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From The Editors, Andrew Lerner, Md, Tasha Kouvatsos, Md, Andrea Fennelly, Md

The Medicine Forum

The editorial staff would like to acknowledge the support of Dr. Diemer and Dr. Kane in producing this year’s Jefferson Forum. We appreciate your guidance and thank you for all that you have done to help bring this issue to print. We would also like to thank our internal medicine resident colleagues for contributing interesting and unique case reports, review articles, original research, travel experiences, and poetry. This issue of the Jefferson Forum could not have been done without your hard work and enthusiasm.

From The Desk Of The Residency Program Director, Gretchen Diemer, Md, Facp

The Medicine Forum

To the Friends of the Department of Medicine:

I am honored to be given the opportunity to lead this talented group of residents as they travel down the path toward completion of their residency training. On September 1st, Dr. Gregory Kane took the reins as the Interim Chair of the Department of Medicine here at Jefferson. A new Program Director could not ask for a more staunch supporter of education to occupy that role than Dr. Kane.

This edition of The Forum showcases the broad variety of patients our residents and students encounter during their training. The submissions to this …

Table Of Contents: The Jefferson Journal Of Psychiatry, Volume 2, Number 1, January 1984

Jefferson Journal of Psychiatry

Table of Contents: The Jefferson Journal of Psychiatry, Volume 2, Number 1, January 1984.

Dedication

Jefferson Journal of Psychiatry

Dedication to Paul J. Fink, MD.

Editors: The Jefferson Journal Of Psychiatry

Jefferson Journal of Psychiatry

Chief Editor, Associate Editors, Former Editors, Cover Design and Faculty Advisor.

Meningitis Presenting As Depression: A Case Report, Karl Doghramji, Md

Jefferson Journal of Psychiatry

The relationship between psychiatric and medical illness has long been recognized by clinicians. Of special importance to psychiatrists are the diagnostic dilemmas posed by medical illnesses presenting as psychiatric disorders. In a review of recent studies, LaBruzza found that "at least one out of every twenty patients receiving an initial psychiatric evaluation may have an underlying medical illness which accounts for the psychiatric symptoms." This was especially true with inpatients, where between 5% and 30% of patients, with a weighted average of 12%, had medical illnesses accounting for their psychiatric complaints 11). One medical illness which can resemble psychiatric illness …

Attention Deficit Disorder, Residual Type- A Case Study, James Stanch, Md

Jefferson Journal of Psychiatry

The syndrome of Minimal Brain Dysfunction (MBD) in children has been well described by a number of authors. Such children were first described in 1941 by Werner and Strauss(1) who made a distinction between brain injury and -simple- mental retardation. In the past such terms as Hyperactive Child Syndrome, Minimal Brain Damage, and Hyperkinetic Behavior Syndrome have been used to describe this syndrome.

A Case Of Recurrent Dissociative Episodes In A Patient With Congenital Defects, Mark Miller, Md

Jefferson Journal of Psychiatry

Case Report

Marie, a 30 year old American-born Hispanic female, was first seen in the emergency room with suicidal ideation (the impulse to jump in front of an oncoming car), depression, anxiety, and distress about "always getting attacked so much."

Interpersonal Relationships As Sources Of Medical Student Stress, Beverly Jones, Md

Jefferson Journal of Psychiatry

Introduction

The issue of physician impairment, that is , decreased ability or quality of functioning due to intemperate use of drugs or alcohol, emotional or psychiatric dysfunction, has recently received attention (1,5) . Studies have indicated the risks physicians face of substance abuse problems(6,7), marital discord(8,9), suicide (lO,ll), and psychiatric problems (l2-14). studies have also addressed the difficulties faced by medical students (15-20).

