Chest Pain, Chest Pain Everywhere
Today’s intern conference was about 2 entirely different etiologies of chest pain. Case #1 18 y.o. high school football player complains of chest pain after workout. Clinical course precipitously deteriorated with hypotension and tachycardia. Labs show elevated CK, renal failure, elevated K and P. Patient then decompensated and died. Post-mortem studies sh0w that patient […]
An Unusual Cause of Abdominal Pain
A 69 yo M with pmhx of HTN, atrial fibrillation on warfarin, unspecified hx of thyroid and parathyroid cancers status post resection presents with acute left-sided abdominal pain. Subsequent labs showed a significant drop in hematocrit and imaging showed a large left-sided adrenal hemorrhage. The patient had his anti-coagulation reversed, then was taken to IR-suite […]
Acetaminophen Toxicity
34 yo M with DM, HTN, DVT on coumadin presenting with a perirectal abscess and was subsequently found to have markedly elevated LFT’s (ALT – 3300, AST – 380). On further history, it was found that the patient was taking Vicodin (acetaminophen + hydrocodone) multiple times daily due to the rectal pain. Patient was diagnosed […]
Hyponatremia and Hyperkalemia in a Post-Op Patient
Hoarseness – not just from yelling too much
This unfortunate case features a 59 y.o. male who presents with 3 months of a hoarse voice. He was subsequently found to have a thyroid mass leading to compression of his left recurrent laryngeal nerve, and invasion into his trachea. He had a tracheostomy soon after presentation because of concern about his airway. Biopsy of […]
Tamponade
A 59 yo M presents with a pneumonia and pericardial effusion. How do you know if the patient is in tamponade? This is a great article in helping you make that distinction. Does this patient with a pericardial effusion have cardiac tamponade? – JAMA. 2007 Apr 25;297(16):1810-8. This patient had an influenza vaccine 1 week prior […]
Aseptic Meningitis
25 yo M with no PMHx presenting with headache, photophobia and nuchal rigidity. LP shows findingins consistent with aseptic meningitis. Here are a couple of papers that discuss meningitis, as ’tis the season. If your students or attendings mention Kernig’s or Brudzinksi’s signs, please refer them to the paper below, which shows how poor they […]
Sepsis
A 49 y.o. man with HIV is admitted to the wards with a pneumonia. Shortly thereafter, he becomes profoundly hypotensive and confused. You have correctly identified septic shock in this patient. Here are some “light readings” about sepsis: Septic Shock (Lancet 2005 Jan 1-7;365(9453):63-78.) – Landmark review which defines “flavours” of sepsis along the continuum […]
Catheter-Associated UTI
Today’s case was an 80 y.o. M with chronic foley catheter admitted with signs of sepsis, with a dirty UA. How do we go about diagnosing and treating catheter-associated UTI? IDSA 2009 Guideines for CA-UTI CA-UTI and the implications of the Medicare rule change (i.e. no Medicare payment for tx of CA-UTI)
Wegener’s/How to Spin Urine 101
What is your differential diagnosis for a 40 yo M who presents with acute glomerulonephritis? If you guessed “Wegener’s granulomatosis but patient did not tell medical team that he had this existing diagnosis,” you would be correct! On your differential for RPGN (rapidly progressive glomerulonephritis), 2 disorders cannot be forgotten: ANCA-associated granulomatous vasculitis Goodpasture’s Disease […]