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Background: Interprofessional collaboration (IPC) between nurses and physicians can be defined as shared responsibility and decision making in working towards the common goal of quality patient care. The positive effect of greater IPC on patient [...]
Case Presentation: A 31-year-old African American woman with past medical history of hypertension (HTN), gastro esophageal reflux disease (GERD), bronchial asthma and a diagnosis of Irritable Bowel Syndrome (IBS) for 10 years presented with complaints [...]
Background: Through collaborative neurosurgical comanagement services, hospital medicine has had an increasing role in the hospital-based care of the neurosurgical patient. This care model has evolved with the change in demographics of traumatic brain injury [...]
Case Presentation: A 75-year-old man with atrial fibrillation and no neurologic history presented to the emergency department with a one day history of somnolence, aphasia, and generalized weakness. He was nonverbal and minimally responsive to [...]
Background: Though commonly used in the outpatient setting, patient portals have not been routinely used in hospital settings and their impact on patients’ knowledge and activation is largely unknown. Methods: We created a patient portal [...]
Background: On a daily basis, hospitalists prescribe Venous Thromboembolism (VTE) prophylaxis. While of benefit to certain populations, VTE prophylaxis has not been proven to benefit medical patients at low risk for VTE. Pharmacologic prophylaxis may [...]
Case Presentation: A 55 year-old male with no known medical history presented to the emergency department after a fall on both knees. He was found to have bilateral patellar tendon ruptures and multiple femoral lytic [...]
Introduction: Pneumonia in an immunocompromised host is unique with respect to the organisms involved. The emergence of new pathogens has significant impact on therapy. Achromobacter xylosoxidans (A.xylosoxidans) is an uncommon pathogen known to cause serious infections [...]
Background: Patients with diabetes and comorbid cardiovascular disease may be at particularly high risk for medication non-adherence and adverse outcomes after hospital discharge. The objective of this study was to design, implement, and evaluate an [...]
Background: Venous thromboembolism (VTE) is considered the most common preventable hospital complication and VTE prophylaxis rates are benchmarks of hospital quality. Hospital-acquired VTE (HA-VTE) is defined as VTE that occurs during hospitalization or within 90 [...]
Background: Anemia is the most commonly encountered hematologic abnormality in preoperative evaluations and has been associated with major adverse outcomes in surgical procedures but often ignored during preoperative evaluation. The purpose of this study is [...]
Background: Signout of newly admitted patients from a night admitting physician to a primary team is common, making up roughly 40% of admissions to the inpatient medical service at our hospital. Nevertheless, little is known [...]
Background: Today’s care of patients in hospitals inevitably involves multiple providers who must coordinate and communicate effectively in an environment that is uncertain and in constant flux. Unfortunately, traditional communication systems, such as pagers or [...]
Background: Physicians frequently prescribe antibiotics to inpatients without knowledge of medication cost. It is not well understood whether providing cost data would change prescribing behavior. Methods: To evaluate the effect of providing cost data alongside [...]
Background: Despite the wide use of warfarin therapy this drug is associated with the largest number of serious adverse event reports by the FDA with 86% of warfarin-associated bleeds resulting in serious outcomes, and 10% [...]
Background: Academic medical procedure services (MPS) arise from the continued need for procedural training in the setting of decreasing procedural opportunities, increasing safety awareness, and increasing demands on inpatient resident time. Prior research has shown [...]
Background: One hopes that all hospitals strive for service excellence, and by 2010 there were more than 30,000 hospitalists delivering the lion’s share of inpatient care in our nation’s hospitals. Although patient satisfaction metrics like [...]
Background: A lack of effective physician-nurse collaboration has long been recognized to adversely impact patient and organizational outcomes. Despite substantial efforts towards developing strategies to improve interprofessional collaboration (IPC) in the acute care setting, consistent [...]
Background: Transitions from hospitals to the ambulatory setting are high risk periods for patients. The success of efforts to improve transitional care likely depends in part on local attitudes, culture, workload, and training. Prior to [...]
Background: Unit-based care teams offer inherent benefits to hospitalist services, including opportunity for improved efficiency, interdisciplinary collaboration, and enhanced patient experience. However, many barriers exist to creation of these care teams such as high occupancy [...]
Background: Effective patient-physician communication is integral for meaningful clinical relationships and patient satisfaction; thus, it is measured by the Hospital Consumer Assessment of Hospitals and Health Systems (HCAHPS) survey. Unfortunately, such surveys often demonstrate significant [...]
Case Presentation: A 31-year-old woman with a history of rheumatic heart disease and a murmur presented with two months of intermittent subjective fevers, diffuse malaise and inability to walk. Physical exam revealed a systolic 2/6 [...]
Background: In an effort to improve pediatric inpatient asthma care, the Joint Commission developed standards for hospital management in 2003. Despite this initiative, inpatient management of asthma exacerbations and adherence to these guidelines varies by [...]
Case Presentation: Calciphylaxis is a rare cause of skin necrosis due to calcium deposition within the vasculature, most commonly seen in patients with end stage renal disease. A 54-year-old male was transferred from a long-term [...]
Background: Point-of-care ultrasound (POCUS) has been rapidly adopted by emergency medicine (EM) as a tool for clinical care. There is growing evidence that POCUS may improve care outside of EM, and POCUS has recently seen [...]
Case Presentation: A 27 year-old male called 911 after intentional ingestion of 3g of lamotrigine and 3g of hydroxyzine. Upon arrival to the ER, approximately one hour after ingestion, the patient had slurred speech and [...]
Background: Per the 2014 State of Hospital Medicine Survey, 94% of adult hospital medicine groups (HMGs) reported financial shortfalls, with a mean of $169,886 in financial support per full time equivalent physician. In addition, many [...]
Background: Effective health care requires a delivery system that is fully coordinated. To achieve this requires structured communication between physicians and nurses yet an increasingly recognized barrier to efficient care is the geographic dispersion of [...]
Case Presentation: A 37 year old Caucasian man with known peptic ulcer disease and generalized anxiety disorder presented with a three week history of worsening right upper quadrant pain, nausea and generalized malaise. He denied [...]
Background: Planning for safe discharge should optimally begin early in each patient’s stay, and focus on individual patient’s needs. The aims of our study were to, beginning at the start of hospitalization and continuing until [...]
Background: As mobile health and technologies to engage patients in self-care gain increasing attention, it is critical to understand not only access to, but also ability and willingness of, underserved populations to use these resources, [...]
Background: Interprofessional bedside rounds have been promoted as a strategy to enhance patient engagement; prior studies have been limited by their use of nonvalidated measures and lack of patient and/or family involvement in design of [...]
Case Presentation: We report the case of a 69-year-old Honduran male with a long history of non-valvular atrial fibrillation with a CHA2DS2-VASc Score= 2 (Age > 65 and Hypertension) anticoagulated with Rivaroxaban 20 mg po [...]
Background: There is a growing appreciation of the increasing prevalence of CREs, but limited data exists on the prevalence of invasive infections due to CRE among adult, hospitalized patients in the various geographic regions of [...]
Background: Transitions from hospitals to the ambulatory setting are high risk periods for patients. The advent of the Patient-Centered Medical Home (PCMH) and Accountable Care Organizations (ACOs) provide an opportunity for true collaboration in which [...]
Background: Unintentional medication discrepancies during hospitalization can contribute to patient harm. Discrepancies can be reduced by performing medication reconciliation; however, effective implementation is challenging. The goals of the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) [...]
Case Presentation: A previously healthy 13-year-old Korean-American girl presented with acute altered mental status. She had fatigue, leg and abdominal pain, and was initially diagnosed with “the flu.” Two days later she progressed to worsening [...]
Case Presentation: 6 month old former 35 week twin Hispanic girls presented to the ED for evaluation of bulging fontanelles for almost one week. Both twins had been fussy for 24 hours, and Twin A [...]
Background: Transitions from hospitals to the ambulatory setting are high risk periods for patients. The success of efforts to improve transitional care practices likely depends in part on baseline practices and local resources, culture, and [...]
Background: Patient safety relies in part on timely review of laboratory and other results by appropriate providers. At our quaternary care, free-standing children’s hospital, providers were directly notified only of “critical” results (<1% of all [...]
Background: Patient is a previously healthy 7-week old Hispanic female who presented to an emergency department with cough, congestion and decreased PO intake x 7 days. Baby had an unremarkable prenatal course and normal delivery. [...]
Case Presentation: A 44-year-old female with end-stage renal disease on hemodialysis presented to the hospital with progressive nausea, vomiting and abdominal pain. The etiology of her renal disease was unknown. She had received a renal [...]
Background: The financial success of a hospital medicine practice is dependent on accurate billing and documentation practices. Academic hospitalists face the additional challenge of educating resident physicians on appropriate documentation. As most patients admitted to [...]
Case Presentation: A 27 year-old African American female with a history of bipolar disorder, cocaine abuse, Mixed Connective Tissue Disease with Raynaud’s syndrome presented to the emergency department with acute onset of altered mental status. [...]
Case Presentation: A 78 year male with history of urothelial carcinoma in situ who had undergone bladder resection, presented to the hospital 24 hours after his third weekly intravesicular BCG (Bacillus Calmette-Guerin) therapy due to [...]
Case Presentation: In June a 53-year old female with a history of NSCLC, chronic obstructive lung disease, initially presented with cough, hemoptysis, and weight loss. Bronchoscopy with trans bronchial biopsy confirmed moderate to poorly differentiated [...]
Case Presentation: A 72-year-old woman with hypertension, Hodgkin's lymphoma status post one dose of chemotherapy with adriamycin/bleomycin/vinblastine/dacarbazine developed an asymptomatic, erythematous, circular rash on her forehead four days after chemotherapy. Patient first presented to a [...]
Case Presentation: 59 year old man with history of metastatic prostate cancer and hypertension presented with a week's history of progressive abdominal distension, anorexia, nausea and vomiting. He did not have fevers, abdominal pain, diarrhea or [...]
Case Presentation: A 65-year-old healthy man presented with a 4 day history of fatigue and fevers. He denied any cough, chest pain, diarrhea or any recent sick contacts. He did complain of nausea and mild [...]
Case Presentation: A 35 year-old man presents to the emergency department with left sided chest pain. The pain is pleuritic, tender, and nonpositional. It is associated with exertional dyspnea, which is new for him. He [...]
Case Presentation: A 45 yo African American woman with lupus nephritis and a previous episode of myocarditis presents with 5 days of abdominal pain, headache, decreased appetite and acute shortness of breath. She was found [...]
Case Presentation: A 50 year-old man with a history of kidney-pancreas transplant was transferred to our hospital for acute onset right side numbness, twitching and altered mental status. Prior to his presentation, he was hospitalized [...]
Case Presentation: An 83-year-old Caucasian man visited an outpatient clinic with a complaint of right ankle pain and swelling for the past 4 months. The patient had a history of bladder cancer with trans-urethral resection [...]
Case Presentation: A 58-year-old man presented with weakness, vomiting, labored breathing, and severe hyperglycemia one week after a previous hospitalization for neck and chest pain. His initial work-up during the prior hospitalization included a neck [...]
Case Presentation: An 81-year-old male with hypertension and diabetes was brought to the ED after 3 days of immobility secondary to left-sided hemiparesis. Initial labs revealed platelet count of 1.3 M/uL, WBC count 22,000 /uL [...]
Case Presentation: A 67-year-old male with acute myelogenous leukemia (AML) with chronic neutropenia presented with acute onset of fevers accompanied by rapidly progressing violaceous lesions with a central eschar within a period of 48-72 hours. [...]
Case Presentation: A 35-year-old Chinese male with no significant past medical history presented to our hospital with a 6 year history of bilateral hand weakness. The patient reported that he first noticed the weakness after [...]
Case Presentation: A 74 year old male with a history of cerebral vascular disease as well essential thrombocythemia that had progressed to myelofibrosis maintained on ruloxitinib for 13 months presented with four months of intermittent [...]
Case Presentation: 58 year old female with no significant past medical history presents to the emergency room with slow heart rate. Patient initially presented to primary care physician with malaise, nausea, and vomiting. She reported [...]
Case Presentation: A 75 year old male from Puerto Rico with past medical history of stage Ia lung adenocarcinoma with bronchoalveolar features treated only with lobectomy, otherwise healthy presented to the ER with non-productive cough, [...]
Case Presentation: A 75 year old male presented with 4 syncopal episodes occurring over the 3 days prior to admission. Each syncope lasted 2-3 minutes and followed a coughing fit. The patient had an aortic [...]
