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 […]
Recurrent Episode of SOB
We discussed a 47 year old M with history of morbid obesity, non-ischemic CMY (EF 60%), pulmonary HTN, PE/DVTs, OSA on CPAP who presented with a 2 day history of shortness of breath. He reports chills, associated pleuritic chest pain as well as a productive cough of brownish sputum. Of note, one week prior to […]
Alcoholic Hepatitis
44 y/o Male presents with progressive jaundice and hyperbilirubinemia after last drink 6 weeks prior. Following exclusion of an obstructive process the likely etiology was determined to be alcoholic hepatitis. This patient did not feel much sicker than usual but by validtaed scoring tools, had a 30 day mortality > 40%. The review article below […]
Blackout in a can
A 19 yo M presenting with non specific complaints of nausea/ vomiting/ abdominal pain and diffuse bodyache and foind to have an AG metabolic and respiratory acidosis with lactate of 13.2 and pH of 7.04. We went through the differential diagnosis of above which included methanol/ ethylene glycol/ isopropyl alcohol amongst others. This patient had […]
Abd Pain in Peritoneal Dialysis: So special?
59 y/o M with hx of ESRD on PD & recurrent pancreatitis of unknown etiology presents with cc of abdominal pain. What diagnosis should you always be considering? How do you assess the peritoneal effluent (diasylate, not ascitic fluid)? What is the best mode of treatment: intraperitoneal or intravenous? Is there an association or increased […]
LLQ Pain with a Twist
A young 24 year old gentleman with history of GERD on omeprazole presented with worsening LLQ pain for the past month. Described as “deep and aching”, it was non-radiating and exacerbated with meals. Additionally, he had associated nausea and non-bloody emesis with resolved non-bloody loose stools over the past week prior to admission. He denies […]
B-cell Lymphoma in the guise of Multiple Myeloma
A very intellectually stimulating discussion of a 54 yo homeless M presenting with acute on chronic R hip pain. More detailed history-taking reveals constitutional symptoms of progressive fatigue, fever with sweats, polyuria and constipation. On evaluation, serum calcium level was 18.8 (after correction), AKI and on MRI+CT multiple bone lesions (spine, R hip) and a splenic lesion as […]
Double teaming Mr. Bean
72 y/o F with recent diagnosis of pulmonary fibrosis secondary to ANCA-MPO + vasculititis presents with acute renal failure with dysmorphic RBCs on U/A. Pt was initially diagnosed with ANCA-MPO + glomerulonephritis and started on high dose steroids and immunosuppressants. Following biopsy, pt noted to have linear IgG deposits along basement membrane which alongside + anti-GBM assay also supported […]
Take a crack at Crack Lung!
A 55yo M presenting with cough, hemoptysis, shortness of breath and wheezing less than 24 hours after smoking “crack” or modified cocaine. The differential diagnosis included amongst many other things, Crack Lung or Acute Pulmonary Toxicity from inhalation (smoking/snorting) of cocaine. Learning points: – acute lung injury from cocaine happens usually with use within 48 hrs […]
Cardiac Tamponade in HIV patient
45 year old M with history of HIV/AIDS (CD4 150, VL 18, 000) presents with one week of worsening dyspnea on exertion. One month prior to admission, he was treated with Azithromycin for a productive cough and symptoms of URI. He reports that his baseline is walking on average 5 miles per day while he […]