Physician-informed medical book reviews and clinical education resources.
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 … Read more
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 … Read more
Introduction Vertigo is a sensation of spinning, either of the patient or of his or her environment. There are four types of vertigo that you must consider in a patient who complains of a spinning sensation: Toxic vertigo Central nervous system vertigo Peripheral nervous system vertigo Hematologic vertigo (hyperviscosity syndrome) Toxic Vertigo Salicylates and anticonvulsants, … Read more
Here’s a workup for suspected myasthenia gravis: Acetylcholine receptor antibody Muscle specific receptor tyrosine kinase (MuSK) antibody Chest CT (to look for thymoma) TSH (concomitant autoimmune thyroiditis is sometimes seen) Search for underlying infectious precipitants as guided by history (e.g., CBC, chest radiograph, urinalysis) Search for underlying concomitant metabolic derangements which may contribute to weakness … Read more
If, on a standardized test, you are asked what’s the “best next step” in the management of a patient with suspected meningitis, prioritize thusly: Droplet precautions if Neisseria meningitidis is suspected (this comes first for public health reasons) Administer acyclovir if HSV meningitis is suspected (there’s no reason to delay this) Draw blood cultures (because … Read more
The following is a comprehensive differential diagnosis and workup for seizures. The workup is (obviously!) not something that you have to do for every patient. You can, however, use the information below for standardized test preparation and to guide your thought process as you work up patients with seizures. Please let me know if there’s anything that you … Read more
Brain CT Scans in Clinical Practice by Usiakimi Igbaseimokumo MD is concise, sharp, brilliantly written, practice changing, and full ofnumerous helpful clinical pearls. In places, the advice is extremely straightforward: blood clots or tumours in the brain deep to the pia mater are called intraaxial and those outside the pia are called extra axial. (P. 26-27) … Read more