Which of the following is the most likely diagnosis?

A. Erythema multiforme

B. Annular urticaria

C. Secondary syphilis

D. Fixed drug eruption

E. Polymorphous light eruption A. Erythema multiforme.

Presents with target lesions favoring the extensor extremities.

Without a hx, one must discover distinguishing features in the clinical photo to arrive at the correct diagnosis.

On the dorsal hand, there are variable edematous urticarial papules, some of which feature three zones:

*a dusky center surrounded by two concentric rings of different colors

Although not all of the lesions are fully developed, based on the presence of typical targets, EM is the best answer

A 20-wks pregnant patient is admitted to ICU with septic shock.

Culture reveals listeria.

The patient is known to have had severe anaphylactic reactions to penicillin

What is the drug of choice for this patient?

A) TMP-SMX

B) Clindamycin

C) Vancomycin

D) Ciprofloxacin Answer:

A) TMP-SMX

In immunocompromised patients, including pregnant women, listeriosis can present as life-threatening sepsis and/or central nervous system (CNS) infection (invasive infection).

In this clinical setting, the mean incubation period is 11 days.

The manifestations of CNS infection include

meningoencephalitis,

cerebritis,

rhombencephalitis (infection and inflammation of the brain stem),

brain abscess, and

spinal cord abscess

65 year old female on day 7 post colectomy with primary anastomosis.

Dysponea ?infective changes.

Decreased breath sounds at both bases.

Findings?

Cause? Answer

Subdiaphragmatic free gas secondary to anastomotic leak

🔴

Radiograph

Large volume of free subdiaphragmatic gas with air-fluid levels under both hemidiaphragms.

Bil pleural effusions and bibasal collapse/consolidation.

Cardiomediastinal contour is within normal limits.

Surgical clips project over the LUQ.

Which of these patterns of treatment of MRSA bloodstream infections significantly decreased odds of all-cause mortality?

Early use (within 3 days) of daptomycin

Early use (within 3 days) of vancomycin

Any use of daptomycin

Any use of vancomycin Answer

Early use (within 3 days) of daptomycin

●A meta-analysis aimed to compare the effectiveness of vancomycin vs daptomycin for the prevention of mortality among adult patients with MRSA bloodstream infections.

●The researchers found that daptomycin treatment was associated with nonsignificant odds of all-cause mortality compared with vancomycin treatment;

*subanalyses revealed that switching to daptomycin from vancomycin within 3 or 5 days made the association significant, decreasing the odds of all-cause mortality by 55% and 45%, respectively.

●However, switching to daptomycin from vancomycin after 5 days of treatment was not significantly associated with reduced odds of mortality.

●An additional meta-analysis indicated that daptomycin should particularly be considered in patients with intermediate- and high-risk sources of bacteremia.

Early (IV) administration of dexamethasone in bacterial meningitis particularly decreases the risk of?

A) hearing loss

B) vision loss Answer:

A) hearing loss

●The use of corticosteroids (typically, dexamethasone, 0.15 mg/kg every 6 hours for 2-4 days) as adjunctive treatment for bacterial meningitis improves outcome by attenuating the detrimental effects of host defenses (eg, inflammatory response to the bacterial products and the products of neutrophil activation).

●Corticosteroids for acute bacterial meningitis. showed that adjunctive corticosteroids were effective in reducing hearing loss and neurological sequelae in patients with bacterial meningitis caused by all pathogens particularly H.influenza.

Interesting case!

10 years old male with 4 days of worsening of long-standing intermittent abdominal distension and diffuse abdominal pain.

Thoughts? Sigmoid volvulus

Radiograph

Grossly dilated large bowel loops.

Dilated bowel with fecal material, predominantly on the right.

A kidney/coffee bean sign with a thick inner wall of opposed bowel loops compared single layered outer walls is identified.

Additionally, the Frimann-Dahl sign with three dense lines of sigmoid walls converging towards the right pelvis.

Bilateral psoas shadows are obscured.

No pneumoperitoneum or air-fluid levels.

No abnormal soft tissue densities or calcifications.

The chest X-ray shows no sub-diaphragmatic free air and is generally unremarkable.

60-yr-old male

swelling over the right side of the face for 20 years

The swelling remained static initially, which gradually increased in size for the last five years and was not associated with any sudden increase in size

He had no other complaints

Likely diagnosis? Pleomorphic adenoma

Post-contrast CECT

A: Coronal, and B: Axial view showing a well-defined fluid attenuating cystic lesion (red arrow) with an eccentric, enhancing nodular solid component (yellow arrow) in the right parotid region.

Fine-needle aspiration cytology (FNAC) from the lesion showed features suggestive of PA.

