https://everydayebm.org/the-other-things daily 0.75 2016-03-03 https://everydayebm.org/the-other-things/2015/12/21/the-antibiotics-in-strep-debate-a-pediatric-perspective monthly 0.5 2015-12-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1450726881891-3MNGQKQVBMPJIXRH6XAO/image-asset.jpeg The Other Things - Antibiotics for Strep Pharyngitis: The Pediatric Perspective https://everydayebm.org/the-other-things/2015/06/i-am-chris-miller-former-party-fowl-and.html monthly 0.5 2015-06-26 https://everydayebm.org/the-other-things/2015/03/how-do-you-foam-anyway.html monthly 0.5 2016-03-03 https://everydayebm.org/the-other-things/2014/12/foam-party-part-i-abscess-diagnosis-at.html monthly 0.5 2014-12-03 https://everydayebm.org/the-other-things/2014/11/foamed-digest-no-9-for-visually-oriented.html monthly 0.5 2014-11-24 https://everydayebm.org/the-other-things/2014/11/expert-commentary-troubleshooting.html monthly 0.5 2014-11-18 https://everydayebm.org/the-other-things/2014/11/foamed-digest-no-8-thank-you-sir-may-i.html monthly 0.5 2014-11-10 https://everydayebm.org/the-other-things/2014/10/wustlem-foamed-digest-7-best-of-best-of.html monthly 0.5 2014-10-25 https://everydayebm.org/the-other-things/2014/10/expert-commentary-arise-and-ed-sepsis.html monthly 0.5 2014-10-13 https://everydayebm.org/the-other-things/2014/10/foamed-digest-6-update-paper-trail.html monthly 0.5 2014-10-13 https://everydayebm.org/the-other-things/2014/10/foamed-digest-6-aint-nobody-got-time.html monthly 0.5 2014-10-13 https://everydayebm.org/the-other-things/2014/09/foamed-digest-5-but-this-one-goes-to-11.html monthly 0.5 2014-10-06 https://everydayebm.org/the-other-things/2014/09/foamed-digest-4-butter-my-biscuit-baby.html monthly 0.5 2014-10-06 https://everydayebm.org/the-other-things/2014/09/foamed-digest-3-you-need-me-on-that-wall.html monthly 0.5 2014-10-06 https://everydayebm.org/the-other-things/2014/09/wuemr-foamed-digest-2-breathless-love.html monthly 0.5 2014-10-06 https://everydayebm.org/the-other-things/2014/08/wuemr-foamed-digest-1-total-eclipse-of.html monthly 0.5 2014-10-06 https://everydayebm.org/the-other-things/tag/Pediatrics monthly 0.5 https://everydayebm.org/the-other-things/tag/insulin monthly 0.5 https://everydayebm.org/the-other-things/tag/MillerTime monthly 0.5 https://everydayebm.org/the-other-things/tag/Infectious+Disease monthly 0.5 https://everydayebm.org/the-other-things/tag/Pharmacotherapy monthly 0.5 https://everydayebm.org/the-other-things/tag/Endocrine monthly 0.5 https://everydayebm.org/the-other-things/tag/Urology monthly 0.5 https://everydayebm.org/the-other-things/tag/Imaging monthly 0.5 https://everydayebm.org/the-other-things/tag/Surgery monthly 0.5 https://everydayebm.org/the-other-things/tag/Gastroenterology monthly 0.5 https://everydayebm.org/the-other-things/tag/Anesthesia monthly 0.5 https://everydayebm.org/the-other-things/tag/DKA monthly 0.5 https://everydayebm.org/the-other-things/tag/Cardiology monthly 0.5 https://everydayebm.org/the-other-things/tag/Ultrasound monthly 0.5 https://everydayebm.org/the-other-things/tag/EKG monthly 0.5 https://everydayebm.org/the-other-things/tag/Dermatology monthly 0.5 https://everydayebm.org/the-other-things/tag/OB%2FGyn monthly 0.5 https://everydayebm.org/the-other-things/tag/Clinical+Decision+Rule monthly 0.5 https://everydayebm.org/the-other-things/tag/EMS monthly 0.5 https://everydayebm.org/the-other-things/tag/Airway monthly 0.5 https://everydayebm.org/the-other-things/tag/Trauma monthly 0.5 https://everydayebm.org/the-other-things/tag/Medicine monthly 0.5 https://everydayebm.org/the-other-things/tag/Neurology monthly 0.5 https://everydayebm.org/the-other-things/tag/Orthopedics monthly 0.5 https://everydayebm.org/the-other-things/tag/Critical+Care monthly 0.5 https://everydayebm.org/the-other-things/tag/Sepsis monthly 0.5 https://everydayebm.org/the-other-things/tag/Paper+Trail monthly 0.5 https://everydayebm.org/the-other-things/tag/Diabetes monthly 0.5 https://everydayebm.org/the-other-things/tag/FOAMed+Digest monthly 0.5 https://everydayebm.org/the-other-things/tag/Pulmonary monthly 0.5 https://everydayebm.org/the-other-things/tag/FOAMed monthly 0.5 https://everydayebm.org/the-other-things/tag/Geriatrics monthly 0.5 https://everydayebm.org/ekg-challenge daily 0.75 2018-01-21 https://everydayebm.org/ekg-challenge/2017/10/7/ekg-challenge-no-18-a-nurse-hands-you-this-ekg-pr5a3 monthly 0.5 2018-01-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1507436289732-SC12L8RAZLIC7UE380D9/EKG_20171006.jpg EKG Challenge - EKG Challenge No. 18 Case Conclusion: A Nurse Hands You this EKG... https://everydayebm.org/ekg-challenge/2017/10/7/ekg-challenge-no-18-a-nurse-hands-you-this-ekg monthly 0.5 2017-10-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1507436289732-SC12L8RAZLIC7UE380D9/EKG_20171006.jpg EKG Challenge - EKG Challenge No. 18: A Nurse Hands You this EKG... https://everydayebm.org/ekg-challenge/2017/4/24/ekg-challenge-no-17-case-conclusion monthly 0.5 2017-04-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1493059595252-RLSHOAQUXCH7PVIQWZKE/ekg1.png EKG Challenge - EKG Challenge No. 17 Case Conclusion https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1493059909108-YWJCDXZ9PK3ZNRLJFYDB/image-asset.png EKG Challenge - EKG Challenge No. 17 Case Conclusion https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1493060176028-NC2R7BSD9FNZLCWIWNT7/image-asset.png EKG Challenge - EKG Challenge No. 17 Case Conclusion The patient's post-admission EKG. Wellen's waves are appreciated in V1 and V2. https://everydayebm.org/ekg-challenge/2017/4/17/ekg-challenge-no-17-now-i-can-focus-on-how-much-my-chest-hurts monthly 0.5 2017-04-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1492454781867-UY4PX65GIX2R1HYEU2JV/image-asset.png EKG Challenge - EKG Challenge No. 17: Now I Can Focus on How Much My Chest Hurts https://everydayebm.org/ekg-challenge/2016/8/6/ekg-challenge-no-16-case-conclusion monthly 0.5 2016-08-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1470516328354-23GZHKPT23F0QQW4RRUH/image-asset.png EKG Challenge - EKG Challenge No. 16 Case Conclusion https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1470516562604-P8EWLUBA2CNA4OZWPWMN/image-asset.png EKG Challenge - EKG Challenge No. 16 Case Conclusion Repeat EKG #1, after treatment for hyperkalemia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1470516599183-BC1OV9Z1ZNPIPBVZ7Y3M/image-asset.png EKG Challenge - EKG Challenge No. 16 Case Conclusion Repeat EKG #2, after treatment for hyperkalemia https://everydayebm.org/ekg-challenge/2016/7/27/ekg-challenge-no-16-time-to-shock-or-block monthly 0.5 2016-07-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1469654828767-0YMBC4HQAENOFUWPCR82/image-asset.png EKG Challenge - EKG Challenge No. 16: Time to Shock or Block? https://everydayebm.org/ekg-challenge/2016/6/9/ekg-challenge-no-15-case-conclusion-too-much-ibuprofen monthly 0.5 2016-06-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1465455319276-THF4W9UNIESJ2491SNYN/image-asset.jpeg EKG Challenge - EKG Challenge No. 15 Case Conclusion: Too Much Ibuprofen? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1466150796734-0BQP2ERYCNL7A3WJE7Q1/image-asset.jpeg EKG Challenge - EKG Challenge No. 15 Case Conclusion: Too Much Ibuprofen? EKG in a patient with a tricyclic antidepressant overdose. The QRS duration here was 122 ms. Note the tall R' in aVR, which is more subtle than the diphenhydramine overdose EKG above. https://everydayebm.org/ekg-challenge/2016/6/9/ekg-challenge-no-15-too-much-ibuprofen monthly 0.5 2016-06-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1465453802643-GUS7ENKL0X9SP1QELUEK/image-asset.jpeg EKG Challenge - EKG Challenge No. 15: Too Much Ibuprofen? https://everydayebm.org/ekg-challenge/2015/07/ekg-challenge-case-conclusion-ekg-sign.html monthly 0.5 2015-10-20 https://everydayebm.org/ekg-challenge/2015/07/ekg-challenge-no-14-elderly-gentleman.html monthly 0.5 2015-07-23 https://everydayebm.org/ekg-challenge/2015/05/ekg-challenge-no-13-case-conclusion.html monthly 0.5 2015-05-08 https://everydayebm.org/ekg-challenge/2015/05/ekg-challenge-no-13-i-feel-much-better.html monthly 0.5 2015-05-08 https://everydayebm.org/ekg-challenge/2015/04/ekg-challenge-no-12-case-conclusion.html monthly 0.5 2015-04-04 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monthly 0.5 https://everydayebm.org/work-1 daily 0.75 2013-08-30 https://everydayebm.org/new-blog-2 daily 0.75 2016-06-14 https://everydayebm.org/new-blog-2/2015/01/brought-in-by-ambulance-5-chemical.html monthly 0.5 2015-01-08 https://everydayebm.org/new-blog-2/2014/11/brought-in-by-ambulance-4-pour-some.html monthly 0.5 2014-11-19 https://everydayebm.org/new-blog-2/2014/11/my-leg-hurts-well-heres-c-collar-pre.html monthly 0.5 2014-11-09 https://everydayebm.org/new-blog-2/2014/09/brought-in-by-ambulance-2-needle.html monthly 0.5 2014-09-29 https://everydayebm.org/new-blog-2/2014/09/vagal-maneuvers-in-svt.html monthly 0.5 2014-10-05 https://everydayebm.org/new-blog-2/2014/08/rigid-backboard-for-spinal.html monthly 0.5 2014-09-23 https://everydayebm.org/new-blog-2/tag/Medicine monthly 0.5 https://everydayebm.org/new-blog-2/tag/insulin monthly 0.5 https://everydayebm.org/new-blog-2/tag/Pharmacotherapy monthly 0.5 https://everydayebm.org/new-blog-2/tag/BIBA monthly 0.5 https://everydayebm.org/new-blog-2/tag/EMS monthly 0.5 https://everydayebm.org/new-blog-2/tag/psychiatry monthly 0.5 https://everydayebm.org/new-blog-2/tag/Diabetes monthly 0.5 https://everydayebm.org/new-blog-2/tag/Cardiology monthly 0.5 https://everydayebm.org/new-blog-2/tag/Trauma monthly 0.5 https://everydayebm.org/new-blog-3 daily 0.75 2018-01-02 https://everydayebm.org/new-blog-3/2015/12/28/pelvicandacetabularinjuries monthly 0.5 2015-12-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1451360645362-1OJ191A6ZEASZ256O5AA/image-asset.png Consultant Teachings - Consultant Teachings No. 5: Pelvic Ring and Acetabular Injuries for the Emergency Provider https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1451359972766-1SSQQNR1N1E3IRKCQASF/APC.jpg Consultant Teachings - Consultant Teachings No. 5: Pelvic Ring and Acetabular Injuries for the Emergency Provider https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1451360181033-1G8H8EI1YT7VF1CFCOMG/image-asset.jpeg Consultant Teachings - Consultant Teachings No. 5: Pelvic Ring and Acetabular Injuries for the Emergency Provider https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1451360287886-ITU9VXHXJHMSRLK9OMKP/image-asset.jpeg Consultant Teachings - Consultant Teachings No. 5: Pelvic Ring and Acetabular Injuries for the Emergency Provider https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1451360925079-7BLOPQIL48IXLELXQLJ1/image-asset.jpeg Consultant Teachings - Consultant Teachings No. 5: Pelvic Ring and Acetabular Injuries for the Emergency Provider https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1451360972116-E12YQYI2H9WVD6SA4NFI/image-asset.jpeg Consultant Teachings - Consultant Teachings No. 5: Pelvic Ring and Acetabular Injuries for the Emergency Provider https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1451361269739-KQEG5CH9QSXGJ3VYCKA4/acetabular_fracture.jpg Consultant Teachings - Consultant Teachings No. 5: Pelvic Ring and Acetabular Injuries for the Emergency Provider Image Source: emedicine.medscape.com https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1451361138848-6YCZUJDKZBAE6XWCJRM3/image-asset.jpeg Consultant Teachings - Consultant Teachings No. 5: Pelvic Ring and Acetabular Injuries for the Emergency Provider https://everydayebm.org/new-blog-3/2015/08/consultant-teachings-no-4-when-history.html monthly 0.5 2015-08-29 https://everydayebm.org/new-blog-3/2015/07/consultant-teachings-no-3-evaluation-of.html monthly 0.5 2015-07-27 https://everydayebm.org/new-blog-3/2015/06/consultant-teachings-no-2-evaluation.html monthly 0.5 2015-06-26 https://everydayebm.org/new-blog-3/2015/04/consultant-teachings-no-1-acute.html monthly 0.5 2015-06-26 https://everydayebm.org/new-blog-3/tag/Neurology monthly 0.5 https://everydayebm.org/new-blog-3/tag/Orthopedics monthly 0.5 https://everydayebm.org/new-blog-3/tag/Imaging monthly 0.5 https://everydayebm.org/new-blog-3/tag/Critical+Care monthly 0.5 https://everydayebm.org/new-blog-3/tag/Trauma monthly 0.5 https://everydayebm.org/new-blog-3/tag/Airway monthly 0.5 https://everydayebm.org/new-blog-3/tag/Consultant+Teachings monthly 0.5 https://everydayebm.org/foam daily 0.75 2023-06-14 https://everydayebm.org/foam/2021/4/27/conference-supplement-4272021 monthly 0.5 2021-04-27 https://everydayebm.org/foam/2021/1/19/conference-supplement-1192021-1 monthly 0.5 2021-01-21 https://everydayebm.org/foam/2021/1/12/conference-supplement-1122021 monthly 0.5 2021-01-19 https://everydayebm.org/foam/2021/1/1/conference-supplement-912020-sm6n2 monthly 0.5 2021-01-09 https://everydayebm.org/foam/2021/1/1/conference-supplement-912020 monthly 0.5 2021-01-01 https://everydayebm.org/foam/2020/8/18/foam-supplement-8182020 monthly 0.5 2021-01-01 https://everydayebm.org/foam/2020/8/15/foam-supplement-8112020 monthly 0.5 2020-08-16 https://everydayebm.org/foam/2020/8/3/foam-supplment-7282020 monthly 0.5 2021-01-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1596477031744-MM7SDWU1WPUGXADBDMFS/Screen+Shot+2020-07-28+at+8.52.48+AM.png The Show Notes - FOAM supplement 7/28/2020 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1596477036770-JJN2UTSAQVIX0PY1KBFM/Screen+Shot+2020-07-28+at+8.54.02+AM.png The Show Notes - FOAM supplement 7/28/2020 https://everydayebm.org/foam/2017/10/9/foam-supplement-emconf-foamed monthly 0.5 2021-01-01 https://everydayebm.org/foam/2017/9/24/foam-supplementemconf-foam monthly 0.5 2017-09-24 https://everydayebm.org/foam/2017/9/10/foam-supplement monthly 0.5 2017-09-10 https://everydayebm.org/foam/2017/8/21/foam-supplement-8142017 monthly 0.5 2017-08-21 https://everydayebm.org/foam/2017/8/11/foam-supplement-872017 monthly 0.5 2017-08-14 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https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1470944994706-HDS82029GF1ZZOI4IO9L/image-asset.png The Show Notes - @WUSTL_EM #EMConf #FOAMed Supplement No. 40 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1470943285671-FS9HC63SX9QKCIA24H86/B37FA8A6-EC72-4125-A5B9-7BA6D3C39791.png The Show Notes - @WUSTL_EM #EMConf #FOAMed Supplement No. 40 https://everydayebm.org/foam/2016/8/4/wustlem-emconf-foamed-supplement-no-39 monthly 0.5 2016-08-04 https://everydayebm.org/foam/2016/7/18/wustlem-emconf-foamed-supplement-no-38 monthly 0.5 2016-07-19 https://everydayebm.org/foam/2016/7/6/wustlem-foamed-supplement-6516 monthly 0.5 2016-07-06 https://everydayebm.org/foam/2016/5/24/wustlem-emconf-foamed-supplement-no-36 monthly 0.5 2016-05-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1464113548353-495X4XN8CWXWMA8VG9G9/image-asset.jpeg The Show Notes - @WUSTL_EM #EMConf #FOAMed Supplement No. 36 https://everydayebm.org/foam/2016/5/4/wustlem-emconf-foamed-supplement-no-35 monthly 0.5 2016-05-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1462376783742-GYNHTB6K00303BPZV8T2/image-asset.jpeg The Show Notes - @WUSTL_EM #EMConf #FOAMed Supplement No. 35 https://everydayebm.org/foam/2016/4/26/wustlem-emconf-foamed-supplement-no-34 monthly 0.5 2016-05-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1462224170531-4TBNV6K0D5ICBBMYONMW/image-asset.jpeg The Show Notes - @WUSTL_EM #EMConf #FOAMed supplement No. 34 https://everydayebm.org/foam/2016/4/12/wustlem-emconf-foamed-supplement-no-33 monthly 0.5 2016-04-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1460815230383-NHMCAR4AENT72RYUC1YT/image-asset.jpeg The Show Notes - @WUSTL_EM #EMConf #FOAMed Supplement No. 33 https://everydayebm.org/foam/2016/3/15/wustlem-fo monthly 0.5 2016-03-20 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29 https://everydayebm.org/foam/2016/2/9/wustlem-emconf-foamed-no-28 monthly 0.5 2016-02-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1455465976396-TIVO6Q55O9J6V49HFYJT/image-asset.jpeg The Show Notes - @WUSTL_EM #EMConf #FOAMed No. 28 https://everydayebm.org/foam/2016/2/5/wustlem-emconf-foamed-supplement-no-27 monthly 0.5 2016-02-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1454870989759-BGFMNEMDWD3TTY2UX8MM/image-asset.jpeg The Show Notes - @WUSTL_EM #EMConf #FOAMed Supplement No. 27 https://everydayebm.org/foam/2016/1/31/wustlem-emconf-foamed-supplement-no-26 monthly 0.5 2016-01-31 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1454276430342-F50J1RM4FYHR2QM0Q7S6/image-asset.jpeg The Show Notes - @WUSTL_EM #EMConf #FOAMed Supplement No. 26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1454274098714-BNVCX731NG6DZQGFUVPR/Airway_teach.jpg The Show Notes - @WUSTL_EM #EMConf #FOAMed 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https://everydayebm.org/blog/p/disclaimer.html monthly 0.5 2015-07-30 https://everydayebm.org/work daily 0.75 2013-08-30 https://everydayebm.org/images daily 0.75 2014-03-21 https://images.squarespace-cdn.com/content/v1/4f6798afe4b097349e410d49/1383938787527-BODFT7PCTVYTFCBGLTP6/20130731_Trade+100_0220.jpg Videos - .. . https://everydayebm.org/about-1 daily 0.75 2014-09-08 https://everydayebm.org/case-based-learning daily 0.75 2018-12-03 https://everydayebm.org/case-based-learning/2018/12/2/trading-joint-ache-for-heartachenbspnsaids-and-ohca monthly 0.5 2018-12-03 https://everydayebm.org/case-based-learning/2018/9/8/clavicular-fractures monthly 0.5 2018-09-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1536432136940-BV0BBUHN8BFPR3J4YDHB/Clavicle+anatomy.gif You're Putting that Needle Where?! - Clavicular Fractures Phadnis J., Bain G.I. (2015) Clavicle Anatomy. In: Bain G., Itoi E., Di Giacomo G., Sugaya H. (eds) Normal and Pathological Anatomy of the Shoulder. Springer, Berlin, Heidelberg https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1536432204471-9AX9C1U3Q8D4EHV9174W/Normal_shoulder_lig.jpg You're Putting that Needle Where?! - Clavicular Fractures 2018 UpToDate, Inc. and/or its affiliates. All Rights Reserved. Normal shoulder ligaments: Anterior view https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1537798708372-ADKP8AXHRIBQ4QTR847O/Clavicle_fx_cephalic_view.jpg You're Putting that Needle Where?! - Clavicular Fractures This midshaft clavicle fracture cannot be appreciated with standard views (radiograph on left). However, by using the 45-degree cephalic tilt view (radiograph on right), bone angulation and a fracture line become apparent. Reproduced with permission from: Eiff, MP, Hatch, RL, Calmbach, W (Eds). Fracture Management for Primary Care, 2nd Edition, W.B. Saunders Company, Philadelphia 2002. Illustration used with permission of Elsevier Inc. All right reserved. Copyright ©2002 Elsevier Inc. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1537798763375-7UZEGQOOHUAWNOOKZVSS/shortening+of+clavicle.jpg You're Putting that Needle Where?! - Clavicular Fractures Courtesy of Robert L Hatch, MD, MPH. From Uptodate 2018. Shortening of greater than 4cm requires surgical consultation. https://everydayebm.org/case-based-learning/2017/10/2/vagal-maneuvers-in-svt-tacky-or-tachy monthly 0.5 2017-10-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1506997462787-9VOK8GHHEFXBBLTED9EJ/EKG+SVT.png You're Putting that Needle Where?! - Vagal Maneuvers in SVT: Give 'em a Leg Up! https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1506997713596-DSDOBSJXJP7RD6IWUKAN/bear+down.jpg You're Putting that Needle Where?! - Vagal Maneuvers in SVT: Give 'em a Leg Up! -     Ok now bear down... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1506998925044-2DWZ8X9OLZ331IXVXTD4/valsalva+gif.gif You're Putting that Needle Where?! - Vagal Maneuvers in SVT: Give 'em a Leg Up! Demonstrating modified Valsalva. https://everydayebm.org/case-based-learning/2017/8/22/evicted-em-book-club monthly 0.5 2017-08-30 https://everydayebm.org/case-based-learning/2017/8/4/lz0mxsum3kgkf4btujt7f0fs5gbc1o monthly 0.5 2017-08-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1503504006248-0LA46YP24DQYLLV2W4NB/CML_blood_smear.jpg You're Putting that Needle Where?! - Blast Crisis and Hyperleukocytosis Characteristic peripheral blood smear of chronic myeloid leukemia shows basophilia and granulocytosis with neutrophils and immature granulocytes. Reproduced with permission from: McClatchey, KD, MD, DDS. Clinical Laboratory Medicine, 2nd Edition. Philadelphia: Lippincott Williams & Wilkins, 2002. Copyright ©2002 Lippincott Williams & Wilkins https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1503504041527-XVL3X3RQ3PI8FNVXM7RI/Genesis_Philadelphia_chromo.jpg You're Putting that Needle Where?! - Blast Crisis and Hyperleukocytosis G-band ideograms (left) and partial karyotype (right) of the CML-associated chromosome translocation t(9;22)(q34;q11.2). Breakpoints are indicated with arrows on the normal chromosome homologs. Translocated segments are framed on the der(9) and Ph ideograms. The translocation results in a slightly longer chromosome 9 [der(9)] and a shorter chromosome 22 [der(22)], which is termed the Philadelphia (Ph) chromosome. Courtesy of Athena Cherry, PhD. https://everydayebm.org/case-based-learning/2017/7/24/reboa-resuscitative-endovascular-balloon-occlussion-of-the-aorta monthly 0.5 2017-07-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1500901007195-UNK139S3EI4QCSDQT2DV/image-asset.png You're Putting that Needle Where?! - REBOA: Resuscitative Endovascular Balloon Occlusion of the Aorta https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1500901036156-LCW3W2K5LVP62U35CSRB/image-asset.png You're Putting that Needle Where?! - REBOA: Resuscitative Endovascular Balloon Occlusion of the Aorta Source: Prytime medical http://prytimemedical.com/wp-content/uploads/2017/05/er-reboa-cath-900.png https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1500901088447-4VN7C1MUVVWFXBOFBCHI/image-asset.png You're Putting that Needle Where?! - REBOA: Resuscitative Endovascular Balloon Occlusion of the Aorta Source: Napolitano LM. Resuscitative Endovascular Balloon Occlusion of the Aorta: Indications, Outcomes, and Training. Crit Care Clin. 2017;33(1):55-70. https://everydayebm.org/case-based-learning/2017/3/26/vitamincsepsis monthly 0.5 2017-03-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1490579611621-M80KQFYSNS18TBDIEYCT/image-asset.png You're Putting that Needle Where?! - Vitamin C in Sepsis: Splashes in the popular press When articles pertaining to emergency medicine and critical care make a splash in the popular press, we’ll do our best to provide a timely appraisal of the evidence. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1490579866056-OHCEERB3CTOKL4UMYBPN/image-asset.png You're Putting that Needle Where?! - Vitamin C in Sepsis: Splashes in the popular press https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1490579900629-MFDS5IIWRPKKABGM3PD9/image-asset.png You're Putting that Needle Where?! - Vitamin C in Sepsis: Splashes in the popular press Vitamin C: Source: https://en.wikipedia.org/wiki/Vitamin_C#/media/File:L-Ascorbic_acid.svg https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1490579993987-BHYA6AHTNHD0EDJF28IF/image-asset.png You're Putting that Needle Where?! - Vitamin C in Sepsis: Splashes in the popular press NNT for death was 3.1 in this study, rounded up to 4 treated patients to avoid one death https://everydayebm.org/case-based-learning/edthoracotomy monthly 0.5 2017-03-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1489754100096-Y35C3WG4REYOUHJZR0TP/image-asset.png You're Putting that Needle Where?! - Emergency Resuscitative Thoracotomy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1489754408154-YA1SR30HGEX4QAPRP98G/EAST.png You're Putting that Needle Where?! - Emergency Resuscitative Thoracotomy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1489754407873-U9S5QZLEK3TN89YAEAOY/WEST.png You're Putting that Needle Where?! - Emergency Resuscitative Thoracotomy https://everydayebm.org/case-based-learning/2017/1/8/you-cant-patch-up-an-ich monthly 0.5 2017-01-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1483934540018-KZM45A1VCB617LZW35NT/image-asset.jpeg You're Putting that Needle Where?! - You Can't PATCH Up An ICH https://everydayebm.org/case-based-learning/2016/8/26/its-okay-to-delay-a-little monthly 0.5 2016-10-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1475880432878-N82W8YJ4C6XX65HL6WOK/image-asset.png You're Putting that Needle Where?! - It's Okay to Delay Your Sequence... a Little. https://everydayebm.org/case-based-learning/2016/10/7/can-i-give-you-an-nsaid-for-your-fracture monthly 0.5 2016-10-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1475879744823-EG5J0RTWB9HVVJL294RJ/image-asset.jpeg You're Putting that Needle Where?! - An NSAID for Your Broken Bone? https://everydayebm.org/case-based-learning/2016/8/19/youre-putting-that-needle-where monthly 0.5 2016-08-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1471628342903-OIMQAH08IZIQ07TE7RPO/image-asset.png You're Putting that Needle Where?! - You're Putting that Needle Where?! https://en.wikipedia.org/wiki/Corpus_cavernosum_penis#/media/File:Gray588.png https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1471628411412-BNYUQG3CXX8YZS20VBGE/image-asset.png You're Putting that Needle Where?! - You're Putting that Needle Where?! https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1471628919763-PRMC3ORD5KSY6TGD8SAY/image-asset.png You're Putting that Needle Where?! - You're Putting that Needle Where?! https://everydayebm.org/case-based-learning/2016/5/3/no-guarantees-mri-imaging-in-the-diagnosis-of-acute-posterior-stroke monthly 0.5 2016-05-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1462845749920-HA3ZVY9WQIM3RK8T2WT3/image-asset.jpeg You're Putting that Needle Where?! - No Guarantees: MRI in the diagnosis of acute posterior stroke https://everydayebm.org/case-based-learning/2016/4/27/ive-got-the-antidote-pradaxa-reversal-in-acute-bleeds monthly 0.5 2016-04-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1461895149597-CJIX9ZGX1VLDUYITHFIZ/image-asset.jpeg You're Putting that Needle Where?! - I've Got the Antidote! Pradaxa reversal in the bleeding patient https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1461894286550-6WSC6DTKMD2FEWS2X5ET/image-asset.jpeg You're Putting that Needle Where?! - I've Got the Antidote! Pradaxa reversal in the bleeding patient https://everydayebm.org/case-based-learning/2015/11/14/xtoers9yghh7y5qholn0ddgd5cscx6 monthly 0.5 2015-11-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1447518156976-23IOHMORMK6E3B651A76/Spinaltap.001.jpeg You're Putting that Needle Where?! - A Comfortable Miss Rate? 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https://everydayebm.org/case-based-learning/2014/11/oh-shacka-dantrolene-for-neuroleptic.html monthly 0.5 2014-11-04 https://everydayebm.org/case-based-learning/2014/10/antibiotics-for-mandible-fractures.html monthly 0.5 2014-10-30 https://everydayebm.org/case-based-learning/2014/10/steroids-for-acute-chest-syndrome.html monthly 0.5 2014-10-28 https://everydayebm.org/case-based-learning/2014/10/a-simple-community-acquired-pneumonia.html monthly 0.5 2014-10-21 https://everydayebm.org/case-based-learning/2014/10/sour-milk-antibiotic-coverage-for.html monthly 0.5 2014-10-21 https://everydayebm.org/case-based-learning/2014/10/and-we-all-fall-down-eventually.html monthly 0.5 2014-10-05 https://everydayebm.org/case-based-learning/2014/09/a-happy-ending.html monthly 0.5 2014-10-05 https://everydayebm.org/case-based-learning/2014/09/antihistamines-for-asthmatics.html monthly 0.5 2014-10-05 https://everydayebm.org/case-based-learning/2014/09/anaphylaxis.html monthly 0.5 2014-09-23 https://everydayebm.org/case-based-learning/2014/09/imaging-in-renal-colic.html monthly 0.5 2014-09-23 https://everydayebm.org/case-based-learning/2014/09/blunt-abdominal-trauma-in-pediatric.html monthly 0.5 2014-09-23 https://everydayebm.org/case-based-learning/2014/08/emergency-department-management-of.html monthly 0.5 2014-09-23 https://everydayebm.org/case-based-learning/2014/07/valproic-acid-and-status-epilepticus.html monthly 0.5 2014-09-23 https://everydayebm.org/case-based-learning/2014/07/does-cervical-seatbelt-sign-mandate.html monthly 0.5 2014-09-23 https://everydayebm.org/case-based-learning/2014/07/insulin-bolus-in-dka.html monthly 0.5 2014-09-23 https://everydayebm.org/case-based-learning/2014/07/pt-is-2-yo-with-history-of-eczema-who.html monthly 0.5 2014-09-23 https://everydayebm.org/case-based-learning/tag/Pediatrics monthly 0.5 https://everydayebm.org/case-based-learning/tag/Infectious+Disease monthly 0.5 https://everydayebm.org/case-based-learning/tag/critical+care monthly 0.5 https://everydayebm.org/case-based-learning/tag/Procedures monthly 0.5 https://everydayebm.org/case-based-learning/tag/psychiatry monthly 0.5 https://everydayebm.org/case-based-learning/tag/Toxicology monthly 0.5 https://everydayebm.org/case-based-learning/tag/atrial+fibrillation monthly 0.5 https://everydayebm.org/case-based-learning/tag/%23FOAMED monthly 0.5 https://everydayebm.org/case-based-learning/tag/delerium monthly 0.5 https://everydayebm.org/case-based-learning/tag/Imaging monthly 0.5 https://everydayebm.org/case-based-learning/tag/Anesthesia monthly 0.5 https://everydayebm.org/case-based-learning/tag/Book+Club monthly 0.5 https://everydayebm.org/case-based-learning/tag/Seizure monthly 0.5 https://everydayebm.org/case-based-learning/tag/DKA monthly 0.5 https://everydayebm.org/case-based-learning/tag/alcohol monthly 0.5 https://everydayebm.org/case-based-learning/tag/REBOA monthly 0.5 https://everydayebm.org/case-based-learning/tag/Social+Justice monthly 0.5 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https://everydayebm.org/case-based-learning/tag/Geriatrics monthly 0.5 https://everydayebm.org/case-based-learning/tag/insulin monthly 0.5 https://everydayebm.org/case-based-learning/tag/anticoagulation monthly 0.5 https://everydayebm.org/case-based-learning/tag/Pharmacotherapy monthly 0.5 https://everydayebm.org/case-based-learning/tag/Endocrine monthly 0.5 https://everydayebm.org/case-based-learning/tag/cardiac+arrest monthly 0.5 https://everydayebm.org/case-based-learning/tag/Urology monthly 0.5 https://everydayebm.org/case-based-learning/tag/procedures monthly 0.5 https://everydayebm.org/case-based-learning/tag/Cardiology monthly 0.5 https://everydayebm.org/case-based-learning/tag/Ultrasound monthly 0.5 https://everydayebm.org/case-based-learning/tag/fluids monthly 0.5 https://everydayebm.org/case-based-learning/tag/gunshot+wound monthly 0.5 https://everydayebm.org/case-based-learning/tag/%23WUSTL_EM monthly 0.5 https://everydayebm.org/case-based-learning/tag/OB%2FGyn monthly 0.5 https://everydayebm.org/case-based-learning/tag/Airway monthly 0.5 https://everydayebm.org/case-based-learning/tag/Medicine monthly 0.5 https://everydayebm.org/case-based-learning/tag/ketamine monthly 0.5 https://everydayebm.org/case-based-learning/tag/acidosis monthly 0.5 https://everydayebm.org/case-based-learning/tag/Critical+Care monthly 0.5 https://everydayebm.org/case-based-learning/tag/Diabetes monthly 0.5 https://everydayebm.org/case-based-learning/tag/hypertension monthly 0.5 https://everydayebm.org/case-based-learning/tag/central+line monthly 0.5 https://everydayebm.org/naunheim-files daily 0.75 2026-03-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1447540025308-ZOHFAXHEWJ58V5HUNHWF/backdrp.001.jpeg The Naunheim Files https://everydayebm.org/naunheim-files/2026/3/30/a-30-yo-woman-woth-a-history-of-migraines-comes-to-the-ed-with-diplopia monthly 0.5 2026-04-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e2bfa70b-a223-4fb5-98c4-d5e7caff621c/ihpap.JPG The Naunheim Files - A 30 y.o, woman woth a history of migraines comes to the ED with diplopia - Make it stand out What does she have? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9ede32d5-6f2c-4188-8c63-be64d2f56194/IH+chrt.JPG The Naunheim Files - A 30 y.o, woman woth a history of migraines comes to the ED with diplopia - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2026/3/22/a-39-yo-comes-to-the-ed-with-nausea-and-vomiting-after-taking-an-herbal-supplement monthly 0.5 2026-03-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/731fd01c-d3c1-438e-ab84-59caedddcac3/tox+pic+of+lob.JPG The Naunheim Files - A 39 y,o comes to the ED with nausea and vomiting after taking an herbal supplement - Make it stand out what did he take? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/eaa02a9f-006f-4838-88a4-58c34db3fdaa/lobelia+seed+podffff.jpg The Naunheim Files - A 39 y,o comes to the ED with nausea and vomiting after taking an herbal supplement - Make it stand out the seed pod of lobelia has been found in the stomach of poisoned individuals https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3bd260c1-04f8-4b7d-8794-c272fbae984f/wagter+hem.webp The Naunheim Files - A 39 y,o comes to the ED with nausea and vomiting after taking an herbal supplement - Make it stand out water hemlock https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/895d50eb-31f4-4ef7-8f8d-7517a307c1d5/castor+beans.JPG The Naunheim Files - A 39 y,o comes to the ED with nausea and vomiting after taking an herbal supplement - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2026/3/16/a-39-yo-woman-from-central-tennessee-comes-to-the-ed-with-fever-and-cough monthly 0.5 2026-03-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/bcdd1a22-081c-4c15-bd23-708768e97660/histo+cxr+pneumonia.JPG The Naunheim Files - A 39 y.o. woman from central Tennessee comes to the ED with fever and cough - Make it stand out what is the next step? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/82bf0bf6-e533-4d6b-9e95-7b0259565cec/histo+grancxr.JPG The Naunheim Files - A 39 y.o. woman from central Tennessee comes to the ED with fever and cough - Make it stand out histo can mimic tuberculosis or sarcoid with granulomas and lymphadenopathy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f559444b-ba77-467f-8c4c-a0708fa2855c/histo+bats.JPG The Naunheim Files - A 39 y.o. woman from central Tennessee comes to the ED with fever and cough - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/bdd0fa3c-9bd2-4a25-bede-3a496e909363/hist+map+nowfff.JPG The Naunheim Files - A 39 y.o. woman from central Tennessee comes to the ED with fever and cough - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f80f8a94-4a5e-4b3a-ab13-4a1440211215/histo+trav+sick.JPG The Naunheim Files - A 39 y.o. woman from central Tennessee comes to the ED with fever and cough - Make it stand out high risk areas https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8021495c-d5ea-467f-a4d3-76534ce694c4/histo+rash.JPG The Naunheim Files - A 39 y.o. woman from central Tennessee comes to the ED with fever and cough - Make it stand out histo can present as a skin rash even in immunocompetent patients https://everydayebm.org/naunheim-files/2026/3/9/a-30-yo-male-comes-to-the-ed-with-decreased-vision-after-being-punched-in-the-eye-the-night-before monthly 0.5 2026-03-11 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/03d25d19-1fd9-422c-a6a1-9ec34048f4a5/rosette.JPG The Naunheim Files - A 30 y.o male comes to the ED with decreased vision after being punched in the eye - Make it stand out Other than 20/50 vision and a small corneal abrasion; he eye exam is normal https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/447b6313-2949-4def-8af6-c16675a5d95a/vossius.JPG The Naunheim Files - A 30 y.o male comes to the ED with decreased vision after being punched in the eye - Make it stand out vossius ring on the lens https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0e9574f0-b100-457f-89c4-3a69303287ea/lens+ectopic+from+eye+trauma.JPG The Naunheim Files - A 30 y.o male comes to the ED with decreased vision after being punched in the eye - Make it stand out dislocated lens https://everydayebm.org/naunheim-files/2026/3/2/a-50-yo-male-comes-to-the-ed-from-the-airport-with-a-high-fever-he-had-been-in-the-caribbean-on-vacation-and-was-swimming-in-the-ocean-on-eutheira monthly 0.5 2026-03-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b1512b7f-42e5-492f-8aa6-73b54bdbb979/leptffff.JPG The Naunheim Files - A 50 y.o. male comes to the ED from the airport with a high fever. He had been in the Caribbean on vacation and was swimming in the ocean on Eleuthera. - Make it stand out He has mild jaundice and muscle aches https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3834b7f5-1bb1-43ee-ae95-916a44974a42/pigs+eutheria.JPG The Naunheim Files - A 50 y.o. male comes to the ED from the airport with a high fever. He had been in the Caribbean on vacation and was swimming in the ocean on Eleuthera. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4f55a2f4-4581-4f73-92b9-cabd500280cb/lept+chart.JPG The Naunheim Files - A 50 y.o. male comes to the ED from the airport with a high fever. He had been in the Caribbean on vacation and was swimming in the ocean on Eleuthera. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a4ecdcef-4af2-49a3-9814-3e048b678f69/pig+cell.JPG The Naunheim Files - A 50 y.o. male comes to the ED from the airport with a high fever. He had been in the Caribbean on vacation and was swimming in the ocean on Eleuthera. - Make it stand out cellulitis from shewnella https://everydayebm.org/naunheim-files/2026/2/23/a-45-yo-male-comes-in-with-a-hand-problem-he-is-unable-to-straighten-his-fingers monthly 0.5 2026-02-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ab44e9e3-1614-43c5-8852-5de6d4d9f76e/duputrensfffff.JPG The Naunheim Files - A 45 y.o. male comes in with a hand problem. He is unable to straighten his fingers. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7db4e810-f6c6-4d3c-9042-1f9227ffca9d/palmar+fascia.JPG The Naunheim Files - A 45 y.o. male comes in with a hand problem. He is unable to straighten his fingers. - Make it stand out Palmar fascia gives the bowl shape to the palm at rest. It lies above the tendons. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ccc0121a-1561-4a1b-af4e-5e1687bb7edc/dd.JPG The Naunheim Files - A 45 y.o. male comes in with a hand problem. He is unable to straighten his fingers. - Make it stand out Early Dupuytren’s https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/00fbc89a-d7f5-44f5-bfb1-0d6df7259ff1/fasciectomy.JPG The Naunheim Files - A 45 y.o. male comes in with a hand problem. He is unable to straighten his fingers. - Make it stand out fascietomy involves multiple incisions across the fibrotic band. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/75a7b4c7-904c-424f-9008-60e1a40c39b0/may+vi.JPG The Naunheim Files - A 45 y.o. male comes in with a hand problem. He is unable to straighten his fingers. - Make it stand out The Vikings raided widely . Their conquests gave us the word “Slavic” meaning “slave”. https://everydayebm.org/naunheim-files/2026/2/16/a-45-yo-welder-with-a-hx-of-hypertension-comes-to-the-ed-with-tingling-and-pain-in-both-feet monthly 0.5 2026-02-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/64c5d568-effe-4767-a0aa-9a88e7d3e899/weldfff.jpg The Naunheim Files - A 45 y.o. welder with a hx of hypertension comes to the ED with tingling and pain in both feet. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6d6ec16a-5ab0-4121-9977-068bdf8b019a/iron+in+lung+prussian+blue.JPG The Naunheim Files - A 45 y.o. welder with a hx of hypertension comes to the ED with tingling and pain in both feet. - Make it stand out iron in the lung of a welder stained with Prussian blue. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/76a4eac4-9e6b-4bda-9cb9-db216b902d2b/cxr+welder.JPG The Naunheim Files - A 45 y.o. welder with a hx of hypertension comes to the ED with tingling and pain in both feet. - Make it stand out 39 y.o. with welder’s anthrax from B cereus who received .the anthrax monoclonal antitoxin, raxibacumab. https://everydayebm.org/naunheim-files/2026/2/9/a-50-yo-woman-comes-to-the-ed-with-sore-throat-cough-and-fever monthly 0.5 2026-02-11 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f0ec888e-42f8-405a-bede-20208b76f369/p.JPG The Naunheim Files - A 50 y.o. woman comes to the ED with sore throat, cough and fever - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a3430388-9b76-4423-8b1d-4981c4b792cd/p2ff.jpg The Naunheim Files - A 50 y.o. woman comes to the ED with sore throat, cough and fever - Make it stand out do you notice a peripheral wedge shaped opacity? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/db5e48ae-ce76-4a50-840a-116dadf8123d/oral+sle.JPG The Naunheim Files - A 50 y.o. woman comes to the ED with sore throat, cough and fever - Make it stand out What systemic disease could present with these findings? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3d041ce0-0d93-42d0-8f30-d99adc5d3015/malar+rash.JPG The Naunheim Files - A 50 y.o. woman comes to the ED with sore throat, cough and fever - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f44b5bfe-28f3-4968-b14e-95860fb138c0/symptoms.JPG The Naunheim Files - A 50 y.o. woman comes to the ED with sore throat, cough and fever - Make it stand out lupus is a systemic disease https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6b20cc28-f6a8-45da-85c4-52807f358209/bubbly.JPG The Naunheim Files - A 50 y.o. woman comes to the ED with sore throat, cough and fever - Make it stand out the bubble sign of a pulmonary infarct https://everydayebm.org/naunheim-files/2026/2/8/a-40-yo-woman-woman-is-brought-to-the-ed-by-family-because-she-woke-up-and-was-unable-to-walk monthly 0.5 2026-02-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/32c53de0-d5f0-4a47-9353-f390e02a26c5/thyroid+nodffff.JPG The Naunheim Files - A 40 y.o woman woman is brought to the ED by family because she woke up and was unable to walk. - Make it stand out there is a nodule in the L lobe of the thyroid https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5c062ba3-d31b-4cfd-ac80-51890a5c47a6/hyperthyroid+doppler.JPG The Naunheim Files - A 40 y.o woman woman is brought to the ED by family because she woke up and was unable to walk. - Make it stand out In Grave’s disease the thyroid is hypervascular https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a16157b6-e875-42f6-b196-a8552de9d08f/thyroid+prevalence.JPG The Naunheim Files - A 40 y.o woman woman is brought to the ED by family because she woke up and was unable to walk. - Make it stand out throid disease is very common in the US https://everydayebm.org/naunheim-files/2026/1/26/a-20-yo-male-comes-to-the-ed-with-syncope monthly 0.5 2026-01-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/41cd6803-e657-4018-b977-321800b654ac/brugadas+cocaine.JPG The Naunheim Files - A 20 y.o. male comes to the ED with syncope. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b58a60c5-ce64-4776-b531-5d022001d667/brunlfff.JPG The Naunheim Files - A 20 y.o. male comes to the ED with syncope. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9627d12b-83a6-448f-8932-befdefb0162a/protonged+QT.JPG The Naunheim Files - A 20 y.o. male comes to the ED with syncope. - Make it stand out 500 msec is considered a worrisome QT interval. https://everydayebm.org/naunheim-files/2026/1/15/a-64-yo-male-presents-to-the-ed-with-difficulty-swallowing monthly 0.5 2026-01-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4a86cc0f-293e-4ccf-8160-ff2544eb0edf/as.JPG The Naunheim Files - A 64 y.o. male presents to the ED with difficulty swallowing - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0cd0501a-7181-41b1-8967-79e13111ee4f/bamboo+spineffff.jpg The Naunheim Files - A 64 y.o. male presents to the ED with difficulty swallowing - Make it stand out bamboo spine in ankylosing spondylitis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c5c5d758-5c64-4f91-9342-1e022c781ebb/dish+from+isotrentoin.JPG The Naunheim Files - A 64 y.o. male presents to the ED with difficulty swallowing - Make it stand out 35 y.o. with cystic acne treated with isotretinoin and vertebral osteophytes. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/77a290ad-30ed-42ea-8694-b89f2451098c/retrograde+intubation.JPG The Naunheim Files - A 64 y.o. male presents to the ED with difficulty swallowing - Make it stand out difficult intubation with ankylosing spondylitis https://everydayebm.org/naunheim-files/2026/1/12/a-64-yo-male-from-mexico-comes-to-the-ed-with-shortness-of-breath monthly 0.5 2026-01-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7c3b4564-dc72-4247-9ffe-26ec37863c7e/simex.JPG The Naunheim Files - A 64 y.o. male from Mexico comes to the ED with shortness of breath. - Make it stand out Hint: He lived in the Trans-Mexico Volcanic belt and had bee a stone cutter for 40 years https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/86c095a3-661c-4fc1-b0b8-5cecf122f33c/cantera+stonefff.jpg The Naunheim Files - A 64 y.o. male from Mexico comes to the ED with shortness of breath. - Make it stand out cantera stone is ideal for carving and comes in many colors. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5ed9d4f2-08ae-4603-bd03-db272da0aa97/reactivated+tbc.JPG The Naunheim Files - A 64 y.o. male from Mexico comes to the ED with shortness of breath. - Make it stand out tuberculosis reactivated in a tuberculoma https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/033ca8bd-76eb-4801-872c-9c229e71b917/trans+mexican+volcanic+belt.JPG The Naunheim Files - A 64 y.o. male from Mexico comes to the ED with shortness of breath. - Make it stand out transMexican volcanic belt. https://everydayebm.org/naunheim-files/2026/1/5/a-26-yo-woman-comes-to-the-ed-with-abdominal-pain-her-wbc-is-20k monthly 0.5 2026-01-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3875c50c-f553-4098-b174-127f9a018b35/morgagni.JPG The Naunheim Files - A 26 y,o woman comes to the ED with abdominal pain. Her WBC is 20K. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/330eaeae-f6ea-4938-909f-193779365f08/traumatic+di+her.JPG The Naunheim Files - A 26 y,o woman comes to the ED with abdominal pain. Her WBC is 20K. - Make it stand out a traumatic diaphragmatic hernia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/75e91abf-4d50-45a9-92af-5ebf65ec31d6/hernias+colorffffff.jpg The Naunheim Files - A 26 y,o woman comes to the ED with abdominal pain. Her WBC is 20K. - Make it stand out types of congenital hernias https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/daf4a482-05f0-46d8-abad-01a65bd499a3/diaphragm+rup+chest+tube.JPG The Naunheim Files - A 26 y,o woman comes to the ED with abdominal pain. Her WBC is 20K. - Make it stand out Case of a young male who fell off a bike. the L is the initial ct, the R is the next day after a chest tube. https://everydayebm.org/naunheim-files/2025/12/29/a-27-yo-male-comes-in-with-a-dogbite-after-receiving-a-puppy-for-xmas monthly 0.5 2026-01-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4e701670-fe13-44e2-970a-12fa074d451c/puppy.JPG The Naunheim Files - A 27 y.o. male comes in with a dogbite after receiving a puppy for Xmas? - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/444ca6ae-1c01-4bfa-82a6-6b5fac9b10e0/dog+bite.JPG The Naunheim Files - A 27 y.o. male comes in with a dogbite after receiving a puppy for Xmas? - Make it stand out our patient had a cellulitis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1d4365a1-406a-41aa-9857-3c8bb2a18de1/capnoffff.JPG The Naunheim Files - A 27 y.o. male comes in with a dogbite after receiving a puppy for Xmas? - Make it stand out Overwhelming sepsis caused by capnophaga canamorsus in another patient. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5b2236e8-e207-4b7a-a10d-7f588be9f090/columbia+exchange.JPG The Naunheim Files - A 27 y.o. male comes in with a dogbite after receiving a puppy for Xmas? - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2025/12/22/a-39-yo-violinist-comes-in-with-an-abnormality-of-the-hand-it-prevents-him-from-playing monthly 0.5 2025-12-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7f4a5a60-cc7e-4534-8b89-b27d45125a54/focalffff.JPG The Naunheim Files - A 39 y.o. violinist comes in with an abnormality of the hand. It prevents him from playing. - Make it stand out spasm of the hand https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e8a8bc71-e022-46db-b628-e9179e91c70d/rfk.JPG The Naunheim Files - A 39 y.o. violinist comes in with an abnormality of the hand. It prevents him from playing. - Make it stand out Robert Kennedy has laryngeal dystonia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/147c4013-b45f-456c-b0c9-ca9eb528ab45/carpoped.JPG The Naunheim Files - A 39 y.o. violinist comes in with an abnormality of the hand. It prevents him from playing. - Make it stand out carpopedal spasm is a dystonia caused by compazine https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a3822cb3-ede8-4f2a-8d57-152acf9167fe/opisthot.JPG The Naunheim Files - A 39 y.o. violinist comes in with an abnormality of the hand. It prevents him from playing. - Make it stand out Infantile tetanus can present with marked spasm of the back resulting in episthotonus. https://everydayebm.org/naunheim-files/2025/12/15/a-65-yo-nurse-with-a-hx-of-diabetes-presents-with-arthritis-and-elevated-liver-enzymes monthly 0.5 2025-12-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5b52afad-2832-4b63-a195-779ae6d11867/hemo+ptff.jpg The Naunheim Files - A 65 y.o. nurse with a hx of diabetes presents with arthritis and elevated liver enzymes. - Make it stand out Hint: she notes her skin is darkening slightly on her face. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e5ec0971-e73b-414d-a8ef-b636034b88d7/eyelidsfff.jpg The Naunheim Files - A 65 y.o. nurse with a hx of diabetes presents with arthritis and elevated liver enzymes. - Make it stand out bronzing of the eyelids from hemochomatosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3a532fad-73ff-4239-8852-1c5867f12f7f/PCT.JPG The Naunheim Files - A 65 y.o. nurse with a hx of diabetes presents with arthritis and elevated liver enzymes. - Make it stand out Porphyria cutanea tarda is a blistering rash found in alcoholics and hemochromatosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f4655542-2362-42f8-94be-1499364f3d92/hemochromxray.JPG The Naunheim Files - A 65 y.o. nurse with a hx of diabetes presents with arthritis and elevated liver enzymes. - Make it stand out arthropathy of the second and third metacarpals in hemochromatosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cf385610-7eae-49f6-87b2-dd2388ccc92e/hepatocytes+in+hemochromatosis.JPG The Naunheim Files - A 65 y.o. nurse with a hx of diabetes presents with arthritis and elevated liver enzymes. - Make it stand out liver biopsy showing iron in the hepatocytes. https://everydayebm.org/naunheim-files/2025/12/8/a-32-yo-woman-presents-to-the-ed-for-sudden-onset-of-shortness-of-breath monthly 0.5 2025-12-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e21164b7-44b7-410a-ac2b-b34fa743f968/lam.JPG The Naunheim Files - A 32 y.o. woman presents to the ED for sudden onset of shortness of breath. - Make it stand out Her O2 sat is normal. What are you concerned about? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/287128df-d0bc-4e8b-badb-293eaaa179cd/lam+cysts.JPG The Naunheim Files - A 32 y.o. woman presents to the ED for sudden onset of shortness of breath. - Make it stand out thin walled cysts in LAM https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/21bd72c0-2abc-4c71-b6b9-1ada85ff71bb/catfff.JPG The Naunheim Files - A 32 y.o. woman presents to the ED for sudden onset of shortness of breath. - Make it stand out brownish endometrial implants on the lung in a 40 40 with spontaneous pneumothorax . Walker C. Tumorlike conditions of the pleura. Radiographics 2012 32:971-985 https://everydayebm.org/naunheim-files/2025/12/1/a-40-yo-farm-worker-from-mexico-comes-to-the-ed-with-fever-and-ruq-pain monthly 0.5 2025-12-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/009ec1da-4a32-4dfd-9131-665b556c190f/liverfff.jpg The Naunheim Files - A 40 y.o. farm worker from Mexico comes to the ED with fever and RUQ pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e9d20c02-7233-411b-b6cc-bc88b82b4902/life+cycleam.JPG The Naunheim Files - A 40 y.o. farm worker from Mexico comes to the ED with fever and RUQ pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b3a4f0c5-503e-48eb-a815-7f3614e1ba7d/hydatid.JPG The Naunheim Files - A 40 y.o. farm worker from Mexico comes to the ED with fever and RUQ pain - Make it stand out hydatid cysts https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4b3b2045-d817-43e4-a956-1dcd8a3f2dd4/pericardial+pus.JPG The Naunheim Files - A 40 y.o. farm worker from Mexico comes to the ED with fever and RUQ pain - Make it stand out the fluid removed from an amebic abscess is described as anchovy paste. https://everydayebm.org/naunheim-files/2025/11/24/a-27-yo-male-returns-from-canoeing-in-northern-minnesota-he-co-a-pruritic-rash monthly 0.5 2025-11-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b2893e5f-c100-451a-a169-e485c433c08c/swimmers+itch.JPG The Naunheim Files - A 27 y.o male returns from canoeing in northern Minnesota. He co a pruritic rash. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/09dd9558-a5c7-4b4c-aba4-9768b7ec9305/swimmers+itch+life+cycle..JPG The Naunheim Files - A 27 y.o male returns from canoeing in northern Minnesota. He co a pruritic rash. - Make it stand out snails are an intermediate host https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/37779f2b-5ed2-4bd7-8ce7-93a28c5ace53/mergan.JPG The Naunheim Files - A 27 y.o male returns from canoeing in northern Minnesota. He co a pruritic rash. - Make it stand out The merganser is not a mallard: it has a long narrow red beak with serrated edges to catch fish. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/44996e3b-30f0-4493-a376-a7fe96289d36/seabathers.JPG The Naunheim Files - A 27 y.o male returns from canoeing in northern Minnesota. He co a pruritic rash. - Make it stand out seabather’s dermatitis can occur under a wet suit https://everydayebm.org/naunheim-files/2025/11/17/a-56-yo-woman-with-a-hx-of-anterior-mi-and-heart-failure-sp-cardiac-resynchronization-therapy-and-defibrillator-placement-crt-d monthly 0.5 2025-11-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ee9e666b-eb8f-442c-ad25-50a555181f0d/atrial+massfff.jpg The Naunheim Files - A 56 y.o. woman with a hx of anterior MI and heart failure sp cardiac resynchronization therapy and defibrillator placement (CRT-D). - Make it stand out the top arrow points to the lesion https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/524aef57-b2d2-4e5c-9124-a35ecab63776/MRI+cardiac+mass.JPG The Naunheim Files - A 56 y.o. woman with a hx of anterior MI and heart failure sp cardiac resynchronization therapy and defibrillator placement (CRT-D). - Make it stand out MRI imaging can differentiate a clot from a mass. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/be3617f4-8e66-4594-adf5-d8371533374c/crtd.JPG The Naunheim Files - A 56 y.o. woman with a hx of anterior MI and heart failure sp cardiac resynchronization therapy and defibrillator placement (CRT-D). - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1ff3ba97-fffe-48c0-9c9b-6145cfc601fa/witheringfff.jpg The Naunheim Files - A 56 y.o. woman with a hx of anterior MI and heart failure sp cardiac resynchronization therapy and defibrillator placement (CRT-D). - Make it stand out digitalis was originally an herbal remedy for dropsy (chf) https://everydayebm.org/naunheim-files/2025/11/10/a-58-yo-male-sp-ablation-for-a-fib-x-2-comes-to-the-ed-with-l-arm-and-l-leg-weakness monthly 0.5 2025-11-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ac3d61bb-4f0a-4950-a642-2566a3438e3c/58+stroke.JPG The Naunheim Files - A 58 y.o. male sp ablation for a fib x 2 comes to the ED with L arm and L leg weakness - Make it stand out what is the differential for the kind of stroke he suffered? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/eba75118-741a-4b89-bc70-137d20b968fa/air+in+lv.JPG The Naunheim Files - A 58 y.o. male sp ablation for a fib x 2 comes to the ED with L arm and L leg weakness - Make it stand out Air was seen in the LV https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4f96645b-3419-40bb-b4b3-4dd81b13cdb5/air+in+fis.JPG The Naunheim Files - A 58 y.o. male sp ablation for a fib x 2 comes to the ED with L arm and L leg weakness - Make it stand out air was seen in the fistula https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/06e6e2cc-272d-4d3a-bd53-c1f044cb2944/watch7.jpg The Naunheim Files - A 58 y.o. male sp ablation for a fib x 2 comes to the ED with L arm and L leg weakness - Make it stand out all that can be seen on cxr is the central knob of the WATCHMAN https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/69a6e87e-9794-483f-87c6-88d7e998377f/watchmanf.JPG The Naunheim Files - A 58 y.o. male sp ablation for a fib x 2 comes to the ED with L arm and L leg weakness - Make it stand out during placement the intra atrial septum must be punctured to place the device. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cacb368b-2c10-4179-9767-6a69b13fd65f/latrial+appendclip.JPG The Naunheim Files - A 58 y.o. male sp ablation for a fib x 2 comes to the ED with L arm and L leg weakness - Make it stand out the L atrial appendage can also be closed with a clip. https://everydayebm.org/naunheim-files/2025/11/3/a-29yo-male-comes-back-from-a-vacation-in-spain-with-a-fever-and-sore-throat-exudate-was-noted-in-the-oropharynx monthly 0.5 2025-11-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d897c652-fffe-4184-b992-698122c72b41/cd.JPG The Naunheim Files - A 29y.o. male comes back from a vacation in Spain with a fever and sore throat. Exudate was noted in the oropharynx - Make it stand out hint: he was feeding feral cats https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/952357f8-d3c2-48b8-9c09-0a16640c66c6/feral+cats.JPG The Naunheim Files - A 29y.o. male comes back from a vacation in Spain with a fever and sore throat. Exudate was noted in the oropharynx - Make it stand out feral cats https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9f33aa65-53bd-4340-b5de-820558a4aa7f/larynx+1902.JPG The Naunheim Files - A 29y.o. male comes back from a vacation in Spain with a fever and sore throat. Exudate was noted in the oropharynx - Make it stand out autopsy specimen of the larynx of an individual dying of diphtheria https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c88f3ffa-e5b2-4d7d-8db5-1bf73f5ab0c2/cutaneous+diph.JPG The Naunheim Files - A 29y.o. male comes back from a vacation in Spain with a fever and sore throat. Exudate was noted in the oropharynx - Make it stand out cutaneous diphtheria https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6cc3dfcb-22b5-42bd-a2c0-62dfef15b1b4/balto.JPG The Naunheim Files - A 29y.o. male comes back from a vacation in Spain with a fever and sore throat. Exudate was noted in the oropharynx - Make it stand out Balto https://everydayebm.org/naunheim-files/2025/10/27/a-24-yo-sexually-active-woman-presents-with-a-rash-in-the-genital-area monthly 0.5 2025-10-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/22182d7c-e2ef-4405-88b5-b607e9879dea/mc.JPG The Naunheim Files - A 24 y.o. sexually active woman presents with a rash in the genital area. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/77e20b90-1b2f-4d2a-950b-6335369c0efd/mc+henderson.JPG The Naunheim Files - A 24 y.o. sexually active woman presents with a rash in the genital area. - Make it stand out Henderson-Patterson bodies in the epidermis of a patient with molluscum https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/eb7f5dd2-8baf-49e8-880e-78a47e540265/condyloma+acuminata+buschke+lowenstein.JPG The Naunheim Files - A 24 y.o. sexually active woman presents with a rash in the genital area. - Make it stand out Buschke-Lowenstein genital warts https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/89fbd496-750b-4b4a-b1ee-fd26f4abf984/virusskin+inf.JPG The Naunheim Files - A 24 y.o. sexually active woman presents with a rash in the genital area. - Make it stand out common and not so common (orf) viral skin infections https://everydayebm.org/naunheim-files/2025/10/20/a-39-yo-female-with-a-history-of-muscle-disease-comes-in-complaining-of-worsening-weakness-and-r-radial-nerve-palsy monthly 0.5 2025-10-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0e56e41e-93b9-4902-8ea5-c01ca9678fae/bs.JPG The Naunheim Files - A 39 y.o. female with a history of muscle disease comes in complaining of worsening weakness and R radial nerve palsy. - Make it stand out What do you notice on the slide? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cfc4519d-7a7a-46da-80b3-6300bcf7f17e/body+diagram.JPG The Naunheim Files - A 39 y.o. female with a history of muscle disease comes in complaining of worsening weakness and R radial nerve palsy. - Make it stand out Lead poisoning has been implicated in some patients with mental illness https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1bb6659c-f008-4db5-83d5-8e31fb62ad6f/moonshie.JPG The Naunheim Files - A 39 y.o. female with a history of muscle disease comes in complaining of worsening weakness and R radial nerve palsy. - Make it stand out Lead poisoning is also a risk in the production of moonshine where metal containers with old solder and brass fittings may be used. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8a4b01f3-1488-4e0d-9c45-f1ffddc71cff/greek+mug.JPG The Naunheim Files - A 39 y.o. female with a history of muscle disease comes in complaining of worsening weakness and R radial nerve palsy. - Make it stand out Beware Greeks bearing gifts—Virgil https://everydayebm.org/naunheim-files/2025/10/13/a-55-yo-woman-presents-with-a-rash-and-chronic-diarrhea monthly 0.5 2025-10-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4506a8c3-5a39-460f-aded-be91b9dd5f46/SM+pic.JPG The Naunheim Files - A 55 y.o. woman presents with a rash and chronic diarrhea. - Make it stand out Stool for O +P, stool culture, C diff screening, alpha feto protein and liver functions were all unremarkable. What is in your differential? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/70e2d07f-1099-4165-97e1-2a352a7eceab/darier.JPG The Naunheim Files - A 55 y.o. woman presents with a rash and chronic diarrhea. - Make it stand out rubbing a lesion will create an urticarial reaction https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/786a191b-dc39-4515-a5dd-57d803be7953/smspine.JPG The Naunheim Files - A 55 y.o. woman presents with a rash and chronic diarrhea. - Make it stand out sclerosis of the spine caused by systemic mastocytosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6886ae3f-27b3-4ba1-a70c-64fac59f7ef8/dog.JPG The Naunheim Files - A 55 y.o. woman presents with a rash and chronic diarrhea. - Make it stand out A dog with mast cell tumors https://everydayebm.org/naunheim-files/2025/10/6/a-32-yo-female-presents-with-elevated-liver-function-tests monthly 0.5 2025-10-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/779f17de-8943-49b8-8554-681e4a758f6f/myositis.JPG The Naunheim Files - A 32 y.o. female presents with elevated liver function tests. AST repeatedly measures high and is currently 215. She also complains of leg weakness. - Make it stand out An MRI shows diffuse myositis. What two tests are still needed? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a24fa93b-f776-410a-af7f-dd1afee66c82/muscovid.JPG The Naunheim Files - A 32 y.o. female presents with elevated liver function tests. AST repeatedly measures high and is currently 215. She also complains of leg weakness. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4270c7bf-fc77-45b1-9990-5e69fb1af5b1/groovefff.jpg The Naunheim Files - A 32 y.o. female presents with elevated liver function tests. AST repeatedly measures high and is currently 215. She also complains of leg weakness. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2025/10/2/a-40-yo-male-from-alabama-comes-in-with-a-pruritic-rash monthly 0.5 2025-10-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/40618f56-ea3d-422a-a7dd-111ea68c5ec8/hookworms.JPG The Naunheim Files - A 40 y.o male from Alabama comes in with a pruritic rash. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/10cbf7a9-b078-448a-baf0-25889d616390/feet+hookworms.JPG The Naunheim Files - A 40 y.o male from Alabama comes in with a pruritic rash. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a7ff0519-5c17-4a9a-9490-cdd9d3a631f2/clinicshookworm.JPG The Naunheim Files - A 40 y.o male from Alabama comes in with a pruritic rash. - Make it stand out hookworm clinic in the US in the 1920’s https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/98bb29be-7c80-477d-b516-bf68bf692054/hwmapfff.jpg The Naunheim Files - A 40 y.o male from Alabama comes in with a pruritic rash. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/97115dfc-0220-49b1-91f1-342b849122bb/hw+match.JPG The Naunheim Files - A 40 y.o male from Alabama comes in with a pruritic rash. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2025/9/22/a-42-yo-male-comes-to-the-ed-with-fever-and-severe-ha-after-vacationing-at-the-lake-of-the-ozarks monthly 0.5 2025-09-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/15841cf5-dc77-491a-8df7-7bd343cc5c60/nf+ct.JPG The Naunheim Files - A 42 y.o. male comes to the ED with fever and severe HA after vacationing at the Lake of the Ozarks. - Make it stand out What do you notice on the CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e773f8d7-96df-49b4-b860-ad25b9f1a54a/naegleria+cdc.JPG The Naunheim Files - A 42 y.o. male comes to the ED with fever and severe HA after vacationing at the Lake of the Ozarks. - Make it stand out tthe life cycle of Naegleria https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b4cf0f68-77b0-4e33-8051-21c54c200bb4/ozarks+pic+lake.JPG The Naunheim Files - A 42 y.o. male comes to the ED with fever and severe HA after vacationing at the Lake of the Ozarks. - Make it stand out The Lake of the Ozarks was created in 1931 by the construction of the Bagnell dam. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a203847f-b83e-4028-a0d6-9d33dfd67d5e/nfcsf.JPG The Naunheim Files - A 42 y.o. male comes to the ED with fever and severe HA after vacationing at the Lake of the Ozarks. - Make it stand out In CSF the organism is shown at A and it is being phagocytosed at C in a WBC https://everydayebm.org/naunheim-files/2025/9/15/a-35-yo-was-photographing-wildlife-in-arizona-and-took-this-photo monthly 0.5 2025-09-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/413b6477-e32c-42f3-a98d-d1f7ddf43b48/gila+m.JPG The Naunheim Files - A 35 y.o. was photographing wildlife in Arizona and took this photo - Make it stand out Unfortunately the lizard bit him and now he is in the ED. What do you need to consider? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c72a0c55-942a-4af9-837e-2f014ea631f7/gila+biteffff.JPG The Naunheim Files - A 35 y.o. was photographing wildlife in Arizona and took this photo - Make it stand out Why is Gila monster venom so important? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e9ecaf73-c0e2-4987-8276-8ae64e46b0e1/ex4.JPG The Naunheim Files - A 35 y.o. was photographing wildlife in Arizona and took this photo - Make it stand out the chemical formula of extendin https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/92694173-7fbc-4855-a57a-cccf878ccb41/side+effects.JPG The Naunheim Files - A 35 y.o. was photographing wildlife in Arizona and took this photo - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2025/9/8/a-70-yp-woman-had-the-sudden-onset-of-pain-in-the-shoulder-when-reaching-over-her-head-she-is-now-unable-to-lift-the-arm-past-the-shoulder-and-it-is-painful-anteriorly- monthly 0.5 2025-09-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/15c3e053-31c6-4365-b940-4e745e02e7f7/shoulder+plainxffff.jpg The Naunheim Files - A 70 y.o. woman had the sudden onset of pain in the shoulder when reaching over her head. She is now unable to lift the arm past the shoulder and it is painful anteriorly . - Make it stand out normal shoulder in a 70 y.o. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f61ca1b0-a970-4b7a-af1f-9790dcf7d0cd/diagr+sh.JPG The Naunheim Files - A 70 y.o. woman had the sudden onset of pain in the shoulder when reaching over her head. She is now unable to lift the arm past the shoulder and it is painful anteriorly . - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f78490aa-91ff-497a-9a6e-3b230e6b5610/empty+can.JPG The Naunheim Files - A 70 y.o. woman had the sudden onset of pain in the shoulder when reaching over her head. She is now unable to lift the arm past the shoulder and it is painful anteriorly . - Make it stand out If the rotator cuff is injured the arm cannot resist downward pressure https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0faac950-00ba-4d62-b3a2-21a845d60c93/septic+arthri+sh.JPG The Naunheim Files - A 70 y.o. woman had the sudden onset of pain in the shoulder when reaching over her head. She is now unable to lift the arm past the shoulder and it is painful anteriorly . - Make it stand out erosion of the humerus can occur with septic arthritis. https://everydayebm.org/naunheim-files/2025/9/1/a-60-yo-male-with-a-hx-of-severe-asthma-and-diabetes-comes-to-the-ed-with-a-rash monthly 0.5 2025-09-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/126eb279-1410-48ec-92bf-612fda0f8549/br.JPG The Naunheim Files - A 60 y.o. male with a hx of severe asthma, and diabetes comes to the ED with a rash. - Make it stand out Hint: a second patient has a similar problem except the second patient is paranoid. He has an anion gap of -21. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8b8c0f67-39b1-4ad9-9d58-6a5862f8c35b/neg+anion+gap.JPG The Naunheim Files - A 60 y.o. male with a hx of severe asthma, and diabetes comes to the ED with a rash. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/81a6112e-2330-4bb6-bdae-784928beb67d/first+gulf+war.JPG The Naunheim Files - A 60 y.o. male with a hx of severe asthma, and diabetes comes to the ED with a rash. - Make it stand out mestinon was given to soldiers in the first gulf war https://everydayebm.org/naunheim-files/2025/8/25/a-22-yo-college-student-returns-from-a-camping-trip-with-a-fever-and-a-cough-productive-of-bloody-sputum monthly 0.5 2025-08-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0155e636-0134-4ed6-8834-bd92fe9f8f78/par.JPG The Naunheim Files - A 22 y.o. college student returns from a camping trip with a fever and a cough productive of bloody sputum. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1fdf6cef-8b6c-4df0-88fb-539e0223a502/cray.JPG The Naunheim Files - A 22 y.o. college student returns from a camping trip with a fever and a cough productive of bloody sputum. - Make it stand out The red swamp crayfish can grow to five inches. It is the most commonly farmed crayfish https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/060801b6-1237-4275-aae0-dcfa58dc9198/scrotal+abscess.JPG The Naunheim Files - A 22 y.o. college student returns from a camping trip with a fever and a cough productive of bloody sputum. - Make it stand out paragonimiasis has been found in a scrotal abscess. It only rarely affects other body part and is usually in the lungs. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/91107392-6d19-42a5-9323-9bad36b7bb0f/dust+storm.JPG The Naunheim Files - A 22 y.o. college student returns from a camping trip with a fever and a cough productive of bloody sputum. - Make it stand out dust storms are a common occurence in Phoenix AZ https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f32f0ebb-96a0-439a-a585-d254b7271193/tower+grove.JPG The Naunheim Files - A 22 y.o. college student returns from a camping trip with a fever and a cough productive of bloody sputum. - Make it stand out fishing for crayfish in tower grove park https://everydayebm.org/naunheim-files/2025/8/11/a-50-yo-male-presents-with-a-pruritic-rash-on-his-shoulder monthly 0.5 2025-08-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/aa8a1468-bac9-44a8-b13e-05d79a68e9d2/lichen+planus.JPG The Naunheim Files - A 50 y.o. male presents with a pruritic rash on his shoulder - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5f989dd1-1d79-4c19-b71a-f0af1f1f78bf/oral+lichen+planus.JPG The Naunheim Files - A 50 y.o. male presents with a pruritic rash on his shoulder - Make it stand out lichen planus can be caused by mercury in fillings https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3f91619b-0e69-4a4e-a461-d58007de0059/genital+lp.JPG The Naunheim Files - A 50 y.o. male presents with a pruritic rash on his shoulder - Make it stand out lichen planus can also be seen in the genital areas https://everydayebm.org/naunheim-files/2025/8/4/a-6-yo-girl-presents-with-fever-and-a-sore-throat monthly 0.5 2025-08-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0a727875-c7c3-4fbd-a5dd-6a053b3557bb/st.JPG The Naunheim Files - A 6 y.o. girl presents with fever and a sore throat. - Make it stand out She also complains that her foot is painful. It is pictured below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/2c2886a1-784e-4fea-87a2-48efb209df6b/sore+foot.JPG The Naunheim Files - A 6 y.o. girl presents with fever and a sore throat. - Make it stand out What illness does she have? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d37b9f24-92bd-4d51-800f-a9ad47b8e9c6/measles+in+the+US.JPG The Naunheim Files - A 6 y.o. girl presents with fever and a sore throat. - Make it stand out In the news lately is measles virus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c1cc9ac4-4f65-4ab2-b2f0-555ff8d2fc69/chicken+pox.JPG The Naunheim Files - A 6 y.o. girl presents with fever and a sore throat. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9e1196e1-0d9b-478d-98b1-fe9d4c04c419/parvo.JPG The Naunheim Files - A 6 y.o. girl presents with fever and a sore throat. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2025/7/28/jw6yfz9ncl4mefr14lde63a0e932vt monthly 0.5 2025-07-31 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/781a05db-a750-42ed-885f-fb7301fcf00e/wn.JPG The Naunheim Files - Make it stand out What do you notice on his MRI? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/151e94a4-e7cd-4278-b908-e50588655037/culex.JPG The Naunheim Files - Make it stand out The Culex mosquito bites holding itself parallel to the surface. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e543056f-8623-40a4-a8ce-cd7be50b6316/anopheles+vs+aides.JPG The Naunheim Files - Make it stand out The biting angle for Anopheles and Aedes aegypti https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f0634ac0-d612-4f1d-86d4-220b38c7e2ef/malaria.JPG The Naunheim Files - Make it stand out Malaria kills over 600,00 people a year world wide. https://everydayebm.org/naunheim-files/2025/7/21/a-69-yo-male-comes-to-the-ed-with-sudden-hearing-loss-in-the-r-ear-it-worsened-over-several-hours-and-now-he-cannot-hear-out-of-the-r-ear monthly 0.5 2025-07-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/839fcec3-c557-47d0-8a60-1aee2f71876b/phils+tm.JPG The Naunheim Files - A 69 y.o. male comes to the ED with sudden hearing loss in the R ear. It worsened over several hours and now he cannot hear out of the R ear. - Make it stand out Hint: the eardrum is normal. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4058326b-6c61-46e1-9c3f-e7383d4c6922/malleous+back+and+downfff.jpg The Naunheim Files - A 69 y.o. male comes to the ED with sudden hearing loss in the R ear. It worsened over several hours and now he cannot hear out of the R ear. - Make it stand out A review of the anatomy of the tympanic membrane https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5d911337-2b86-46b3-8985-2b6be1cc838a/MRIffff.jpg The Naunheim Files - A 69 y.o. male comes to the ED with sudden hearing loss in the R ear. It worsened over several hours and now he cannot hear out of the R ear. - Make it stand out T2 weighted images showing hyperintense foci in the L middle cerebral peduncle. The problem is this was six days after the hearing loss and emphasizes the fact that posterior strokes can be missed on MRI. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/51f2b3ab-ac86-406b-979f-5903abf66a4c/central+features.JPG The Naunheim Files - A 69 y.o. male comes to the ED with sudden hearing loss in the R ear. It worsened over several hours and now he cannot hear out of the R ear. - Make it stand out do not do a HINTS unless nystagmus is present https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/87f2eb32-4294-4cf6-ad7f-7af68118737f/HINTS.JPG The Naunheim Files - A 69 y.o. male comes to the ED with sudden hearing loss in the R ear. It worsened over several hours and now he cannot hear out of the R ear. - Make it stand out skew is the most sensitive and hardest to detect Nystamus should be done at rest and looking to the sides through a sheet of paper to prevent fixation which decreases nystagmus. https://everydayebm.org/naunheim-files/2025/7/14/a-30-yo-male-comes-in-with-dystonia-involuntary-spasms-where-his-head-turns-right monthly 0.5 2025-07-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7e5900bc-5162-41d7-90db-7c4709d53778/eye.JPG The Naunheim Files - A 30 y.o. male comes in with dystonia; involuntary spasms where his head turns right. - Make it stand out Something is seen in the basal ganglia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0ea99b71-7735-4eb7-952d-871bebd84a2a/tigerfff.jpg The Naunheim Files - A 30 y.o. male comes in with dystonia; involuntary spasms where his head turns right. - Make it stand out Amur tiger at the St.Kouis zoo https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/bea8ce02-6572-4ac8-b825-59082b07099a/beriberi.JPG The Naunheim Files - A 30 y.o. male comes in with dystonia; involuntary spasms where his head turns right. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d8a63ec4-fcef-4e28-b66e-b45d3858edee/pellegra.JPG The Naunheim Files - A 30 y.o. male comes in with dystonia; involuntary spasms where his head turns right. - Make it stand out dermatitis in pellegra https://everydayebm.org/naunheim-files/2025/7/4/a-20-yo-woman-is-referred-to-the-ed-after-a-diagnosis-of-acute-leukemia-is-made-at-an-osh monthly 0.5 2025-07-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/510e7989-2114-481d-b12f-baf703a3680c/faty+lymph.JPG The Naunheim Files - A 20 y.o. woman is referred to the ED after a diagnosis of acute leukemia is made at an OSH - Make it stand out atypical lymphocytes https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f3bd8948-7c0a-4b12-a8f5-f0de497d241f/node+bx.JPG The Naunheim Files - A 20 y.o. woman is referred to the ED after a diagnosis of acute leukemia is made at an OSH - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a5683f19-2686-4063-a494-ff2795689008/hemophagocytosis+on+bx.JPG The Naunheim Files - A 20 y.o. woman is referred to the ED after a diagnosis of acute leukemia is made at an OSH - Make it stand out molecular diagnosis is used for the primary or hereditary forms. https://everydayebm.org/naunheim-files/2025/6/30/a-70-yo-male-who-wears-contact-lenses-comes-to-the-ed-with-a-red-eye-and-loss-of-vision monthly 0.5 2025-07-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/35db0e5d-20f2-44e0-a5ed-dc1de61e30b8/cornea.JPG The Naunheim Files - A 70 y.o male who wears contact lenses comes to the ED with a red eye and loss of vision. - Make it stand out this is his cornea on slit lamp exam https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/af0e6d85-24a3-478f-8d28-b9340c354f29/eye+descemets.JPG The Naunheim Files - A 70 y.o male who wears contact lenses comes to the ED with a red eye and loss of vision. - Make it stand out With corneal edema Descemet’s membrane can buckle causing the whitish patches seen here. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0ede1970-4942-464d-ba53-c22aef6ea07a/oncho.JPG The Naunheim Files - A 70 y.o male who wears contact lenses comes to the ED with a red eye and loss of vision. - Make it stand out River blindness ( onchocerciasis) affects the cornea https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ff1284ef-b0fe-4f3c-9978-a09d52905a2f/acantha+corneal.JPG The Naunheim Files - A 70 y.o male who wears contact lenses comes to the ED with a red eye and loss of vision. - Make it stand out circular corneal lesion from ancanthamoeba https://everydayebm.org/naunheim-files/2025/6/23/a-70-year-old-male-comes-to-the-ed-with-fever-and-confusion-he-has-a-hx-of-ht-and-depression monthly 0.5 2025-06-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1408c133-862b-42a0-85d3-961798cf1488/mb+urine.JPG The Naunheim Files - A 70 year old male comes to the ED with fever and confusion. He has a hx of HT and depression. - Make it stand out hint: green urine can be the result of a blue dye https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5df29ad0-98bd-4c60-8441-0409f03fe353/serotonin+syndrome.JPG The Naunheim Files - A 70 year old male comes to the ED with fever and confusion. He has a hx of HT and depression. - Make it stand out criteria for serotonin syndrome https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3e72cfea-c949-48f2-8221-927203a15156/blue+brain.JPG The Naunheim Files - A 70 year old male comes to the ED with fever and confusion. He has a hx of HT and depression. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2025/6/16/a-50-yo-male-was-mowing-grass-for-the-highway-department-and-developed-a-febrile-illness monthly 0.5 2025-06-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7f2ebea7-c36f-4f9e-8c64-4f5b241caccc/IMG_3116+2.jpeg The Naunheim Files - A 50 y.o. male was mowing grass for the highway department and developed a febrile illness. - Make it stand out He has a cough and body aches; what do you notice on his CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/890b44a8-2494-4f49-8114-69932f974061/Image+%284%29.jpeg The Naunheim Files - A 50 y.o. male was mowing grass for the highway department and developed a febrile illness. - Make it stand out less common forms of tularemia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a603894a-75d0-4392-affc-431c03607321/rab.jpeg The Naunheim Files - A 50 y.o. male was mowing grass for the highway department and developed a febrile illness. - Make it stand out tularemia is also called rabbit fever https://everydayebm.org/naunheim-files/2025/6/13/a-30-yo-male-comes-in-with-fevertachycardia-cough-and-diarrhea-he-appears-ill monthly 0.5 2025-06-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e8decebb-0fdc-4ace-9af7-4f2057a7a424/nodulefff.JPG The Naunheim Files - A 30 y.o. male comes in with fever,tachycardia, cough and diarrhea. He appears ill. - Make it stand out His CT shows a pulmonary nodule and no PE. https://everydayebm.org/naunheim-files/2025/6/9/a-15-year-old-boy-comes-in-five-days-after-his-leg-was-injured-by-debris-during-a-tornado monthly 0.5 2025-06-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/85ed7e60-e0fc-4c16-836f-8b2d79ca7add/mucor.JPG The Naunheim Files - A 15 year old boy comes in five days after his leg was injured by debris during a tornado - Make it stand out hemorrhagic bulla https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/004d7e54-7c8b-4b2d-9798-c83b84daae74/fonda+bullae.JPG The Naunheim Files - A 15 year old boy comes in five days after his leg was injured by debris during a tornado - Make it stand out non immune hemorrhagic bullae from fondaparinux https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/fbdac319-f84e-4e69-9957-852227cadadb/differential+for+hemorrhagic+bullae.JPG The Naunheim Files - A 15 year old boy comes in five days after his leg was injured by debris during a tornado - Make it stand out and Mucor https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/330e92b8-895c-436a-901d-61792a847fcb/nf.JPG The Naunheim Files - A 15 year old boy comes in five days after his leg was injured by debris during a tornado - Make it stand out Diabetic pt with necrotizing fasciitis https://everydayebm.org/naunheim-files/2025/6/2/a-70-yo-woman-was-stepped-off-the-curb-and-felt-a-sudden-pain-in-the-leg monthly 0.5 2025-06-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9155d833-e2dc-44e5-a387-68d98a34bc84/bis.JPG The Naunheim Files - A 70 y.o. woman stepped off the curb and felt a sudden pain in the leg. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c0ae95de-30a2-4141-858f-f72a828fafcb/womanphos.JPG The Naunheim Files - A 70 y.o. woman stepped off the curb and felt a sudden pain in the leg. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/383dd2ad-6418-4258-b94b-137a20386dfd/bronj.JPG The Naunheim Files - A 70 y.o. woman stepped off the curb and felt a sudden pain in the leg. - Make it stand out BRONJ https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c3f374f2-b8ab-432a-9f57-2c4137536ad0/T-score.JPG The Naunheim Files - A 70 y.o. woman stepped off the curb and felt a sudden pain in the leg. - Make it stand out T-score https://everydayebm.org/naunheim-files/2025/5/26/a-19-yo-pitcher-presents-with-a-sore-shoulder-he-describes-the-pain-as-achy-and-it-has-been-going-on-several-months monthly 0.5 2025-05-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/973f71ef-1179-43f9-9a8b-15621c746b7a/osteo+humerus.JPG The Naunheim Files - A 19 y.o. pitcher presents with a sore shoulder. He describes the pain as achy and it has been going on several months. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c887a538-f0c6-4010-8f6e-975bbec120fa/os+mets.JPG The Naunheim Files - A 19 y.o. pitcher presents with a sore shoulder. He describes the pain as achy and it has been going on several months. - Make it stand out calcified mets from osteosarcoma https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/eae94899-a510-4a30-bf95-2e5dc7b69ce0/codman%27s+triangle+ad.JPG The Naunheim Files - A 19 y.o. pitcher presents with a sore shoulder. He describes the pain as achy and it has been going on several months. - Make it stand out Codman’s triangle https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/80f6e10b-53b1-434a-9613-94bee99c8e6c/sunburst.JPG The Naunheim Files - A 19 y.o. pitcher presents with a sore shoulder. He describes the pain as achy and it has been going on several months. - Make it stand out The image appears brighter on the R due to ectopic bone production. https://everydayebm.org/naunheim-files/2025/5/18/a-9-yo-was-sitting-on-a-swim-platform-with-her-mother-and-suddenly-passed-out monthly 0.5 2025-05-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0284ad18-beed-406e-a4aa-b5c8fbe7415d/swim+platformff.JPG The Naunheim Files - A 9 y.o. was sitting on a swim platform with her mother and suddenly passed out. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/53fb1101-6e90-41d9-a2da-47e33dc40d2c/vortex+onefff.jpg The Naunheim Files - A 9 y.o. was sitting on a swim platform with her mother and suddenly passed out. - Make it stand out Faster moving air around the boat has a higher pressure than the slower moving air behind the boat. This creates a low pressure zone behind the boat and draws exhaust back in https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7b2e6e57-ce2b-4857-85cb-c70c1896be94/clouds+karman+vortices.JPG The Naunheim Files - A 9 y.o. was sitting on a swim platform with her mother and suddenly passed out. - Make it stand out A Karman vortex cloud formation over a mountain. https://everydayebm.org/naunheim-files/2025/5/12/a-25-yo-outdoorsman-in-oregon-returned-from-a-camping-trip-with-diarrhea monthly 0.5 2025-05-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/15f19a80-9382-48d9-b013-0bd3ab066db7/blue+hand.JPG The Naunheim Files - A 25 y.o. outdoorsman in Oregon returned from a camping trip with diarrhea. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d1f87506-bef3-4d00-9362-79803764246a/usa.JPG The Naunheim Files - A 25 y.o. outdoorsman in Oregon returned from a camping trip with diarrhea. - Make it stand out distribution of false morel mushrooms in the US https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7f9f0b7b-f143-450f-be25-3a1b3e13372d/morels+vs+false+morels.JPG The Naunheim Files - A 25 y.o. outdoorsman in Oregon returned from a camping trip with diarrhea. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cf2eda91-13cb-4042-8c59-b3e4ef2b2404/dave%27s+sushi.JPG The Naunheim Files - A 25 y.o. outdoorsman in Oregon returned from a camping trip with diarrhea. - Make it stand out Dave’s sushi in Bozeman Montana where 60 people had documented mushroom poisoning and two died in 2023.. https://everydayebm.org/naunheim-files/2025/5/5/a-25-yo-femal-resident-had-a-seizure-in-the-call-room-she-has-no-history-of-seizure-and-complains-only-of-lank-pain-after-her-recovery monthly 0.5 2025-05-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0b253be1-6781-46d7-b0e1-1034ce7c552e/angiomyolipoma.JPG The Naunheim Files - A 25 y.o. female resident had a seizure in the call room. She has no history of seizures and complains only of flank pain after her recovery. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/671b1ca0-32e3-4801-97ce-9bd3e95a96ee/tuberous+scleosis+on+mri+subepen.JPG The Naunheim Files - A 25 y.o. female resident had a seizure in the call room. She has no history of seizures and complains only of flank pain after her recovery. - Make it stand out subependymal lesions on MRI https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d8ffdbb1-ab00-427a-be8e-bcca2d983b53/angiofibromas.JPG The Naunheim Files - A 25 y.o. female resident had a seizure in the call room. She has no history of seizures and complains only of flank pain after her recovery. - Make it stand out angiofibromas in tuberous sclerosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/25b68219-a386-4643-b1bd-43fc669a1ef4/tuberous+sclerosis+chart.JPG The Naunheim Files - A 25 y.o. female resident had a seizure in the call room. She has no history of seizures and complains only of flank pain after her recovery. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2025/4/28/a-28-yo-male-was-brought-to-the-ed-after-being-found-unconscious-on-the-sidewalk-in-a-rainstorm monthly 0.5 2025-04-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0f55198a-2289-4e43-b247-266982abffcc/shoe.JPG The Naunheim Files - A 28 y.o. male was brought to the ED after being found unconscious on the sidewalk in a rainstorm. - Make it stand out what do you notice? He spontaneously woke and complained of decreased hearing. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/95758d94-17af-427a-8b66-79af56ad3763/ben3.jpg The Naunheim Files - A 28 y.o. male was brought to the ED after being found unconscious on the sidewalk in a rainstorm. - Make it stand out Ben Franklin was actually standing in a doorway out of the rain when he did the experiment. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d2f0dec4-a405-49eb-813e-0872eddf231f/lictenberg.JPG The Naunheim Files - A 28 y.o. male was brought to the ED after being found unconscious on the sidewalk in a rainstorm. - Make it stand out Lichtenberg figure https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d19f3155-7425-4492-8cbe-127c5993b498/sprites.JPG The Naunheim Files - A 28 y.o. male was brought to the ED after being found unconscious on the sidewalk in a rainstorm. - Make it stand out sprites are seen high above a thunderhead. They are a plasma effect similar to auroras https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a03cb178-7fa0-40d1-adc2-ffed1c201de9/lightning+hitting+the+arch.JPG The Naunheim Files - A 28 y.o. male was brought to the ED after being found unconscious on the sidewalk in a rainstorm. - Make it stand out The arch is struck 1-2 times per year on average. https://everydayebm.org/naunheim-files/2025/4/21/a-20-yo-returns-from-spring-break-in-curacao-he-has-fever-and-diarrhea monthly 0.5 2025-04-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5721b7f9-13de-452c-9d6b-7588f407091e/curacao.JPG The Naunheim Files - A 20 y.o. returns from spring break in Curacao. He has fever and diarrhea. - Make it stand out Curacao https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d1874eef-90bf-43bd-8d46-640bfe7e8380/o2.JPG The Naunheim Files - A 20 y.o. returns from spring break in Curacao. He has fever and diarrhea. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/76bc282e-e9d3-4b01-9b6c-79ccba5f6e48/curpigs.JPG The Naunheim Files - A 20 y.o. returns from spring break in Curacao. He has fever and diarrhea. - Make it stand out fun in Curacao https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/28fc77b5-f80a-48ee-acab-60701a82cf2c/rose+spots.JPG The Naunheim Files - A 20 y.o. returns from spring break in Curacao. He has fever and diarrhea. - Make it stand out rose spots in typhoid fever are thought to be bacterial emboli https://everydayebm.org/naunheim-files/2025/4/9/a-63-yo-male-with-a-history-of-alcohol-abuse-presents-with-a-chief-complaint-of-arm-tightness-he-has-noted-several-masses-under-the-skin monthly 0.5 2025-04-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/679da187-7c43-4b96-85d0-393f10e47c6a/madel.JPG The Naunheim Files - A 63 y.o. male with a history of alcohol abuse presents with a chief complaint of arm tightness. He has noted several masses under the skin. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5f8edb1c-85ca-4753-ae9e-399deb784c55/made2.JPG The Naunheim Files - A 63 y.o. male with a history of alcohol abuse presents with a chief complaint of arm tightness. He has noted several masses under the skin. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/19cb8c57-ff1a-4db4-af5d-ad78353395bf/MAD1ffff.jpg The Naunheim Files - A 63 y.o. male with a history of alcohol abuse presents with a chief complaint of arm tightness. He has noted several masses under the skin. - Make it stand out the horse collar https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1a9f8614-9237-4633-8586-d31a3884e25a/buffalo.JPG The Naunheim Files - A 63 y.o. male with a history of alcohol abuse presents with a chief complaint of arm tightness. He has noted several masses under the skin. - Make it stand out the buffalo hump https://everydayebm.org/naunheim-files/2025/4/7/a-5-yo-girl-presents-with-fever-and-sore-throat-one-day-later-she-develops-a-rash monthly 0.5 2025-04-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0a887385-bc77-43d7-bdc1-bae26023ae75/hannah.JPG The Naunheim Files - A 5 y.o. girl presents with fever and sore throat. One day later she develops a rash - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/fba83219-1f55-42ad-9044-96300e21cbf3/straw.JPG The Naunheim Files - A 5 y.o. girl presents with fever and sore throat. One day later she develops a rash - Make it stand out strawberry tongue begins with redness and white patches and then swells. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c1970fef-a1e6-4423-86bc-63db09ce2a02/impetigo.JPG The Naunheim Files - A 5 y.o. girl presents with fever and sore throat. One day later she develops a rash - Make it stand out impetigo is also caused by S pyogenes https://everydayebm.org/naunheim-files/2025/3/31/a-39-yo-male-comes-in-with-severe-epistaxis monthly 0.5 2025-04-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/06d78400-a149-4ff8-a161-3cb846aff8a2/hh.JPG The Naunheim Files - A 39 y.o. male comes in with severe epistaxis. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0e5eb25e-becf-479c-89b6-6e5550905fa9/pulmavm.JPG The Naunheim Files - A 39 y.o. male comes in with severe epistaxis. - Make it stand out 40% of patients with HHT have pulmonary avms. The triangle is the avm, the small arrow is the feeding artery and the large arrow is the draining vein. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/277b367f-b179-46bd-a43f-b94d3a4a010d/bevhht.JPG The Naunheim Files - A 39 y.o. male comes in with severe epistaxis. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/18a9ae52-a325-4698-b79f-8dfa85ccbeb9/mast+adult.JPG The Naunheim Files - A 39 y.o. male comes in with severe epistaxis. - Make it stand out cutaneous mastocytosis in an adult urticaria pigmentosa https://everydayebm.org/naunheim-files/2025/3/24/a-58-yo-male-comes-in-after-a-week-of-a-viral-syndrome-he-co-shortness-of-breath monthly 0.5 2025-03-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d1ace611-45c1-4032-b77f-3bf2836dba04/sin+hombre.JPG The Naunheim Files - A 58 y.o. male comes in after a week of a viral syndrome. He co shortness of breath - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/248c5ac7-545c-4232-866f-4991dfbd4fe7/hdeerm.JPG The Naunheim Files - A 58 y.o. male comes in after a week of a viral syndrome. He co shortness of breath - Make it stand out deer mouse https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e7449418-b4ba-4561-b8bd-8236bc497c95/pancantrrrrr.JPG The Naunheim Files - A 58 y.o. male comes in after a week of a viral syndrome. He co shortness of breath - Make it stand out Theodore Roosevelt signed the first laws restricting immigration https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5c0f322b-bcac-41d6-8674-2f2f41a5dbc7/dengue.JPG The Naunheim Files - A 58 y.o. male comes in after a week of a viral syndrome. He co shortness of breath - Make it stand out the rash of dengue is very fine. https://everydayebm.org/naunheim-files/2025/3/13/a-21-yo-woman-with-a-history-of-seizures-comes-to-the-ed-with-abdominal-pain monthly 0.5 2025-03-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a87bfe42-1721-4e9e-8620-e66672af260d/urine+in+aip.JPG The Naunheim Files - A 21 y.o. woman with a history of seizures comes to the ED with abdominal pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d37fbbd8-ac01-479e-a30d-018a041b3d56/pct+chart.JPG The Naunheim Files - A 21 y.o. woman with a history of seizures comes to the ED with abdominal pain. - Make it stand out There are 8 steps in the pathway which can lead to overproduction of porphyrins. ALA is the rate limiting step. It can be induced by prolonged fasting or drugs like estrogen causing more heme to be produced by P450 pathway induction. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/94da9ec1-a077-490e-9d55-6201fab1749b/PCT.JPG The Naunheim Files - A 21 y.o. woman with a history of seizures comes to the ED with abdominal pain. - Make it stand out porphyria cutanea tarda https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/937db835-d7ca-48f7-851e-67bae3e4468d/girofor+por.JPG The Naunheim Files - A 21 y.o. woman with a history of seizures comes to the ED with abdominal pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2025/3/10/a-44-yo-woman-from-nigeria-comes-to-the-ed-with-a-lesion-on-her-neck monthly 0.5 2025-03-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1192dfdf-0f27-4e4a-a1bf-87ff46ecb18a/ens.jpg The Naunheim Files - A 44 y.o. woman from Nigeria comes to the ED with a lesion on her neck. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/13f98738-b1b2-4b8e-acaf-47ec761e3ae7/early+mf.JPG The Naunheim Files - A 44 y.o. woman from Nigeria comes to the ED with a lesion on her neck. - Make it stand out early stage, plaques https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/96a47154-e829-4726-a2d4-7e5f84ef2b0d/leish.JPG The Naunheim Files - A 44 y.o. woman from Nigeria comes to the ED with a lesion on her neck. - Make it stand out leishmaniasis in Guatemala https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/06501a0a-8d29-4549-934a-f7adf94b40ee/venous+insufficiency+ulcers.JPG The Naunheim Files - A 44 y.o. woman from Nigeria comes to the ED with a lesion on her neck. - Make it stand out venous ulcer https://everydayebm.org/naunheim-files/2025/3/3/a-70-yo-male-presents-with-abdominal-pain monthly 0.5 2025-03-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0468527b-f1b4-4fde-ad9f-10d56b0edd35/portal+vein+thrombosis.JPG The Naunheim Files - A 70 y.o. male presents with abdominal pain - Make it stand out what is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/68f22ac2-de5f-442d-a69a-9b8f8afb7185/varices+of+cxr.JPG The Naunheim Files - A 70 y.o. male presents with abdominal pain - Make it stand out varices on cxr https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/086997ff-5952-4fb7-a3cd-af27a1ea2860/schixoto.JPG The Naunheim Files - A 70 y.o. male presents with abdominal pain - Make it stand out schistosomes migrate to the liver https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d099de3f-cf00-47fa-8fad-2127ff728a10/tips.JPG The Naunheim Files - A 70 y.o. male presents with abdominal pain - Make it stand out TIPS https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/011b9513-ca68-4ca5-8eb1-2c669ee28167/tips+us.JPG The Naunheim Files - A 70 y.o. male presents with abdominal pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2025/2/24/ec0iyj0yuxfiy9xxn8dsu3lo3mbjk6 monthly 0.5 2025-02-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cef1e23b-8d61-4f46-b5cc-6182129746f0/macaque.JPG The Naunheim Files - a A 30 y.o. lab tech comes in with a monkey bite. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/01968e97-7bc1-4555-8a6c-7d11228ffc9f/MAC+BITE+IN+PARK.JPG The Naunheim Files - a A 30 y.o. lab tech comes in with a monkey bite. - Make it stand out tourist from Oregon sustaining a monkey bite in Thailand https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3d6af9e4-b3e7-489b-b9c4-ce592666f9e5/MRI+temp+lobe.JPG The Naunheim Files - a A 30 y.o. lab tech comes in with a monkey bite. - Make it stand out temporal lobe inflammation on MRI with viral encephalitis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/03360fd5-f210-4974-8a2b-c053f91de2d3/curious+george.JPG The Naunheim Files - a A 30 y.o. lab tech comes in with a monkey bite. - Make it stand out A monkey with no tail https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/dbbb4add-dd5f-4cb1-9d66-a1a0c3341fae/map+of+mac.JPG The Naunheim Files - a A 30 y.o. lab tech comes in with a monkey bite. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2025/2/17/npaxj6utapwve5zohfy530cm6nwmcg monthly 0.5 2025-02-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5b217026-6f1f-45e4-b4a4-7a755793846c/pled+final.jpeg The Naunheim Files - A 55 y.o woman comes to the ED with shortness of breath - Make it stand out What do you notice in the picture? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/337b3663-d1c0-478b-a867-8d5867283b31/goiter+f.JPG The Naunheim Files - A 55 y.o woman comes to the ED with shortness of breath - Make it stand out Boticelli’s Virgin with a goiter https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/2ee8fbea-6782-4aaa-8d58-b64cbb86b3f4/goiter+belt.JPG The Naunheim Files - A 55 y.o woman comes to the ED with shortness of breath - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b6a31320-4400-4378-b9c4-bf5847b859d5/cretin.JPG The Naunheim Files - A 55 y.o woman comes to the ED with shortness of breath - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2025/2/10/a-28-yo-woman-comes-to-the-ed-with-a-complaint-of-vision-loss-and-weakness monthly 0.5 2025-02-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/64061eb5-e2e4-4e29-9b3a-b6fca1302e94/centrocecal++scotoma.JPG The Naunheim Files - A 28 yo woman comes to the ED with a complaint of vision loss and weakness - Make it stand out the small square is the physiologic blind spot toward the temporal side. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/89330723-72f2-44b6-9bf5-5c30267b8a4b/NAION.JPG The Naunheim Files - A 28 yo woman comes to the ED with a complaint of vision loss and weakness - Make it stand out optic neuropathy can appear with disc edema as on the L or disc pallor on the R https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8377e215-ca55-4e47-9271-61cda437972a/optic+n+dia.JPG The Naunheim Files - A 28 yo woman comes to the ED with a complaint of vision loss and weakness - Make it stand out NEJM article showing where the damage occurs in different types of optic neuritis. https://everydayebm.org/naunheim-files/2025/2/3/a-44-yo-policeman-in-la-county-comes-in-with-a-rash monthly 0.5 2025-02-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0ffe6fc4-276f-4146-806d-82d4e83a695a/typhus.JPG The Naunheim Files - A 44 y.o. policeman in LA county comes in with a rash. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0fe15b8e-4253-4513-a793-9c76745cbbe6/body+lice.JPG The Naunheim Files - A 44 y.o. policeman in LA county comes in with a rash. - Make it stand out body lice are vectors of epidemic typhus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/bf2bd76a-e05c-4783-8b11-0e1e3c62ee9a/flying+squirrel.JPG The Naunheim Files - A 44 y.o. policeman in LA county comes in with a rash. - Make it stand out flying squirrels are a reservoir of epidemic typhus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8dea79aa-5b95-4eeb-b190-293710a8e9e2/scrub+typhus.JPG The Naunheim Files - A 44 y.o. policeman in LA county comes in with a rash. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2025/1/27/a-57-yo-woman-comes-to-ed-with-extreme-sob-after-a-shoulder-surgery-that-day monthly 0.5 2025-01-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3003d9bf-f5c4-42c5-a74f-9341c566e35c/scalene+block%2Cdiaphragm+paralyzed.jpg The Naunheim Files - A 57 y.o. woman comes to ED with extreme SOB after a shoulder surgery that day. - Make it stand out what happened? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/26914ecf-06cf-44a8-8d18-8a2d2bdc9559/interscalen+block+diag.JPG The Naunheim Files - A 57 y.o. woman comes to ED with extreme SOB after a shoulder surgery that day. - Make it stand out landmarks for the block https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c38ee0db-0875-4fcd-9059-f7ca8351811a/goiter+phrenic+n.JPG The Naunheim Files - A 57 y.o. woman comes to ED with extreme SOB after a shoulder surgery that day. - Make it stand out A goiter can cause diaphragmatic paralysis as well https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/147de089-74c4-4ebd-8db0-1dd4a296cb17/us+how+to.JPG The Naunheim Files - A 57 y.o. woman comes to ED with extreme SOB after a shoulder surgery that day. - Make it stand out the stop light sign is the best landmark on US. https://everydayebm.org/naunheim-files/2025/1/20/a-27-yo-woman-presented-with-hematuria-and-l-flank-pain monthly 0.5 2025-01-22 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3e5b889e-a5a7-410b-8178-1d5f1d6dbb66/mskct.JPG The Naunheim Files - A 27 y.o. woman presented with hematuria and L flank pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8fa04e8c-ddf1-45bb-b129-e5fb41f6fb29/diamsk.JPG The Naunheim Files - A 27 y.o. woman presented with hematuria and L flank pain. - Make it stand out congenitally dilated ducts of Bellini https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/070ddec1-fccb-476b-8571-7e95d0043d0e/us+of+msk.JPG The Naunheim Files - A 27 y.o. woman presented with hematuria and L flank pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/55f9fe58-c79e-4930-9c24-01082638f07c/mskplain+film.JPG The Naunheim Files - A 27 y.o. woman presented with hematuria and L flank pain. - Make it stand out end stage medullary sponge kidney requring nephectomy https://everydayebm.org/naunheim-files/2025/1/13/a-42-yo-male-comes-to-the-ed-with-hand-pain monthly 0.5 2025-01-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8089e814-2497-452c-a2c1-b69b1a4e2fa8/acro.JPG The Naunheim Files - A 42 y.o. male comes to the ED with hand pain - Make it stand out What causes this problem? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/16e4ac31-2427-4efd-9c16-975f6f3a8540/clubbing.JPG The Naunheim Files - A 42 y.o. male comes to the ED with hand pain - Make it stand out clubbinb https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8591dad0-2072-49af-84cd-b74b1bc8a3c8/lung+cancer.JPG The Naunheim Files - A 42 y.o. male comes to the ED with hand pain - Make it stand out lung cancer https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/65c3d73d-91b9-487b-a949-01663ef4c62c/fluorosis.JPG The Naunheim Files - A 42 y.o. male comes to the ED with hand pain - Make it stand out periosteal reaction from fluorosis on the right https://everydayebm.org/naunheim-files/2024/12/30/a-48-yo-recent-refugee-from-colombia-complains-of-a-subcutaneous-nodule-which-has-been-present-for-two-years monthly 0.5 2025-01-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ef667fd4-40b6-4c1e-a909-5e397996a9d9/onchoff.JPG The Naunheim Files - A 48 y.o. recent refugee from Colombia complains of a subcutaneous nodule which has been present for two years. - Make it stand out What is the diagnosis? and what are the lesions present? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8c1b6138-9fdc-4690-9451-c165d43f9545/onchoffarr.jpg The Naunheim Files - A 48 y.o. recent refugee from Colombia complains of a subcutaneous nodule which has been present for two years. - Make it stand out the arrow points to the uteri in the adult worms filled with filariae https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/781b62d7-e6e1-406e-b230-b441a113157e/nodule.JPG The Naunheim Files - A 48 y.o. recent refugee from Colombia complains of a subcutaneous nodule which has been present for two years. - Make it stand out the nodule on our patient’s leg https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8ab991c4-5e45-4856-bc8b-52f191575d0f/eyefff.JPG The Naunheim Files - A 48 y.o. recent refugee from Colombia complains of a subcutaneous nodule which has been present for two years. - Make it stand out The parasites can sometimes be seen in the anterior chamber of the eye https://everydayebm.org/naunheim-files/2024/12/23/a-79-yo-non-english-speaker-comes-to-the-ed-with-nausea-vomiting-and-hypotension monthly 0.5 2024-12-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e8f8c0f9-c87a-471e-81c4-bc68116c50e8/IMG_2604.jpg The Naunheim Files - A 79 y.o. non English speaker comes to the ED with nausea, vomiting and hypotension. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/53c53ae6-c646-446f-b28c-b03c6bca356b/Imagefff+12-27-24+at+7.07+AM.jpg The Naunheim Files - A 79 y.o. non English speaker comes to the ED with nausea, vomiting and hypotension. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5fd878ba-c4ba-4938-8520-d8e8bf6cef56/pc+gallstones.JPG The Naunheim Files - A 79 y.o. non English speaker comes to the ED with nausea, vomiting and hypotension. - Make it stand out a yellow cholesterol stone and dark pigment stones. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/37763603-2d1b-4977-b589-df710d2f9fac/MARYFFF.jpg The Naunheim Files - A 79 y.o. non English speaker comes to the ED with nausea, vomiting and hypotension. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8d7e819c-2991-464d-bacf-c73517aa503b/wegovy.JPG The Naunheim Files - A 79 y.o. non English speaker comes to the ED with nausea, vomiting and hypotension. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/12/16/a-72-yo-male-with-chronic-lymphocytic-leukemia-comes-in-with-painful-hands monthly 0.5 2024-12-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ca7c166e-1e66-4218-a522-f72ddc5b2089/ibrutinib.JPG The Naunheim Files - A 72 y.o. male with chronic lymphocytic leukemia comes in with painful hands. - Make it stand out brittle nails and areas of early paronychia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/be87506b-2b64-4b2d-a638-595229bad8f3/pembrolizumab.JPG The Naunheim Files - A 72 y.o. male with chronic lymphocytic leukemia comes in with painful hands. - Make it stand out nail changes with pembrolizumab https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ab6d01b4-b0d5-4772-9afd-8b266f2672e3/melanonychiafff.jpg The Naunheim Files - A 72 y.o. male with chronic lymphocytic leukemia comes in with painful hands. - Make it stand out melanonychia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d6a3e6ad-721e-4639-aaeb-2e1947796a40/fungal+nail.JPG The Naunheim Files - A 72 y.o. male with chronic lymphocytic leukemia comes in with painful hands. - Make it stand out fungal infection https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5eeb876a-bd6d-4c99-ad7c-cbbe9b8ff0bd/chart+nail.JPG The Naunheim Files - A 72 y.o. male with chronic lymphocytic leukemia comes in with painful hands. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/12/9/a-62-yo-woman-was-in-a-headon-crash-with-a-truck-she-was-a-restrained-driver-and-airbags-deployed monthly 0.5 2024-12-11 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/567da5a4-b839-4610-95e1-5e8ab779ac81/fftraumatic+hernia.jpg The Naunheim Files - A 62 y.o. woman was in a headon crash with a truck. She was a restrained driver and airbags deployed - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6dbf2c66-ea20-4305-9fc5-3d6cd33d72df/abdherniasubtle.JPG The Naunheim Files - A 62 y.o. woman was in a headon crash with a truck. She was a restrained driver and airbags deployed - Make it stand out traumatic hernia from high energy impact. