Aquifer Internal Medicine 
         36 cases covering the Clerkship Directors in Internal Medicine’s (CDIM) General Internal Medicine Core Medicine 
         clerkship curriculum. 
  
           Case                          Differential Diagnosis                                                 Final Diagnosis 
           Internal Medicine 01:         Unstable Angina, Non ST elevation MI                                   Acute ST elevation 
           49-year-old male with                                                                                myocardial infarction 
           chest pain 
           Internal Medicine 02:         Angina, myocardial infarction, GERD, pulmonary embolism                Stable angina pectoris 
           60-year-old female with 
           chest pain 
           Internal Medicine 03:         Obstructive cardiac disease; Arrhythmia; Cardiac Ischemia;             Syncope related to atrial 
           54-year-old female with       Peripheral vascular or circulatory dysfunction; Central nervous        fibrillation and mitral 
           syncope                       system disorder: including transient ischemic attack (TIA) and         stenosis 
                                         stroke. Metabolic derangement: including hypoglycemia. 
                                         Potassium, magnesium and calcium disorders can cause 
                                         arrhythmias which can lead to syncope. Hyponatremia can 
                                         lead to seizure presenting like syncope. 
           Internal Medicine 04:         Congestive heart failure, asthma, chronic obstructive                  Heart failure with 
           67-year-old female with       pulmonary disease (COPD), pneumonia, cardiac ischemia,                 reduced ejection fraction 
           shortness of breath and       interstitial lung diseases;  psychogenic causes 
           lower-leg swelling 
           Internal Medicine 05:                                                                                Major depression 
           55-year-old male with 
           fatigue 
           Internal Medicine 06:         N/A                                                                    Stage 2 hypertension 
           45-year-old male with 
           hypertension 
           Internal Medicine 07:         hypotension, polyuria, nausea, vomiting, and diarrhea:                 Hyperosmolar 
           28-year-old female with       pregnancy, urosepsis, acute hyperglycemia, gastroenteritis,            hyperglycemic state, 
           lightheadedness               adrenal insufficiency                                                  newly diagnosed Type 2 
                                                                                                                diabetes mellitus 
           Internal Medicine 08:         N/A                                                                    Type 2 diabetes mellitus 
           55-year-old male with                                                                                with micro and 
           chronic disease                                                                                      macrovascular 
           management                                                                                           complications 
           Internal Medicine 09:         cholecystitis, gastritis, pancreatitis, peptic ulcer disease, small    Acute pancreatitis, acute 
           55-year-old female with       bowel obstruction, spontaneous bacterial peritonitis                   alcohol withdrawal 
           upper abdominal pain 
           and vomiting 
          Internal Medicine 10:       Causes of upper gastrointestinal bleed (UGIB): peptic ulcer        Bleeding peptic ulcer, H. 
          48-year-old female with     disease esophageal or gastric varices, erosive esophagitis         pylori infection, febrile 
          diarrhea and dizziness      erosive gastritis Mallory-Weiss tear gastric cancer epistaxis      non-hemolytic 
                                      Causes of lower gastrointestinal bleed (LGIB): angiodysplasia      transfusion reaction 
                                      diverticulosis ischemic colitis hemorrhoids anal fissures colon 
                                      cancer inflammatory bowel disease 
          Internal Medicine 11:       acetaminophen toxicity, alcoholic liver disease, autoimmune        Active hepatitis C 
          45-year-old male with       hepatitis, hemochromatosis, hepatitis B, hepatitis C, non-         infection 
          abnormal liver              alcoholic steatohepatitis (NASH), metastatic liver cancer, 
          chemistries                 hepatitis A. 
          Internal Medicine 12:       pseudomembranous colitis (Clostridium difficile infection),        Acute sigmoid 
          55-year-old male with       inflammatory bowel disease, gastroenteritis, small bowel           diverticulitis 
          lower abdominal pain        obstruction, renal colic, appendicitis 
          Internal Medicine 13:       N/A                                                                Osteopenia 
          65-year-old female for 
          annual physical 
          Internal Medicine 14:       N/A                                                                UTI, chlamydia 
          18-year-old female for 
          pre-college physical 
          Internal Medicine 15:       Allergic rhinitis, acute bacterial sinusitis, acute bronchitis,    Viral upper respiratory 
          50-year-old male with       influenza, Streptococcal pharyngitis, bacterial pneumonia          infection (common cold); 
          cough and nasal                                                                                Tobacco use disorder 
          congestion 
          Internal Medicine 16:       N/A                                                                Obesity, Dyslipidemia 
          45-year-old male who is 
          overweight 
          Internal Medicine 17:       DDx: pigmented lesion--melanoma, benign nevus; seborrheic          Melanoma, adverse drug 
          28-year-old male with a     keratosis; cafe au lait spots;Melasma; Freckles; Post-             reaction, psoriasis, 
          pigmented lesion            inflammatory hyperpigmentation hemosiderin deposition              seborrheic dermatitis, 
                                      DDx:Acute erythematous maculopapular erythematous rash             MRSA abscess, and 
                                                                                                         contact dermatitis 
          Internal Medicine 18:       N/A                                                                Major neurocognitive 
          75-year-old male with                                                                          disorder, Alzheimer’s 
          memory problems                                                                                dementia subtype 
          Internal Medicine 19:       anemia, B12 deficiency, iron deficiency                            Iron deficiency, 
          42-year-old female with                                                                        pernicious anemia 
          anemia 
          Internal Medicine 20:       tuberculosis, Pneumocystis jiroveci (formerly Pneumocystis         Disseminated 
          48-year-old female with     carinii), cryptococcosis, viral hepatitis, cytomegalovirus         Mycobacterium avium 
          HIV                         (CMV), mycobacterium avium complex (MAC), toxoplasmosis,           infection 
                                      endocarditis, lymphoma, protozoan infection (Microspora, 
                                      Isospora, Cryptosporidium), disseminated histoplasmosis, 
                                      Bartonella infection, coccidioidomycosis, visceral 
                                      leishmaniasis. 
