MD & DO B2B Medical Cases & Discussion Thread

[Redpancreas]

Clinical Cases Intro:
I'm going to be writing up hypothetical medical cases here from scratch. The objective is for this to spur discussion regarding management to help medical students. I want to emphasize that I'm not the smartest cookie or even close to the highest qualified person on this forum to be conducting this. I just enjoy doing it and think it will be a fun learning opportunity. These cases will mostly be within the domain of Internal Medicine because 1) it makes up a large bulk of medical school curriculum and 2) it is the subject I feel most comfortable discussing. I would not be opposed to someone contributing a surgery/psychiatry case, etc. and taking over the discussion. The target audience for these cases would be M3+ although anyone who feels like it can participate.

Disclaimers:
1.) None of these cases are based off of real life/textbook scenarios.
2.) When conducting discussions, I will likely be wrong on occasion hence why I'm doing this here and not a professional capacity. I welcome all levels to correct/ask for clarification if something doesn't make sense.

How It Works:
I'll write up a case and ask some initial questions. After a decent discussion, I'll give some updates and ask a second round of questions. Once we've discussed the major points we will progress to the next case. The cases will span across multiple medical settings and hopefully cover a wide range of organ systems. I'll start pretty basic so everyone's on the same page and hopefully we will progress to more advanced topics gradually. Depending on how much interest there is and how busy things get, I'll try to put out cases once a week and we will see if this takes off.

Mods please free to displace to another forum if more appropriate.

EDIT 2/12/21: Doesn't seem like there's much interest now. Still...I check SDN daily and feel free to respond if you see this. Maybe this will gain traction later ?

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[Redpancreas]

Case #1: The focus here will be on management.

69M presents to the ED for chief complaint of shortness of breath starting 4 days ago associated with increased fatigue and weight gain. The symptoms are worse at night, but patient denies chest pain, palpitations, cough, fever, weakness, GI symptoms, nor syncope. Medical history consists of HTN on medication, Coronary Artery Disease via prior NSTEMI treated in 2008 treated medically, NIDDM (HbA1c-7.2), COPD (FEV-1: 70%, 20 PY smoking history, 1 prev. admission, not intubated), Obesity, Osteoarthritis, PUD, and GERD. Medications include Chlorthalidone 25 mg, Empagliflozin 10 mg, Metformin 1000 mg BID, Omeprazole 20 mg, Tiotropium Inhaler, Albuterol PRN, and Ibuprofen PRN. Surgical/Procedural history included EGD w/ biopsy in 2012 after which he stopped his daily Aspirin. No Allergies. Family history pertinent for father with CAD at 55 and colon cancer diagnosed at 56.

Pertinent Exam: 159/85, 84HR, 98.8F, 95% sat, 16RR, BMI-36, age-appearing gentleman in mild distress, alert/orientedx3, mild conjunctival pallor, moist mucous membranes, elevated JVP, auscultation difficult but S1/S2 auscultated and no MRG appreciated, lung sounds diminished at bases with mild wheezing spanning up to midlung, soft, non-distended abdomen with normal bowel sounds and no masses, extremities reveal 2+ pitting edema up to mid-shin, patient is grossly non-focal with no visible skin deformities present.

Labs:
BMP: Na-141, K-3.9, Cl-100 HCO3-22, BUN-22, Cr-1.0
CBC-WBC-12.5, Hb-10.8, Plt-255
UA-No pertinent findings
CXR: Bilateral pleural effusions, enlarged heart border, upper lobe venous congestion, and increased interstitial markings.

1. What is your focused differential for this patient's symptoms?
2. As the admitting resident, you meet with the ED resident outside the patient's room and you two discuss the case. What initial labs, imaging, tests, or medications would you like to draw/administer?
3. After this, what additional history would you to know to further guide your management?
4. What is this patient's most likely disposition after the ED?