Background: Dettol liquid (4.8% chloroxylenol, pine oil, isopropyl alcohol) is a commonly used liquid disinfectant. Various effects have been associated with its ingestion and this includes central nervous system depression, airway obstruction, gastro-esophagitis and cardiac [...]
Case Presentation: A 53-year-old man presented with a new-onset seizure. The patient recently quit drinking because his wife would no longer give him money to pay for alcohol. He was treated for acute alcohol withdrawal [...]
Case Presentation: 50-year-old Hispanic man with uncontrolled diabetes mellitus type 2 who presented initially in DKA was found to have an epidural abscess and transferred to our tertiary center for neurosurgical management with laminectomy and [...]
Case Presentation: A 38 year-old male with diet controlled diabetes presented with 3 months of unprovoked episodes of sweats. He noted that these episodes would come on at any time of day, last several minutes [...]
Case Presentation: An 85-year-old woman presents with worsening somnolence and altered mental status. Symptoms began one week prior with lethargy progressing to unresponsiveness. Her past medical history is significant for diabetes, hypertension and atrial fibrillation. Medications include carvedilol, lisinopril, and amiodarone. Initial vital [...]
Case Presentation: A 78 year old man with atrial fibrillation and hemochromatosis complicated by locally advanced hepatocellular carcinoma (HCC) was admitted from a skilled nursing facility with new onset bilateral lower extremity edema. He was [...]
Case Presentation: An 83 year old male with history of uncomplicated cardiac bypass 1 year prior without pericardiectomy presented with symptoms of acute decompensated congestive heart failure despite Lasix therapy and salt- controlled diet. Following [...]
Case Presentation: An 81 year old female with chronic kidney disease, severe tricuspid regurgitation and a pacemaker presented after a fall with a completely displaced left femoral neck fracture. She underwent a left hip hemiarthroplasty [...]
Case Presentation: A 49 year-old, previously healthy woman presented with one day of progressively worsening right-sided body pain and shortness of breath. She noted her pain started while in bed the previous morning, radiating from [...]
Case Presentation: A 78-year-old male was admitted to the hospital with a one week history of shortness of breath and lower extremity edema. His past medical history was significant for atrial fibrillation, chronic obstructive pulmonary [...]
Case Presentation: A 27-year-old African American female presented to the hospital with generalized body pain. Her medical history included sickle cell disease (SCD) HbSS type, bipolar disorder type 1 with severe depression, anxiety, post-traumatic stress [...]
Case Presentation: A 78-year-old Caucasian male presented to the emergency department with complaints of persistent loose stools for the past 2 weeks associated with vague diffuse abdominal pain, loss of appetite and 15 pounds weight [...]
Case Presentation: A 54 years old female with past medical history of hypertension, frequent UTIs, andhypothyroidism presented with 3 days of sharp LUQ abdominal radiating to the left flank, 8/10in severity and worsened with eating. [...]
Case Presentation: A 40 year-old woman with HIV (CD4 268) on antiretrovirals and pulmonary MAC on treatment presented to the hospital with abdominal pain and diarrhea. She was subsequently admitted to the intensive care unit [...]
Case Presentation: A 63-year-old man was admitted to our hospital because of aspiration pneumonia. The patient had long-standing progressive supranuclear palsy (PSP) with dysphagia and he had had placement of percutaneous endoscopic gastrostomy (PEG). After [...]
Case Presentation: A 27-year-old man with recently diagnosed human immunodeficiency virus (HIV) not on antiretroviral therapy presents with several months of cough, fever, abdominal pain, weight loss, gait imbalance, and hallucinations. On presentation, he was [...]
Case Presentation: Tissue pathology of a mass is often the gold standard for diagnosis of a malignancy. The dilemma is when the lesion is central and a biopsy cannot be safely obtained. The diagnostic burden [...]
Introduction: Duodenal diverticula are fairly common and mostly remain asymptomatic but can elicit potential complications including duodenal diverticulitis, hemorrhage, perforation and abscess formation. Pancreatitis secondary to duodenal diverticulitis is a rare clinical entity. We describe a [...]
Case Presentation: An 83-year old woman with a history of atrial fibrillation on amiodarone and warfarin was admitted with a supratherapeutic INR. She incidentally noted a two month history of fatigue, anorexia, nausea and increase [...]
Case Presentation: 31 year-old Hispanic male with history of HIV presented to the hospital with a 5-month history of progressive pain and weakness in bilateral upper and lower extremities. Review of systems was also significant [...]
Case Presentation: A 46 year old female with a history of hypertension presented to the ED with recurrent abdominal pain for a month located in the epigastric region and occasionally radiating to the back. She [...]
Case Presentation: A 33 year old man with treatment refractory bipolar disorder was titrated onto clozapine 200mg daily in an inpatient psychiatric facility. 10 days into his course, he was noted to have fevers, diaphoresis, [...]
Case Presentation: A thirty-five year old African-American female with a history Multiple Sclerosis and uterine fibroids presented with anemia, acute kidney injury (AKI), and lower extremity edema for two weeks. Initially AKI was attributed to [...]
Case Presentation: A 45 yo male with PMH of morbid obesity, hypertension, congestive heart failure, diabetes mellitus type II, and obstructive sleep apnea presented for evaluation of shortness of breath and hemoptysis x24hrs. The patient had completed a 22hr [...]
Case Presentation: A 63 year-old male was evaluated for rapidly progressive dementia. His illness began with flu-like symptoms. One month later, the patient presented to the hospital for confusion and dizziness. At that time evaluation [...]
Case Presentation: A 69 year old male who lives in Michigan with a past medical history significant for chronic pulmonary obstructive disease and hypertension presented with worsening dyspnea that began while vacationing in Florida. Prior [...]
Case Presentation: A 62-year-old man with a history of ulcerative colitis presented to our institution for evaluation of fever, dyspnea, and positive blood cultures. His ulcerative colitis had been controlled with a regimen of mesalamine [...]
Case Presentation: A 26 year old African-American male with past medical history of pancytopenia and hepatosplenomegaly was transferred to our facility for evaluation of his acute kidney injury. Patient presented with nausea, vomiting, anorexia and [...]
Case Presentation: A 52-year-old white female presented to our institution with acute onset of abdominal pain. Physical examination was significant for diffuse tenderness in epigastric region with decreased bowel sounds to auscultation. Pertinent work up [...]
Case Presentation: 35 yo AAF, PMH of HTN, T2DM, TIA, and L internal carotid stenosis (ICA) on daily ASA presented to the ED with acute dysarthria and a stroke workup was initiated. CT stroke showed [...]
Case Presentation: A 22 year-old male presented to an academic medical center with complaint of constant, sharp, diffuse abdominal pain with nausea and vomiting of four days duration. Eating worsened symptoms. He admitted to being [...]
Case Presentation: A 46-year-old male with a history of GERD and psoriasis presented with a tender, erythematous right ankle rash. First noted ten days prior to admission, he did not improve with trimethoprim-sulfamethoxazole and sought [...]
Case Presentation: 85 year-old female with history of depression and osteoarthritis presented with right upper and lower extremity weakness with difficulty ambulating. She also complained of transient substernal non radiating chest tightness which resolved upon [...]
Case Presentation: A 70 year-old woman with diabetes and end stage renal disease presented with acute severe left hand pain and swelling. Six hours prior, she incurred a puncture wound from a catfish spine while [...]
Case Presentation: A 50 year old woman was admitted with generalized fatigue, exertional dyspnea, epigastric discomfort and night sweats. Two months prior she had been to the Pacific coast of Mexico with family. A CT [...]
Case Presentation: A 29 year old gentleman with history of prior malaria infections presented for evaluation after a 3 day history of bodily aches, nausea and bilious vomiting. He had no history of hemetemesis, melena, [...]
Case Presentation: A 37 year old man presented with complaints of abdominal pain and lower extremity edema. His past medical history was remarkable for an “enlarged liver.” Physical examination revealed muscle wasting, palmar erythema, spider [...]
Case Presentation: A 55 year-old African American male with a history of homelessness, hepatitis B, and no known history of renal insufficiency presented with complaints of bilateral lower extremity swelling, and hematuria for five days. [...]
Case Presentation: A 31-year-old Hispanic male, presented to Emergency Department with nausea and vomiting associated with intermittent blurry vision for 4 days. He also noted malaise, epigastric pain, polyuria, polydipsia and about 40lb unintentional weight [...]
Case Presentation: A 42-year-old man with a history of severe hypertension, chronic kidney disease (stage 3), obesity, and smoking presented with one day of acute onset abdominal pain. The pain awoke him from sleep at 4 AM, starting in [...]
Case Presentation: A 55-year-old man with hepatitis C was admitted for fevers, night sweats, weight loss, and a swollen inguinal lymph node. He first noticed pain in his right groin one month ago, like someone was burning him [...]
Case Presentation: A 56 year old female presented with intractable pain and a cold right lower extremity. She had End Stage Renal Disease (ESRD) on hemodialysis, hypertension, and severe peripheral vasculature disease (PVD), with bilateral [...]
Case Presentation: A 52 year-old woman presented with two days of chest and back pain. History was significant for treated Cryptococcus fungemia, multi drug resistant urinary tract infection, hepatitis c and intravenous illicit drug use. [...]
Case Presentation: An 18 year old male with 1 year of headache, dizziness, mood swings, memory dysfunction, abnormal gait, presented with 2 days of prolonged epistaxis and non-bilious vomiting for few months. He denied use [...]
Case Presentation: A 50 year old African-American male presented with 2 weeks of headaches, neck pain, and photophobia. Exam revealed positive meningeal signs and a fever of 101oF. CT head and MRI showed small cerebellar [...]
Case Presentation: A 56 year-old female with no PMH presented to hospital with left sided chest pain of 2 months duration. Chest pain was pleuritic in nature and not associated with exertion. She also had [...]
Case Presentation: A 59 year-old black male with a past medical history significant for tobacco and polysubstance abuse presented to our Emergency Department with severe left-sided chest pain and pressure beginning 45 minutes after using [...]
Case Presentation: A 37-year old man presented to the hospital for hemoptysis of 4 weeks duration. He has PMH of Granulomatosis with polyangiitis (GPA) with pulmonary and renal involvement; diffuse alveolar hemorrhage and chronic maxillary [...]
Case Presentation: An 84 year-old man presented to hospital one day after the sudden onset of a severe, right-sided headache. He was on warfarin therapy following mitral valve replacement. The sharp, stabbing pain had worsened [...]
Case Presentation: A 30-year-old Caucasian man with a history of uncontrolled diabetes mellitus complicated by peripheral neuropathy, diabetic foot ulcers, methicillin-resistant S. aureus (MRSA) osteomyelitis and amputation of the left 2nd distal phalanx presented to [...]
Case Presentation: A 45-year-old woman, with a medical history of IV drug use and chronic hepatitis C virus infection presented to our institution with a complaint of right eye pain and inability to see. She [...]
Case Presentation: A 75 year old woman with past medical history of hypertension, diabetes mellitus, Barrett’s esophagus, and chronic constipation presented to the hospital complaining of one week of dyspnea after an international flight. CT [...]
Case Presentation: 45 year old quadriplegic female with history of hypertension, SLE (APLS negative) with vasculitis on chronic steroids, CAD status post bare metal stents on chronic anti-platelet therapy, and suprapubic catheter presented with two [...]
Case Presentation: An 80 year-old man with history of hypertension, remote cerebrovascular accidents (CVA), and multiple admissions for syncope and orthostatic hypotension presented with sudden syncope, hypotension, and acute respiratory failure requiring intubation. Vital signs [...]
Case Presentation: An 89-year-old man was transferred to our facility for altered mental status, fever, acute renal failure, and thrombocytopenia. He was in his usual state of health until a week prior when his children [...]
Case Presentation: A 66 year -old woman presented with three days of worsening abdominal pain. She described the pain as severe sharp epigastric pain which radiated to her back and both lower abdominal quadrants. She [...]
Case Presentation: A 40 year-old female with no significant past medical history presented with nausea, vomiting, easy bruising, dyspnea on exertion, and presyncope. She had been treated with Levofloxacin for a urinary tract infection one week [...]
Case Presentation: A 70 year-old woman presented to the hospital via her son after she told him someone had “cut my body in half.” For the past week, the son had noted her to be [...]
Case Presentation: A 25-year-old female at 29 weeks gestation presented to the inpatient obstetrics service with hypertension, gestational diabetes and concerns for preeclampsia. Physical exam was significant for a blood pressure of 151/93 and a [...]
