonance over the same area. (2 differentials)

1 - Pleural effusion 2 - Pneumonia

A 70-year-old woman is 2 days post-operative for knee replacement surgery. Her past medical history includes type 2 diabetes and a 40 pack-year history of smoking. She reports feeling suddenly unwell with dizziness, nausea, and vomiting. She denies any chest pain. On examination she is hypotensive and diaphoretic. (4 differentials)

1 - ACS 2 - Pulmonary embolism 3 - Atrial fibrillation 4 - Pericarditis

An 8-month-old boy of Mediterranean origin presents with pallor and abdominal distension, both of which are progressive. The perinatal history was uneventful, and the boy is noted to be pale, with poor feeding, decreased activity, and failure to thrive. Hepatosplenomegaly and mild bony abnormalities of the skull are noted (frontal and parietal bossing). (3 differentials)

1 - Beta Thalassemia anaemia 2 - Acute lymphocytic leukemia 3 - Sickle cell anaemia

A 54-year-old man with a medical history of hypertension, diabetes, dyslipidaemia, smoking, and family history of premature coronary artery disease presents with retrosternal crushing chest pain (10/10 in intensity), radiating down the left arm and left side of the neck. He feels nauseated and light-headed and is short of breath. Examination reveals hypotension, diaphoresis, and considerable discomfort with diffuse bilateral crackles on chest auscultation. (4 differentials)

1 - ACS 2 - Unstable angina 3 - Stress cardiomyopathy 4 - Aortic dissection

A 62-year-old man presents to his primary care physician for an annual physical. He denies any complaints such as fever or chills, weight loss, or fatigue. Of note, his blood tests show an elevated WBC count. The WBCs are predominantly lymphocytes, with a differential of 80% lymphocytes and an absolute lymphocyte count of 75 x 10⁹/L (75 x 10³/microlitre). (4 differentials)

1 - Chronic lymphocytic leukemia 2 - Chronic myeloid leukemia 3 - Viral infection 4 - Viral pneumonia

A 72-year-old man with a history of cigarette smoking presents with mild shortness of breath. Pulmonary function tests are performed and show restriction rather than obstruction, along with impaired diffusing capacity for carbon monoxide. A follow-up chest radiograph shows prominent bi-basilar interstitial markings. (4 differentials)

1 - Idiopathic Pulmonary Fibrosis 2 - Pneumoconiosis 3 - Sarcoidiosis 4 - Interstitial lung disease by other cause

Rosuvastatin, atorvastatin

Statin -> 1: Competitive inhibitors of HMG CoA reductase = decrease synthesis of cholesterol 2: Up-regulate LDL receptors = decrease LDL in blood 3: Increase HDL secretion

A 5-year-old girl presents to the emergency department with a 2-day history of coryza and cough with intermittent low-grade fever. She developed an audible wheeze and respiratory distress that was initially responsive to salbutamol via a pressurised metered-dose inhaler and small-volume spacer. However, symptoms have recurred within 2 hours of salbutamol administration. The patient has had a number of episodes of wheeze and dyspnoea over a 2-year period; these were more common during the winter months. She required prednisolone on 2 occasions to treat severe wheeze. On examination she is in visible respiratory distress with a respiratory rate of 40 breaths/minute and has accompanying accessory muscle use. Her oxygen saturations are 92% in room air, and on auscultation of her chest there is widespread polyphonic wheeze and equal air entry. She has an audible moist cough. (4 differentials)

1 - Acute asthma exacerbation 2 - Pneumonia (ARDS) 3 - COVID-19 4 - Bronchiectasis

A 25-year-old woman presents with shortness of breath. She reported that in secondary school, she occasionally had shortness of breath and would wheeze after running. She experiences the same symptoms when she visits her friend who has a cat. Her symptoms have progressively worsened over the past year and are now a constant occurrence. She also finds herself wheezing when waking from sleep approximately twice a week. (4 differentials)

1 - Asthma 2 - Cystic fibrosis 3 - Bronchiectasis 4 - COPD (Alpha1 - trypsin deficiency)

A 56-year-old woman presents with a painless right neck lump that has been slowly enlarging for the last 2 years. She denies fevers, night sweats, or weight loss. Physical examination reveals bilateral cervical and axillary adenopathy and a palpable spleen. (4 differentials)

1 - Lymphoma 2 - Chronic lymphocytic leukemia 3 - Multiple myeloma 4 - Myelodysplastic syndrome

A 52-year-old woman with a history of rheumatoid arthritis reports gradual worsening of symptoms over the past 2 months with fatigue, malaise, and increased stiffness of the wrists and joints of the hands. Physical examination is significant for warmth, tenderness, and synovial thickening in wrists, metacarpophalangeal joints, and proximal interphalangeal joints bilaterally. She takes non-steroidal anti-inflammatory drugs as needed. (4 differentials)

1 - Anaemia (chronic disease) 2 - Rheumatic fever 3 - Anaemia (normocytic) 4 - Anaemia (macrocytic)

A 78-year-old man presents to his primary care physician with 2 months of progressive shortness of breath on exertion. He first recognised having to catch his breath while gardening and is now unable to walk up the stairs in his house without stopping. Previously he was healthy and active. On physical examination there is a loud systolic murmur at the right upper sternal border radiating to the carotid vessels. (4 differentials)

1 - Aortic stenosis 2 - Mitral regurgitation 3 - Anaemia 4 - Stable angina

A 55-year-old manpresents to the emergency department with chest pain. The pain is described as quite severe, and rates it as a 7 out of 10. The pain came on suddenly after dinner, whilst he was sitting on the couch watching television. He denies ever having a pain like this before. The pain has now been present about 30 minutes, and has not changed much despite him taking some antacid tablets. When asked about any additional symptoms, he states that he is also feeling quite short of breath, and is a little sweaty. Past medical history of hypertension and hypercholesterolemia. Has a 43 pack year smoking history. Father diagnosed with heart failure and COPD and mother diagnosed with hypertension (4 differentials)

