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🔝Case#1: ID 0504926
🔝Topic: Hematology, Pharmacology

A 65-year-old woman undergoes an elective total knee arthroplasty. On post-operative day 4, while on prophylactic unfractionated heparin, she is found to have a platelet count of 45,000/microL, decreased from a baseline of 250,000/microL. A peripheral blood smear does not show schistocytes. Her serotonin release assay is positive. Doppler ultrasonography of her lower extremities is negative for deep vein thrombosis. Her skin manifestation is shown in the picture.

🔝Case#2: ID 05011016
🔝Topic: Cardiovascular system

A 64-year-old woman presents to the emergency department with sudden chest discomfort. She describes the pain as a "crushing" sensation, which began while walking her dog, radiating to her left shoulder and jaw. She is nauseous and feels lightheaded. On examination, her BP is 130/80 mmHg, pulse 86 bpm, and RR 20/min. An ECG is shown in the picture.

🔝Case#3: ID 05041928
🔝Topic: Hematology and Oncology

A 58-year-old male presents with a 6-month history of headaches, vision changes, and increasing forgetfulness. An MRI of the brain reveals a large, enhancing mass in the right temporal lobe consistent with Glioblastoma. He undergoes tumor resection and subsequently starts chemotherapy with nitrosoureas. Four weeks into treatment, routine labs reveal increased liver enzymes, a drop in white blood cell count, and thrombocytopenia.

🔝Case#4: ID 0105923
🔝Topic: Pharmacology

A 72-year-old male with a history of atrial fibrillation, hypertension, and chronic kidney disease is currently taking warfarin, metoprolol, and furosemide. His most recent international normalized ratio (INR) was therapeutic at 2.5. Due to a recent diagnosis of gastroesophageal reflux disease (GERD), his primary care physician prescribed a new medication. One week later, he presented to the emergency department with coffee-ground emesis and melena. Lab results show an elevated INR of 6.8. An ECG shows normal sinus rhythm.

🔝Case#5: ID 05021021
🔝Topic: Endocrinology

A 45-year-old male presents to the emergency department complaining of flushing and dyspnea, which he describes as bronchospasm. He has a history of diabetes mellitus and is taking metformin and aspirin. Additionally, he reports frequent diarrhea over the past month. His initial vital signs are stable, but he appears uncomfortable and flushed. CT scan was performed and shown in the picture.

🧪Laboratory Data:
Serum Glucose: 180 mg/dL
5-Hydroxyindoleacetic Acid (5-HIAA): Elevated

🔝Case#6: ID 02031023
🔝Topic: Metabolism

A 28-year-old man consults his physician for complaints of jaundice, loss of appetite, and fatigue. He arrived from Europe 3 days ago, is not married, and does not drink alcohol or smoke. Physical examination reveals icteric skin on his face and palms, as well as icteric sclera. Ultrasound of the gastrointestinal tract is unremarkable.

🧪Laboratory findings:
Red Blood Cells: 4.7 x 10^12/L
Leukocytes: 6.11 x 10^9/L
Platelets: 210 x 10^9/L
Hemoglobin: 135 g/L
ESR: 5 mm/hour
Indirect Bilirubin: 25.8 µmol/l
Direct Bilirubin: 4.5 µmol/l
ALT: 13.64 U/L
AST: 14 U/L

🔝Case#7: ID 02061123
🔝Topic: Neurology, Pharmacology

A 68-year-old man presents with resting tremor in his left hand, slowness in movements, and difficulty with walking. He also reports constipation and urinary frequency. His symptoms have been progressively worsening over the past two years. On neurological examination, you note cogwheel rigidity in the left arm and a shuffling gait. An MRI of the brain shows no structural abnormalities. He is diagnosed with Parkinson's disease and started on levodopa/carbidopa. His son brings in a video from 5 years ago where the patient exhibited similar but milder symptoms. He asks you if his father could have had Parkinson's for that long.

🔝Case#8: ID 02091223
🔝Topic: Reproductive, Endocrinology

A 30-year-old Caucasian woman presents with fatigue, myalgia, somnolence, nausea, and arterial hypotension, six days after undergoing an elective surgical procedure for a pelvic mass. Prior to surgery, she had no significant medical history and was not on any medications. Postoperatively, she experiences a marked decline in her energy levels and physical stamina. Laboratory tests reveal elevated thyroid-stimulating hormone (TSH) levels and decreased thyroxine levels. She responds well to thyroxine replacement therapy, with a significant improvement in her symptoms. Her preoperative CT scan is shown.