Also seeing as I am the epitome of a black cloud there are supposed to be tornadoes in my area tonight.

I really hope this doesn’t happen as I would like to make it out unscathed tonight and would like a night free of trauma.

Case presentation was here

So, most people guessed hyponatremia. Which was a reasonable diagnosis and was one of our differentials but not our first. Sodium levels on the CMP were in the mid 120s. While low, not low enough to cause the memory issues the parents were reporting. 

The patient actually had Wernicke-Korsakoff Syndrome as was shown by her reduced thiamine levels. Although normally seen in alcoholics, it can now be seen in bariatric surgery patients due to malnutrition and is made worse if they don’t follow post op instructions carefully. Thiamine deficiency results in heavy damage to the mammillary bodies of the hypothalamus, as well as damage to the connections between them, the prefrontal cortex, thalamus. Her presentation of symptoms wasn’t so heavy on signs of Wernicke’s encephalopathy, with her only real manifestation being her weakness and ataxia. However, her very interesting story about sally gave a hint towards Korsakoff syndrome. Korsakoff’s syndrome can present with confabulation, where the patient actually believes a false story in lieu of having amnesia about that period of time. The patients don’t know they’re lying and generally and strongly believe that what they’re saying is the truth. They also have problems with anterograde amnesia, on varying levels of severity. Kelly had issues forming new memories and was seen by her inability to remember speaking to her parents only 5 to 10 minutes after their conversations.

Why the thiamine deficiency with her? Thiamine is primarily absorbed in the duodenum, which is bypassed during gastric bypass. Couple this with a probably poor diet before her surgery and the N/V afterwards (extremely common side effect in bariatric surgery of any kind) led to too much of a thiamine deficiency, hence her strong belief that she had gone on a strawberry milkshake ridden adventure.

I gotta give props to WayfaringMD for starting the trend, but here’s a fun way for everyone to get all knowledgeable

Presentation: A younger woman Kelly, in her mid to late 20s presents to the ED with her parents. Per the family, Kelly presents with complaints of amnesia, generalized weakness, and nausea/vomiting for one week. They say that about 2.5 weeks ago their daughter had a gastric bypass due to her weight and everything had been progressing fine until about one week after the surgery when she began vomiting, although they are unsure of a more exact time frame as they both work demanding jobs. They say she slowly had increased generalized weakness and became more bedridden than normal, being unable to get out of bed without their help. This progressed until Kelly was vomiting at least once after every “meal”. Last night, they noticed that she was having some memory problems. She couldn’t seem to remember the events of her day correctly and even seemed to be outright lying. She was adamant that she had driven her friend Sally to the movies that day so they could see a movie they both wanted to see, even though their daughter is to weak to get out of bed…and sally moved to another state three years ago. Kelly would also forget having conversations with her parents just five or ten minutes after having them. While they tell this to you, Kelly adamantly says that she saw sally yesterday and after the movies they went out for Hamburgers and Milkshakes. She says she knows this is true because they both got strawberry milkshakes, which is their favorite flavor.

I think this should be enough to give a good guess
What do y’all think?

Anonymous asked: Why do you want to be a doctor?

this is the first time I’ve ever gotten this question surprisingly.

I’ve wanted to be a physician since I took my first medical science class when I was in 10th grade. I was hooked. It felt like I had stepped into a wonderful never before seen world that fascinated me. I loved learning about the intricacies of the body and the unique ways that health professionals help save lives and improve the lives of their patients. Medicine to me is exciting but yet still gives me the intellectual stimulation I need. In medicine you’re always thinking and challenging yourself to come up with dynamic solutions that fit to the situation at hand,something I find extremely appealing. I also want to be a physician because I believe it puts me in the most opportune place to help people and give back to the community. Of course most people say this, but I really do believe it. That isn’t to say being a physician isn’t the only way to “help people”, but it is the only career where you can get the satisfaction of helping those in need culminated with the ability to be constantly having to learn and improve in a constantly changing environment. Everyday as a physician you improve the lives of so many people and improve their quality of life. Giving back to the community is something I was taught at a very young age as a parent, and I believe a life as a physician is the ultimate way to give.  Ever since I stepped foot in that classroom in 10th grade, I’ve been drawn to medicine and becoming a physician. As I learn more and more about medicine and what being a physician is like through my job,the evermore confident I become that a future as a physician is what I want. I feel like medicine is an environment that I can thrive in yet constantly be a student, the amount of learning in medicine is practically limitless.  

