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Questions and Answers
What is the most likely mechanism of this patient's jaundice?
What is the most likely mechanism of this patient's jaundice?
What is the most appropriate next step to confirm the cause of the oliguria?
What is the most appropriate next step to confirm the cause of the oliguria?
What is the most appropriate next step in evaluation of the urinary tract?
What is the most appropriate next step in evaluation of the urinary tract?
What is the most likely diagnosis for bloody discharge from the right nipple?
What is the most likely diagnosis for bloody discharge from the right nipple?
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What is the most appropriate next step in management for a patient with a tender mass on her left breast?
What is the most appropriate next step in management for a patient with a tender mass on her left breast?
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Over the next 10 years, this patient is at greatest risk for which of the following?
Over the next 10 years, this patient is at greatest risk for which of the following?
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What is the most appropriate next step in diagnosis for the patient with a scrotal hematoma?
What is the most appropriate next step in diagnosis for the patient with a scrotal hematoma?
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What is the most likely diagnosis for a patient with irritability, frequent bowel movements, and a thyroid nodule?
What is the most likely diagnosis for a patient with irritability, frequent bowel movements, and a thyroid nodule?
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What is the most appropriate pharmacotherapy for the patient showing circumoral paresthesia after thyroid surgery?
What is the most appropriate pharmacotherapy for the patient showing circumoral paresthesia after thyroid surgery?
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Which of the following is the most appropriate next step in management for arterial blood gas analysis with pH 7.25, Pco2 60 mm Hg, and Po2 70 mm Hg?
Which of the following is the most appropriate next step in management for arterial blood gas analysis with pH 7.25, Pco2 60 mm Hg, and Po2 70 mm Hg?
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Which of the following mechanisms is the most likely cause of arterial blood gas findings with pH 7.31, Pco2 56 mm Hg, and Po2 72 mm Hg?
Which of the following mechanisms is the most likely cause of arterial blood gas findings with pH 7.31, Pco2 56 mm Hg, and Po2 72 mm Hg?
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Which of the following is the most likely diagnosis for a patient involved in a head-on motor vehicle collision with decreased breath sounds over the left lung base?
Which of the following is the most likely diagnosis for a patient involved in a head-on motor vehicle collision with decreased breath sounds over the left lung base?
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Which of the following is the most appropriate next step in diagnosis for a patient with fever and left pleural effusion after splenectomy?
Which of the following is the most appropriate next step in diagnosis for a patient with fever and left pleural effusion after splenectomy?
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Which of the following is the most likely diagnosis for a 25-year-old woman with chronic abdominal cramps and stool mixed with mucus?
Which of the following is the most likely diagnosis for a 25-year-old woman with chronic abdominal cramps and stool mixed with mucus?
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What is the most appropriate colon cancer screening for a 33-year-old man with a history of ulcerative colitis?
What is the most appropriate colon cancer screening for a 33-year-old man with a history of ulcerative colitis?
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What is the most appropriate next step in management for a 67-year-old man with unresolved gastroesophageal reflux disease symptoms after maximum proton pump inhibitor therapy?
What is the most appropriate next step in management for a 67-year-old man with unresolved gastroesophageal reflux disease symptoms after maximum proton pump inhibitor therapy?
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What is the most appropriate next step in management for a 67-year-old woman with rectal bleeding and diverticula?
What is the most appropriate next step in management for a 67-year-old woman with rectal bleeding and diverticula?
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What is the most appropriate next step in diagnosis for a 57-year-old woman with dysphagia and a benign stricture found during endoscopy?
What is the most appropriate next step in diagnosis for a 57-year-old woman with dysphagia and a benign stricture found during endoscopy?
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What is the most appropriate analgesic pharmacotherapy for a patient with postoperative pain after inguinal hernia repair?
What is the most appropriate analgesic pharmacotherapy for a patient with postoperative pain after inguinal hernia repair?
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What is the most likely diagnosis for a 5-week-old boy with progressive jaundice and white stools?
