UOTW #73

A 65 year old male presents to emergency department with a one week history of nausea and lethargy. He reports having consulted his GP early into his symptoms, for which he was given a course of antibiotics. He reports that his symptoms have not improved. The emergency physician sends blood work and the patient’s creatinine comes back at 18mg/dl with urea of 42mmol/L and K of 6.8. Patient is referred to Critical care for urgent dialysis. On further probing by the critical care team, patient reports history of occasional chills over the past one week and has also noticed that his urine output may have been lower than normal. The critical care physician places a probe on the patient’s abdomen and this is what he sees:


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UOTW #72

This patient is a 52 year old woman with a history of type 2 diabetes who presents with a 1 week history of bilateral flank pain associated with fevers and dysuria. 95/50 115 16 102.5F 100%RA


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UOTW #71

This patient is a 61 year old female with a history of hypertension and diabetes who presents with 3 weeks of intermittent exertional left sided chest pain. The pain is dull, non-pleuritic, always comes on when walking around and resolves with rest. +shortness of breath. Vitals: 95/50 125 22 98.6 97% RA. What diagnosis is suggested by the following bedside echo, and what can be measured to clinch the diagnosis?


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UOTW #70

A 60 year old female presents with painful right neck swelling. She has a past medical history of alcoholic hepatic cirrhosis. Her vitals signs are within normal limits. On examination she has a mass in the right submandibular area. It is tender to palpation, but smooth with no fluctuance. The following images are obtained of the swollen mass.


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UOTW #69

The patient is a 32 year old male who has a history of IV drug use, presents as a transfer from an outside hospital (OSH) for sepsis. Was taken to the OSH with bouts of lethargy/AMS mixed with episodes of combativeness. Noted to be febrile, hypotensive. Given 5L NS and a dose of vancomycin PTA. On exam you hear a blowing diastolic murmur. What is the diagnosis and most appropriate management for this patient?


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