Rare/Interesting Topics

Disease  Sample Board Case
Thyrotoxic Periodic Paralysis: 31-year-old Hispanic male with  a PMH of HTN (on Bystolic) comes in with acute onset paralysis. Potassium 1.6 on admission. Monomorphic V-tach > V-fib in the ED > successfully shocked. Discovered to have thyrotoxicosis. Had received amiodarone, so couldn’t do thyroid scan.  Saw endocrine and nephrology in ICU.
Carcinoid tumor / Neuroendocrine tumor: Healthy, whole foods, natural medicine proponent presenting with classic symptoms of carcinoid tumor.
Mesenteric Ischemia.
Case #1
Elderly woman with chronic abdominal pain out of proportion to examination and explosive diarrhea. Pain had been going on for several months and two CT scans had been done.
Mesenteric Ischemia.
Case #2
Elderly woman brought to the ED with abdominal pain that started while she was eating dinner 2 hours prior. Daughter thinks she had over eaten. On PE, abd is hard and rubbery to touch and pain is out of proportion to physical exam. Patient with many children is c/o of pain that is greater than that of childbirth without anesthesia. On morphine but hardly enough. Surgery is not called at 9:00pm when the patient is seen but called in the morning. Surgery is delayed further 2/2 to family’s DNAR status. By the time surgery is done, colectomy is done because bowel was dead. Patient left with colostomy bag.
Tertiary Syphilis  HIV patient w/ Tertiary Syphilis
Heat stroke.   Pt in his 40s. Did meth, stayed in the hot sun in the desert, came in with heat stroke, temp 107 in the ED. The patient had burns on pressure points from lying on the back. Multi-organ failure.
Hermansky Pudlak syndrome type 3  25 yo with Hermansky Pudlak syndrome type 3 (which includes increased bruising, increased bleeding time, nystagmus , and oculocutaneous albinism) presents with recurrent episodes of syncope.
 Moyamoya Female in early 30s with stroke.Workup reveals moyamoya.