What is the most likely diagnosis for a 5-week-old boy with progressive jaundice and white stools?
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What is the most likely mechanism of the patient's condition after having a transfusion?
What is the most likely mechanism of the patient's condition after having a transfusion?
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What is the most likely diagnosis in a 62-year-old woman after a blood transfusion who has shortness of breath?
What is the most likely diagnosis in a 62-year-old woman after a blood transfusion who has shortness of breath?
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What is the most appropriate next step in management of the 18-year-old patient's abdominal injuries?
What is the most appropriate next step in management of the 18-year-old patient's abdominal injuries?
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What is the most likely cause of this patient's persistent hypotension?
What is the most likely cause of this patient's persistent hypotension?
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What is the most appropriate next step in management for the 20-year-old woman with headaches and blurred vision?
What is the most appropriate next step in management for the 20-year-old woman with headaches and blurred vision?
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What is the most likely diagnosis for the lesion on the 76-year-old man's nose?
What is the most likely diagnosis for the lesion on the 76-year-old man's nose?
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What is the most appropriate next step in management of the man's enlarging lesion on the forearm?
What is the most appropriate next step in management of the man's enlarging lesion on the forearm?
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What is the most appropriate next step in management of the man found on the snow-covered mountain?
What is the most appropriate next step in management of the man found on the snow-covered mountain?
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What is the most likely diagnosis for the 87-year-old man with black skin on his leg?
What is the most likely diagnosis for the 87-year-old man with black skin on his leg?
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What is the most appropriate next step in management of the 67-year-old woman with a swollen leg?
What is the most appropriate next step in management of the 67-year-old woman with a swollen leg?
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What is the most likely cause of tachycardia in the hospitalized 77-year-old woman?
What is the most likely cause of tachycardia in the hospitalized 77-year-old woman?
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If the 37-year-old man with severe shortness of breath is not treated, he will be at increased risk for what?
If the 37-year-old man with severe shortness of breath is not treated, he will be at increased risk for what?
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What is the most appropriate next step for the patient 3 hours after partial colectomy with shortness of breath?
What is the most appropriate next step for the patient 3 hours after partial colectomy with shortness of breath?
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What is the most appropriate next step for the 57-year-old woman who is agitated and tachypneic after colon resection?
What is the most appropriate next step for the 57-year-old woman who is agitated and tachypneic after colon resection?
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Study Notes
### Transfusion Reactions
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A 43-year-old male experiences sudden shortness of breath, pain at the IV site, and back pain while receiving a packed red blood cell transfusion, one day after splenectomy.
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He is diaphoretic with vital signs including a temperature of 37.2°C, pulse of 90/min, respirations of 24/min, and blood pressure of 120/60mmHg.
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His oxygen saturation is 97% on room air.
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The most likely mechanism of these findings is endotoxin release from infused bacteria.
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A 62-year-old female experiences shortness of breath immediately after beginning a transfusion of fresh frozen plasma and packed red blood cells.
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She has a history of mechanical valve replacement for aortic stenosis.
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Vital signs are: temperature 37.8°C, pulse 110/min, respirations 28/min, blood pressure 100/60mmHg.
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Oxygen saturation is 82% on room air.
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Crackles are heard from the lung bases to the midlung fields.
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The most likely diagnosis is transfusion-related acute lung injury.
Trauma
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An 18-year-old male is brought to the emergency department 30 minutes after being thrown from a motorcycle, sustaining head, chest, and abdominal injuries.
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He received 2L of crystalloid en route.
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Vital signs on arrival are: temperature 35.9°C, pulse 110/min, blood pressure 115/90 mmHg.
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Glasgow Coma Score is 11.
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He has multiple ecchymoses and abrasions.
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His hematocrit is 29%.
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CT scan of the head shows diffuse axonal injuries.
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Chest x-ray shows pulmonary contusion.
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The most appropriate next step in the management of his abdominal injuries is a repeat CT scan in 24 hours.
