Acidemia in Short Bowel Syndrome
53 yM with hx of Protein C Deficiency (on LMWH), remote hx of mesenteric thrombosis and bowel resection (’81) admitted for severe mixed anion gap and non-anion gap acidosis (bicarb of 7 and ΔΔ <1). Teaching points: – estimate AG using albumin even though the measured AG appears normal- there may be an inapparent AG – calculate ΔΔ […]
Elderly Woman with Periumbilical Pain
Today’s case involved a 77 year old F with CAD s/p CABG 2008, atrial fibrillation, HTN, DMII who presented with 1 week of periumbilical pain with associated nausea and emesis. Additionally, she was found to have a monocytosis as well as pre-renal azotemia. Although a poor historian, residents were able to delve into potential differentials […]
Oligoarthritis in an HCV patient
– In addition to all other causes of arthritis, HCV related arthropathy should be on the differential diagnosis of any patient with chronic inflammatory arthritis and especially in patients with known HCV infection – Two distinct groups have been described in HCV related arthropathy ; RA-like arthritis (bilateral, symmetric, small joints) and Oligoarthritis (often associated […]
Catheter-Associated UTI
Today’s case was an 80 y.o. M with chronic foley catheter admitted with signs of sepsis, with a dirty UA. How do we go about diagnosing and treating catheter-associated UTI? IDSA 2009 Guideines for CA-UTI CA-UTI and the implications of the Medicare rule change (i.e. no Medicare payment for tx of CA-UTI)
Wegener’s/How to Spin Urine 101
What is your differential diagnosis for a 40 yo M who presents with acute glomerulonephritis? If you guessed “Wegener’s granulomatosis but patient did not tell medical team that he had this existing diagnosis,” you would be correct! On your differential for RPGN (rapidly progressive glomerulonephritis), 2 disorders cannot be forgotten: ANCA-associated granulomatous vasculitis Goodpasture’s Disease […]
Bradycardia Bites in New England
55 y/o F presents with acute onset lightheadness usually worse when lying down at night and dyspnea on exertion for the last three days with a recent history of outdoor activity near the Cape and ticks on her cat! (less than 4 weeks ago) Pt admitted with HR of 36, BP 134 59 and afebrile. […]
The Saga of Ascites and Albumin
59 y/o M with HCV, ETOH and Cirrhosis readmitted from rehab with worsening ascites and renal function. Important questions that were discussed. Ascites: Pathophysiology of Ascites? The importance of splanchnic vasodilitation in circulatory dysfunction? Treatment options based on pathophysiology? How infection worsens splanchnic vasodiliation and thus ascites? Renal and Circulatory Dysfunction in Cirrhosis: Current Management and Future […]
Septic Joints
A couple of cases on the wards currently of septic prosthetic joints – one patient with an infected hip and one patient with an infected knee. Monoarticular arthritis has a different differential diagnosis than migratory arthritis. Diagnosis of a septic joint is difficult to make based on symptoms and physical exam (see the JAMA article […]
Lyme Carditis
Today’s Resident Report featured a fascinating case of Lyme carditis. Cardiac Implications of Lyme Disease – International Journal of Cardiology Volume 129, Issue 1, 16 September 2008, Pages 15-21 2006 IDSA Guidelines for Treatment of Lyme Disease – Clinical Infectious Diseases 2006; 43:1089–134 Did you know that there is a huge controversy in treatment of chronic […]
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 […]