The patient underwent a right superficial parotidectomy.

Which of the following is NOT a common cause of metabolic alkalosis?

A.
Diuretic use

B.
Hyperkalemia

C.
Hypovolemia

D.
Prolonged vomiting Answer:

B: Hyperkalemia

Causes of Metabolic Alkalosis

10-yr-old, fully conscious, boy

with 1 M hx of a gradually appearing almond-sized, swelling on the right side of the head with dull aching pain.

👉 increased to the size of a walnut with increase in the intensity of pain for last 15 days

👉 became pulsatile and at the same time pain continued unabated

Thoughts?


A plain CT-scan of the head with bone window revealed eroded right parietal bone with subperiosteal debris and extradural hematoma of mixed density.

This pt presented with jaw pain

found to have an ⤴️ alkaline phosphatase and a normal serum creatinine

Which one of the following tests would confirm the diagnosis?

Bone scan

IGF-1

Serum calcium

Abdominal usg

Testing the fn of the facial N Answer

Bone scan

Paget's disease, acromegaly, and renal osteodystrophy are among the causes of jaw enlargement, visible in this image.

Man in his 50s without any significant medical hx

admitted in (ICU) for coma following seizures

Had recent abdominal pain and hepatitis

Sx progressively ⤴️ within the last few wks with asthenia, HA and drowsiness

Thoughts?

Neurological examination at ICU admission revealed tetrapyramidal syndrome and comatose state requiring mechanical ventilation.

This neonate presented with tachypnea, pulmonary hypertension, respiratory distress, and early heart failure

Diagnosis?

Sign? Scimitar Sign:

produced by an anomalous pulmonary vein that drains any or all of the lobes of the right lung.

51-yr-old man

Rash, abnormal kidney function, hypercalcaemia, and proteinuria

What is the most likely aetiology of his disease?

Multiple myeloma
Sarcoidosis
Tuberculosis
Histoplasmosis Answer

Ichthyosis in sarcoidosis:

A girl born by normal vaginal delivery at 34 weeks’ gestation 👉 discrete midline scalp swelling from birth

non-tender, non-pulsatile and measured 10 mm in diameter

At 4 wks of age👉 tuft of hair over it, with a surrounding erythematous and non-indurated area

Sign?Diagnosis? Sinus pericranii in a neonate with the scalp hair tuft sign

55 year old male with history of severe sleep apnea

Chest radiograph shows..... The 'INSPIRE' device battery pack overlies the right lower chest.

A lead to the tongue base extends upward toward the neck, out of the field of view.

A disconnected diaphragm lead also extends over the right mid chest.

This neonate had this cherry-red mass in the umbilicus.

Diagnosis? Answer

Umbilical Granuloma

38-year-old man

👉presented with fatigue, dyspnea on exertion and minor bleeding of the gums

Diagnosis? 👉examination revealed gum hypertrophy and an extensive petechial rash

👉Hb 53 (normal 135–175) g/L,

👉 leukocyte count was 110.7 (normal 4.5-11.0) × 109/L

👉 platelet count was 25 (normal 150–400) × 109/L.

👉 had a normal coagulation profile

19-yr-old man 👉 pedal oedema and facial puffiness of 3 M' duration

👉 denied h/o orthopnoea, PND, oliguria, haematuria, fever, sore throat, joint pains, rashes, exposure to heavy metals, or any drug abuse

Urinalysis 👉 dysmorphic red cells, albuminuria (4+);

Diagnosis? 👉 examination showed periorbital swelling, pallor, Mees' lines (figure), and pedal oedema.

Systemic examination was unremarkable.

34 year old male with HIV

Diagnosis? Answer

HIV photodermatitis

👉 a presenting feature of a myriad of clinical conditions, which should be considered in patients with HIV/AIDS

👉who present with a pruritic, photodistributed eruptio

Drug-induced photosensitivity remains a frequent clinical concern.

Comment on this combination! ‘CHARGE’ is an acronym that describes a constellation of clinical features including

Coloboma,

Heart defects,

choanal Atresia,

Retardation (of growth and/or development),

Genitourinary malformation and

Ear abnormalities.

69-yr-old woman

👉new-onset, asymptomatic HTN and hypokalemia

👉 physical examination was normal

👉mean 24-hr ambulatory blood pressure was 220/110 mm Hg

👉 serum creatinine level was 74 (normal 44–97)

👉 serum K was low at 2.8

👉 10 mg amlo once daily

Thoughts? 👉plasma metanephrines were normal

👉 plasma renin was 12.0 (normal 0.3–2.2) nmol/L/h,

👉 aldosterone was 1765 (normal < 630) pmol/L

👉 aldosteroneto-renin ratio was 147 (normal < 800)