The Clinical Problem Solvers

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/HDX_BMCBrigham_Sharmin_FINAL-2.mp3

Dr. Leela Chockalingam presents a Human Dx unknown to Sharmin and BMC resident – Dr. Amir Gilad and Brigham resident  – Dr. Hannah Chen.

Download CPSolvers App here

Patreon website

Human Dx case

Abdominal pain schema

Dyspnea schema

Altered mental status schema

Amir Gilad

Amir Gilad is a PGY-1 (very soon to be PGY-2!) at Boston Medical Center. Born and raised in Toronto, he attended Boston University for medical school and loved it so much that he stayed on for his internal medicine residency. He’s an aspiring cardiologist who is passionate about medical education. Outside of medicine he enjoys cheering on his beloved Toronto sport teams, jogging along the Charles River, and exploring the beautiful city of Boston. 

Hannah Chen

Hannah Chen is a second year internal medicine resident at the Brigham & Women’s Hospital. She graduated from the University of North Carolina School of Medicine.  She has an interest in hospital medicine, nephrology, and health equity.  In her spare time, she enjoys eating/cooking and hiking.  

Leela Chockalingam

Leela Chockalingam grew up in Rochester, NY. She studied Chemistry at Carnegie Mellon University and then attended medical school at the Icahn School of Medicine at Mount Sinai in New York City. During medical school, she spent a year in Vietnam doing tobacco use treatment research. She is currently an Internal Medicine resident at the University of Colorado in Denver, CO. She is interested in pursuing pulmonary critical care fellowship, and would ultimately love to be a clinician educator focused on clinical reasoning and evidence based medicine. Her hobbies include reading fiction, being outside, and cooking for family and friends. 

Case recap

A 47-year-old man with alcohol and meth use presented with acute dyspnea, abdominal pain, and encephalopathy, and was found to be in acute congestive heart failure with atrial fibrillation and rapid ventricular rate. While in the emergency department, his oxygen requirement rapidly increased and he required intubation for hypoxemia and airway protection. Further evaluation revealed a suppressed thyroid stimulating hormone with an elevated free T3 and free T4, confirming a diagnosis of thyrotoxicosis meeting criteria for thyroid storm.

Teaching points

Hyperthyroidism refers to increased synthesis and release of thyroid hormones from the thyroid gland, whereas the term “thyrotoxicosis” represents the clinical syndrome produced by excess circulating thyroid hormone. The most common causes of hyperthyroidism include Grave’s disease, toxic nodular goiter/adenoma, and drug induced thyroid dysfunction. Thyrotoxic states can also occur when thyroid hormones are released from an injured thyroid gland in thyroiditis (autoimmune, viral, suppurative) or ingestion of exogenous thyroid hormone.

The clinical manifestations of hyperthyroidism can result from the thyrotoxic state itself (e.g., palpitations, fatigue, tremor, weight loss) or be related to the underlying cause of hyperthyroidism (e.g., grave’s ophthalmopathy, globus sensation/dysphagia from enlarged goiter). Complications of thyrotoxicosis include atrial fibrillation (with possible heart failure), thyrotoxic periodic paralysis, osteoporosis, and reproductive issues. Thyroid storm represents life-threatening thyrotoxicosis and its diagnosis is supported by the Burch & Wartofsky Score, which takes into account temperature, central nervous system effects, gastrointestinal/hepatic dysfunction, cardiovascular dysfunction, and the presence/absence of a precipitating trigger.

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/Episode-100-Juneteenth.m4a

Dr. Kimberly Manning and her father, Mr. William Draper, commemorate Juneteenth, the holiday that celebrates the day when all remaining enslaved Black Americas were freed in Galveston Texas, on June 19th, 1865, with this hour-long storytelling event. 

Click here to watch the video on the CPSolvers Virtual Morning Report platform

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/Episode-99.mp3Meet the CPSolvers family who share their origin story, and tell you more about all the things we do beyond the podcast. Meet Us VMR Twitter Patreon Download CPS app here Instagram Schema page Illness script page Blog COVID page

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/SLS_Syncope-and-Splenomegaly_Sharmin_FINAL-Audacity.mp3

Steph, Sharmin, Arsalan and Dan share a case of syncope and splenomegaly – let’s practice those schemas together!