          Internal Medicine 21:       cardiogenic shock, hypovolemic shock, neurogenic shock,            Urosepsis, mesenteric 
          78-year-old male with       anaphylactic shock, adrenal crisis, and septic shock               ischemia, metastatic 
          fever, lethargy, and                                                                           colon cancer 
          anorexia 
          Internal Medicine 22:       Common cold, acute bronchitis, influenza, acute COPD               Right lower lobe 
          71-year-old male with       exacerbation, pulmonary embolism, CHF, pneumonia, lung             pneumonia 
          cough and fatigue           cancer, aspiration 
          Internal Medicine 23:       chronic kidney disease                                             Chronic kidney disease 
          54-year-old female with                                                                        probably due to 
          fatigue                                                                                        hypertensive 
                                                                                                         nephropathy 
          Internal Medicine 24:       Bacterial meningitis, cerebral vasculitis, cerebrovascular         Bacterial meningitis 
          52-year-old female with     accident, cluster headache, intracerebral abscess, migraine, 
          headache, vomiting, and     primary central nervous system lymphoma, subarachnoid 
          fever                       hemorrhage, temporal arteritis, tension headache, 
                                      toxoplasmosis, viral meningitis 
          Internal Medicine 25:       Electrolyte imbalance, medication adverse reaction                 Delirium due to thiazide-
          75-year-old female with                                                                        induced euvolemic 
          altered mental status                                                                          hypotonic hyponatremia 
          Internal Medicine 26:       electrolyte abnormality, toxic ingestion, infection, hypoxia,      Ethylene glycol toxicity, 
          58-year-old male with       hypercarbia, intracranial hemorrhage                               hypernatremia 
          altered mental status 
          and experiencing 
          homelessness 
          Internal Medicine 27:       Primary hyperparathyroidism (sporadic) Familial: Familial          Stage II squamous cell 
          65-year-old male with       isolated hyperparathyroidism, Multiple endocrine neoplasia         lung cancer and 
          hypercalcemia               (MEN) 1 and 2a, Familial hypocalciuric hypercalcemia (FHH)         neutropenic fever 
                                      Hypercalcemia of malignancy; Parathyroid hormone-related 
                                      protein (PTHrp);Osteolytic bone metastases and local 
                                      cytokines Vitamin D intoxication Chronic granulomatous 
                                      disorders Medications: Lithium, thiazide diuretics, vitamin A 
                                      excess Miscellaneous Hyperthyroidism Acromegaly 
                                      Pheochromocytoma Adrenal insufficiency Immobilization 
                                      Parenteral nutrition Milk alkali syndrome 
          Internal Medicine 28:       COPD, lung cancer and pneumonia. Less likely diagnoses are         COPD exacerbation, cor 
          70-year-old male with       also discussed.                                                    pulmonale 
          shortness of breath and 
          cough 
          Internal Medicine 29:       community-acquired pneumonia, CHF, tuberculosis, lung              Active pulmonary 
          55-year-old female with     malignancy, pulmonary embolism, lymphoma, sarcoidosis,             tuberculosis 
          fever and chills            acute bronchitis 
          Internal Medicine 30:       cellulitis, DVT, ruptured popliteal cyst and superficial           Lower extremity deep 
          55-year-old female with     thrombophlebitis.                                                  venous thrombosis and 
          leg pain                                                                                       pulmonary 
                                                                                                         thromboembolism 
          Internal Medicine 31:       bursitis, crystal arthropathy, and osteoarthritis                  Osteoarthritis 
          40-year-old male with 
          knee pain 
          Internal Medicine 32:       SLE, RA, systemic sclerosis and Sjögren syndrome.                  Systemic lupus 
          39-year-old female with                                                                        erythematosus (SLE) 
          joint pain 
          Internal Medicine 33:                                                                          Prerenal acute renal 
          49-year-old female with                                                                        failure due to 
          confusion                                                                                      hypovolemia 
          Internal Medicine 34:       vertebral metastasis, vertebral or epidural infection, acute       Acute mechanical back 
          55-year-old male with       mechanical back pain, spinal stenosis, herniated disk,             pain with sciatica 
          low back pain               pyelonephritis 
          Internal Medicine 35:       Acute HIV infection; Acute viral hepatitis; Drug Reaction;         Adult Still disease 
          35-year-old female with     Endocarditis; Hodgkin disease; Adult Still disease; Systemic 
          three weeks of fever        lupus erythematosus (SLE); Urinary tract infection; Venous 
                                      thromboembolism 
          Internal Medicine 36:       Alcoholic hepatitis; Ascending cholangitis; Gastrointestinal       Spontaneous bacterial 
          49-year-old male with       hemorrhage; Hepatorenal syndrome; Spontaneous bacterial            peritonitis (SBP), 
          ascites                     peritonitis; Urinary tract infection                               hepatitis C cirrhosis