Case Presentation: A nineteen year old male with a history of hypertrophic obstructive cardiomyopathy, and status post implantable cardioverter defibrillator for non-sustained ventricular tachycardia, presented to the hospital after cardiac arrest. Prior to transfer to [...]
Case Presentation: A 34 year old man presented with five days of severe right eye pain. Hours after popping a pimple on the supraorbital ridge of his right eye, he developed fevers, chills, headache, blurry [...]
Case Presentation: We report a case of 48 year old male with no significant past medical history, presented to hospital with complaint of left arm weakness and dysarthria that started 2-3 hours before. He had [...]
Case Presentation: A 62-year-old right-handed female with a past medical history significant for hypertension, hyperlipidemia, and diabetes mellitus presented to the emergency department with a one week history of perioral numbness, gait imbalance and increased [...]
Case Presentation: A 74 year-old male with end-stage renal disease (ESRD) on hemodialysis (HD) for the past 10 years due to autosomal-dominant polycystic kidney disease (ADPKD) presented with progressive left leg pain and sudden inability [...]
Case Presentation: A 32 year-old Caucasian female with history of asthma, hypothyroidism, and renal cell carcinoma (RCC) status-post right nephrectomy, presented with a progressively enlarging goiter causing solid food dysphagia. She had been diagnosed with [...]
Case Presentation: A 45-year-old male with a history of asthma and diabetes presented to a New York hospital complaining of fevers, night sweats, dyspnea with non-productive cough and bilateral joint pains for two days. The [...]
Case Presentation: A 50 year old man with a past medical history of coronary artery disease and COPD presented with complaints of recurrent syncope. These episodes occurred about 5 to 7 times weekly. Additional symptoms [...]
Case Presentation: An 81-year-old white male with history of hypertension, coronary artery disease, atrial fibrillation, ulcerative colitis and cryptogenic cirrhosis was readmitted with generalized weakness, persistent leukocytosis and weight loss. He was recently discharged with [...]
Case Presentation: A 58 year old male with a history of NASH cirrhosis, diabetes mellitus, and obstructive sleep apnea presented due to multiple symptoms that had been present for the past 3 months, including severe [...]
Case Presentation: A 76 year old male presented to the Emergency Department with weakness 2 days after discharge from a hospitalization in which he was treated for pyelonephritis. His urine culture from that admission revealed [...]
Case Presentation: A 36 year-old woman presented with three days of progressive shortness of breath and chest pain. Her symptoms began while walking in the mall. She had a history of HIV/AIDS (CD4 count 34) [...]
Case Presentation: A 38-year-old Caucasian male presented to our emergency room (ER) with left-sided abdominal pain that has been progressively worsening for 2 days. He reported that the pain started gradually in the left lower [...]
Case Presentation: A 60 year-old Asian man with a five year history of psoriasis presented to the ER with painless hematuria. Subsequent imaging and biopsy confirmed renal cell carcinoma with metastasis to the lungs. In [...]
Case Presentation: A 59-year-old woman with HIV (CD4 1064 cells/mm3), chronic HCV, hypertension and peripheral vascular disease presented with progressive dyspnea on exertion over the past month. Her medication regimen was stable and included Lamivudine/zidovudine, [...]
Case Presentation: A 22-year-old African American male presented to our hospital with a 2-day history of bleeding gums while brushing and “swollen glands” on the neck. He denied any fevers, chills, night sweats, weight loss [...]
Case Presentation: A 51 year-old man with untreated HCV (HCV-RNA 460978 IU/ML, Genotype 3a), prior heroin abuse on methadone maintenance presented with hematuria and right upper quadrant pain for 2 days. The exam was significant for [...]
Case Presentation: A 50 year old African American male presented to the Emergency Room with headache, nausea, vomiting, and three seizures in the past 24 hours. The patient was recently discharged from a hospitalization for [...]
Case Presentation: A 31 year old male was admitted to the critical care unit following status epilepticus (precipitated by recent antiepileptic dose reduction) requiring intubation and mechanical ventilatory support. He was a known epileptic since [...]
Case Presentation: A 38 year-old man presented with left upper quadrant (LUQ) pain radiating to the shoulder. Two weeks prior, he was evaluated for arthralgias, malaise, and intermittent “black spots” in his vision. Physical exam [...]
Case Presentation: A 63 year old gentleman with a history of throat cancer and hypertension was transferred from a community hospital with a diagnosis of meningitis. Ten days prior, the patient awakened with a severe [...]
Granulomatosis with Polyangiitis (GPA) is a multi-system, immune-mediated disorder characterized by necrotizing vasculitis. Diagnosis can be difficult since symptoms are nonspecific and often hard to distinguish from non-vasculitic processes. We present a diagnostic dilemma for [...]
Case Presentation: A 39 year-old Ecuadorian man with no past medical history presented with one month of fevers and nausea. Two weeks prior to admission, the patient presented to the emergency department with these symptoms. [...]
Case Presentation: A 33 year-old woman with no known medical history presented with one week of sharp, stabbing right upper quadrant abdominal pain along with fever to 103 degrees Fahrenheit. She had also noticed a [...]
Case Presentation: A 77-year-old male with systolic heart failure (EF 28%), hypothyroidism, and CKD stage 3 presented with dyspnea on exertion and paresthesias in all four extremities. Physical exam revealed anasarca. CT scan of chest/abdomen/pelvis [...]
Case Presentation: A 62 year old Chinese male was admitted for 2-month history of left sided hemiparesis. Brain imaging showed multiple lesions suspicious of brain metastases. Otherwise asymptomatic, he was noted to be febrile at [...]
Case Presentation: A 33 year old male with a very recent diagnosis of HIV presented with a 3 week history of fevers and profuse diarrhea, and a 2 day history of a diffuse rash. His [...]
Case Presentation: A 79-year-old man with a 40 pack-year smoking history presented with progressive right hip pain. During the two months prior to his admission, he noted generalized fatigue, poor appetite, and an unintentional weight [...]
Case Presentation: A 73-year-old male with a history of small cell lung cancer with metastases to the brain and left adrenal gland was admitted for progressive fatigue and dysphagia. Physical examination disclosed a non-tender thyroid [...]
Case Presentation: A 78 year old female with pulmonary hypertension and diastolic congestive heart failure presented to the emergency room secondary to shortness of breath and a rash. The shortness of breath began three days [...]
Case Presentation: A 31-year-old man with no past medical history presented after a pre-syncopal event. He felt increasingly unwell over the four weeks prior to admission with decreased appetite, fatigue, and intermittent night sweats. Several [...]
Case Presentation: A 79 year old Hispanic male with a past medical history of prostate cancer in remission, hypertension and hyperlipidemia presented with fever and left upper quadrant pain. The left upper quadrant pain began [...]
Case Presentation: A 68 year old Egyptian male came with complaints of nausea, non-bilious, non-bloody vomiting, mild right lower quadrant abdominal pain and generalized weakness for one week associated with decreased appetite and 15 pounds [...]
Case Presentation: A 23-year-old Hispanic woman, presented to the Emergency Department with periodic bilateral lower extremities flaccid weakness and numbness for 3 months. She reported her symptoms had worsened in severity over the last 2 [...]
Case Presentation: A 50-year-old Caucasian male presented with complaints of worsening shortness of breath, cough productive of thick, yellow colored phlegm and fever for three days. His past history was significant for adenocarcinoma esophagus requiring [...]
Case Presentation: A 61-year-old man with no known medical history presented to the Emergency Department with two weeks of increasing abdominal distension. He also reported having progressive left eye pain and vision loss since a [...]
Case Presentation: A 31 year old Caucasian female, with a history of cyclical vomiting presented with abdominal pain and intractable nausea and vomiting for 4 days. Abdominal pain was 10/10 in severity, diffuse, pressure type, [...]
Case Presentation: A 55 year-old Hispanic female with a history of human immunodeficiency virus (HIV) (recently started on highly active antiretroviral therapy, CD4 count of 213 cells/mm3, viral load of 69,835 copies/mL), and non-pulmonary tuberculosis [...]
Case Presentation: A 32-year-old male patient, Jehovah’s Witness, of no known medical history presented with a 3-month duration of intermittent bloody diarrhea, fatigue and progressive 14 kg weight loss. He denied any fever, chills, night sweats, [...]
Case Presentation: A 48 year-old woman with past medical history of Graves’ disease and vitiligo was referred to the emergency department after she presented to clinic with worsening dizziness and generalized malaise over several weeks. [...]
Case Presentation: A 45-year-old female presented with a two-week history of painful skin lesions on both inner thighs. Her medical history was significant for alcoholic cirrhosis and hypothyroidism. On physical exam, several tender violaceous plaques [...]
Case Presentation: A 59 year old white male was transferred from an outside hospital with back pain, fever and neurological deficits and found to have an epidural abscess with MRSA positive blood cultures. Emergent debridement [...]
Case Presentation: A 43 year-old man presented to emergency room with 3 days of altered mental status and aphasia. A friend checked on him and called 911 after 3 consecutive days of non response to [...]
Case Presentation: A 73-year-old female, with a history of hypertension, dyslipidemia, diabetes, and peripheral arterial disease presented with generalized weakness, nausea and vomiting after an Africanized Bee attack receiving more than 50 bee stings. Vital [...]
Case Presentation: A 25 year old man was recently diagnosed with HIV/AIDS and had a CD4 count of 29 and a viral load of 85 thousand. At the time of his initial presentation, he was [...]
Case Presentation: 76 year-old man presented with multiple episodes of vomiting and melena for 1 day. He was postop day 11 after laparoscopic cholecystectomy. His PMH included gall stone pancreatitis, partial gastrectomy in remote past, [...]
Case Presentation: A 32 year old Hispanic female with a history of IV drug use presented with a 3 day history of fever, bloody diarrhea and abdominal pain. She denied recent antibiotic use, sick contacts, [...]
Case Presentation: A 76–year-old white male, with type 2 diabetes mellitus (DM), presented with three days history of confusion and difficulty finding words which started after aggressive vomiting of two days duration. His medications list [...]
Case Presentation: A 53-year-old man with past medical history of alcohol use presented to the emergency room with a 1-month history of fatigue, night sweats, high fevers, and 20-pound weight loss over 3 months. Physical [...]
Case Presentation: A 28-year-old female with a history of hypertension presented with difficult to control hypertension after sustaining a motor vehicle accident. She initially developed asymptomatic hypertension at age 21 denying paroxysms of headache, sweating, [...]
Case Presentation: A 71 Year old Hispanic female with significant history of coronary artery disease status post coronary artery bypass grafting, chronic mastoditis with mastoidectomy few years ago, type 2 diabetes mellitus, hypertension and hyperlipidemia [...]
Case Presentation: A 49 year old Caucasian female presented to the emergency department (ED) with increasing shortness of breath of one week. She had an initial orthotopic heart transplantation for giant cell myocarditis followed by [...]
Introduction: The use of an entirely subcutaneous implantable Cardioverter defibrillator (S-ICD) is a better alternative for patients who have limitations to placing pacemaker leads intravenously. We report a case of S-ICD use because of presence [...]
Case Presentation: A 19 year old African American male presented with progressive shortness of breath over one month. Associated symptoms were dry cough and forty pound weight loss. Past medical history was pertinent for meningitis [...]
Case Presentation: A case of Pasturella multocida infection, which manifested as sepsis, endopthalmitis, and native mitral-valve endocarditis, in an older patient on imatinib for a recently diagnosed gastrointestinal stromal tumor (GIST). Discussion: The patient is [...]
Case Presentation: 80-year-old male with Rheumatoid Arthritis (RA). He was confirmed seropositive with Rheumatoid factor positive, Anti- Citrullinated protein positive as well as a high titer ANA positive. He was started on Abatacept for symptom [...]
Case Presentation: A 66-year-old woman with multiple comorbidities including chronic mesenteric ischemia, chronic respiratory failure status post tracheostomy, and end-stage renal disease on dialysis presented with intermittent nausea and large-volume emesis. For several weeks prior [...]
Case Presentation: An 88 year-old female initially presented to an outside hospital five days ago with concern for nausea, dizziness, and lightheadedness of one day duration. At the time, the patient was found to have hemoglobin [...]
Case Presentation: A 61 year old male with a history of multiple knee replacements for osteoarthritis and septic arthritis presented to the hospital with symptoms of fevers, chills, and generalized malaise. He had recently been [...]
Case Presentation: 52 year old male with no past medical history presents to the emergency department with 3 months of increasing fatigue, upper extremity weakness, and oropharyngeal dysphagia. Review of systems was notable for fevers, [...]