1 - ACS 2 - Pneumothorax 3 - Pulmonary embolism 4 - Pneumonia

A 4-year-old girl presents with lethargy, dyspnoea, fever, and bruising. On examination she has hepatosplenomegaly. Chest x-ray shows a mediastinal mass and pleural effusion. (4 differentials)

1 - Acute lymphocytic leukemia 2 - Myelodysplastic syndrome 3 - Myelofibrosis 4 - Pleural effusion (exudative cause)

A 58-year-old man presents to his primary care physician with increasing tiredness, accompanied by bruising on his legs. He also complains of aching bones. He has no previous illnesses. On examination, he is pyrexial and pale, has bony tenderness over the sternum and tibia, and has petechiae on his legs. There are no palpable lymph nodes. He has crepitations at the left base. The liver and spleen are not palpable. (4 differentials)

1 - Acute myeloblastic leukemia 2 - Chronic myeloid leukemia 3 - Myelodysplastic syndrome 4 - Myelofibrosis

A 60-year-old man develops shortness of breath while he is in hospital recovering from a recent myocardial infarction. He is unable to lie flat without significant discomfort, has marked laboured breathing, and has a respiratory rate of 36 breaths per minute. Auscultation of the chest reveals diffuse rales. During examination, breathing becomes more rapid and shallow and the patient slowly loses consciousness. (4 differentials)

1 - Acute respiratory failure 2 - Pneumonia (ARDS) 3 - Hyperventilation secondary to metabolic acidosis 4 - Hyperventilation secondary to anxiety

A 3-year-old girl presents with a history of episodes of wheeze and troublesome cough over the past 2 years. These episodes are more common through the winter months. In the past 6 months she has had monthly episodes of wheezing with shortness of breath. Between these episodes she is well, although her mother has noted some wheeze after vigorous playing. Her father has asthma and the child herself has eczema. (4 differentials)

1 - Asthma 2 - Cystic fibrosis 3 - Bronchiolitis/Bronchiectasis 4 - COPD (Alpha1-trypsin deficiency)

An 11-year-old girl presents to the emergency department with a 12-hour history of a troublesome cough followed by wheezing and increasing breathlessness unresponsive to inhaled salbutamol. On examination she is extremely distressed. She appears slightly cyanosed on air, and pulse oximetry shows an oxygen saturation of 84%. She has marked use of accessory muscles and is unable to speak in sentences but can say single words. She has marked pulsus paradoxus on palpation. On auscultation of the chest, there is widespread expiratory wheeze but equal air entry. (4 differentials)

1 - Asthma exacerbation 2 - T1RF 3 - Pneumonia (ARDS) 4 - COVID-19

A 27-year-old woman presents to the emergency department with progressive worsening of shortness of breath, wheezing, and cough over 3 days. She reports prior exposure to a person who had a runny nose and a hacking cough. She did not receive significant relief from her reliever inhaler, with worsening symptoms, despite increased use. Her cough is disrupting her sleep pattern and as a consequence she is experiencing daytime somnolence, which is affecting her job performance. (4 differentials)

1 - Asthma exacerbation 2 - Pneumonia (ARDS) 3 - COPD exacerbation 4 - Heart failure

A 56-year-old woman with a 6-week history of weight loss, anxiety, and insomnia presents with palpitation and dyspnoea. Her pulse rate is irregular at 140 to 150 bpm. Her BP is 95/55 mmHg. She looks thin, frail, and rather anxious and jittery. Her palms are sweaty and have fine tremors. She has a palpable smooth goitre. Examination of the eyes shows bilateral exophthalmoses. (4 differentials)

1 - Atrial fibrillation 2 - Hyperthyroidism 3 - Supraventricular tachycardia 4 - Stress cardiomyopathy

A 65-year-old man with a history of hypertension, diabetes mellitus, and hyperlipidaemia presents to the accident and emergency department with the first episode of rapid palpitations, shortness of breath, and discomfort in his chest. His symptoms came on suddenly 4 hours ago. Physical examination shows an irregularly irregular radial pulse rate at 90 to 110 bpm, a BP of 110/70 mmHg, and respiratory rate of 20 breaths per minute. Heart sounds are irregular, but no S3 or S4 gallop or murmurs are audible. There are no other abnormalities on examination. (4 differentials)

1 - Atrial fibrillation 2 - Supraventricular tachycardia 3 - Acute coronary syndrome 4 - Hyperthyroidism

A 70-year-old woman with a history of hypertension, diabetes mellitus, hyperlipidaemia, and prior myocardial infarction presents to the emergency department with palpitations and shortness of breath. These symptoms started 2 days ago. She was diagnosed to have AF with rapid ventricular rate response a year and a half ago, at which time an attempted direct current cardioversion and a trial of sotalol to maintain sinus rhythm and prevent further episodes of AF were unsuccessful. The patient was treated with digoxin and metoprolol to control rate and warfarin to prevent stroke. Current physical examination shows that she is febrile and has an irregularly irregular radial pulse at a rate between 90 and 110 beats per minute, blood pressure 100/70 mmHg, and respiratory rate of 26 breaths per minute. Heart sounds are irregular, but no third or fourth heart sound gallop or murmurs are audible. The breath sounds are of bronchial character associated with crepitations over the left basal lung area. (4 differentials)

1 - Atrial fibrillation 2 - Supraventricular tachycardia (atrial flutter) 3 - Acute coronary syndrome 4 - Hyperthyroidism

A 7-year-old boy is brought for review by his parents who are concerned about a persistent, wet cough that is affecting his sleep. His teachers report that he is tired during the school day. Since starting childcare aged 1 year old, he has experienced recurrent lower respiratory tract infections, which have resulted in several hospital admissions. His history is notable for preterm birth at 34 weeks. On examination a wheeze is present. (4 differentials)

