What is your diagnosis (5) – Internal Medicine

Just sharing πŸ™‚

Whoever can answer everything correctly within 24 hours is a genius and efenem will download a 700MB-movie at his/her request πŸ™‚


  1. A 70 year old man on 5th day of hospitalization for acute myocardial infarction has a recurrent chest pain and an increase in both CK-MB and troponin-1. What is the most likely diagnosis?
  2. A febrile 22 year old medical student complains of acute onset of right flank pain, suprapubic discomfort, dysuria, increased frequency of urination. Urinalysis reveals clumps of leukocytes, WBC casts, occasional RBCs and numerous motile bacteria. Diagnosis?
  3. What test distinguishes pituitary Cushings from adrenal and ectopic cushings?
  4. A 47 year old man with Crohn’s Disease for 20 years complains of fatigue. Physical exam: HR 106/min, pale conjunctivae, angular cheilosis and beefy tongue. Hct 21%, MCV 105 fl. The patient is at risk of what problems in the future?
  5. An 23 year old man complains of 3-week history of worsening dry and non-productive cough. He also has a  throbbing headache along with mild fever and complains of malaise and sore thorat. Treatment of penicillin does not relieve his symptoms. His 18 year old brother also had similar symptoms recently. Diagnosis?
  6. A 62 year old woman presents with constipation, flatus, left-sided abdominal pain, tenderness, fever, tachycardia and elevated WBC count. What is the most likely diagnosis? What is a contraindication for this patient?


Happy answering!


18 thoughts on “What is your diagnosis (5) – Internal Medicine

  1. 1. recurrent MI
    2. PN
    3.High dose DEXA suppression test would distinguish Cushing disease from the Cushing syndrome while ACTH would then differentiate between ectopic ACTH and adrenal cushing
    4. with signs of pallor and Signs suggestive of vitamin B12 deficiency such as angular cheilosis and stomatitis and together with MCV more than 100 it is too obvious that the patient has vit B12 deficiency anemia. if left untreated, it may lead to subacute combined degeneration of spinal cord
    5. it is suggetive of meningitis with fever and headache. To be honest, need more description of the condition of patient.
    6. DD: toxic megacolon, peritonitis, diverticulitis….. again i wana ask u prepare the question urself or u copy from other site(s) and then ‘ summarize’ it.

    • i copy from some book πŸ™‚
      thnks for trying… will let know πŸ™‚

      p/s: while DDx is highly appreciated, the quiz here is only about “the most likely diagnosis”… Of course, in real clinical situation you have to do this exam and that exam, but the most likely diagnosis is the first suspicion of disease that might come first from your head from a limited presentation.

  2. then i would go for toxic megacolon as the most likely diagnosis but then there is no feedback….

    I think it is better to describe the condition of patient more in details.

  3. Since u r not giving anymore details, i would like to ask izzit possible to ask questions for example whether menigeal sign is present in the patient with throbbing headche

    • Was in russian class.
      According to wrongdiagnosis.com, throbbing (pulsating) headache is caused by:

      Basilar artery
      Chemical poisoning – nitroglycerine
      MSG adverse reaction
      Temporal arteritis

      There’s no mentioning of meningeal signs for throbbing headache

  4. Thx for the info although it seems useless to me.

    I think we would agree we think on basis of combination of symptoms. Mayb i dun trust the pat too much.

    If i think in ur point of view, then i m waiting for 1 of the answers u suggested from the wrongdiagnosis.com that i dun think so would appear as ur answer.

    by the way, is it a good trend to search for the diagnosis using google etc as u just did it..

  5. ngeh i hate being 2nd coz my answers wud then seem like i copied from the 1st person answering the Qs. hehe.. but then wth.. πŸ˜›

    1. recurrent MI
    2. PN + cystitis.. dysuria is unlikely to occur alone in PN. it’s more typical for dysuria.
    3. hi-dose dexamethasone suppression test
    4. CNS probs not specifically for spinal cord only.. brain can be affected too as a result of demyelinization of nerves – tingling, numbness, gait prob, dementia, psychosis, etc.

    5. not sure yet! but meningitis is very unlikely jer.. hmmm… tough one! coz too general! haha! but i think it’s viral origin.

    6. gotta agree with huicy. the Sx n Sm for GIT Ds are quite general so can only give DDx b4 making any Ix to confirm the Dx. but for me, the most likely Dx wud be either ileus or diverticulitis (presence of triad Sm – fever, leukocytosis, LLQ pain) n c/i: barium x-ray (ileus), NPO (ileus), colonoscopy (diverticulitis)

  6. 5. *chronic* rhinovirus infection? hehe! seriously i have no idea. i need more symptoms or lab test results! haha!

