1- A 27-year-old black woman complains of non-productive cough, SOB, fatigue and malaise. X-ray shows bilateral hilar lymphadenopathy. What is your diagnosis? How does this condition affect ACE?
This is a case of sarcoidosis. It affects mostly black women (80%) at the age of 20-40. ACE is elevated in about 70% of cases and is used in those patients to monitor its progress.
2- A 38-year-old man with a history of Marfan syndrome presents the ER complaining of tearing retrosternal pain radiated to the back. What is your diagnosis? What is the drug of choice of a stable chronic patient?
This is a case of aortic dissection. The drug choice of a stable chronic aortic dissection is beta blocker. Read more
3- A 32-year-old schizophrenic patient presents to the ER with a high fever (104 F), altered mental status, rigidity and hypotension (85/50). He is treated with haloperidol. What is your diagnosis? What is the appropriate treatment?
This is neuroleptic malignant syndrome, a life threatening condition. It is treated with symptomatic treatment and dantrolene.
4- A 48-year-old man is brought to the ER from the airport with a complaint of sudden onset shortness of breath and chest pain. He arrived from France after a 10-flight. What is the most likely diagnosis?
This is most likely a case of pulmonary embolism due to deep venous thrombosis. Ventilation/perfusion (V/Q) scan is diagnostic. It is precipitated by the long sitting position and dehydration.