@medicalcreationsofficial - Medical Creations

📚Medical Books, Supplies and Equipment 📌Our brand new SUTURE PRACTICE KIT is finally OUT 📦 Check out our products on Amazon! Click the link to shop👇
https://www.amazon.com/shop/medicalcreations

144.2K followers

Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) syndrome associated with azithromycin presenting like septic shock.
A 44-year-old otherwise healthy Caucasian man, with a past medical history of anxiety and 15 pack year tobacco use, initially presented to his primary care physician with several days onset of fevers, congestion and cough. He was prescribed azithromycin, promethazine hydrochloride and dextromethorphan hydrobromide syrup. One week later, the patient developed an acute diffuse blistering morbilliform erythematous rash involving bilateral hands, which was extremely pruritic and associated with high-grade fever. Within two weeks, the rash spread to involve nearly his entire body surface, sparing only his face. He presented to an outside hospital with persistent fever, rash, and hypotension consistent with systemic inflammatory response syndrome. He was treated for severe sepsis and presumptive superimposed skin infection with vancomycin and aztreonem, given his history of penicillin allergy. Despite aggressive therapy, the patient rapidly deteriorated with worsening skin involvement, and was subsequently transferred for higher level care.Upon arrival, his vital signs were temperature of 38.2°C, blood pressure of 95/20mmHg, heart rate 68 beats/min, respiratory rate 20 breaths/min, and oxygen saturation 95% on 2L nasal canula. Shortly thereafter, the patient became hypotensive despite aggressive fluid resuscitation and was started on norepinephrine. The patient was subsequently intubated due to worsening level of consciousness. A physical examination revealed an ill-appearing sedated man with evidence of generalized ill-defined coalescing erythema and diffuse pinpoint petechiae. A pulmonary examination was notable for bilateral crackles and diffuse rhonchi and a cardiovascular examination was normal except for tachycardia. There was no lymphadenopathy. A detailed skin examination revealed keratotic desquamation of his palms and soles. His lips and oral mucosa were dry with some cracking of vermilion lips but no bullae. His tongue was diffusely red. His conjunctivae were injected. The case continues in the comments section below
Medical Creations - @medicalcreationsofficial Instagram Profile - ingigram.xyz
medicalcreationsofficial
28

Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) syndrome associated with azithromycin presenting like septic shock. A 44-year-old otherwise healthy Caucasian man, with a past medical history of anxiety and 15 pack year tobacco

A gallbladder with marked cholelithiasis (gallstones), filled with hundreds of cholesterol stones!! Cholelithiasis is the presence of one or more calculi (gallstones) in the gallbladder. In developed countries, about 10% of adults and 20% of people >65 yr have gallstones. Gallstones tend to be asymptomatic. The most common symptom is biliary colic; gallstones do not cause dyspepsia or fatty food intolerance. More serious complications include cholecystitis; biliary tract obstruction (by stones in the bile ducts [choledocholithiasis]), sometimes with infection (cholangitis); and gallstone pancreatitis. Diagnosis is usually by ultrasonography. If cholelithiasis causes symptoms or complications, cholecystectomy is necessary. Biliary sludge is often a precursor of gallstones. It consists of calcium bilirubinate (a polymer of bilirubin), cholesterol microcrystals, and mucin. Sludge develops during gallbladder stasis, as occurs during pregnancy or use of TPN. Most sludge is asymptomatic and disappears when the primary condition resolves. Alternatively, sludge can evolve into gallstones or migrate into the biliary tract, obstructing the ducts and leading to biliary colic, cholangitis, or pancreatitis. There are several types of gallstones. Stones occasionally traverse the cystic duct without causing symptoms. However, most gallstone migration leads to cystic duct obstruction, which, even if transient, causes biliary colic. Biliary colic characteristically begins in the right upper quadrant but may occur elsewhere in the abdomen. It is often poorly localized, particularly in diabetics and the elderly. The pain may radiate into the back or down the arm.
Episodes begin suddenly, become intense within 15 min to 1 h, remain at a steady intensity (not colicky) for up to 12 h (usually 
Medical Creations - @medicalcreationsofficial Instagram Profile - ingigram.xyz
medicalcreationsofficial
30

A gallbladder with marked cholelithiasis (gallstones), filled with hundreds of cholesterol stones!! Cholelithiasis is the presence of one or more calculi (gallstones) in the gallbladder. In developed countries, about 10% of adults and 20% of people 

