Dr. Doerr’s Diagnostic Dilemma
28 y/o M w/ hx of Bipolar (noncompliant with lithium) who presents with cc of myalgias and itchy painful penile rash over the last few days. Initial FSG 600s. On ROS pt noted to have polyuria, polydipsia over the last few weeks and weight gain ~ 80lbs over the last year. Has maternal history of […]
Eosinophils Everywhere!
Resident report reviewed an ongoing case of a 37yo Guatemalan man who presented initially with 3 weeks of malaise, fatigue, subjective fevers and muscle aches found to have LLL infiltrate and small pleural effusion. He was sent home from the ER with a Z-pack. He represented to the ER 3 days later with no resolution […]
Why are my toes blue?
A case of a 40 year old woman from Honduras presenting with Raynaud’s disease to Rheumatology clinic – cyanosis and ulceration of her left foot digits. She had atypical features of primary Raynaud’s – age > 30, asymmetric digit cyanosis, sclerodactyly/hand skin thickening – which prompted further work-up. She was found to have high titer […]
Don’t Fall for This One!
This was a case of a 97 y/o male who was admitted with a diagnosis of mechanical fall. More than 30% of adults over the age of 65 suffer a fall and 10% of these cases result in serious life-altering injuries. Therefore, we discussed the importance of fall prevention, highlighting Vit D supplementation and its pathophysiologic relationship […]
TB or not TB?
27 y/o Egyptian Male presents with cc of progressive hemoptysis and weight loss while on treatment for TB. Imaging reveals a large LLL cavitary lesion with multiple heterogeneous peripheral cystic/cavitary lesions. What’s going on? Key topics covered: 1)Differential for hemoptysis; 2) treatment regimen in TB, MDR-TB & XDR-TB; 3) cystic versus cavitary lesions Current Concepts […]
Multiple Problems
67 y/o M presents with back pain, generalized fatigue, anorexia, nausea & vomiting. Exam reveals: altered mental status and profound volume depletion. Labs reveal normocytic anemia, acute renal failure, hypokalemia 2.9, hypercalcemia to 14 and hypergammaglobinemia. Imaging reveals lytic lesions in T10. Pt on initial presentation was noted to have severe hypercalcemia with resultant diabetes […]
Thyrotoxicosis presenting as Heart Failure
61 y/o Male who was treating a “fast HR” for years with Chinese herbals presents with history of increasing lower extremity edema and difficulty breathing. History significant for NYHA Class II/III symptoms and weight loss of 30lbs. Exam significant for cachexia, lid lag, pulmonary congestion, tachycardia, elevated JVP, possible pulsatile liver, pitting edema extending up […]
Thiazide-Induced Hyponatrémie
Where there are thiazides will there also be Hyponatremia? Today, this is not in question, but rather, where do you want to be when you have it. We have a French Female Flutist presenting to BMC via logan airport with a Na of 111. Teaching Points: Differential for Hypotonic Hyponatremia by volume status. Mechanism of Hyponatremia via Thiazide […]