A 17 Year Old Girl Admitted With 6 Month History Of Weight loss And A Murmur On Auscultation

A 17 year old girl was admitted in the hospital with a 6 month history of generalized body pains, loss of weight and night sweats. Over the past 6 weeks she has started to become breathless on mild exertion. At the time of admission she had a temperature of 101 F and on examination she had a early diastolic murmur on the left sternal border on auscultation of the precordium. On doing a fundoscopic examination following was seen:

Roth spots in the retina ( hemorrhagic area with a pale center)

On examination of her hands subungal splinter hemorrhage was seen in one of the finger nails. The picture is shown below:

What is the most likely diagnosis?

A 12 Year Old Girl Presents With Abdominal Pain, Bloody Diarrhea And A Purpuric Rash.

A 12 year old girl is admitted to the pediatric ward with a 2 day history of Lower abdominal pain and blood stained diarrhea. Three days later she began to complain of pain in her ankles and the right elbow. She also felt nauseous but there was no history of vomiting.
On examination the patient looks sick, has a periorbital edema and a purpuric rash affecting the arms and the legs.
The picture of her rash on lower extremeness is shown below:

She is afebrile but her BP is 150/95 mmHg.
The lab workup and the results are given below:

• Hb = 10g/dl
• WBC= 12000/cmm
• Platelets= 135,000/cmm
• ESR= 35
• PT = 13 sec (control= 13 sec)
• aPTT= 34 sec ( control= 36 sec)
• Sodium=138 mmol/l
• Potassium= 5.9mmol/l
• Urinalysis= Blood++, Protein++

Based on the above history and investigations what is the most probable diagnosis?

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Henoch-Schonlein Purpura ( The combination of lower abdominal pain, bloody diarrhea, purpuric rash, nephritis, and a high blood pressure in a young girls are all suggestive of the disease)

A 40 Year Old Woman Presents With Sudden Facial Asymmetry

A 40 year old woman woke up in the morning and felt her left side of the face being peculiar and heavy. On looking in the mirror she saw that the corner of her mouth on the left side was drooping and her left lower eyelid seemed to be lower than her right. When she attempted to smile her left side of the face remained immobile and broad like. On eating her breakfast she felt the food to stick on the left side of her cheek. She was terrified and came to the emergency department for a checkup.
On examination she has paralysis of the entire left side of her face.
The picture of the lady is shown below:

Diagnosis: Bell's Palsy ( Caused by a lesion of the left facial nerve that supply the muscles of facial expression).

Case Discussion:
Bell's palsy is a paralysis or weakness of one side of the face caused by a damage to the facial nerve. The condition comes on suddenly usually overnight and fortunately gets better on its own over a few weeks.

A 38Year Old Man Presents With A Six Week History Of Dyspnoea and Wheezing

A 38 year old man presents with history of difficulty breathing and wheezing that has started about six weeks back, For 2 weeks he has also developed cough productive of yellow sputum and fever. There is no history of night sweats.
The patient has a past history of asthma and recurrent atopic symptoms.

A Chest X ray done as a part of diagnostic workup is shown below:

X ray findings show diffuse peri-hilar infiltrates.

On blood workup there was an eosinophillia and the sputum culture was negative.

Based on the above history and investigations for is the most likely diagnosis?

Allergic bronchopulmonary aspergillosis

Case Discussion:

A 68 year Old Woman With Rheumatoid Arthritis Presents With Swollen Ankles

A 68 year old woman who was diagnosed with rheumatoid arthritis about 20 years ago now presents with swollen ankles and edematous feet. Her rheumatoid arthritis was relatively well controlled with non steroidal anti inflammatory drugs until six months ago when her symptoms of pain and swelling needed the addition of penicillamine. Patient also has a history of hypertension controlled with drugs.
On examination she has symmetric joint deformities consistent with long standing rheumatoid arthritis. The picture of her hands is shown below:

Her heart rate was 90 beats/min and irregular. Her blood pressure was 140/90 mm Hg. JVP was not raised and her heart sounds were normal and chest was clear on auscultation.
Inspection of the lower limbs reveal pitting edema. Picture is shown below:

 On investigation urinalysis shows +++ proteinuria.

What is the cause of her edema and what will be the management??

A 20 Year Old College Student Complains Of Chest Pain And Shortness Of Breath During Exercise

A 20 year old college student comes to his physician concerned about his health because he feels chest pain and gets short of breath during exercise or sports. He also describes having episodes of feeling his heart beat very fast. He wanted to have workup done because his brother died suddenly at an age of 18 years while participating in his school sports event.
On examination the patient is a healthy looking young man and there were no abnormalities detected on his chest examination.
An ECG was done which is shown below:

The above ECG is notable for inverted T waves, and deep narrow dagger like Q waves in the leads V4, V5 and V6

On Echocardiography there is septal hypertrophy with left ventricular outflow tract obstruction.

Based on the ECG and the history of the patient what is the most probable diagnosis?
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Hypertrophic Obsstructive cardiomyopathy