Welcome back Clinical Problem Solvers. My name is Reza Manesh, a clinician educator at Johns Hopkins,

and a co-host for the Clinical Problem Solvers. Tonight episode is a clinical unknown, and we have a very

special guest, Dr. Bob Centaur. Dr. Centaur is Professor Emeritus of Internal Medicine at the

University of Alabama at Birmingham. He's chair

emeritus for the Board of Regents for the American College of Physicians and a retired

dean working part-time at Huntsfield and the VA in Alabama. Follow Dr. Bob Centaur on Twitter

at MedRance, M-E-D-R-A-N-T-S.

He also serves as the chairman for the curbsiders, my favorite internal medicine podcast.

Dr. Centaur is a P-G-Y-43, and tonight he presents a challenging case of hypercalcemia to Robbie and myself. We learned so much from him during the

recording of this episode, and we had a blast. We even talk about the Princess Bride and Andre the

giant. That's no clue to the final diagnosis. Remember to challenge yourself, as each aliquot of

information is presented, this is an opportunity to practice

applying your schema for hypercalcemia. Good luck. Hey folks, just a quick reminder that this

podcast is not meant to be used for medical advice, just good old-fashioned education.

Gentlemen, it's a pleasure to be on with you.

I've really enjoyed the podcast that you've started putting out and treasure listening to them.

I'd like to present a case to you that I saw in 1976. I'm not sure if y'all were alive back then. It was a really nice year. I was a second

year resident on the cardiology service at our VA. And so I come in to make rounds the next morning.

And back in the 70s, the resident would do work rounds from 8 to 9.

Then the resident would go off to morning report from 9 to 10 while the intern did scutwork.

And there was a lot of scutwork to be done.

And then from 10 to 12, we had sort of quasi attending rounds,

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