A woman's swollen and drooping left eyelid led British doctors to an eye-popping discovery: a rigid contact lens, wrapped completely in a cyst, hidden in the fold of skin. The last time she used such a contact? About 28 years ago. The woman, 42, visited an ophthalmologist after swelling had persisted for about six months. The woman couldn't recall how the lens would have gotten there, but her mother did: A mishap during a badminton game 28 years prior resulted in the woman 'losing' her contact lens as a teenager. The lens was unscathed when discovered, engulfed in the eyelid's soft tissue, only to chip as doctors removed it. And while the cyst amassed to a pea-shaped lump beneath her left brow, the woman showed no signs of the scratchy pain, redness or sensitivity associated with stuck lenses during those 28 years. 
The lens apparently migrated into the eyelid after the injury nearly three decades earlier.
Cr: BMJ Case Reports
Medical Creations - @medicalcreationsofficial Instagram Profile - ingigram.xyz
medicalcreationsofficial
30

A woman's swollen and drooping left eyelid led British doctors to an eye-popping discovery: a rigid contact lens, wrapped completely in a cyst, hidden in the fold of skin. The last time she used such a contact? About 28 years ago. The woman, 42, v

A 41-year-old woman presented to the endocrinology clinic with nail changes that had occurred over several months and hair loss that had progressively worsened over 2 years. Physical examination revealed dry skin, thickened and brittle nails with horizontal ridges, marked hair loss with coarse hair, and a diffusely enlarged thyroid gland. The results of laboratory evaluations were notable for a thyrotropin level of 30.5 μIU per milliliter (reference range, 0.5 to 5.0) and a serum free thyroxine level of 0.4 ng per deciliter (5.7 pmol per liter; reference range, 0.9 to 1.7 ng per deciliter [11.6 to 21.9 pmol per liter]). Findings from further testing showed an antithyroglobulin antibody level of 793 IU per milliliter (reference value, ≤55) and an antithyroid peroxidase antibody level of 2439 IU per milliliter (reference value, ≤9). Ultrasonography revealed diffuse goiter with heterogeneous internal echogenicity. Hypothyroidism due to Hashimoto’s (chronic lymphocytic) thyroiditis was diagnosed. Hypothyroidism should be considered in the differential diagnosis of thickened and brittle nails and hair loss, although this extreme presentation is atypical. Five years after the initiation of levothyroxine therapy, the nail changes and hair loss had resolved.
Medical Creations - @medicalcreationsofficial Instagram Profile - ingigram.xyz
medicalcreationsofficial
26

A 41-year-old woman presented to the endocrinology clinic with nail changes that had occurred over several months and hair loss that had progressively worsened over 2 years. Physical examination revealed dry skin, thickened and brittle nails with hor

A 42-year-old woman presented with a 1-week history of swelling and pain in the fifth finger of her left hand. She reported no related trauma. She had systemic lupus erythematosus and was being treated with mycophenolate mofetil and prednisone. Physical examination of the affected finger revealed soft-tissue swelling, with erythema and warmth, that was most prominent between the proximal and distal interphalangeal joints, sparing the fingertip. Radiography and magnetic resonance imaging revealed swelling of soft tissue but no bony abnormalities. Examination of a biopsy specimen of the deep dermis after Fite staining revealed numerous acid-fast bacilli (Second picture, arrow). Culture of a tissue sample grew Mycobacterium tuberculosis. Findings on radiography of the chest were normal. The patient had undergone a purified protein derivative skin test before starting immunosuppressive therapy; the result was negative. Further investigation revealed that the patient’s husband, who had recently traveled to China, had a cough that developed soon after his return home. He subsequently received a diagnosis of active pulmonary tuberculosis. Although infection of the finger is a rare extrapulmonary manifestation of tuberculosis, it is an important consideration in immunosuppressed patients. This patient was treated with a four-drug antituberculosis regimen for a total of 9 months and had complete resolution of her symptoms.
Cr: Jennifer Mandal, M.D. Mary Margaretten, M.D.
University of California at San Francisco, San Francisco, CA
Medical Creations - @medicalcreationsofficial Instagram Profile - ingigram.xyz
medicalcreationsofficial
46

A 42-year-old woman presented with a 1-week history of swelling and pain in the fifth finger of her left hand. She reported no related trauma. She had systemic lupus erythematosus and was being treated with mycophenolate mofetil and prednisone. Physi

