A nursing home patient is brought by ambulance with a cough. Nursing home staff believe the patient may have aspirated lunch 30 minutes ago. The patient’s workup is normal except for his EKG which is shown below (you can click on it for a much larger/printable version). What’s the diagnosis? What needs to be done with the patient? Does it make any difference whether this was a new finding or an old finding? I’ll provide the answer in the comments section in a couple of days.Read More »
Tag Archives: What’s the Diagnosis?
An elderly patient presents with leg weakness over the prior two days. The day of presentation he also notices pain in his upper back which seems to be fairly persistent. His medical history includes diabetes and renal failure. He was dialyzed the afternoon prior to his presentation and his glucose was 264. The patient’s daughter stated that he “wasn’t acting himself.” The patient’s physical exam was fairly normal. Perhaps a little weakness in his legs, but he still moved all extremities. His current EKG (dark background) and another EKG faxed from a different hospital done six months earlier (light background) are shown below. You can click on them for larger images. What’s the diagnosis and what’s the next step? I’ll post the answer underneath the EKGs in a couple of days. . . . . . . . .Read More »
A patient in her late 60’s comes in with vomiting and some vague abdominal pain over the previous 24 hours. Her husband states that her stomach looks swollen. It does. X-rays below can be clicked upon to give you a higher resolution image if you want one. What is wrong with the patient? What’s the treatment? I’ll post the answer in the comments section in a couple of days. . . . . . . . . . . . . . . . . . . . . . . .Read More »
A breast cancer patient presents with painful rash to her hands and feet for the past 24 hours. The palms and soles were warm and she had a horrible “burning” sensation that didn’t improve with pain medications. Putting ice on her hands and feet seemed to provide her with temporary relief. She started several new medications recently including an an ACE inhibitor, prednisone, pyridoxine, and Vicodin. She had finished one round of chemotherapy and did not have a satisfactory response. Her oncologist had therefore started her on a different regimen several days prior to her emergency department visit. Vital signs were stable. The rash stopped at the wrist creases and the ankles and was nowhere else on her body. CBC and basic chemistries were normal. She had mild relief with IV morphine. The dermatologist on call said that it sounded like contact dermatitis and that he would see the patient in his office the following day. What’s the diagnosis? Why does the rash occur? What is the treatment? I will post the answer in the comments section in a couple of days. . . . . . . . . . . . . .Read More »
A 15 year old girl goes to a pharmacy chain’s walk in clinic with a nonproductive cough and nasal congestion. She is diagnosed with “bronchitis” and is of course given antibiotics. Two days later, she presents with joint pains and the rash below. What’s the diagnosis? What is/are the likely cause(s)? What is the treatment? What two clinical findings are most likely to predict an increased risk of death from this disease? Answers in the comments section in a couple of days.Read More »
A 55 year old patient comes in with itching to her scalp – so bad that it is setting off her migraine headaches. She’s been to her family physician twice already and was first prescribed antibiotics for a scalp infection, then was prescribed steroid lotion for the inflammation. She was feeling worse. When I examined her, she had several bite marks to the base of her neck and over the ears. You could also see the dried hydrocortisone cream in her hair. Then I saw movement and I pulled out the insect pictured. What is the diagnosis and what is the treatment? UPDATE AUGUST 25, 2010 OK, you all are too smart. Head lice, it is. I had never seen a live head louse before and had to look it up on the internet. I knew it wasn’t a bedbug and suspected it was a louse because of the couple of lice nits on the patient’s hair. Treatment recommendations vary. Shaving the head is a radical but curative approach. The American Academy of Pediatrics recommends copious amounts of amoxicillin, then Augmentin if that doesn’t work just came out with an excellent clinical report on head lice last month (.pdf format). Pediculicides (chemicals) such as “Quell,” “Nix” and “Rid” are still the mainstay of treatment according to this paper. Benzyl Alcohol also works well. While oils have been used to remove lice, the report states that their effect is not reproducible. Occlusive agents such as petroleum shampoos, mayonnaise, and herbal oils “have not been evaluated for effectiveness in randomized, controlled trials.” A dessicator can be used to blow hot air on the lice to kill them – with good results. Using a blow dryer to try this at home will cause live lice to become airborne and spread all over your house. Don’t do it.Read More »