1 - Bronchiectasis 2 - Asthma 3 - LRTI 4 - Pneumonia

A 55-year-old woman presents for evaluation of a chronic cough, productive of thick, yellow sputum that sometimes becomes blood-tinged. She has experienced recurrent episodes of fever associated with pleuritic chest pain. She states that she is embarrassed by the persistent, intractable nature of her cough and has been prescribed multiple courses of antibiotics. Over the last 5 years, she has developed shortness of breath with exertion. Her past medical history is significant for pneumonia as a child and sinus polyps during adulthood for which she has had surgery. (4 differentials)

1 - Bronchiectasis 2 - Pneumonia 3 - COPD 4 - LRTI

A 62 year old patient is complaining of difficulty breathing. During your examination you find a barrel-shaped chest and noticed that the patient tends to exhale by pursing his lips and actively expelling air from his lungs by muscular exertion during a prolonged expiration. X-ray films show no dark spots or lesions on the lungs. (two differentials)

1 - COPD 2 - Bronchiectasis

A 66-year-old man with a smoking history of one pack per day for the past 47 years presents with progressive shortness of breath and chronic cough, productive of yellowish sputum, for the past 2 years. On examination he appears cachectic and in moderate respiratory distress, especially after walking to the examination room, and has pursed-lip breathing. His neck veins are mildly distended. Lung examination reveals a barrel chest and poor air entry bilaterally, with moderate inspiratory and expiratory wheezing. Heart and abdominal examination are within normal limits. Lower extremities exhibit scant pitting oedema. (4 differentials)

1 - COPD 2 - Congestive Heart Failure 3 - Bronchiectasis 4 - Pneumonia

A 56-year-old woman with a history of smoking presents to her primary care physician with shortness of breath and cough for several days. Her symptoms began 3 days ago with rhinorrhoea. She reports a chronic morning cough productive of white sputum, which has increased over the past 2 days. She has had similar episodes each winter for the past 4 years. She has smoked 1 to 2 packs of cigarettes per day for 40 years and continues to smoke. She denies haemoptysis, chills, or weight loss and has not received any relief from over-the-counter cough preparations. (4 differentials)

1 - COPD 2 - Pneumonia 3 - COVID-19 4 - Asthma

A 67-year-old presents with 3 days of worsening dyspnoea and increased frequency of coughing. Her cough is now productive of green, purulent sputum. The patient has a 100-pack-year history of smoking. She has had intermittent, low-grade fever of 37.7°C (100°F) for the past 3 days and her appetite is poor. She has required increased use of rescue bronchodilator therapy in addition to her maintenance medications to control symptoms. (4 differentials)

1 - COPD 2 - Pneumonia 3 - COVID-19 4 - Bronchiectasis

A 26-year-old woman presents at her local infectious disease testing clinic with symptoms of a sore throat and loss of taste. She denies having a fever. (4 differentials)

1 - COVID-19 2 - Common cold 3 - Other URTI (viral cause) 4 - Pneumonia (viral cause)

A 61-year-old man presents to hospital with fever, dry cough, and difficulty breathing. He also reports feeling very tired and unwell. He has a history of hypertension, which is controlled with enalapril. On examination, his pulse is 120 bpm, his temperature is 38.7°C (101.6°F), and his oxygen saturation is 88%. He appears acutely ill. He is admitted to hospital in an isolation room and is started on oxygen, intravenous fluids, and venous thromboembolism prophylaxis. Blood and sputum cultures are ordered. Chest x-ray shows bilateral lung infiltrates, and computed tomography of the chest reveals multiple bilateral lobular and subsegmental areas of ground-glass opacity. (4 differentials)

1 - COVID-19 (ARDS) 2 - Pneumonia (ARDS/Non-covid) 3 - Type 1 respiratory failure 4 - Interstitial lung disease

A 65-year-old man without medical history presents with decreased exercise tolerance and progressive dyspnoea at rest, beginning 3 days before presentation. He does not recall any recent illness, denies recent travel or illicit habits, and takes no medicines. Over the past 24 hours he has also noted bilateral ankle oedema. He is in mild distress, with a jugular venous pressure (JVP) of 13 cm and distant heart sounds. His lungs are clear and 1+ pedal oedema is noted. His blood pressure is 120/80 mmHg and there is a pulsus paradoxus, which is <10 mmHg. (4 differentials)

1 - Cardiac Tamponade 2 - Congestive Heart Failure 3 - Pulmonary Embolism 4 - ACS

A 65-year-old man presents with insomnia and frequent awakenings at night. Two years ago he was diagnosed with coronary artery disease and had ischaemic cardiomyopathy. He has had three hospitalisations for decompensated congestive heart failure (CHF) in the past year and he is now in atrial fibrillation. He reports intermittent orthopnoea and occasional paroxysmal nocturnal dyspnoea. On further questioning he states that he frequently falls asleep during the day if he is not active. After his nocturnal awakenings, he has difficulties getting back to sleep. He had a near-miss car accident 2 weeks ago because he fell asleep while driving. His wife reports that his breathing at night has changed. She notes some periods when he stops breathing and others when his breathing is rapid and deep, and at times accompanied by snoring. (3 differentials)

1 - Central sleep apnoea 2 - Obstructive sleep apnoea 3 - Congestive heart failure

A 60-year-old man presents with swollen lymph nodes in the cervical and inguinal region that have been present for 2 months and are gradually increasing in size. The lymphadenopathy is painless and has not responded to a course of antibiotics prescribed by the primary care physician. The patient denies any recent history of infection, fever, or chills. A blood test shows an elevated WBC count. The WBCs are predominantly lymphocytes, with a differential of 88% lymphocytes and an absolute lymphocyte count of 80 x 10⁹/L (80 x 10³/microlitre). (4 differentials)

