Interesting Clinical Vignettes: 101 Ice Breakers for Medical Rounds Texas Tech University Health Sciences Center (TTUHSC) Contributing Faculty Jannette M. Dufour Gurvinder Kaur Cassandra Kruczek Neha Mittal Alan N. Peiris Rebecca B. Sleeper TTUHSC Contributing Trainees Jessica Agrimor Anna Calara Sarah Jaroudi Jeremy Moon Sneha Raju Shannon Rice Kandis Wright With Assistance from Meredith Gavin 2 Foreword In West Texas, like many rural areas, a high demand for physicians persist. Providing general medical care to patients remains a time honored and gratifying vocation. Medicine has seen many technological advances. It has been challenging to maintain an interest in predominantly clinical specialties among trainees. If we are to maintain Internal Medicine at the gateway of providing care to adults we need a pipeline of young enthusiastic trainees. This book addresses this issue by providing a perspective on some interesting clinical vignettes. We are very pleased that Dr. Alan Peiris and his colleagues initiated this book. Dr. Peiris is a well-recognized physician leader in education and scholarship. He was ably assisted by similarly talented TTUHSC faculty and trainees in diverse departments in our Lubbock campus. The inclusion of the Basic Science and Pharmacy perspective in this book of clinical vignettes is a major bonus. Internal Medicine remains a vast field, and there are multiple textbooks that provide specific and detailed information. The authors wisely chose not to duplicate such efforts. The main intent of this book is to stimulate interest in general Internal Medicine and assist in the generation of a broader clinical differential diagnosis. We found the cases stimulating and enthusiastically recommend this book to you Steven L. Berk, MD Dean, School of Medicine, Executive Vice President and Provost, Texas Tech University Health Sciences Center Tedd L. Mitchell, MD President, Texas Tech University Health Sciences Center August 2018 3 Preface In Medicine we only recognize what we know and we only know what we critically read and evaluate. The idea to describe interesting cases in General Medicine has been a goal of mine for a number of years. I enjoyed publishing a book on spot clinical diagnoses in Medicine with my fellow residents while in the United Kingdom1. Medicine, especially Internal Medicine, remains a fascinating and challenging field in which mastery is elusive. I also want to acknowledge the help of many mentors, they helped instill the perpetual learner model. Writing a multi-author book is not for the faint of heart! Many expressed interest however only a few remained committed to this endeavor. The book has been a couple of years in the making. I am grateful to the entire group of trainees and faculty that made time in their busy schedules to help compile this book. It is especially gratifying that faculty encompassed many different fields participated in this endeavor. Drs. Jannette Dufour, Gurvinder Kaur and Cassie Kruczek and their teams provided a basic science background in the clinical cases. Dr. Rebecca Sleeper assisted in the Pharmacy therapeutics arena. Dr. Neha Mittal provided an Internist’s perspective on the clinical cases. Our trainees Jessica Agrimor, Anna Calara, Sarah Jaroudi, Jeremy Moon, Sneha Raju, Shannon Rice and Kandis Wright came from very diverse backgrounds, however, their team spirit and participation was pivotal to the completion of this book. I am indebted to the entire group for their sense of good humor and esprit de corps. The purpose of this book is to describe medical entities that hopefully will be of interest to you. We hope these cases will spur you towards additional reading on these and other similar topics. While the information contained may help you in managing patients, we do not recommend that this book be the sole source of reference for patient management. Appropriate consultation and the pursuit of second opinions in challenging and complex medical problems remains a time honored method of ensuring the patient gets the best care. The material contained in this book is provided at no cost as long as the source is fully acknowledged. As in any academic work there may be errors within this book or areas that you, the reader, disagree with the narrative for a variety of reasons. If so, we would be pleased to hear from you. I want to thank my daughter Emma Peiris, MD (AOA, 2014) for sharing some of her interesting Internal Medicine cases. I want to also acknowledge the assistance and support I have received from Dean Steven Berk, MD and President Tedd Mitchell, MD and their commitment to excellence in medical education which makes Texas Tech University Health Sciences Center (TTUHSC) a great academic setting for faculty, students, and residents. Alan N. Peiris, MD, PhD, FRCP (London), FACE, FACP Professor, Vice-Chair and Chief of Geriatrics - Internal Medicine, Myrick-Myers Endowed Chair in Geriatrics, Executive Director – Clinical Research Institute, Texas Tech University Health Sciences Center [email protected] 1 A photographic quiz in medicine by Philip Ebden, Alan Peiris, Michael J. Dew. 216 p, Lloyd-Luke Medical Books, 1984. London, England. NLM ID: 8502049 4 Biography of Contributors Faculty: Jannette M. Dufour, PhD Dr. Jannette M. Dufour received her PhD in Genetics and Cell Biology from Washington State University in 1999. She then trained as a postdoctoral fellow with the Islet Transplantation Group in the Surgical Medical Research Institute, Department of Surgery at the University of Alberta, Edmonton, Canada. In 2005, she joined the faculty at TTUHSC where she is currently a Professor in the Department of Cell Biology and Biochemistry and the Associate Dean for Research in the School of Medicine. She is the Director of the medical student research program and teaches anatomy, diabetes and transplantation immunology. Gurvinder Kaur, PhD Dr. Gurvinder Kaur received her PhD in Biomedical Sciences with a concentration in Cell Biology and Biochemistry from TTUHSC in 2012. She then trained as a postdoctoral fellow in the fields of transplantation immunology and diabetes from 2012-2016. She is currently an Assistant Professor in the Department of Medical Education, School of Medicine, TTUHSC and the Co-Associate Block Director for Clinically Oriented Anatomy. Cassandra Kruczek, PhD Dr. Cassandra Kruczek received her PhD in Biomedical Sciences with a concentration in Medical Microbiology and Immunology from TTUHSC in 2013. She joined the Department of Surgery at TTUHSC as a post-doctoral research associate from 2013-2014, then was an instructor in the Honors College at TTU. She is currently an Assistant Professor in the Department of Medical Education at TTUHSC. Neha Mittal, MD Neha Mittal completed her medical school from the SMS Medical College, India in 1999 and completed her IM residency from the University of Pittsburgh Medical Center (UPMC) McKeesport hospital in 2003. She joined Texas Tech in 2006. She is currently an associate professor in department of IM at the TTUHSC SOM and has been serving as clerkship director since 2012. She has been a recipient of the Robert Kimbrough professorship in medical education since 2017 and is a part of the core faculty of the TTUSHC IM residency program. Alan N. Peiris, MBBS(London), MD(London), FRCP(London), MRCS(Eng) Dr. Peiris is a British medical graduate (St. Bartholomews Hospital) and Tenured Professor of Medicine and Vice-Chair in the Department of Internal Medicine. He holds the Myrick-Myers Endowed Chair in Geriatrics. He was the holder of the TJ and Margaret Talkington Endowed Chair at TTUHSC in Endocrinology between 2015 and 2017. Dr. Peiris is the Executive Director of the Clinical Research Institute at TTUHSC. He is a board certified Internist in the US and UK (MRCP). His US specialty board certifications include Endocrinology and Geriatrics. His interests encompass clinical research, clinical medicine, bedside diagnosis and Vitamin D metabolism. He has published in many different research arenas and enjoys promoting research and scholarship efforts among trainees and faculty. Rebecca B. Sleeper, PharmD, FCCP, FASCP, BCPS Dr. Sleeper is a Professor of Pharmacy Practice in the Geriatrics Division and is Associate Dean of Curriculum at the Texas Tech University Health Sciences Center School of Pharmacy. She received her Doctor of Pharmacy from the University of Rhode Island and completed specialty residency training in Geriatric Pharmacotherapy from TTUHSC School of Pharmacy. She is a board certified Pharmacotherapy specialist and a fellow of the American College of Clinical Pharmacy and the American Society of Consultant Pharmacists. She is the co-editor of the textbook "Fundamentals of Geriatric Pharmacotherapy" and participates in the instruction of Pharmacy and Medical students in long term care, dementia care, and skilled nursing environments. 5 Trainees Jessica Agrimor Jessica Agrimor completed her pre-pharmacy coursework at Texas Tech University and is now a current fourth year pharmacy student at TTUHSC School of Pharmacy. During her years as a pharmacy student, she has been an active member and an officer for Student National Pharmaceutical Association, an organization that focuses on pharmacy and healthcare related issues geared towards serving the underserved community. She will be graduating this 2018 and plans to pursue a career in a retail or ambulatory care setting. Anna Calara Anna Calara graduated from The University of Texas at Austin in 2014 with a Bachelor of Science degree in Nutritional Sciences. She is pursuing an MD degree at TTUHSC in Lubbock, Texas and expects to graduate in 2019. Sarah Jaroudi Sarah Jaroudi graduated from the University of Houston in Houston, Texas with a Bachelor of Science degree in Nutritional Sciences in 2015. She is pursuing an MD degree at TTUHSC in Lubbock, Texas and is expected to graduate in 2019. Jeremy Moon Jeremy Moon graduated from the University of California, Los Angeles, California in 2015 with a Bachelor of Science degree in Physiological Sciences.