The Clinical Problem Solvers Episode 278: Schema Episode: Lower Extremity Edema, Thyrotoxicosis, and Pharyngitis
Mar 2, 2023
The hosts discuss a perplexing medical case involving lower extremity edema, tachycardia, and later pharyngitis. They explore the evaluation and differential diagnosis of sinus tachycardia and lower extremity edema, interpretation of lab findings in thyroid toxicosis, diagnosis and treatment of pharyngitis, differential diagnosis of leukopenia and neutropenia, and engage in a complex case discussion with some mustache jokes.
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Physiology Behind Sinus Tachycardia
- Sinus tachycardia often reflects low stroke volume or increased sympathetic drive rather than a primary cardiac arrhythmia.
- Evaluate for hypovolemia, shock states, hypoxia, endocrine causes, and stimulants when HR is high.
Systematic Approach To Leg Edema
- When evaluating lower extremity edema, inspect for systemic signs like JVD or stigmata of liver disease.
- If exam is unrevealing, prioritize renal disease, medications, venous obstruction, protein-losing enteropathy, and endocrine causes.
High-Yield Differentials For Young Tachycardic Patient
- In a young woman with tachycardia, dyspnea, and bilateral nonpitting edema, DVT/PE and hyperthyroidism are high-yield diagnoses.
- Initial labs should include CBC, CMP (with albumin), ECG, D-dimer, and TSH.