Today we had a patient with unremarkable PMH presenting with jaundice. LFTs were in the 1000s, a clinical scenario with limited DDx. They ultimately had liver biopsy and diagnosed with autoimmune hepatitis. Take home points: Pale/grey stools and dark urine are associated with conjugated (and not unconjugated) hyperbilirubinemia with narrower DDx AST/ALT > 1,000 has … Continue reading Recruitment lecture 10.11.2019
First recruitment day! today had a case of non resolving pneumonia in a healthy young patient, which was ultimately diagnosed with blastomycosis. Take home points from today: Recognize delayed resolution of pneumonia Have a systematic differential diagnosis based on etiology, host, complications and noninfectious etiologies Recognize the difference in geographic, clinical and laboratory presentation of endemic … Continue reading Recruitment lecture 10.7.2019
Today we had an excellent case led by Dr. McGee of a patient with B-symptoms of unknown etiology, with some great varied discussion points. One of them was regarding digoxin toxicity, check it out! Digoxin Toxicity Who is at risk? Older age, reduced BMI, and acute or chronic renal insufficiency. Clinical s/sx; Arrhythmias! (any kind, … Continue reading Morning Report 10/02
Interesting morning report today about IgA vasculitis secondary to MRSA bacteremia. This is a nice review about IgA vasculitis: https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/hospital-medicine/henoch-schonlein-purpura-iga-vasculitis/ some interesting points: classic tetrad of HSP – GI symptoms / abdominal pain, histopathylogy, arthralgias and renal involvement. In adults renal involvement more severe than in children and more end up needing RRT. In adults … Continue reading Morning report 9/18, IgA vasculitis
At this today's morning report we talked through a case of acute, agitated encephalopathy in a gentleman who had recently been diagnosed with atrial fibrillation. While thorough history and examination ruled out many of the usual suspects (i.e. intoxication, infection, etc.) we were reminded of the extensive list of causes of altered mental status (see … Continue reading Morning Report 8/28/19: The Head and The Heart – A Case of Encephalopathy
Today at morning report we had an interesting case of young patient with jaundice, pruritus, abdominal pain and weight loss. ANCA was positive. Following liver biopsy and MRCP the patient was diagnosed with primary sclerosing cholangitis and ultimately with Crohn's. We also discussed this great article from NEJM about DILI (nejmra1816149) which describes 3 patterns … Continue reading Primary sclerosing cholangitis causing intrahepatic cholestasis – morning report 7.31.2019
Today on our monthly clinical reasoning and physiologic mechanisms of disease lecture we discussed a case of classic heat stroke. These great articles about serotonin syndrome (nejmra041867) and heat stroke (nejmra1810762) were quoted and are both a highly recommended read!