Background: Multiple educational modalities have been utilized to teach high value care to trainees, including lectures, facilitated group discussion, and behavioral nudges and prompts (1–3). However, little has been done to compare different educational strategies delivered via the same modality. The goal of this study was to explore whether different educational prompts encouraging thoughtful lab [...]

Case Presentation: A 28 year old pregnant female G1P0 (31 weeks) presented with shortness of breath and fever. She was Covid-19 positive by PCR. We present a case of a pregnant woman with Covid-19. On admission she was hypoxic with oxygen saturation of 94% on 6 liters oxygen. Pulse 120-130, Temp 101 F. PE was [...]

Case Presentation: A previously healthy 5 year-old boy presented to the emergency room with a “red and swollen penis”. No history of trauma or inciting event. The day prior, he complained of suprapubic pain and had 4 episodes of NBNB emesis. No fevers and otherwise negative ROS. Labs in the ED were significant for a [...]

Background: Wilson Disease (WD) is a known cause of liver test abnormalities. Guidelines have been established to help clinicians avoid routine testing. According to the American Association for the Study of Liver Diseases (AASLD) Guideline, screening for WD—with serum ceruloplasmin, 24-hour urinary copper excretion, and slit-lamp examination for Kayser-Fleischer rings—is warranted in any patient with [...]

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 73 year old female with a PMH of CKD 3a, GERD, and laryngeal cancer s/p total laryngectomy presented with epigastric pain for one day, radiating to bilateral upper abdominal quadrants, nausea, and vomiting.On exam the patient was hypertensive (240/90s), but otherwise hemodynamically stable. Lab work was unremarkable. A HIDA scan showed acute [...]

Case Presentation: An 88-year-old woman with a history of hypertension, atrial fibrillation, and HFpEF presented with a right femur fracture following a mechanical fall. Physical exam revealed a right femur fracture and small ascites. The patient underwent a right hemiarthroplasty on hospital day (HD) 4 and received cefazolin perioperatively.On HD 9, the patient developed abdominal [...]

Background: Gout is a condition that is commonly diagnosed and treated in hospitalized patients. The gold standard for diagnosis of gout is identification of negatively birefringent, needle shaped uric acid crystals within neutrophils in fluid obtained by joint aspiration of affected joints. There have been a number of small studies that have shown serum uric [...]

Case Presentation: A 54 year old African American female with a past medical history of significant tobacco use presented with worsening shortness of breath and increased cough. She reported having hemoptysis 2 months ago which resolved, unexplained weight loss (30 lbs over 6 months), orthopnea, and diaphoresis. Physical examination was positive for wheezing and rhonchi, [...]

Case Presentation: A 70-year-old male presented with generalized fatigue and worsening shortness of breath with exertion. A diagnosis of acute exacerbation of heart failure was made. Initial evaluation with echocardiogram and MRI raised suspicion for amyloidosis. A PYP scan was performed, which was not suggestive for transthyretin amyloidosis (ATTR). Serum free light chain (sFLC) testing [...]