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 🚨

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

What comes to mind when a patient with recurrent UTIs presents with 2 weeks of progressive pruritus and jaundice?

More from @LHortonGI and @sanjiv_chopra from today's morning report below... 🧐

#livertwitter 💫Jaundice and pruritus presenting together = *cholestatic* jaundice!

✖️Can typically rule out hemolytic jaundice - unless invoking Hickam's dictum and multiple problems🙂

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.

Make sure to carbo-load 🍭🍝🍬 before diving into this morning report, with @LHortonGI and the one and only Dr. Marshall Wolf!

We learned about a dramatic presentation with severe hypoglycemia causing a fender-bender... Dr. Allen O. Whipple's "triad" of pathologic hypoglycemia originated from observing unnecessary exploratory surgeries for suspected insulinoma.

Reminder of his triad...
📉Hypoglycemia
😢Neuroglycopenic symptoms
☺️🍭Prompt resolution of symptoms with glucose administration

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

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

Happy Monday!

All about the thyroid this morning with teach resident presenter Dr. Deepa Manjunath and faculty discussant Dr. Pedro Sanchez.

We love these high-yield tips on initiating levothyroxine - but don't miss the other awesome pearls below 👇

1/ 💡The biochemical profile of elev TSH, normal FT4 has a broad DDx beyond subclinical hypothyroid!

💡Predictors of progression from subclinical to overt hypothyroidism include:
⚠️female sex
⚠️TSH >10 mIU/L
⚠️Presence of anti-TPO antibodies

2/

🚨Alert! Introducing a new approach to hyponatremia 🚨

Toss aside that pesky "hypo-, eu-, hyper-volemic" algorithm framework...

Welcome to "The Pallais Approach " 1. Is it hypotonic?

Ensure no *rare* forms of pseudohyponatremia or hyperglycemia and confirm serum osm <275