The Clinical Problem Solvers

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/Gurpreet-and-Anna-7-10-20-10.04-AM.mp3Dr. Costello presents a clinical unknown to Dr. Dhaliwal.Download CPSolvers App herePatreon websiteDr. Anna CostelloAnna Costello is a Pediatric Hospitalist at the Children’s Hospital of Philadelphia, where she completed her residency and chief residency. Her interests within Medical Education include clinical reasoning and linguistically and culturally competent care. Outside of the hospital, she is an avid reader, painter, and soccer player. Dr. Gurpreet DhaliwalDr. Dhaliwal is a clinician-educator and Professor of Medicine at the University of California, San Francisco. He is the site director of the internal medicine clerkship at the San Francisco VA Medical Center, where he teaches medical students and residents in the emergency department, urgent care clinic, inpatient wards, outpatient clinic, and morning report. His academic interests are the cognitive processes underlying diagnostic reasoning and clinical problem-solving and the study of diagnostic expertise. Dr. Dhaliwal enjoys playing pickup basketball with his two sons … even though both can handily defeat him

https://clinicalproblemsolving.com/wp-content/uploads/2020/06/HDxNYU_Arsalan_FINAL.mp3Dr. Ryan Haran presents a Human Dx unknown to Arsalan and NYU residents – Drs. Jenny Whealdon and Greg Rubinfeld.Download CPSolvers App herePatreon websiteHuman Dx caseDr. Jenny WhealdonJenny was born and raised on Bainbridge Island in Seattle, Washington. She attended Haverford College where she studied religion and theoretical chemistry; ultimately staying in the Philadelphia area to attend the University of Pennsylvania School of Medicine. There, she developed an interest in behavioral economics and decision making, particularly in the critical care setting. She completed her internal medicine training at NYU and is staying on as a Chief Resident.Dr. Greg RubinfeldGreg is currently a chief resident at NYU Grossman School of Medicine.He aspires towards a career in academic cardiology where he hopes to find a marriage of his interests in thrombosis and coronary artery disease.When he is not in the hospital or at home with his wife and son, you might find him scuba diving wrecks along the east coast, nose deep in classic literature, or playing pick-up street hockey and collecting more bruises than he cares to admit.Dr. Ryan HaranRyan grew up in Oregon and after attending Oregon State University went to medical school at Virginia Commonwealth University in Richmond, Virginia.He completed an internal medicine internship then spent a year as a radiology resident at Northwestern University in Chicago, Illinois before deciding that while radiology is cool and all he had learned too much medicine to just go and forget everything. As such, he decided to return to medicine and has now completed an internal medicine residency at his home institution of VCU where he will be staying on faculty as a hospitalist.Case Recap A 55-year-old previously healthy woman presented with subacute abdominal distension and acute emesis. On examination, she was found to be hypotensive and hypoxemic with evidence of ascites. Laboratory evaluation was notable for severe transaminase elevation (AST 2500, ALT 1300), leukocytosis to 53,000 per cubic millimeter, hemoglobin of 20 mg/dL, and a mildly elevated erythropoietin level. Imaging demonstrated an acute portal vein thrombus as well as a right-to-left intracardiac shunt. A bone marrow biopsy revealed trilineage hypercellularity with an erythroid predominance and JAK-2 positivity. The ultimate diagnosis was polycythemia vera with a secondary EPO-dependent polycythemia (likely secondary to her intracardiac shunt).Teaching pointsAn absolute erythrocytosis refers to elevation in the red blood cell (RBC) mass and can be due to primary bone marrow, secondary (e.g., hypoxia, erythropoietin secreting tumors), and congenital etiologies. A key branch point is evaluation of the erythropoietin level (the primary stimulus for RBC synthesis), with normal/suppressed levels suggesting the presence of a primary or congenital disorder. Polycythemia vera (PV) is the most common primary erythrocytosis and lies on the spectrum of myeloproliferative neoplasms. Thrombosis and bleeding are life-threatening complications.