A 26-year-old previously healthy man presented to the emergency department with a 3-day history of fever, dry cough, and nonpruritic rash. A physical examination was notable for crackles on the left side of the chest and a macular, targetoid rash on his hands and feet, including the palms and soles. A radiograph of the chest showed infiltrates in the left lower lung field. Over the next 3 days, severe mucositis developed that involved the lips, buccal mucosa, conjunctivae, and urethral meatus. Bacterial cultures of the blood and sputum and a polymerase-chain-reaction (PCR) test for herpes simplex virus in a specimen from the oral lesions were negative. Testing for Mycoplasma pneumoniae by PCR of the nasopharyngeal aspirate and for serum IgM antibody was positive. Mycoplasma is commonly associated with exanthems. In this case, the clinical presentation was consistent with Mycoplasma pneumoniae–induced erythema multiforme, also referred to as mycoplasma-induced rash and mucositis. Given the severity of the mucosal involvement, a nasogastric tube was placed for nutrition and for administration of medications. After approximately 2 weeks of treatment with doxycycline, the patient had complete resolution of his respiratory illness and mucositis (second picture).
Medical Creations - @medicalcreationsofficial Instagram Profile - ingigram.xyz
medicalcreationsofficial
32

A 26-year-old previously healthy man presented to the emergency department with a 3-day history of fever, dry cough, and nonpruritic rash. A physical examination was notable for crackles on the left side of the chest and a macular, targetoid rash on

A 21-year-old dental assistant attempted suicide by injecting 10 ml (135 g) of elemental mercury (quicksilver) intravenously. She presented to the emergency room with tachypnea, a dry cough, and bloody sputum. While breathing room air, she had a partial pressure of oxygen of 86 mm Hg. A chest radiograph showed that the mercury was distributed in the lungs in a vascular pattern that was more pronounced at the bases. The patient was discharged after one week, with improvement in her pulmonary symptoms. Oral chelation therapy with dimercaprol was given for nine months, until the patient stopped the treatment; the urinary mercury level did not change during this period. At follow-up at 10 months, she was healthy, with none of the renal, gastrointestinal, or neurologic effects that can result from the oxidation of mercury in the blood and consequent exposure of these organ systems. The abnormalities on the chest radiograph were still apparent. Although these abnormalities are striking, the absence of clinical toxicity in this patient illustrates the differences in the acute and chronic effects of exposure to elemental mercury, inorganic mercury (e.g., mercuric chloride), and organic mercury (e.g., dimethylmercury). Inorganic and organic mercury are much more toxic than elemental mercury; for example, a dose of 400 mg of mercury in the form of dimethylmercury is usually lethal.
Medical Creations - @medicalcreationsofficial Instagram Profile - ingigram.xyz
medicalcreationsofficial
101

A 21-year-old dental assistant attempted suicide by injecting 10 ml (135 g) of elemental mercury (quicksilver) intravenously. She presented to the emergency room with tachypnea, a dry cough, and bloody sputum. While breathing room air, she had a part

Loiasis is a filarial nematode infection with Loa loa. Loiasis is confined to the rain forest belt of western and central Africa. Humans are the only known natural reservoir for this parasite. Loa loa microfilariae are transmitted by day-biting tabanid flies (Chrysops [deer fly or horse fly]). Microfilariae mature to adult worms in the subcutaneous tissues of the human host; females are 40 to 70 mm long, and males are 30 to 34 mm long. The adults produce microfilariae. Adults migrate in subcutaneous tissues and under the conjunctiva of the eye, and microfilariae circulate in blood. Flies become infected when they ingest blood from a human host during the day (when microfilaremia levels are the highest). Most infected people are asymptomatic, but eosinophilia is common. Infection produces areas of angioedema (Calabar swellings) that develop anywhere on the body but predominantly on the extremities; they are presumed to reflect hypersensitivity reactions to allergens released by migrating adult worms. In native residents, swellings usually last 1 to 3 days but are more frequent and severe in visitors. Worms may also migrate subconjunctivally across the eyes. This migration may be unsettling, but residual eye damage is uncommon. Nephropathy generally manifests as proteinuria with or without mild hematuria and is believed to be due to immune complex deposition.
Encephalopathy is usually mild, with vague CNS symptoms. Diagnosis is by detecting microfilariae in peripheral blood or seeing worms migrating across the eye. Loa-specific antibody tests have been developed, but they are not widely available in the US. Treatment is with diethylcarbamazine. In patients with heavy infection, pretreatment with apheresis or albendazole is recommended because in these patients, the filarial antigens released as diethylcarbamazine kills microfilariae may trigger encephalopathy, leading to coma and death. Clinicians should seek expert assistance when measuring the number of microfilariae and thus determining the severity of the infection.
Medical Creations - @medicalcreationsofficial Instagram Profile - ingigram.xyz
medicalcreationsofficial
179

Loiasis is a filarial nematode infection with Loa loa. Loiasis is confined to the rain forest belt of western and central Africa. Humans are the only known natural reservoir for this parasite. Loa loa microfilariae are transmitted by day-biting tab

