The Clinical Problem Solvers Episode 400: Clinical Unknown Series with Dr. Mengyu Zhou
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Jun 6, 2025 In this engaging conversation with Dr. Mengyu Zhou, an IMG from China who now practices as a hospitalist in Oregon, listeners dive into complex clinical cases. The team tackles a 57-year-old woman suffering from constipation and confusion, navigating through diagnostic strategies and historical context. They also explore challenging conditions like Takayasu's arteritis and hypercalcemia with pancytopenia. By weaving personal stories into the mix, they emphasize the balance between life and medicine. It's a rich blend of clinical reasoning and human experience!
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Focus on Constipation Alarm Features
- Focus on constipation as the chief complaint when multiple symptoms are present.
- Constipation with alarm features can guide toward narrowing the differential diagnosis.
Hypercalcemia and Pancytopenia Links
- Hypercalcemia explains constipation, confusion, and weakness in this patient.
- Pancytopenia and hepatosplenomegaly suggest a possible granulomatous disease or bone marrow involvement.
Granulomatous Disease Causes Hypercalcemia
- Low PTH plus elevated 1,25 vitamin D suggest granulomatous disease as hypercalcemia cause.
- Consider infections like TB or fungal diseases in immunosuppressed patients with pancytopenia.