Term
| A 54-year old male presents with progressive weakness, vomiting and weight loss. On examination, the BP is low and the skin is hyperpigmented especially in the skin creases. CMP shows hyperkalemia and hyponatremia. Serum cortisol levels fail to rise after administration of ACTH. |
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| A 45-year old divorced female presents with fatigue for the past nine months. In addition there is muscle pain, insomnia, sleep that is not refreshing and poor concentration. On examination, there are no abnormal findings. CBC, CMP, TFTs and ESR are normal. |
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| A 61-year old female presents with unintentional weight loss. She recently reported a change in her bowel habits diarrhea alternating with constipation. On examination, there is mild pallor. CBC shows a mild microcytic hypochromic anemia and the guaiac stool test for occult blood is positive. Colonoscopy reveals a polypoid mass in the splenic flexure of the colon. |
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| 79-year old female presents with fatigue and orthopnea. She complains that her ankles are swollen especially towards the end of the day. On examination, there is bilateral pitting ankle edema, a positive hepatojugular reflex and distended jugular veins. Her B-type Natriuretic Peptide levels are above 500. |
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Definition
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| A 46-year old female presents with fatigue and excessive weight pain. She also complains of menstrual irregularity. On examination, her BP is 160/100. She is hirsute. Her face is round and she has fatty hump just below her neck. There are purple striae on her abdomen. CMP reveals hyperglycemia, hypernatremia and hypokalemia. Her ACTH levels are marked elevated. |
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| A 42-year old male complains fatigue for the past month. On further inquiry, his appetite is poor, he has trouble sleeping and cannot concentrate at his job. He is sad and has lost his sex drive also. There is nothing worthy of note on examination. CBC, CMP and Thyroid Function Tests are normal. |
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Definition
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| A 21-year old male presents with frequent urination for the past three weeks following a head injury. He drinks a lot of water also. On examination, there is nothing of note. Urinalysis shows a constant specific gravity of less than 1.005 in spite of water deprivation. |
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| An overweight 51-year old female complains of fatigue and vulvar itching. She also complains of increased urinary frequency, increased thirst and eating too much. On examination reveals a red inflamed vulva with a cheesy white discharge. CMP shows a glucose level of 325 mg/dL and there is glycosuria in the urinalysis. |
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Definition
| Diabetes Mellitus Type II and candida vulvovaginitis |
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Term
| A 53-year old female presents with fatigue for the past 4 months. In addition she also complains of multiple aches and pain all over her body and has trouble sleeping. On examination, there is 12 tender spots in specific areas on both sides of her body. CBC, CMP and TFTs are normal. |
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Definition
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| A 51-year old male presents with fatigue for the past 3 months. He has erectile dysfunction and increased thirst. On examination, there is hyperpigmentation or bronzing of his skin. CMP shows hyperglycemia. X-ray of his hands show peculiar beaklike osteophytes on the radial margins of the metacarpal heads. Serum ferritin, transferring and iron are all elevated. |
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| A 35-year old male presents with fatigue and unintentional weight loss. On examination, there is generalized painless lymphadenopathy and purplish lesions on his arms and in the oral cavity. CBC shows leukopenia. His CD4 count is <200 and the Western Blot test is positive. |
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Definition
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| A 35-year old male presents with fatigue. He complains of weight loss in spite of an increased appetite. On examination, the BP is 150/96. There is bilateral exophthalmos and a diffuse goiter. His DTRs are brisk [3+] and he has a fine tremor in both hands. Thyroid Function Tests show an elevated T3 and low TSH. |
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Definition
| Hyperthyroidism [Graves Disease] |
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Term
| A 67-year old female presents with lack of energy and constipation for the past two months. Her hair has been falling out and her voice has deepened also. On examination, there is loss of the other third of her eyebrows and her DTRs are slow to relax. TFTs reveal low T3 and T4 with an elevated TSH. |
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Definition
| Hypothyroidism [most likely Hashimoto Disease] |
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Term
| A 49-year old female complains of always being tired. She also has menorrhagia and polymenorrhea. On examination, there is marked pallor of her mucous membranes. Her uterus is normal in size and shape. CBC shows low hemoglobin and hematocrit. Her MCV and MCHC are both low. The WBC and platelets are normal. |
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Definition
| Iron deficiency anemia [secondary to excessive menstrual loss] |
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Term
| A 65-year old male smoker presents with fatigue and diplopia. On examination, there is bilateral ptosis and increasing muscle fatigue of deltoid muscle with repetitive contraction. Chest x-ray shows an irregular 5 cm mass in the middle zone of the left lung. Biopsy reveals that it is a small cell carcinoma. There are antibodies to the calcium-gated channels in the neuromuscular junction. The tensilon test is negative |
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Definition
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| A 10-year old child of unemployed parents living in an inner city block of apartments presents with fatigue. On examination, there is marked pallor of the mucous membranes. There is a bluish discoloration on his gums. CBC shows low hemoglobin and hematocrit. His MCV and MCHC are both low. His WBC and platelets are normal. A peripheral blood smear reveals basophilic stippling of his red blood cells. |
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Definition
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| An 8-year old child presents with fatigue and easy bruising. On examination, there are numerous ecchymoses in the skin. His spleen is enlarged and he has generalized lymphadenopathy. CBC shows a marked elevation of his white blood cell count >25,000. |
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Definition
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| An 18-year old teen from Connecticut presents with fatigue, headache and mild joint pain for the past three weeks after playing in the nearby woods. On examination, there is bull’s eye rash on the forearm. |
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| 62-year old female presents with fatigue and recurrent low grade fever for the past month. On examination, there are numerous rubbery enlarged lymph nodes in the neck and axilla. CBC shows leukocytosis. Chest x-ray reveals bilateral hilar lymphadenopathy. Lymph node biopsy shows numerous Reed-Sternberg cells. |
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Definition
| Lymphoma [Hodgkin variety] |
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Term
| A 35-year old female presents with fatigue and diplopia. She says that her arms get tired easily especially when she has to brush her daughter’s hair. She also complains that her jaw gets tired when she chews. On examination, there is bilateral ptosis and increasing muscle fatigue of deltoid muscle with repetitive contraction. Chest x-ray shows a mass in the anterior mediastinum. The tensilon test is positive. |
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Definition
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| A 63-year old male presents with fatigue and headaches. There is some hearing loss also. On examination, there is anterior bowing of his tibia. CMP shows an elevated alkaline phosphatase with normal calcium levels. X-ray of the skull shows a cotton wool appearance and there is a brim sign in the pelvic x-ray. |
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Definition
| Paget’s Disease of the bone |
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Term
| A 63-year old female presents with pains in the shoulder and hip regions bilaterally. On examination, there is tenderness of the shoulder and pelvic girdle muscles. ESR is markedly elevated [> 60 mm/hr]. |
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Definition
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| A 33-year old black female presents with fatigue and insidious onset of shortness of breath. She also complains of painful bumps on both of her legs and mild joint pains. On examination, there are several red painful swollen areas over the anterior aspects of both legs. A chest x-ray reveals bilateral hilar lymphadenopathy. Biopsy of the lymph node shows non-caseous granulomas. |
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Definition
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| A 49-year old homeless male presents with progressive shortness of breath, fever, night sweats and hemoptysis. On examination, there is bronchial breathing in the apex of the left lung and there is clubbing of the fingers of both hands. Chest x-ray reveals left apical consolidation with several large cavities. Examination of his sputum reveals several bacilli when stained with the Ziehl-Neelsen method. The Lowenstein Jensen culture results are pending. |
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