“Coughing Up Blood” part 2

Patient is intubated for airway protection. She is also resuscitated with 2 liters of IV crystalloid fluids. Initial workup elicits the following: Lab WBC 10.2 (normal differential), Hgb 11.4, Plt 190K Na+ 136, K+ 4.0, Cl– 110, HCO3– 24, BUN 52, Cr 2.6, Glucose 112 AST: 27, ALT 25, Total Bilirubin 0.2, Albumin 3.2 ABG:Continue reading ““Coughing Up Blood” part 2″

“Coughing Up Blood” part 3

This patient has two separate problems: Hemoptysis (with likely Diffuse Alveolar Hemorrhage) and Acute Kidney Injury (with likely glomerulonephritis as evidenced by urinalysis findings) in the setting of elevated inflammatory markers. Diffuse Alveolar Hemorrhage Diagnosed by bronchoscopic alveolar lavage (BAL) obtaining sequential 5mL aliquots that show increasing RBCs Differential Diagnosis: Pulmonary capillaritis Vasculitis Anti-GBM diseaseContinue reading ““Coughing Up Blood” part 3″

“My blood pressure is high” continued

This young male with difficult-to-control hypertension on maximum-dose therapy of two antihypertensives requires a workup for secondary hypertension. Labs WBC 6,400, Hgb 13.6, Plt 245,000 Na+ 146, K+ 2.8, Cl– 110, HCO3– 30, BUN 27, Creatinine 0.8, Calcium 8.5 TSH: 2.4 8 AM Plasma Aldosterone Concentration (PAC): 22 ng/dL; Plasma Renin Activity (PRA): 0.6 ng/mLContinue reading ““My blood pressure is high” continued”


The inner ear is composed of two separate departments: the cochlea (for hearing), and the vestibule (for balance/positioning). The vestibular system consists of three semicircular canals, all at 90 degrees from each other. The semicircular canals contain an outer, “osseous”, labyrinth and an inner, “membranous” labyrinth. Inbetween the two labyrinths lies endolymphatic fluid. These canalsContinue reading “Vertigo”

Secondary Hypertension

~10% of cases of hypertension are secondary to another disease process (1). Secondary hypertension should be evaluated in young patients with otherwise-unexplained hypertension or patients with difficult-to-control hypertension. The most common etiologies are: Hyperthyroidism Hyperaldosteronism Hypercalcemia Obstructive Sleep Apnea Renovascular Hypertension Chronic Kidney Disease Coarctation of the Aorta Cushing Syndrome PheoChromocytoma One mnemonic to rememberContinue reading “Secondary Hypertension”

Cushing Syndrome

Definitions Cushing syndrome: Elevated cortisol levels from any cause (exogenous or endogenous, ACTH-dependent or independent) Cushing disease: Hypercortisolism specifically due to an ACTH-secreting pituitary adenoma Signs/Symptoms Hypertension Hyperglycemia Abdominal striae Lipid re-distribution Central obesity “Moon” facies “Buffalo hump” on back of neck Fatigue/weakness Workup Management: Cushing’s Disease (ACTH-secreting pituitary adenoma) (1) 1st Line Surgical resectionContinue reading “Cushing Syndrome”

Tick-Borne Disease

Suspect tick-borne disease when a patient presents with a flu-like illness +/- a rash in a geographical location consistent with known tick-borne disease. Classically, patients will also present with transaminitis and thrombocytopenia. Diagnosis can be confirmed with serology, but often, the diagnosis can be made clinically and empiric treatment may need to be initiated beforeContinue reading “Tick-Borne Disease”

“Blood in My Urine” continued

Nephrolithiasis Urology consulted, performed ureteroscopic stone fragmentation and removal the following day Hypercalcemia Treated with IV fluids, Zoledronic Acid, and Calcitonin -> serum calcium normlized within 2 days Hydrochlorothiazide was discontinued PTH resulted low at 8 pg/mL 25-OH-Vitamin D and 1,25-OH-Vitamin D levels were within normal limits PTHrP ordered, returned a few days later elevatedContinue reading ““Blood in My Urine” continued”

“I’m Tired” (continued)

Further labwork: LDH elevated at 1500, Haptoglobin low at <10 This led to a suspicion for hemolytic anemia Vitamin B12 low at 67 pg/mL Unexplained by dietary intake Folate within normal limits Peripheral smear showed 1+ schistocytes A direct antiglobulin test returned positive for a warm IgG antibody. This explained, in part, her hemolytic anemiaContinue reading ““I’m Tired” (continued)”