Case Presentation: A 67 year-old man presented with shortness of breath that began three days prior to presentation. He reported an acute onset of dyspnea with no change in exertion. His past medical history included [...]
Case Presentation: A 53 year-old man with HIV (CD4 51/10%) presents with progressive confusion and weakness over two months. He had previously been employed and able to perform all activities of daily living. He is [...]
Case Presentation: 69-year-old male with past medical history of hyperlipidemia, gout and eczema brought in to the emergency department in early fall for altered mental status. Patient was found unresponsive on the floor with non-bloody [...]
Case Presentation: 32-year-old woman with a past medical history of Hashimoto's thyroiditis and fibromyalgia was admitted to the hospital with frequent episodes of muscular weakness and pain. The patient noted to have a life long [...]
Case Presentation: A 51-year-old female with past medical history of chronic renal insufficiency, insulin dependent diabetes mellitus, asthma and active nicotine dependence presented to the hospital with nausea, vomiting and abdominal pain for five days. [...]
Case Presentation: A 58-year-old woman with PMH significant for asthma, COPD, history of breast cancer s/p mastectomy on Tamoxifen, OSA, RA and a recent admission 3 weeks ago for asthma exacerbation; presented to the Emergency [...]
Case Presentation: A 6 year old male with no past medical history presented to the emergency room (ER) with six hours of right lower quadrant (RLQ) pain. The pain was described as sharp and non [...]
Case Presentation: 85 year old woman with history of bio-prosthetic mitral valve presented with fever and rigors few days after dental work for which she took trimethoprim-sulfamethoxazole (TMP-SMZ). On physical examination, she had maculopapular rash [...]
Case Presentation: A healthy 6-year-old boy with an unremarkable family history sustained a minor trampoline injury accompanied by mild back and neck pain. The neck pain resolved within several days, but back pain persisted for [...]
Case Presentation: A 4 month-old female presented with decreased movement of the right lower extremity. Exam revealed a flexed, abducted right leg and pain with passive motion. CBC, inflammatory markers and CK were normal and [...]
Case Presentation: A 5-week-old previously healthy male presented to an ER with 2 days of fever. He was lethargic with a sunken fontanel. Labs revealed a WBC of 13.5 with 15% bands, c-reactive protein of [...]
Case Presentation: A 22-year-old man with a history of a Meckel’s diverticulum resected 10 years prior presented with diffuse abdominal pain and nausea for five days. The pain was sharp and stabbing in nature with [...]
Case Presentation: A 21 year old woman had recently delivered a healthy male infant. This was her first pregnancy, it was complicated in the third trimester by pre eclampsia due to which she underwent a [...]
Case Presentation: A 79-year-old man presented with 4 months of progressive muscle weakness, shortness of breath, and anorexia associated with a 25 lb weight loss. His exam was notable for hypoxemia requiring 4 liters of [...]
Case Presentation: A 73 y/o F was admitted with new onset seizure and altered mental status. PMH was significant for HTN and recently diagnosed multiple myeloma (MM). She had received bortezomib 4 days prior to [...]
Case Presentation: A 29 year old male with a history of Crigler–Najjar syndrome and working out with CrossFit, a high intensity core strength and conditioning exercise program, presented with two days of bilateral arm swelling. [...]
Case Presentation: A 55-year-old male admitted with a diagnosis of pulmonary embolism and complaints of several episodes of intermittent palpitations was referred for cardiac evaluation for supraventricular tachycardia. Family history was significant for heart failure [...]
Case Presentation: A 76-year-old female with past medical history of Paroxysmal Atrial Fibrillation, HTN, CAD, and cholangiocarcinoma (in remission since 2002) presented after a mechanical fall and also complained of increasing abdominal distention. Initial labs [...]
Case Presentation: A 45-year-old Caucasian female with insignificant medical history presented to a community medical center with typical 8/10 left-sided chest pain radiating to left arm. It resolved with sublingual nitroglycerin, only to present with [...]
Case Presentation: A 31-year-old Caucasian female presented in active labor during her second pregnancy. She was planned for a cesarean section under spinal anesthesia with bupivacaine, morphine and fentanyl. Immediately, post-delivery she reported severe headache [...]
Case Presentation: A 71-year-old African American woman with history of coronary artery disease, hypertension and sulfa allergy, presented with indolent onset retrosternal chest discomfort which was positional, pleuritic, and unresponsive to sublingual nitroglycerin. Her medications [...]
Case Presentation: A 61-year-old Caucasian male presented with melena, dizziness and anemia with hemoglobin of 6.0 gm/dL. He received appropriate hemodynamic resuscitation including six units of packed red blood cells. Urgent gastrointestinal tract evaluation was [...]
Case Presentation: : A 70-year-old woman presented to the emergency department with general malaise and fatigue. She has a history of diabetes mellitus type 2, hypertension and dyslipidemia for which she takes Metformin, Nifedipine and [...]
Case Presentation: 67 year old right-handed female with past medical history of morbid obesity, hirsutism and pre diabetes mellitus presented to the Emergency Department with a chief complaint of acute onset of slurred speech. Notably [...]
Case Presentation: A 57 year old male with past medical history of COPD and schizophrenia presented with complaints of shortness of breath. The patient was discharged from a different hospital a day prior to the [...]
Case Presentation: A 36 year-old-male with a history of seizure disorder presented to the hospital with high-grade fevers, chest pain, and sore throat. At the time of presentation, he had a fever of 38.3°C, a [...]
Case Presentation: An 82 year old female with history of perforated appendicitis with open appendectomy at age 15, presented with 3 years of episodic abdominal pain and distention associated with nausea and vomiting. Prior episodes [...]
Case Presentation: A 58 year-old male guitarist presented to the hospital with worsening generalized weakness for a week. He also had sore throat and generalized malaise with diarrhea and decreased oral intake. Past medical history [...]
Case Presentation: A 62 year old man with a history of end stage liver disease secondary to Hepatitis C and alcohol, chronic obstructive pulmonary disease, and benign prostate hyperplasia presented to the hospital with a [...]
Case Presentation: 65 years old male with past medical history of ischemic cardiomyopathy with Automatic Implantable Cardioverter Difibrillator (AICD) presented with complaints of multiple AICD shocks. Lab works at presentation were within normal limits. AICD [...]
Case Presentation: A 21 year old African-American male with no medical history presented with multiple organ injuries secondary to gunshot . He had exploratory laparotomy with repair of abdominal wall , colonic resection, splenectomy, and [...]
Case Presentation: A 25 year-old man presented with one month of progressively painful, bruised, and swollen bilateral calves. Symptoms started as bilateral feet and ankle pain followed by the development of bruising over the posterior [...]
Case Presentation: A 20 year old African American Male presented with 1 day history of bilateral throbbing headache , nausea , vomiting .On further questioning, he reported experiencing flu like symptoms 2-3 weeks ago with [...]
Case Presentation: A 71 year old woman with a history of transformed diffuse large B-cell Non-Hodgkin’s Lymphoma, currently in remission, was transferred to our hospital for several days of malaise and persistent fevers. She was [...]
Case Presentation: A 37 year old African-American man presented with numbness in the hands and weakness of both the upper and lower extremities for a month's duration. Patient stated that the proximal muscle weakness has [...]
Case Presentation: 39 year old man with a PMH of testicular seminoma s/p orchiectomy presents with intermittent, sharp, left-sided abdominal pain in the subcostal region with radiation to the left flank and back of 2 [...]
Case Presentation: 85-year-old man with hypertension and prostate cancer presents with five days of fever, chills, poor oral intake, constipation and a non-productive cough. Patient had just completed a course of Azithromycin provided by his primary [...]
Case Presentation: A 40-year-old woman with postablative hypothyroidism from Graves Disease presented with 3 weeks of fatigue and myalgias. She reported severe constipation and worsening bilateral anterior thigh pain exacerbated by movement. Physical examination revealed [...]
Case Presentation: 23 y.o. female with no significant PMH presented to OSH ED 1 week post brown recluse spider bite. She had fever of 102.4 and was started on abx. Over the next several days, [...]
Case Presentation: 85 year old female presented to the ED with the worst headache of her life for four days. Past medical history was significant for migraines, diabetes mellitus, and recent zoster involving CN VII. [...]
Case Presentation: A 77 year-old Caucasian male with a history of recently diagnosed myelodysplastic syndrome (MDS), hypertension, hyperlipidemia, atrial fibrillation, lung cancer treated with resection, and amyloidosis of the kidneys, presented to the ED with [...]
Case Presentation: A 38-year-old male admitted for gastroenteritis was found to have an incidental finding of linear density in right ventricle (RV) on abdominal x-ray. He had a history of lower extremity deep venous thrombosis [...]
Case Presentation: A 39-year-old man with no past medical history presented to an outside hospital with several weeks of fevers, chills, night sweats, vomiting, diffuse abdominal pain and a 7 kg weight loss. Vital signs [...]
Introduction:Esophagitis dissecans superficialis (EDS) is a rare although likely underreported endoscopic finding characterized by sloughing of large fragments of esophageal mucosal lining. It is commonly seen in immune suppressed patients and those with multiple comorbidities. [...]
Case Presentation: A 61 year old woman was brought into the emergency department by her brother for evaluation of confusion, hallucinations, and paranoia. Her medical comorbidities included anxiety, hypertension, and stage III chronic kidney disease. [...]
Case Presentation: A 61-y.o. woman with pulmonary sarcoid presented with 3 weeks of fever, malaise, and 15-lb weight loss. Social, travel, and family history was unremarkable. Initial exam noted diffuse lymphadenopathy. Labs revealed leukopenia, anemia, [...]
Case Presentation: A 62 years old male presented to the emergency department with soft tissue swelling, urticarial skin rash and acute respiratory failure. He was diagnosed with acute anaphylactic reaction with angioedema. He was given [...]
Case Presentation: A 26 year old male with past medical history significant for gastroesophageal reflux disease, presented with complaints of ongoing right upper quadrant and epigastric abdominal pain over the previous 6 months. He reported [...]
Case Presentation: A 34 year old African American male with history of alcoholism, chronic pancreatitis, recurrent upper GI bleeding with unknown etiology presented with acute onset of epigastric and LUQ abdominal pain, hematemesis and melena. [...]
Case Presentation: A 22 year-old man presented to the emergency department in Cochabamba, Bolivia, with headache and left-sided weakness. Both were present for three weeks, both progressively worsening. The patient was from Aiquile, a rural [...]
Case Presentation: A 27 yo female with biopsy-proven Crohn’s disease presented with fever, chills, abdominal pain and diarrhea occurring intermittently for the past year. Previously, she had been maintained on TNF inhibitor alone with antibiotics [...]
Introduction: Invasive Klebsiella Pneumoniae Liver Abscess Syndrome (IKPLAS) consists of liver abscess findings on imaging with blood cultures or aspirate positive for Klebsiella Pneumoniae, in the absence of hepatobiliary disease. This entity is ominous from [...]
Introduction: Thyrotoxic Periodic Paralysis (TPP) is complication of hyperthyroidism, characterized by recurrent episodes of flaccid paralysis associated with hypokalemia. This unusual but serious complication of hyperthyroidism can lead to paralysis, cardiac arrhythmias and respiratory failure. [...]
Case Presentation: A 58 year old male is sent from a behavioral health unit for altered mental status, lethargy, and vomiting for one day. He has a history of hypertension and schizoaffecive disorder, for which [...]
Case Presentation: A 39 year-old woman presented with 4 months of progressive dyspnea on exertion and chest tightness. Her symptoms first began near the end of her usual 2 mile walk, resolving with rest after [...]
Case Presentation: A 50 year old woman with history of left breast cancer, treated with lumpectomy and eight weeks of radiation therapy completed four months ago, presented with one month of dyspnea, dry cough, and low grade [...]
Case Presentation: A 79 year old female with history of osteoporosis, remote breast cancer s/p mastectomy and radiation therapy, and history of multiple vertebral compression fractures presented to the hospital three days after kyphoplasty of [...]
Case Presentation: An 82-year old male presented to emergency department with complaints of severe “prostate” pain with movement, defecation, and micturition for several months, with increase in pain severity 2 weeks prior to presentation. He [...]
Case Presentation: A 42-year-old African American female presented to the emergency room complaining of dizziness, headache, nausea, fever and chills for 3 days. The patient reported at least 3 similar episodes in the past 5 [...]
Case Presentation: A 56 year old African American man with a past medical history of HIV, TB (treated), and very severe stage IV COPD (FEV1 25%) with a thirty pack years smoking history presented for [...]