To me, being a physician isn’t just a career. It’s a lifelong commitment to help those in need and a commitment to the community. I honestly can’t see myself in the future as being anything but a physician, and I know it’s a commitment that I want to make. While a lot of people seem daunted or afraid of their futures as doctors, I am excited and thrilled to one day be able to have people place their trust in me. 

(Rebloggable by request)

Well I’m back

The test went well, I think.

Although this week there have been some interesting first for me

• First time falling asleep at the library 
• First time falling asleep in the student union common area
• First time falling asleep in my dorm/appt building study room
• First time having a weird series of dreams in which I was justifying why I was sleeping to people in my life. My parents, my academic adviser, my friend’s cat, and one of my high school teachers were all guest stars.

ALSO another surprising guest star in my “justifying why I’m sleeping” dream series was CRANQUIS. I was having quite the interesting dream in which I was talking to a floating head of Hugh Laurie (who called himself cranquis) who told me that “TOADS never sleep!”.

Quite an interesting week and I’m really glad it’s over.  

Black Cloud (n)- A Doctor or medical professional who attracts a high number of difficult and critical patients or a high number of code blues

Synonyms: ME

So there was this question on one of my practice tests and I want to know if I got it right, so I’m forcibly going to enlist all y’all knowledgeable folk out there to answer this question:

“A 17 year old female presents to the ER with complaints of an obviously broken leg. This is her second fracture in two months, and you are seriously concerned about her health. A social worker reports that her family life is stable and there is no evidence of abuse. You decide to order a blood calcium level and it comes back markedly high. You also notice an abnormal growth/swelling in her neck. What do you think the problem is and why?”

OKAY so this is possibly out of my depth and I don’t know why it was even a problem, but my first thought was like Primary hyperparathyroidism (before I used the google machine) from a parathyroid adenoma(??? I only guessed that because I thought they were the main type of growth for hyperparathyroidism???) but I wanted some feedback.

What do y’all think?

wayfaringmd:

• most people in the room at once: 23
• % of pantsless chatters: supposedly 100%, as it was a requirement for the room, though I have my doubts
• my identity as a female was once again called into question
• Dr. Cranquis showed up and the crowd went wild. (y’all know he’s regular people, right?)
• there was lots of talk of brothels
• we formed a pretty solid business plan to pay off all our school debts: a brothel/bed & breakfast/booze joint that exclusively serves bacon for breakfast. It comes complete with a taco stand/minute clinic run by Dr. Cranquis in the parking lot. 
• much discussion on how to acquire a sugar daddy. I believe I am first in line for sugar daddy dispensation, if we go by seniority (Cranquis is older, but he doesn’t count because he already has a sugar mama)
• chaos abounded as about 6 different conversations went on at once
• a “whose is bigger” glove-size showdown, won by everyone’s favorite black cloud, ERmedicine, who claims a very impressive size 9 sterile glove
• more explanations about sizzurp
• Lord Voldemort creeped silently in the corner.

If you didn’t join in, you missed out!

It’s more like every size 8 I have ever worn ends up with a hole somewhere

and yes: there are size 9s :)

http://www.amazon.com/Dynarex-Sterile-Surgical-Gloves-Size-50Pairs/dp/B003TYAJ3M

wayfaringmd:

Join here.

The Rules of the chat: 

1. No cameras.

2. No pants. 

3. Be hilarious.