Top Ten eMedicine Case Studies 2008

Here are the Top Ten eMedicine case studies of 2008. What is the diagnosis?

1.

A 33-Year-old Woman with Sudden-Onset Severe Headache and Vomiting A 33-year-old woman presents to the ED with a severe headache, associated vomiting, blurred vision, and weakness in her left leg. She states that it is the worst headache of her life, and it is worsening despite her use of acetaminophen. She has a 4-year history of oral contraceptive use. Her pupils show a slightly sluggish reaction to light, and bilateral papilledema is noted on the funduscopic examination. What is the diagnosis?

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2.

A Puzzling Facial Rash on a 17-Year-Old Boy A 17-year-old boy presents to the pediatric infectious disease clinic with a 10-day history of a facial rash. The rash began as several pimples over the forehead and cheek that spread to most of the right side of his face. The lesions are not itchy, but they are painful. No improvement was noted with 2 separate courses of antibiotic therapy. The patient is very active on his school wrestling team, and he was happily preparing for an upcoming competition. What is the most likely diagnosis?

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3.

Red and Swollen Eye in a 61-Year-Old Man A 61-year-old man presents to the emergency department (ED) with a 5-day history of pain with associated redness and swelling in his right eye. The patient's pain and swelling have worsened since he began taking acyclovir a few days ago for a presumptive diagnosis of herpes zoster infection of the eye. The affected eye demonstrates ptosis of the upper eyelid, generalized proptosis, and mild periorbital erythema with associated edema. What is the diagnosis?

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4.

Acute Onset of Abdominal Pain in a 76-Year-Old Man A 76-year-old man presents to the emergency department (ED) with sudden-onset abdominal pain that began 4 hours ago. The pain is centered in the epigastrium and is described as deep and burning. The patient has a past medical history of coronary artery disease and hypertension, as well as one of "indigestion." Hyperactive bowel sounds are heard on auscultation. What is the diagnosis?

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5.

A Young Athlete in Cardiac Arrest A 17-year-old male was found in cardiac arrest following a blow to the chest. The patient immediately dropped to the ground and was unresponsive after being elbowed by a teammate who ran into him. What is the likely pathophysiology that led to the cardiac arrest?

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6.

A Diver Unconscious at the Surface After a Recreational Dive A 22-year-old recreational diver was performing an open-ocean dive and lost consciousness while ascending. Emergency measures were performed and the diver regained consciousness; within about 30 seconds, he began coughing pink, frothy sputum. The diver was taken to the ED. Auscultation of the left lower lung field revealed diminished breath sounds, and a CT scan of his chest was obtained. What was the cause of the loss of consciousness during the diver's ascent?

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7.

Fleshy Lesions on a 32-Year-Old Woman A 32-year-old woman presents to the emergency department (ED) with several flesh-colored papules and patches with well-defined borders on her face, trunk, and upper extremities. She first developed the lesions at 10 years of age. The patient's medical and surgical history includes environmental allergies, frequent episodes of bronchitis, and excision of recurring skin papules. What is the diagnosis?

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8.

Small-Bowel Obstruction While on a Cruise A 57-year-old man presents to the emergency department (ED) with severe acute-onset abdominal pain in the right lower portion of his abdomen, along with progressive bloating, nausea, vomiting, night sweats, and low-grade fever. He has experienced intermittent abdominal discomfort with constipation and a 30-lb loss over the past 2-3 months. He has not been able to have a bowel movement on the day of presentation. There is a palpable mass in his right lower quadrant. What is the diagnosis?

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9.

A Traveler's Fever A 17-year-old man presents to the ED with a 2-day history of headache, fever, and intermittent sweats. The patient recently returned from a 3-week trip to Nigeria. According to the patient, he felt well when he initially returned; however, today he has developed a worsening headache, bilious emesis, palpitations, and sweats. A blood smear is obtained. What is the diagnosis?

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10.

Near-Syncope in a 24-Year-Old Man A 24-year-old man presents to the emergency department (ED) after several episodes of nearly blacking out that have occurred 3-4 times over the past 3 days. The patient states that he also felt his "heart beating really fast" and associated light-headedness. He smokes 2-4 packs of cigarettes per day and has done so for 5-6 years. No history of significant cardiac disease or sudden cardiac death in his family is noted. An electrocardiogram (ECG) is obtained. What is the diagnosis?