A 77-year-old man was referred to the endocrinology clinic for the evaluation of subclinical hyperthyroidism. He had no symptoms of thyrotoxicosis and no dyspnea or dysphonia that would suggest tracheal compression. Physical examination revealed an enlarged thyroid with no palpable nodules or cervical lymphadenopathy. Pemberton’s sign — reversible facial congestion after elevation of both arms — was noted. The plasma thyrotropin level was 0.2 mIU per liter (reference range, 0.4 to 4.4), and the serum level of free thyroxine was normal. Computed tomography of the neck revealed an enlarged thyroid that was compressing the subclavian and jugular veins and a patent trachea that deviated to the left (arrow). Pemberton’s sign is indicative of superior vena cava syndrome due to obstruction of the thoracic inlet. The patient underwent an uncomplicated total thyroidectomy, and a benign goiter was observed on pathological analysis. Thyroid hormone therapy was prescribed, and the patient was euthyroid on follow-up 6 months after surgery.
Cr: Thomas Cuny, M.D., Ph.D.
University Hospital of Marseille, Marseille, France
Medical Creations - @medicalcreationsofficial Instagram Profile - ingigram.xyz
medicalcreationsofficial
4

A 77-year-old man was referred to the endocrinology clinic for the evaluation of subclinical hyperthyroidism. He had no symptoms of thyrotoxicosis and no dyspnea or dysphonia that would suggest tracheal compression. Physical examination revealed an e

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery.
Unlike systemic chemotherapy delivery, which circulates throughout the body, HIPEC delivers chemotherapy directly to cancer cells in the abdomen. This allows for higher doses of chemotherapy treatment. Before patients receive HIPEC treatment, doctors perform cytoreductive surgery to remove visible tumors within the abdomen. Once as many tumors as possible have been removed, the heated, sterilized chemotherapy solution is delivered to the abdomen to penetrate and destroy remaining cancer cells. 
The solution is 41 to 42 degrees Celsius, about the temperature of a warm bath. The solution is then drained from the abdomen and the incision is closed. This aggressive multimodality treatment is complex, not only regarding surgical technique, but also regarding anesthesia, and is associated with major hemodynamic and metabolic changes. As well as primary disease and complexity of surgery.
Medical Creations - @medicalcreationsofficial Instagram Profile - ingigram.xyz
medicalcreationsofficial
30

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery. Unlike systemic chemotherapy delivery, which circulates throughout the body, HIPEC del

F*CK PLAN B.  That’s my motto.  That’s been my motto since I was 17.  Everyone was always telling me to get a “back up plan” in case I didn’t get into medical school.  I didn’t get in, but guess what….I was going to find a way.  About 95% of people told me to give up and do something else.  Except ONE DOCTOR.  He said, if you want to do it, find a way.  In fact he even helped me get a direction a little bit.  He told me to go to a Caribbean school as long as I was eligible to get a US residency I could do it.  It wasn’t going to be easy….in fact he told me it was going to be much harder than I could ever think of, but if I wanted to be a surgeon, that was the way.  So I listened to him.  I went to a Caribbean med school even tho many people laughed and made fun of me for years. I fought with blood, sweat and tears for over 20 years to get where I am today.  Now, I get to help people when they are about to die.  I have the knowledge, skill and balls to open someone’s chest or belly when they are minutes from death, and I can bring them back.  If you want to be a doctor or a surgeon and many people have told you to give up or that you shouldn’t do it……I can help you.  I ain’t gonna do the work for you but I can help you along the way.  FOLLOW @drbuckparker for pre-med guidance, crazy surgical photos and to learn what it’s like to be a surgeon.  F*CK PLAN B.
Medical Creations - @medicalcreationsofficial Instagram Profile - ingigram.xyz
medicalcreationsofficial
29

F*CK PLAN B. That’s my motto. That’s been my motto since I was 17. Everyone was always telling me to get a “back up plan” in case I didn’t get into medical school. I didn’t get in, but guess what….I was going to find a way. About 9

C h e w I n g • F i n g e r s
.
.
This is an X-Ray of a patient who had a long history of chewing and gnawing their fingers to the bone.
.
.
As you can imagine, this resulted in severe bacterial infections which had to be treated with antibiotics and eventually multiple amputations. .
.
Maybe you’ll think twice about biting your fingernails. Hope you all have a great weekend!
.
.
Case: @drcellini
Medical Creations - @medicalcreationsofficial Instagram Profile - ingigram.xyz
medicalcreationsofficial
82

C h e w I n g • F i n g e r s . . This is an X-Ray of a patient who had a long history of chewing and gnawing their fingers to the bone. . . As you can imagine, this resulted in severe bacterial infections which had to be treated with antibiotics a