Download CPSolvers App here

Patreon website

Splenomegaly Schema

Syncope Schema

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/RLR-7-ALI.m4a

Episode description

Reza and Rabih tackle a case of acute liver injury.

One RLR episode will be freely available each month but the remainder will be uploaded on Patreon only.

Why?

More about the RLR series here.

You can find the article referenced in the episode Here

 

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/HDx_Mercy__Sharmin_PREAU_UPDATED.m4a

Episode Description

Dr. Julia Burns presents a Human Dx unknown to Sharmin and Mercy residents  – Drs. Brady Alling and Aaron Sabal.

Download CPSolvers App here

Patreon website

Human Dx case

Dr. Brady Alling

Brady is a PGY 3 at Mercy Health in Muskegon, MI. Next year, he will be doing a fellowship in pulmonary & critical care in Colorado. His favorite thing about internal medicine is is the profound sense of accomplishment he feels when replacing electrolytes that are just slightly below the normal range.

Dr. Aaron Sabal

Aaron was born and raised in Westland, MI (Detroit metro area). He went to Wayne State University for my undergraduate studies thinking he would be a physical therapist, massage therapist, and dietitian (yes, all three of those). However, about one week prior to starting my massage therapy program, he had an epiphany and decided to go to medical school instead. He was fortunate to be accepted to MSUCOM and fell in love with Internal Medicine. His passions include all things medical. In particular, he is passionate about medical education, how best to help physicians learn, diagnostic reasoning, and creating an environment of learning where no one is afraid to express what they’re thinking. When he is not pursuing his love of learning, He is spending time with his wife and their boys (2 cats and a dog), playing with his animals, doing DIY home-improvement projects, exploring national parks, or reading a good non-medical book with a cat or dog in his lap begging for his love and attention.

Dr. Julia Burns

Julia is currently a geriatrics fellow at Mount Sinai Hospital in Manhattan. She earned her undergraduate degree from Fairfield University. She then went on to obtain a master of science in biomedical sciences from New York Medical College followed by her medical degree at Albany Medical College. She completed her internal medicine residency at NYU Winthrop Hospital on Long Island. Her academic interests include medical student and resident education.

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/Human-Dx_Utah_Arsalan-FINAL.m4a

Dr. Kavea Panneerselvam presents a Human Dx unknown to Arsalan and Utah residents  – Drs. Marja Anton and Guinn Dunn.

Download CPSolvers App here

Patreon website

Human Dx case

Dr. Marja Anton

Marja is a chief medical resident at the University of Utah. She is originally from
Chicago, IL and received her undergraduate degree from the University of
Wisconsin-Madison (go Badgers!). She then moved back to Chicago for medical
school at Loyola University Stritch School of Medicine. In her free time, you can find her traveling with her husband in their camper van, rock climbing with friends, tending to her garden or listening to the Clinical Problem Solvers! Next year she is excited to stay on at the University of Utah as an academic hospitalist.

Dr. Guinn Dunn

Guinn is a first year Internal Medicine resident at the University of Utah. She was
born and raised in Salt Lake City, received her undergraduate degree at the
University of Puget Sound, then headed back to Utah for medical school and
residency. She is interested in academic hospital medicine and quality improvement. She enjoys skiing, backpacking, and is looking forward to the birth of her first kiddo in a few weeks.

Dr. Kavea Panneerselvam

Kavea Panneerselvam is about to complete her intern year at Baylor College of medicine in Houston, TX. She grew up in the Houston area and completed her undergraduate at the University of Texas at Austin and is a proud Longhorn, and obtained her medical degree at UT Houston. After residency she hopes to pursue a career in gastroenterology. Specifically, she has an interest in IBD. In her free time she enjoys playing board games, discovering new movies, and making art for her friends and family.


https://clinicalproblemsolving.com/wp-content/uploads/2017/05/Parteon-Announcement-Final.m4a

Episode description

Reza and Rabih have an important announcement about the RLR series.

More about the RLR series here.

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/MUSC-FINAL-.m4a

Rabih and Reza tackle a clinical unknown at MUSC with host, Dr. Marc Heincelman.

Download CPSolvers App here

Patreon website

Schema #1

Schema #2

Dr. Marc Heincelman

Marc Heincelman is an assistant professor within the Department of Medicine at the Medical University of South Carolina, where he also serves as director of the Medicine Clerkship and Acting Internship.  He received his undergraduate degree from the University of Pittsburgh, medical degree from Loyola University of Chicago, and completed his combined internal medicine/pediatrics residency at the Medical University of South Carolina in 2014.  His passion for medical education stems from his mission to motivate and inspire learners to become the best physicians possible for their future patients.

