MTD 🩺

Which arthritis presents with "sausage fingers"?

Stool microscopy in a patient with acute diarrhea showing "smiley face" organisms. What is the diagnosis?

This rash was seen on the leg of a patient with Crohn's disease. What is this extraintestinal manifestation?

What's the most likely diagnosis?

What is the name of this radiographic sign? A. Westermark sign B. Hampton hump C. Luftsichel sign D. Golden S sign

🩺 Answer: Cluster headache 100% oxygen is a first-line acute treatment for cluster headache. High-yield facts: 🎯 Severe, unilateral periorbital/temporal pain. ⏱ Lasts 15–180 minutes, often occurs in clusters over weeks. 👁 Associated ipsilateral autonomic symptoms:Lacrimation Conjunctival injection Nasal congestion/rhinorrhea Ptosis and miosis (partial Horner syndrome) 🚶 Patients are typically restless or agitated during attacks (unlike migraine patients, who prefer to lie still). Treatment: Acute:✅ 100% oxygen via a non-rebreather mask (12–15 L/min for ~15–20 minutes) Subcutaneous or intranasal sumatriptan Prevention:Verapamil (first-line) Alternatives: lithium, galcanezumab, short course of corticosteroids as bridge therapy.

Which type of headache is treated with oxygen?

🩺 Answer: Langerhans cell histiocytosis (LCH) "Tennis racket" granules on electron microscopy refer to Birbeck granules, which are characteristic of Langerhans cells and are diagnostic of Langerhans cell histiocytosis (LCH). High-yield facts: 🏓 Birbeck granules = rod-shaped cytoplasmic organelles with a terminal expansion ("tennis racket" appearance). 🧫 Immunohistochemistry:CD1a positive Langerin (CD207) positive (responsible for Birbeck granule formation) S100 positive 🦴 Common manifestations:Lytic bone lesions Diabetes insipidus (pituitary involvement) Exophthalmos Skin rash Exam pearl:

Which disease is characterized by "tennis racket" granules on electron microscopy?

🩺 Answer: Autoimmune adrenalitis In developed countries, the most common cause of primary adrenal insufficiency (Addison disease) is autoimmune destruction of the adrenal cortex. High-yield facts: ✅ Most common cause in developed countries: Autoimmune adrenalitis (≈70–90% of cases). 🧬 Often associated with Autoimmune Polyglandular Syndrome (APS):APS-1: Addison disease + hypoparathyroidism + chronic mucocutaneous candidiasis. APS-2: Addison disease + autoimmune thyroid disease ± type 1 diabetes mellitus. 🌍 In developing countries, tuberculosis remains a leading cause of primary adrenal insufficiency.

What is the most common cause of primary adrenal insufficiency (Addison disease) in developed countries?

🩺 Diagnosis: Dermatomyositis The combination of heliotrope rash and Gottron's papules is highly characteristic—and essentially pathognomonic—of dermatomyositis. Classic features: 🟣 Heliotrope rash: Violaceous discoloration with edema of the upper eyelids. ✋ Gottron's papules: Violaceous, scaly papules over the extensor surfaces of the MCP, PIP, and DIP joints. 💪 Symmetric proximal muscle weakness (difficulty climbing stairs, rising from a chair, combing hair). ↑ Creatine kinase (CK), aldolase. Autoantibodies: Anti-Mi-2, anti-MDA5, anti-TIF1-γ, Anti-NXP2, Anti-Jo-1 (less commonly than in antisynthetase syndrome). High-yield associations: Increased risk of malignancy, especially:Ovarian cancer Lung cancer Gastric cancer Colorectal cancer Pancreatic cancer Non-Hodgkin lymphoma Interstitial lung disease (especially with anti-MDA5 or antisynthetase antibodies).

What is the diagnosis?

How would you treat this?

What is being removed from this patient’s tonsil?

The Cardiac Cycle 💡

Atrial septal defect closure device💡

🩺 Diagnosis: Congenital hypothyroidism (Cretinism) This classic constellation of findings strongly suggests untreated congenital hypothyroidism: 🫃 Pot belly 🔘 Protruding umbilicus (umbilical hernia) 👅 Poked-out tongue (macroglossia) 😶 Puffy face (myxedematous facies) 🤍 Pallor with dry, coarse, or yellowish skin (often due to carotenemia) High-yield associated features: Prolonged neonatal jaundice Poor feeding Constipation Hypotonia Hoarse cry Large anterior and posterior fontanelles Developmental delay if untreated Diagnosis: Elevated TSH with low free T4 (primary congenital hypothyroidism). Treatment: Prompt levothyroxine replacement to prevent irreversible neurodevelopmental impairment.

Pot belly Protruding umbilicus (umbilical hernia) Poked-out tongue (macroglossia) Puffy face Pallor (pale, dry, or yellowish skin) What is the diagnosis? 🚨

🩺 "Watermelon stomach" refers to Gastric antral vascular ectasia (GAVE). It is classically associated with systemic sclerosis (especially the diffuse cutaneous form), although it can also occur with: Liver cirrhosis Chronic kidney disease Autoimmune diseases (e.g., Systemic lupus erythematosus) High-yield pearl: Endoscopy: Longitudinal red streaks radiating from the pylorus, resembling a watermelon rind. Presentation: Chronic occult gastrointestinal bleeding → iron deficiency anemia. Treatment: Endoscopic argon plasma coagulation (APC) is first-line.

"Watermelon stomach" is seen in which condition?