Clinical Cases & Journal Review

Hanna Richkind, Elaine Yu A 37-year-old woman with a past medical history of anxiety, insomnia, chronic low back pain, and intermittent lower abdominal pain presented to the Emergency Department with several days of worsening lower abdominal and back pain. Her symptoms acutely worsened after eating a meal and were accompanied by nausea, vomiting, and diarrhea. Although the vomiting and diarrhea subsequently resolved, she continued to experience lower abdominal discomfort with pain radiating to the left flank and mid-back. At times, the severity of the discomfort caused her to crouch for rel...

Rachel Feiner MS4, Anthony J. Medak, MD A 38-year-old female at 12 weeks gestation presented to the ED with acute-onset abdominal pain following intercourse with associated dizziness, nausea and diarrhea, which started the night before her presentation. She also described dizziness and presyncope on standing. She denies any vaginal bleeding, cramping, fever, or chills. PMH: Asthma, Dog allergy, DeQuervain's tenosynovitis OB Hx: G4P2022. Cesarean section, Low Transverse in 2020 for arrest of dilation. Cesarean section, inverse-T uterine incision in 2023 for transverse presentation. ...

Matthew Van Ligten, Bryan Merte A 52-year-old woman with epilepsy treated with levetiracetam and lamotrigine, hypertension, and non-Hodgkin lymphoma previously treated with chemotherapy and in remission presented after being found confused and incontinent of urine. Her daughter found her staring blankly after being unable to reach her by phone for approximately one hour. As the patient remained postictal and was a limited historian, additional history was obtained from emergency medical services. Paramedics had been called for what appeared to be one of her typical seizures with prolonge...

Olivia Yale, Colleen Campbell A 40-year-old male with no pertinent past medical history apart from significant cigarette use presented to the emergency department, referred from urgent care, for SOB and outside CXR concerning for a large right pleural effusion. The patient stated that over the past two months, he has had increasing SOB, coughing fits, and a 20-lb weight loss. The patient was born in Costa Rica but has lived in the United States for most of his life and is fully vaccinated. He denied any recent viral illness, recent travel, sick contacts, fever, abdominal pain, rashes, or ch...

A. Elashmawy, B. Merte, and A. J. Medak Chief Complaint: Left knee pain and swellingHistory of Present IllnessA 63-year-old male with a past medical history of hypertension and diabetes presented with five days of progressive left knee swelling, redness, and discomfort. Symptoms were localized to the midline area inferior to the patella. The patient described worsening swelling, warmth, and tenderness to palpation in the area. He denied fever, recent trauma, or prior similar episodes. The patient had recently been prescribed trimethoprim-sulfamethoxazole, but he had not started taking the m...

Maya Ibelaidene, Rachna Subramony A 45 year old male with a past medical history of gastric sleeve presented to the Emergency Department with two days of progressively worsening right upper quadrant (RUQ) abdominal pain. The pain was constant, dull in character, and radiated intermittently to the back. It was associated with nausea, vomiting, fever, chills, but no chest pain, or changes in bowel habits. He denied prior similar episodes, alcohol misuse, or known gallstone disease. There was no history of liver disease. Vital Signs: BP 130/83 mmHg | HR 56 | T 98.7°F | RR 18 | SpO₂ 100% ...

Sabrina Straus, Rachna Subramony A 68-year-old female with no past medical history on file presented to the emergency department for evaluation of a painless red left eye and visual disturbance. She reported noticing a horizontal line across her vision in the left eye for approximately one month. She described the visual phenomenon as a wave-like, ribbon-shaped distortion that appeared suddenly while she was at rest and had remained unchanged in severity since onset. She denied eye pain, headache, diplopia, vertigo, focal weakness, sensory deficits, or other neurologic symptoms. She also...

Sargis Manukyan, Akash Desai Point-of-care ultrasound (POCUS) is an important tool for today’s practitioners. Studies have supported the use of POCUS in many clinical decision-making scenarios compared solely to standard examinations and other imaging modalities1. Its integration in the emergency medicine (EM) setting has been pivotal and is now gaining momentum for implementation in internal medicine (IM).1 POCUS differs from formal radiological US assessments in that it is a fast, dynamic bedside tool that both performed and interpreted by the sonographer-physician.2 A recent systema...

Hannah Oelschlager MD, Aarish Shahab MD, Rachna Subramony MD, Bryan Merte MD A 63-year-old man with bladder cancer and type 2 diabetes mellitus presented on postoperative day 8 after robotic-assisted laparoscopic radical cystoprostatectomy with orthotopic neobladder creation. He had been discharged three days earlier with a transurethral Foley catheter in the neobladder and externalized ureteral stents draining into an abdominal collection appliance. His postoperative course had otherwise been uncomplicated, with adequate urinary drainage before discharge.  D...

Liam DiZio, Elaine Yu A 43-year-old female with a history of hepatic adenoma status post embolization and microwave ablation presented to the emergency department with one week of constant right flank and right lower chest wall pain. She denied fever, nausea, vomiting, dysuria, hematuria, chest pain, dyspnea, or recent trauma. An outpatient ultrasound performed two days prior demonstrated an 8 mm nonobstructing right renal calculus. Given her history, recurrent hepatobiliary pathology, nephrolithiasis, and musculoskeletal pain were at the top of her differential. Vital Signs: BP 121/89 |...