A group of medical students at the University of North Carolina came together to investigate the subject of medical student impairment . A survey was constructed in order to ascertain the sources of stress in medical school. …

Olfaction And Sexuality, Michael Buxbaum, Md

Jefferson Journal of Psychiatry

A patient who describes himself as "sanitary" told me of his concern with odors. Whenever he thinks about establishing a sexual relationship , he develops a fear that his partner may smell offensive, especially around her genital area. He describes signs and symptoms of sympathetic overactivity when he engages in foreplay, and is afraid that he might be impotent if he smells anything offensive. In fact, he has to insert a finger into his partner's vagina during foreplay, to test the nature of the odor. He feels relieved when the smell is neutral or perfumed, and demonstrates enhanced sexual performance. …

Editors' Column

Jefferson Journal of Psychiatry

With this issue, The Jefferson Journal of Psychiatry , a Resident Publication, comes into being.

The purpose of this journal is to provide a forum for the presentation of ideas, data, and discussion. We are trying to give residents a setting in which to communicate in a way more formal than the seminars of residency training, but less forbidding than national journals.

Download Entire Issue-The Medicine Forum, Volume 12, 2010

The Medicine Forum

Download entire issue-The Medicine Forum, Volume 12, 2010

Poem, Andrew Lerner, Md

The Medicine Forum

She is a small lady,

85 years old.

Digital Clubbing, Yiu Tak Leung, Md, Phd

The Medicine Forum

This is a 66 year-old male with a history of cirrhosis who came into the office for a routine check-up and was noted to have “drumbstick fingers” or digital clubbing. Digital clubbing is a clinical sign most commonly associated with pulmonary diseases, such as lung cancer and interstitial lung disease, cyanotic heart disease and cirrhosis of the liver, but clubbing also may be idiopathic or congenital.

Chronic Tophaceous Gout, Sara Beltz, Md

The Medicine Forum

Gout, existing since antiquity as “the king of diseases and the disease of kings,” can present as an acute gouty arthritis or as achronic depositional arthropathy (chronic tophaceous gout). If left untreated, chronic tophaceous gout will develop in up to 30% of acute gout patients over 5 years.

Calciphylaxis, Darren Andrade, Md

The Medicine Forum

A 51-year-old man with a history of end-stage renal disease on hemodialysis and diabetes mellitus presents with suprapubic pain and a worsening penile ulcer that he first noticed two months ago. What finally prompted the patient to go to the emergency

Rare Gram-Negative Sepsis In A Non-Ventilated Neutropenic Patient With Aml, Jay Sellers, Md, Paurush Shah, Md

The Medicine Forum

Case Report

A 57-year-old man with history of hypertension, hyperlipidemia,and gout presented for evaluation of both a perioral infection and an infection in his right great toe from an injury on the beach at his shore house. The toe trauma was complicated by a massive hematoma and phlebitis, which required antibiotics. His primary care physician ordered basic laboratory studies thatshowed an anemia and thrombocytopenia. He was sent to a Hematology and Oncology specialist and subsequently directly admitted to Thomas Jefferson University Hospital for blood transfusion and further work-up. Upon further questioning, thepatient admitted to chills starting 2 weeks prior to …

Post-Pneumonectomy Changes, Charles-Lwanga Bennin, Md

The Medicine Forum

Case

A 71-year-old woman, with a history of non-small cell lung cancer (NSCLC) with subsequent pneumonectomy presented with worsening dyspnea on exertion and non-productive cough.

The patient first noted the shortness of breath and cough 4 weeks prior to presentation, which were refractory to albuterol nebulization. The patient also reported a 6 lb. weight loss duringthis time period. She denied fevers, chills, night sweats or chestpain. The patient was diagnosed with NSCLC 11 years ago andunderwent a right-sided extrapleural pneumonectomy at that time. She received no radiation or chemotherapy. She did not require home oxygen and reported a generally good …

A 35-Year-Old Man With New Onset Blindness, Cecilia Kelly, Md, Claire Raab, Md, Aimee Lee, Msiv

The Medicine Forum

Case Report

A 35 year-old homosexual male from Trinidad with no known past medical history presented with a complaint of new-onset blindness. He stated that his vision had become increasingly “dim” to the point that at presentation, he had minimal light perception in either eye. This decrease in vision had occurred over the course of a week. He denied any trauma, eye pain, headache, nausea or vomiting.

