Steroid Psychosis
A 57 y.o. F presenting with altered memory and difficulty reading which has been occurring over the past 2-3 months. On neurologic workup, a large left-sided temporal lobe lesion was noted on MRI. Craniotomy and resection were performed and patient was found to have a stage IV GBM (glioblastoma multiforme). She was treated with steroids […]
Thrombocytopenia
A 34 year-old Turkish man with PMHx of testicular CA (stage III and s/p BEP chemotherapy regimen and surgical excision), presents to BMC with a rash on arms and legs and bleeding m0uth. He was recently started on an H2 blocker for GERD-like symptoms. In a 5 day span, his platelet count dropped from > […]
Acute Pulmonary Embolus
A 49 y.o. M with HTN, HL and prior history of treated PE presents with dyspnea on exertion and CT-PA showing acute pulmonary embolus. Oxygen saturation was in the 80s on room air, but patient was normal heart rate and normal blood pressure. What are the next steps in management? Remember that after the patient’s […]
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 […]
Septic Arthritis in a Patient with Rheumatoid Arthritis
77 y.o. F with past medical history of rheumatoid arthritis on etanercept (TNF-a inhibitor), DM, HTN presenting with whole body pain and fatigue consistent with flare of rheumatoid arthritis. Blood pressure was noted to be lower than normal. On exam, she was noted to have multiple painful small joints but also had a tender L […]
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; […]
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 […]
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. […]
How to recognize TCA toxicity
We learnt how to recognize TCA toxicity via discussion of a case of a 54 yo F who was brought in unresponsive by EMS after her son called 911. She had a PMH of HCV, prior opioid abuse, depression who was on several medications including toprol, lisinopril, ASA, chlorthalidone, celexa, buspirone, mirtazipine, amitryptiline, MS Contin, klonipin […]