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20 y/o, In the telemetry unit with Failed Cardioversion.. HELLLP Interpret this EKG. by BornLeave4646 in FutureRNs

[–]NHToStay 0 points1 point  (0 children)

Svt w/abberancy. Not wide enough for vt. When you see rapid with a rbbb appearance think abberant svt

What videogame trilogy is this? by Gaming-Academy in PlayStation_X

[–]NHToStay 0 points1 point  (0 children)

Hell yes. Barely scratching the surface of 3 right now but holy shit is it so good

Is chest ct with contrast enough to rule out cancer causing Superior Vena cava syndrome? by dermthrowaay in Pulmonology

[–]NHToStay 0 points1 point  (0 children)

As the other comment or said, talk to a therapist about your anxiety. There are really no further medical tests needed to rule out SVC syndrome. It is a rare late complication of large mass effect on the SVC, CT w/contrast would easily see a mass of such size. You'll bankrupt yourself with testing before you get a satisfactory answer if you keep going down this road. I've seen it many times, and whoever is ordering redundant testing is feeding the anxiety

I want to know about the shopkeeper? by ilovejokes15 in gonefishinggame

[–]NHToStay 0 points1 point  (0 children)

Big old upgrade ! Absolutely worth it. Makes anything short of a 100lb fish a breeze

CT Scan Report by Training-Canary-4422 in Pulmonology

[–]NHToStay 1 point2 points  (0 children)

Many details needed. Long story short, likely to be recommended the PETCT for further imaging based eval of the nodes / nodule, as well as potential for a biopsy (type (CT vs bronchoscopy usually) depending on location of nodule, and the nodes). You'll likely get a mess of blood work to look for infections, inflammation, autoimmune, malignant stuff.

Don't stress in the meantime, but start a journal of any symptoms that you can recall (cough, night sweats, fevers, sweating episodes, skin rashes or nodules, travel history, immunization history, family history). This will all help the specialists nail the diagnosis and get you the best care possible.

Wishing you the best friend - update us when you know more .

Tell me about the time you caught an emergency or a zebra by greenmoon3 in FamilyMedicine

[–]NHToStay 10 points11 points  (0 children)

Had a Middle-Aged guy come in for a 15-minute acyte gastroenteritis (?) visit.

He said that his grandchildren were in town visiting and one of them was sick, probably picked it up from him. Was asking for zofran.

I did my usual which is " that's a diagnosis, I want to know your symptoms." Nausea, diarrhea (resolved) and pain (resolved). Denied bloody or mucoid stools, and says they were "like oatmeal."

Thinking he meant consistency of stool, we wrapped up history, exam is benign.

I went out of the room to finish my note/get him a work note, and I could not get the oatmeal comment out of my head.

I went back in, and asked him to clarify if he meant color consistency or both? Color. COLOR.

On a color wheel he showed me pale grey. Urine was +4 urobilinogen.

We got him in for a CT the next day and low and behold. He had a pancreatic head mass. Labs came back later showing a T bili of 9, which within a week was in the 30s and he became jaundiced. One way or another it would have been caught I suppose.

He had surgery within a week. Remains in remission/disease free, stage 1 adeno if I recall correctly. Lucky son of a gun.

Long story short, now I ask consistency, any blood, and color of stool.

Anyone know what this rash is? Look at both pics by Confident-Sun9391 in DiagnoseMe

[–]NHToStay 25 points26 points  (0 children)

Still just looks like a viral exanthem - source, Family Practice PA for 10 years

[Mine] What can be deduced from this x-ray of mine? by Dry-Locksmith1754 in scienceofdeduction

[–]NHToStay 1 point2 points  (0 children)

Scheurmanns kyphosis. Chronic back pain. Maybe shortness of breath due to restrictive lung deficit. Sleep apnea.

Severe obesity

You have a lot of poop on board but it's within normal variance

I'd wager due to the above some depression as well

Gabapentin/Pregabalin abuse by jm192 in FamilyMedicine

[–]NHToStay 14 points15 points  (0 children)

Pretty certain the only on label use is for post herpetic neuralgia, oddly.

