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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.

An 8-year-old boy is brought to the pediatrician by his mother over concerns of a new-onset rash. He is otherwise healthy, though his mother mentions that he was unwell two weeks prior to the rash appearing. On examination, numerous small salmon-pink scaly papules are seen on his trunk and extremities. What infection most likely preceded this cutaneous eruption?

A 56-year-old man presents with a three-month history of erectile dysfunction and bilateral buttock pain on exertion, but not at rest. Examination reveals bilaterally diminished femoral pulses. What’s the most likely diagnosis? Look up «Figure1Questions» on the Figure 1 app to see the full case discussion.

A 40-year-old male presents to his family physician with a pruritic, erythematous lesion on his foot after returning from vacation in coastal Brazil a week earlier. He adds that the lesion has migrated since he first noticed it. On examination, a serpiginous, slightly elevated tunnel can be seen on the lateral aspect of his left foot. He is otherwise well, but mentions that the intense pruritus is disturbing his sleep. What is the next best step for this patient? Look up «Figure1Questions» on the Figure 1 app to see the full case discussion.

Happy New Year!

A 58-year-old male with a history of recurrent pleural effusions presents with worsening dyspnea and lower extremity edema. Examination reveals bilateral pitting edema of his legs and feet and yellow, dystrophic nails on his fingers and toes. Chest X-ray demonstrates a large right pleural effusion. A diagnosis of yellow nail syndrome is suspected and thoracentesis is performed. What characteristics would you expect to find on pleural fluid analysis?
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Quiz: Do you recognize these cutaneous findings?
An otherwise healthy 50-year-old male presents to his new family physician with a rash he’s had for several years. He mentions that the skin eruption becomes erythematous and pruritic after exercising, and when he scratches it. On examination, reddish-brown freckle-like macules are seen on his upper extremities, back, and abdomen. A skin biopsy reveals an increased number of dermal mast cells. Look up «Figure1Questions» on the Figure 1 app to see the full case discussion.

A 54-year-old male presents with fatigue, lethargy, and frequent headaches. He has a one-year history of hypertension that has been resistant to treatment, and on examination, his blood pressure is 145/82 mmHg. Laboratory tests reveal a serum potassium level of 3.1 mmol/L. Subsequent investigations demonstrate an increased ratio of plasma aldosterone concentration to plasma renin activity, and the findings seen here on CT. Based on this patient’s most likely diagnosis, what medication should be initiated? Look up «Figure1Questions» on the Figure 1 app to see the case discussion.

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