A 35-year-old female presents with intermittent right arm pain and numbness that has been worsening for the last month. Symptoms are worsened by lifting her arm above her head. She has also noticed new hand swelling and a “cold” sensation in her fingertips. On exam, she has diminished sensation in the 4th and 5th digit with noticeable hand swelling. What is the diagnosis?
EM@3AM: Thoracic Outlet Syndrome Read More »
A 37-year-old African American female presents with persistent dry cough and generalized fatigue that has been worsening over the last two months. She has had some mild dyspnea on exertion but denies any fevers or unexplained weight loss. She has had a few episodes that she had attributed to the intensity of her cough. On exam, patient has some diffuse intermittent wheezing and a dry cough. There are a few enlarged lymph nodes in the cervical and axillary regions. She additionally has tender, warm, red, and firm subcutaneous nodules on her bilateral pretibial surfaces.
EM@3AM: Sarcoidosis and its Complications Read More »
A 35-year-old male presents with left eye pain and vision loss after an unwitnessed altercation. On exam, there is significant left periorbital edema and ecchymosis; the left eye appears mildly proptotic. He is unable to open the eye unassisted due to swelling and pain. His left eye has conjunctival injection, chemosis, and a dilated pupil, which is non-reactive to direct light but constricts in response to light shone in the contralateral eye. The patient is unable to participate in extraocular testing secondary to pain and distress. Intraocular pressures are 18 on the right, 42 on the left.
EM@3AM: Retrobulbar Hematoma Read More »
A 95-year-old man presents after waking with sudden inability to move the fingers and thumb of his right hand. He can lift his arm, flex and extend his wrist normally, and reports intact sensation. He denies numbness, facial droop, dysarthria, headache, gait disturbance, chest pain, or dyspnea. He has 0/5 strength in finger flexion and extension as well as in the intrinsic hand musculature, with preserved proximal upper extremity strength and intact sensation. He has no other appreciable deficits and normal vital signs. What is the diagnosis?
EM@3AM: Cortical Hand-Knob Stroke Mimicking Peripheral Nerve Injury Read More »
A 34-year-old male presents to the ED about 30 minutes after he slipped on ice while shoveling snow at his house. He currently has a superficial abrasion approximately 6 X 6 cm to his posterior scalp without any laceration present that could be closed with sutures. The abrasion is profusely bleeding. What is the next best strategy for managing this patient?
EM@3AM: Topical Hemostatic Agents Read More »
A 45-year old African American woman presents with progressive fatigue over the past week and has experienced intermittent episodes of severe hand pain that typically self-resolve. She has also noted a worsening headache over the last day. Her blood pressure is 197/105 mm Hg and heart rate is 90 bpm. The physical exam is notable for smooth and taut skin on the patient’s face and hands. Laboratory values show a creatinine of 3.1 mg/dL. What is the likely diagnosis?
EM@3AM: Scleroderma and Severe Sequelae Read More »
A 12-year-old girl presents to the ED with a 2-day history of headache and fever. The patient started vomiting with fevers this morning, and her mother was unable to wake her from her afternoon nap. She is lethargic and responds to painful stimuli with temperature of 38.2 C, blood pressure 88/65 mmHg, and HR 132 bpm. She has a petechial rash on her lower back and lower extremities, as well as resistance to neck flexion. What is the diagnosis?
EM@3AM: Meningococcal Disease Read More »
A 24-year-old female G4P1 who is 9 weeks pregnant presents with abdominal pain and vaginal bleeding for 3 days. Vital signs include HR 115, BP 100/76, T 38.7, RR 13, SpO2 99% on RA. She is ill-appearing and has tenderness to palpation of the bilateral lower quadrants and suprapubic region. Pelvic exam reveals blood in the vaginal vault and foul-smelling discharge from the cervix with no other abnormalities. What is the likely diagnosis?
EM@3AM: Septic Abortion Read More »
A 58-year-old male presents with 1 day of severe vertigo associated with nausea and vomiting, tinnitus, and sudden-onset hearing loss. He reports several days of left-sided ear pain and discharge from his left ear. Vital signs reveal T 38.9C, HR 120, BP 138/96, RR 18, SpO2 99% on room air. He is ill-appearing with an HEENT exam notable for an inflamed left external auditory canal with purulent drainage and an erythematous tympanic membrane with evidence of perforation. He has left-sided hearing loss, left-beating horizontal nystagmus, and a mildly unsteady gait. He has leukocytosis with bandemia. CT head shows no acute intra-cranial process. What is the most likely diagnosis?
EM@3AM: Suppurative Labyrinthitis Read More »
