Clinical Microvignettes Flashcards
60-year-old woman with long-term estrogen replacement therapy with new onset of vaginal bleeding
Endometrial carcinoma
8-year-old boy with acute scrotal pain; a small “blue dot” is seen through the scrotal skin
Testicular appendage torsion
22-year-old woman with acute onset of lower abdominal pain, hypotension, tachycardia, adnexal mass, and free uid on vaginal ultrasound?
Ectopic pregnancy rupture
70-year-old male retired leather worker, cigarette smoker; presents with painless gross hematuria
Bladder transitional cell carcinoma
22-year-old male who develops a right scrotal hydrocele with elevated serum β-HCG
Testicular Cancer
28-year-old woman involved in a high-speed, side-impact motor vehicle collision (MVC); stable vital signs; chest x-ray reveals widened mediastinum
Toracic aortic injury
55-year-old woman with diabetes, recurrent pyelonephritis, increased creatinine, increased BUN; IVP reveals radiolucent defects in the kidney collecting system
Papillary necrosis
31-year-old man with right ank pain radiating into
scrotum, gross hematuria, right-sided hydronephrosis, and normal abdominal x-ray
Uric acid kidney stone
18-year-old women with fever; costovertebral tenderness; flank mass; and WBCs, RBCs, and gram-negative rods in the urine
Kidney (renal) abscess
65-year-old man with groin pain who goes into septic shock after a rectalprostatic exam
Bacterial prostatitis
19-year-old man status post (s/p) spinal anesthetic for a groin hernia repair returns to clinic with back pain, fever, and decreased left lower extremity sensation and movement
Epidural Abscess
30-year-old woman with thoracic back pain, destruction of thoracic vertebral bodies on x-ray, 1 PPD
Pott’s Disease
22-year-old man s/p MVC with transection of right optic nerve; progresses to blindness in the contralateral le eye 3 weeks later
Sympathetic ophthalmia
29-year-old diabetic with chronic bacterial sinusitis, new-onset seizures, fever, and right-sided weakness
Brain Abscess
28-year-old man with intermittent vertigo, intermittent hearing loss, tinnitus, and a subjective feeling of having ear swelling
Ménière’s disease
16-year-old girl with severe sore throat, lateral uvula displacement, bulging tonsillar pillar, 1 Streptococcus pyogenes
Quinsy’s abscess (peritonsillar abscess)
60-year-old woman with a thyroidmass,1 follicular cellsonbiopsy,1 capsular invasion,1 vascular invasion
Thyroid Follicular Carcinoma
42-year-old woman with thyroidmass,1 amyloid on histology, hypercalcemia
Medullary thyroid carcinoma
25-year-old man with thyroid mass,1 psammomabodies on histology
Papillary thyroid carcinoma
Hypothyroidism, “woody” hard thyroid, tracheal compression
Riedel’s thyroiditis
17-year-old woman with upper respiratory tract infection followed by fever, neck pain, dysphagia, tender thyroidgland,1 strep cultures
Acute suppurative thyroiditis
28-year-old woman
with tender thyroid, hypothyroidism, elevated antimicrosomal antibodies, increased antithyroglobulin antibodies
Hashimoto’s thyroiditis
45-year-oldwomanwith itching of the right nipple for 6 months and a right breast mass
Paget’sdisease(infilltrating ductal carcinoma with spread to the nipple)
60-year-old man with nipple discharge
Male breast cancer
36-year-old woman with arightbreastmassa after hitting her right breast on a door handle
Fat necrosis
39-year-old woman with bilateral milky breast discharge, decreased lateral vision fields, and pituitary mass
Prolactinoma
28-year-old woman with unilateral green-brown nipple discharge increasing immediately before menses?
Fibrocystic disease
WhatistheGCSforan 18-year-old woman s/p MVC in a “coma”?