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A 20-year-old man is brought to the emergency department 50 minutes after being involved in a motor vehicle collision.
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He was an unrestrained passenger.
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He reports neck pain and numbness in both legs with an inability to move them.
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Vital signs are: temperature 37.2°C, pulse 70/min, respirations 20/min, blood pressure 80/50 mmHg.
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Cervical spine is tender with sensation absent below the mid-chest.
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After 2L of crystalloid, his blood pressure does not improve.
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The most likely cause of his persistent hypotension is a spinal cord injury.
Neurology
- An 18-year-old woman presents with a 3-week history of headache worsening to the point of blurry vision.
- Her mother has a history of migraines.
- She is 163cm tall, weighs 91kg with a BMI of 34kg/m2.
- Vital signs are: temperature 37°C, pulse 76/min, respirations 16/min, blood pressure 140/80mmHg.
- Funduscopic examination reveals bilateral papilledema.
- CT scan of the head without contrast is normal.
- The most appropriate next step in management is a lumbar puncture.
Dermatology
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A 76-year-old man presents with a gradually increasing lesion on his nose for the past 5 years.
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He has hypercholesterolemia treated with atorvastatin.
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The lesion is 1cm in size.
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Examination reveals no lymphadenopathy.
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The most likely diagnosis is a basal cell carcinoma.
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A 65-year-old man presents with an enlarging lesion on his left forearm for 6 months.
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The lesion is painless and non-itchy, with no bleeding or shape change.
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The most appropriate next step in management is an excision with 1-cm margins.
### Emergency Medicine
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A 47-year-old man is brought to the emergency department after being found on a snow-covered mountain.
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He became lost while cross-country skiing and reports numbness in his toes.
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Vital signs are: temperature 36°C, pulse 60/min, respirations 16/min, blood pressure 120/65mmHg.
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Examination reveals pale toes bilaterally with blisters on the 4th and 5th toes.
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Sensation to touch is absent over the toes bilaterally.
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Pedal pulses are faintly palpable bilaterally.
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Ankle brachial index (ABI) is 0.85 bilaterally (N>1).
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After immersion of feet in 104°F water bath, his feet become painful.
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The most appropriate next step in management, in addition to acetaminophen, is hospital admission for observation.
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An 87-year-old man is transferred to the hospital from a skilled nursing facility after staff noticed black skin on his right leg.
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He has a history of three strokes, hypertension, and type 2 diabetes mellitus.
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Current medications include metoprolol, glipizide, and clopidogrel.
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He is not communicative and only responds to painful stimuli.
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Examination reveals black skin over the right ankle and foot with absent pulses distally.
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The most appropriate next step in management is arteriography with contrast.
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A 47-year-old woman presents with a 2-year history of a lump on her right ankle that has increased in size over the past 2 months.
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The lump is slightly painful only during activity.
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Examination reveals a 2.8cm raised lesion that is firm and adherent to the bone with no skin changes or lymphadenopathy.
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Full range of motion in the ankle is present.
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X-ray of the right lower extremity is shown.
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The most appropriate next step in management is a biopsy of the lesion.
### Surgery
- A 72-year-old man presents with increasing abdominal pain 3 days after undergoing emergency partial gastrectomy for upper gastrointestinal hemorrhage.
- He has a history of hypertension and type 2 diabetes mellitus, and he underwent coronary angioplasty with stent placement 2 years ago.
- Current medications include patient-controlled morphine, and subcutaneous unfractionated heparin.
- He is anxious and diaphoretic.
- Vital signs are: temperature 37.2°C, pulse 110/min, respirations 20/min, blood pressure 145/90mmHg.
- Examination shows an upper midline incision without signs of infection.
- His hematocrit is 32% and leukocyte count is 8000/mm3.
- The most appropriate next step in management, in addition to administering morphine, is a CT scan of the abdomen.
### Cardiology
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A 62-year-old woman presents for a routine health maintenance examination.
