The Clinical Problem Solvers Episode 424 – The Clinical Unknown Series with Debora, Mark, Noah and Rabih
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Oct 9, 2025 In an engaging discussion, the hosts dive into a complex case of a patient facing dizziness and dyspnea. They explore the critical role of anemia in diagnosing symptoms. The team assesses the implications of severe iron deficiency and debates the necessity of transfusions. As they analyze potential causes of occult bleeding, the suspense builds. The revelation of esophageal adenocarcinoma from endoscopic evaluations highlights the challenges in diagnostic medicine. Listeners gain insights into effective clinical reasoning and the importance of thorough investigation.
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Moment That Cemented A Diagnostic Path
- Rabih recounts a defining moment reading a New England Journal case about disseminated histoplasmosis causing HLH.
- That case crystallized his interest in diagnostic reasoning and clinical problem solving.
Stand-Up Dizziness Needs Broader Thinking
- Dizziness provoked by standing can reflect more than orthostatic hypotension and may signal neurologic or perfusion problems.
- Trust the patient's symptoms and test further when orthostatic vitals don't explain the complaint.
Start With CBC And Glucose For Orthostatic Symptoms
- When standing provokes dizziness and dyspnea, prioritize cardiovascular causes alongside neurologic ones.
- Order basic labs (CBC, glucose) early because anemia or cardiac problems can explain both symptoms.