Day 1 Pathophysiology of secondary hyperparathyroidism (secondary to CKD)   Calcium and phosphorous homeostasis is tightly regulated between bone, the kidney, and the parathyroid gland. Key modulators of calcium and phosphorous include FGF-23, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and parathyroid hormone. FGF-23 is released from bone due to increasing serum phosphorus levels and acts in the kidney to increase phosphorous excretion and decrease 1 alpha hydroxylation of 25-hydroxyvitamin D. FGF-23, along with serum phosphorous, also decreases parathyroid hormone secretion, to maintain calcium and phosphorous balance. Renal hyperparathyroidism (rHPT) is a common complication of CKD characterized by derangements in the homeostasis of …

Day 1: Ranson’s Criteria vs APACHE Scoring System Ranson’s criteria are used to predict severity and mortality of acute pancreatitis.  The criteria with 11 parameters are used to assess the severity of alcoholic pancreatitis. The 5 parameters on admission are age older than 55 years, WBC count greater than 16,000 cells/mm^3, blood glucose greater than 200 mg/dL (11 mmol/L), serum AST greater than 250 IU/L, and serum LDH greater than 350 IU/L. At 48 hours, the remaining 6 parameters are: serum calcium less than 8.0 mg/dL (less than 2.0 mmol/L), hematocrit fall greater than 10%, PaO2 less than 60 mmHg, …

35 y/o year old female with no past medical history presenting to the emergency department with abdominal pain. She states the pain started off intermittently 10 months ago but has been constant over the last month. She is “always in pain” and feels it diffusely throughout the abdomen. No medications have worked and no position makes it better or worse. Patient was seen by PCP and a gastroenterologist, where many tests and exams were done but all came out negative. She has tried cutting out dairy, wheat, and meat with no relief. She is worried and anxious that something is …

Day 1 Menopause • occurs around 45-55 years, when the ovaries stop ovulating and menstrual periods end • Most women experience several years of changes in their menstrual periods before stopping completely ◦ Menstrual periods more or less often than usual ◦ Have bleeding that lasts for fewer days ◦ Skip one or more menstrual periods Symptoms ◦ As ovaries stop working, estrogen levels fall, leading to many symptoms – these often begin during menopausal transition, before stopping periods completely ◦ Hot flashes is the most common, affecting 60-80% of women ◦ Typically begin as a sudden feeling of heat …

Day 1: Pneumonia Pneumonia is most common and dangerous in very young children, people over the age of 65, and people with underlying medical conditions such as heart disease, diabetes, or chronic lung disease. This patient who comes from a nursing home will most likely have Nursing home acquired pneumonia (NHAP). It is one of the most common infectious diseases in long term care facilities and is a significant cause of mortality and morbidity among residents of such facilities. Dysphagia has been identified as a risk factor. This type of pneumonia closely resembles community acquired pneumonia.  The pathophysiology of NHAP …

DAY 1: Clinical manifestations of ALL  Acute lymphocytic leukemia (ALL) aka acute lymphoblastic leukemia is the most common type of malignancy in children, making up 25% of childhood cancers. The incidence of ALL is about 1:25,000 children per year, including 3,000 children per year in the United States. The peak is 2-5 years of age, and is seen more in males than females. Children with Down syndrome have a 14 fold increase in the overall rate of leukemia.  ALL is a malignancy arising from immature lymphoid stem cells in the bone marrow. There is an overpopulation of immature WBCs (blasts) …

EM typhon

My first site evaluation went very well. I chose to share an H&P on a 48 year old male who presented to the emergency department with shortness of breath and chest pain for 2 hours. My evaluator gave great constructive feedback on my H&P and we discussed a list of differential diagnoses and treatment plans. He suggested I keep working on my list of differentials and discussing why they may not be the diagnosis. **My second site evaluation was cancelled by my evaluator due to the current COVID circumstances. I will update this post once that is rescheduled**

I chose to discuss this article after encountering a patient with acute appendicitis. The first line treatment is appendectomy, however, controversy exists since conservative therapy may have fewer complications than surgery. This article was a meta-analysis that compared the outcomes between conservative treatment with antibiotics and appendectomy in adults with acute appendicitis. The outcomes observed were adverse effects, length of hospital stay, and efficacy. There was a total of 11 trials and 2,751 patients that were studied. What researchers found was that patients receiving conservative treatment had a lower overall effective rate and complication rate. This group also had a …

Identifying Data Name: Female Address: NYQH Date of Birth: 67 y/o Location: NYHQ Source of Information: Self   Chief Complaint: shortness of breath x1 week History of Present Illness: 67 y/o female with PMH of COPD, asthma, CAD s/p MI x2 stents 2012, CHF, HTN, HLD, type 2 DM, Parkinson’s disease, renal cell carcinoma s/p right nephrectomy 1998, anxiety, depression presenting with worsening shortness of breath for 1 week. Associated with subjected fever, chills, productive cough of yellow phlegm, and chest pain only with cough. Patient was seen by PMD 1 week ago and diagnosed with pneumonia, for which she …