Acute sarcoidosis/ Lofgren’s syndrome
A few weeks ago, a young patient (24yo) was admitted to our hospital with complaints of bilateral ankle pain, swelling and redness or “periarthritis” for 1 day with no other systemic symptoms. On ankle exam, was found to have pain with active movements of the ankle but none with passive. +tenderness along posterior tibialis and peroneus tendons […]
Headache – Is it different if the patient has HIV?
A case of a 34yow from the Dominican Republic with a hx of HIV (not on ART) and G6PD who presented with 3 months of frontal/top of the head 10/10 throbbing headaches that kept her awake at night, woke her up in the morning and lasted through the day. Also with 3 months of rhinorrhea […]
Tongue Ulcers
A case of a 38yom with hx HIV (CD4 234, ran out of ART 1 month prior) presented with 2 weeks of a painful ulceration on his tongue and painful bilateral neck swelling (lymphadenopathy with necrotic nodes on CT). The differential diagnosis for oropharyngeal ulcerations was discussed as well as how to diagnose and treat […]
Who Should be Ruled out for TB?
Ever asked yourself whether someone should be ruled out for TB and weren’t sure how to answer the question? Here are a couple of articles that help answer the question. TB risk factors, positive PPD, fever, upper lobe infiltrate are all positive predictors of TB infection. Shortness of breath and crackles were negative predictors. http://archinte.ama-assn.org/cgi/reprint/160/16/2471 – […]
Pancreatitis with no CBD dilitation
52 y/o M with HCV presents with RUQ & epigastric abdominal pain with associated nausea, vomitting and inability to tolerate PO. No EtOH use. Exam significant for volume depletion, icterus and RUQ tendermess/epigastric tenderness with negative Murphy’s sign & no shifting dullnes. Labs reveal hypochloremia, volume contraction, Transaminitis in 20o0s. TBilil 111, DBili 9, AlkP […]
RSV Pneumonia as a cause of dyspnea and hypoxia
A 43 y/o man w/ morbid obesity, OSA, diastolic heart failure and asthma presented with 3 days of worsening dyspnea on exertion, cough, subjective fevers and rhinorrhea. He had a low grade fever and hypoxia with normal lung sounds, significant LE edema and negative CXR. A JVP could not be appreciated due to body habitus. […]
Staphalococcus lugdunensis endocarditis in a patient with ESRD
A 71 y/o woman w/ ESRD on HD sent to ED for altered mental status during dialysis. On arrival patient was slightly confused and lethargic. Despite suspicion of dialysis related volume shifts causing brain hypoperfusion, the team astutely sent blood cultures due to high risk of infection in dialysis patients. These returned positive for coagulase […]
Recurrent C. difficile or Ulcerative Colitis flare?
A case of a 24yo woman with rapidly progressive ulcerative colitis and recurrent C. dif was presented. We reviewed how to diagnose C. dif (ELISA vs. PCR vs. culture) and available treatments, including a new antibiotic fidaxomicin. ISDA guidelines were also reviewed. Cost of various treatment regimens were mentioned: metronidazole course ~$100; vancomycin course ~$200; […]
Busted Basal Ganglia
64 y/o M w/ worsening Bipolar & Spinal Stenosis with recent Abilify initiation/uptitration & opioid change is transferred from OSH with altered mental status. Careful history reveals increased difficulty with all motor actions including swallowing. Exam reveals diffuse tremor at rest with postural features superimposed on diffuse myoclonic jerks, cog-wheel rigidity & narrow-based shuffling gait. […]
Resources For Code Leadership
Given that the overall trend, in the hospital as well as nationwide, has been a decline in the number of Codes and an increase in the number of Rapid Responses, Residents have expressed significant concerns of feeling unprepared in leading codes. In response to this, we have sensed the need to implement a Code Leadership Training Series which includes the following […]