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Sinai Hospital of Baltimore IM Residency Profile picture
@SinaiBmoreIMRes
Jul 26, 2022 • 9 tweets • 4 min read • Read on X
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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
4/9
 CT HEAD: CT Head WO Contrast: ill-defined hypoattenuation involving predominantly the subcortical white-matter in both parietal and occipital lobes, concerning for PRES
researchgate.net/figure/Posteri… Image
5/9
 The Dx of PRES was made with signs suggestive on MRI: Image
6/9:
Pathogenesis: Image
7/9:
Causes & Presentation Image
8/9
 A few Ddx of PRES:
ICH
Subdural/Subarachnoid hemorrhage
Cerebral sinus venous thrombosis
Posterior circulation ischemic or hemorrhagic stroke
thrombosis of the basilar artery
Vasculitis of the CNS
HSV encephalitis
Autoimmune encephalitis
Uremic encephalopathy
Hypoglycemia
9/9
 Management: ImageImage

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More from @SinaiBmoreIMRes

Sinai Hospital of Baltimore IM Residency Profile picture
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
Sinai Hospital of Baltimore IM Residency Profile picture
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
Sinai Hospital of Baltimore IM Residency Profile picture
Jul 30, 2021
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
Read 10 tweets
Sinai Hospital of Baltimore IM Residency Profile picture
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
Sinai Hospital of Baltimore IM Residency Profile picture
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
Sinai Hospital of Baltimore IM Residency Profile picture
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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