Case Presentation: A 43-year-old Caucasian man with a history of asplenia, nephrolithiasis, and prior mesenteric lymphadenitis presented with fevers, headache, and rash in areas of prior tattoos and scars. Review of systems revealed two months [...]
Case Presentation: A 63 year-old Caucasian male with a history of severe symptomatic aortic insufficiency and coronary artery disease was seen in the intensive care unit status-post aortic valve replacement and single vessel coronary artery bypass graft (CABG). The patient tolerated the [...]
Case Presentation: A 21 year-old woman with acquired immune deficiency syndrome (CD4 count 22) and chronic platelet clumping was admitted with a sore throat of 24 hours duration. She had enlarged, erythematous tonsils bilaterally; no [...]
Case Presentation: A 51 year old male patient with a history of injection drug use was admitted with MRSA bacteremia and lumbar epidural abscesses. He reported developing new neck pain on hospital day two. Urgent cervical MRI [...]
Case Presentation: A 78-year-old woman presented to an outside facility with dyspnea and abdominal distension. Abdominal examination revealed distension and a fluid wave. Pulmonary examination revealed decreased breath sounds and dullness to percussion in the [...]
Case Presentation: A 40 year old man with history of hyperlipidemia and elevated transaminases and alkaline phosphatase for the last 10 years, which he attributed to statin use, presented with dark urine, pruritus, scleral icterus, and [...]
Case Presentation: A 51 year old woman presented with one month of progressive dyspnea on exertion, increasing abdominal girth and 20 lbs weight gain. She denied fevers, night sweats, nausea, vomiting, chest pain, orthopnea, paroxysmal [...]
Case Presentation: A 46-year-old gentleman presented to the ED with one day history of acute onset epigastric pain. He is a nonsmoker and nonalcoholic, with past medical history of hypertension. His abdominal pain was sharp [...]
Case Presentation: 55-year-old Hispanic female with no significant past medical history who was in her usual state of health presented with complaints of multiple syncopal episodes that were preceded by nausea and vomiting for three [...]
Case Presentation: A 58 year old gentleman with no known past medical or surgical history, or history of smoking or alcohol intake, presented to the ED with abdominal pain, nausea, vomiting ,constipation with generalized weakness [...]
Case Presentation: A 66-year-old man with a history of Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia(SLL/CLL) in remission, hypogammaglobulinemia and atrial fibrillation presented to an outside hospital with shortness of breath, facial swelling and bilateral upper extremity edema.Computed tomography scanning done prior to [...]
Case Presentation: A 54y man with history of DM2 on insulin and ESRD on HD presented to the ER with worsening bilateral foot pain. The patient was admitted 1 month prior for osteomyelitis of the [...]
Case Presentation: A 32 year-old African American man with a history of asthma was admitted to the ICU with acute respiratory failure due to diffuse alveolar hemorrhage (DAH), diagnosed by bronchoscopy, requiring intubation and blood [...]
Case Presentation: An 85 year old man with a history of HCV, hypothyroidism on levothyroxine, and anemia presented with a 1 day history of total body pain. He stated that he was in his usual [...]
Case Presentation: A 48 year-old Chinese man with background history of major depression, presented 7 hours after ingestion of unknown amount of multiple drugs including immediate-release gliclazide, simvastatin, fluvoxamine and pacofen (paracetamol, codeine and caffeine). [...]
Case Presentation: A 57 year old female with a past medical history of Lyme disease was admitted to the hematology service with DIC. Acute promyelocytic leukemia was diagnosed and a PICC line was placed for [...]
Case Presentation: A 59 year old man with a history of acute intermittent porphyria was admitted with weakness and subjective chills. Exam revealed severe proximal muscle weakness and areflexia. Blood cultures grew E. coli, treated [...]
Case Presentation: A 60 y/o African American Female with history of Manic-depressive disorder was brought to emergency room for altered mental status of three day duration. Her home medications included Lithium, Trazadone, Paliperidone. She had [...]
Case Presentation: A 48 year old woman presented to the ED with painful skin lesions on thighs, nose, and ears which appeared after smoking cocaine the night prior. The patient reported at least five previous [...]
Case Presentation: A 49 year old man with a medical history significant for hypertension and hyperlipidemia presented to the ER with worsening shortness of breath, cough and malaise. His initial work-up revealed normal lab values [...]
Case Presentation: A 78 year old lady with recent pacemaker placement for sick sinus syndrome, and paroxysmal atrial fibrillation on flecainide (150 mg bid) for the past one year, presented to the ER with nausea [...]
Case Presentation: A 63 year-old female presented with a fall and presyncope. A year ago, the patient had transient dysarthria with progressive confusion, cognitive decline, and several falls. The patient denied recent headache, SOB, palpitations, [...]
Case Presentation: 64-year-old man with a history of remote IV drug abuse, untreated hepatitis C, and poor medical follow-up presented with two months of increasing weakness. One week prior to presentation, he reported a flu-like illness with neck swelling, presumed lymphadenopathy, after which his weakness acutely [...]
Case Presentation: A 24 year old female with a history of bipolar disorder was admitted for nausea, dizziness and jitteriness that started after intentional ingestion of 4 gm of lamotrigine and 80 mg of aripiprazole, [...]
Case Presentation: A 54-year-old male with type 2 diabetes mellitus presented to the emergency department with occipital headache, neck pain, fevers, and dysuria for three days. He was diagnosed with a urinary tract infection and [...]
Case Presentation: A 69 year old male with history of Gastro esophageal reflux disease and Billroth type II procedure for peptic ulcer disease, presented to the hospital with sudden onset of abdominal pain, nausea and [...]
Case Presentation: A 25 year old Ethiopian female presented with a four week history of painful genital ulcer, oral lesions and intermittent back pain with dysuria. Ulcer initially started as painless bumps that progressively became [...]
Case Presentation: 66 years old male with past medical history of Hypertension, chronic kidney disease, active smoker and alcohol abuse, presented with two episodes of hemoptysis. Patient was admitted initially with working diagnosis of possible [...]
Case Presentation: 51 year old Caucasian male with history of hyperlipidemia presented with complain of melena. Patient had noticed one episode of bright red blood per rectum. On questioning patient also complained of feeling tired [...]
Case Presentation: A 63 year old man with poorly controlled diabetes presented to his primary care physician with fevers, chills, urinary frequency, and back pain. He was referred to the Emergency Room (ER) for presumed [...]
Case Presentation: A 46 year old male with hypertension and uncontrolled type 2 diabetes mellitus presented with sharp, non-radiating sub sternal chest pain. EKG showed diffuse ST elevations, transthoracic echocardiogram (TTE) showed no abnormalities and [...]
Case Presentation: A 41 year old Hispanic female with history of methylenetetrahydrofolate reductase deficiency and migraines presented with worsening right sided retro-orbital headache, new onset diplopia, right facial numbness and right facial droop. She presented [...]
Case Presentation: A 59-year-old man with end-stage renal disease (ESRD) on hemodialysis presented to the hospital with six days of progressive, symmetric, bilateral, lower extremity weakness and paresthesias, and imbalance. At baseline he could ambulate [...]
Case Presentation: A 50 year-old male with no past medical history presents with 3 months of worsening headache (HA), neck stiffness, photophobia, nausea and vomiting. Patient was evaluated by neurology 2 weeks prior to admission. [...]
Case Presentation: A previously healthy 58 year old male presented with increasing dyspnea for three days. On admission, his heart rate was 110, respiratory rate was 19, and his oxygen saturation was 85% on room [...]
Case Presentation: A 58-year-old African-American woman with multiple sclerosis and history of recent left thalamic stroke presented with six days of generalized weakness and fatigue. One week prior, she was hospitalized for a transient episode [...]
Case Presentation: A 44 year old man with history of obesity and hyperlipidemia presents to the ER with two week history of right ankle pain, found to have acute kidney injury warranting admission. He presented [...]
Case Presentation: A 60 year-old Chinese man with a seven-month history of two ulcerative lesions in the dorsal surfaces of the right forearm and the right fourth proximal interphalangeal (PIP) joint presented with diffuse pruritic [...]
Case Presentation: A 60 year-old Polish woman with stage IV adenocarcinoma of the lung (ALK fusion oncogene positive) on crizotinib, with a recent history of steroid use, presented with one week of malaise. In the [...]
Case Presentation: A 64 years old Chinese female, with background of hypertension and diabetes mellitus, presented with progressive bilateral lower limb weakness over 3 weeks. Examination revealed normal upper limbs, bilateral foot drop and absent [...]
Case Presentation: A 43 year-old gentleman with a history of obesity, hypertension, obstructive sleep apnea, and recently diagnosed stage IV gastric adenocarcinoma treated only with 2000 centigrays of radiotherapy to his stomach one week prior [...]
Case Presentation: A 66 year-old man presented with six months of migratory body aches, slowed walking and twenty-pound weight loss. He had no neurological deficits. Labs showed hemoglobin 10.5 g/dL, creatinine 1.2 mg/dL, and normal [...]
Case Presentation: A 63 year-old woman presented with one-week history of severe neck pain radiating to the left arm, along with two days of weakness and numbness of both upper limbs, left greater than right. [...]
Case Presentation: A 50-year-old physician presented to the emergency department with waxing and waning fevers, chills, and sweats. Nine days prior to presentation he developed a sore throat, fevers, night sweats, and chills, which resolved [...]
Case Presentation: A 23 year old male presented to the emergency department with left sided pleuritic chest pain radiating to the back, mild cough, clear sputum and shortness of breath for 2 days. He had [...]
Case Presentation: A 48 year-old man presented with disorientation, mumbling speech, aggressive behavior, and visual hallucinations. He was healthy until two months prior when he developed hallucinations. He had been given a diagnosis of schizophrenia [...]
Case Presentation: A 49 year old man with stage IIIB colon cancer currently undergoing chemotherapy with 5-fluorouracil and oxaliplatin was referred to the emergency department (ED) for gram negative rod bacteremia. The day prior to [...]
Case Presentation: A 52 yo AA female presented with SOB, cough productive of green sputum and a 12lb weight loss over 3 months. PMH: AIDS (CD4 180), hx pulm TB (treated, yrs ago), DM2, ex-IVDU [...]
Case Presentation: A 32 year old woman presented to the emergency department with a 2 day history of headache, fever, stiff neck, and photophobia. Her past medical history was significant for 5 episodes of [...]
Case Presentation: A 21 year old man presented with severe shortness of breath and hypoxia. He had history of Anti-GBM disease (Goodpasture’s syndrome), living related donor renal transplant, failed renal transplant due to medication non-adherence [...]
Case Presentation: A 59 year-old woman with a history of diabetes presented with one day of right shoulder pain. The pain was sudden, severe, and woke her in the night. She denied recent joint trauma. [...]
Case Presentation: A 47 year-old African American female who presented for routine annual check-up, was found to have abnormal labs; Creatinine(Cr) of 4.7 and Blood urea nitrogen(BUN) of 37. Her creatinine was 0.8, 6 years [...]
Case Presentation: A 44 year-old woman with a history of untreated rheumatoid arthritis (RA) initially presented to an outpatient gynecologist with several days of vaginal discharge and itching, which was diagnosed as bacterial vaginosis. Examination [...]
Case Presentation: A 33-year-old man with history of beta thalassemia major and cirrhosis due to multiple blood transfusions presented with two months of increased frequency of urinary incontinence. He sustained a fall four months ago [...]
Case Presentation: A 61 year-old uncontrolled diabetic complicated by bilateral femoral- femoral bypasses due to peripheral vascular disease presented with intractable left leg pain after a fall. In the Emergency Department, he was noted to [...]
Case Presentation: A 50-year-old man with no prior history presented with one month of progressively worsening shortness of breath, now occurring with minimal exertion. He endorsed nausea and bilious vomiting, but denied hemoptysis, hematemesis, hematochezia, [...]
Case Presentation: A 63 yr old gentleman with a history of ischemic stroke and hypertension presented to the ED from his assisted living center for evaluation of R hip & knee pain. The patient reported [...]
Case Presentation: A 51-year-old man with no prior history presented with a 2-day complaint of right leg pain and swelling. He was undergoing an outpatient work up for a 6-month history of chronic cough and [...]
Case Presentation: A 57-year-old African-American man presented with a pruritic rash and fever for two days. Past history was significant for chronic dermatitis for 9 months that initially involved the head and neck, which was [...]
