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Figure 1  Expand your clinical knowledge. View, share, and discuss medical cases from every specialty. Free download on the App Store and Google Play. #meded

A 65-year-old male presents to his family physician with complaints of increasing fatigue, dyspnea on exertion, and unintentional weight loss within the last six months. ⁣

On examination, he is noted to have macroglossia and peripheral edema. Crackles are audible bilaterally on chest auscultation. What test will help confirm this patient’s most likely diagnosis? ⁣

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A 10 y/o female presents with a persistent fever and intermittent bloody stools. She is found to have hepatosplenomegaly, anemia, and high EBV DNA copy numbers. A colonoscopy reveals large ulcers traversing the colon, and an ileocecal mass that is EBER positive. How would you manage this case?

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A 25-year-old male presents to the emergency department with headache, retro-orbital pain, and diplopia when gazing to the right. He had visited an urgent care clinic with right ear pain two weeks earlier, and had received a short course of antibiotics. ⁣

After some initial improvement, he became increasingly unwell before presenting today. Otoscopy reveals purulent discharge in the right ear canal, and a CT scan demonstrates the findings seen here. Which organism is most commonly responsible for this patient’s likely diagnosis?⁣

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This is the Manouguian technique for aortic root enlargement. The patient required an aortic valve replacement, however, it was impossible to fit a prosthetic valve large enough for the patient's body size. The aortic annulus was enlarged by extending the cut in the aorta down between the left and noncoronary cusps into the fibrous tissue of the subaortic curtain. A patch of bovine pericardium was used to reconstruct the defect.

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A 37-year-old male admitted for observation was found obtunded in his room the next morning. He was intubated and admitted to critical care. ⁣

The first #ECG is performed upon arrival to the CCU. The second, 30 minutes later. What do you suspect has happened?⁣

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59-year-old male with an incidental pancreatic head lesion on CT. He is asymptomatic, and his Ca 19.9 is normal. What’s the differential diagnosis for this cystic lesion?
Would you request any other investigations before proceeding to a Whipple procedure?
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A 20-year-old male with presumed dermatomyositis. Patchy inflammation in deltoids on MRI, but biopsy is negative. Unusual because he also has a diagnosis of myasthenia gravis. Have you seen these two diagnoses together before?

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A 70-year-old smoker presents with a four-week history of dyspnea, cough, and facial swelling that is exacerbated by bending forward. A physical examination reveals venous collaterals on the chest wall, and imaging is ordered. What is the most likely cause? #FOAMed #MedEd

Quiz: What's causing this teenager's vision loss?

A 14-year-old boy is brought to the pediatrician by his mother over concerns of difficulty walking and worsening clumsiness. He reports a gradual loss of night vision, and a long history of chronic diarrhea which is pale and foul-smelling. Examination reveals an ataxic gait, and loss of deep tendon reflexes. Bilateral retinitis pigmentosa is noted on fundoscopy and a peripheral blood smear reveals the findings seen here.
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For #RareDiseaseDay, here’s how one physician is improving the diagnostic delay for patients battling a rare disease. View the full video by tapping the link in our bio.

A 4-year-old boy with known G6PD deficiency is brought to the pediatrician by his mother with a blistering pruritic rash. On examination, numerous tense vesicles and bullae are seen on his neck, lower abdomen, and extremities. Ulcerative lesions on his buccal mucosa are also noted. Direct immunofluorescence of a skin biopsy later reveals linear deposits of immunoglobulin A (IgA) at the dermoepidermal junction. What treatment is recommended for this patient?

A 67-year-old woman presents to the emergency room with acute chest pain and dyspnea after the death of her husband. She is hypotensive, tachycardic, and diaphoretic. A diagnosis of takotsubo cardiomyopathy (“broken-heart” syndrome) is suspected. How would you confirm this diagnosis? Look up «Figure1Questions» on the Figure 1 app to see the full case discussion.

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