• Case Study # 1:

  ID/CC A 24 year old African American female complains of crampy abdominal pain, inability to pass flatus, abdominal distention, nausea, and vomiting.

  HPI After lack of improvement in 24 hours of nasogastric-tube suction and IV fluid, she underwent laparotomy to relieve bowel obstruction from a mass.

  PE Hyperpigmented macules on lips and buccal mucosa and on palms, fingers, and toes. (look at the pics)

  Labs CBC/PBS: microcytic, hypochromic anemia. Positive stool guaiac test.

  

  1.  What is the Diagnosis? (not a very common case but the presentation is classic).

  Case Study # 2:

  Case Study # 2:

  ID/CC A 33 year old female complains of increasing pain and difficulty swallowing liquids and solids over the past several months.

  HPI She has lost 20 pounds in the past three months and has occasionally experienced acute substernal pain and regurgitation of food into her mouth when lying down.

  PE Unremarkable.

  Labs Esophageal manometry: aperistaltic esophagus; increased lower esophageal sphincter pressure; negative antinuclear antibodies.

  1.  What is the Diagnosis?

  

  Case Study # 3:

  Case Study # 3:

  ID/CC A 54 year old white female complains of colicky pain in the left lower abdomen and fever.

  HPI She has had frequent attacks of moderate pain in the same area for several months and one episode of bloody stools without excessive mucus.

  PE Pallor; tenderness; rebound and guarding of the left lower quadrant but normal stools; sigmoid colon palpable, thickened, and tender.

  Labs CBC: normocytic, normochromic anemia; neutrophilic leukocytosis with associated left shift. Stool culture reveals no pathogens.

  1.  What is the Diagnosis?

  

  Case Study # 4:

  Case Study # 4:

  ID/CC An 18 month old male is brought to the emergency room by his parents because of acute, intermittent abdominal pain, abdominal distention, and passage of red jelly-like stools.

  HPI The child had previously been well, and his immunization schedule is complete. He vomited twice following his admission.

  PE Child crying and screaming, with knees drawn to abdomen; abdomen tender and distended; oblong mass in abdomen in tthe right upper quadrant that hardens with palpation; examining finger stained with mucus and blood on digital rectal examination.

  Labs No parasites on stool exam; no pathogen on culture.

  1.  What is the Diagnosis?

  Case Study # 5:

  Case Study # 5:

  ID/CC A 12 year old white female, the daughter of Norwegian immigrants, complains of diarrhea and flatulence.

  HPI Her parents say she has suffered from weight loss despite the fact that she eats very well. Her mother adds that her stool is foul-smelling and floats but no blood or mucus.

  PE Patient pale and thin; dryness and thickness of skin; rash on knees, elbows, and neck; itchiness and redness and some scaling of the skin.

  Labs CBC: macrocytic, hypochromic anemia, K ⁺ = 3.1 mEq/L (normal 3.6-5.2 mEq/L).

  Three questions:

  1. What is the Diagnosis? 
  2. What is the Etiology of Macrocytic anemia? (one line only) 
  3. What is the Etiology of Hypokalemia? (one line only)

  Spot Diagnosis # 1:

  Spot Diagnosis # 1:

   

  1.  What is the diagnosis (name the drug that causes this condition)?

  

  Spot Diagnosis # 2:

  Spot Diagnosis # 2:

   

  1.  What is the Diagnosis?

  

  Spot Diagnosis # 3:

  Spot Diagnosis # 3:

  

  1.  What is/are the Drug(s) involved?

ANSWER: