Bad Belly

57 year old male with a long history of heavy alcohol consumption presents with complaints of severe abdominal pain and nausea. On exam he's mildly agitated and disoriented to time. Mildly febrile, tachycardic, tachypnic, blood pressure 90s/50s, normal O2 saturation. Jaundiced, numerous spider angiomata including telangiectasias on his face, arms, and chest. Abdomen is grossly distended, obvious fluid wave, and diffusely tender, no guarding but tenderness is elicited on abdominal percussion and rebound.

What acute illness to you most suspect? How will you confirm the diagnosis? How will you perform the diagnostic test? What results do you suspect? If results confirm your suspicion, how will you manage the patient?

Click here for checklists, videos, and guides on this diagnostic question.

Young Man with Chest Pain - Stumper!

Watch this video for a Chest Pain Stumper! by The Consult Guys, a new series by Annals of Internal Medicine (ACP).

Click here for an important mnemonic to help you remember this mystery diagnosis! (also attached to this are the slides associated with the video linked above).

The New Building Blocks of Learning

Need to imbed the video, talking points, questions?

http://www.ted.com/talks/sugata_mitra_the_child_driven_education.html

1. Broadband

2. Collaboration

3. Encouragement

4. Challenge

Sinus Transillumination

A simple and practical physical exam maneuver to aid in the detection of sinusitis and other sinus space-occupying lesions.

Review these notes from the FPnotebook and these videos on frontal (one and two) and maxillary (one and two) sinus transillumination and practice on a number of "normals", include in your routine examination, and of course use in your focused ENT exams.

Include the sinusitis scoring criteria (Sapira's).