🔝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.

🔝Case#9: ID 02021223
🔝Topic: Endocrinology, Hematology

A 58-year-old woman with a history of Type 2 diabetes presents to the clinic for a routine check-up. She mentions occasional episodes of blurred vision and increased thirst over the past few months. Her current medications include metformin and a statin. Recent lab tests show fasting plasma glucose levels consistently above 7 mmol/L. Her blood pressure is within normal limits, and physical examination shows no abnormalities. She has no history of smoking or cardiovascular disease. However, she expresses concern about her increased risk of heart disease due to her diabetes.

🔝Case#10: ID 05031021
🔝Topic: GI, Pathology

A 45-year-old male presents to the emergency department with severe upper abdominal pain radiating to the back. The pain started suddenly a few hours ago and has been persistent since then. It is associated with nausea and vomiting. The patient admits to heavy alcohol use over the past week. On examination, his blood pressure is 110/70 mmHg, heart rate is 96 beats per minute, and he appears in distress. His abdomen is tender in the epigastric region with no rebound tenderness. Laboratory tests reveal elevated amylase and lipase levels. There is no history of similar episodes in the past. Abdominal CT scan is shown.

🔝Case#11: ID 05021019
🔝Topic: Pharmacology

A 25-year-old male with a history of schizophrenia presents to the psychiatric clinic for a follow-up visit. He has been on haloperidol for the last year but reports that the medication is not working effectively. He claims that he hears voices and feels restless. No acute distress is noted, and vitals are within normal limits. Blood tests indicate elevated prolactin levels. An MRI of the brain shows no structural abnormalities.

🔝Case#12: ID 021225
🔝Topic: Physiology, Cardiology

A 63-year-old man with a history of hypertension and diabetes presents to the clinic complaining of shortness of breath and fatigue that have progressively worsened over the past few months. He reports a recent increase in his blood pressure readings at home. Physical examination reveals a displaced and sustained apical impulse, and a late peaking systolic murmur heard best at the left sternal border. Laboratory tests show elevated levels of serum natriuretic peptides. His ECG is shown in the illustration. The patient's current medications include metformin and a thiazide diuretic.

🔝Case#13: ID 0105923
🔝Topic: Pharmacology

A 58-year-old man is started on simvastatin to manage his elevated cholesterol levels. Two weeks later, he was given fluconazole for a fungal nail infection. He soon presents with muscle pain and weakness. On investigation, his serum creatine kinase level is markedly elevated. A possible drug interaction is considered.

🔝Case#14: ID 02010124
🔝Topic: Physiology, Cardiovascular

A 28-year-old woman at 32 weeks of gestation presents to the emergency room with sudden onset of vaginal bleeding and abdominal pain. The patient has had an uncomplicated pregnancy thus far. Her prenatal screenings and ultrasounds have been within normal limits. On examination, she appears pale and anxious, with a blood pressure of 90/60 mmHg and a heart rate of 120 bpm. The fetal heart monitor shows episodes of bradycardia with a baseline of 100 bpm, significantly lower than the normal 120-160 bpm. There is no history of trauma, and her previous pregnancies were uneventful. The clinical team is concerned about the abrupt change in fetal heart rate and maternal hemorrhage.