Case Presentation: A 17 y.o. female with systemic lupus erythematosus (SLE) presented with several weeks of worsening migratory polyarthralgia, as well as sporadic fevers, night sweats, and chills. Prednisone was begun 3 weeks prior for a presumed SLE flare, given elevated anti double-stranded DNA (anti-dsDNA) and erythrocyte sedimentation rate (ESR) and hematuria, but provided no [...]

Background: Diagnostic consultations between the General Internal Medicine (GIM) departments and specialty departments are becoming increasingly important to achieve team-based diagnosis and diagnostic excellence, but there have been limited studies on the appropriateness of the GIM diagnostic consultations with specialty departments. We conducted this study to clarify the appropriateness of diagnostic consultations from the GIM [...]

Background: Clinical documentation is essential for adequate representation of patient quality care metrics and accurate diagnosis capture but rarely taught in graduate medical education. Inaccurate capture of diagnoses leads to clinical documentation integrity (CDI) queries, which increase workload on busy providers. Implementation of a standardized note template for our resident physicians previously resulted in an [...]

Background: The diagnostic process, inherently fraught with uncertainty and susceptible to errors, has been associated with adverse outcomes when physicians exhibit lower tolerance for uncertainty (1,2). The Diagnostic Time-Out (DTO) serves as a structured tool to outline a problem representation, prioritize the differential diagnosis, and communicate diagnostic uncertainty in high-risk situations for diagnostic errors. In [...]

Case Presentation: 21 cases of small intestine anisakiasis were analyzed in terms of medical history, examinations of symptoms, vital signs, laboratory data, and CT findings. 9 cases were identified through specific anisakiasis Immunoglobulin E or Immunoglobulin A testing. 2 cases were confirmed by the detection of anisakis by endoscopic examination. 10 cases were diagnosed based [...]

Case Presentation: A 29-year-old man with a history of morbid obesity, asthma, and chronic tracheostomy presented with 3 weeks of abdominal pain. The pain was intermittent and epigastric, without relationship to eating. He had poor appetite and nausea, though no emesis. He denied use of ibuprofen or alcohol. He denied fevers or chills. The pain [...]

Case Presentation: A 22-year-old male with no past medical history presented with a three-week history of a frontal headache associated with nausea and vomiting. He denied various symptoms, including bloody diarrhea, dysuria, or hematuria. He had no history of renal calculi, recent illness, antibiotic exposure, or drug allergies. He recently traveled to Jamaica and Florida [...]

Case Presentation: A 48-year-old male with major depressive disorder, bipolar disorder and borderline personality disorder with multiple psychiatric admissions was admitted to the hospital for sepsis secondary to aspiration pneumonia with associated chronic dysphagia and unintentional weight loss. He also reported suicidal ideation, homicidal ideation, and intrusive thoughts of hurting others. Per family he had [...]

Case Presentation: A 70-year-old man visited our hospital for lower extremity edema and involuntary weight loss. A routine check-up at his diabetes clinic five months earlier revealed anemia and an increased inflammatory response. His medical history included hypertension, dyslipidemia, and type 2 diabetes. Computed tomography (CT), blood cultures, gastrointestinal endoscopy, and colonoscopy findings were unremarkable; [...]