#21 57F with confusion: Hoofbeats segment

Core IM | Internal Medicine Podcast

Core IM Team

Mental Health, Education, Health & Fitness, Medicine

4.8 • 1K Ratings

🗓️ 15 August 2018

⏱️ 36 minutes

🔗️ Recording | iTunes | RSS

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Summary

Dissect an interesting case and think about the way clinicians think! Many clinical reasoning pearls here: * Case history and exam 00:40 * Causal models 11:24 * Facets versus diagnoses 13:25 * Problem representation 16:37 * Part two of the case 17:10 * Occam’s razor, Hickam’s dictum, and Crabtree’s bludgeon 23:00 * Diagnostic uncertainty 27:10 * Learning points 34:24 For show notes: https://www.coreimpodcast.com/2018/08/15/hoofbeats-57f-with-confusion/ (https://www.coreimpodcast.com/2018/08/15/hoofbeats-57f-with-confusion/) Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

Transcript

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0:00.0	Hi everyone John Wong here. I want to welcome you back to another episode of Hoofbeat. In this segment, we challenge you to solve
0:15.9	diagnostically difficult real world cases alongside experienced clinicians. As always, I'm here with my partner,
0:22.3	Dr. Cindy Feng.
0:24.0	Hi everyone, this is Cindy Feng.
0:26.0	So this week we are tackling one of John's cases,
0:29.0	back from last episode to walk us through this case
0:32.0	is our colleague Dr. Shriatravedi.
0:34.8	All right, so this is a case of a 57 year old woman that's admitted to you for confusion and
0:41.2	word-finding difficulties for one day. So for her history it's in part provided by accompanying family
0:48.7	members who brought her to the ED after noticing that over the past day, she's been saying things that don't really make
0:56.8	sense. She seemed to have trouble with placing her words, and at times those words would slightly be slurred.
1:05.0	The symptoms were completely new for her.
1:08.0	The patient is complaining of moderate to severe headaches
1:12.4	that are bilateral over the temples and the vertex
1:15.3	lasting for the past several hours.
1:18.9	She has been experiencing similar but milder headaches intermittently over the past several months, but they were less problematic and usually relieved with
1:27.0	endset. She also notes subjective fevers which she first noticed months ago.
1:34.4	They were infrequent at that time, but over the past week have become prominent.
1:38.9	She also reports an ongoing rash over her legs, which she describes as slightly itching but not painful.
1:47.3	The rash has actually fluctuated over the last six months.
1:51.6	Initially, she saw her PCP who empirically prescribed her two
1:56.1	weeks of prednisone and mycophonolate. The rash improved, but when that
	...

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