This is an uninsured 40 year old Hispanic female with a hist | Figure 1

mendozaPA-C

•Follow

Physician Assistant

Some actions are only available when you log in.

This is an uninsured 40 year old Hispanic female with a history of diabetes, hyperlipidemia, and hypothyroidism all refractive to treatment. Her PCP had her on 400 mcg of levothyroxine! She recently began complaining of chest pain, dizziness, and blurry vision. My physical exam was positive for a visual field defect. What's you DDx and next step?

Why you should join Figure 1

Case Summaries

Case 1

25 y/o male; pmhx hypothyroidism (unknown etiology). Presenting with frequent hot flashes, new/persistent acne breakout on back, stated inability for past thyroid levels to be regulated.

Case 2

client has elevated T3 but relatively normal levels for rest of thyroid panel. My thoughts for T3 blockage could be environmental toxins or possible candida? Opinion?

Case 3

impressive thyroid mass read as multimodal at goiter vs large thyroid nodule. Pt has dysphagia and SOB 3/3.

Case 4

64 y/o F presents with AMS, husband could not wake her up, so called the squad. Originally was a stroke alert but was canceled at the hospital. Pts sodium level was 123. CT head negative. Admitted to floor, had around a 30 second seizure, transferred to ICU, Na 118. Pt started on 3% saline at 25 ml/hr for 8 hours. Sodium level remained 121. Mental status remained the same: lethargic, sleepy, but was able to be aroused and follow simple commands before going back to sleep. Equal strength, PEERL. All vitals WNL. Vaprisol gtt started, infused for 8 hours, NA remained 121, urine output 200 for 12 hour shift. What is going on and why is her sodium level not budging?! History of non Hodgkin's lymphoma with a spot on her adrenal gland. Has been in remission for 8-10 years. Afib, OSA, GERD. Family states she has been sleeping most of the day for past 3 weeks. Pt was more awake as the day progressed, still repeating same questions about why she is admitted to the hospital. Anyone have any ideas??

Trending Cases

Trending Case 1

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

Trending Case 2

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

Trending Case 3

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Trending Case 4

patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?