1 - Chronic lymphocytic leukemia 2 - Chronic myeloid leukemia 3 - Viral infection 3 - Viral pneumonia

A 70-year-old woman describes increasing exertional dyspnoea for the last 2 days and now has dyspnoea at rest. She has a history of hypertension for the last 5 years and a 35 pack-year smoking history, but no other established illnesses. Current medications are a diuretic daily for the last 3 years. She has been prescribed an ACE inhibitor but failed to collect the prescription. On examination her BP is 190/90 mmHg, and her heart rate is 104 bpm. There is an audible S4 and the jugular venous pressure is elevated 2 cm above normal. Lung examination reveals fine bibasal crepitations. (4 differentials)

1 - Congestive Heart Failure 2 - Unstable angina 3 - Acute respiratory distress syndrome (cor pulmonale) 4 - Restrictive lung disease (interstitial)

A 56-year-old woman presents to the emergency department with shortness of breath at rest, orthopnoea, and paroxysmal nocturnal dyspnoea that developed in the last 5 days. Her past medical history includes obesity, hypertension, diabetes mellitus, and chronic kidney disease stage II. She had a cardiac catheterisation done 2 years ago due to exertional chest pain that revealed non-obstructive coronary artery disease. On examination she is tachycardic with a heart rate of 110 bpm and her blood pressure is 192/98 mmHg. She has jugular venous distension up to her jaws, trace lower extremity oedema, and bi-basal crackles. She has a normal S1 and S2, but has a summation gallop with no murmurs. (4 differentials)

1 - Congestive heart failure 2 - Acute coronary syndrome 3 - Acute respiratory distress syndrome 4 - Pulmonary embolism

A 67-year-old woman presents to her primary care physician complaining of increasing shortness of breath, especially when trying to sleep. She has a history of poorly controlled hypertension and hyperlipidaemia, and is being treated with a beta-blocker and statin therapy. She does not smoke and drinks alcohol in moderation. On examination, her blood pressure is 160/90 mmHg and heart rate is 126 beats per minute. There is an audible S4 and the jugular venous pressure is elevated 3 cm above normal. There is no oedema, but she has fine bilateral mid to lower zone crepitation on lung examination. (4 differentials)

1 - Congestive heart failure 2 - Acute coronary syndrome 3 - Obstructive sleep apnoea 4 - Pleural effusion from other aetiology

A 76-year-old man presents with progressive symptoms of dyspnoea and increasing peripheral oedema. He denies palpitations. He has a history of congestive heart failure from hypertensive heart disease. He reports that he is taking his medications as directed and has had no recent medication or dietary changes. (4 differentials)

1 - Congestive heart failure 2 - Obstructive lung disease (COPD/Asthma) 3 - Restrictive lung disease 4 - Anaemia

A 67-year-old retired construction worker has shortness of breath with activity that has been gradually getting worse, and a chronic cough. He denies chest pain. He has a 45-pack-year smoking history, but stopped smoking aged 50 years. There is no family history of lung disease. He does not take any respiratory medicine on a regular basis. With colds he has noticed wheezing and his doctor once prescribed an inhaler. (4 differentials)

1 - Pneumoconiosis 2 - COPD 3 - Idipoathic Pulmonary Fibrosis 4 - Sarcoidosis

A 76-year-old woman presents to the outpatient clinic with a complaint of shortness of breath with moderate exertion that has been gradually worsening over the past 6 months. She is a fairly active and healthy person except for a history of hypertension that her primary care physician has been treating for about 20 years with lisinopril and hydrochlorothiazide. She denies any chest pain with exertion. On physical examination, she has normal jugular venous pressure, no hepatojugular reflux, and no lower extremity oedema. Her cardiac examination reveals a non-displaced apical impulse, normal S1 and S2, and a fairly loud S4 with no murmurs. (4 differentials)

1 - Congestive heart failure 2 - Stable angina 3 - Asthma/COPD 4 - Anaemia

A 60-year-old man presents to the accident and emergency department. He reports being progressively short of breath. He has a history of hypertension, non-insulin-dependent diabetes mellitus, and has been a heavy smoker for more than 40 years. He underwent a successful primary angioplasty for a large acute anterior myocardial infarction 2 months ago. His blood pressure is 75/40 mmHg, his heart rate 110 beats per minute, and his respiratory rate 30. He has elevated neck veins and a prominent S3. (4 differentials)

1 - Congestive heart failure 2 - Acute coronary syndrome 3 - Acute respiratory distress syndrome 4 - Pulmonary embolism

A 73-year-old woman with a history of myocardial infarction presents to the accident and emergency department. She is breathless and finding it difficult to talk in full sentences. On examination she is centrally cyanosed with cool extremities. Her pulse is 110 bpm and systolic BP only just recordable at 80 mmHg. Jugular venous pressure is elevated 5 cm above normal, there is a gallop rhythm, and the cardiac apex beat is displaced. Respiratory rate is increased and she has widespread crackles and wheezes on chest examination. (4 differentials)

1 - Congestive heart failure 2 - Acute coronary syndrome 3 - Obstructive lung disease (COPD) 4 - Acute respiratory distress syndrome

A 60 year old presents to his general practitioner with fatigue and shortness of breath on exertion. He had been diagnosed with a Non-ST elevation myocardial infarction five years ago. He states that he has been needing to sleep on 3 pillows at night, when he used to only sleep on 1. On physical examination, he had an heart rate of 84 bpm, blood pressure of 142/91 mmHg, respiratory rate of 14 breaths per minute, oxygen saturation of 96% and temperature of 36.9 degrees

1 - Congestive heart failure 2 - Obstructive sleep apnoea 3 - Stable angina 4 - Anaemia