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She is a non-smoker and only drinks socially.
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A systolic ejection murmur is best heard over the second right intercostal space with transmission to the carotid arteries.
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ECG shows normal sinus rhythm and a pattern of left ventricular hypertrophy with strain.
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Manifestations that would indicate the need for aortic valve replacement include angina and syncope.
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A 77-year-old man presents to the emergency department 5 hours after being awakened by severe pain in his left leg.
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He reports numbness in his left foot and cannot move it or his toes.
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He has a history of stable claudication of both calves, hypercholesterolemia, and type 2 diabetes mellitus.
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He was recently diagnosed with atrial fibrillation.
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His current medications are aspirin and digoxin.
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Vital signs are: pulse 84/min and irregularly irregular, and blood pressure 145/85 mmHg.
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The left lower extremity is pale and cool below the knee.
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Femoral pulses are 1+ on the right and absent on the left.
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The most likely diagnosis is a left femoral artery embolism.
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A 67-year-old woman develops swelling of her left leg 3 days after Roux-en-Y choledochojejunostomy for an obstructing cancer of the head of the pancreas.
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Venous Doppler ultrasonography is positive.
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The next step in management is anticoagulant therapy with heparin.
### Respiratory
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A 77-year-old woman develops tachycardia two hours after admission to the hospital for injuries sustained in a motor vehicle collision.
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She was the restrained driver of a vehicle that struck a tree head-on.
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She sustained bilateral anterior fractures of the 5th and 6th ribs.
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On admission, ECG showed occasional premature atrial contractions and 1L of lactated Ringer solution was administered.
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Vital signs are: temperature 37.4°C, pulse 100/min and irregular, respirations 24/min, blood pressure 110/60 mmHg.
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Posterior crackles are heard over the lower quarter of the lung fields bilaterally.
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Her hematocrit is 43%.
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The most likely cause of the cardiovascular findings is cor pulmonale.
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A 37-year-old man presents with his wife due to a 10-week history of severe shortness of breath after walking one block and swelling in his legs.
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His wife reports he has snored for many years and has episodes every night where he stops breathing for 15 seconds and then wakes up.
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He's been experiencing constant daytime fatigue for the past three months.
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He has a history of hypertension and type 2 diabetes mellitus.
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Vital signs are: pulse 90/min, respirations 24/min, blood pressure 144/88mmHg.
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Oxygen saturation is 96% on room air.
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Examination shows decreased air movement at the lung bases with scattered rhonchi.
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Heart sounds are distant with brawny induration and 3cm granulating ulcers above the medial malleoli bilaterally.
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He has 3+ pitting edema to the mid-tibia bilaterally.
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Arterial blood gas analysis on room air shows a PCO2 of 50mmHg and a PO2 of 52 mmHg.
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If left untreated, this patient will be at increased risk for cor pulmonale.
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A 62-year-old man presents to the emergency department 3 hours after the onset of shortness of breath at rest.
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He was recently discharged from the hospital after undergoing a partial colectomy due to a diverticular abscess.
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He is in mild respiratory distress.
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Vital signs are: temperature 37°C, pulse 110/min, respirations 22/min, blood pressure 140/98mmHg.
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Lung auscultation is clear.
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Oxygen saturation is 89% on room air.
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Oxygen via nasal cannula improves his symptoms.
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Chest x-ray shows no abnormalities.
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ECG shows sinus tachycardia.
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The next step in management is heparin therapy.
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A 57-year-old woman presents with tachypnea and agitation one hour after undergoing a colon resection for a sigmoid carcinoma.
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She was extubated in the operating room and is receiving 30% oxygen by nasal cannula.
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Vital signs are: pulse 120/min, respirations 40/min, blood pressure 135/90 mmHg.
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Breath sounds are shallow and symmetrical.
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Heart sounds are normal.
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Arterial blood gas shows pH 7.25, PCO2 60mmHg, PO2 70mmHg.
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The next step in management is intubation.
