Thank you to our PD emeritus Dr. Marshall Wolf & @tmmeade1 for kicking off the week with a case of syncope yesterday!
The 💰 is in the 🗣️! 1. Is this true syncope? Transient LOC + spontaneous and rapid recovery 2. How worried 😱 are you for 💔 etiology? Any ❤️ disease, new chest pain/palpitations, exertional or supine syncope, FHx sudden cardiac death, abnormal VS or ECG should set off 🚨
...May be reassured by syncope stable x years, with clear prodrome & trigger, in a younger individual (<40 y/o)
🤔 In thinking about worrisome etiologies, recurrent syncope less likely to be tamponade, dissection, ACS, PE but arrhythmia🔌💓 still on the table!
#TheBrighamFamily looooooooves a good TTE!
But consider ROMEO score (shout out to @tony_breu and @thecurbsiders) - a score of zero 99.5% sensitive for a normal TTE, so may not be needed in all comers with syncope!
In this case, our patient had recurrent syncope and recent event monitor:
Dropped beats concerning for Mobitz I vs. II - 2:1 block makes it challenging to distinguish!
While Mobitz II confers worse prognosis and ⬆️ progression to CHB, symptoms/syncope + 2nd degree block = class 1 PPM indication!
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Can't miss noon conference with Dr. Loscalzo! Yesterday we tackled a case of cardiac arrest 💔 in a ♀️ with a history of heart transplant.
Our patient had been transplanted for LMNA mutation
🩺 Most common genetic cause of familial DCM
Can present with or without 💪 muscular dystrophy
💟 Conduction disease typically precedes DCM, and pts often need PPM or ICD
Timing from transplant, host and donor factors can help to shape your ddx 🤔
So many great ID 💎💎💎 with @dsolsMD at morning report today, discussing a case of preseptal cellulitis + parotitis!
🦠Staph aureus, Strep sp, and anaerobes 🦠 implicated!
Preseptal cellulitis - infection anterior to orbital septum - can be differentiated from orbital cellulitis by pain with EOM 👀🙄 due to inflammation of extra ocular muscles and fatty tissue.
When contemplating 💊: 1. who is the host? Not as simple as immunocompromised 😷 or not. Consider "area under curve" - total lifetime exposure to immune suppressing medications or conditions.
Can't beat starting the day with morning report with APD Dr. @MariaYialamas! Today we delved into the world of ♀️ health with a case of amenorrhea!
In generating your ddx, common causes along the HPO axis include functional amenorrhea (due to any physical or emotional stress 😬), elevated prolactin, and PCOS.
Don't forget to include structural causes - mainly adhesions due to prior D&C
Exam pearl alert 🚨: rapid onset hirsutism, hair growth on back or upper abdomen, clitoromegaly ➡️ androgen secreting malignancy > PCOS.
Thanks to Dr. Carolyn Becker for a great discussion of ⭐️surprise!⭐️ osteoporosis 2/2 asymptomatic primary hyperparathyroidism!
There are MANY 2ndary causes of osteoporosis- use hx 🔎 to tailor work up. All comers get:
🧑🔬 BMP - Cr (CKD), Ca/Phos (⬆️⬇️parathyroid)
🧑🔬 LFTs - AST/ALT/bili (cirrhosis), ALP (bone turnover), albumin (nutrit. status)
🩸CBC - anemia ➡️ inflam, malabsorb
🦴 25 OH Vit D
In evaluation of hypercalcemia, PTH shapes your ddx!
🦴Inappropriately nl or ⬆️, ➡️ use urine Ca to distinguish from Fam Hypocalciuric Hypercalcemia
🦴Low PTH then can move on to more extensive work up - problems with AB or REsorption of Ca++