Case Presentation: A 23 year-old woman with history of acute liver injury three years ago with use of an oral contraceptive pill (OCP) presented complaining of severe generalized itching and diffuse yellow discoloration of her [...]
Case Presentation: A 74-year-old woman with morbid obesity presented with chest pain for three hours. Chest pain was constant, pressure sensation, located in her left chest and accompanied with shortness of breath. Her blood pressure [...]
Case Presentation: A 52-year-old female with history of hypertension and smoking presented with increasing dyspnea for five days. She also reported numbness in her legs and inability to walk for few days. She was cachectic, [...]
Case Presentation: A 56 year-old Hispanic female with a history of asthma, chronic sinusitis, and nasal polyps presents with diarrhea and abdominal pain for 6 months. Patient had previously been admitted twice with a diagnosis [...]
Case Presentation: A 22-year-old male with a history of pancytopenia and peptic ulcer disease presented with one week of fevers, chills, and night sweats and was found to have elevated transaminases and worsening thrombocytopenia. Over [...]
Case Presentation: A 62 year old male with colon carcinoma and liver metastasis presented to emergency department after developing right flank pain while undergoing 6th cycle of oxaliplatin infusion. He was on FOLFOX (Folinic acid, [...]
Case Presentation: A 42 year old female noticed numbness and a tingling sensation over her feet bilaterally. This sensation progressed to involve the entire lower extremities and was accompanied by unsteady gait and weakness over [...]
Case Presentation: A 53 year-old woman with unspecified arthritis presented with recurrent rash. She reported frequent episodes of skin tenderness that escalated to pruritic, ulcerating blisters containing dark fluid and necrotic ecchymoses throughout her extremities [...]
Case Presentation: A 33-year-old Japanese man, with no significant past medical history, presented to our hospital with a two-day history of fever, diarrhoea and diffuse maculopapular rash. Four weeks before, he had taken cefaclor, and [...]
Case Presentation: A 23-year-old previously healthy African-American female presented with one month history of progressive symptoms: first fever, night sweats, sore throat, malaise and body aches; then poor oral intake, severe fatigue, lower abdominal pain [...]
Case Presentation: An 86-year-old male with hypertension, diabetes, and pulmonary tuberculosis on therapy presented to the ED with fever and a rash. He developed an erythematous rash over his body two months prior to admission. [...]
Case Presentation: A 26 year old male with no relevant past medical history, had presented to the hospital after two episodes of syncope with diaphoresis and lightheadedness. On physical examination his blood pressure and pulse [...]
Case Presentation: A 69 year-old man presented with pleuritic chest pain for several hours. Prior to admission he had hiked throughout the northeast United States. Five days prior to presentation he noticed a small, non-painful, [...]
Case Presentation: A 61 year-old man with cryptogenic cirrhosis, type 2 diabetes mellitus, hypertension, and chronic kidney disease presented with worsening abdominal pain for 3 weeks. He had discontinued oral vancomycin two months earlier for [...]
Case Presentation: A 62 year-old native Filipino woman with poorly controlled diabetes mellitus presented with three days of fevers and one day of confusion. Her last visit to the Philippines was 14 years ago. She [...]
Case Presentation: A 28-year-old woman presented with two weeks of fever. She had been healthy until three months prior, when she developed an episodic pink macular rash over her upper arm that gradually spread to [...]
Case Presentation: A 21 year old Spanish-speaking male immigrant from Guatemala with no significant past medical history presented to the emergency department (ED) with nausea, vomiting, neck pain, and vertigo. He was noted to have [...]
Case Presentation: A 37-year-old man presented with 10 days of right flank pain. It was of variable intensity, but never completely went away after onset. He had episodic nausea and vomiting and several episodes of [...]
Case Presentation: A 24-year-old man with no past medical history was brought to the emergency department after being struck in the chest by a post while docking a [...]
Case Presentation: This is the case of a 68-year-old Hispanic woman with a history of hypertension, non-insulin dependent diabetes mellitus and dyslipidemia who presented to the ED with AMS for 1 day. Collateral history from [...]
Case Presentation: A 61-year-old male with traumatic brain injury, paraplegia and HCV cirrhosis presented with hematemesis secondary to esophageal varices. His course was complicated by aspiration pneumonia and Vancomycin, Aztreonam and Metronidazole were started. On [...]
Case Presentation: Coronary artery aneurysms (CAA) are incidental findings during coronary angiography noted during 0.15-4.9% of patients[1]. These are usually a consequence of atherosclerotic coronary disease, the absence of which should raise the suspicion of [...]
Research Topic: Diffuse alveolar hemorrhage is a clinical syndrome resulting from pulmonary capillaritis, bland pulmonary hemorrhage, or diffuse alveolar damage.1 DAH has been reported as a rare adverse event with amiodarone therapy, warfarin therapy, and [...]
Case Presentation: A 56-year-old woman presented with jaundice and abdominal bloatedness, associated with poor appetite for the last 2 weeks. She has a past history of chronic sclerosing sialadenitis, with immunoglobulin G4 (IgG4) predominant lymphoplasmacytic inflitrate [...]
Case Presentation: Dengue fever (DF) presents with a myriad of symptoms. Abdominal pain is uncommon in DF. We report a case of DF presenting as pancreatitis. A 44 year old male presented to our hospital [...]
Case Presentation: A 49 year old male, diagnosed with Human Immunodeficiency Virus infection 6 months ago, and initiated on anti-retroviral therapy (ART); was admitted with 2-day history of fever and cough productive of green sputum. [...]
Case Presentation: A 23-year-old female presented with 7-day history of rash and oral ulcers. The blisters started from the face then spread to neck, left arm and rest of her body. She also complained of [...]
Case Presentation: A 25-year-old African-American man with history of AIDS CD4 79 and partially treated cryptococcal meningitis presented with headache and blurred vision. Physical exam demonstrated bilateral cranial nerve six palsies. CT head on arrival [...]
Case Presentation: A 19-year-old African-American woman with history of neonatal meningitis with baseline mental retardation, left hemiparesis and seizure disorder presented with altered mental status, decreased responsiveness, new right hemiparesis and aphasia. Brain and spine [...]
Case Presentation: A 54 year old man with Hepatitis C without cirrhosis, complicated by porphyria cutanea tarda (PCT), presented with painful bruising and swelling of his legs and arms. There was no inciting trauma, he [...]
Case Presentation: A 66-year-old Hispanic male with hypertension presented with slurred speech, dizziness and blurred vision. One day prior to admission, he was diagnosed with gout, involving his right toe and started on indomethacin 50 mg [...]
Case Presentation: A 70 year old man with lung cancer presented from home to the emergency department after a bout of massive hematemesis. Four months ago, he was diagnosed with lung cancer spreading to mediastinal [...]
Case Presentation: A 47year old Caucasian man came to the emergency room with of fever, severe headaches, severe body aches and pain for 4days. Headaches worsened and he developed photophobia on day 5. He was taking Bactrim [...]
Case Presentation: A 69year old Caucasian female who presented to the emergency room after 3 weeks of diarrhea preceded by constipation and 1 weeks of abdominal pain. Abdominal pain was severe colicky and generalized, with [...]
Case Presentation: A 26 year old man without significant medical history presented on October 10, 2014 with 24 hours of severe abdominal pain. He was found to have severe pancreatitis with multiorgan failure requiring [...]
Case Presentation: A 69 years old male with past medical history of C5-C6 quadriplegia and atrial fibrillation presented to clinic complaining of left temporal area discomfort for 2 weeks associated with visual alteration. He denied [...]
Case Presentation: A 53 year old gentleman presented to the emergency department with acute left arm weakness and altered mental status with difficulty with memory and performing activities of daily living. His past medical history [...]
Case Presentation: A 23-year-old male with schizoaffective disorder was admitted to the psychiatry service with acute psychosis and treated with clozapine. Low-grade fever developed after 23 days, prompting medical consultation. He reported chest discomfort [...]
Case Presentation: A 61-year-old woman with a 9-month history of an asymptomatic parathyroid nodule presented to the hospital with three weeks of malaise, constipation, unsteady gait, and confusion. Over the three weeks, she described how [...]
Case Presentation: A 78 year old man presented with right upper quadrant abdominal pain to the emergency department. He had no signs of acute abdomen. Labs were significant for low platelet count, elevated alkaline phosphatase. [...]
Case Presentation: An 89-year-old woman with history of hypothyroidism, hyponatremia, and hypertension presented with unresponsiveness and myoclonic jerking of the lower extremities. At baseline, she was alert and oriented to person, place and time, and [...]
Case Presentation: A 20 year old woman presented with a 5 day history of a right sided abnormal facial sensation and a 1 day history of right hand ataxia. She described the right side of [...]
Case Presentation: The patient is a 63-year-old male with history of colon cancer (status post resection, on adjuvant capecitabine/oxaliplatin chemotherapy) who presented with chest pain and inferolateral ST segment elevations on his EKG. The chest [...]
Case Presentation: A 78 year old man presented with neck pain, fever, and malaise for 3 days. He noted progressively worsening pain and stiffness of the anterior neck bilaterally. He reported right- sided headache and [...]
Case Presentation: A 57 year old female presented to our institution for evaluation of progressive dyspnea. Symptoms were present for three months prior to presentation. She was seen in the emergency department and initial laboratories [...]
Case Presentation: An 82-year-old woman with dementia, right eye blindness, prior right retinal surgery, atrial fibrillation, and prior stroke presented to an outside hospital with a six-month history of weakness, confusion, ataxia, and falls. A [...]
Case Presentation: A 53-year-old man presented with nine months of abdominal pain, nausea, constipation, dizziness and syncope with standing, weight loss, and edema. He had anasarca, persistent orthostatic hypotension, anemia, hypoalbuminemia, and nephrotic-range proteinuria. BNP [...]
Case Presentation: A 51-year-old man with a past medical history of diabetes mellitus, polysubstance abuse, chronic kidney disease stage 3a and major depressive disorder presented to a Texas hospital after a suicide attempt using liquid [...]
Case Presentation: 65 year-old woman with a history of essential thrombocythemia presents with four months of left upper quadrant abdominal pain. The patient was admitted to an outside hospital two weeks prior to the current [...]
A case of wegner with C-ANCA, anti GBM+ with preserved kidney function in a 22 year old Case Presentation: 22 years old male, Jehovah's witness with no past medical history. He was in a normal [...]
Case Presentation: A 67-year-old man with a history of type 2 diabetes and hypertension was referred to our hospital for evaluation of persistent hiccups and fever. The patient developed hiccups seven days before the admission, [...]
Case Presentation: A 57 year old female presented to the ER with complaints of worsening dyspnea for three weeks. Immediate arterial blood gas revealed: pH 7.26 PO2 79.5 PCO2 55 HCO3 30.5 with Sa02 87% on 6L O2. There was [...]
Case Presentation: A 53 year old female presented to the ER complaining of one month of progressive lower back pain with radiation to her right leg, and associated severe bilateral tight hamstrings. The patient was unable [...]
Case Presentation: A 78 year- old female was admitted with progressive rash. The rash began as a pruritic eruption in between her fingers one month ago. Her primary care physician advised her to use moisturizing [...]
Case Presentation: A 41-year-old super morbidly obese man (245.4 kg, BMI= 82 kg/m2) presented to the emergency room 9 days after laparoscopic sleeve gastrectomy complaining of sudden dyspnea, dry cough, palpitations, and painful left lower [...]
Case Presentation: Patient is a previously healthy 11-year old Hispanic female who presented to an emergency department with altered mental status, opus-myoclonus movements, aphasia, hallucinations and slurred speech. Six weeks prior to presentation, patient had [...]
Case Presentation: A 12-year-old girl presented with restrictive eating, weight loss (BMI 12.17 kg/m2; -4.10 SD), and orthostatic hypotension. She was admitted to a tertiary referral children’s hospital and placed on an eating disorder protocol [...]
Case Presentation: A 16-year-old male presented with a petechial rash and paresthesias for three weeks. Three weeks prior, he developed a petechial rash on the lateral aspects of both feet that progressively spread to the [...]
Case Presentation: A five year old Hispanic female presented with a five day history of high grade fevers and generalized rash. She also had bilateral anterior and posterior cervical [...]
Case Presentation: A 4 y.o. African American male presented with headache x 4 days and decreased level of consciousness. He was very sleepy with decreased po intake, sore throat, photophobia, loss of balance, and weakness. [...]
Case Presentation: A 21 mo old female with respiratory distress and decreased fluid intake for 3 days presented to our pediatric ED. She was previously healthy, no fever, cough, or wheeze. Upon initial exam she [...]
