Background: At Barnes-Jewish Hospital/Washington University residency programs, non-internal medicine interns undergo a significant portion of their training via the Hospitalist Medicine Division to fulfill their ACGME requirement of inpatient internal medicine. The hospitalist schedule is a 7-on and 7-off rotation, resulting in new attendings each week for both supervising direct patient care and leading intern [...]

Case Presentation: A 12-year-old female presented to the ER with a 1-week history of painful swelling of her right upper back not alleviated by NSAIDs or warm packs. She denied a history of recent trauma or fever. She has a history of surgical removal of a cranial myofibroma at 5 months of age and persistent [...]

Case Presentation: 53-year-old postmenopausal Caucasian female presented with low-trauma, recurrent metatarsal fractures. She reports her first metatarsal fracture at age 21, and since then had at least 8 more metatarsal fractures over her lifetime. On further inquiry, she reported history of gait disturbance as a child and dental issues (spacing and loosening). Labs showed normal [...]

Case Presentation: A 54-year-old never-smoker female with hypothyroidism and rheumatoid arthritis on etanercept presented with intermittent hemoptysis. Three days prior, she reported coughing ~100mL of frank blood and clots (Figure 1) over the course of 24 hours, with smaller volumes over the next two days (~50 mL total). She recounted a similar episode of hemoptysis [...]

Case Presentation: A 59-year-old man with a history of a chronic provoked bilateral pulmonary embolism with left lower extremity deep vein thrombosis (DVT), Non-ST-elevation myocardial infarction and hypercholesterolemia presented to the emergency department with acute, severe, constant left calf pain and swelling, exacerbated by standing. He stated that “I think I have another blood clot [...]

Case Presentation: 54 yo White Male with PMH of hereditary hemorrhagic telangiectasia (HHT) presented with right-sided focal neurological deficits, word finding difficulties, confusion and headache.  He was treated for a brain abscess with surgical resection and antibiotics X 1 month at an OSH attributed to recently sustained head trauma.  Follow up MRI 1 month later, [...]

Case Presentation: A 4-month-old unvaccinated male, presented with left-sided weakness and decreased activity. Initial physical exam demonstrated right gaze deviation, left hemineglect, decreased left-sided movements, and absent left plantar reflex. Labs showed leukocytosis 22.8 K/uL, anemia 8.6gm/dL, and thrombocytosis 661K/uL. CT brain demonstrated intracerebral edema in the distribution of the right middle cerebral artery (MCA). [...]

Case Presentation: A 69-year-old female with a medical history of morbid obesity presented to a rural hospital with a one-week history of extreme fatigue, malaise, jaundice, and anorexia. Her initial vital signs were unremarkable. Physical exam revealed a distressed-appearing woman with diaphoresis, scleral icterus, jaundice, and lower extremity edema. Laboratory findings revealed significant elevation of [...]

Case Presentation: A 16-month-old male with a history of reactive airway disease presented to clinic for evaluation of vomiting for four months. He had a history of chronic cough and had been started on acid suppression for gastroesophageal reflux but did not have any improvement in symptoms. His physical examination was unremarkable. He also had [...]

Case Presentation: A 36-year-old female with history of recurrent pleural effusion presented with worsening shortness of breath. One year prior, she was treated for presumed aspiration pneumonia after a moderate left pleural effusion and left lower lobe consolidation were noted on imaging. Initial ultrasound-guided thoracentesis revealed transudative pleural fluid, resolving her symptoms. Despite repeated therapeutic [...]