A 65-year-old woman presents with unilateral leg pain and swelling of 5 days' duration. She has a history of hypertension, congestive heart failure, and recent hospitalisation for a total knee replacement. She had been recuperating at home but on beginning to walk, her right leg became painful, tender, and swollen. On examination there is pitting oedema on the right and the right calf is 4 cm greater in circumference than the left when measured 10 cm below the tibial tuberosity. Superficial veins on the right foot are more dilated than on the left and easily visible. The right leg is slightly redder than the left. There is tenderness on palpation in the popliteal fossa behind the right knee. (top differential)

1 - Deep Vein thrombosis (DVT)

A 31-year-old male presents to his general practitioner with intermittent chest discomfort. He is a non-smoker with no significant past medical history or family history. He describes the episodes of chest discomfort as a burning sensation rising from the chest to the throat. It is usually precipitated by laying down or by eating large meals. (top differential)

1 - GORD

A 20-year-old black woman presents to her primary care physician complaining of generalised weakness, fevers, and light-headedness for 2 weeks. Her symptoms have worsened over the previous week, when she developed left lower chest pain and left upper quadrant abdominal pain. A urinalysis was obtained, and she was treated for a UTI. She returns to her primary care physician when symptoms continue to worsen. (2 differentials)

1 - Haemolytic anaemia 2 - Leukemia

A 65-year-old man presents with gradually progressive dyspnoea on exertion and a non-productive cough. He has no history of underlying lung disease and no features that would suggest an alternative aetiology for his cough and dyspnoea. He has no history of joint inflammation, skin rashes, or other features of a systemic inflammatory disease such as lupus or rheumatoid arthritis. He takes no medications and has no environmental exposures to organic allergens such as mould. On examination, he has fine crackles audible over his lung bases bilaterally; however, he has no lower-extremity oedema, elevations in jugular venous pressure, or any other findings to suggest volume overload. He has clubbing of his fingers. (4 differentials)

1 - Idiopathic pulmonary fibrosis 2 - Sarcoidosis 3 - Interstitial Pneumonia 4 - Lung cancer

A 31-year-old woman presents with a 1-week history of fever, chills, fatigue, and unilateral ankle pain. Her past medical history includes mitral valve prolapse and hypothyroidism. She admits to infrequent intravenous heroin use and has a 10-pack-year history of smoking. Physical examination reveals temperature of 39°C (102°F), regular heart rate 110 beats per minute, blood pressure 110/70 mmHg, and respiration rate of 16 breaths per minute. Her cardiovascular examination reveals a grade 2/4 holosystolic murmur that is loudest at the right upper sternal border. Her right ankle appears red and warm, and is very painful on dorsiflexion (3 differentials)

1 - Infective endocarditis 2 - Rheumatic heart disease 3 - Aortic stenosis

A 68-year-old man presents with fatigue and dark stools. On examination his vital signs are normal, but he is pale and has a rectal mass. Biopsy of the rectal mass reveals adenocarcinoma. (4 differentials)

1 - Iron deficiency anaemia 2 - Normocytic anaemia 3 - Leukemia 4 - Secondary haemostasis bleeding disorder

A 25-year-old woman presents with a history of fatigue, ice craving, and dyspnoea upon exertion. She has three children. She did not tolerate antenatal vitamins during pregnancy, because of nausea. Examination reveals pallor and spooning of her nails. Vital signs are normal. There is no lymphadenopathy or hepatosplenomegaly. (4 differentials)

1 - Iron deficiency anaemia 2 - Folate deficiency anaemia 3 - Normocytic anaemia (bleeding) 4 - B12 deficiency anaemia

A 55-year-old male farmer presents with worsening shortness of breath, night sweats, fevers, bilateral axillary lymphadenopathy, and a 7.7 kg (12%) total body weight loss over 3 months. Recently, he has not been able to work because of fatigue. Physical examination revealed a 3.5 cm left axillary mass, enlarged cervical, axillary, and inguinal lymph nodes, splenomegaly, and no hepatomegaly. (4 differentials)

1 - Lymphoma 2 - Chronic lymphocytic leukemia 3 - Acute myeloblastic leukemia 4 - Myelodysplastic syndrome

A 25-year-old man presents to his general practitioner with a slowly enlarging, painless right neck mass. He denies recent upper respiratory tract infections, fevers, night sweats, or unintentional weight loss. He is otherwise healthy. Social history and family history are unremarkable. On examination he is afebrile with normal vital signs. Pertinent findings include a 3-cm, firm, round, non-tender, mobile mass in the mid-right neck. There is no other peripheral lymphadenopathy. Liver and spleen are not enlarged. (4 differentials)

1 - Lymphoma 2 - Chronic lymphocytic leukemia 3 - Multiple myeloma 4 - Myelodysplastic syndrome

A 52-year-old woman presents with dyspnoea on exertion, fatigue, and occasional palpitations. She has no prior cardiac history. She denies chest pain, orthopnoea, paroxysmal nocturnal dyspnoea, or lower extremity oedema. On physical examination her jugular venous distension is around 12 cm and her lungs are clear to auscultation. Cardiac examination reveals a slightly displaced apical impulse with a palpable P2. Cardiac auscultation reveals III/VI holosystolic murmur at the apex that radiates to the axilla with diminished S1 and P2 greater than A2.

