The Clinical Problem Solvers Episode 391: Clinical Unknown Series with Marcela Santana
Apr 25, 2025
In this discussion, Marcela Santana, a second-year resident at WashU and close friend of Noah, dives into a riveting clinical case presented by Debora. They dissect the challenges of diagnosing a 36-year-old woman suffering from right upper quadrant pain and post-operative complications following cholecystectomy. The conversation highlights the importance of differential diagnosis and a thorough evaluation. With engaging anecdotes and clinical insights, they emphasize collaborative assessment, especially when navigating complexities like neutropenic fever and discordant lab results.
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Friendship Beyond Medicine
- Noah and Marcela formed a close friendship after matching at WashU and supporting each other's careers.
- Their bond extends beyond work, sharing life philosophies and offering mutual advocacy.
Applying IMADE Mnemonic
- Use the IMADE mnemonic (Infection, Malignancy, Autoimmune, Drugs, Endocrine) for fever differential diagnosis.
- Adjust differential based on patient age, symptoms, and epidemiologic exposure for precision.
Surgery and Latent Infections
- Surgery five weeks prior may not directly cause current symptoms but can cause indirect complications.
- Consider latent infections reactivation after surgical stress, especially in patients from endemic regions.