Case of the Day

The art, science, history, and process of differential diagnosis is fascinating to me. Although this blog is not meant to hone that skill per se, it reflects my interest in pattern-recognition, heuristics, and fun medical trivia. For those interested in a deeper methodological study of the DDX, there are many other textbooks, articles, and resources on this (I personally enjoyed reading Clinical Problem Solving by NEJM).

This project was inspired by one of my best teachers, Dr Andy Josephson of UCSF neurology who had a very similar set-up during our neuroscience block in the first year of medical school, about ten years ago. We all learn differently, and for me, it was a really sticky way of adhering the reams of knowledge we had to acquire to my brain. I began this blog as a way of active learning, to encourage myself to read UpToDate, collect images, and keep track of diseases I wanted to know more about. Indeed, over the last ten years, I've kept scraps of paper and email drafts containing lists of diseases, signs, symptoms, and syndromes that come up for patients I meet, lectures I attend, articles I read, and conversations I have. Some of the diseases still on the list that I wanted to write a Case of the Day on but didn't get to include: tinnitus, splenic vein thrombosis, percheron stroke, cavitary pulmonary nodules, CMV pneumonitis, IBS, isopropyl alcohol intoxication, MCA CVA (insular ribbon sign), basal ganglia CVA (comma sign), sterile pyuria, anaphylaxis, air embolism, compartment syndrome (abdominal and extremity), quinidine effect, bupropion overdose. I'm not sure where these come from; they're just culled over time.

I've learned an incredible amount from this blog, and I hope you have gained something too. I have such great appreciation for my readers. I've had about 350,000 pageviews, mostly from the U.S., but also Canada, France, India, Brazil, the UK, Ukraine, Australia, Algeria, and Israel. In these thousand medical mysteries, I procured 1127 pictures. My backup file of the entire blog contents is 1445 pages long (my answers document is 188 pages). I'm sure I spent at least several weeks of my life working on this project. It's been wild.

I've never been good at saying goodbye to things, but it's time for me to move onto other projects despite the time invested and momentum built here. I may go through the cases someday and make small adjustments or organizational changes. With time, some of the medical information here may become obsolete or change, but I hope it remains a useful resource for readers.

Thank you all for your time, your kind words, and your participation. It has meant a great deal to me. Please feel free to contact me (I will reply to any comments) and I wish you all the best in your futures.

Craig Chen MD

Studying for ICU Boards

I'm studying for my critical care boards this week so next case will be next Monday. Also, just as a heads up, I am thinking of winding down this blog; we're getting close to reaching a thousand cases total. Thanks for reading!

Craig

Taking Another Break

Hi everyone,

Thank you all for participating in the last few weeks of cases. It's been a lot of fun but I'm going to take a break to recharge and study for my critical care boards. I'll be back next Monday with new cases.

Craig

No Cases This Week

Sorry! I don't have my things together this week so no cases. I will try to get back on track next weekend.

Craig

No Cases this Week

I'm feeling slightly burnt out. I'm going to take this week off for some self-care. I hope you do too. I'll try to get answers up soon for the last several cases. See you next week.

Craig

Apology

I take writing cases of the day very seriously. I'm really proud of this project, which has been going on for nearly ten years. I know that during fellowship and since, I have missed weeks unintentionally, and now I am going to do something I don't think I've ever done which is to skip two weeks in a row. I'm attending in the intensive care unit, and I don't think I can write any cases this week. There are a couple interesting patients so I have ideas for next week. I apologize but will get back on track soon.

Craig

No Cases This Week

This week I'm taking some time for myself. I'll try to get back to case-writing next Monday. Thanks for following along!

Craig

Well, I Tried

Though not planned, I guess there are no cases this week. Oops! I'll have them over the holiday week next week. Sorry about that. I know I also have to get around to posting answers - it's all on the to-do list.