1 - Mitral regurgitation 2 - Aortic stenosis 3 - Atrial fibrillation 4 - Congestive heart failure (other cause)

A 45-year-old woman presents to the accident and emergency department with nausea, vomiting, and confusion. She has a history of low back pain of 6 months' duration and increasing sciatic pain in the last 2 weeks. On physical examination, the patient is pale and dehydrated with bone tenderness in the lumbar region. Neurological examination reveals an upgoing plantar reflex on the left with intact power in all muscle groups and at all joints. Magnetic resonance imaging reveals an L5 compression fracture. This is associated with hypercalcaemia and renal insufficiency. (4 differentials)

1 - Multiple myeloma 2 - Chronic lymphocytic leukemia 3 - Acute myeloblastic leukemia 4 - Chronic myeloid leukemia

A 60-year-old previously healthy man presents with 2 to 3 months of back pain. Over the last 3 weeks, he has developed a cough and increasing fatigue. On examination he has evidence of pneumonia and osteolytic lesions on radiography. (4 differentials)

1 - Multiple myeloma 2 - Chronic lymphocytic leukemia 3 - Acute myeloblastic leukemia 4 - Chronic myeloid leukemia

A previously healthy 72-year-old man presents with fever, chills, cough, and shortness of breath. Chest x-ray shows a right-middle-lobe infiltrate. He is diagnosed with pneumonia and admitted for intravenous antibiotics. Blood cultures eventually grow Streptococcus pneumoniae. By day 3 he is afebrile but his haemoglobin is 105 g/L (10.5 g/dL), a decrease from 124 g/L (12.4 g/dL) on admission, and 135 g/L (13.5 g/dL) 1 month ago. He has no evidence of gastrointestinal blood loss or overt haemolysis. (2 differentials)

1 - Normocytic anaemia (inflammation) 2 - Macrocytic anaemia

A 41-year-old obese man presents with loud chronic snoring and gasping episodes during sleep. His wife has witnessed episodic apnoea. He reports unrefreshing sleep, multiple awakenings from sleep, and morning headaches. He has excessive daytime sleepiness, which is interfering with his daily activities, and he narrowly avoided being involved in a motor vehicle accident. His memory is also affected. He has been treated for hypertension, gastro-oesophageal reflux, and type 2 diabetes (4 differentials)

1 - Obstructive sleep apnoea 2 - Central sleep apnoea 3 - Congestive heart failure 4 - Poor sleep hygiene

An otherwise healthy 30-year-old man presents with a several-day history of progressive, severe, retrosternal chest pain that is sharp and pleuritic in nature. The pain is worse on lying down and improved with sitting forward. There is radiation to the neck and shoulders and specifically to the trapezius muscle ridges. The pain is constant and unrelated to exertion. (4 differentials)

1 - Pericarditis 2 - Spontaneous Pneumothorax 3 - Pulmonary embolism 4 - Aortic dissection

A 70-year-old woman presents with slowly increasing dyspnoea. She cannot lie flat without feeling more short of breath. She has a history of hypertension and osteoarthritis, and she has been taking non-steroidal anti-inflammatory drugs with increasing frequency over the previous few months. On physical examination, she appears dyspnoeic at rest, her blood pressure is 140/90 mmHg, and pulse is 90 bpm. Her jugular venous pressure is elevated to the angle of the jaw. The left lung field is dull to percussion with quiet breath sounds basally. Crackles are heard in the right lung field and above the line of dullness on the left. Lower extremities have pitting oedema to the knee. (4 differentials)

1 - Pleural effusion (Heart failure) 2 - Pleural effusion from other cause 3 - MI 4 - ARDS

A 56-year-old man has pain in his right chest with deep inspiration and is short of breath at rest and with exertion. He has felt feverish for a week and complains of a productive cough with foul-smelling and -tasting sputum. He regularly drinks alcohol and was inebriated and vomited 1 week before his symptoms began. Past medical history and family history are unremarkable. On physical examination, he is febrile at 38°C (100.7°F), blood pressure is 130/78 mmHg, and pulse is 110 bpm. He looks unwell and has poor dental hygiene. Breath sounds are quiet over the right lower lobe with dullness to percussion and decreased tactile fremitus in the lower half of the lung field. (4 differentials)

1 - Pleural effusion (exudate) 2 - Pneumonia 3 - Pulmonary embolism 4 - Pneumothorax

A 55-year-old factory maintenance worker falls at work. A chest x-ray (CXR) is performed to evaluate the patient for a possible broken rib. Bilateral pleural thickening is seen on CXR. Further history indicates he is very active without any respiratory symptoms. He smokes 20 cigarettes a day. There is no family history of lung disease. He does not take any respiratory medicine. (4 differentials)

1 - Pneumoconiosis 2 - COPD 3 - Idiopathic Pulmonary Fibrosis 4 - Sarcoidosis

A 76-year-old retired steelworker has shortness of breath with activity that has been gradually getting worse, and a chronic cough. He denies chest pain. He has a 45-pack/year smoking history, but stopped aged 50. There is no family history of lung disease. He does not take any respiratory medication on a regular basis. He has noticed that he wheezes when he has an upper respiratory infection (URI), and his doctor once prescribed him an inhaler. He is also bothered by joint swelling and stiffness. Lung auscultation is normal. (4 differentials)

1 - Pneumoconiosis 2 - COPD 3 - Idiopathic Pulmonary Fibrosis 4 - Sarcoidosis

An 88-year-old female resident of a nursing home, who typically does not present to the acute care hospital, has frequent urinary tract infections (UTIs) that are managed by the nursing home physician. In the nursing home, she develops a UTI due to multidrug-resistant pathogens. On admission to hospital, she has poor mental status and her bed is left with the head elevated to only a 5° angle. On hospital day 4, a chest x-ray reveals a right lower lobe opacity. (4 differentials)

1 - Pneumonia 2 - Congestive heart failure 3 - COVID-19 4 - LRTI

A 54-year-old smoker with multiple comorbidities (diabetes, hypertension, coronary artery disease) presents with a 2-day history of a productive cough with yellow sputum, chest tightness, and fever. Physical examination reveals a temperature of 38.3°C (101°F), BP of 150/95 mmHg, heart rate of 85 bpm, and a respiratory rate of 20 breaths per minute. His oxygen saturation is 95% at rest; lung sounds are distant but clear, with crackles at the left base. Chest x-ray reveals a left lower lobe infiltrate. (4 differentials)

