65 years-old man
CC: Bullous skin changes
Symptoms:
Large & tense blisters that heal without scarring on the lower legs, palms, soles, groin, & axilla
What are the differentials?
What are the diagnostic tests?
What is the diagnosis?
- Differential Diagnoses:
1) Pemphigus vulgaris
2) Dermatitis herpetiformis
3) Allergies - Diagnostic Tests:
1) Immunohistochemistry
(Antibodies against hemidesmosomes)
2) Nikolsky’’s sign (negative)
Diagnosis: Bullous Pemphigoid
- Treatment:
1st line high-dose topical steroids
2nd line systemic glucocorticoids and immunosuppressants
(second line)
75 years old
CC: confusion
Other symptoms:
Onset of headaches, fatigue, suprapubic tenderness, as well as frequent/urgent foul smelling dysuria
What are the differentials?
What are the diagnostic tests?
What are the treatment options?
What is the diagnosis?
- Differential Diagnoses:
1) Stroke
2) Meningitis - Diagnostic Tests:
1) Urinalysis (gold standard)
2) Urine culture
3) CT of head
4) Lumbar puncture (meningitis) - Diagnosis: Delirium from UTI
- Treatment:
1) Supportive treatment
(increased fluids)
2) Antibiotic therapy
8yr old
CC: Bedwetting
Other symptoms:
Polyuria, polydipsia, polyphagia, fatigue, blurred vision, calf cramps, poor wound healing, & weight loss
What are the differentials?
What are the diagnostic tests?
What is the diagnosis?
What are the treatment options?
- Differential Diagnoses:
1) UTI
2) Child abuse
3) Diabetes insipidus - Diagnostic Tests:
1) Blood glucose levels, C-peptide & HbA1c
2) Urinalysis (glucosuria, ketones) - Diagnosis: Diabetes Mellitus (1)
- Treatment:
1) Insulin therapy & patient (family) education (how to monitor, manage, diet, lifestyle)
Mother complaining that her 2-year-old FEMALE child has a fever
CC: Fever
Other symptoms:
1) Fever & pulling at ear
2) Rash
3) Irritable
4) Refusal to feed
What are the differentials?
What are the diagnostic tests?
What is the diagnosis?
What are the treatment options?
- Differential Diagnoses:
1) Bronchiolitis
2) UTI
3) Meningitis - Diagnostic Tests:
1) Otoscopic examination
2) CXR, urinalysis - Diagnosis:
Ear Infection (otitis media) - Treatment:
1) Usually self-limited
2) Oral analgesia, antibiotic therapy
20 year old
CC: Polyuria
Other symptoms:
1) Polyuria
2) Polydipsia
3) Polyphagia
4) Fatigue/blurred vision
5) Calf cramps
6) Poor wound
healing, weight loss
What are the differentials?
What are the diagnostic tests?
What is the diagnosis?
What are the treatment options?
- Differential Diagnoses:
1) Diabetes insipidus
2) UTI
3) Cystitis - Diagnostic Tests:
1) Blood glucose levels, C-peptide & HbA1c
2) Urinalysis (glucosuria, ketones) - Diagnosis: Diabetes Mellitus
- Treatment:
1) Insulin therapy and patient education (how to monitor, manage, diet, lifestyle)
30-year-old man
CC: Acute painful scrotal mass
Other symptoms:
1) Unilateral scrotal pain and swelling (radiates to ipsilateral flank)
2) Positive Prehn sign
3) Tenderness along
posterior testis
4) Red, shiny & edematous scrotal skin
5) Dysuria, frequency, urgency
What are the differentials?
What are the diagnostic tests?
What is the diagnosis?
What are the treatment options?
- Differential Diagnoses:
1) Hematoma (trauma)
2) Orchitis
3) Strangulated hernia
4) STD
STD; >35 y.o. UTI)
- Diagnostic Tests:
1) urinalysis and culture
2) Scrotal ultrasound (gold standard)
3) Check urine for Chlamydia and
Gonorrhea STD (>35 y.o. UTI)
- Diagnosis:
Epididymitis (<35 y.o.) - Treatment:
1) Scrotal elevation
2) Icepacks
3) Surgical drainage
4) Antibiotic therapy
23 year old
CC: Painless scrotal mass
Other symptoms:
1) Painless swelling of scrotum
2) Palpation above hydrocele possible
3) Positive transillumination
What are the differentials?
What are the diagnostic tests?
What is the diagnosis?
What are the treatment options?
- Differential Diagnoses:
1) Spermatocele
2) Testicular cancer
3) Ependymitis - Diagnostic Tests:
1) Ultrasound (gold standard)
2) Positive transillumination - Treatment:
1) Surgical excision of the hydrocele sac
2) Percutaneous aspiration of the hydrocele fluid - Diagnosis: Hydrocele
40 years-old
CC: Hemoptysis
Other symptoms:
1) Fever/Fatigue
2) Weight loss
3) Night sweats
4) Lymphadenopathy
5) Dyspnea/Productive
cough (hemoptysis) lasting more than 3 weeks
What are the differentials?
What are the diagnostic tests?
What is the diagnosis?
What are the treatment options?
- Differential Diagnoses:
1) Pulmonary embolism
2) Bronchogenic carcinoma
3) Pneumonia
4) Pleurisy
5) Pulmonary embolism - Diagnostic Tests:
1) CXR
2) Sputum microscopy with acid-fast stain and culture (gold standard) - Diagnosis: Tuberculosis
- Treatment:
1) Isolation
2) Isoniazid INH, rifampin, pyrazinamide, & ethambutol (antibiotics)
40 yr old
CC: Productive cough
Other symptoms:
1) Fever/Fatigue
2) Weight loss
3) Night sweats
4) Lymphadenopathy
5) Dyspnea/Productive
cough (hemoptysis) lasting more than 3 weeks
What are the differentials?
What are the diagnostic tests?
What is the diagnosis?
What are the treatment options?
- Differential Diagnoses:
1) Pneumonia
2) Sinusitis
3) Pneumonia
4) Pleurisy
5) Pulmonary embolism - Diagnostic Tests:
1) CXR
2) Sputum microscopy with acid-fast stain and culture (gold standard) - Diagnosis: Tuberculosis
- Treatment:
1) Isolation
2) Antibiotics (INH, rifampin, pyrazinamide, & ethambutol)
40yr old
CC:
Pleuritic chest pain
Other symptoms:
1) Fever/Fatigue
2) Weight loss
3) Night sweats
4) Lymphadenopathy
5) Dyspnea/Productive
cough (hemoptysis) lasting more than 3 weeks
- Differential Diagnoses:
1) Pneumonia
2) Pleurisy
3) Pulmonary embolism - Diagnosis: Tuberculosis
- Diagnostic Tests: CXR, sputum microscopy with acid-fast stain and culture (gold standard)
- Treatment: isolation, INH(isoniazid), rifampin and pyrazinamide, ethambutol