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/HDX_BMCBrigham_Sharmin_FINAL-2.mp3Dr. Leela Chockalingam presents a Human Dx unknown to Sharmin and BMC resident – Dr. Amir Gilad and Brigham resident  – Dr. Hannah Chen.Download CPSolvers App herePatreon websiteHuman Dx caseAbdominal pain schemaDyspnea schemaAltered mental status schemaAmir GiladAmir Gilad is a PGY-1 (very soon to be PGY-2!) at Boston Medical Center. Born and raised in Toronto, he attended Boston University for medical school and loved it so much that he stayed on for his internal medicine residency. He’s an aspiring cardiologist who is passionate about medical education. Outside of medicine he enjoys cheering on his beloved Toronto sport teams, jogging along the Charles River, and exploring the beautiful city of Boston. Hannah ChenHannah Chen is a second year internal medicine resident at the Brigham & Women’s Hospital. She graduated from the University of North Carolina School of Medicine.  She has an interest in hospital medicine, nephrology, and health equity.  In her spare time, she enjoys eating/cooking and hiking.  Leela ChockalingamLeela Chockalingam grew up in Rochester, NY. She studied Chemistry at Carnegie Mellon University and then attended medical school at the Icahn School of Medicine at Mount Sinai in New York City. During medical school, she spent a year in Vietnam doing tobacco use treatment research. She is currently an Internal Medicine resident at the University of Colorado in Denver, CO. She is interested in pursuing pulmonary critical care fellowship, and would ultimately love to be a clinician educator focused on clinical reasoning and evidence based medicine. Her hobbies include reading fiction, being outside, and cooking for family and friends. Case recapA 47-year-old man with alcohol and meth use presented with acute dyspnea, abdominal pain, and encephalopathy, and was found to be in acute congestive heart failure with atrial fibrillation and rapid ventricular rate. While in the emergency department, his oxygen requirement rapidly increased and he required intubation for hypoxemia and airway protection. Further evaluation revealed a suppressed thyroid stimulating hormone with an elevated free T3 and free T4, confirming a diagnosis of thyrotoxicosis meeting criteria for thyroid storm.Teaching pointsHyperthyroidism refers to increased synthesis and release of thyroid hormones from the thyroid gland, whereas the term “thyrotoxicosis” represents the clinical syndrome produced by excess circulating thyroid hormone. The most common causes of hyperthyroidism include Grave’s disease, toxic nodular goiter/adenoma, and drug induced thyroid dysfunction. Thyrotoxic states can also occur when thyroid hormones are released from an injured thyroid gland in thyroiditis (autoimmune, viral, suppurative) or ingestion of exogenous thyroid hormone.The clinical manifestations of hyperthyroidism can result from the thyrotoxic state itself (e.g., palpitations, fatigue, tremor, weight loss) or be related to the underlying cause of hyperthyroidism (e.g., grave’s ophthalmopathy, globus sensation/dysphagia from enlarged goiter). Complications of thyrotoxicosis include atrial fibrillation (with possible heart failure), thyrotoxic periodic paralysis, osteoporosis, and reproductive issues. Thyroid storm represents life-threatening thyrotoxicosis and its diagnosis is supported by the Burch & Wartofsky Score, which takes into account temperature, central nervous system effects, gastrointestinal/hepatic dysfunction, cardiovascular dysfunction, and the presence/absence of a precipitating trigger.

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/Episode-100-Juneteenth.m4aDr. Kimberly Manning and her father, Mr. William Draper, commemorate Juneteenth, the holiday that celebrates the day when all remaining enslaved Black Americas were freed in Galveston Texas, on June 19th, 1865, with this hour-long storytelling event. Click here to watch the video on the CPSolvers Virtual Morning Report platform

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/Episode-99.mp3Meet the CPSolvers family who share their origin story, and tell you more about all the things we do beyond the podcast. Meet Us VMR Twitter Patreon Download CPS app here Instagram Schema page Illness script page Blog COVID page

