Dual dilemma
We discussed two cases today. Case#1: 61 yo F with HTN, DM brought in by daughter for acute onset of a single acute episode of visual hallucinations. She saw a girl (non existent) run across her living room and then saw lasagna (non existent) all over herself. Daughter was with her at this time and called […]
Classic Grave’s hyperthyroidism with anterior mediastinal mass
Stimulating discussion at Intern Report of a case of classic Grave’s hyperthyroidism. 21 yo F presenting with 40 lbs weight loss, palpitation, SOB/DOE, neck swelling, diarrhea, irregular menses for 6 months. On further evaluation was found to be hyperthyroid per labs and diagnosed with Grave’s disease (TSI/ thyroid stimulating immunoglobulins- elevated). She was also found to have […]
Acute Onset of Lactic Acidosis
Here is a case of a 71 year old woman with a history of CAD s/p left carotid endarterectomy, pulmonary hypertension on tadalafil and Home O2 therapy, symptomatic cholelithiasis, HTN, DM II (A1c 7.3%) presenting with two days of right sided flank pain. Described as sharp and constant, it radiates up to lower scapula border […]
Severe CAP- review of IDSA/ATS guidelines
48 yo F brought into ED for severe SOB with respiratory distress after 3 days of URI/flu like symptoms, SOB and cough. While in the ED she tires out and goes into respiratory failure needing intubation and mechanical ventilation. We reviewed the current combined IDSA/ATS guidelines for the follwing issues: Criteria for admission to the […]
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 […]
Candidiasis threatening airway
We discussed a 48 yo M with HIV who was admitted for progressive worsening pain and swelling of his throat and neck with odynophagia over the preceding couple of mos but worse over the past 2 weeks. He was seen at an outside clinic 10 days prior to this for similar symptoms and treated with […]
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 […]
Flush the clog?
A very intellectually stimulating discussion of a 52 yo M with alcohol overuse hx, with a new presentation of abdominal pain with distension over a course of 3 weeks which on further evaluation was found to be ascites with portal hypertension and subtle signs of cirrhosis. Abdominal US with doppler revealed thrombosis of the main and […]
Air where it’s not supposed to be
Today we talked about a 60yF (NH resident) with quadriplegia, dementia, IDDM, hx of staghorn calculus found to have emphysematous cytitis and pyelitis. – it is a rare but severe condition with high mortality without appropriate management – DM is a risk factor – determine management plan and prognosis by CT classification based on extension of gas into/ […]
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 […]