1 - Pneumonia 2 - LRTI 3 - Pulmonary oedema from other cause 4 - COVID-19

A 20-year-old student presents with a 3-day history of cough, fever, malaise, and headache. On examination, he is febrile to 38.3°C (101°F) and he has crackles in the right-lower lung field. (4 differentials)

1 - Pneumonia (bacterial) 2 - URTI 3 - Pulmonary oedema 4 - COVID-19

A 55-year-old man with a history of peripheral vascular disease, who presents with a complaint of a left foot ulcer and pain when walking short distances, is found to have a popliteal stenosis and admitted for re-vascularisation. Four days after admission, on postoperative day 3, he develops shortness of breath, hypoxia, and a productive cough. Auscultation of his chest reveals decreased breath sounds at the lower aspect of the right side of his chest. His morning leukocyte count is slightly higher than the day before at 11,000 cells/mL3. An anterior-posterior bedside chest x-ray reveals right lower lobe opacity. (4 differentials)

1 - Pneumonia (viral caused) 2 - LRTI 3 - COVID-19 4 - Pulmonary embolism

A 65-year-old patient presents to the emergency department with complaints of worsening shortness of breath and right-sided chest discomfort. He states that these symptoms occurred suddenly 1 hour prior to presentation. He denies fevers and chills. He also denies increased sputum production and a change in the colour or character of his sputum. He continues to smoke cigarettes against medical advice. The patient's blood pressure is 136/92 mmHg, heart rate is 110 beats per minute, and respiratory rate is 24 breaths per minute. Chest excursion is decreased on the right more than the left. His right hemithorax is more hyperinflated than the left. His right hemithorax is hyper-resonant on percussion. Breath sounds are distant bilaterally but more diminished on the right. (4 differentials)

1 - Pneumothorax 2- COPD exacerbation 3 - Pleural effusion 4 - ACS

A 20-year-old man presents to the emergency department with complaints of left-sided chest pain and shortness of breath. He states that these symptoms began suddenly 4 days ago while he was working at his computer. He initially thought that he might have strained a chest wall muscle, but because the pain and dyspnoea had not resolved, he decided to seek medical attention. He has no significant past medical history but has smoked cigarettes since the age of 16 years. His older brother suffered a pneumothorax at the age of 23 years. The patient's vital signs are normal. He appears in mild discomfort. Examination of his chest reveals that the left hemithorax is mildly hyperexpanded with decreased chest excursion. His left hemithorax is hyper-resonant on percussion, and breath sounds are diminished when compared with the right hemithorax. His cardiovascular examination is normal. (4 differentials)

1 - Pneumothorax 2 - Pleural effusion 3 - Pneumonia 4 - COPD exacerbation

A 55-year-old man has had routine physical examinations for several years and has always been healthy, does not smoke, and has no history of pulmonary disease. His primary care physician has noted a gradually increasing haemoglobin level over the past few years (to a current level of 195 g/L [19.5 g/dL]), mild leukocytosis, and mild thrombocytosis. He has frequent episodes of facial flushing that are associated with slight headaches and a feeling of fullness in his head and neck. He has noted intermittent burning, stinging, and tingling sensations in his fingertips. He has recurrent, often severe, pruritus that is exacerbated by taking a hot bath. On examination, he has a red face and neck and the spleen is mildly enlarged. (4 differentials)

1 - Polycythemia vera 2 - Essential thrombocytosis 3 - Chronic lymphocytic leukemia 4 - Myelofibrosis

A 62-year-old man, who has always been healthy, arrives for a pre-operative check prior to a minor procedure. A routine full blood count reveals an elevated haemoglobin level of 190 g/L (19.0 g/dL). He is surprised to hear about this abnormal result, as he has not noticed any symptoms or signs that have caused him concern. On examination, the only abnormality is a red facial complexion. (4 differentials)

1 - Polycythemia vera 2 - Essential thrombocytosis 3 - Chronic lymphocytic leukemia 4 - Myelofibrosis

A 65-year-old man presents to the emergency department with acute onset of shortness of breath of 30 minutes' duration. Initially, he felt faint but did not lose consciousness. He is complaining of left-sided chest pain that worsens on deep inspiration. He has no history of cardiopulmonary disease. A week ago he underwent a total left hip replacement and, following discharge, was on bed rest for 3 days due to poorly controlled pain. He subsequently noticed swelling in his left calf, which is tender on examination. His current vital signs reveal a fever of 38.0°C (100.4°F), heart rate 112 bpm, BP 95/65 mmHg, and an O₂ saturation on room air of 91%. (4 differentials)

1 - Pulmonary embolism 2 - Pneumothorax 3 - Pneumonia 4 - Pleural effusion

A 29-year-old woman presents with shortness of breath, cough, and painful red skin lesions on the anterior surface of the lower part of both legs. CXR reveals bilateral hilar lymphadenopathy with pulmonary infiltrates. (4 differentials)

1 - Sarcoidosis 2 - Tuberculosis 3 - Leukemia (with infection) 4 - Idiopathic pulmonary fibrosis

A 50-year-old man presents with a complaint of central chest discomfort of 2 weeks' duration, occurring after walking for more than 5 minutes or climbing more than one flight of stairs. The chest discomfort resolves with rest within several minutes. He is obese, has a history of hypertension, and smokes 10 cigarettes a day. His father died from a myocardial infarction at the age of 54 years. On examination, his blood pressure is 144/92 mmHg with a heart rate of 82 bpm. The remainder of his examination is normal. (4 differentials)

1 - Stable angina 2 - Unstable angina 3 - Obstructive pulmonary disease 4 - Aortic stenosis

