Faaavorite diagnosis.

[RustedFox]

Warning: Totally not an academic thread. All opinions/flames/hijacks welcome.

I have three medical students that live near me. We are buddies. I do some not-for-profit teaching/mentoring/lecturing for them. It amounts to: they occasionally buy me a beer, and they know that if they have a test coming up, and if they need clarification on some matter... then they just come and knock on my door, and ask whatever it is that they need. I occasionally pop in with a good "learning" EKG, or whatever. Its fun.

It got me "remembering" my days as an MS-1/2/3... where I would first learn about some clinical entity, and think to myself - "Wow, what a cool diagnosis." Some things were cool because they were complex, some because they were obscure, some because they were common, some because they were sinister.

Anyone got a "favorite" ?

One of mine is TB. Probably because its so sneaky and sinister, and I saw so much of it as a medical student. I also know a scary amount about radiation sickness and dosimetry. My buddies know that if a bomb drops somewhere in the northeast, they're calling me first.

Yours ?

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[Hypomanics]

Anything that's not CHF, COPD, or asthma.

I get excited with the prospect of an ethylene glycol toxicity. Not as cool as radiation sickness..

 

[RustedFox]

Had an isopropanol toxicity recently. Not as cool as ethylene glycol, but maaaan, was that guy effed up.

Best part was that it happened while I was still a resident, and I had a young muslim female attending on-shift at the time. Clearly, she had never experienced alcohol intoxication NOS. She was freaking out. "He's losing his airway ! We have to intubate him ! OH MY GOD !"

"No. He's just fine. This is what is supposed to happen when you're effed up." Came my reply. "Let him sleep it off." Granted, it was gonna be a long sleep-it-off, but as long as he was happy to be upright at 45 degrees, he was not gonna buy a tube in my book.

 

[EM2013]

Tumor lysis syndrome

WPW syndrome

Neutropenic fever

Lyme Disease (all the different presentations / rashes)

Thyroid Storm

DKA

Acute angle closure glaucoma

 

[docB]

Superior vena cava syndrome. Red face, big JVD, no SOB. Esoteric enough than when you call it and predict what the CT will show everyone thinks you're smart.

Zoster masquerading as chest pain. If they're at all old they'll get ASA, EKG, CXR and so on but no one will look at their skin. When you find the rash and send them home they're always grateful.

 

[Venko]

it was cool to walk into a room with a learner who thought a patient had an allergic reaction and to diagnose the patient with Scombroid. I also like thyroid storm, Lemmiere's Syndrome, and gigantism as cool diagnoses. I've never made the diagnosis of porphyria but I hope to someday.

 

[loveoforganic2]

As a chemistry nerd, the light-sensitive porphyrias, big time

 

[RustedFox]

Tumor lysis syndrome

Totally, very cool. Not all that common, but yeah - I get you.

WPW syndrome

Meh. Novelty wears off after the third case.

Neutropenic fever

Maxipime FTW. Cool, yes - but there's never any telling what might be the source. Unfinished symphony.

Lyme Disease (all the different presentations / rashes)

Both my father and sister had Lyme Disease at one point. We lived in the one county in Pennsylvania that had more cases than any other. Neither had the rash. Neither has any neurologic sequelae. Dad has some pretty bad arthritis. I have been bitten by a hundred plus ticks.

Thyroid Storm

Suggesting this as a possibility totally made me look like a rockstar one day during my fourth year. Keep this in your back pocket. Wink-wink.

DKA

Biochemically cool, yeah. CLOSE THE GAP!

Acute angle closure glaucoma

Hate this, only because I need to ship out all ophtho, and... paperwork.

 

[Somnus Tuto]

Dressage-responsive MS



(disclaimer: not saying it doesn't help...I'm just saying they skipped this therapy in my med school neurology rotation with all the emphasis on tysabri, betaserone, copaxone, plasmapheresis etc)

 

[RustedFox]

Dressage-responsive MS



(disclaimer: not saying it doesn't help...I'm just saying they skipped this therapy in my med school neurology rotation with all the emphasis on tysabri, betaserone, copaxone, plasmapheresis etc)

I'm sorry... what ?