Case Summary

A middle-aged woman with a history of treated breast cancer and unspecified uveitis presented with subacute fever, arthralgias, and headache. She was found to have elevated inflammatory markers, extensive lymphadenopathy, and a cholestatic pattern of liver injury with an unrevealing evaluation for infectious and autoimmune pathologies. She remained febrile despite broad-spectrum antibiotics. She was then started on empiric doxycycline, which resulted in prompt resolution of her fevers. A serologic test for Rickettsia rickettsii returned positive, confirming the diagnosis of “spotless” Rocky Mountain Spotted Fever.

Teaching Points:

• Rocky mountain spotted fever(RMSF) is an acute, life-threatening febrile illness caused by the intracellular pathogen,Rickettsia rickettsii. Endemic  to the southeastern and south central regions of the United States, it is transmitted by ticks (esp Dermacentor ). The classic triad of symptoms includes fever, headache, and rash (often beginning on the wrists and ankles, progressing from maculopapular to petechial). Roughly 10-12% of cases may present without rash (i.e., “spotless” RMSF), more commonly reported in elderly and/or African American patients. Given its high mortality rate, prompt initiation of empiric doxycycline is important for improving outcomes.

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/51920_VMR_Audio-QT.m4a

Episode description

Drs. Kimberly Manning and Gurpreet Dhaliwal discuss an unknown case as part of the 50th CPSolvers Virtual Morning Report.

Virtual Morning Report

Click here to learn more about joining VMR and learn together, live.

Dr. Kimberly Manning

Kimberly D. Manning, MD is a general internist/hospitalist who serves as Associate Vice Chair of Diversity, Equity, and Inclusion for the Department of Medicine at Emory University School of Medicine. Manning was recently promoted to Professor of Medicine and additionally serves as residency program director for the Transitional Year Residency Program at Emory. She has a strong commitment to supporting underrepresented minorities in medicine, serving underserved populations, and creating better understanding of our patients and each other through storytelling and narrative medicine. A huge fan of the CP Solvers, Dr Manning is as enthusiastic about being a teacher as she is being a lifelong learner. 

Dr. Gurpreet Dhaliwal

Dr. Dhaliwal is a clinician-educator and Professor of Medicine at the University of California, San Francisco. He is the site director of the internal medicine clerkship at the San Francisco VA Medical Center, where he teaches medical students and residents in the emergency department, urgent care clinic, inpatient wards, outpatient clinic, and morning report. His academic interests are the cognitive processes underlying diagnostic reasoning and clinical problem-solving and the study of diagnostic expertise. Dr. Dhaliwal enjoys playing pickup basketball with his two sons … even though both can handily defeat him

Case Summary

A 69-year-old man with a history of prior cerebrovascular accident (CVA) presented with acute onset right leg weakness and paresthesias. Laboratory analysis was notable for elevated inflammatory markers. A magnetic resonance image of the brain showed a ring-enhancing lesion in the left parietal lobe, with fine needle aspiration revealing gram positive cocci in chains. Cultures grew Streptococcus intermedius (a member of the S. anginosusgroup), and the patient was diagnosed with a bacterial brain abscess.

Teaching Points:

• Brain abscesses can be caused by bacteria, fungi, and parasites. Bacterial brain abscesses can arise via contiguous spread of bacteria from head and neck sources or by hematogenous routes. The causative organism often varies with the underlying immune status of the host. Among immunocompetent hosts, the most common organisms are Staphylococcusand Streptococcus spp (e.g., S anginosus). Neurosurgical sampling may be required to identify the pathogen and achieve source control.
• Lacunar infarctions are an important form of ischemic strokes (representing ~20%) caused by cerebral small vessel disease. Pathophysiologically, the most important risk factor is uncontrolled hypertension, which can lead to small vessel injury and subsequent occlusion. Most lacunar strokes involve the basal ganglia, pons, and subcortical white matter structures (e.g., internal capsule). While many clinical syndromes have been described, the 5 most common include pure motor, pure sensory, mixed sensorimotor, ataxic hemiparesis, and dysarthria-clumsy hand syndrome.