Medcases Clinical Cases

Leading provider of practical #medicaleducation. Leverages interactive clinical cases to help healthcare professionals improve their clinical skills.

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Alpha-1-antitrypsin deficiency (AATD) can lead to

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#USMLE
A 32-year-old woman presents with worsening episodes of numbness and tingling in her right arm, intermittent double vision, and difficulty walking for the past week. She also has a past episode of unilateral vision loss that resolved spontaneously. On examination, she exhibits hyperreflexia, spasticity, and mild intention tremor. MRI of the brain and spinal cord reveals multiple areas of demyelination. Based on these findings, which cell type is primarily affected in this condition?

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47 y/o M in ICU for LGIB, hx ETOH cirrhosis. PE: marked ascites, splenomegaly (tip 4 cm below LCM). Labs: Cr 1.5, Hct 29%, Hgb 9.7, Plt 105k, PT 25s, INR 2.5. Which mech most ↑ bleeding risk?

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Quick reminder @ neurology

Weber’s syndrome, also known as midbrain stroke syndrome, is a neurological condition characterized by ipsilateral oculomotor nerve palsy and contralateral hemiparesis

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The loss of neurons that produce orexin in the hypothalamus results in:

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Right-sided heart failure or left-sided heart failure?

Typical symptoms:
- Peripheral edema (lower extremities, sacral area if bedridden)
- Jugular venous distension (JVD)
- Hepatomegaly (enlarged, congested liver)
- Ascites
- Anorexia, nausea (due to gut edema)

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Yes, you are correct; it is hypertension. According to the AHA and ESC guidelines, a diastolic pressure greater than 90 mmHg qualifies as hypertension.

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BP 138/95. Hypertension or not?

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🩺 Hypertension
Do you know the answer?

The new definition of hypertension, established by the American College of Cardiology and the American Heart Association in 2017, classifies high blood pressure as readings of _____ mm Hg or higher for systolic and _____ mm Hg or higher for diastolic measurements.

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The most common cause of glomerulonephritis is ______ nephropathy.

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USMLE Step 3

48 y/o M w/ 10-yr hx of intrusive thoughts about house safety, worsened over 2 mos. Spends 4 hrs/day checking locks/stove (↑ from 2 hrs), impairing work/social life. Exam: fully oriented, anxious mood, sad affect, no hallucinations/delusions. Best pharmacotherapy targets which NT?

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You rock! 🔥

Oral lactulose is the best answer for possible choices.

I remember a patient with similar symptoms and lab results. Lactulose made them speak and behave normally. It was so exciting to see that a “simple” blood-cleaning from ammonia can make such a huge difference. Bravo 👏

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USMLE Step 2

A 68 y/o M w/ 2-day hx of progressive lethargy + tremors. Hx of alcoholism (abstinent x2 wks) + opiate, cocaine, & amphetamine use disorder. Also has alcoholic cirrhosis. Med: daily multivitamin. Previously drank 6 beers/day. Exam: somnolent, T 36.8°C, HR 100/min, RR 18/min, BP 100/60 mm Hg, SpO2 94% RA. Findings: conjunctival icterus, ascites, 2+ LE edema, postural/action tremor w/ sudden, brief muscle strength loss, intact CNs, 4/5 strength. Speech normal, able to follow simple commands. Labs: total bili 3 mg/dL. Blood/urine cultures negative. Intervention most likely to improve cognition + movement?

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Hyperthyroidism is the right answer 👍🏻

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✍️📷 USMLE Step 3 A 45 y/o F w/ several-month hx of brittle, white nails lifting off nail beds (onycholysis) + intermittent warmth & sweating. PMH: IV drug use 25 yrs ago. Takes multivitamin, LMP 3 wks ago. Appears thin, mildly anxious. Ht 170 cm, Wt 48.5 kg, BMI 17. Vitals: T 37°C, HR 106/min, RR 20/min, BP 136/92 mm Hg. Exam: white nail discoloration, otherwise WNL. Most likely dx?

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https://t.co/LuipKhBonc

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💡Rare diseases brief review of the week:

Café-au-lait spots and early puberty can be signs of McCune-Albright Syndrome (MAS), a rare disorder that affects bones and hormone production. Early diagnosis is crucial.

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@OGdukeneurosurg

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A 45-year-old female presents with 3 months of progressive fatigue and exertional dyspnea. She also reports new-onset bilateral pedal edema. On exam, she has JVD, 2+ pitting LE edema, and a soft systolic murmur at the apex. She was noted to have new-onset atrial fibrillation (AF) on ECG, which also showed nonspecific ST-T wave changes. Labs reveal Hgb 9.8 g/dL. CXR shows cardiomegaly.
The most likely diagnosis is ____, and the initial diagnostic test of choice to confirm this condition is _____.

Answer choices for the first blank:
A) Mitral valve prolapse
B) Dilated cardiomyopathy
C) Hypertrophic cardiomyopathy
D) Pericarditis
E) Right-sided heart failure

Choices for the second blank:
A) Cardiac catheterization
B) Echocardiogram
C) Chest CT scan
D) Serum troponin levels
E) Stress test

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Nephrotic vs Nephritic Syndrome MindMap