Brady Pregerson, MD

: A woman in her 50’s with a history of asthma presents to the emergency department for cough, tactile fever and SOB. She denies syncope, palpitations, chest pain or other complaints. She thinks she’s probably having an asthma attack but hasn’t had one in over a decade so did not have medicine at home.

: Vital signs are notable for a pulse of 134, BP 113/62, temperature is 98.6, and a saturation of 95% on RA. Exam is notable for obesity, tachycardia, and mild wheezing with good air movement and no respiratory distress. There is no leg edema.

COMPUTER EKG READ: Sinus tachycardia, Left axis deviation, Low voltage QRS, Inferior infarct, age undetermined.

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Our latest case report from Dr. Brady Pregerson features a woman in her 50s presenting with cough, tactile fever, and shortness of breath. Can you determine the correct diagnosis?

Case Report: Cough and Tachycardia 

: A 62-year-old male with a history of obesity, coronary disease, anxiety, and COPD presents to the emergency department for 2 days of intermittent shortness of breath after starting Keflex for cellulitis. He denies any chest pain, fever, rash, throat or lip swelling, or cough. He states the SOB seems to get worse about an hour after taking Keflex but then gradually gets better, which is why he thinks it may be an allergic reaction. His inhalers don’t seem to help.

: Vital signs are normal including pulse ox and respiratory rate. Exam is otherwise normal except for the cellulitis which is both in his groin below his pannus and in his right lower leg. Specifically, there is no rash, oral swelling, rales, or wheezing.

COMPUTER EKG READ: Sinus rhythm with occasional PVC. Possible inferior infarct, age undetermined

Our latest case report from Brady Pregerson, MD, features a 62 y/o male with a history of obesity, CAD, anxiety, and COPD presenting with SOB after stating cefalexin. Can you determine the correct diagnosis?

Case Report: Shortness of Breath After Cefalexin

A pleasant 53-year-old male with a history of obesity, DM on glucophage, and HTN on Lasix presents to the ER with one month of migratory bilateral ankle pain, currently worse on the left. He has seen many doctors, had x-rays and been prescribed orthotics, but no one is sure of the cause and he has not been able to work for the past two weeks due to severe worsening pain. He denies any fever, injury, increase in activity prior to symptom onset, calf swelling, chest pain, shortness of breath, or other complaints.

Vital signs are normal except for a blood pressure of 172/98. His physical exam is normal except for some mild bilateral ankle tenderness. He is quite obese, so you cannot really tell if the ankles are swollen or just fat, but they look symmetric. There is no redness. There seems to be slight warmth on the left, compared to the right ankle.

X-ray of the ankles showed mild osteoarthritis.

The left ankle joint was tapped but no fluid was obtained. After removal of the needle, the plunger was pulled back a bit more to make sure there was no fluid in the needle lumen or hub. None was noted. Right before the doctor was about to throw away the syringe, a small amount of white paste about 1 mm x 1 mm was noted. See image below of the paste after it was flattened up against the distal end of the syringe to check consistency and better visualize it.

Check out our latest endocrine case report from Brady Pregerson, MD, which features a 53-year-old male with a history of obesity, DM on glucophage, and HTN on Lasix. Can you determine the correct diagnosis?

Endocrine Case Report: White Paste

A woman in her late 70’s is brought to the ER by medics for facial droop, slurred speech, and left-sided weakness. She lives at a nursing home and at baseline is bedridden but A+Ox4 and able to feed herself. She was last seen normal about 1.5 hours prior to ER arrival. Her PMH includes stroke, HTN, DM, CAD, CHF, AFib, and GERD. She is hard to understand due to her slurring but does complain of headache without vomiting. No other complaints.

Vital signs are normal except for BP 171/89. Physical exam is notable for weakness in all extremities but she is able to lift her right arm and leg off the bed but not the left side, though she can move it a little. Speech is slurred to the point of being difficult to understand with left facial droop. Heart is regular and lungs are clear. Her skin is dry. A stroke code order set is entered.

Check out our latest emergency department case report from Dr. Brady Pregerson. Can you determine the correct diagnosis?

Brady Pregerson, MD

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Case Report: Cough and Tachycardia

Case Report: Shortness of Breath After Cefalexin

Endocrine Case Report: White Paste

Endocrine Case Report: Stroke Code?