Study 8100+ #MedEd "flash-XCreations"- Reminders of topics to do a deeper study-dive. Zebra hoof-beats? Think Tyrannosaurus Rex 🦖Thanks 56,000!

Earth, WHO jurisdiction
Joined November 2009
Pulmonary tuberculosis... Classic TB s/s. CXR confirms --> thin-walled right upper-lobe cavity with surrounding nodular consolidation and bronchogenic spread, in apical distribution; Confirmation: sputum AFB smear, mycobacterial culture, Xpert MTB/RIF; airborne isolation
A 32-year-old man presents with chronic cough, low-grade fever, night sweats and weight loss for 3 months. He has no known immunodeficiency. Spot Diagnosis? A. Pulmonary tuberculosis B. Necrotizing pneumonia C. Lung abscess D. Cavitating squamous cell carcinoma
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Hereditary angioedema: autosomal-dominant; Random, recurrent, potentially fatal swelling in GI tract, upper airway & skin; Path: low or impaired C1 inhibitor function --> dysregulated plasma kallikrein --> excess bradykinin production --> ↑ vascular permeability + swelling
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Rx: Torsades de pointes --> IV magnesium 1 to 2 g. Correct potassium & magnesium. D/C offending QT-prolonging drug(s). Temporary pacing. Isoproterenol to increase heart rate and abolish postectopic pauses.
ECG shows polymorphic VT with twisting QRS complexes around the baseline. Which drug is preferred? A. IV magnesium sulfate B. Verapamil C. Digoxin D. Adenosine
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Bruising around umbilicus = Cullen's sign (periumbilical ecchymosis); An indicator of intra-peritoneal or retroperitoneal hemorrhage. Blood tracks along falciform and gastrohepatic ligaments to pool and discolor the subcutaneous tissue; MCC:
Which clinical sign is characterized by bruising around the umbilicus?
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Platelet-rich plasma (PRP) = autologous blood-plasma + supraphysiologic concentration of platelets; On activation (exposure to collagen or activator CaCl or thrombin), platelets degranulate / release growth factors + cytokines - PDGF, TGF-β, VEGF, IGF-1, FGF, EGF
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Likely auto recessive, pulmonary alveolar microlithiasis (bilateral, diffuse, symmetric micronodular "sandstorm" calcific opacities, mid & lower zones; DiffDx: TB, Sarcoid, Pneumoconiosis, Idiopathic pulmonary hemosiderosis, fungal (histo, coccidio, blasto), cancer metastases
What is the diagnosis of this asymptomatic male in his 20s?
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Dengue = MC arboviral dz global, caused by any of 4 antigenically distinct serotypes of dengue virus (DENV-1 to DENV-4), a single-stranded RNA flavivirus, transmitted by daytime-biting Aedes aegypti and Aedes albopictus mosquitoes; Endemic across tropical and subtropical regions
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C. Enalapril: ACE inhibitors (& ARBs) are contraindicated in pregnancy & can cause fetal renal injury, oligohydramnios, renal failure & renal tubular dysgenesis, along with other fetopathy (skull hypoplasia, hypotension, death), particularly with 2nd & 3rd trimester
Q::Which antihypertensive drug is contraindicated during pregnancy because of the risk of fetal renal injury? A. Amlodipine B. Labetalol C. Enalapril D. Methyldopa
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Reed-Sternberg cell: "owl's eye" appearance, large, bi-lobed nucleus where each lobe contains a prominent, dark-staining eosinophilic nucleolus surrounded by a clear halo; Diff dx: Hodgkin Lymphoma, Cytomegalovirus (CMV), and/or Epstein-Barr Virus (EBV)
Q::The characteristic histological finding in this image is known as?? A. Negri body B. Councilman body C. Owl’s eye intranuclear inclusion D. Psammoma body
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Beta-thalassemia minor (β-thalassemia trait) = asymptomatic heterozygous carrier state for β-globin gene mutation --> relative α/β-globin chain imbalance; s/s: microcytic anemia, NL-to-high RBC count, elevated HbA2, no response to iron, microcytosis, hypochromia, MCV <79 fL
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Lens-shaped (biconvex) hyperdense collection on non-contrast head CT = acute epidural hematoma; Sits between inner table of skull and periosteal (outer) layer of the dura, and its biconvex shape arises because the tightly adherent dura at cranial sutures constrains the collection
Where is this intracranial hemorrhage located? A. Epidural B. Subdural C. Subarachnoid D. Intraparenchymal
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Naegleria fowleri, free-living amoeba (a protozoan parasite), causes primary amebic meningoencephalitis (PAM), rapidly fatal CNS infection
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Multiple Myeloma s/s: Bone/back pain, fatigue/generalized weakness, bone/osteolytic involvement, anemia, weight loss, kidney failure (Cr >2 mg/dL), hypercalcemia (Ca++ >11.5 mg/dL); "CRAB" --> Calcium elevation, Renal failure, Anemia, Bone damage
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Aschoff bodies are specific for post-rheumatic carditis.
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Kayser–Fleischer rings from copper deposited in Descemet's membrane of cornea; golden-brown, yellowish-green, or brownish pigmented band at the corneal periphery (limbus) = Wilson's disease
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Pterion - weakest point of human skull, directly overlies middle meningeal artery; Meeting point of Frontal, Parietal, Temporal and Sphenoid bones; Highly susceptible to fracture from direct blow + arterial damage = Epidural Hematoma (lucid interval --> fatal brain herniation
What is the Importance of the Circled Structure?
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Michaelis–Gutmann = concentric, laminated, basophilic inclusion bodies found inside cytoplasm of macrophages (von Hansemann cells); Diagnostic, pathognomonic hallmark of malakoplakia (rare, chronic inflammatory dz of genitourinary tract
#MedX Michaelis-Gutmann bodies are seen in :-
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Polymyalgia rheumatica - 2nd MC idiopathic inflammatory rheumatic dz after RA; Adult women 50+ y/o w/ bursitis, tendinitis, intense pain and stiffness of neck, shoulders, and pelvic girdle
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"Boot-shaped heart" on CXR classically assoc with: ✅ Tetralogy of Fallot -- Right ventricular hypertrophy (RVH) → elevates the cardiac apex; Concavity of the pulmonary artery segment → creates characteristic "boot" contour [Boot-shaped heart = Tetralogy of Fallot]
boot-shaped heart on chest X-ray is classically associated with A. Mitral stenosis B. Tetralogy of Fallot C. Atrial septal defect D. Ventricular septal defect E. Aortic stenosis
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G6PD clues: Young male, Mediterranean descent , drug trigger (like Sulfa), Hemolysis 24–72 hrs after drug, high LDH, reticulocytosis, low haptoglobin, elevated indirect bilirubin confirm intravascular hemolysis, Bite cells, Heinz bodies (denatured hemoglobin precipitates)
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