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A 42-year-old man presents for an examination prior to undergoing gastric bypass.
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He reports a 2-month history of shortness of breath after walking less than a half block.
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He has hypertension treated with hydrochlorothiazide.
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Vital signs are: pulse 84/min, respirations 14/min, blood pressure 132/82mmHg.
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Oxygen saturation is 96% on room air.
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Examination shows decreased breath sounds bilaterally with decreased heart sounds.
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Arterial blood gas on room air shows: pH 7.31, PCO2 56 mmHg, PO2 72 mmHg.
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The most likely cause of these findings is a ventilation-perfusion mismatch.
### General Medicine
- A 32-year-old woman is brought to the emergency department 30 minutes after being involved in a head-on motor vehicle collision.
- She was the unrestrained front seat passenger.
- She is alert.
- Vital signs are: temperature 36.8°C, pulse 110/min, respirations 16/min, blood pressure 140/85 mmHg.
Case 20 - Chest X-ray Findings
- A 32-year-old unrestrained woman is brought to the emergency department 30 minutes after a head-on motor vehicle collision.
- She is alert with ecchymoses on her forehead, left chest, and upper abdomen.
- Pupils are equal and reactive to light, no jugular venous distention, and normal heart sounds.
- Decreased breath sounds are heard over the left lung base.
- Abdominal examination reveals epigastric tenderness and chest x-rays.
- The most likely diagnosis is Hemothorax due to the decreased breath sounds over the left lung base and potential for trauma-related internal bleeding.
Case 21 - Postoperative Complications
- A 25-year-old woman undergoes splenectomy for refractory bleeding after being kicked by a horse.
- Seven days postoperatively, the patient experiences fever (39°C), malaise, and decreased breath sounds on the left.
- Laboratory findings reveal a left shift in leukocyte count (25,000/mm³) and a left pleural effusion on chest x-ray.
- The most appropriate next step in diagnosis is a CT scan of the abdomen to assess for potential post-splenectomy complications, such as infection or abscess formation.
Case 22 - Intermittent Abdominal Cramps
- A 25-year-old previously healthy woman presents with 4 months of intermittent abdominal cramps and occasional mucus in stools.
- The patient is underweight (BMI: 16 kg/m²) with mild tenderness in the right lower quadrant.
- Rectal examination reveals brown stool and positive occult blood.
- The most likely diagnosis is Crohn’s disease due to the intermittent abdominal pain, mucus in stools, and positive occult blood in a young patient with a history of low BMI.
Case 23 - Intermittent Bright Red Rectal Bleeding
- A 16-year-old boy presents with a 6-month history of intermittent bright red rectal bleeding.
- Endoscopy reveals scattered polyps throughout the colon, biopsied and confirmed as dilated, cystic, mucus-filled glands with abundant lamina propria and inflammatory infiltrates.
- The most likely diagnosis is Juvenile Polyposis due to the age of onset, intermittent rectal bleeding, and endoscopic findings of scattered polyps with characteristic histopathology.
Case 24 - Colon Cancer Screening
- A 33-year-old man with a 13-year history of well-controlled ulcerative colitis on mesalamine presents for colon cancer screening.
- His mother has Type 2 diabetes and his father was diagnosed with colon cancer at age 55.
- The patient does not smoke, drinks minimally, and has no other health concerns.
- The most appropriate colon cancer screening for this patient is colonoscopy now due to his personal history of inflammatory bowel disease and family history of colon cancer.
Case 25 - Barrett's Esophagus
- A 67-year-old man with a 2-year history of gastroesophageal reflux disease (GERD) presents for follow-up.
- He has not achieved symptom relief despite maximal proton pump inhibitor therapy.
- Esophagogastroduodenoscopy (EGD) reveals grade III esophagitis and Barrett's esophagus with mild dysplasia.
- Following successful Nissen fundoplication and symptom resolution, the most appropriate next step is repeat EGD and biopsy in 6 months to monitor for any changes in the Barrett's esophagus, particularly dysplasia progression.
