🔝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.

🔝Case#15: ID 02080124
🔝Topic: Pharmacology, Renal

A 55-year-old male with a history of chronic heart failure presents to the emergency department with a severe headache and confusion. His medical history includes hypertension and type 2 diabetes mellitus. A brain MRI shows a large intracerebral hemorrhage. To manage increased intracranial pressure, he receives an intravenous osmotic diuretic along with furosemide and a beta-blocker. Several hours later, the patient develops acute respiratory distress. On examination, his blood pressure is 110/70 mmHg, heart rate 102 bpm, respiratory rate 30 breaths/min, and oxygen saturation 88% on room air. Chest auscultation reveals bilateral crackles, and there is no evidence of jugular venous distension. Chest Xray is shown.

🔝Case#16: ID 02010124
🔝Topic: Cardiovascular, Pulmonary

A 26-year-old patient with a history of idiopathic pulmonary hypertension (PH) underwent a heart transplantation due to severe right heart failure. Following the transplantation, the patient began to manifest symptoms including shortness of breath, lower extremity edema, and abdominal discomfort.

📱As I mentioned earlier, I recently encountered an interesting case. I was fortunate enough to capture a series of excellent photographs, which you’ll find included in the explanation. This scenario is drawn from an actual case in my clinical practice.

A 56-year-old man with a long history of heavy alcohol consumption presents to the emergency department with severe, persistent epigastric pain that started a few hours after a large evening meal accompanied by multiple beers. The pain radiates to his back, intensifies when supine, and is slightly alleviated by sitting forward. On examination, he appears acutely ill, with mild hypotension, tachycardia, and low-grade fever. His abdomen is markedly tender in the upper region, though without significant rebound tenderness. Laboratory tests reveal markedly elevated serum amylase and lipase. Serum glucose is also elevated. An abdominal CT scan is shown. Despite aggressive intravenous fluid resuscitation, pain management, and supportive measures, the patient rapidly deteriorates and dies within a short period of admission.