#29 A 43M with Diarrhea: Hoofbeats Segment

Core IM | Internal Medicine Podcast

Core IM Team

Mental Health, Education, Health & Fitness, Medicine

4.8 • 1K Ratings

🗓️ 5 December 2018

⏱️ 33 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: Time stamps: * Case [1:19] * Diagnostic weight [8:42] * Hypothesis driven reasoning [12:26] * Anomalous clinical data [19:30] * Final diagnosis [22:20] * Take away points [31:21] Human Dx Case link: https://www.humandx.org/o/co7yrer3dim2y59t5c0sbd370?s=FEED (https://www.humandx.org/o/co7yrer3dim2y59t5c0sbd370?s=FEED) For show notes: https://www.coreimpodcast.com/2018/12/05/hoofbeats-43m-with-diarrhea/ (https://www.coreimpodcast.com/2018/12/05/hoofbeats-43m-with-diarrhea/) 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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0:13.0	Hi everyone. This is Cindy Fan. I want to welcome you back to another episode of Foodbeats. In this segment we challenge you to solve
0:16.0	dynastically difficult real world cases alongside experienced conditions.
0:20.0	As always, I'm here with my partner, Dr. Jean-Hwang.
0:24.0	Hey everybody.
0:25.0	So if you remember on our last episode, we invited you to submit your diagnoses to us
0:30.0	via the online case platform HumanDX, so that we could crowd source a collective differential
0:35.2	diagnosis.
0:36.2	And we purposely chose a case in which the final diagnosis was kind of a questionable one,
0:40.8	one that we could practice subjecting to scrutiny and to slightly subvert the concept of the case didactic I think.
0:47.0	Well we're going to do things a little bit differently in this episode.
0:49.9	For starters we have already submitted this case to HumanDX a while ago incognito and so
0:56.0	we already have a collective differential which we can analyze later and this time
1:00.1	we've got a case with a definite answer which will reveal at the end of this episode.
1:05.0	So you're a hundred percent sure of the answer?
1:07.5	As close as can be reasonably expected.
1:09.5	I mean nothing in medicine is a hundred percent after all. Well that's very meta. Without further do
1:15.0	let's hear this case from our colleague Dr. Marty Free. All right thanks for having me
1:19.8	again guys. So today we're going to talk about a 43 year old man presenting with one week of diarrhea.
1:26.0	Two weeks prior to presentation, the patient started developing dysmia on exertion.
1:30.0	His exercise tolerance went from unlimited to five to six blocks due to shortness of breath
1:35.0	also associated with two-pillow orthopnea.
1:38.0	One week later, he developed profuse, watery, non-bloody diarrhea.
	...

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