A 60-year-old man with a history of a myocardial infarction presents for follow-up. He was started on aspirin, beta-blocker, and statin therapy after his heart attack. In the past 2 weeks the patient has noted return of chest pressure when he walks rapidly. The chest pressure resolves with sublingual glyceryl trinitrate or a decrease in his activity level. He is a former smoker and has modified his diet and activity to achieve his goal body weight. He is normotensive on examination with a heart rate of 72 bpm. The remainder of his examination is normal. (4 differentials)

1 - Stable angina 2 - GORD 3 - Unstable angina 4 - Aortic dissection

A 65-year-old man, who smokes and has a history of hypertension and peripheral vascular disease, now presents with increasing frequency and severity of chest discomfort over the past week. He reports that he previously had chest pain after walking 100 metres, but now is unable to walk more than 50 metres without developing symptoms. The pain radiates from his chest to the left side of the neck and is only eased after increasing periods of rest. (4 differentials)

1 - Stable angina (lasting 5-10 minutes, relieved at rest) 2 - Unstable angina (without exercise, taking longer to resolve) 3 - Pericarditis 4 - Pulmonary embolism

A 34-year-old man presents to his primary care physician with a 7-week history of cough that he describes as non-productive. He has had a poor appetite during this time and notes that his clothes are loose on him. He has felt febrile at times, but has not measured his temperature. He denies dyspnoea or haemoptysis. He is originally from the Philippines. Physical examination reveals a thin, tired-appearing man but is otherwise unremarkable. (4 differentials)

1 - TB 2 - Post viral cough 3 - Lung cancer 4 - Pneumonia

A 42-year-old Asian woman presents to her primary care physician with a 7-week history of an enlarging mass on the left side of her neck. She denies pain or drainage. The mass failed to respond to antibiotics. She denies cough, fever, night sweats, or anorexia. She is originally from Vietnam but has lived in the US for 15 years. Physical examination reveals a well-appearing woman. There is a 2 x 4 cm left neck mass consistent with a lymph node in the anterior cervical chain. There is no tenderness; the node is firm and mobile. There are smaller subcentimetre lymph nodes in the left supraclavicular fossa. The physical examination is otherwise unremarkable. (4 differentials)

1 - Tuberculosis 2 - HIV 3 - Epstein Bar Virus 4 - Streptococcus

A 66-year-old man presents to the emergency department with a history of fever and weight loss. He reports that he has had little appetite for the last 3 months and has lost 11 kg during that time. He has noted tactile fevers over the last 6 weeks but has not had access to a thermometer. He has been having headaches for the last week but denies cough, haemoptysis, or chest pain. He has been intermittently homeless over the last 2 years and has a history of heavy alcohol use but recently stopped. On examination, he is a thin man with a temperature of 38.8°C (101.9°F) and a respiratory rate of 20 breaths per minute. Physical examination is notable for temporal wasting and hepatomegaly without tenderness. (4 differentials)

1 - Tuberculosis 2 - Leukemia 3 - Long COVID 4 - HIV/HBV

A 67-year-old man presents with fever and cough. He complains of worsening shortness of breath and the inability to get enough oxygen. His mental status waxes and wanes and he is cyanotic around the lips and cheeks. During examination, ventilatory efforts rapidly deteriorate. (4 differentials)

1 - Type 1 respiratory failure 2 - Pneumonia (ARDS) 3 - COPD exacerbation 4 - Severe COVID-19

A 45-year-old woman with type 1 diabetes (diagnosed when she was a teenager) presents to the accident and emergency department with abdominal pain, nausea, and shortness of breath that woke her up from sleep. (4 differentials)

1 - Unstable angina 2 - Congestive Heart Failure 3 - MI 4 - Pericarditis

A 24-year-old woman presents to the emergency department 8 weeks postnatal with heavy vaginal bleeding, fatigue, and light-headedness. This was her first pregnancy. She has a history of menorrhagia since menarche and iron-deficiency anaemia. She had no bleeding symptoms during her pregnancy, and her vaginal bleeding was not excessive in the first few days after delivery, but it has continued since the delivery and in the past week has increased in flow. Her past medical history is remarkable for an appendectomy at age 14 years without bleeding complications, but she had to return to the oral surgeon for suturing after wisdom tooth extraction at age 16 years. Her family history is remarkable for a sister with heavy menses. Her father had recurrent nosebleeds as a child and had several cauterisations as therapy. (4 differentials)

1 - Von Willebrands disease 2 - Haemophilia 3 - Factor V deficiency 4 - Acute lymphoblastic leukemia

Candesartan, valsartan

Angiotensin II receptor blocker -> angiotensin II receptor antagonist -> decrease binding of angiotensin II -> decrease vasoconstriction + decrease aldosterone release = decrease Na+/water retention = decrease blood volume = decrease blood pressure

Ticagrelor

Antiplatelet -> P2Y12 receptor inhibitor = decrease binding of ADP = decrease synthesis of GP IIb/IIIa receptor on platelet -> decrease binding with fibrinogen -> decrease platelet aggregation

Aspirin

Antiplatelet -> inhibits the COX2 gene = decrease synthesis of thromboxane 2a = decrease synthesis of GP IIb/IIIa receptor on platelet -> decrease binding with fibrinogen -> decrease platelet aggregation

Bisoprolol, propanolol, atenolol

Beta blocker -> B2 receptor antagonist -> decreased binding of epinephrine -> decrease chronotropic (slow SA-AV conduction = decrease HR) and ionotropic effect (decrease contractility = decrease stroke volume) = decrease BP

A 1-year-old child presents with failure to thrive. The child was born at the 50th percentile for weight, but has crossed multiple percentile lines despite a ravenous appetite. The child has more bowel movements per day than other children of the same age, and the stools often look shiny and have an unusually foul smell. In addition, the child has been treated with multiple courses of antibiotics for a persistent, wet cough. The child is small for age, with weight and length below the third percentile. (1 differential)

Cystic fibrosis