Case 26 - Rectal Bleeding
- A 67-year-old woman presents with rectal bleeding of 6 hours duration.
- Colonoscopy reveals maroon blood and stool throughout the colon and a radiolabeled erythrocyte scan shows activity in the right lower quadrant.
- Despite a recent history of diverticula and a recent blood transfusion, the most appropriate next step in management is capsule endoscopy to evaluate for potential bleeding sources in the small bowel, as the radiolabeled erythrocyte scan suggests possible upper gastrointestinal bleeding.
Case 27 - Halitosis and Dysphagia
- A 62-year-old woman presents with progressive dysphagia, spontaneous regurgitation of undigested food, halitosis, and weight loss over the past 2 years.
- The most appropriate next step in diagnosis is esophagogastroduodenoscopy (EGD) to evaluate for potential causes of dysphagia, such as strictures, esophageal cancer, or a Zenker’s diverticulum.
Case 28 - Epigastric Pain and Nausea
- A 57-year-old man presents with a 4-week history of mild epigastric pain and nausea 1 hour after meals.
- He has no other gastrointestinal symptoms, a normal examination, and a positive stool occult blood test.
- The most appropriate next step in management is esophagogastroduodenoscopy (EGD) to evaluate for potential causes of the symptoms, such as gastritis, peptic ulcer disease or a malignancy.
Case 29 - Severe Abdominal Cramping
- A 53-year-old woman with a 3-year history of ulcerative pancolitis presents with worsening abdominal cramping and malaise.
- She had hematochezia 4 days ago and has not responded to prednisone therapy.
- Abdominal examination reveals distention, diminished bowel sounds, and tenderness.
- X-rays show gas distending the colon.
- The most likely diagnosis is toxic megacolon due to the patient's history of ulcerative colitis, severe abdominal pain, fever, and radiographic findings of colonic distention.
Case 30 - Abdominal Cramps and Bleeding
- A 72-year-old man presents with abdominal cramps and bright red rectal bleeding 6 hours after a surgical resection of an infrarenal abdominal aortic aneurysm.
- He had a hemorrhage during the operation and received 6 units of packed red blood cells.
- The most likely diagnosis is aortoenteric fistula due to the recent aortic aneurysm surgery, abdominal cramps, and bright red rectal bleeding.
Case 31 - Abdominal Distention and Obstipation
- A 77-year-old woman presents with abdominal distention and obstipation for 2 days, with no history of abdominal surgery.
- A plain abdominal x-ray confirms the likely diagnosis of volvulus of the sigmoid colon, which is a twisting of the sigmoid colon leading to obstruction.
Case 32 - Rectal Pain, Itching, and Bleeding
- A 37-year-old woman presents with rectal pain, itching, and bleeding with bowel movements.
- Digital rectal examination reveals tender and inflamed rectal tissue.
- The most appropriate next step in diagnosis is anoscopy due to the presenting symptoms and digital rectal findings, which suggest a potential cause in the anal canal.
Case 33 - Severe Abdominal Pain
- A 42-year-old woman presents with severe abdominal pain, fever, and chills.
- She has had episodes of epigastric and right upper quadrant pain for 2 weeks, with some relief from antacids.
- Examination reveals scleral icterus, right upper quadrant tenderness, guarding, and positive bilirubin in her urine.
- The most likely diagnosis is cholangitis due to the patient's history of epigastric and right upper quadrant pain, recent onset of fever, chills, and elevated bilirubin.
Case 34 - Chest Pain after Endoscopy
- A 57-year-old woman presents to the emergency department with severe left-sided chest pain after an upper gastrointestinal endoscopy.
- She underwent balloon dilation of a benign-appearing stricture of the distal esophagus 6 hours prior.
- The most appropriate next step in diagnosis is CT scan of the chest to evaluate for potential complications of the endoscopic procedure, such as a perforation of the esophagus or a pneumothorax.
