Kasus: A 44-Year-Old Man With Back Pain and Progressive Weakness

Background

A 44-year-old man is referred for neurosurgical evaluation secondary to a 6-month history of progressive bilateral lower extremity numbness and weakness. Additionally, he reports a history of back pain over the past 4 years that he describes as an occasional sharp shooting pain down his right thigh. The only medication that he has taken is ibuprofen for pain relief. His surgical history only includes an appendectomy at 14 years of age. He denies tobacco, alcohol, or illicit drug use.

Figure 1

Kasus: Sudden Onset Chest Pain in a Young Man

History

An 18-year-old man presents to the emergency department stating he felt like he “was going to die.”  While on break at work, he experienced sudden onset sharp, midsternal chest pain.  He had no dyspnea or radiation of the pain.  He had not suffered any recent chest trauma but did strike his head on a piece of equipment at work without sequelae. Three days prior to presentation he had cough productive of yellow sputum without fevers or chills.  At the time of evaluation, the pain had been present for several hours and was only relieved by narcotic medications.
His past medical history was significant for bipolar disorder, which was controlled without medications.  He worked as a stock clerk at a department store.  He was a current smoker, 1 pack per day for 2 years, and he gave a history of prior cocaine use, but denied any recent illicit drug usage.

Kasus: lession on head

The patient is suffering from exophthalmos , lytic bone lesions and diabetes insipidus

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Kasus: High creatinin and Urea after back pain medication

A 46-year-old Caucasian male (CM) with chronic back pain takes large doses of over-the-counter pain medications. He works 12-hour night shifts and has to take 15-20 pills, especially Motrin (ibuprofen) and Aleve (naproxen), during the shift and about the same amount during the day in order to "function."

He went to the ER today because of his back pain. CBC and BMP are ordered.

Past medical history (PMH)Back pain.

Medications
Motrin (ibuprofen), Aleve (naproxen), Advil (ibuprofen), Ultram (tramadol), Tylenol (acetaminophen).

Physical examination
Limited range of motion (ROM) of lower back, otherwise unremarkable.

Laboratory results
BMP showed a creatinine of 3.3 mg/dL, BUN 25 mg/dL. CBC was normal.

The patient had a normal CBC and BMP one month ago.

Author: V. Dimov, M.D.
Reviewer: S. Noor, M.D.

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Wheezing dan Eosinophilia pada laki-laki umur 24 tahun

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History

The patient is a 24-year-old Asian-Indian male who initially presented to a community hospital with a 10-day history of mild hemoptysis (2 -3 tablespoons of blood per day), followed by arthralgias, joint stiffness (knees, shoulders, elbows) and myalgias of the proximal muscles.  Moreover, he complained of tactile fevers but denied any rashes.  He also complained of a slight occipital headache, pleuritic chest pain (right greater than left), and loose watery diarrhea without hematochezia or melena.  An initial chest radiograph showed a left upper lobe infiltrate and hilar adenopathy.  The patient was treated for community-acquired pneumonia with Levofloxacin, Ceftriaxone and Azithromycin.  He then developed hypoxic respiratory failure requiring 100% oxygen via a non-rebreather mask.  A computed tomography of the chest showed diffuse patchy, ill-defined infiltrates and increased interstitial markings at the bases.  There was no evidence of pulmonary embolism.  He was transferred to a tertiary care hospital.

Kasus: Kecelakaan

X-Ray berikut diambil dari seorang pasien post-kecelakaan lalu lintas.

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Kasus: chest X ray

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