Brady Pregerson, MD

A female in her 30’s with no significant PMH other than obesity presents to the emergency department with 2 days of gradually worsening suprapubic and RLQ pain that radiates to the back and is associated with 5 episodes of non-bloody vomiting but no fever, dysuria, diarrhea, or discharge. She denies any other complaints or recent unprotected sex.

Vital signs are all normal. The abdomen is soft with diffuse lower abdominal tenderness, which is worse on the right and guarding as well as right CVA tenderness.

A pelvic ultrasound shows a 3.5 cm simple right ovarian cyst with good flow and no free fluid

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Our latest emergency department case report from Brady Pregerson, MD, features a woman in her mids 30s presenting with 2 days of gradually worsening suprapubic and right lower quadrant pain. Can you determine the correct diagnosis?

Endocrine Case Report: Right Lower Quadrant Pain

A man in his early 30’s is brought to the emergency department for vomiting. Medics state she said he has been drinking and often forgetting to take his insulin and his Jardiance. Over the past few hours, he vomited multiple times and she saw some blood and proceeded called 911. The patient is alert but a bit giddy. He denies any fever, pain, melena, or other complaints.


Vital signs are normal except for a pulse of 110. Physical exam is otherwise normal except for the odor of alcohol and a bit of non-bloody emesis on his shirt

: normal except for a hemoglobin of 10.2 with macrocytic indices

: normal except for a gap of 21 and a glucose of 193

Our latest case report from Dr. Brady Pregerson features a man in his 30s presenting to the ED after drinking and admits to forgetting his insulin and poor adherence to other antidiabetes medication. Can you determine the correct diagnosis?

Endocrine Case Report: Vomiting and Drunk

: A middle-aged woman with a history of diabetes and hypertension is brought to the emergency department by paramedics as a field-activated ST-elevation MI. They report that about 40 minutes ago she fainted and when she came to she had anxiety, chest pain, and shortness of breath. There was no head injury.

Medics gave aspirin plus 3 doses of nitroglycerin en route without relief.

: On exam, the patient is obese, diaphoretic, and appears very anxious bordering on delirious. She is unable to give much history and is thrashing around.

: Pulse 131, BP 95/58, pulse ox 98% on oxygen. Lungs are clear and heart is tachycardic with normal heart sounds. Abdomen is rotund and non-tender. Legs have no edema, chords, tenderness, or erythema. Pulses are symmetric.


Our latest case report from Brady Pregerson, MD, features a middle-aged woman brought to the emergency department by paramedics as a field-activated ST-elevation MI. Check out the EKG and see if you can determine the correct diagnosis.

Endocrinology Case Report: Syncope and ST-Elevation

: A man in his 40’s presents to the emergency department with shortness of breath and leg edema for 2 months that has become worse during the last 2 days. He has a history of diarrhea & protein wasting due to prior gastric bypass surgery, but is otherwise healthy. He denies fever, chest pain, or cough.

: Vitals are notable for tachypnea and tachycardia. He is 5’8” and weighs 258 lbs. Pulse ox is 95% on room air. The oropharynx is moist and his lungs are clear without wheezing or rales. His legs have 1-2+ bilateral edema with a negative Homan’s sign and no erythema.

: Atrial fibrillation at a rate of 158 and nonspecific ST abnormalities.

: Sodium 150, chloride 128, carbon dioxide 11, creatinine 1.7, magnesium low at 1.2, albumin low at 1.7.



VQ scan of same patient showing perfusion defect in left lingula.

Our latest case report from Dr. Brady Pregerson features a man in his 40s presenting with shortness of breath and worsening leg edema. Can you determine the correct diagnosis?

Brady Pregerson, MD

Articles

Endocrine Case Report: Right Lower Quadrant Pain

Endocrine Case Report: Vomiting and Drunk

Endocrinology Case Report: Syncope and ST-Elevation

Case Report: Shortness of Breath and Worsening Leg Edema