Case 35 - Postoperative Incisional Pain
- A 25-year-old man presents with postoperative pain 6 hours after an inguinal hernia repair under local anesthesia.
- The most appropriate analgesic pharmacotherapy for incisional pain is infiltration of the wound with bupivacaine as it provides sustained local analgesia at the incision site.
Case 36 - Progressive Jaundice
- A 5-week-old boy presents with progressive jaundice and acholic stools.
- Liver examination reveals hepatomegaly, and laboratory test results show elevated total and direct bilirubin, alkaline phosphatase, and normal alpha-1 antitrypsin.
- The most likely mechanism of this patient's jaundice is impaired bile flow through ducts as evidenced by the elevated direct bilirubin, alkaline phosphatase, and the absence of a gallbladder on imaging.
Case 37 - Postoperative Oliguria
- A 25-year-old woman presents with oliguria 24 hours after splenectomy for trauma.
- She experienced intraoperative hypotension and blood loss.
- The most appropriate next step to confirm the cause of oliguria is measurement of urine sodium and creatinine concentrations to assess for renal function and differentiate between prerenal azotemia (common following surgery and blood loss) and acute kidney injury.
Case 38 - Blood at the Urethral Meatus
- A 32-year-old man presents with lower abdominal tenderness and blood at the urethral meatus after a motor vehicle collision.
- The most appropriate next step in urinary tract evaluation is retrograde urethrography to identify a potential urethral injury.
Case 39 - Bloody Discharge from Nipple
- 32-year-old woman presents with bloody discharge from the right nipple, no breast masses, and normal mammogram findings.
- The most likely diagnosis is intraductal papilloma due to the bloody nipple discharge, absence of a breast mass, and the negative mammogram.
Case 40 - Tender Breast Mass
- A 40-year-old woman presents with a tender breast mass.
- Mammography and ultrasound reveal a solitary, well-defined, fluid-filled, compressible mass.
- The most appropriate next step in management is fine-needle aspiration (FNA) of the mass to obtain cytological analysis in order to differentiate between a benign or malignant process.
Breast Cancer Diagnostic Procedures
- Excisional biopsy is a surgical procedure where the entire tumor is removed and examined under a microscope.
- Incisional biopsy, only a portion of the tumor is removed for examination.
- Mammography-localized core needle biopsy is a procedure where a small sample of tissue is removed from the breast using a needle and examined under a microscope.
- MRI can be used to detect abnormalities in the breast tissue that may not be visible on a mammogram.
- Needle aspiration is where a needle is inserted into the breast lump and fluid is withdrawn, followed by examining the fluid under a microscope.
Breast Cancer Risk
- A 42-year-old woman with a history of fibroadenoma and lobular carcinoma in situ is at greater risk for invasive ductal carcinoma within the next 10 years.
Testicular Injury
- Doppler ultrasonography of the testes is used to evaluate for blood flow to the testes following a scrotal hematoma, which can occur from a traumatic injury.
- A 21-year-old male who suffered a fall resulting in a scrotal hematoma and lack of blood flow to the testes, requires surgical exploration.
Hyperthyroidism
- A 32-year-old male presenting with irritability, increased bowel movements, weight loss, and a single thyroid nodule with elevated serum thyroxine (T4) and suppressed thyroid-stimulating hormone (TSH) is most likely suffering from a toxic adenoma.
- Toxic adenoma is a condition where a single nodule in the thyroid gland overproduces thyroid hormones.
Post-Thyroidectomy Complications
- A 57-year-old woman who underwent total thyroidectomy and lymph node dissection for metastatic papillary thyroid carcinoma developed circumoral paresthesia, tingling fingertips, and hyperreflexia of the facial nerve.
- These symptoms point to hypocalcemia, a potential complication of thyroid surgery due to damage to the parathyroid glands.
- Contacting the hospital ethics committee or proceeding with tracheostomy are not appropriate next steps in this situation.
- The patient should be evaluated for hypocalcemia and treated accordingly.
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