Craig

Interlude - QuantiaMD

Since readers of this blog might be interested in other websites with "case of the day" type presentations, I wanted to put a plug in for QuantiaMD. It is a community for health care practitioners (requiring an MD, DO, NP, or PA degree to sign up) with focused educational videos on many topics throughout medicine (from basic diagnosis and treatment of diseases to health care policy to physician well-being). Every field from radiology to surgery to oncology is covered. There are lots of "mystery" cases similar to the material I have here. Participating in it leads to rewards, which makes it fun and engaging. The material is pretty solid and it awards CME credits. If you're interested, check it out: QuantiaMD. It does require you to verify your clinician status. Full disclosure - I do get a referral if you sign up.

Thanks,
Craig

Happy Thanksgiving!

I am thankful for you, reading this blog. I know there's a whole lot of other things out there to read and enjoy, and I really appreciate your time and attention. I'm going to take this week off for the holidays. I'll be back with new cases soon. Just a heads up - I have been pondering for a while how much longer to keep this blog going, and I think I might start wrapping it up within the next six months. It has been a real pleasure, lots of fun and lots of learning, but it may be time for me to move onto other projects. I wish you a lovely Thanksgiving.

Craig

Busy

Hi,

I usually try to plan ahead, but I haven't been so great about it. I'm attending in the ICU this week, and looking at the census - including someone who survived 65 minutes of compressions and 20 defibrillations - I don't think I'll get around to writing cases of the day. I'll try but if not, I'll be back next week.

Craig

Board Exam this Week

The next in a never-ending series of tests happens this week for me. I'm going to be out of town taking my oral board exams, so next case will be a week for now. Thanks for reading.

Craig

Taking a Break

Hi everyone,

Thanks for following along Case of the Day. I'm going to take a break this week. I have my oral board exams coming up in a month so things are looking quite busy; I'll probably take a breather then as well. I feel a little like a hamster running on a wheel, always playing catch-up so hopefully this will give me a chance to get on top of things.

Craig

Last Week of Fellowship

Dear all,

July 1st is a major calendar turn for most hospitals; newly minted interns write their first orders, residents take up that cloak of supervision, and fellows begin narrowing their area of expertise. For me, this July 1st is a big transition; I will finally be done with four years of medical school and five years of training. That's nine years of case-of-the-day! As I do so, I'm rethinking of what this blog is and could be; I have many ideas, but haven't yet decided. Meanwhile, I will take this week off as a break from cases. I envision that I will continue having projects like this, but the form and content are still up in the air. Even if this doesn't continue forever, I will try to keep all the archived cases available for education and study. Hopefully I'll be back in a week.

Thanks,
Craig

Away for the Weekend

Sorry there was no case of the day yesterday. I am out of town for Memorial Day weekend. Depending on how much free time and internet access I have, Monday's case is up in the air. I will definitely be back next Thursday. Thanks!

Craig

Time Off

Hello,

I'm traveling internationally for the next two weeks, so I'm going to take this week off from cases, and next week might be a little spotty. I'll try to have them ready, but we'll see. Thank you for following, and I really appreciate your support.

Craig

Happy Holidays!

Dear readers,

Thank you for following along Case of the Day! I know that cases have been a little spotty here and there, and I apologize. I am pretty happy to have almost 900 cases (my solutions document is 170 pages long). I will be taking today and next Thursday off for the holidays, but there should be a new case on Monday. Next year, I will try to be a little more cognizant of posting cases and solutions on time. At some point, I will probably retire this blog, but there are still a few more mysterious and fascinating diseases I want to cover. Wishing you and your family happy holidays.

Craig Chen

Holiday Week!

Happy Thanksgiving, everyone! Unfortunately, I am on call this Thursday, but I wish you all a warm and happy holiday. No cases this week; we'll see what I come up with next Monday. Thank you for following along.

Craig

Whoops!

Sorry! This week has come around and I have neglected to prepare cases of the day. Unfortunately, the free time I usually count on to write cases disappeared this last week. I apologize, but we'll both take this week off. Thanks for following!

Craig

Taking Boards!

Hi everyone,

Thanks for participating! I'm taking my board-certification exam next week so I'm going to take a break from cases for a week. We will be back soon!

Craig