Category: Visual Diagnosis
Posted: 8/25/2013 by Haney Mallemat, MD
(Updated: 8/26/2013)
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23 year-old patient presents with a rash on his palms and soles. He also states that he had a something strange on his genitals several weeks before. What's the diagnosis and what’s the treatment (including dosing) for this disease?
Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention. 2010 Treatment Update.
http://www.cdc.gov/std/syphilis/treatment.htm
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Category: Visual Diagnosis
Posted: 8/19/2013 by Haney Mallemat, MD
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Which echocardiographic view of the heart is this and can you name all 6 segments of the left ventricle? (Hint: A = Anteroseptal wall)
Parasternal short-axis view at the level of the papillary muscles
Category: Visual Diagnosis
Posted: 8/10/2013 by Haney Mallemat, MD
(Updated: 8/12/2013)
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Patient with liver disease presents with dyspnea, fever, and the following ultrasound? What's the diagnosis? (Hint: there are two)?
Answer: Complex pleural effusion and ascites
The take away point from this case is to always place the diaphragm in the center of the screen in order to distinguish peritoneal from thoracic fluid. Fluid in both compartments will sometimes be present (as in this case).
Complex pleural effusions
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Category: Visual Diagnosis
Posted: 8/5/2013 by Haney Mallemat, MD
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45 year-old man presents after he cannot close his left eye. In the photo below, he is trying to simultaneously raise his forehead and smile. Of note, he was also started on doxycycline recently for Lyme disease. What two medications should he receive?
Bell Palsy
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Category: Visual Diagnosis
Posted: 7/29/2013 by Haney Mallemat, MD
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13 year-old female fell on right shoulder while catching a rebound during a basketball game. The patient is holding her arm in adduction and has exquisite scapular tenderness on exam. What’s the next step in management? …oh, and what’s the diagnosis?
Answer: Non-displaced scapular fracture
Treatment:
Bonus Pearls: #foam4yrdome
This installment of #foam4yrdome will focus on freeemergencytalks.net which is quite possibly the best Critical Care and Emergency Medicine FREE lecture website.
The website was founded and is maintained by Professor Joe Lex (@joelex5); the website hosts hundreds of free talks.
Check out talks from all the major conferences featuring the best speakers in Emergency and Critical care medicine today.
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Category: Visual Diagnosis
Posted: 7/22/2013 by Haney Mallemat, MD
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A 3 year-old boy was attacked by a dog and sustained the injury below. Name one injury that should be strongly considered (Hint: there are several)
Important injuries to consider (image below):
This patient had only a corneal abrasion on fluorescein exam.
Bonus Pearl: #Foam4yrDome
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Category: Visual Diagnosis
Posted: 7/15/2013 by Haney Mallemat, MD
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46 year-old female presents with a headache. The following is seen on visual inspection of the eye. What's the diagnosis?
Pterygium
Six-word Summary: Cornea, benign, UV, supportive, surgery, and sunglasses
Bonus Pearl
As a new academic year begins, I will be sharing some amazing free educational online resources/links. These free materials are known as Free Open Access Meducation (or FOAMed) and for those familiar with FOAMed this is an emerging educational revolution. If you don't know what FOAMed is, read about it here and then read this. Updates will happen every Monday and will be known as #FOAM4yourDome
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Category: Visual Diagnosis
Posted: 7/8/2013 by Haney Mallemat, MD
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3 year-old male develops rash 5 days after starting amoxicillin for acute otitis media. What's the diagnosis?
Erythema Multiforme
Erythema multiforme (EM) is a pruritic, erythematous, and blanchable maculopapular rash; it is serpiginous or targetoid in shape, with central clearing or pallor.
EM is generally symmetric, appearing on hands, feet, groin, and extensor aspects of legs and forearms.
It is classically associated with upper respiratory infections, medications, connective tissue diseases, and malignancies.
Treatment includes:
Habif, et al, Skin Disease, 3rd Ed. 2011
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Category: Visual Diagnosis
Posted: 7/1/2013 by Haney Mallemat, MD
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65 year-old male presents with nausea and diffuse abdominal pain, 3 days after knee replacement surgery. What's the diagnosis?
Adynamic ileus
Risk factors include
Imaging reveals distention of both large and small bowel without a transition zone, which differs from a small or large bowel obstruction. Such cases can be difficult to differentiate clinically from one another, so physicians often rely on imaging, specifically CT scanning to define a discrete obstruction versus an ileus.
References
1. Hayden and Sprouse, Bowel Obstruction and Hernia, Med Clin N Amer 29 (2011) 319-345
2. American College of Radiology, Suspected Small Bowel Obstruction, ACR Appropriateness Guidelines, rev. 2010
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Category: Visual Diagnosis
Posted: 6/23/2013 by Haney Mallemat, MD
(Updated: 6/24/2013)
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Name three differential diagnoses based on the CXR below.
The diagnosis in this case is Non-Hodgkin lymphoma, but read below for more differentials.
Mediastinal Masses
The mediastinum is subdivided into the regions shown below. Here are some differential diagnoses based on region.
Anterior / Superior Mediastinum
Middle Mediastinum
Posterior Mediastinum
Congratulations to all the graduating residents, especially our own at the University of Maryland. I wish you all the best as you start your phenomenal careers!