  7. 1. CK-MB usually peaks at 24 hours after acute myocardial infarction and decreases its level on 3rd day. Rising of CK-MB after 3rd day is suggestive of reinfarction.

    2. Pyelonephritis – ascending urinary tract infection.

    3. Dexamethasone suppression test πŸ˜‰ easy right?

    4. Patients with Crohn’s Disease are susceptible to Vitamin B12 deficiency as the lesion is in terminal ileum (site for B12 – intrinsic factor reabsorption). B12 deficiency if left untreated are prone to various neurological problems (demyelinating process); paresthesia, ataxia, subacute combined degenration among others

    5. Walking pneumonia (primary atypical pneumonia) or mycoplasma pneumonia is the most common cause of pneumonia in teenagers and young adults. Mycoplasma has no cell wall, its membrane contains cholesterol, explaining why penicillin wont work on this microbe. Infection with mycoplasma pneumoniae typically results in mild upper respiratory tract disease; low grade fever, malaise, headache, nonproductive cough. Symptoms gradually worsen for few days and lasts for more than 2 weeks. Close contact can spread the infection.

    6. I agree that imaging and full blood count are needed for this patient. But with combined presentations of constipation, flatus, left-sided abdominal pain, tenderness, fever, tachycardia and elevated WBC count, plus the woman’s age in her 60’s are suggestive of diverticular disease, but other diseases should be ruled out by additional tests. Colonoscopy is contraindicated in patients with diverticular disease as it might induce perforation.

    Congratulations to Huicy and Jatdin for answering these questions correctly, except for walking pneumonia πŸ™‚

  8. thanks for the answer although i dun agree with some of the answers either by u or jatdin.
    1st bout Jatdin, for the second question u must be a very newbee for saying cystitis is ur diagnosis as in contrast to PN, it doesn’t require treatment. and please from where u read cystitis got systemic symptoms.
    For question no.4 , jatdin i agree with ur bla bla bla but if left untreated for a long time, it is commonly ass with SACDSC.
    then for q no 5. who said menigitis is equivalent to bacterial infection.
    for question no 6, if it is diverticular disease it is more commonly presents with fever, local tenderness and leukocytosis but the signs of tachycardia is more suggestive of toxic megacolon. u can check it urself.

    anyway, thanks for posting questions and i sincerely hope you would continue sharing with others.

    They are just my point of view.

  9. ngeh! stopet atypical pneumonia! if only there were such thing as *chronic rhinovirus infection* then i wud have got the answer right! or in case of shorter duration of Ds! hehe!~

  10. dun get me wrong, i principally agree with mycoplasma pneumonia as i did come across this possibility but u described it as throbbing so i opt to choose a disease better to overdiagnose than underdiagnose.

    thanks for teling me but i stil think diverticulitis shouldn’t be considered as first in ur list of DDX as toxic megacolon is more severe.

    what do u mean by u should be more specific with symptoms?

    for most of the questions, the symptoms u described r not specific eg for the last question, u said constipation.. what is the onset then u mentioned left sided abdo pain- where? LUQ, lumbar fossa or LLQ. tenderness? superficial or rebound?

    just exactly like the question regarding mycoplasma, can the throbbing headach of acute onset? is it first time in his life? as sometimes 2 diseases maybe present in 1 pat. Penicillin? what type of penicillin and the dosage?

    hope u dun feel offended but i am quite curious why u didn’t point out mistakes made by forgot his or her name

    • toxic megacolon is a life threatening condition from other intestinal diseases. Given that the lady has no prior history of intestinal disease, toxic megacolon is unlikely. So does ileus, as she has no prior history of intra-abdominal operation. Mind you, the question is always the MOST LIKELY diagnosis.

  11. 2. oh please did u not read carefully? i wrote PN + cystitis meaning PN in combination with cystitis ( you must be a not-so-good doctor or superior-newbee for saying PN is more likely to cause dysuria). my internal knowledge might sux but i learn from one of the best int med teacher and im 100% sure bout my answer)

    4. the Qs wants what ‘problems’ in the future not specific name of a disease, so CNS disorders are more likely. πŸ˜›

    5. who said meningitis is totally bacterial related? im just saying that, that kind of clinical pictures may have viral origin instead. meningitis wud never come to my mind with such general symptoms. meningitis has an even brighter symptoms mind u! and i wud definitely order a CXR examination instead of a lumbar puncture for such patient. πŸ˜›

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