🩺 Most likely diagnosis: Renal cell carcinoma with pulmonary ("cannonball") metastases Why? The triad strongly points to metastatic renal cell carcinoma (RCC): Hematuria → classic presenting symptom of RCC Hemoptysis → due to lung metastases Weight loss → constitutional symptom of malignancy Chest X-ray/CT: Cannonball metastases → multiple, well-circumscribed round pulmonary nodules, classically seen with hematogenous spread from RCC High-yield USMLE pearls Classic triad: Hematuria + flank pain + palpable abdominal mass (seen in a minority of patients) Most common paraneoplastic syndromes:↑ EPO → polycythemia ↑ PTHrP → hypercalcemia ↑ Renin → hypertension ↑ ACTH Associated with:Smoking Obesity Hypertension Von Hippel–Lindau syndrome (clear cell RCC) 🚨 Cannonball pulmonary metastases + hematuria = think renal cell carcinoma until proven otherwise.

🩺 Most likely diagnosis: Kawasaki disease (mucocutaneous lymph node syndrome) The combination of: High-grade fever (≥5 days) Bilateral nonpurulent conjunctivitis Lower extremity edema (erythema/edema of hands and feet) Coronary artery aneurysms on coronary angiography is classic for Kawasaki disease. Key features Fever for ≥5 days (essential criterion) Bilateral non-exudative conjunctivitis Oral mucosal changes (strawberry tongue, cracked lips) Polymorphous rash Cervical lymphadenopathy Extremity changes (hand/foot edema, erythema, later periungual desquamation) Most feared complication Coronary artery aneurysms due to medium-vessel vasculitis Can lead to thrombosis, myocardial infarction, or sudden death Treatment IVIG (within the first 10 days of illness, ideally as soon as diagnosed) High-dose aspirin during the acute phase, followed by low-dose aspirin until inflammation resolves and coronary arteries normalize (or longer if aneurysms persist)