 

[Somnus Tuto]

I'm sorry... what ?

You know, the criticisms of Ann Romney's belief that dressage, or "horse ballet" played a role in alleviating her Multiple Sclerosis symptoms

[YOUTUBE]http://www.youtube.com/watch?v=XpWcFCSGPJc&feature=g-vrec[/YOUTUBE]

 

[Cerberus]

I still love a nice third degree heart block requiring a pacer. Not that rare, but fun and gratifying.

Methemoglobinemia - I'm a sucker for tox in general but this is one of my favorites because of the fact that you can call it pretty quickly without labs (you see that dusky appearance and pulse ox reading of 86% once and you can spot it pretty quickly - being able to predict the color of the abg is just icing)

Nursemaid's - the parents think you are some kind of wizard once you fix their kids "broken arm" in 2 seconds.

 

[deleted77919]

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[RustedFox]

Dunno, I think that anything that involves a high-degree of neuromuscular activity/integration that is practiced for a long time (be it hoity-toity, or not) could very well lend itself to better cognitive and motor function as days go on. I have absolutely no science to support my ideas, but hey, here's what I'm sayin:

I play a good bit of roller hockey now. At age 31. I skate almost every day, just to practice. I don't mean just doing laps around the rink, but - I lay down the cones in different patterns, and I *drill*. I get into and out of traffic, forward attack and backwards defense... collapsing defense.. pinch defense... whatever. I'm almost certain that my neurologic status at age 70 will be acceptable (for me), if I can keep this up from here until then.

Keep the brain active, keep the neural networks changing, keep the skill set expanding, keep yourself alive. It just might help. and if it doesn't... well... its cooler than just sitting there and not doing anything else new.

EDIT: Forgot to click "QUOTE". This is in response to the "dressage" gig.

 

[Somnus Tuto]

Methemoglobinemia - I'm a sucker for tox in general but this is one of my favorites because of the fact that you can call it pretty quickly without labs (you see that dusky appearance and pulse ox reading of 86% once and you can spot it pretty quickly - being able to predict the color of the abg is just icing)

.

Love it when you give benzocaine just prior to nasotracheal intubation and the pulse-ox reading drops to 85% and you think you're not ventilating

 

[Somnus Tuto]

Keep the brain active, keep the neural networks changing, keep the skill set expanding, keep yourself alive. It just might help. and if it doesn't... well... its cooler than just sitting there and not doing anything else new.

EDIT: Forgot to click "QUOTE". This is in response to the "dressage" gig.

absolutely agree

 

[RustedFox]

absolutely agree

Just started to pick up the flute, too. (No joke... g'head and laugh at me, all - but I want you to listen to "Locomotive Breath" by Jethro Tull (artist) and tell me that the flute can't freaking rock.)

When I'm fifty... I want to put on the skates and say - "Well, maybe I can improve my forechecking, seeing as how I'm not going to out-sprint the kids to the other end of the rink."

 

[dotcb]

Call me cheap - I love shoulder dislocations.

Cardioverting recent onset A-fib and discharging the patient.

 

[beanbean]

Love all the stuff you guys mentioned, except Lyme...only because I practice on the CT shoreline about 10 minutes from Lyme, CT. Half of the population has it and the other half is crazy and think they do! Quite a lucrative market for chronic Lyme quacks here which is unfortunate for the people who truly have a medical issue but get sucked into chelation therapy or some other nonsense.

In keeping with the tick theme...babesiosis is very cool.

 

[RustedFox]

Shoulder dislocations *are* cool. Dun care what anybody says. I get a kick out of reducing those as well.

