INTERESTING CASES....

Just the other day I've seen a few real interesting cases in the emergency department.
In fact, interesting because they are quite rare even by ER standards....and to have
seen it all on one 12 hour shift is even more unique.


1. RELAPSING POLYCHONDRITIS

An elderly woman presented with a painful and swollen, beet red right ear.
She tought it was an insect bite...but does not recall being bitten.
Upon further questioning, she states to have similar occurence in the left ear
two months ago, which resolved with NSAID's...and reddeneded ears about
one year prior. Fortunately for her, no tracheal symptoms were present.




2. ACUTE PERICARDITIS

Yes, it is more common then the above...bit still only see few clinical cases per year.
This 30 year old woman presented with 2 weeks history of recurrent sharp anterior
chest pains and symptoms of dyspnea.
EKG revealed classis ST elevations in inferior leads with CONCAVE downsloping.
Another give away was the pathgnomonic KNUCKLE sign in AVR.
Upon seeing it....it was reassuring to await the enzymes. She was admitted for observation
and a 2D-Echo.




3. ACUTE VIRAL HEPATITIS

A 22 year old male presented with 8 days history of recurrent vomiting and not feeling
well. Also complained of fatigue and darker urine.
What was unusual is the lenght of vomiting. Normally with gastroenteritis symtoms,
vomiting last 3-4 days.
Upon receiving the lab tests, all liver enzymes were modereately elevated.
A hepatitis panel was ordered and on re-exam a faint scleral icterus was noted, not
picked up on the initial exam
The patient probably experienced the prodromal phase of Acute Hepatitis A (HAV)
infection with his lingering constitutional symptoms.




All on one shift:)!

ENDOCRINOLOGY...Part I

It has been a bit of a hiatus since the last posting...but we'll just continue on the path of learning
new and exciting material....in Endocrinology.


Q: What is SHEEHAN'S SYNDROME?


A: It affects affects only WOMEN in the immediate POST PARTUM time period.
Due to sudden hypovolemia or shock, therefore decreased blood flow to the
PITUITARY GLAND....causes silent infarction of the gland. Subsequently,
patients experience LACK of normal LACTATION, AMENORRHEA and FATIGUE.



Q: What is GALACTORRHEA?


A: It is an abnormal and inapproproate release of MILK (lactation) in both men and women.

The primary cause is usually due to a PROLACTIN releasing PITUITARY ADENOMA.
It can also be caused by various medications e.g. OPIOIDS, PHENOTHIAZINES, and
METHYLDOPA. Diagnosis is usually made by an elevated SERUM PROLACTIN levels.
An MRI of the Pituitary gland is the radiologic diagnosis of choice in identifying the
adenomas, being either a microadenoma (<10mm)>10mm) in size.



Q: What is DIABETES INSIPIDUS (DI)?


A: It is a either a DEFICIENCY of VASOPRESSIN (ADH) due to a hypopthalamic-pituitary
disorder....called CENTRAL DIABETES INSIPIDUS (CDI)...Hint: CNS!!!

....or from RESISTANCE of the KIDNEYS to VASOPRESSION (ADH)....this is called.
NEPHROGENIC DIABETES INSIPIDUS (NDI).

The main symptoms are due to enormous amount of fluids being consumed by the
patient...thus, THIRST, POLYDIPSIA, POLYURIA ...and very commonly, NOCTURIA.


Q: Which THYROID CANCER type is MOST COMMON?


A: PAPILLARY CARCINOMA....tumor usually occurs on patients ages 30-60.
Female to male ratio, usually 3:1.



Q: Which Thyroid Cancer is MOST COMMON among the ELDERLY?


A: FOLLICULAR CARCINOMA



Q: Which Thyroid Cancer produces CALCITONIN?


A: MEDULLARY CARCINOMA...the hormone is produced by the parafollicular cells,
called, C-CELLS. Thus, the best test is a SERUM CALCITONIN level, which is
significanlty elevated.



Thanks for your time, we'll return shortly.