Core Cases of the Month

March 2016

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"a piece of turkey stuck in my throat"

HPI

39 yo F with no PMH presented with “a piece of turkey got stuck in my throat” during dinner. Immediately afterwards, reports non-bloody, non-bilious vomiting with relief of foreign body sensation. Now unable to swallow saliva. Denied any fever, throat pain, chest pain, shortness of breath, trouble breathing, voice changes, cough, nausea, abdominal pain, back pain. Currently has no pain.

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January 2016

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Injury to R hand

HPI

51yo right hand dominant man presents one hour after high-pressure epoxy paint gun accidental injury to right hand. Patient states that while testing a paint gun, a stream of paint hit his hand causing 2 puncture wounds to his palm. Denies paresthesias, weakness. Patient complains of swelling to area of puncture with mild bleeding.

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December 2015

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"I slept all day"

HPI

Patient presented 3 weeks ago to ED with fever and dyspnea and was found to be HIV positive with PCP pneumonia. He was started on treatment with Bactrim, prednisone and HAART.

He was feeling well since discharge, compliant with all medications until 2am the day prior when he took melatonin as a sleep aid. He then woke up 18 hours later. When he woke, patient reports feeling generally fatigued but has no specific complaints. Denies sick contacts, fevers/chills, increased cough, abdominal pain, nausea/vomiting/diarrhea, rash, headache, neck stiffness, dysuria, back pain.

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November 2015

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Shortness of breath two hours after arthroscopy

HPI

75 yo F presents with shortness of breath 2 hours after arthroscopy. Patient states she had an outpatient arthroscopy of R shoulder that was uneventful but felt short of breath at discharge, about 30 min post-procedure, that is now progressively worsening.  Denies chest pain, fevers/chills, cough, nausea/vomiting.

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October 2015

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Refusing to bear weight on left leg x2 days

HPI

Two year-old girl brought in by mom for refusal to bear weight on left leg for the past 2 days. Mom noticed two “bug bites” on the pt’s left knee with surrounding erythema and swelling three days ago. Two days ago, the patient started refusing to bear weight on her L leg. The following day, the pt was seen by pediatrician who prescribed Keflex with improvement in erythema but she is still refusing to bear weight prompting presentation to the ED.  Denies any trauma, fever, vomiting, other rashes, tick bites, similar previous episodes.

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September 2015

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R flank pain x 3days

HPI

32 yo M w/no PMH reports 3 days of constant, dull, non-radiating progressively worsening R flank pain. He went to outside hospital 2 days ago and was told that he had kidney stones. Per his CT report he had “minimal R perinephric infiltrative changes without evidence of nephrolithiasis.” He denies a history of previous stones, denies fever, chills, chest pain, shortness of breath, dysuria, hematuria, abdominal or groin pain, illicit substance use, family history of kidney stones/clotting disorders.

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August 2015

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Right wrist pain

HPI

19 yo RHD M with no PMH presents with R wrist pain. Patient was snowboarding today, jumped into air, fell backwards onto hyperextended R wrist. Seen in mountain clinic, was told most likely ligamentous injury and sent home. Took Tylenol, but continues to have significant pain, concerned about fracture. Denies injuries to head or anywhere else.

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July 2015

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96 yo woman with h/o Afib, HTN and CKD presents with altered mental status

HPI

The pt’s family notes that she has been lethargic for the last 24 hours with decreased appetite. They also note she has developed a diffuse non-pruritic, erythematous rash and a low-grade fever. The patient is high functioning at baseline and performs most ADLs independently. She reports having slipped in shower, but was able to grab onto railing and denies head trauma or LOC.

Currently she denies any complaints. No HA/visual changes, sick contacts, recent hospitalizations.

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