5-8
28-year-old man involved in high-speed MVC with lower back spine fracture, bladder/ bowel incontinence, decreased lower extremity sensation, and decreased lower extremity strength
Cauda equina syndrome
24-year-old woman with spine fracture; paraplegia but with touch and proprioception intact
Anterior spinal cord syndrome
29-year-old man s/p 45-foot fall with left-sided loss of temperature and pain sensation; right-sided paresis and loss of right-sided proprioception
Brown-Sequard syndrome
18-year-old woman with a cervicalspinalfracturea after diving into a shallow pool; intact perianal sensation and decreased lower extremity sensation and movement
Central cord syndrome
50-year-old woman with painless proptosis and a brain tumor stuck to the dura
Meningioma
24-year-old heavy cigarette smoker with initial onset of foot pain followed by digit necrosis
Buerger’s disease
55-year-old woman with calf claudication, “hourglass” stenosis on angiogram of popliteal artery, and cyst on ultrasound of posterior knee
Cystic degeneration of the popliteal artery
65-year-old woman started on Coumadin alone for atrial fibrillation develops acute DVT
Coumadin-induced hypercoagulable state due to decreased protein C & S
56-year-old woman with hemorrhoids that prolapse with defecation but then retract by themselves
2nd-degree internal hemorrhoids
67-year-old male smoker on Coumadin for chronic DVTnoticesLLQpaina after a strenuous coughing spell; LLQ mass detected on physical exam
Rectus sheath hematoma
34-year-old woman with hemorrhoids that prolapse after defecationandthatshe has to “push back in”
3rd-degree internal hemorrhoids
56-year-old woman with hemorrhoids that are “stuckout”a erabowel movement
4th-degree internal hemorrhoid
61-year-old man develops acute onset of pain and “blurry” vision in the right eye; sees “rings” around lights; states that he feels a little nauseated
Open-angle glaucoma
61-year-old woman with history of left-sided headaches, left temporal tenderness with swelling, pain in the left side of her jaw when she eats, elevated ESR
Temporal Arteritis
2-year-old boy with a “lazy” left eye; left eye has decreased vision and lacks “red refkex”onexam
Retinoblastoma
34-year-old male carpenter develops a decrease in coordination in his hammer hand (right hand); he wakes in the middle of the night with right hand pain and “pins and needles” in the right thumb/index/middle fingers
Carpal tunnel Syndrome
16-year-old boy with right knee pain and fevers; x-ray reveals a distal femur lesion with “sunburst” pattern with a triangle of elevated periosteum
Osteosarcoma
72-year-old man with history of hypertension
and tobacco abuse presents with 20 minutes of left eye blindness. Left carotid bruit is detected on exam
TIA-amurosis fugax
67-year-old man with hypotension, abdominal pain, and an abdominal mass that pulsates
Ruptured abdominal aortic aneurysm
67-year-old female smoker with a history of 25-pound weight loss over 3 months duetoabdominalpaina after eating; nontender abdomen on exam
Chronic mesenteric ischemia
45-year-old man with long- term left lower leg swelling develops a nonhealing sore over the left medial malleolus
Venous Stasis Ulcer
6-year-old child with finger clubbing and history of cyanosis as an infant develops anxiety/increase in respiratory rate and cyanosis with strenuous exercise that is relieved by “squatting down”
Tetralogy of Fallot
57-year-old man develops confusion and wide swings in heart rate and systolic blood pressure POD #2
after an appendectomyfora perforated appendix;
Sats5 99%,HCTstable, electrolytes normal, chest x-ray normal
Alcohol withdrawal
54-year-old woman with
reflux disease and columnar epithelium on distal esophageal biopsy
Barrett’s Esophagus
56-year-old alcoholic woman receives D51/2 NS IV bolus in the ER; she develops confusion, ataxia, and inability of gaze laterally
Wernicke’s encephalopathy
POD #1a erbariatric gastric bypass a 34-year-old woman develops fever and crackles on chest auscultation
Atelectais
24-year-old man with ulcerative colitis receives Lomotil for excessive diarrhea and develops fever, abdominal pain and tenderness, and a massively dilated colon on abdominal x-ray
Toxic Megacolon
28-year-old man with nonbloody diarrhea, low-grade fever, abdominal pain, perirectal abscesses, perianal fistulae
Crohn’s disease
45-year-old man back from a visit to South America who was exposed to Trypanosoma cruzi now presents with dysphagia
Chagas disease
54-year-old woman with dysphagia (to both liquid and solids) and intermittent chest pain; food “comes up” after fallingasleepat night; manometry reveals high LES pressures that do not decrease with swallowing; absent esophageal peristalsis
Achalasia
28-year-old man with groin mass,vomiting,air-fluid levels on abdominal x-ray
Incarcerated inguinal hernia
