Background: Early development of clinical reasoning and problem-solving competencies are essential in generating individualized, outcome-based, and cost-effective patient care plans (Nat Acad Press 2015). However, few medical schools and residency programs have an explicit curriculum in clinical reasoning (Graber et al., 2012). A recent survey of internal medicine clerkship directors found medical students receive limited [...]

Background: Hospitalists routinely precept third year medical students on general internal medicine wards. One of the key patient care tasks for students is to present and interpret common laboratory test abnormalities. Formal training in interpreting routine diagnostic tests is lacking for students transitioning from preclinical to clinical years. We designed and implemented a module on [...]

Case Presentation: A 61-year-old man presented to his primary care provider’s office but could not recall reason for his visit. Over the past year, there had been numerous instances of similar forgetfulness, oftentimes upon completing routine activity without additional symptomatology. Medical history was notable for factor V Leiden, hypothyroidism, and transient ischemic attacks. Physical examination [...]

Case Presentation: A 78-year-old man with medical comorbidities of CAD with PCI to LAD and LCx, persistent A. fib, COPD, HTN, and Type 2 Diabetes Mellitus was admitted to our hospital for worsening epigastric pain, nausea, and vomiting. Prior to the presentation, he was treated for an upper gastrointestinal bleed secondary to duodenal ulcers. Dabigatran [...]

Case Presentation: A 47- year-old man with a history of hypothyroidism presented to the emergency room (ER) for the evaluation of generalized body weakness and jaundice of a week duration. There was also associated intense generalized pruritus of about 6 months; subjective weight loss, recurrent fevers, nausea and vomiting. Physical examination was significant for an [...]

Case Presentation: A 37-year-old Hispanic female with no medical history presented to the hospital with bilateral lower extremity edema of 3-week duration. Concurrently, she also experienced dysphagia to solids associated with 30-lb weight loss and low-grade fever. Initial examination was significant for bilateral erythematous rash of lower extremities with 3+ pitting edema that extended from [...]

Case Presentation: Pericardial effusion is relatively common in patients with uncontrolled hypothyroidism, but rarely, it progresses to cardiac tamponade. We describe a case of myxedema coma presenting with cardiac tamponade.   Discussion: A 63-year-old African American morbidly obese lady with history of hypothyroidism presented with worsening dyspnea and unresponsiveness. Family reported that she is non-compliant [...]

Case Presentation: An 88 year old female with no past medical history presented to the ED with low back pain, chronic cough and one episode of pinkish sputum.  Chest CT showed bilateral nodular lesions. Serological tests including ANCA were sent before her discharged home. Next day, she returned with acute right lower extremity weakness and [...]

Case Presentation: A 61-year-old male with history of hypertension, asthma, and morbid obesity presented with left arm, chest, and face numbness, back pain, and shortness of breath at rest. He denied weakness with the numbness. His symptoms were akin to “being kicked by an elephant.” These symptoms had been worsening for one week prior to [...]

Case Presentation: A 72-year-old man with known multiple myeloma is admitted to hospital for initiation of chemotherapy due to cancer progression. He was first diagnosed with smoldering myeloma in 2003. He was then diagnosed with multiple myeloma after a bone marrow biopsy in 2021 revealed 98% plasma cells. One year after diagnosis, he started noticing [...]