Peripancreatic Tuberculosis With Involvement Of The Porta Hepatis In A 41-Year-Old Thai Female Diagnosed Via Fine Needle Aspiration, Paurush Shah, Md, Ali Siddiqui, Md

The Medicine Forum

Case Report

A 41-year-old Thai female with past medical history of gastroesophagealreflux disease and duodenal ulcer who immigrated to the United States six years ago presented with a complaint of intermittent right upper quadrant (RUQ) pain for the last several years. Over the last year, she reported that the pain had significantly increased in intensity. She described the pain as crampy, beginning in the RUQ and radiating around to her back. There was no associated nausea, vomiting or weight loss. The patient had initially presented to an outside hospital a few months prior, was diagnosed with costochondritis, and was subsequently …

Chest Pain And Troponin Leak In A Healthy 38-Year-Old Female, Gunjan Shah, Md

The Medicine Forum

A 38-year-old female with a medical history significant only for a cholecystectomy for cholelithiasis presented to an outside hospital with a one day history of sharp, non-radiating midsternal chest pain that began when she bent over to pick something up. She has associated light-headedness and dizzinesswhen she stood up, as well as palpitations, diaphoresis, and a sense of throbbing in her left arm. The symptoms persisted at rest for one hour before the patient arrived at the outside hospital. She was found to be in new-onset atrial fibrillation witha rapid ventricular rate up to 160 beats per minute. A diltiazeminfusion …

Gi Dysmotility: A Case Report, Katie Osley, Md, Yiu Tak Leung, Md, Phd

The Medicine Forum

Case Report

A 75-year-old male, with a medical history of diabetes, hypertension, coronary artery disease, status post coronary artery bypass graft, and left-sided breast cancer, status post left breast mastectomy, was transferred from an outside hospital with complaints of a month of constipation, nausea and vomiting. The patient presented to an OSH a month prior withrecent onset of constipation, with no bowel movements for 10 days, changed from his usual habit of daily bowel movements. He initially responded to lactulose with a bowel movement andwas discharged on a regimen of stool softeners and laxatives; however, upon returning home, he was …

Primary Cutaneous Nocardiosis In A Heart Transplant Patient: A Case Report, Kiran Devaraj, Md, Joanna Rodriguez, Md, Bryan Hess, Md, Paul Mather, Md

The Medicine Forum

Case

A 38-year-old female with history of longstanding non-ischemiccardiomyopathy underwent orthotopic heart transplantation (OHT). Her past medical history was significant for factor V leiden and methylenetetrahydrofolate reductase (MTHFR) heterozygous deficiencies with chronic pulmonary embolism, sickle cell trait, atrial flutter, type 2 diabetes mellitus, and hypertension. The patient had a long and complicated course post-transplantation. Immediately after OHT, she was noted tohave donor- specific human leukocyte antigen (HLA) antibodiestreated with 5 cycles of plasmapheresis. On further biopsies it wasnoted that she had acute cellular rejection requiring pulse-dose parenteral steroids on multiple occasions. Her immunosuppressiontherapy consisted of tacrolimus, mycophenolate and prednisone. Six …

A Rare Case Of Abacavir Hypersensitivity Syndrome, Charles-Lwanga Bennin, Md

The Medicine Forum

Case

A 56-year-old African American male with a history of type II diabetes mellitus complicated by neuropathy, infections with human immunodeficiency virus (HIV), with a known CD4 count of 25 per cubic millimeter, hepatitis B and hepatitis C presented with six months of generalized weakness over his lower extremities, poor balance, nausea and vomiting. The patient had recently started anti-retroviral therapy (ART) and noticed that the onset of his symptoms coincided with the initiation of this therapy. He was taking Trizivir, which consistsof abacavir (300mg each day), lamivudine (150mg each day), and zidovudine (300mg each day), atazanavir (300mg each day)and …

