Diaphragmatic Paralysis: A Presentation of Spontaneous Chest Pain and Shortness of Breath
Donna Dorriz, Hilary Lois, Candace Wise, and Brady Dehart
Chest pain accounts for approximately 7.6 million annual visits to emergency departments (ED) in the United States and can include a broad differential1. The workup warranted includes extensive testing with the goal of demonstrating a reassuring cardiopulmonary status. When preliminary chest pain workup is negative, the subtle features of common primary symptoms can provide insight into other less common etiologies. This case looks to highlight the rare presentation of a relatively healthy middle age male with complaint of chest pain and shortness of breath, worsened with exertion and supine position. When standard cardiopulmonary workup was negative, further specialty testing was pivotal to identify a rare and potentially life threatening cause to his symptoms in the form of diaphragmatic paralysis. Frequently asymptomatic, presenting symptoms can vary in severity from common dyspnea, shortness of breath, and orthopnea to acute respiratory failure. Consideration of rare causes, such as diaphragmatic paralysis, is important to ensure accurate evaluation and identification of this physiologic defect.
A Case of Simpson-Golabi-Behmel Syndrome Presenting with Cutaneous Findings
Tessa B. Mullins, Abigail Russell, and Chad Johnston
Simpson-Golabi-Behmelsyndrome is a rare, X-linked recessive syndrome associated with mutations in the genes encoding glypican 3 (GPC3). The majority of cases have been described in pediatric males, with those affected showing manifestations of overgrowth, congenital heart defects, and increased incidence of neoplasia. Due to the X-linked nature of this disorder, penetrance is not well understood in female cases. Very few cases of female presentations of Simpson-Golabi-Behmelsyndrome have been described. We present a case of GPC3 gene mutation suggestive of Simpson-Golabi-Behmelsyndrome in an adult female patient, diagnosed based on genetic testing performed due to a diagnosis of sebaceous carcinoma.
Initial Evaluation of a Wellness Game
Bing Parkinson and Bruce St. Amour
Physician wellness has recently been a topic of significant national interest.1-8 The term “wellness” has many definitions, and was best defined by Around et al. 1 as “one’s personal recipe for thriving and not just surviving.” Wellness refers to interconnected dimensions of physical, mental, and social well-being that extend beyond the absence of illness. Wellness has traditionally been measured in the negative sense by assessing rates of burnout, emotional exhaustion, and depersonalization. It is known that physician burnout is at its highest point during residency1, 4, 5 and burnout is linked to many negative outcomes including: substance abuse and suicidal idealization by the physician; lower quality of patient care; increased patient recovery times; reduced physician productivity; and a doubled risk of medical error.9 Most researchers have focused on organizational-level interventions such as corporate wellness or resilience training to reduce burnout, although individual level interventions such as meditation and mindfulness have shown some promise as a means to help reduce burnout.2 However there is still room for significant improvement and innovation in the development of wellness resources. Working long hours in residency can lead to loneliness and this social isolation, combined with loss of friends and support systems brought on by moving to a new environment, may have a significant impact on wellness with increased burnout.7 People are often hesitant to develop intimate connections and disclose personal details, and thus begin the bonding process with strangers. Interpersonal connections and engagement is necessary to thrive in residency. The game “Well…For Me” means to address an avenue to help residents build healthy connections in a manner that promotes bonding with fellow residents.
Progressive collateral stenosis leading to symptomatic chronic total occlusion
Farhan Shah and Andrew Maiolo
Chronic total occlusion is defined as the complete obstruction of a coronary artery, with TIMI 0 or TIMI 1 flow, and an occlusion duration of greater than 3 months. We present a case of symptomatic chronic total occlusion in a functional 79 year old female with no past history of coronary artery disease, previously asymptomatic due to robust collateral circulation.
A Case Study on Toxoplasmosis: Ocular Disease
Caleb A. Vass and Elliot Freed
Toxoplasmosis is an infection caused by the protozoan parasite Toxoplasma gondii. Primary infection by this organism is usually asymptomatic. Some immunocompetent patients infected with this parasite can present as an acute systemic infection but symptoms can also present as ocular disease. In these instances, the ocular disease may be the only symptom, and can be from either an acute infection or a reactivation of the disease.
Featuring scholarly activity by HCA Healthcare Graduate Medical Education residents from the Capital Division.
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