Brady Pregerson, MD

A 40-ish-year-old male with a history of type 1 diabetes presents to the emergency department for 2 weeks of waxing and waning right groin & inner thigh pain that is aggravated by activity. Even at rest it is bad and he cannot sleep due to the pain.He even started using a cane for the first time in his life. He has had chills but denies any fever, injury or other complaint. He has no other past medical history and denies drug use.

Vital signs are normal except for a temperature of 99.3. Physical exam is normal except for limping and pain with forced internal rotation of the hip.

: WBC = 9.4, Hb = 12.9, plt = 519. CRP moderately elevated

: glucose 316, sodium 131. Everything else normal. No anion gap

Articles

This endocrine case report from Brady Pregerson, MD, features a man in his 40s with a history of T1D presenting with waxing and waning right groin and inner thigh pain. Can you determine the proper diagnosis? 

Endocrine Case Report: Hip Pain

A patient in their early-60’s with no known medical history presents to the ER with 30 minutes of chest pain radiating to his both armpits as well as to the anterior neck, but not to the back. The pain is not pleuritic but there is some dyspnea. He has had about 6 episodes in the past 3 days but this one is more severe and lasting longer. He does not use tobacco but does smoke marijuana; other than that he has no modifiable risk factors for CAD. He denies any known family history of early CAD or of PE.

Vital signs are normal. The physical exam is normal with symmetric pulses x 4

: NSR at 83, ST depression consider subendocardial injury
Credit: Bardy Pregerson, MD

Alert Cardiology Depending on Troponin Results

This cardiology case report from Brady Pregerson, MD, features a man in his early 60s with no known medical history presenting with chest pain radiating to both armpits and anterior neck, but not to the back. How would you react?

Cardiology Case Report: Armpit Pain

A patient in their mid-30’s with a history of hypertension, renal failure and CHF is brought to the hospital by rescue ambulance from home for peripheral edema and generalized weakness that has come on gradually over the past 3-4 days. He has missed dialysis at least twice and possibly more.

Vital signs are normal. Physical exam is notable for anasarca but the lungs are clear.

: NSR at 63, IVCD, minimal ST depression, prolonged QT

This cardiology case report from Brady Pregerson, MD, features a man in his mid-30s brought by ambulance after 3-4 days of peripheral edema and generalized weakness after a missed dialysis appointment. Can you determine the correct diagnosis?

Cardiology Case Report: Missed Hemodialysis

A woman in her early 50s with a history of type 2 diabetes and hypothyroidism presents to the emergency department for epigastric pain, vomiting, and headache for 5 days. She was seen yesterday in your ED and had belly labs and ultrasound, all of which are essentially unremarkable except for a fatty liver. 

A careful history reveals that the headache was actually the first symptom and the abdominal pain isn’t that bad and only started after the vomiting. When probed she also endorses chills and photophobia. She came back because she feels that yesterday the doctor only focused on the abdominal pain and once those tests came back OK, he seemed uninterested in her other symptoms.

She appreciates you asking more questions and it also comes up that she was admitted at another hospital a little over a month ago for “fungal pneumonia,” but she can’t remember any more details about that other than that she finished the medication about 3 weeks ago.

Vital signs are normal except for a BP of 161/99 and a temperature of 99.1. A physical exam is notable for initially having her head covered with a black sweater, an across-the-room clue to photophobia, and a positive jolt sign.

: normal except for WBC of 9.1 with 79% PMN’s

: opening pressure 35 with sputtering fluid

: glucose 30, protein 275, WBC 1,800 (50% lymphs, 15% PMNs), RBC 15

This endocrine case report from Brady Pregerson, MD, features a woman in her early 50s with a history of type 2 diabetes and hypothyroidism presenting with 5 days of epigastric pain. Can you determine the correct diagnosis?