A 40-Year-Old Woman With Chest Pain, St Elevation, Elevated Troponin And Normal Coronary Arteries: A Case Report, Bhalaghuru Chokkalingam-Mani, Md, Avinash Chandra, Md

The Medicine Forum

Electrocardiographic changes resembling myocardial ischemia or infarction can be caused by a variety of causes other than ischemia. One of them is acute myocarditis which further confounds clinical judgment by causing elevation in troponins as well. We report a case of myocarditis which underscores the importance of identifying the clinical presentation of acute myocarditis and the electrocardiographic changes that can be associated with it.

Brain Zygomycosis In A Patient With High Risk Myelodysplastic Syndrome After Initiation Of Chemotherapy, Sameh Gaballa, Md, Ali Al-Ameri, Md

The Medicine Forum

Introduction

Zygomycetes are a group of fungi that can cause a variety of life-threatening infections particularly in immunocompromised patients. Zygomycosis manifests as a spectrum of diseases including stroke.1-3 We present a case of disseminated zygomycosis with central nervous system (CNS) involvement in a patient with myelodysplastic syndrome (MDS) after initiationof chemotherapy.

A 52-Year-Old Female With Ramsay Hunt Syndrome, Ketki Soin, Msiii, Eric Struble, Md, Whitney Jackson, Md

The Medicine Forum

Case Report

A 52 year-old female with a history of poorly controlled type IIdiabetes and a recent admission of right-sided pre-septal orbitalcellulitis presented with a facial rash and severe ear and eye painfor three days. The patient noted sudden right-sided vision lossand associated right-sided face, ear and eye pain three days prior toadmission. The pain was a 9/10 and was worsening since its onset.Upon questioning she also noted decreased taste sensation. Shedenied tinnitus, vertigo, hearing loss, nausea, vomiting, or fevers.

Acute Hiv, Rhabdomyolysis, Renal Failure, And Hepatitis: A Case Report, Eve R. Merrill, Md

The Medicine Forum

Case Report

A 19 year old African-American male with no significant past medical history presented to an outside hospital with two days of diffuse abdominal pain, myalgias, muscle weakness, and darkurine. Two weeks prior to presentation, the patient was treated as an outpatient with an unknown antibiotic for symptoms of a sore throat, nausea, and non-bloody, non-bilious emesis. The patient denied any sick contacts, recent travel, trauma, strenuousexercise, or the use of non-steroidal anti-inflammatory drugs, acetaminophen, alcohol, or illicit drugs. The patient reported being sexually active with one female partner and had no historyof sexually transmitted infections. The patient was …

West Nile Virus Encephalitis In A Patient With Renal Transplant, Charles-Lwanga Bennin, Md, Steve Krawitz, Md, Emma Weaver, Md

The Medicine Forum

Introduction

Most cases of West Nile Virus infection are asymptomatic. 60% to 70% of neuro-invasive cases of West Nile virus infection result in meningitis or encephalitis; however, West Nile encephalitis occurs in less than 1% of patients infected with the West Nile virus.1

A Case Of Metastatic Breast Cancer To The Meninges, Carolyn M. Ross, Msiii, Jie Cui, Md

The Medicine Forum

Case Report

A 44-year-old woman with a history of triple-negative breast cancer metastatic to the brain presented with changes in mentalstatus, lower back pain, and a left facial Bell’s palsy.

The patient had previously been ambulatory and fully cognizantof her surroundings until one week prior to presentation when she began to exhibit progressively worsening confusion. As hermental status began to change, the patient developed new onsetpain over her lumbar spine, supra-pubic area, bilateral flanks, hips, and knees. The pain was refractory to an epidural injectioninto her lumbar spine performed at the patient’s local hospital. Other complaints included a recent onset …