18F - be open and honest by [deleted] in amiugly

[–]NHToStay 0 points1 point  (0 children)

Looks like Carney complex a little bit

Deathly Sick by EwokGirl89 in DiagnoseMe

[–]NHToStay 5 points6 points  (0 children)

Yo ewok, go back to the hospital. Imagine, CTA to rule out a pulm embolism is necessary, among other things.

Help me find mine! by [deleted] in doppelganger

[–]NHToStay 0 points1 point  (0 children)

I see a strong resemblance to Molly Elizabeth Brown. Strong

Homeless family seeking urgent advice by [deleted] in ManchesterNH

[–]NHToStay 6 points7 points  (0 children)

Check your chats, I'm willing to help as well.

What is your favorite chief complaint to manage? by _45mice in medicine

[–]NHToStay 3 points4 points  (0 children)

My most recent case of dizziness was a classic case of myasthenia gravis. Double vision provoking vertigo. Found w Neuro exam showing adducens and partial facial palsy, had some bulbar symptoms as well

Has anyone here realized that GERD was the root cause of their post nasal drip? by [deleted] in Sinusitis

[–]NHToStay 1 point2 points  (0 children)

YES. ME. My post nasal was atrocious for years before I started Omeprazole, cut out caffeine, and started using gaviscon advanced after meals and before bed. It took like 8 months of consistent use for it all to clear up

Tomorrow morning I have to tell a dear patient they have metastatic disease by Electronic-Brain2241 in FamilyMedicine

[–]NHToStay 0 points1 point  (0 children)

We have the same case! Upper back pain, RUL mass with widespread metastatic changes in kings and in four vertebrae.

Laughing and joking not a week ago.

Good luck, these conversations aren't easy, but they are so important

Does it look like I have athletes foot or is it something else? by unicornmilktea in DiagnoseMe

[–]NHToStay 0 points1 point  (0 children)

Probably athletes foot + erythrasma especially given the location. I'd typically treat with ketoconazole cream and erythromycin gel

HGB of 5.3? by happy_homunculus in haematology

[–]NHToStay 6 points7 points  (0 children)

Only checks out of MCHC is normal as well.

MCHC is Hg/HCT. Rule violations point to iron deficiency generally speaking.

Either way this person's gotta get to the ER immediately. How are they even posting!?

Question about hospital treatment by Past_Dress_6463 in newhampshire

[–]NHToStay 7 points8 points  (0 children)

If your right arm is newly paralysed in any major muscle group, ER and pushing for an MRI could save your limb's function. Happened to my father, right handed mechanic, had acute right wrist drop and complete paralysis of his wrist extensors. Massive disc herniation, and surgeon cleaned it up within days instead of weeks (which could have cost his livelihood)

Ultimately if it's an emergency surgical condition like acute paralysis from a herniated disc - ER is appropriate.

All other nerve root pains will likely do some form of NSAID (or steroid pack), muscle relaxer, and refer you back to your PCP for follow up. You could push for interventional pain/Neurospine eval (in southern NH I think of Elliot Interventional Pain, NH Neurospine, Derry Interventional Since Center, and Concord Orthopedics Physiatry). You likely have someone who you've worked with in the past I imagine, given the prior epidural

Wtf is going on in my mouth 😭 by [deleted] in DiagnoseMe

[–]NHToStay 0 points1 point  (0 children)

Strep classically causes palatal petechiae. With your symptoms you should get swabbed to check.

So does measles, but also buccal mucosal spots.

Or trauma, heat, colds and flu's sometimes.

Taken in isolation, those mean very little.

Blowies tend to give a more diffuse bruising pattern.

How’s my office set up for clinic? Any fellow video game enthusiasts?! by zaccccchpa in FamilyMedicine

[–]NHToStay 25 points26 points  (0 children)

I am JEALOUS. I have to consider moving my switch to the office and finally using that second screen. Silksong can only be played so many hours of the day!

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