A-fib is pretty much standard issue where I'm at (gulf coast of Florida - my average patient age is 65), so that doesn't get me going anymore. I see what you're saying, though. It is cool to make it "go back to sinus".

So.. about this Connecticut place... I have to admit - I kinda have a bizarre fascination with the place. I've been there a few times. Its nice. Sell it to me, from a professional standpoint. Please.

 

[la gringa]

anytime my "spidey sense" leads me to a diagnosis i think others may have missed.
catching myself in a near miss.

 

[la gringa]

sorry duplicate

 

[Daiphon]

Lots of my faves have already been listed, but here's a few more:

Scromboid - it's just cool.

Alcohol withdrawal - somewhat mundane, but always looking to set personal records for benzo use.

Salicylate poisoning - one of the great masqueraders, especially chronic salicylism... potentially bad dx for a patient, but really fun to make & manage.

Some of my non-faves:
Acute norcopenia
Perioral cheetosis-associated abdominal pain

cheers!
-d

Sent from my DROID BIONIC using Tapatalk

 

[Rendar5]

Stay away from Lyme Country rusted. I did residency in eastern long island where we had the same sisue of everyone either having lymes, or being cray and thinking they do, or being even crazier and claiming chronic lyme disease (not chronic arthritis s/p lyme treatment) with enough quacks out there supporting the crazies. of course, diagnosing coinfection with babesiosis or ehrlichiosis is cool as is admitting a 28yo girl with profound sinus brady only to f/u on her later and finding she went into heart block as an inpt and was diagnosed positive for lyme. The other cool thing is that antibiotics ends up being actually useful for Bell's Palsy.

My personal fav's are inferior alveolar blocks and upper gi bleeds (I enjoy throwing the kitchen sink at these guys).

 

[Greenbbs]

V65.5 pt with feared complaint in whom no diagnosis was made
E845.0 accident involving spacecraft injuring occupant of spacecraft

Somebody's been searching the volumes of ICD-9's in EPIC...

 

[winkleweizen]

Mania....they are hilarious

 

[CommunityED]

Scromboid is cool. The nurses are always impressed.

I also love doxycycline induce pill esophagitis

 

[docB]

V65.5 pt with feared complaint in whom no diagnosis was made
E845.0 accident involving spacecraft injuring occupant of spacecraft

Our new EMR makes us search the ICD9 codes so I've started to run into these. There's a whole section on injury by military hardware. Must be a VA thing.

So here's the scary part... ICD10 is coming soon because ICD9 "does not provide the detail and specificity needed."

 

[WilcoWorld]

Adrenal crisis.

Akithesia.

Clean toxidromes.

Meralgia paresthetica (just because residents usually miss it).

Non-psych stuff in psych patients (had an acute appendicitis present complaining of having been shot telepathically from 2 states away).

Mostly, I like diagnoses that I catch when I stick to my own rules, which would've been missed had I cut the corners I wanted to.

 

[Arcan57]

Favorite diagnosis I've never seen: erotic vomiting (it's on the list of ICD-9 codes I have to scroll through to find vomiting)

Favorite diagnosis I've actually seen: hyperkalemic periodic paralysis due to undiagnosed severe hyperthyroidism.

 

[Cerberus]

Our new EMR makes us search the ICD9 codes so I've started to run into these. There's a whole section on injury by military hardware. Must be a VA thing.

So here's the scary part... ICD10 is coming soon because ICD9 "does not provide the detail and specificity needed."

"Dizziness and Giddiness" is my favorite ICD9 code

 

[wholeheartedly]

E845.0 accident involving spacecraft injuring occupant of spacecraft

Wait, I just googled that. That's a real code!!!?!!! WTF? Please tell me by space craft they meant like a space shuttle and the occupant works for NASA or something right? Otherwise is that a psych diagnosis?

 

[WilcoWorld]

Wait, I just googled that. That's a real code!!!?!!! WTF? Please tell me by space craft they meant like a space shuttle and the occupant works for NASA or something right? Otherwise is that a psych diagnosis?

