Bizarre cases

[K82]

I had a 28 y/o pt yesterday who I did a breast ultrasound on. She has 25 fibroadenomas! I did a lit search and found a report of someone with 50, so not the record but pretty impressive!

[Dusn]

are we talking 360 degree head rotation and projectile vomiting?

i used to think the exorcist was a movie about demonic possession. Ever since having toddlers myself though I now realize that the movie was just about a kid going through a normal childhood phase, perhaps she was “overtired.”

[Brains428]

An old lady in the ICU who had developed an incidental cough had a sputum sent to my lab - when I looked at it, I saw Strongyloides stercoralis on the smear. Totally unexpected diagnosis, and no one could figure out how she picked that up.

the type of case only a pathologist can appreciate (maybe some ID docs, too).

Micro was one of my least favorite parts of med school. Just one of those things my brain didn't want to commit to memory.

I can't say anything- the seasoned radiologist favorite case is the subtle one, or the one you only thought you'd see in a book.

[Hatton]

An old lady in the ICU who had developed an incidental cough had a sputum sent to my lab - when I looked at it, I saw Strongyloides stercoralis on the smear. Totally unexpected diagnosis, and no one could figure out how she picked that up.

interesting

[Hatton]

Fibroids to the Xyphoid in a Jehovah's Witness patient.

[MPMD]

When I was in med school many moons ago I took a history from a Vietnam vet who had depression. I assumed all the typical reasons for the problem and was shocked to find that he was depressed because the war was over and he couldn't kill people anymore. He loved killing people. I imagine you folk in psych see that occasionally but it was a bit surprising to me.

i knew a guy like that who was a recon marine.

loved war, came home and was very unhappy, nothing ever lived up.

[MPMD]

Wow, that sounds bizarre! What specifically was the pt doing?

let's say extreme agitation that was very bizarre (not typical psych pt stuff) interspersed w/ periods of totally normal behavior during which time they would confirm aspects of possession.

are we talking 360 degree head rotation and projectile vomiting?

not that bad but some weird stuff.

Did you…did you consult a priest?

i did not personally but something similar to this did happen.

[childay]

let's say extreme agitation that was very bizarre (not typical psych pt stuff) interspersed w/ periods of totally normal behavior during which time they would confirm aspects of possession.



not that bad but some weird stuff.



i did not personally but something similar to this did happen.

Probably conversion disorder. More interesting than pseudoseizures though!

[Cytogal]

30's woman with lobular breast cancer and CDH1 mutation (increased likelihood of stomach cancer). In her random stomach biopsies I found 5 cells of stomach cancer. Like literally 5. Her gastrectomy showed less than 1mm of cancer, but that probably saved her life. She had several children, was young and otherwise completely healthy. Screening works!!

[Bdoc]

psych pt w/ fibroids refusing blood transfusions...walked in with hb 1.5 and fatigue. Also have had psych pt refusing insulin walking around in DKA have full conversation with pH 6.5

Very impressed w/ both of these cases

[Sigrid]

Had a guy once with a blood ethanol level of 769 who was awake and talking to me.

I mean, he wasn't making any sense, but he was awake!

Also just recently had two cases in one shift of conversion disorder. This is weird because I'm an Emergency doc.

[K82]

When I was in residency I did an angiogram on a pt in his 30's for HTN. He was all tatoo'ed up, had the look of not the most upstanding citizen. He was taken to the post procedure recovery room where I needed to pull the catheter and hold pressure over his femoral artery for 15-20 minutes. There was no one else in the room at the time. I pulled his catheter out and due to his significant HTN a large squirt of blood shot up and got me in the face hitting me right in the eyes. I had blood dripping off my face and there was nothing I could do. I couldn't release the firm pressure I had to apply with both hands to keep his puncture site from spewing blood and there was no one in the room to help me. My conjunctiva were burning. As I stood there for 20 minutes holding pressure I was wondering what interesting bugs were entering my mucous membranes. Fun times.

[blippi]

Probably conversion disorder. More interesting than pseudoseizures though!

or perhaps autoimmune encephalitis or excited catatonia?

[legobikes]

-15 yo who shot himself in temple, only to have the bullet travel along the braincase and exit
-after getting back up, shot himself under the chin, which then exited the back of his neck, missing every vital structure including the ext carotid by 3 mm

(IIRC - I was a first year)

[VentAlarm]

When I was in residency I did an angiogram on a pt in his 30's for HTN. He was all tatoo'ed up, had the look of not the most upstanding citizen. He was taken to the post procedure recovery room where I needed to pull the catheter and hold pressure over his femoral artery for 15-20 minutes. There was no one else in the room at the time. I pulled his catheter out and due to his significant HTN a large squirt of blood shot up and got me in the face hitting me right in the eyes. I had blood dripping off my face and there was nothing I could do. I couldn't release the firm pressure I had to apply with both hands to keep his puncture site from spewing blood and there was no one in the room to help me. My conjunctiva were burning. As I stood there for 20 minutes holding pressure I was wondering what interesting bugs were entering my mucous membranes. Fun times.

Nah man. That guy gets a pseudoaneurysm and you clean your self off.