The Clinical Problem Solvers Episode 406 – Spaced Learning Series – Flank Pain, Hypercalcemia, and Granulomas
Jul 5, 2025
Anna Fretz, a second-year pulmonary medicine fellow, and Seyma Yildirim, a resident on the nephrology ward, dive into a compelling case of flank pain tied to hypercalcemia and granulomatous diseases. They explore the intricate links between acute symptoms and chronic conditions like sarcoidosis. Listeners will be captivated by their discussion on the importance of differential diagnoses, the management of kidney stones, and the complexity of diagnosing granulomatous diseases from a clinical perspective.
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Split Symptoms by Timeframe
- Always split symptoms into acute and subacute timeframes to focus your diagnosis and management effectively.
- Use detailed schemas like flank pain and lethargy to guide considering common and rare causes systematically.
Joint Pain Pattern Insights
- Joint pain patterns can guide whether infectious or autoimmune causes are more likely.
- Rash types provide vital clues to differentiate causes like viral arthritis, disseminated gonorrhea, and sarcoidosis.
Systematic Hypercalcemia Evaluation
- Check and correct for albumin when assessing hypercalcemia to confirm true elevation.
- Use PTH to differentiate PTH-mediated vs. non-PTH-mediated hypercalcemia, then evaluate vitamin D metabolites and malignancy markers accordingly.