It means any spacecraft. Presumably NASA, but maybe the Russians made it, or perhaps it was privately funded by Redbull. Extraterrestrial-origin spacecraft wouldn't be excluded, but you must be a passenger to qualify. So you'd have to have been a passenger on the UFO.

 

[EvoDevo]

My fave diagnosis was marijuana induced hyperemesis. Heard the ERCast episode and I **** you not, I had a guy show up in my ER less than a week later who gave the perfect history. When I asked how often he smoked bud, he was "Like all day, every day, doc."

Felt like a rock star on that one.

 

[BF2BC EMT]

achalasia

 

[StevieStud]

Non-psych stuff in psych patients

Love'em.

Try admitting them.

nobody (docs) want to take them to their service and administration would rather board them in the ED then entering into the fray between the psych unit and med/surg units.

 

[StevieStud]

Wait, I just googled that. That's a real code!!!?!!! WTF? Please tell me by space craft they meant like a space shuttle and the occupant works for NASA or something right? Otherwise is that a psych diagnosis?

http://en.wikipedia.org/wiki/Pascagoula_Abduction

 

[wholeheartedly]

So are ICD9 codes like that old joke "If there's a warning not to do it, somebody, somewhere has tried it."

if there's a code for it, someone has actually needed it

 

[EM2BE]

SMA thrombosis (calling it before the CTA)

Abd compartment syndrome

 

[diphenyl]

Some of my favorites over the past 4 years:

Lemmiere's Syndrome

Brugada's syndrome

Marphan's w/ aortic dissection

Beta blocker overdose w/ subsequent mesenteric ischemia/ sepsis

Necrotizing fasc w/ subsequent amputation of 2 extremities (by surgery that same day not by me lol)

astrocytoma

malaria

 

[CraftyMed]

Lyme disease that presented as syncope...turned out to have heart block.

I love a good Nursemaid's too. It's like a magic trick!

If you have an EMR that lets you search for the code/diagnosis, try "fall" and "assault." By far my favorite lists of weird possible diagnoses.

 

[pratik7]

I like putting acute exacerbation of fibromyalgia on the chart. It makes me laugh

 

[EvoDevo]

Also, diagnosed a leaking and close to blowing aortic aneurysm in a Marfan pt c/o flank pain.

And an aortic root dissection in a thirty y/o F c/o atypical chest pain c neg trops and neg d-dimer.

 

[The White Coat Investor]

Nursemaid' elbow.

I'm the parents' hero, at least until they get the bill.

 

[RustedFox]

Also, diagnosed a leaking and close to blowing aortic aneurysm in a Marfan pt c/o flank pain.

And an aortic root dissection in a thirty y/o F c/o atypical chest pain c neg trops and neg d-dimer.

How'd you pick up on these ? Spider sense ?

 

[Hypomanics]

"Dizziness and Giddiness" is my favorite ICD9 code

Ugh I hate that one. And I hate the "hypopotassemia" code as well. Who the hell creates these?

 

[la gringa]

SMA dissection

anything i have to look up to figure out how to treat it

 

[EvoDevo]

How'd you pick up on these ? Spider sense ?

Well the Marfan lady was a very good historian and when I walked into the room, she had quite appreciable arachnodactyly. So when I asked about a history of stones ("no") then of course I was on alert.

The other lady was pure Spidey sense after the initial w/u was negative and she was still really remarking on the pain....the scary part is, had I been slammed that day I may very well have blown her off....

 

[shookwell]

V65.5 pt with feared complaint in whom no diagnosis was made
E845.0 accident involving spacecraft injuring occupant of spacecraft

this is the best ICD9 code:

799.9 Other unknown and unspecified cause
Undiagnosed disease, not specified as to site or system involved
Unknown cause of morbidity or mortality

 

[deleted77919]

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