Background: Esophageal varices with bleeding (EVB) are one of the most common causes of deaths in cirrhotic patients in the United States. Over the course of years, studies have reported an increase in the incidence of EVB and is associated with a high risk for morbidity and mortality. Data is lacking with regards to recent [...]

Case Presentation: A ten month old male born at term with a past medical history of pneumonia diagnosed at six months of age presented with fever, cough and respiratory distress. His exam was notable for decreased breath sounds and crackles over the entire left lung. A chest x-ray was obtained and demonstrated near complete opacification [...]

Background: Proton pump inhibitors (PPI) are the mainstay of treatment and symptomatic remission in GERD. Recently, PPI over-utilization has been a major concern due to associated increased risk of adverse events and unnecessary healthcare cost. Internal Medicine residents treat patients with GERD and prescribe a significant amount of PPI. However, very few studies have assessed [...]

Background: Echocardiography is an essential evaluation in the diagnosis of infectious endocarditis (IE). Transthoracic echocardiography (TTE) is a portable study that is widely available and non-invasive. Though transesophageal echocardiography (TEE) is traditionally known for higher sensitivity and specificity, it is speculated that improvements in modern TTE imaging could produce higher diagnostic yield than previously thought. [...]

Case Presentation: A 57-year-old incarcerated male with end stage renal disease (ESRD) on hemodialysis, coronary artery disease (CAD), and Gastroesophageal reflux disease (GERD) presented to the emergency department with several episodes of hematemesis, shortness of breath and fatigue for the past 2 days without any associated abdominal pain, dysphagia, or odynophagia. On exam, he was [...]

Case Presentation: A 62-year-old male with a history of paroxysmal atrial fibrillation presented with hypotension and 2 week history of chest pain after an ablation with pulmonary vein isolation. Transthoracic echocardiography demonstrated a pericardial effusion. Pericardial fluid sampling revealed an elevated leukocyte count of 130,000 cells per cubic millimeter and culture grew rare strep mitis/oralis [...]

Case Presentation: A 22-year-old male with no medical history presented to the emergency department with a 4-day history of fevers and odynophagia which progressively prevented intake of solids and liquids. He reported associated shortness of breath with pleuritic chest pain. He appeared nontoxic with sputum collecting in a bedside cup. He had a fever of [...]

Case Presentation: A 55-year-old female presented with headaches and intermittent fevers. On initial examination, she had left hand weakness. Laboratory findings revealed leukocytosis; brain MRI demonstrated multiple bilateral cerebral infarcts. Initial workup was concerning for embolic stroke which initiated our search for a cardioembolic source. No significant abnormalities were seen on transthoracic echo (TTE) and [...]

Case Presentation: A 28 year old woman with a history of metastatic adenocarcinoma and peritoneal carcinomatosis with partial bowel obstruction presented with 6 days of progressive nausea and vomiting. The patient also reported chest pain that was associated with retching and mild shortness of breath. She experienced change in vocal quality over the past few [...]

Case Presentation: A 70-year-old female with a complex medical history including Barrett’s esophagus, Class 3 obesity, obstructive sleep apnea, obesity, atrial fibrillation, and adenocarcinoma of the esophagus in remission, presented with three days of intractable nausea, vomiting, and epigastric abdominal pain. She categorized the pain as sharp and radiating to the right and left upper [...]