1/10 #Morningreport recently
@SinaiBmoreIMRes by S. Sridhar recently featured a pt with a 3 week history of generalized pruritic rash
#DDx ?
#MedTwitter #MedStudentTwitter #FOAMed Image
2/10 The rash was insidious in onset, initially involving extremities and progressed to involve rest of the body, sparing face, palms, and soles.
Reports ~40 lb unintentional weight loss in previous 4-5 months.
Ddx for this rash would be :
emedicalhub.com/maculopapular-… Image
3/10
Vital Signs: T-36.2, HR-92, RR-16, BP-109/75​
Physical Exam:​
Diffuse, erythematous, macular rash involving majority of bilateral upper and lower extremities, anterior and posterior trunk and abdomen. ​
Left occipital LN 1cm +. Rest of the examination was normal
4/10
Data: Image
5/10
The rash appeared similar to below:
dermnetnz.org/assets/Uploads… Image
6/10
Dermatology ➡️ onset of symptoms was within a few days of initiation of allopurinol, 🚫 facial edema, DRESS was considered unlikely.
Reaction thought to be a simple drug reaction/Morbilliform rash.
Prednisone 40 mg Qday started X 5 days and resolution was achieved.
7/10
Morbilliform drug eruption is the most common form of drug eruption. Many drugs can trigger this allergic reaction, but antibiotics are the most common group. The eruption may resemble exanthems caused by viral and bacterial infections. Image
8/10 Dress/DIHS Teaching points: Image
9/10
Remember to use the scoring system for DRESS: RegiSCAR
ncbi.nlm.nih.gov/pmc/articles/P… Image
10/10
In summary : ImageImage

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More from @SinaiBmoreIMRes

Oct 18, 2022
1/6
#Morningreport recently @SinaiBmoreIMRes
featured an interesting case by Paul Stendahl Dy
A young pt presenting with right sided CP, dyspnea s/p MVA and recent dx of necrotizing PNA,
DDx ???
#MedTwitter #Medstudenttwitter @SinaiChiefs Image
2/6
Vital signs:
T 37.8 P 117 BP 125/71 SPO2 94 % on RA
Exam:
Chest- decreased BS right lower side.
WBC: 15 https://slideplayer.com/sli...
3/6 Imaging:
CXR: (image from internet) https://www.researchgate.ne...
Read 6 tweets
Jul 26, 2022
1/9
#Morningreport this week @SinaiBmoreIMRes
featured an interesting case by N. walia
A young Pt presenting with pancreatitis - develops complaints of "bilateral vision loss with progressively worsening headaches "
DDx ???
#MedTwitter #Medstudenttwitter Image
2/9
BP noted to be: BP: 207/117
Exam:
Eyes: EOMI.
Cannot count fingers.
Appreciates some movement on the right which appear as shadows.
Unable to detect static objects
Neuro: Exam normal
3/9
DDx: Vision loss/Headache ??
Giant Cell Arteritis (GCA)
Migraine
Retinal migraine
Hypertensive retinopathy
optic neuritis
Cerebral venous sinus thrombosis
Intracranial hemorrhage
Posterior circulation stroke
Primary CNS vasculitis
etc
Read 9 tweets
Aug 24, 2021
1/9 #Morningreport recently @SinaiBmoreIMRes
by M. Thomas featured a middle aged pt presenting with sudden collapse whilst getting ready in the morning.
No prodromal episodes
#DDx ?
#MedTwitter #MedStudentTwitter #FOAMed
2/9
For acute collapse, this would need to be defined along the spectrum of:
Pre-syncope-> Syncope-> Near SCD-> SCD.
3/9
A quick review of medications show multiple medications that can present with this condition:
Read 9 tweets
May 1, 2021
1/10 #Morningreport recently @SinaiBmoreIMRes
by N.Rapista recently featured an elderly pt with an episode of dysphagia x 1 week
#DDx ?
#MedTwitter #MedStudentTwitter #FOAMed Image
2/10 Further history:
Unable to swallow any solid food
• “held in the throat”
• coughing frequently
• Generalized malaise
• New left ptosis
3/10EXAM:
T: 36.4°C BP: 139/69 HR: 68 RR: 18 SpO2: 100% on room air
Gen: Awake, alert
HENT: Left ptosis
Neuro: A&Ox3, CN 2-12 grossly intact. Moves all extremities spontaneously, 5/5 all extremities but had some fatigue and dropped to 4/5 with resistance. Cerebeller Neg
Read 10 tweets
Nov 21, 2020
1/#Morningreport @SinaiBmoreIMRes
by @NasirAlhamdan featured a presentation of progressive fatigue and tachypnea X 2 months. This presentation opens up a significant number of #DDx's !
#MedTwitter #MedStudentTwitter Image
2/Other findings were:
-unexplained weight loss.,
- Tachypnea & mild SOB
- Intermittent chronic diarrhea, Intermittent small amount of bright blood per rectum
- Bruises on thighs
Now the DDx shift from the respiratory system to maybe an overlap of a hematologic etiology
3/A quick overview of our thoughts were: Image
Read 7 tweets
Aug 31, 2020
1/#Morningreport @SinaiBmoreIMRes
featured a young patient presenting with abdominal pain X 2 weeks with a serum K=2.8.
There was also increased urinary frequency
some weakness and fatigue during the past 2 weeks
#DDX #MedTwitter #medstudents #FOAMed
2/The DDX for Hypokalemia requires consideration of a 3 pronged approach: 1)Decreased intake 2)Renal and GI losses and 3) IC shifts. Image
3/For the workup: Spot urine potassium and 24 hour urinary Potassium suggested urinary K wasting.
[UK] high (>40 mEq/L) =renal K loss
TTKG of 9 was concerning for renal potassium wasting
In hypokalemia (K⁺ <3.5 mEq/L), the TTKG > 7 suggests renal K wasting. Image
Read 9 tweets

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