19-year-old woman involved in a high-speed MVC and was thrown unrestrained into the windshield; she has a GCS of 15 at the scene and initially upon admission to the ER; she then becomes comatose with a GCS of 3
Epidural hematoma and “lucid interval”
Patient with head trauma and a peripheral “crescent”-shaped hematoma on CT
Subdural hematoma
Patient with head trauma and a peripheral “lenticular” (lens-like) hematoma on CT
Epidural hematoma
21-year-old man involved
in high-speed MVC with obvious unstable pelvis, gross blood from the urethral meatus, high-riding prostate on rectal exam
Urethral injury
45-year-old woman involved in high-speed MVC complains of abdominal pain and shortness of breath; decreased breath soundsonthe left ;chest x-ray reveals the NGT tube coiled up in the left chest
Ruptured left diaphragm
56-year-old involved in a high-speed motorcycle collision complains of severe shortness of breath. On exam the left chest wall moves inwards not outwards on inhalation
Flail Chest - “paradoxic respirations”
67-year-old involved in a high-speed MVC presents with a GCS of 5, bilateral periorbital ecchymosis, le mastoid ecchymosis, and clear uid draining form the le ear
Basilar skull fracture—Battle’s and raccoon signs
Femur fracture, dyspnea, mental status changes, tachycardia, petechiae
Fat embolism syndrome
Pain over the anatomic “snuffbox”
Scaphoid/navicular fracture
Pain on passive exion/ extension, arm or leg pain “out of proportion to injury”
Extremity compartment syndrome
34-year-old in the ICU s/p Iaparotomy with fascia closed, decreased urine output, increased peak airway pressure, decreased CVP, normal chest x-ray, normal EKG
Abdominal compartment syndrome
Hypoxia after braininjury without lung injury, no fractures, no DVTs
Neurogenic pulmonary edema
Coagulopathy afer isolated brain injury
Brain thromboplastin
Midline laparotomy wound that drains continuous straw-colored fluid
fascial dehiscence
POD #1 with bright red wound infection
Streptococcus infection
POD #1 with painful wound and weeping bronze-colored fluid
Costridial wound infection
8-year-old boy with a history of claudication when running, epistaxis, decreased left extrimity (LE) pulses, and headaches
Aorctic coarctation
6 year old girl with purpuric rash, abdominal pain, hematuria, and joint pain,
Henoch-Schonlein Purpura
Recurrent pneumonias, infiltrate on chest x0ray, no bronchus leading to area of infiltrate
pulmonary sequestration
29-year-old male smoker with necrotic fingers
Buerger’s disease
Skier with fingers that go from white to blue to red
Raynaud’s phenomenon
LAP chole POD #3, fever, RUQ fluid collection, no biliary dilation
Biloma(MC caus of cysttic duct leak)
POD #7 following laparoscopic cholecystectomy— jaundice and dilated intrahepatic biliary ducts
Clipping or transection of common bile duct
21-year-oldwomanwith fever, leukocytosis, lower abdominal pain,
1 chandeliersign
PID(pelvic inflammatorydisease)
45-year-old female with CHF, diastolic murmur, atrial fibrillation, atrial hypertrophy
Mitral Stenosis
33-year-old old woman with jaundice, fever, RUQ pain, hypotension, and confusion
Suppurative cholangitis
29-year-old woman with a mass below inguinal ligament
Femoral hernia
43-year-old woman with RUQ pain and right subscapular pain for
2 hours intermittently over 4 months
Biliary colic
19-year-old man in motorcycle crash with knee dislocation and loss of pedal pulses
Thrombosed popliteal artery
34-year-old woman POD #2 gastric bypass with tachycardia and vague abdominal discomfort
Anastomotic leak
Elderly man with shortened and inverted LE
Hip dislocation
28-year-old woman on BCPs with abdominal pain “out of proportion to exam”; SMA open on Doppler
SMV thrombosis
Pregnant 22-year-old woman with LUQ pain and hypotension
Ruptured splenic aneurysm
S/P gastrojejunostomy with postprandial tachycardia, diarrhea, and abdominal pain
Dumping syndrome
27-year-old woman who following menses develops rash, hypotension, and fever
Toxic Shock Syndrome
Claudication, impotence, atrophy of thigh
Leriche syndrome
56-year-old man on IV Heparin with atrial
fibrillation develops thrombocytopenia
Heparin induced thrombocytopenia
56-year-old male alcoholic with new-onset NGT feeds develops hypokalemia, hypophosphatemia, and hypomagnesemia
Refeeding syndrome
39-year-old man with caput medusae, hemorrhoids, and splenomegaly
Portal hypertension
58-year-old male smoker with oat cell cancer of the lung and hyponatremia
SIADH
28-year-old woman s/p total abdominal colectomy and ileostomy now with increased ileostomy output and U waves on EKG
Hypokalemia
51-year-old man with alcoholic cirrhosis has a sodium level of 127. The intern corrects the sodium to 140 in 1 hour with hypertonic saline and reveals neurologic signs and symptoms
Central Pontin demyelinosis
