The Clinical Significance of the Various Descriptions of Vomitus

Undigested food = esophageal issue (e.g., pharyngeal pouch or achalasia). Note: this is not really vomiting, but regurgitation, which is much less forceful and does not come from the stomach. Non-bilious, with partially digested food = gastric outlet obstruction or gastroparesis Bilious = small bowel obstruction distal to the hepatopancreatic ampulla (of Vater) Coffee ground emesis = blood altered by stomach acids Feculent (brown & foul-smelling) =  bacterial… Read More »

Physical Examination of Muscles in Systemic Disease

How to examine patients and report findings in patients with suspected muscle diseases: Abnormal movements Fasciculation → peripheral nerve injury Tremor Resting → Parkinsonism (with bradykinesia and rigidity) Intention → cerebellar issue → look for additional signs of cerebellar problems (e.g., ataxia) Myoclonus (involuntary purposeless jerks of limbs) → toxic metabolic issues (e.g., hypoxia, uremia, serotonin syndrome, opioid… Read More »

The 25 Best Medical Books of All Time

Here is the Medical Media Review’s list of the 25 best medical books of all time: Dr. Gerald de Lacey, The Chest X-Ray: A Survival Guide by  (2008, reviewed here). Igbaseimokumo, Usiakimi, MD, Brain CT Scans in Clinical Practice (2009, reviewed here) Herring, William, MD, Learning Radiology, Recognizing the Basics, 3e (2015, previous edit reviewed here) Kurtz, Ira, MD, Acid Base Case Studies (2004, reviewed here) Desai, Samir P., MD, Clinician’s Guide… Read More »

Central vs. Peripheral Vertigo Simplified

The first and most important step in evaluating a patient with vertigo is to attempt to distinguish vertigo of central origin from vertigo of peripheral origin because the management of central vertigo (brain imaging, hospital admission) is very different from the management of peripheral vertigo (symptomatic treatment, outpatient referral). Differences Between Central and Peripheral Vertigo Peripheral Vertigo Central Vertigo Percentage… Read More »

Stroke & TIA Mimics

Here are the important stroke and TIA mimics: Systemic and metabolic insults: especially hypoglycemia, but also a very wide variety of other systemic insults such as infections (urinary tract infections, pneumonia) and toxins, all of which can cause re-expression of symptoms of old strokes. Peripheral neuropathies such as idiopathic seventh cranial nerve (Bell’s) palsy, peripheral vestibulopathy, and even… Read More »

Headache: The Ominous Causes

Introduction Most headaches are benign and do not require a specific workup. Here are the ominous ones that require a specific workup and management. From the Patient History Sudden, severe, and maximal at onset, especially in an older patient without a prior history of headaches → subarachnoid hemorrhage → get a head CT without contrast → CT angiogram or cerebral angiogram. Systemic… Read More »

Medical Question: Flank Pain

A 60-year-old female presents to the emergency department complaining of intense left sided-flank pain radiating to the groin. Urinalysis is positive for gross hematuria, while a non-contrast CT of the abdomen and pelvis is negative for stones. The patient is sent for a contrast CT of the abdomen and pelvic, from which the following image is taken:   The… Read More »