Immune System

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This patient has presented with an complex constellation of signs and symptoms:\nAcute upper back pain that appears to be mechanical in nature, in association with kyphosis, a gibbous deformity over the thoracic spine, and point tenderness of the T10-T12 vertebrae; "},{"insert":"\n","attributes":{"list":"bullet"}},{"insert":"A chronic nonproductive cough and constitutional symptoms, with increased vocal resonance, bronchial breathing, and coarse crepitations over the left apex. "},{"insert":"\n","attributes":{"list":"bullet"}},{"insert":"The above findings involve both the musculoskeletal and respiratory systems. The question is if these are due to two separate pathologies\u2014or a single condition. Two such potential unifying diagnoses are vertebral metastasis secondary to a primary lung malignancy; and pulmonary tuberculosis with extrapulmonary manifestations.\n\nHis basic bloodwork shows normocytic anemia and elevated inflammatory markers. Chest x-rays reveal a heterogeneous opacity in the left apex. Unfortunately, these findings are not specific enough to distinguish between the above differentials. \n\nMRI of the spine is a good next step. This show extensive destruction of the thoracic spine; and rim-enhancing paravertebral and sub-ligamental lesions suggestive of abscesses"}]}

Want to continue playing?

Open your Clinical Odyssey account today.

Enjoy unlimited access to 600+ simulations.
Safely improve your skills, anytime and anywhere.
Get answers to your follow-up questions from practicing physicians.