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/SLS_Syncope-and-Splenomegaly_Sharmin_FINAL-Audacity.mp3Steph, Sharmin, Arsalan and Dan share a case of syncope and splenomegaly – let’s practice those schemas together!Download CPSolvers App herePatreon websiteSplenomegaly SchemaSyncope Schema

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/RLR-7-ALI.m4aEpisode descriptionReza and Rabih tackle a case of acute liver injury.One RLR episode will be freely available each month but the remainder will be uploaded on Patreon only.Why?More about the RLR series here.You can find the article referenced in the episode Here 

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/HDx_Mercy__Sharmin_PREAU_UPDATED.m4aEpisode DescriptionDr. Julia Burns presents a Human Dx unknown to Sharmin and Mercy residents  – Drs. Brady Alling and Aaron Sabal.Download CPSolvers App herePatreon websiteHuman Dx caseDr. Brady AllingBrady is a PGY 3 at Mercy Health in Muskegon, MI. Next year, he will be doing a fellowship in pulmonary & critical care in Colorado. His favorite thing about internal medicine is is the profound sense of accomplishment he feels when replacing electrolytes that are just slightly below the normal range.Dr. Aaron SabalAaron was born and raised in Westland, MI (Detroit metro area). He went to Wayne State University for my undergraduate studies thinking he would be a physical therapist, massage therapist, and dietitian (yes, all three of those). However, about one week prior to starting my massage therapy program, he had an epiphany and decided to go to medical school instead. He was fortunate to be accepted to MSUCOM and fell in love with Internal Medicine. His passions include all things medical. In particular, he is passionate about medical education, how best to help physicians learn, diagnostic reasoning, and creating an environment of learning where no one is afraid to express what they’re thinking. When he is not pursuing his love of learning, He is spending time with his wife and their boys (2 cats and a dog), playing with his animals, doing DIY home-improvement projects, exploring national parks, or reading a good non-medical book with a cat or dog in his lap begging for his love and attention.Dr. Julia BurnsJulia is currently a geriatrics fellow at Mount Sinai Hospital in Manhattan. She earned her undergraduate degree from Fairfield University. She then went on to obtain a master of science in biomedical sciences from New York Medical College followed by her medical degree at Albany Medical College. She completed her internal medicine residency at NYU Winthrop Hospital on Long Island. Her academic interests include medical student and resident education.

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/Human-Dx_Utah_Arsalan-FINAL.m4aDr. Kavea Panneerselvam presents a Human Dx unknown to Arsalan and Utah residents  – Drs. Marja Anton and Guinn Dunn.Download CPSolvers App herePatreon websiteHuman Dx caseDr. Marja AntonMarja is a chief medical resident at the University of Utah. She is originally fromChicago, IL and received her undergraduate degree from the University ofWisconsin-Madison (go Badgers!). She then moved back to Chicago for medicalschool at Loyola University Stritch School of Medicine. In her free time, you can find her traveling with her husband in their camper van, rock climbing with friends, tending to her garden or listening to the Clinical Problem Solvers! Next year she is excited to stay on at the University of Utah as an academic hospitalist.Dr. Guinn DunnGuinn is a first year Internal Medicine resident at the University of Utah. She wasborn and raised in Salt Lake City, received her undergraduate degree at theUniversity of Puget Sound, then headed back to Utah for medical school andresidency. She is interested in academic hospital medicine and quality improvement. She enjoys skiing, backpacking, and is looking forward to the birth of her first kiddo in a few weeks.Dr. Kavea PanneerselvamKavea Panneerselvam is about to complete her intern year at Baylor College of medicine in Houston, TX. She grew up in the Houston area and completed her undergraduate at the University of Texas at Austin and is a proud Longhorn, and obtained her medical degree at UT Houston. After residency she hopes to pursue a career in gastroenterology. Specifically, she has an interest in IBD. In her free time she enjoys playing board games, discovering new movies, and making art for her friends and family.

https://clinicalproblemsolving.com/wp-content/uploads/2017/05/Parteon-Announcement-Final.m4aEpisode descriptionReza and Rabih have an important announcement about the RLR series.More about the RLR series here.