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Category: Visual Diagnosis
Posted: 6/10/2013 by Haney Mallemat, MD
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13 year-old female with ankle pain following fall down escalator. What's the diagnosis?
Answer: Tri-plane ankle fracture
Tri-plane Fractures
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Category: Visual Diagnosis
Posted: 6/3/2013 by Haney Mallemat, MD
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Ever wonder how to place a pigtail catheter?
Check out this video to learn how, click here
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Category: Visual Diagnosis
Posted: 5/27/2013 by Haney Mallemat, MD
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9 month-old presents with wheezing and the CXR is shown below. What's the diagnosis?
Congenital anterior diaphragmatic defects with herniated bowel.
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Category: Visual Diagnosis
Posted: 5/20/2013 by Haney Mallemat, MD
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30 year-old male presents with right wrist pain after falling off his bicycle. What's the diagnosis?
Scapholunate dislocation
Scapholunate Dislocation (a.k.a. “Terry Thomas” or “David Letterman” sign)
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Category: Visual Diagnosis
Posted: 5/13/2013 by Haney Mallemat, MD
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60 year-old male with a history of pulmonary fibrosis presents to the Emergency Department after a lung biopsy. He is complaining of facial swelling and dyspnea. What's the diagnosis?
Answer: Massive subcutaneous emphysema
Click here
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Category: Visual Diagnosis
Posted: 5/5/2013 by Haney Mallemat, MD
(Updated: 5/6/2013)
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38 year-old male with a past medical history of diabetes presents with back pain and hypotension. CT scan is shown below. What's the diagnosis?
Emphysematous Pyelonephritis (EPN)
EPN is a necrotizing infection of the renal and peri-nephric tissues with accumulation of gas within the tissues and collecting system of the kidney; it is rapidly fatal if not recognized and aggressively treated early.
Risk factors include an immunocompromised host; Diabetics are at particularly increased risk.
The most common etiologic organisms are Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa. Infection with anaerobic species is relatively uncommon.
In addition to the classic signs / symptoms of pyelonephritis, (e.g., flank pain, fever, pyuria, etc.), patients presenting with EPN may experience the passage of air in the urine (pneumaturia) or crepitus over their flank.
Abdominal CT scan is the diagnostic test of choice when clinical presentation and laboratory tests are suggestive (see below)
Treatment should include:
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Category: Visual Diagnosis
Posted: 4/29/2013 by Haney Mallemat, MD
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57 year old male presents with a cough. The CXR is shown below. What's the diagnosis?
Answer: Left Ventricular Assist Device (LVAD)
An LVAD is a mechanical pump that pulls blood from the left ventricle and pumps it to the ascending aorta for systemic delivery; LVADs are increasingly being placed in patients with heart failure so you must be aware of them.
The three indications for an LVAD are:
There are several models, which have been implanted in people (http://www.mylvad.com/lvad-devices). The main distinction between devices are pulsatile or non-pulsatile (or linear) flow; newer generation devices are non-pulsatile.
Patients with LVAD may develop complications such as infections, arrhythmias, or anemia, but bleeding can be a life-threatening one; bleeding occurs secondary to an acquired von Willebrand factor deficiency, AVMs within the GI tract, or secondary to over anti-coagulation (typically with Warfarin).
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Category: Visual Diagnosis
Posted: 4/15/2013 by Haney Mallemat, MD
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35 year-old female presents with fever and hypotension. Bedside ultrasound is performed and is shown here. What's the diagnosis?
Answer: Aortic valve vegetation secondary to infective endocarditis.
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Category: Visual Diagnosis
Posted: 4/8/2013 by Haney Mallemat, MD
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64 year-old female presents with chest pain following an argument with her husband. Her echocardiogram (apical four-chamber view) and ECG are shown. Her initial troponin is 10. What's the diagnosis?
Answer: Takotsubo (a.k.a Stress) cardiomyopathy (TC)
TC is left ventricular dysfunction (hypokinesia, akinesia, or dyskinesia) secondary to catecholamine surge (e.g., physical / emotional stress) causing myocardial stunning; it is not due to acute coronary occlusion. TC disproportionately affects postmenopausal women, occurring in up to 90% of cases.
Patients often present with chest pain or dyspnea; 85% of patients will have an abnormal ECG (e.g., ST elevation or T wave inversions), making diagnosis difficult to differentiate between TC and acute coronary syndrome (ACS). TC has been found to be the diagnosis in 2.5% of patients initially worked up for ACS.
Diagnosis can usually be confirmed with echocardiography but cardiac catheterization (with ventriculogram) is sometimes performed if ACS is strongly suspected. Catheterization demonstrates normal coronary arteries with an abnormal ventriculogram (click for video), typically in mid-to apical portion of the left ventricle.
Treatment is symptomatic and similar to congestive heart failure (e.g., diuretics, beta-blockers, etc.); 95% of patients have full recovery within one month.
Refer to this prior PEARL by Dr. Tewelde for additional information
Reference
T Pilgrima, T Wyss, Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review, Int J Card 2008 Mar 14;124(3):283-92
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Category: Visual Diagnosis
Posted: 4/1/2013 by Haney Mallemat, MD
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What's the Diagnosis?
Answer: Normal CXR...April Fool's Day ;)
Our international friends can learn more about April Fool'sDay here
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