Iqra Asghar @iqrajaffri14 on GrepMed

Quincke's Pulse in a patient with a normal echocardiogram (non-valvular) A 70 y/o man presents with new exertional dyspnea, orthopnea/PND, wide pulse pressure (~100 mm Hg), and elevated JVP. A physical finding is identified (video). Echo: preserved systolic function, no valvular disease. Thoughts? What would you do next? Incredible discussion. Like many here I questioned the echo. Then realized Quincke's pulse = high-output state (not always AR). Sent for RHC to confirm high-output HF. Sure enough, CO was 12.5 L/min (CI 4.8 L/min/m2). Workup for cause underway. Physical exam was pivotal in this case. Without it, most of us would have concluded that this was "just another case of diastolic heart failure" and stopped there. Without seeing Quincke's pulse, there is no question that I would have unknowingly marched down the wrong path. At this point thiamine deficiency (beriberi) and AV shunt are highest on my differential. Patient drinks ~2 glasses of wine/day. EtOH causes thiamine deficiency via several mechanisms, so even if patients consume a normal diet and don't appear malnourished, it is still possible. Dr. André Mansoor @AndreMansoor - Author of Frameworks for Internal Medicine https://amzn.to/2LmUODZ #Quinckes #Quinkes #Pulse #AorticRegurgitation #Diagnosis #PhysicalExam #Fingernails #Nailbed #Cardiology

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Diagnosing Brucellosis Epidemiological Exposures - Endemic Regions - Clinical Micro Lab Technicians - Animal/Vaccine Exposure: Vets, Slaughterhouse workers, hunters - Unpasteurized Dairy Consumption: Esp. non-fermented products (milk, soft cheese, ice cream) Clinical Features - Constitutional: Fevers (Undulating), Malaise, Night Sweats, Weight loss - End Organ Complications: Osteoarticular (Sacroiliac joint), Cardiovascular (IE), Neurological, Ocular, Genitourinary Diagnostic Tests: - CBC + Chemistry: Anemia, Leukopenia/Leukocytosis, Thrombocytopenia, Transaminitis - Radiology: Sacroiliitis / spondylitis Diagnostics: Culture (blood, bone marrow, biopsy), Convalescent Serology (SAT, ELISA), 16S PCR Dr. Ahmed Babiker @Ahmed_HBabiker #Brucellosis #Diagnosis #Criteria #Workup #Testing

Primary and Secondary Causes of Hypertension - Differential Diagnosis Algorithm Primary (Essential) (95%) - Onset between age 20 and 50. Positive family history. No features of secondary hypertension. • Long-standing • Uncontrolled • Drug Withdrawal Mislabelled - Repeatedly normal blood pressure when taken at home, work or when using an ambulatory monitor. • White-coat Hypertension • Masked Hypertension Secondary Causes (5%) - Onset age < 20 or > 50 years, No family history. Hypertensive urgency. Resistant hypertension. - Exogenous • Corticosteroids • Oral Contraceptive Pills • Cocaine • Black licorice • Medications - Renal • Renal parenchymal disease - CKD, AKI, Glomerulonephritis • Renovascular disease (unilateral and bilateral renal artery stenosis) - Mechanical • Aortic coarctation • Obstructive Sleep Apnea - Endocrine • Glucocorticoid excess (Cushing syndrome or disease) • Catecholamine excess (pheochromocytoma) • Mineralocorticoid excess (primary aldosteronism) • Hyperthyroidism (mainly systolic hypertension) • Hypothyroidism (mainly diastolic hypertension) • Hyperparathyroidism • Pregnancy (Gestational hypertension) #Hypertension #Primary #Secondary #HTN #Cardiology #Differential #Diagnosis #Algorithm #causes

Pathogenesis of Diabetic Ketoacidosis - Insulin deficiency or severe insulin insensitivity #DKA #Pathophysiology #Endocrinology #Diabetes #Ketoacidosis #Diabetic

