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| A 56-year old overweight male smoker presents with episodes of squeezing precordial chest pain whenever he is angry. There is no family history of heart Disease, however his father died at age 63 from a massive stroke. On examination, there are bilateral diagonal ear lobe creases. His BP is 180/110. ECG shows depressed ST segments during a stress ECG test. His troponin and CK-MB levels are normal. |
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| A 72-year old male presents with a persistent cough for the past month and hemoptysis since last week. He smoked a pack of cigarettes a day for over thirty years but stopped three years ago because of a clot in his leg. On examination, there is clubbing of the fingers in both hands. Chest x-ray shows an irregular perihilar mass on the left side measuring > 7 cm. |
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| A 52-year old divorced female complains a persistent dull ache in her left chest for over a month. On further inquiry, she also has insomnia, poor concentration, loss of libido, sadness and guilt feeling for the past month. There is nothing worthy of note on examination. CBC, CMP and Thyroid Function Tests are normal. |
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| A 67-year old male with Marfan’s Syndrome presents with sudden onset of tearing chest pain. He is sweating and has a feeling of impending doom. On examination, his BP is 100/60 and his left radial pulse is weaker than the right. Chest x-ray shows a widening of the superior mediastinum. |
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| Dissecting Thoracic Aorta |
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| A 47-year old female presents with multiple aches and pain all over her body. In addition she complains of fatigue and not being able to sleep well. On examination, there are 14 tender spots in specific areas on both sides of her body. CBC, CMP and TFTs are normal. |
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| A 27-year old overweight male complains of burning epigastric pain which seems to go up into his chest whenever he lies down to watch TV after a heavy meal in the evenings. He also complains occasionally of having a cough that wakes him up. An upper GI barium series shows a hiatal hernia. |
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| A 59-year old female presents with pleuritic chest pain for the past three days and a rash along the right side of the chest since yesterday. On examination, there is a vesiculopustular rash along the dermatome of T5. |
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| A 61 year-old male presents with acute onset of fever, cough and headache. He also complains of muscle pains. Examination reveals a temperature of 1020F. There is mild redness of the pharynx. The lungs are clear and there is no neck stiffness or tenderness on percussion of his sinuses. What is your diagnosis? |
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| A 43-year old obese male presents with sudden onset of chest pain which radiates into his left jaw and down along the inner aspect of his left arm. On examination, he is sweating profusely. The ECG show ST elevation and large Q waves in the anterior chest leads. |
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| A 23-year old female college student presents with sharp precordial chest pain. The chest pain is worse on lying down and better when she sits up and leans forward. On examination, there is precordial friction rub. CBC shows mild elevation of her lymphocytes. ECG shows widespread ST elevation but there are no pathological Q waves. |
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A 28-year old male smoker presents with chills, fever, pleuritic chest pain, a cough with rust-colored sputum. On examination, the tactile fremitus is increased over the lower left side of the chest.
The percussion note is dull and there is bronchial breathing and egophony present over the same area.
CBC shows marked elevation of his neutrophils and a leukocytosis. Chest x-ray shows consolidation in the lower lobe on the left side. |
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| Pneumonia most likely caused Strep. pneumoniae |
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A 23-year old male scuba diver presents with sudden onset of chest pain and shortness of breath shortly after a dive this morning. On examination, his respiratory rate is 24/minute.
Breath sounds are absent over the entire right side of the chest. The trachea is central and there is no cyanosis. Chest x-ray shows a collapsed right lung. |
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| A 36-year old female presents with sudden onset of shortness of breath, sticking chest pain and hemoptysis shortly after arriving at the airport from an 8-hr flight from Juno, Alaska. She has been on the contraceptive pill for the past 10 years. On examination, her left leg is warm and swollen. |
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| A 20-year old male football player complains of sticking chest pain after a very rough tackle in a game last night. The pain is worse on deep breathing and coughing. On examination, sternal compression makes the chest pain worse. There is localized tenderness over the shaft of his 5th rib in the midaxillary line. Breath sounds are normal. |
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| A 19-year old male army private presents with pain over the left side of his chest. The pain started a day after he returned from boot camp. On examination, there is tenderness and swelling of his 2nd left costochondral junction. |
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