A 60 Year Old Man With Fever, Productive cough and Weight Loss

A 60 year old man is referred to a pulmonary specialist with the complains of high grade fever with chills, a productive cough for about 4 weeks and a history of  weight loss. The patient complains of a purulent sputum which is sometime streaked with blood and about a tablespoon full in quantity. His wife says that she has noticed a foul smell from his breath.

Patient has brought the following X ray with him that was done a day before:

Chest x-ray demonstrates a large intrapulmonary cavity with an irregular air/fluid level interiorly. The wall of the cavity is ill-defined, ranging from very thin and smooth laterally to somewhat nodular superomedially. 

The Patient is diagnosed as a case of Lung Abscess

Case Discussion:

Lung Abscess:

Lung abscess is defined as a cavitating area of localized , suppurative infection within the lung.

Causes: A lung abscess may occur due to :

A 35 Year Old Man Goes For Physical Examination For Job Fitness

A 35 year old man is having a physical examination as a requirement for job fitness. He is asked to do a pulmonary function test and blow through a spirometer.

What is spirometry?

Spirometry is a powerful tool that helps measure the functional lung volumes and detect any underlying obstructive or restrictive lung disorders.

Below is a graph to help understand lung volumes:

Spirometric values

A 5 Year Old African Child With Swelling Of The Jaw

A 5 year old African child is referred to a Pediatrician for the presenting symptoms of a progressive painless swelling of the jaw that has not responded to antibiotic treatment and is growing rapidly leading to disfiguring of the face. The child has low grade fever for over 4 months and has also lost weight. He has lost his appetite and interest in daily activities.

The picture is shown below:

Blood workup shows Anemia and low platelet count. Serum LDH was markedly elevated and serum uric acid levels were also high.
A biopsy was taken from the tumor and the case was diagnosed as Burkitt Lymphoma.

Case Discussion:

BURKITT LYMPHOMA
Burkitt lymphoma is a form of non Hodgkin's lymphoma in which the cancer cells start in the immune cells known as B cells.

A 3 Year Old Boy With Sudden Choking While Playing With His Toys

A 3 year old boy is brought to the emergency department when he was seen to have a sudden choking while he was normal and playing with his toys. He has no history of any respiratory infection.

The Chest X ray is shown below:

What is the most probable diagnosis?

Inhaled foreign body

Case Discussion:

A 45 Year Old Man Presents With Abdominal Distention

A 45 year old man is brought to the doctor's office by his wife in a confused state, and complains of fatigue, weakness and pain under his right rib cage for the past several months. He is a drug abuser and has a history of jaundice in the past. His wife says he has been diagnosed with hepatitis C but they don't have any medical record with them.

On examination the patient is acting strangely and is not able to give a proper history. He has anemia and a mild jaundice. His abdomen is distended, tender and firm with prominent veins at the umbilicus. Liver and spleen are both enlarged and palpable.

The lab work shows:

• AST = 145 IU/L
• ALT = 150 IU/L
• Serum total billirubin = 7.5 mg/dl
• PT = 18.2

The patient's bedside abdominal view is shown below:

Based on the given history in the above case what is the most likely case of the patient's abdominal distension?

A 50 Year Old Man Presents With Fatigue And Easy Bruising

A 50 year old man presents to his primary care physician with complains of fatigue and recently noticed having bruises after minor trauma. Although he has never taken his temperature he feels that he has low grade fever on and off over the last few months.
On Examination he was noticed to have an enlarged spleen and few bruises.
His blood workup showed low RBC, WBC and platelet count. The peripheral smear is shown below:

 What is the Diagnosis?
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Hairy cell leukemia