48 year old man came to the hospital last Friday complainin | Figure 1

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Clinical Case

Patient Information

A 48-year-old man came to the hospital last Friday complaining of 3 days of vomiting and dizziness. He only vomits after drinking tap water once. He vomited once in those 3 days. The vomit is brown and green. No diarrhea or stomach pain or hemoptysis.

Physical exam: no organomegaly. Abdomen slightly distended.

Labs: WBC, neutrophils, lymphocytes are HIGH. RBC, hemoglobin, HCT is low. Platelets normal. AST and ALT HIGH.

No previous medical history or chronic medication.

Patient was given Cefotaxime and got better.

What is the diagnosis?

Additional Cases

35-year-old male with hypertension, diabetes, hyperlipidemia.

The patient was diagnosed with hypertension at 34 years of age and is on losartan and metoprolol and states that he is compliant with his medication including taking his medications today. He states he went to his primary care physician for routine visit and his blood pressure was noted to be elevated of greater than 250 once to the emergency room. The patient otherwise has no symptoms. He states he has been urinating normally with no chest pain, no shortness of breath, no headache, no visual changes, no neurologic symptoms including confusion. In the emergency room, his initial blood pressure was 250/159. His creatinine is 6.3. Troponin 0.8 without increasing trend. He denies tobacco or alcohol use. Paternal side has hypertension and diabetes. Echo was normal.

Think he’s having hypertension from worsening renal failure?

9-year-old male admitted through ED medically free

Complaining of sudden wet cough for 4 days started after waking from sleep, with sputum greenish in colour associated with SOB. Next day he started to have intermittent fever (axillary, 38°) responded to antipyretic. He vomited once (food content, no blood). No Hx of contacting sick people, diarrhea, cyanosis or rash.

What do you think is the diagnosis?! And treatment?!

40-year-old male who presented with abdominal pain, nausea, and vomiting.

This was his urine several days after admission.

75-year-old male with past medical history of hypertension

Atrial fibrillation, CKD stage 4. He came with history of LOC, high intestinal bleed.

52-year-old man

Presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

28-year-old woman

Presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

4-month-old male infant

Presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens

Presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?