Figure 1

Interested to see if anyone can give me a spot dx on this? Pt was an elderly male with TBI s/p 8 foot fall off his camper. He was unresponsive to pain and intubated for 2 weeks. When emptied his urine bag I noticed this white colored clusters floating in the urine. I eventually noticed them more and more and scooped a few out to investigate further. Once emptied from the bag, these clusters would float to the top of the urine. They had a very crystallized appearance almost like a sandy/sugary texture.

I have seen tiny clumps of fat in blood samples of pts with high cholesterol/lipids before and that is what these reminded me of at first, but the texture of these clusters was very gritty and they were delicate, almost like a chain link, not lumpy like the fat in the blood.

Update to previous care where pt hit his lower leg and developed an eschar. This looks like blood clots to me. I don't see any sign of infection.

40 year old non smoking male caught me in the hallway and told me he was scheduling an appointment because he was urinating blood. He told me he had noticed some occasional low back pain radiating to his testicles, no other symptoms. Well appearing, discussion about his symptoms was very matter-of-factly. Because my schedule was full, ordered UA to confirm suspicion of stones and ordered flomax.

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.

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.

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.

70 yo WF with 20y hx HTN lost 21 lbs on a semaglutide but still BMI over 30, shows drop in BP when standing, stabilizing at 102-116 systolic, 65-75 diastolic. Discontinued all HTN meds x 30 days and no episodes of HTN. Could a small weight loss like this cause a drop to normal BP? Has anyone heard of a side effect of lowering BP?