"Eight I's" mnemonic for the main causes of hyperglycemia. #hhs #dka #ketoacidosis #diabetes #diabetic #em #differential #diagnosis

The Iron Cross of Weakness - Teaching Script Differential - Jeff Wiese, MD, FACP #Weakness #IronCross #Differential #Diagnosis #Causes

Hypertension and Altered Mental Status (AMS) - Differential Diagnosis Framework Hypertension: • Hypertensive emergency • Hypertensive encephalopathy • PRES • Sympathetic stimulation Cardiac: • CHF • Fluid overload Endocrinopathies: • Cushing’s syndrome • Primary aldosteronism • Pheochromocytoma • Hyperthyroidism CNS: • Stroke - with compensatory HTN • Seizures/NCSE • Delirium/agitation • CNS tumor • Intracranial mass OB: • Eclampsia/Pre-Eclampsia Renal: • Acute GN • Acute/Chronic renal failure • Renal artery stenosis Autonomic Hyperactivity: • GBS Autoimmune: • Vasculitis • Lupus • Polyarteritis nodosa • Scleroderma renal crises Drug (+): • Cocaine • NMS • Serotonin syndrome • Sympathomimetic agents • Amphetamine intoxication • Monoamine oxidase inhibitors Drug (-): • ETOH withdrawal • Opioid withdrawal • Clonidine cessation #Hypertension #AMS #encephalopathy #altered #Differential #Diagnosis #causes

Posterior Reversible Encephalopathy Syndrome (PRES) - Diagnosis Clinical Features: • Altered mental status (Either lethargy, confusion, or agitation) • Seizures (Generalized > focal) • Headache (Typically constant, global, and refractory) • Vision changes (acuity, visual field deficits, hallucinations, cortical blindness) Risk Factors: • Hypertensive emergency • Preelampsia / Eclampsia • Immunosuppressive / Immunomodulatory meds: Cyclosporine, Cisplatin, Tacrolimus, VEGF inhibitors • Renal failure • Autoimmune disease Diagnosis: Risk Factor + Clinical Features + Neuroimaging - Dr. Eric Strong @DrEricStrong - Strong Medicine https://www.youtube.com/c/EricsMedicalLectures/ #PRES #Posterior #Reversible #Encephalopathy #Syndrome #Diagnosis #Neurology

Posterior Reversible Encephalopathy Syndrome (PRES) - Treatment Blood pressure control: • Aim for 10-25% BP reduction within first 2-6 hrs • Easily titratable IV meds are preferred Seizure control: • No specific med favored • Can usually be d/c'd after recovery Cessation of potentially causative meds (at least temporarily) - Dr. Eric Strong @DrEricStrong - Strong Medicine https://www.youtube.com/c/EricsMedicalLectures/ #PRES #Posterior #Reversible #Encephalopathy #Syndrome #Treatment #Management #Neurology

Adult-Onset Still's Disease Clinical triad: Fever, Arthralgia/arthritis, Skin rash ± odynophagia + Biological inflammation: Increased neutrophils, Hyperferritinemia, decreased glycosylated fraction < 20% Differential Diaqnoses: • Infectious: Mycoplasma, yersinia, borrelia, Rubeola, HBV, Coxsackie, CMV, EBV, HIV, HTLVI, Hantavirus • Malignant hemopathies, solid cancers • Systemic diseases : other autoinflammatory diseases (mevalonate kinase deficiency, Schnitzler) Complications: MAS, Visceral, DIC, TMA • Cardiac: pericarditis, rhythm abnormalities, conduction abnormalities • Muscular: normal CK, normal biopsy • Lymphadenopathies, splenomegaly • Hepatic: hepatomegaly, hepatitis • Pulmonary: pleural effusion, infiltrates • Neurological: meningoencephalitis, . • Ocular: uveitis, episcleritis By Dr. Prunelle Getten #AdultOnset #Stills #Disease #diagnosis #management #treatment #rheumatology