Blood sugar 524. Would you send him home?
I know of another doc sending a 19 y/o athlete to the ER with a c/o myalgias, fatigue, polydipsia and polyuria. BS in his office was 438. No known h/o DM. Pt sent to ER for fluids/bloodwork/management and possible/probable admission.
Authored by a Family Medicine, OBGYN Physician

Clonazepam and Diazepam plus alcohol for sleep - what to do?
70 yo old very robust, educated white male taking no medications for HTN, cholesterol, etc. Type A, successful businessman, still working some. Broadly allergic to many herbal compounds such as melatonin and valerian root (skin rash). Was prescribed clonazepam for sleep problems 30 years ago and has continued use.
Authored by an Ophthalmology Physician

Cardiac Arrest in an 81yo Female
In the aftermath of "Hurricane" Irene, nearing the end of my ED shift, EMS called in that a BLS crew was bringing in an 81yo female in cardiac arrest from home, no ALS available. I cynically told the other docs who were on that I would take this one since...
Authored by an Emergency Medicine Physician

Need help with necrotic fingertip
4 yo healthy male saw dermatology 13 days ago for a wart on the tip of his right 5th finger. The wart was destroyed chemically with cantharin application per mom. The next day a brown blister began to form at the area of the topical application.
Authored by an OBGYN Physician

Superficial vs deep vein and what would you do?
there is acute occlusive DVT in two pairs of Gastronemius viens, from the pop fossa to the proximal calf. The gastrocnemius veins are dilated and non compressible. The pop vein is not invovled.
Authored by an Internal Medicine Physician

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Priorities- Please Give Some Input what to Tx 1st.
Corporate executive type patient w/ h/o morbid obesity, HTN, ankylosing spondylitis, obstructive lung disease of undetermined etiology, he calls it "adult onset asthma" (but I suspect it's actually due to GERD). He takes Benicar HCT, Mobic for back pain, Singulair and Advair (on and off if sx get worse) presented in the late winter for assistance with weight loss.
Authored by an Internal Medicine Physician

FDA recommending Celexa not be used at over 40 mg
The U.S. Food and Drug Administration (FDA) is informing healthcare professionals and patients that the antidepressant Celexa (citalopram hydrobromide; also marketed as generics) should no longer be used at doses greater than 40 mg per day because it can cause abnormal changes in the electrical activity of the heart.
Authored by a Psychiatry Physician

iConsult - Otolaryngology
When you take out a retained tube there for years with small surrounding small hole, is it really worth doing a paper patch? I have not been impressed with paper patch success Any tricks on keeping the patch on??
Authored by an Otolaryngology and Pediatric Physician

Pain management conundrum.
Patient with chronic pelvic pain being evaluated for possible diagnostic lap.
Authored by an OBGYN Physician

13 yo male w/UTI
pt is a 13 yo male who in july had several weeks of GI sxs ie "gassiness", swollen stomach, intermittent vomiting, stools loose and "explosive"; exam shows hypoactive BS and epigastric and LUQ tenderness w/o peritoneal signs; checked KUB, cbc, lytes, urine-all nl...
Authored by a Femily Medicine and OBGYN Physician

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How would you handle this pain patient?
40's female, 7 years out from MVA which led to chronic MSK (no fxs) pain on opioids coming to your clinic for the first time. States she has been weaning opioids due to gastroparesis and now has significant increase in pain. Comorbidity obesity, anxiety, depression, fibromyalgia, on disability.
Authored by a Pain Medicine, Anesthesiology Physician

Eleven year old can't eat.
An eleven year old hispanic male has been having stomach aches for two years. Initially, he was seen and told it was due to stress/anger and to be more calm. Bloodwork done then was nl, including LFTs, CBC, h.pylori. .
Authored by a Pediatrics Physician

Hypertensive urgency, when to send to ER?
Do you have a certain threshold blood pressure value where you will reflexively send a patient to the ER for admission? Assuming an asymptomatic patient, would you send someone with a blood pressure of 250/110 to the emergency room?
Authored by a Internal Medicine Physician

"Do you smoke crack?"
I have 2 of these patients on service, one in the burn unit (pictured). They both smoke crack, one is neutropenic. What are your thoughts?
Authored by a Dermatology Physician

Unusual Case - Acute Retinal Necrosis from CMV?
She is an 81 yo F with an ocular history including advanced glaucoma OU s/p failed trab OD. She is phakic with a mild cataract OD and pseudophakic OS. No recent eye procedures or surgeries.
Authored by an Ophthalmology Physician

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Newborn with skeletal abnormality
This 34 week gestational age female infant was born to a 21 yo G2P1 mother whose first child was normal. Delivery was by induction for worsening polyhydramnios.
Authored by a Pathology, Pediatrics, OBGYN Physician

Brown recluse identification and bites (Educational)
So, a gentleman in his mid thirties presents to you with this wound on his elbow. It is centrally fluctuant, with a little purulent drainage. He first noticed pain about 2 days ago. He might have had some subjective fevers, but otherwise no systemic symptoms.
Authored by a Emergency Medicine Physician

Five Days Old baby girl with blood in diaper!
The attached picture of diaper show fresh red blood on a diaper of a 5 days old baby girl. The material tested positive for blood. She has been having it for the last three days, mother brought diapers along with.
Authored by a Pediatrics, Psychiatry Physician

Facial papules in a 9 year old, molluscum?or other?
This 9 year old girl has had these flesh colored papules since age 3. Have been calling it molluscum but I'm not so sure, have never gotten inflamed,none have ever disappeared.
Authored by a Pediatrics Physician

Foreign body ingestion in a child
A 5 yrs old ingested a coin. No tracheal compromise. No acute issues. Serial X rays ordered. After more than 24 hrs hrs its still in stomach. Should the patient have an upper GI endoscopy to retrieve the coin or can it be watched closely for another day or two?
Authored by a Family Medicine Physician

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