40 years old male, familial antecedent of stroke, CID, heart | Figure 1

rAndrieux

Internal Medicine

40 years old male, familial antecedent of stroke, CID, heart failure and diabetes. He refers a "hypertension problem" in management with Clonazepam (im not joking, that's what the patient said). He presents 17 hours ago an oppressive chest pain that irradiated to both arms, at the physical examination AP 195/125 torr, Sat 97%, EKG shows this. Just to share with you guys.

Case Discussion

1. A 40 year old gentleman presents in an anxious state around 50 miles away from his home address where he states he was using a Chopsaw when his hand came into contact with the rotating blade.

He has no power or sensations in this middle, fourth and little fingers. He is in extreme pain but is uncontrollably anxious. Which nerves are damaged?

2. 68 years old, male. Carrier of depression and hypothyroidism.

He uses Puran T4 50 mcg/day and Escitalopram 20 mg/day. 3 days ago he began to feel widespread itching and these erythematous plaques appeared on his skin. The daughter denies changes in diet or use of other medications. She said that her father has been very nervous and anxious in the last few days. What is the probable diagnosis in this case?

3. A 22-year-old male with no prior significant medical or psychiatric history presented to his primary care physician with a chief complaint of breathlessness, described subjectively as “unable to fully expand my lungs.”

On examination, the patient was tachycardic, with a heart rate of 110 bpm, and blood pressure of 140/90 mmHg. His temperature was normal. Auscultation of heart and lungs was unremarkable. A chest X-ray was performed and showed no abnormalities. Given the context of recent psychosocial stressors—relocation to a new city and university pressures—the symptom was attributed to anxiety, and the patient was referred to a psychiatrist.

4. A 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.

5. A 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.