Case Presentation: The patient is a 16 year old male who presented with 6 days of fever, nausea, vomiting, and diarrhea, 2 days of headache and neck pain, and 1 day of dysuria. He [...]
Case Presentation: We report a 14 year old boy who presented with acute pharyngitis, complicated with multifocal pneumonia and an epidural abscess collection with bilateral frontal and sphenoidal sinus abscesses. He did not have any [...]
Case Presentation: We report a 12 year old girl who presented with a burning rash on the left forearm for 2 hours. The child noticed an insidious burning sensation and saw redness of the skin [...]
Case Presentation: A 15 year-old boy presented to a referring facility with right lower extremity weakness, numbness and urinary retention following a spider bite. The weakness subsequently spread to the contralateral leg with ascending numbness [...]
Case Presentation: A 3 year old girl with no significant past medical history presented with fever of unknown origin (FUO). Ten days prior to hospital presentation she began having daily fevers with mild URI symptoms. [...]
Case Presentation: A 10 year old boy presented to an outside Emergency department with increased seizure activity. The boy was a recent immigrant from Guatemala. Additional history revealed that the boy was born in the [...]
Case Presentation: RM is a 7-year-old African American male seen twice in 2 days in the emergency department. He had a 3 day history of fever to 39.7°C, right neck pain and swelling, vomiting, and [...]
Case Presentation: A 14yo female presented with fever, altered mental status and seizure. Her primary care provider had seen her several times in the preceding two months with complaints of chronic cough and headaches. In [...]
Case Presentation: A 16 year old, otherwise healthy female presented with five days of intermittent fever, progressive neck pain and swelling. Prior to admission, she had been seen by her primary care physician and started [...]
Case Presentation: A 15-year-old boy was transferred to the hospital with a 10 month history of a left cervical mass and 6 months of right calf swelling. The neck mass appeared after the patient sustained [...]
Case Presentation: A 13 y/o female presented with a 1 month history of painless left inguinal swelling and a 2 day history of worsening inguinal pain, diffuse pruritis, myalgias and fever. On presentation she was [...]
Case Presentation: A 17 year old female presented with 4 days of worsening epigastric pain, persistent bilious emesis, one episode of diarrhea, anorexia and fever for two days. Initial examination revealed an ill appearing, tachycardic [...]
Case Presentation: AR is a 3-week-old full term, previously healthy girl, who presented to the Emergency Department (ED) with a rash involving the perianal skin and gluteal crease. The rash began at 1 week of [...]
Case Presentation: A 12-year-old male presented with right-sided headache for 5 weeks described as constant, throbbing, and radiating to his neck, waking him from sleep. There was a reported 11 pound weight loss and right-sided [...]
Case Presentation: A 5-year-old previously healthy boy was referred from his new primary care provider for hospital admission after presenting with 8 months of progressive weight loss and 2 months of new-onset torticollis. He had recently [...]
Case Presentation: An 8 year old girl with no past medical history presented to the emergency department with sore throat, fever and nonspecific neck pain that was initially diagnosed as viral pharyngitis. Recurrent episodes of [...]
Case Presentation: A 5 month old girl presented with 5 day history of fever and swelling of the right side of her neck. Physical examination denoted a febrile, well appearing infant with a 3cm X [...]
Case Presentation: A 13-year-old female was admitted for hyponatremia in the setting of unremitting bilious emesis. Within one week, her sodium level decreased from 131 mmol/L to 116 mmol/L. In addition to vomiting, she complained [...]
Case Presentation: A 3 hour old male infant born via spontaneous vaginal delivery at 39 weeks gestational age presented due to an enlarged scrotum and associated skin lesion. Maternal medical history was significant for a [...]
Case Presentation: A 9 year old male presented to the emergency department (ED) with a 3 day history of fever to 103°F, sore throat, and decreased oral intake due to throat pain. On the day [...]
Case Presentation: A 13 year old female presents with 2 months of progressive right neck swelling, right ear pain, and fatigue. Two months prior to presentation, she hit her right side of the neck on [...]
Case Presentation: A 12 month old female was admitted with 8 days of intermittent fever and rash; she had also developed bilateral hand swelling the day of admission. She had marked elevations in her WBC [...]
Case Presentation: An 8 year old previously healthy Hispanic boy was admitted with a prolonged history of fever for about 14 days with vague right upper quadrant abdominal pain. He had been seen at an [...]
Case Presentation: An 11-year-old girl presented to the Emergency Department with one week history of sore throat, 3 days of abdominal pain, headache, diarrhea and increasing dizziness over the last day. She had been seen [...]
Case Presentation: A 6-day old male newborn was transferred to our institution for evaluation of conjugated hyperbilirubinemia. Examination was significant for jaundice and hepatomegaly. All anthropometric measurements plotted at the 3rd percentiles. He was born [...]
Case Presentation: A 14 year-old male with Shone Complex and a history of a pulmonary valve replacement presented with 3 months of nausea and vomiting, a 45-pound weight loss, and fatigue. He endorsed night sweats, [...]
Case Presentation: A 6-year-old girl with spina bifida, chiari II malformation, and shunted hydrocephalus presented with persistent discomfort of the left leg and one day of knee swelling. She has had intermittent bilateral leg pain after [...]
Case Presentation: A 7-year-old boy with moderate persistent asthma presented with increased lethargy, poor oral intake, and two days of emesis with hematemesis noted on day of admission. His pediatrician recently noted pallor and started [...]
Case Presentation: A 3 month old, former term male with a history of NICU admission for persistent pulmonary hypertension and SVT, presents to our emergency room with new-onset bulging fontanelle. Mother noticed this persistent “bump” [...]
Case Presentation: A 16 year old female with a history of bipolar disorder presented with worsening fatigue and acute on chronic menorrhagia. Over the past 4 to 6 weeks, her periods were regular, but with [...]
Case Presentation: A 17 year-old boy presented with 5 days of left arm pain. He was visiting relatives in Texas when symptoms began. Pain began abruptly, waking him while he was sleeping on the floor. [...]
SHM Clinical Abstract‘She’s Just Not That Interested’Case Presentation: Patient is a previously healthy 7-week old Hispanic female who presented to an emergency department with cough, congestion and decreased PO intake x 7 days. Baby had [...]
Case Presentation: A four month-old boy presented with abdominal distension. His parents had noted increasing abdominal size over several weeks. They also reported a diaper rash for two months and nasal congestion for one month. [...]
Case Presentation: A 13-year-old male with a history of Graves' disease was admitted with 24 hours of vomiting and diarrhea. The patient awoke at 4:30 AM on the day prior to admission with non-bloody, non-bilious [...]
Case Presentation: Unstable hemoglobins occasionally occur as de novo mutations, often causing diagnostic dilemmas[1-3]. We herein present the 18th case and only the second recorded male case of Hemoglobin Hammersmith (HbHS)[4]. A 14-year-old Caucasian male [...]
Case Presentation: A 3 month old male was referred to the ED by his PMD for failure to thrive (FTT), reflux and noisy breathing with feeds. He was the term product of a normal pregnancy [...]
Case Presentation: A 10-year-old male from China with prior history of a presumed parasitic infection was admitted for abdominal pain, vomiting, and diarrhea. Ten days prior to admission, he traveled to the United States and [...]
Case Presentation: A 5 year old boy from Saudi Arabia without past medical history presented with 3 months of fevers, weight loss, and a large abdominal mass. 3 months prior to presentation, while living in [...]
Case Presentation: An 8 week old female born 33 4/7 weeks was referred by her primary care provider (PCP) for evaluation of failure to thrive (FTT). At birth, she required a 2 week NICU stay [...]
Case Presentation: A 15 year old male presented to the ED after being found unresponsive in his yard. He had defecated, urinated, and had suspected seizure activity. Initial assessment revealed altered mental status, normotension, excessive [...]
Case Presentation: A 10-year-old Hispanic girl with a history of UTIs presented to our ED with seven days of facial rash and dysuria. She had been taking cephalexin for an E. coli UTI as prescribed [...]
Background: Many hospitals have tried to improve their medication reconciliation processes, with mixed results. Currently, there are insufficient data to guide hospitals in the best ways to improve their practices. In the Multi-Center Medication Reconciliation [...]
Background: Routine preoperative coagulation tests continue to be ordered despite the lack of evidence supporting their use or ability to predict bleeding complications. This may delay surgery, cause unnecessary concern if "abnormal", and increase cost. [...]
Background: Emergency department (ED) crowding is a widespread national issue which has been shown to negatively impact patient experience and the quality and safety of care delivery. A community hospital within our academic health system [...]
Background: Successful inpatient glycemic control programs achieve both improved glycemic control and low rates of hypoglycemia. Using results from the analysis of performance in glycemic control and hypoglycemia, we identified top performers and those demonstrating [...]
Background: Both the ACP through its High Value, Cost-Conscious Care Initiative, and the ABIM through its Choosing Wisely campaign, have called on clinicians to engage in efforts to improve the value of the care we [...]
Background: Pediatric obesity is a major public health and economic burden in the US. Recent reports suggest a possible crest in the pediatric obesity epidemic. Many researchers have focused on childhood obesity epidemic and comorbidities [...]
Background: Efficiently improving transitions in care requires hospitals to target discharge interventions at those patients at high risk of potentially avoidable readmission (PAR). We previously derived the “HOSPITAL” score, an easy to use prediction model [...]
Background: Ward rounds at our hospital traditionally have been performed by a team of physicians and medical students outside of patients’ rooms, with minimal involvement of nursing staff and limited time spent with patients. As [...]
Background: As a requirement of the Affordable Care Act, the Center for Medicare and Medicaid Services (CMS) established the Hospital Readmissions Reduction Program (HRRP) and started reduced payments to hospitals with excess 30-day readmissions on [...]
Background: There is little evidence that systemic improvements in hospital quality, safety, and cost of care have occurred in the U.S over the last 15 years despite calls to action and intense local efforts.1,2 [...]
Background: Hospitalization identifies patients who are particularly costly to the Medicare system and current policy efforts to reduce costs focus on the 30 days after discharge; however, much less is known about which patients will [...]
Background: Caring for patients involves multitudes of moving parts – from teams of physicians, nurses and radiologists to tests, medications and an array of electronic health record (EHR) systems. However, as medical care has evolved, [...]
Background: Previous research has explored the impact of delayed ICU transfer on patient outcomes, but the subjective nature in defining onset of critical illness in many of these studies has made it difficult to accurately [...]
Background: As part of the ABIM Choosing Wisely initiative, the Society of Hospital Medicine has emphasized repetitive complete blood count (CBC) and chemistry testing among its top 5 practices that physicians and patients should question. [...]
Background: Beginning January 1, 2014, under the Affordable Care Act (ACA), 28 states expanded Medicaid eligibility to include additional low-income individuals aged 19-65 years. As a result, an estimated 10.5 million low-income Americans newly gained [...]
Background: To maximize its effectiveness, performance feedback must be personalized, accurate, timely, and visually appealing. In the clinical environment, effective feedback must therefore extract accurate data from an electronic health-record system, link patient care activity [...]
Background: A recent nationwide recall for large glass evacuated containers has led to new innovations performing large volume paracentesis (LVP). Compared to the individually manufactured evacuated containers traditionally used in the past, wall suction systems [...]
Background: Acute upper GI bleed (UGIB) is a major cause of hospital admissions, with peptic ulcers being the most common cause. In addition to pre-endoscopic PPI and urgent endoscopic intervention, current consensus guidelines recommend intensive [...]
Background: Structured interdisciplinary rounds improve communication between healthcare team members, improve patient safety, decrease costs and improve length of stay. The impact of interdisciplinary rounds on patient satisfaction is less clear. Our patient experience scores [...]
Background: The general medicine service at the Hospital of the University of Pennsylvania has recently undergone a significant restructuring with the addition of new teams and redesign of rounding workflow. Bedside interdisciplinary rounds now include [...]
Background: Code status discussions can be an almost daily occurrence for residents in the hospital. Published literature supports the fact that residents are lacking in knowledge and confidence in having these crucial discussions. Medical students [...]
Background: A precursor to improving patient-centered communication is accurate and reliable identification of all the members of the care team. Providers must quickly identify other providers caring for specific patients, and increasingly patients and [...]
Background: The impact of hospitalists on the patient experience has gained attention with the advent of the HCAHPS survey. Hospitalists face multiple challenges in establishing quick rapport with new, acutely ill patients, possibly amplified in [...]
Background: A fundamental aspect of patient care is the therapeutic relationship between the patient and his or her healthcare team. Previous studies have shown that many physicians fail to introduce themselves when meeting patients and [...]
