A 19-year-old female exchange student presents to the emergency department with severe abdominal pain and a swollen right knee. She has had recurrent episodes of abdominal pain for the past 5 years which last 2-3 days before resolving spontaneously. Previous investigations have all failed to identify a cause. She mentions that several family members back home in Turkey have similar symptoms. On examination, she has a temperature of 39.4°C and a heart rate of 125. Her abdomen is diffusely tender with rebound tenderness. A right knee effusion is present, and a raised, tender erythematous lesion on her left lower leg is noted. Laboratory testing reveals an elevated white cell count with a neutrophilic predominance, as well as elevated ESR, CRP, and SAA protein.
quiz of the week
Dyspnea and abdominal pain—how would you manage this patient?
A 66-year-old male with a history of hypertension presents to the emergency department with dyspnea and sharp abdominal pain radiating to his back. On examination, his blood pressure is 180/120 mm Hg. A CT scan demonstrates the findings seen here and laboratory testing indicates that his renal function is preserved. Which of the following is the most appropriate next step given this patient’s likely diagnosis?
Developmental Delay and Hypocalcemia—What’s the Cause?
Case Details
A 9-year-old girl is brought to a new pediatrician by her mother over concerns regarding her weight. She has a history of developmental delay, and her mother mentions that she is noticeably shorter than her peers. She is noted to have a round face and bilaterally shortened fourth metacarpals on examination. She is in the 96th percentile for weight and below the 3rd percentile for height for her age. Laboratory testing reveals hypocalcemia. Which additional laboratory findings are associated with this patient’s most likely diagnosis?
What’s causing this characteristic appearance on CT?
A 37-year-old female presents to her family physician with recurring abdominal and flank pain. She mentions her mother suffered from kidney problems but doesn’t know many details. Examination reveals a blood pressure of 170/110 mmHg and proteinuria is present on dipstick. Laboratory tests show an elevated hematocrit, microalbuminuria, and microscopic hematuria. A CT scan later reveals the findings seen here.Which of the following conditions is most commonly associated with this patient’s likely diagnosis?
Dyspnea, Cough, and Facial Swelling—What’s the Cause
What’s causing this teenager’s vision loss?
A 14-year-old boy is brought to the pediatrician by his mother over concerns of difficulty walking and worsening clumsiness. He reports a gradual loss of night vision, and a long history of chronic diarrhea which is pale and foul-smelling. Examination reveals an ataxic gait, and loss of deep tendon reflexes. Bilateral retinitis pigmentosa is noted on fundoscopy and a peripheral blood smear reveals the findings seen here. Which additional laboratory finding is most likely?
When to initiate treatment in patients with HIV
A 60-year-old man who is HIV positive presents with fever, dyspnea, and inflammatory lesions on the skin. A biopsy reveals a diagnosis of histoplasmosis. At what threshold should antiretroviral therapy (ART) be initiated in adults with HIV?
Quiz: How would you treat this tumor?
A 21-year-old female presents with a six-month history of irregular menses, decreased libido, impaired vision, and galactorrhea. An MRI is completed.Based on this imaging and the patient’s clinical findings, which of the following should be recommended as a first-line treatment?
Do You Recognize This Blistering Pruritic Rash? Â
A 4-year-old boy with known G6PD deficiency is brought to the pediatrician by his mother with a blistering pruritic rash. On examination, numerous tense vesicles and bullae are seen on his neck, lower abdomen, and extremities. Ulcerative lesions on his buccal mucosa are also noted. Direct immunofluorescence of a skin biopsy later reveals linear deposits of immunoglobulin A (IgA) at the dermoepidermal junction. Which of the following treatments is recommended for this patient?
Quiz: A Case of Broken-Heart Syndrome
A 67-year-old woman presents to the emergency room with acute chest pain and dyspnea after the death of her husband. She is hypotensive, tachycardic, and diaphoretic. A diagnosis of takotsubo cardiomyopathy is suspected. Which of the following findings best confirms this diagnosis?
What’s causing this patient’s diminished femoral pulses?
A 56-year-old man presents with a three-month history of erectile dysfunction and bilateral buttock pain on exertion, but not at rest. His past medical history is significant for type 2 diabetes, dyslipidemia, and hypertension. Examination reveals bilaterally diminished femoral pulses. What is the most likely diagnosis?
A Creeping Eruption
A 40-year-old male presents to his family physician with a pruritic, erythematous lesion on his foot after returning from vacation in coastal Brazil a week earlier. On examination, a serpiginous, slightly elevated tunnel can be seen on the lateral aspect of his left foot. He is otherwise well, but mentions that the intense pruritus is disturbing his sleep. Which of the following treatments is the next best step?
Is this patient high-risk?
A 55-year-old female presents with a low-grade fever, a new heart murmur, and Janeway lesions one week following a dental cleaning, and a preliminary diagnosis of infective endocarditis is made. Prophylactic antibiotics are administered prior to dental cleanings to prevent endocarditis in patients considered to be high-risk. Which of the following valvular conditions requires prophylactic antibiotics prior to dental cleanings?
Quiz of the Week: Painful urination, a swollen knee, and eye pain—what’s the cause?
A 31-year-old female presents to the emergency department with a two-day history of pain on urination and discomfort in her left knee and heel. She also complains of right eye pain, which is exacerbated by reading and bright lights. She recently recovered from a gastrointestinal illness two weeks earlier, but is otherwise healthy. Examination reveals a swollen left knee that is warm to the touch, and tenderness at the insertion point of the left Achilles tendon. Her right eye is red, and she has direct and consensual photophobia. Cells and flare are noted in the right anterior chamber on slit lamp examination. Based on this patient’s probable diagnosis, which of the following cutaneous manifestations is most likely?