Monday, April 28, 2014

Cath Lab I

A 60 year old smoker with hypertension presents with acute onset back pain. A chest X-ray is shown above. A CT scan is shown below.
Challenge: What's your diagnosis?

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Thursday, April 24, 2014

Easter II

Forty-eight hours after an Easter egg hunt, several people who went to the same party all develop nausea, vomiting, fever, diarrhea, and cramping. Nobody gets bacteremic. The illness is self-limited; fever resolves within 2 to 3 days, and diarrhea resolves within 4 to 10 days. Stool cultures show a gram-negative facultatively anaerobic organism. They are lactose-negative and produce hydrogen sulfide.

Challenge: How's your microbiology?

Image is in the public domain, from Wikipedia.

Monday, April 21, 2014

Easter I

A rash of rampaging rabbits ravage Missouri, Oklahoma, and Kansas, and you are sent to investigate an outbreak of disease among laboratory workers, farmers, veterinarians, hunters, landscapers, and meat handlers. Most have abrupt onset fever, chills, anorexia, and/or malaise. Some have headache, fatigue, chest soreness, myalgias, abdominal pain, vomiting, or diarrhea. For some, the fever abates and then returns.

Some patients have skin lesions like the one above. Others don't have skin manifestations but have regional lymphadenopathy. A small percentage have eye pain, photophobia, tearing, and conjunctival erythema and edema. A few have sore throat, exudative pharyngitis, and tonsillitis.

Challenge: What's the culprit?

Image is in the public domain.

More Than Meets the Eye

You've been seeing a 50 year old patient with resistant hypertension for a while. He was diagnosed several years ago, and you've been slowly increasing his antihypertensives to include hydrochlorothiazide, lisinopril, and amlodipine. Nevertheless, his blood pressures are still consistently 180/100. He has no other significant past medical or surgical problems. He is currently asymptomatic, has no chest pain, shortness of breath, altered mental status, headaches, visual disturbances, edema, or other signs or symptoms.

Laboratory values demonstrate a normal hematocrit, sodium 147, potassium 3.0, chloride 100, bicarb 18, creatinine 1.1, and low plasma renin.

Challenge: What's the diagnosis?

Image is in the public domain.

Thursday, April 17, 2014


You are an emergency medicine physician moonlighting as the doctor for a football team. An otherwise healthy teenager wearing a football helmet is tackled. He reports feeling dizzy and "slow" but denies headache, nausea, vomiting, balance problems, or incoordination. His vision is "slightly off." He has no numbness, tingling, or neck pain. On exam, he does not appear confused or uncoordinated. You test vestibular and oculomotor function and there are no noted deficits. He does have some inattention, deficits in recall, and concentration impairment, but he says this is due to being in the heat of the game. His sensory and motor exam are normal. Then, you retest vestibular and oculomotor function and he begins to feel nausea and more dizzy. He wants to return to the game and acts uncharacteristically irritable.

Challenge: What's your diagnosis? Should you send him to the emergency department? Can he return to the game?

Image shown under Creative Commons Attribution Share-Alike License, from Wikipedia.

Monday, April 14, 2014

Slow Down!

Challenge: What do you see on this fetal heart monitor?

Image shown under Fair Use.

Monday, April 7, 2014

Take a Break This Week

Hi everyone,

I am on a particularly tough rotation this month in the cardiac surgery ICU. No cases this week to give me some time to recharge. Hopefully I won't be too sporadic the rest of the month. Thanks for following along!


Thursday, April 3, 2014


Challenge: What's this phenomenon called?

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