Background: In order to deliver patient-centered care, healthcare organizations are focusing heavily on efforts to engage patients and caregivers. Fundamental to this effort is involving patients in establishing the primary goal for recovery after hospitalization. [...]
Background: Hospitalized patients frequently relate that they feel poorly informed about their treatment, which may contribute to lower patient satisfaction scores. Whiteboards placed in the patients rooms may facilitate communication between healthcare providers and patients. [...]
Background: Hospitalized patients are visited by numerous health care professionals daily and are often unable to identify the attending physician who is in charge of their care. Methods: We asked alert and oriented patients on [...]
Background: Patients with limited English proficiency (LEP) report greater satisfaction when professional interpreters are used as compared with ad-hoc (family members or friends) or no interpreters in the ambulatory setting, but the impact of professional [...]
Background: Effective communication between providers and patients in the hospital is essential for high-quality care. Communication quality metrics, including HCAHPS scores, are increasingly tied to hospital reimbursement, and public reporting of these metrics has raised [...]
Background: According to the 2003 National Assessment of Adult Literacy 88% of adults do not have the health literacy skills needed to adequately manage their own health care. Low health literacy is associated with poorer [...]
Background: Educating and empowering patients to actively participate in their own care through shared decision-making (SDM) can improve patient satisfaction as well as health outcomes. Prior work has led to the development and validation of [...]
Background: Health care teams provide patients and families with large amounts of written information during their hospitalization. This includes discharge information that is often provided immediately prior to discharge leaving patients and families with insufficient [...]
Background: Failures in communication among healthcare personnel are known threats to patient safety. Inpatient medical units are particularly vulnerable to ineffective communication given the varied work structure of each care team member. The goal of [...]
Background: Under Medicare Value Based Purchasing incentives, patient satisfaction scores comprise about one-third of a hospital’s total performance score. Standard patient satisfaction assessment instruments, such as the Hospital Consumer Assessment of Healthcare Providers and Systems [...]
Background: Shared decision-making (SDM) improves patient engagement and health care outcomes. Evidence indicates that patients are both willing and able to engage in SDM with their providers. Despite the demonstrated value of SDM across disciplines, [...]
Background: High-quality communication between physicians and patients is necessary to provide effective care. Hospital settings present unique challenges to the patient-physician relationship, including numerous dynamic care teams and fast pace of clinical care. A substantial [...]
Background: Caring for patients in the hospital requires the efforts of many physicians, with multiple handoffs. Several studies have highlighted that most inpatients are unable to identify the physician(s) responsible for their care, which may [...]
Background: Numerous studies have shown that hospitalists may spend as little as 12-17% of their time at the patient bedside. In contrast, hospitalists may spend between 64-69% of their time engaged in indirect patient care [...]
Background: It is recommended that hospitalized patients understand and know who is in charge of their care. Yet the complex system of physician teams in academic teaching hospitals may interfere with current recommendations that patients [...]
Background: Due to their higher incidence of pre-existing medical conditions, a growing number of older trauma patients require increased involvement of medical providers. Trauma patients most often are admitted by a trauma surgeon or surgical [...]
Background: The Society of Hospital Medicine considers perioperative medicine a core competency in hospital medicine. It also challenges hospitalists to lead, coordinate, and participate in multidisciplinary efforts to improve perioperative care within their organizations. Hospitalist [...]
Background: There are few procedures which internal medicine residents must be able to perform competently to become ABIM certified. However, residents are concerned that the elimination of these requirements may have affected their procedural training and [...]
Background: The United States spends more on healthcare than other nations but often has worse outcomes.1,2 Healthcare costs place a substantial burden on American families and are a leading cause of bankruptcy.3 Patient access to healthcare [...]
Background: Studies show that family centered rounds (FCR) improve family satisfaction by involving the families in their children’s care (Pediatrics, 2003). Medical students consistently find FCR beneficial to families but have differing attitudes regarding benefits [...]
Background: As the racial/ethnic diversity of the US population continues to increase, the proportion of patients with limited English proficiency (LEP) expands. Language barriers can pose as a significant obstacle to receiving high-quality health care [...]
Background: The transition out of the hospital is a vulnerable time for patients and families and is ripe for physician training. We implemented a discharge curriculum focusing on the competence of a ‘Safe and Effective [...]
Background: The Liaison Committee on Medical Education (LCME) developed a recent accreditation standard requiring medical schools “must prepare medical students to function collaboratively on health care teams that include health professionals from other disciplines as [...]
Background: Hospitalized patients are consented for procedures on a daily basis, and obtaining informed consent is a core competency in professionalism and medical ethics for hospitalists. This provides an opportunity for academic hospitalists to evaluate [...]
Background: While studies have shown that physicians are limited in their ability to accurately self-assess, many continue to believe that they have reasonably good insight into their own capacity and performance. Because of this incongruence, [...]
Background: Safe and effective coordination of care within and across health care delivery systems is a national patient safety priority and an important competency for Internal Medicine residents. Residents are expected to work in teams [...]
Background: Medicare patients account for over 50% of hospital days and over 30% of all hospital discharges in the United States. The number of healthcare providers with specialized geriatric training dedicated to the care of [...]
Background: Increased scrutiny of length of stay (LOS) and readmission rates has led to a changing landscape for hospital medicine. Geographic rounding has been studied in academic settings with good results, including a decrease in [...]
Background: In many teaching hospitals, internal medicine residents participate in a majority of patient interactions. However, the impact of trainees on patient satisfaction and the care experience is unknown. We sought to determine how resident [...]
Background: Continuity of care—one provider caring for an individual patient throughout an episode of care—is a highly valued ideal in healthcare. However with the complexity of inpatient care involving hospitalists, consultants, and trainees, it is [...]
Background: HCAHPS is a nationally standardized, publically reported survey of patients' perspective of healthcare. However, the effect of HCAHPS reporting on hospitals with baseline low versus baseline high patient satisfaction with physicians has not been [...]
Background: Provider etiquette behaviors at the bedside may be important determinants of patient satisfaction. However, the degree to which providers are able to assess their own etiquette-based behaviors and the degree to which these self-assessed [...]
Background: Patients are often kept fasting by nil per os (NPO) orders during hospitalization. This practice may lead to patient dissatisfaction or affect their nutrition status. However, the prevalence and appropriateness of these orders are [...]
Background: A 42 year old male with know stage IV rhabdomyosarcoma of the neck presented to the ED from subacute rehab with severe dyspnea. He had already undergone chemotherapy and radiation therapy, and had planned [...]
Background: Recent studies have called into question the net efficacy of post arrest hypothermia therapy to 33°C. To better understand the risks of hypothermia to 33°C, we specifically focused on the clinical complications of such [...]
Background: Hospital length of stay (LOS) is an important indicator of the quality, safety, efficiency, and cost of inpatient care. Hospitalists are often charged with identifying the root causes for excess LOS in order to [...]
Background: Hospitalizations are disruptive, stressful, and costly for patients and families. Readmissions are costly for payers. Readmissions within 30 days occur in 13% of pediatric hospitalizations; prior studies estimate 30-day unplanned readmission rates to children’s [...]
Background: Christiana Care’s medicine service line previously implemented Interdisciplinary Admission (IDA) and Inter Disciplinary Rounding (IDR) to enhance team-based care of our patients. IDA included an admissions team comprised of attending physician, nurse, pharmacist, case [...]
Background: Social and environmental factors negatively affect the healthcare of low-income, vulnerable populations. Such determinants of health are often manifested as unmet basic needs that may be remedied through legal mediation, most commonly regarding housing, [...]
Background: MRSA osteomyelitis in adults is a challenging disease to treat with a high rate of amputation. Patients often undergo prolonged antibiotic therapy and multiple debridements with varied success. In our study, we examine outcomes [...]
Background: Compared to warfarin, the new target-specific oral anticoagulant rivaroxaban may have advantages in treating patients with venous thromboembolism because injectable bridging therapy and routine laboratory monitoring are not required. The objective of this study [...]
Background: Continuity of care and good doctor-patient relationships are valued by patients and may improve outcomes. The Comprehensive Care Program (CCP) is a care delivery model in which physicians focus their practice on caring for [...]
Background: Pain management is an important part of patient satisfaction. We set out to apply the A3 approach in our hospital to improve our patient’s perception of pain control. The A3 LEAN method, derived from [...]
Background: Patients with dementia are more likely to be hospitalized as compared to those without dementia. Once hospitalized this population has a higher rate of developing complications such as delirium and falls, often leading [...]
Background: Current guidelines recommend transfusing red blood cells in hospitalized patients at “restrictive” hemoglobin (Hb) concentrations and for symptoms of anemia. However, there is little data on how the symptoms of anemia, specifically fatigue, are [...]
Background: Calcification and inflammation have been shown to have a prominent role in the progression of Aortic Stenosis (AS). Experimental data from patients suggest that bisphosphonates (BPT) may limit vascular and valvular calcifications. However, studies [...]
Background: New onset fever is a common symptom among hospitalized patients and it may be a manifestation of fatal illnesses such as infection. However, its epidemiology and predictors for mortality have not been determined in [...]
Background: Contact precautions have been reported to decrease healthcare worker visits and increase the number of medical harms. Contact precautions may also lead to increased adverse events. Our objective was to determine the association between [...]
Background: Healthcare-associated infections (HAIs) are estimated to affect 1 in every 25 patients admitted to an acute care hospital in the United States. Despite the major consequences associated with HAIs, suboptimal adherence to hand hygiene [...]
Background: Hospitalized medical patients who are at risk for venous thromboembolism (VTE) require pharmacologic prophylaxis. However, patients often refuse the administration of the prophylactic anticoagulant. The primary objective of our study was to determine if [...]
Background: The American Academy of Pediatrics (AAP) published updated guidelines for safe sleep environments for infants in 2001. The guidelines note that parents who observe unsafe sleep practices performed by a healthcare provider are significantly [...]
Background: Recognizing that residents are at the forefront of patient care, New York- Presbyterian Hospital/Weil Cornell Medical Center developed the Housestaff Quality Council in 2008 to facilitate resident involvement in hospital wide patient care and [...]
Background: Falls among hospitalized patients are common, difficult to prevent, and potentially harmful. Each year between 700,000 and 1 million falls occur among patients at US hospitals. In the past three years, our large urban [...]
Background: Compassionate extubation is the withdrawal of mechanical ventilation at end of life (EOL) ensuring a comfortable and peaceful experience for the patient and family. EOL care encompasses instances when a decision is made to [...]
Background: Many hospitalized children have ongoing social stressors and strains. Universal routine social screening is often impractical in clinical practice; however, information on where a child resides is universally available. We sought to determine the [...]
Background: Family Centered Rounds (FCR) is recommended by the American Academy of Pediatrics as a process for improving communication between the health care team and families, increasing efficiency of rounds, providing a positive learning environment [...]
Background: We have an obligation as a healthcare system to eliminate irrelevant, expensive, and painful procedures if they do not change our clinical management. Previous research demonstrated a lack of evidence in the utility and [...]
Background: Rapid, frequent handoffs between multiple parties within the peri-operative unit pose communication challenges for patients and their healthcare providers. Miscommunication creates a suboptimal patient experience and can compromise patient safety and quality of care. [...]
Background: Increasing cost is one of the biggest challenges for present day health care systems. Standardized admission processes help in reducing length of stay (LoS) which in turn can reduce health care cost significantly. We [...]
Background: Increasing emphasis has been placed on teaching medical residents the importance of cost conscious management while maintaining the focus on patient centered care. Classroom lectures on performance improvement methods are often dry and rarely [...]
Background: Despite the efforts of many projects and the creation of internal benchmarks, data suggest that delays in patient discharges continue to negatively affect patient throughput in many hospitals. Lean six sigma has been shown to improve [...]
Background: Many patients admitted to hospitals develop hospitalization-associated disability, or the loss of the independence in performing one or more activities of daily living during a hospitalization and it is well-known that restricted mobility during [...]
Background: Patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are at high risk for readmission. In September 2012, a COPD longitudinal inpatient pathway and transition (CLIPT) was implemented at a 552-bed academic [...]
Background: Common labs such as a daily complete blood count (CBC) or a daily basic metabolic panel (BMP) represent possible waste and have been targeted by professional societies and the Choosing Wisely campaign for critical [...]
Background: The current discharge process to skilled nursing facilities (SNF) from our hospital lacks standardization which results in longer length of stay (LOS), wasting hospital resources, exposing