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/12cfff33-6f5c-4ab1-8417-fb096ddc0e8f/handlebar+hernia.JPG The Naunheim Files - A 62 y.o. woman was in a headon crash with a truck. She was a restrained driver and airbags deployed - Make it stand out handlebar hernia from low energy localized impact https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4bf2704c-a5ab-4a16-8264-b642014072bc/lumbar+hernia.JPG The Naunheim Files - A 62 y.o. woman was in a headon crash with a truck. She was a restrained driver and airbags deployed - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/813b6aa4-9dd7-4b9d-8b37-c90f53afeea8/staggered+abs.JPG The Naunheim Files - A 62 y.o. woman was in a headon crash with a truck. She was a restrained driver and airbags deployed - Make it stand out there is no cure for staggered abs https://everydayebm.org/naunheim-files/2024/12/3/a-45-yo-male-with-a-history-of-gastric-bypass-comes-in-with-a-rash-on-his-legs monthly 0.5 2024-12-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/29b62ec9-de3d-4458-b4f7-63f4b9e32f40/vit+C+def.JPG The Naunheim Files - A 45 y.o. male with a history of gastric bypass comes in with a rash on his legs. - Make it stand out the patient has petechial hemorrhages https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/43b609a5-d9bc-445e-bf82-d9b51d49f012/gum+edema.JPG The Naunheim Files - A 45 y.o. male with a history of gastric bypass comes in with a rash on his legs. - Make it stand out gum edema in scurvy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b56a1b36-2cbe-43e9-a346-b0f521c4a64f/corkscrew+hairsff.jpg The Naunheim Files - A 45 y.o. male with a history of gastric bypass comes in with a rash on his legs. - Make it stand out corkscrew hairs are found in scurvy because of defective collagen https://everydayebm.org/naunheim-files/2024/11/11/a-43-yo-with-a-hx-of-drug-use-comes-to-the-ed-complaining-of-sores-in-his-mouth-and-skin-lesions monthly 0.5 2024-11-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/fae9c714-121b-4d5c-a9d4-310782a9fd3f/pem3.JPG The Naunheim Files - A 43 y.o. with a hx of drug use comes to the ED complaining of sores in his mouth and skin lesions. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0880e01d-20dd-455b-9718-cc087eb77d7e/pemcocaine.JPG The Naunheim Files - A 43 y.o. with a hx of drug use comes to the ED complaining of sores in his mouth and skin lesions. - Make it stand out Cocaine induced pemphigus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f3cbe506-204c-4589-8e8f-5bb20e9ff479/pink+cocaine.JPG The Naunheim Files - A 43 y.o. with a hx of drug use comes to the ED complaining of sores in his mouth and skin lesions. - Make it stand out pink cocaine https://everydayebm.org/naunheim-files/2024/11/4/a-65-yo-woman-presented-with-hypoxia-and-hypotension-secondary-to-influenza-a-l-ij-was-placed monthly 0.5 2024-12-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c4e27e1b-c419-4f5d-989e-b9ecc09d19c5/Lsvc.JPG The Naunheim Files - A 65 y.o. woman presented with hypoxia and hypotension secondary to influenza. She was intubated and a L IJ was placed. - Make it stand out Where is it? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8c0f552d-4594-4adb-9ef6-6f42a3bbe019/lsvcto+coronary+sinusff.jpg The Naunheim Files - A 65 y.o. woman presented with hypoxia and hypotension secondary to influenza. She was intubated and a L IJ was placed. - Make it stand out this is a line in the L svc draining to the coronary sinus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b39f6fe2-8ffc-458e-bde5-a0b3a3f9f3ac/cxrsangeev.JPG The Naunheim Files - A 65 y.o. woman presented with hypoxia and hypotension secondary to influenza. She was intubated and a L IJ was placed. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c27fa0a8-bdcc-433e-9314-3334424b4951/radio.JPG The Naunheim Files - A 65 y.o. woman presented with hypoxia and hypotension secondary to influenza. She was intubated and a L IJ was placed. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8f42b693-f258-4124-a2dd-a12a47bb11e5/radiotext.JPG The Naunheim Files - A 65 y.o. woman presented with hypoxia and hypotension secondary to influenza. She was intubated and a L IJ was placed. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/10/28/a-41-yo-male-comes-in-with-weight-loss-and-spotty-alopecia monthly 0.5 2024-10-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/831603cf-5b29-46a0-bd82-607f442a9e5c/hg1.JPG The Naunheim Files - A 41 y.o. male comes in with weight loss and spotty alopecia. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/66769e65-26f5-4a34-a1c2-8fc498d8a8e1/hgcloseup.JPG The Naunheim Files - A 41 y.o. male comes in with weight loss and spotty alopecia. - Make it stand out does a close up help? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3ff36556-c479-4057-8209-3df0a3982c75/lev+final.JPG The Naunheim Files - A 41 y.o. male comes in with weight loss and spotty alopecia. - Make it stand out Another hint: from Dr. Levine https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1147fc11-b1c2-4965-8ba3-4138a1fd0a98/ef.JPG The Naunheim Files - A 41 y.o. male comes in with weight loss and spotty alopecia. - Make it stand out erythrism from mercury poisoning in a child https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ef5c959c-58b9-446c-b3d0-62dc59a558e2/Capture.JPG The Naunheim Files - A 41 y.o. male comes in with weight loss and spotty alopecia. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e6626220-0517-4070-b14e-f07de8933325/caduceus.JPG The Naunheim Files - A 41 y.o. male comes in with weight loss and spotty alopecia. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/10/21/a-61-yo-comes-in-with-a-fall-from-her-couch-complaining-of-l-sided-flank-pain monthly 0.5 2024-10-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c91c6859-d430-43f3-ab19-a46240978bd9/rphf.JPG The Naunheim Files - A 61 y.o. comes in with a fall from her couch complaining of L sided flank pain. - Make it stand out The patient quickly spikes a temp and becomes hypotensive and septic; what could be wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/35b8012f-f5e5-4a4d-99c9-f6a0e4360171/rpabscesssub.JPG The Naunheim Files - A 61 y.o. comes in with a fall from her couch complaining of L sided flank pain. - Make it stand out Retroperitoneal infections can be subtle as in the case above but rapidly lead to necrotizing fasciitis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/36dd6b6e-2d22-4a62-ba2e-1b6e14806729/divertepiplo.JPG The Naunheim Files - A 61 y.o. comes in with a fall from her couch complaining of L sided flank pain. - Make it stand out while a diverticulum can be a perforation through the colonic wall, it can also contain fat as in an epiploic outpouching causing epiploic appendagitis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/14940ccf-90cc-446a-a8ca-d9b3bb5b6f11/gut+microbiome.JPG The Naunheim Files - A 61 y.o. comes in with a fall from her couch complaining of L sided flank pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/10/14/a-76-yo-woman-comes-in-with-a-chief-complaint-of-my-head-fell-off monthly 0.5 2024-10-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/927c6021-8d63-42ae-aafc-b79fb6225f5d/aadisff.jpg The Naunheim Files - A 76 y.o. woman comes in with a chief complaint of "my head fell off" - Make it stand out the patient is unable to move her head to the R https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7eee3909-56cb-47e7-a732-d48cd57d3e6b/dia.JPG The Naunheim Files - A 76 y.o. woman comes in with a chief complaint of "my head fell off" - Make it stand out The left shows normal alignment of the dens and C1; the R shows ligamentous laxity. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cb4fb395-d28e-4d5f-b8ce-c3c98e945842/grisels.JPG The Naunheim Files - A 76 y.o. woman comes in with a chief complaint of "my head fell off" - Make it stand out An 11-year-old girl with a fixed torticollis and right hand weakness on a background of >1 month of neck pain and recurrent tonsillitis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/eceb811c-5375-4043-b982-ef1620c2ec96/aarepair.JPG The Naunheim Files - A 76 y.o. woman comes in with a chief complaint of "my head fell off" - Make it stand out The ligamentous laxity is now fixed. https://everydayebm.org/naunheim-files/2024/10/7/a-73-yo-male-presents-with-a-problem-with-his-tongue monthly 0.5 2024-10-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/fbb9ff63-cff3-46df-b520-417a262e2c26/macroglossia.JPG The Naunheim Files - A 73 y.o. male presents with a problem with his tongue - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/2492399f-8fb5-4316-b6ce-42b8eb64e440/now.JPG The Naunheim Files - A 73 y.o. male presents with a problem with his tongue - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/108beb2a-adfb-4f1d-8943-658b7670d805/blue+chart.JPG The Naunheim Files - A 73 y.o. male presents with a problem with his tongue - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/2043f0ab-255e-41df-b10a-8a130bdd8904/techfff.jpg The Naunheim Files - A 73 y.o. male presents with a problem with his tongue - Make it stand out cardiac scan positive for ATTR https://everydayebm.org/naunheim-files/2024/9/30/a-43-yo-man-comes-to-the-ed-complaining-of-chest-pain monthly 0.5 2024-10-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f2a965a5-a5a2-4e87-87b8-cca565569a7c/schudercxr.JPG The Naunheim Files - A 43 y.o. man comes to the ED complaining of chest pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7e902946-6983-4feb-a4bd-70f257c44358/anatomy+scapula.JPG The Naunheim Files - A 43 y.o. man comes to the ED complaining of chest pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/34e62769-2ca8-44db-af00-2b436b0feaaf/2+yrs+later.JPG The Naunheim Files - A 43 y.o. man comes to the ED complaining of chest pain. - Make it stand out no shoulder dislocation is seen https://everydayebm.org/naunheim-files/2024/9/23/a-78-yo-woman-presents-with-weakness-and-a-bluish-discoloration-of-her-nose monthly 0.5 2024-09-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/65705a39-2ddd-4ce8-902e-821a878b1b80/thumbnail_blue.jpg The Naunheim Files - A 78 y.o. woman presents with weakness and a bluish discoloration of her nose - Make it stand out our patient has lymphoma https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8fe04d99-da27-4dac-aa7a-019cbeabe31f/apstchar.jpeg The Naunheim Files - A 78 y.o. woman presents with weakness and a bluish discoloration of her nose - Make it stand out The complicated chart of how APS is diagnosed. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c5ef3788-6fd0-4cd0-aed8-d79b41e5d345/cryo9-24-24+at+8.14+AM.jpeg The Naunheim Files - A 78 y.o. woman presents with weakness and a bluish discoloration of her nose - Make it stand out A patient with cryoglobulins, no vasculitis on biopsy and an ischemia nassal tip which responded to steroids. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/85308f01-222c-45ec-9ae8-35cf582c1e00/livedo.jpeg The Naunheim Files - A 78 y.o. woman presents with weakness and a bluish discoloration of her nose - Make it stand out livido retiularis and covid toes are associated with aPL in covid https://everydayebm.org/naunheim-files/2024/9/16/a-19-yo-male-comes-to-the-ed-with-abdominal-pain monthly 0.5 2024-09-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f8f8a253-730d-495f-8766-b03f25333fce/mono.jpeg The Naunheim Files - A 19 y.o. male comes to the ED with abdominal pain. - Make it stand out what could be wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f06ff514-67a0-41ef-a4ed-48d6cc36f4a1/spleen+or.JPG The Naunheim Files - A 19 y.o. male comes to the ED with abdominal pain. - Make it stand out subcapsular hematoma with rupture of the spleen https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f9cf34d7-3184-4154-81af-b9d280c7b33c/worlds+fair1904.PNG The Naunheim Files - A 19 y.o. male comes to the ED with abdominal pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/9/9/a-40-yo-marathon-runner-in-colorado-presents-with-a-rash monthly 0.5 2024-09-11 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/fe28dbbc-b77a-4041-b836-5471ae65309f/wnv.jpeg The Naunheim Files - A 40 y.o. marathon runner in San Diego presents with a rash. - Make it stand out The picture below is a clue to the diagnosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e72c2304-a2f2-4502-aaf6-4121f7041757/Screen+Shot+2024-09-09+at+9.17.19+AM.png The Naunheim Files - A 40 y.o. marathon runner in San Diego presents with a rash. - Make it stand out This is a corvid https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/19185f82-8559-4358-aef9-1b4d78246842/Screen+Shot+2024-09-11+at+11.01.15+AM.png The Naunheim Files - A 40 y.o. marathon runner in San Diego presents with a rash. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/353860bd-44eb-4d1e-83ba-bf017ce27ba1/anti.jpeg The Naunheim Files - A 40 y.o. marathon runner in San Diego presents with a rash. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8ad3baf2-2baa-43fc-8e30-6e2ed21e3e3b/Image+9-11-24+at+10.05+AM.jpeg The Naunheim Files - A 40 y.o. marathon runner in San Diego presents with a rash. - Make it stand out cases by state in 2024 https://everydayebm.org/naunheim-files/2024/9/2/a-73-yo-male-is-referred-from-an-osh-for-a-red-eye-with-decreased-vision monthly 0.5 2024-09-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ec6cedc9-e764-4727-882e-131b0e2b73f4/endopeyef.jpeg The Naunheim Files - A 73 y.o. male is referred from an OSH for a red eye with decreased vision - Make it stand out What is wrong with his eye? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0ca9a25a-c175-4c34-a2d7-c0d5bce47d93/eyediag.jpeg The Naunheim Files - A 73 y.o. male is referred from an OSH for a red eye with decreased vision - Make it stand out intravitreal injections are generally given in the lower outer quadrant of the eye(away from the nose) https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c82da711-f8ad-4de8-a173-087bcab8db35/Image+9-4-24+at+1.54+PM.jpeg The Naunheim Files - A 73 y.o. male is referred from an OSH for a red eye with decreased vision - Make it stand out a hypopyon https://everydayebm.org/naunheim-files/2024/8/27/a-2 monthly 0.5 2024-08-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/65f20fe8-a138-4fe3-bbf2-b6ca08d55da4/elbow.JPG The Naunheim Files - A 26 y.o. woman comes to the ED with elbow pain - Make it stand out What do you notice? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/281ec1ec-eca7-40a7-99f2-657b39e1bf99/antarrowfJPG.JPG The Naunheim Files - A 26 y.o. woman comes to the ED with elbow pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/437ea392-cae6-47d4-ba7d-5b605bd73333/fat+padsJPG.JPG The Naunheim Files - A 26 y.o. woman comes to the ED with elbow pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4c1c43e6-30dd-4b0e-aea2-14ad284aa041/lipohemarthrisiskneefff+-+Copy.jpg The Naunheim Files - A 26 y.o. woman comes to the ED with elbow pain - Make it stand out lipohemarthrosis with a tibial plateau fracture. https://everydayebm.org/naunheim-files/2024/8/22/a-42-yo-male-is-found-outside-in-august-unresponsive monthly 0.5 2024-08-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b0c2d7d0-c28e-49f4-a931-ee1a3ec223a1/hypoffff.jpg The Naunheim Files - A 42 y.o. male is found outside in August unresponsive - Make it stand out what else do you notice on his EKG? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a598db40-a754-4d83-b257-ace8046a9fc9/hypothermfffff.JPG The Naunheim Files - A 42 y.o. male is found outside in August unresponsive - Make it stand out degrees of hypothermia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cc128e0b-49ab-434a-922e-62b9ca86150a/physiol.JPG The Naunheim Files - A 42 y.o. male is found outside in August unresponsive - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8ce6211a-31a3-4a69-bb2b-063c089a4f7e/crack+pipe.JPG The Naunheim Files - A 42 y.o. male is found outside in August unresponsive - Make it stand out crack pipes often result in burns on the fingers and lips. https://everydayebm.org/naunheim-files/2024/8/12/a-85-yo-woman-comes-from-a-nursing-home-after-a-fall-she-has-a-small-scalp-laceration-and-co-her-palms-itching monthly 0.5 2024-08-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/324cf497-f5b9-455c-adb3-15b53eb81b79/nscab.JPG The Naunheim Files - A 85 y.o. woman comes from a nursing home after a fall. She has a small scalp laceration and co her palms itching. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f5dba3c6-d620-44f3-8626-eda30bcd7da2/the+mite.JPG The Naunheim Files - A 85 y.o. woman comes from a nursing home after a fall. She has a small scalp laceration and co her palms itching. - Make it stand out The mites can be seen on skin scrapings either on a wet mount or KOH https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a2a7f974-abfd-46c7-b940-e35d4348e678/psor+rupoid+plaques.JPG The Naunheim Files - A 85 y.o. woman comes from a nursing home after a fall. She has a small scalp laceration and co her palms itching. - Make it stand out Psoriasis, shown above, HIV, syphilis and leprosy can all present with rupiod plaques. https://everydayebm.org/naunheim-files/2024/8/5/a-35-yo-woman-with-no-medical-history-comes-to-the-ed-with-shortness-of-breath monthly 0.5 2024-08-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ee21e022-d872-4c45-93e2-ef7a22a9df10/teflon.JPG The Naunheim Files - A 35 y.o. woman with no medical history comes to the ED with shortness of breath - Make it stand out What was wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/862f0ed6-6c05-449e-820d-ad5f4c9e9dad/teflon+monomer.JPG The Naunheim Files - A 35 y.o. woman with no medical history comes to the ED with shortness of breath - Make it stand out The teflon monomer has four fluorine atoms which would rather attach to other fluorine atoms. This causes them to form long chains called polymers. They do not bind easily to other compounds which makes them perfect for non-stick pans https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/002f144c-8559-4bd4-895f-2978883c632f/cockatielJPG.JPG The Naunheim Files - A 35 y.o. woman with no medical history comes to the ED with shortness of breath - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/7/8/an-82-yo-woman-was-found-unresponsive-in-a-car-there-was-no-evidence-of-trauma monthly 0.5 2024-07-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5f2c8d34-f5a4-42a4-90af-57de013c1fbd/hyperK1f.jpg The Naunheim Files - An 82 y.o. woman was found unresponsive in a car. There was no evidence of trauma. - Make it stand out what is the differential based on her EKG? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/bc49a6ae-5481-4d1b-a79a-48ce916a16e9/lvh.JPG The Naunheim Files - An 82 y.o. woman was found unresponsive in a car. There was no evidence of trauma. - Make it stand out LVH with ST elevation in the precordial leads; not an MI https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/715ca8d3-d7b9-4b12-af6b-c869a2f902f7/watermelon.JPG The Naunheim Files - An 82 y.o. woman was found unresponsive in a car. There was no evidence of trauma. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/7/1/a-63-yo-woman-presents-with-widening-of-the-mediastinum-on-cxr monthly 0.5 2024-07-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0d1dbdd6-83ad-4967-b002-b3ba00a959c9/intwideningJPG.JPG The Naunheim Files - A 63 y.o. woman presents with widening of the mediastinum on CXR - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/93bcaaed-21fd-4495-8dd5-a89a5642ce73/marchJPG.JPG The Naunheim Files - A 63 y.o. woman presents with widening of the mediastinum on CXR - Make it stand out In this view from March there is a small periaortic hematoma which is much worse on the current film at the top. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/481c53ef-fbad-4263-bc11-0368eb357700/types+of+endoleaks.JPG The Naunheim Files - A 63 y.o. woman presents with widening of the mediastinum on CXR - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/76f74efe-3682-4617-8038-e20f991dfe60/stent+picJPG.JPG The Naunheim Files - A 63 y.o. woman presents with widening of the mediastinum on CXR - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3568318f-bf12-460f-b3a5-ae2d6704de3f/typeII.JPG The Naunheim Files - A 63 y.o. woman presents with widening of the mediastinum on CXR - Make it stand out type II endoleaks can also lead to rupture of the aneursym sac as shown above; but this occurs rarely. https://everydayebm.org/naunheim-files/2024/6/21/a-50-yo-woman-was-sitting-in-a-chair-and-had-the-sudden-onset-of-severe-ha monthly 0.5 2024-06-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6ed81c54-a123-4053-bcb0-46e7b91dd487/csf+leak+into+headJPG.JPG The Naunheim Files - A 50 y.o woman was sitting in a chair and had the sudden onset of severe HA. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6a9ccb98-3fd7-40f2-95b2-ff6d8eb77cf0/golfer.JPG The Naunheim Files - A 50 y.o woman was sitting in a chair and had the sudden onset of severe HA. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a4cd3f99-51d9-438a-b871-08f94fb72332/types+of+leaksfff.JPG The Naunheim Files - A 50 y.o woman was sitting in a chair and had the sudden onset of severe HA. - Make it stand out The ateral dorsal leaks are the easiest to locate https://everydayebm.org/naunheim-files/2024/6/17/a-51-yo-woman-comes-in-from-a-drug-rehab-facility-with-altered-mental-status monthly 0.5 2024-06-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/895ddcf7-7eae-423e-971d-fcbf9ecb2b6c/aminasep.JPG The Naunheim Files - A 51 y.o. woman comes in from a drug rehab facility with altered mental status - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/92daa67a-3000-4cbf-8e59-c4223e2a1494/aminatri.JPG The Naunheim Files - A 51 y.o. woman comes in from a drug rehab facility with altered mental status - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9c84d4ff-ef50-45b0-9365-0ff23ea75c8c/aspergillomaJPG.JPG The Naunheim Files - A 51 y.o. woman comes in from a drug rehab facility with altered mental status - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6d33202a-635f-449f-9bbf-58c2b56562f8/weg.JPG The Naunheim Files - A 51 y.o. woman comes in from a drug rehab facility with altered mental status - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/6/10/a-5-yo-girl-presents-to-the-adult-ed-by-mistake-her-complaint-is-severe-abdominal-pain monthly 0.5 2024-06-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b474a01e-6fbc-4d0e-b8d1-05324c8e58c2/hatct.JPG The Naunheim Files - A 5 y.o. girl presents to the adult ED by mistake. Her complaint is severe abdominal pain - Make it stand out The CT was normal. What could be wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/89fbac76-41dc-40ac-8b9b-7443b774e810/lone+star+tick+.JPG The Naunheim Files - A 5 y.o. girl presents to the adult ED by mistake. Her complaint is severe abdominal pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cf836def-fd60-4fc6-8734-665d12015c84/where+is+alphabluefff.jpg The Naunheim Files - A 5 y.o. girl presents to the adult ED by mistake. Her complaint is severe abdominal pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0b3849d4-d02a-4e1c-ba36-67925945646b/agalpicture.JPG The Naunheim Files - A 5 y.o. girl presents to the adult ED by mistake. Her complaint is severe abdominal pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/6/3/a-33-yo-male-with-a-hx-of-fentanyl-use-arrives-with-a-lesion-on-his-arm-and-shortness-of-breath monthly 0.5 2024-06-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/83406edb-7a09-4fdc-a28f-26ff21d502c1/xyl.jpg The Naunheim Files - A 33 y.o. male with a hx of fentanyl use arrives with a lesion on his arm and shortness of breath. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/25fe8b00-c373-47b0-87b3-ab08ea1bfb46/cxr+xyl.JPG The Naunheim Files - A 33 y.o. male with a hx of fentanyl use arrives with a lesion on his arm and shortness of breath. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ffa415f9-f747-4a97-8dfd-4ae14dde0b90/xylchem+structures.JPG The Naunheim Files - A 33 y.o. male with a hx of fentanyl use arrives with a lesion on his arm and shortness of breath. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/be0f0fe9-662b-4b87-9fd4-6e890f1be4c2/xylazinemap.JPG The Naunheim Files - A 33 y.o. male with a hx of fentanyl use arrives with a lesion on his arm and shortness of breath. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4fc778a2-c655-42a2-afca-f2e7c151c12b/xylazine+trends.JPG The Naunheim Files - A 33 y.o. male with a hx of fentanyl use arrives with a lesion on his arm and shortness of breath. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/5/27/a-31-yo-woman-presents-to-the-ed-one-week-after-a-brazilain-butt-lift-with-sepsis-and-a-temp-of-104 monthly 0.5 2024-05-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8856d4e9-88c7-4f25-ab6b-546d74a5281c/bbl2+final.JPG The Naunheim Files - A 31 y.o. woman presents to the ED one week after a Brazilian butt lift with sepsis and a temp of 104. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f594edc2-aef3-47d4-b8ac-9d530ecdbcc8/bblct.JPG The Naunheim Files - A 31 y.o. woman presents to the ED one week after a Brazilian butt lift with sepsis and a temp of 104. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1d82d6ee-54dc-422f-8be1-0d42b1e56658/harvest+the+fat.JPG The Naunheim Files - A 31 y.o. woman presents to the ED one week after a Brazilian butt lift with sepsis and a temp of 104. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/dc3aa415-a337-4b23-b340-69ec12765f3d/purifying+the+fat.JPG The Naunheim Files - A 31 y.o. woman presents to the ED one week after a Brazilian butt lift with sepsis and a temp of 104. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d61ebf00-3f21-4bcf-9836-284df3bcd7ad/reinjecting+fatJPG.JPG The Naunheim Files - A 31 y.o. woman presents to the ED one week after a Brazilian butt lift with sepsis and a temp of 104. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/5/20/a-65-yo-woman-with-cardiomyopathy-is-sp-a-roux-en-y-gastric-bypass-one-year-earlier monthly 0.5 2024-05-22 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d04a7a10-733a-4508-97a8-e0dbd732a4c6/ulcer+on+ugi.JPG The Naunheim Files - A 65 y.o. woman with cardiomyopathy is sp a Roux-en-Y gastric bypass one year earlier. - Make it stand out Hint: the short arrow shows the gastrojejunal anastomosis. The long arrows on the L show the problem. The gastric remnant is on the R. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8bdfc442-9bdf-4947-93b9-3b322a071369/Roux+en+Yfff.JPG The Naunheim Files - A 65 y.o. woman with cardiomyopathy is sp a Roux-en-Y gastric bypass one year earlier. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d0de2de5-e9e5-448c-8b7a-0b701f3efd94/roux+internal+herniaPG.JPG The Naunheim Files - A 65 y.o. woman with cardiomyopathy is sp a Roux-en-Y gastric bypass one year earlier. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1320fc72-8b93-4646-8438-703e3e71bace/jeancarlo.JPG The Naunheim Files - A 65 y.o. woman with cardiomyopathy is sp a Roux-en-Y gastric bypass one year earlier. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/685949fb-e2bf-4450-bbbc-6697159456dd/post+script.JPG The Naunheim Files - A 65 y.o. woman with cardiomyopathy is sp a Roux-en-Y gastric bypass one year earlier. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/5/13/rvysp1skijcw9ptpsi9slph59gbn79 monthly 0.5 2024-05-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/80197f7b-12b4-43aa-8beb-88a66ffccb78/TUBATYFF.JPG The Naunheim Files - A 38y.o. woman presents with nodules in the skin - Make it stand out What could this be? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/067f0bcd-0435-4b07-a1c7-324ad567f9d7/ziehl.JPG The Naunheim Files - A 38y.o. woman presents with nodules in the skin - Make it stand out Ziehl-Neelson stain for acid fast bacteria https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/01b6e98d-570e-4a5a-af32-4ea699369a1b/pathogenic+tbcfff.JPG The Naunheim Files - A 38y.o. woman presents with nodules in the skin - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ee322d4e-f9f6-42d7-a754-25cb1561e977/scrofulaJPG.JPG The Naunheim Files - A 38y.o. woman presents with nodules in the skin - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e1d5616a-ccc3-4663-8d77-90cd97fb3b0b/mycobact+marinum.JPG The Naunheim Files - A 38y.o. woman presents with nodules in the skin - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cba35cd0-51aa-455a-9f0f-330e88146aef/leprosyf.JPG The Naunheim Files - A 38y.o. woman presents with nodules in the skin - Make it stand out insensate lesions in a one year old child https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e0d5695b-2668-40b2-8e9f-fad557bd7aed/armadillo.JPG The Naunheim Files - A 38y.o. woman presents with nodules in the skin - Make it stand out nine banded armadillo https://everydayebm.org/naunheim-files/2024/5/2/a-25-yo-male-presents-with-pain-in-the-finger-and-lesions-near-the-corner-of-his-mouth monthly 0.5 2024-05-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9ab9fe25-44c9-4690-a6f6-72108324b0a9/blhand+xfff.jpg The Naunheim Files - A 25 y.o. male presents with pain in the finger and lesions near the corner of his mouth - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/2addfbb1-4e2b-431c-8921-f382502aae95/blast+1smfff.jpg The Naunheim Files - A 25 y.o. male presents with pain in the finger and lesions near the corner of his mouth - Make it stand out lesions near the corner of the mouth on the left. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/de51024d-16f0-4ec4-ad3c-4a3f1fccbdd5/blasto+on+bx.JPG The Naunheim Files - A 25 y.o. male presents with pain in the finger and lesions near the corner of his mouth - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6e933cd4-8921-435b-bdc5-50bf5cb9de03/fungal+infections.JPG The Naunheim Files - A 25 y.o. male presents with pain in the finger and lesions near the corner of his mouth - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3f783a88-ecfe-4810-b0ae-a2dbb3f8af53/dog+osteoJPG.JPG The Naunheim Files - A 25 y.o. male presents with pain in the finger and lesions near the corner of his mouth - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/4/29/a-19-yo-presents-with-seizures monthly 0.5 2024-05-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a42c7b12-4205-4fb2-876c-f80b2d1ee181/eeg+nmda+.JPG The Naunheim Files - A 19 y.o. presents with seizures - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/df265b2a-f095-4b8d-88a4-3eac78e48f6a/nmethylJPG.JPG The Naunheim Files - A 19 y.o. presents with seizures - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d8c64830-b661-4b6b-aa58-e639a9872251/tera+aJPG.JPG The Naunheim Files - A 19 y.o. presents with seizures - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0afe7518-f2f2-416d-aae7-4b1d942ee2ab/autoantibd+ence.JPG The Naunheim Files - A 19 y.o. presents with seizures - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/4/22/a-66-yo-male-sp-an-ahmed-glaucoma-valve-one-year-earlier-cones-in-with-r-eye-redness monthly 0.5 2024-04-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6424b4f1-06e5-4667-b3ae-1762b15a5552/tiff+case.JPG The Naunheim Files - A 66 y.o. male sp an Ahmed glaucoma valve one year earlier comes in with R eye redness - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/45c78101-84e9-4c6f-835d-07d59366a1f7/ant+chamlight.JPG The Naunheim Files - A 66 y.o. male sp an Ahmed glaucoma valve one year earlier comes in with R eye redness - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5d343c4e-a0c0-4d45-9c00-568cc75dd235/nl+ant+chamberJPG.JPG The Naunheim Files - A 66 y.o. male sp an Ahmed glaucoma valve one year earlier comes in with R eye redness - Make it stand out just for reference this is a normal depth of the anterior chamber https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9e3f1661-8f95-4dcc-9f34-86e748267bd4/ahmed+finJPG.JPG The Naunheim Files - A 66 y.o. male sp an Ahmed glaucoma valve one year earlier comes in with R eye redness - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/44f94f4f-73d7-4fe4-a767-c3c2168433ce/sclem.JPG The Naunheim Files - A 66 y.o. male sp an Ahmed glaucoma valve one year earlier comes in with R eye redness - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/4/15/a-65-yo-woman-with-a-hx-of-lung-cancer-with-a-large-l-hilar-mass-is-transferred-from-an-outside-hospital monthly 0.5 2024-04-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/88a0fab3-20ef-435d-8a80-2e96333fec80/exvac.JPG The Naunheim Files - A 65 y.o. woman with a hx of lung cancer with a large L hilar mass, is transferred from an outside hospital - Make it stand out hint: it has something to do with the hilar mass https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0471609b-e450-4dc3-81e1-d2b5b925e3c0/eads+bridge+colorPG.JPG The Naunheim Files - A 65 y.o. woman with a hx of lung cancer with a large L hilar mass, is transferred from an outside hospital - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/2967c429-20c5-4732-8743-29947c6cab1b/eudkafffJPG.JPG The Naunheim Files - A 65 y.o. woman with a hx of lung cancer with a large L hilar mass, is transferred from an outside hospital - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/4/8/a-60-yo-male-with-diabetes-obesity-and-ht-comes-to-the-ed-with-a-complaint-of-i-can-no-longer-see-to-drive monthly 0.5 2024-04-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/fd9f1305-8fef-477a-8a2f-de2b6450bc27/choroidal+nevus.JPG The Naunheim Files - A 60 y.o. male with diabetes, obesity and HT comes to the ED with a complaint of "I can no longer see to drive. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6970ab43-ad7a-4959-be0e-94e8e23f31b0/warnermri.JPG The Naunheim Files - A 60 y.o. male with diabetes, obesity and HT comes to the ED with a complaint of "I can no longer see to drive. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/43b2a379-5252-4fae-a2f3-25df1a5ec8d9/visual+pathways.JPG The Naunheim Files - A 60 y.o. male with diabetes, obesity and HT comes to the ED with a complaint of "I can no longer see to drive. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e926a2b6-cc54-4c2b-a318-052c1757e185/nl+amsler+grid.JPG The Naunheim Files - A 60 y.o. male with diabetes, obesity and HT comes to the ED with a complaint of "I can no longer see to drive. - Make it stand out A normal amsler grid https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5760ff64-24b1-4e2e-aef2-45b8f018f4f0/abnl+amsler+grid.JPG The Naunheim Files - A 60 y.o. male with diabetes, obesity and HT comes to the ED with a complaint of "I can no longer see to drive. - Make it stand out An Amsler grid with macular damage. https://everydayebm.org/naunheim-files/2024/4/1/a-54-yo-male-comes-in-with-nausea-and-vomiting-his-cxr-is-shown-below monthly 0.5 2024-04-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6117d016-7702-4967-8905-36b025261e23/cxrdka.JPG The Naunheim Files - A 54 y.o. male, with a history of lung cancer, comes in with nausea and vomiting. His cxr is shown below. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/241ec187-3f83-42c8-8b23-9ec438058e10/comp+of+check+pt+inh.JPG The Naunheim Files - A 54 y.o. male, with a history of lung cancer, comes in with nausea and vomiting. His cxr is shown below. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4c7e32b1-682a-4282-8d84-799b9a5a7295/approved+for+iciJPG.JPG The Naunheim Files - A 54 y.o. male, with a history of lung cancer, comes in with nausea and vomiting. His cxr is shown below. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/20feabf8-b8e0-46dc-9987-21a098d18374/hypogly.JPG The Naunheim Files - A 54 y.o. male, with a history of lung cancer, comes in with nausea and vomiting. His cxr is shown below. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/3/25/a-37-yo-woman-presents-with-severe-pain-in-the-l-leg-hx-of-varicose-veins-but-no-evidenceof-dvt-on-imaging monthly 0.5 2024-03-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3eb780b6-3f56-4670-9a81-30b40fa6e437/knee+mass.JPG The Naunheim Files - A 37 y.o. woman presents with severe pain in the L leg. Hx of varicose veins but no evidenceof dvt on imaging. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cc072dd4-93c6-48af-92fd-7795b79a1dc2/schwann+cells.JPG The Naunheim Files - A 37 y.o. woman presents with severe pain in the L leg. Hx of varicose veins but no evidenceof dvt on imaging. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9da91dea-9a1f-451e-9941-42e4a013666a/spinal+schwannoma.JPG The Naunheim Files - A 37 y.o. woman presents with severe pain in the L leg. Hx of varicose veins but no evidenceof dvt on imaging. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/3/18/a-52-yo-male-from-haiti-presents-with-a-sore-throat monthly 0.5 2024-03-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/fda762d0-3583-4dd3-8912-655f4cd09fea/salfff.JPG The Naunheim Files - A 52 y.o. male from Haiti presents with a sore throat. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/27db45ef-a9c3-41d8-bbf2-981e09543a07/salivary+glands.JPG The Naunheim Files - A 52 y.o. male from Haiti presents with a sore throat. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/fb51471a-e12a-4ac3-b9e6-ed79051cd5a2/mumps.JPG The Naunheim Files - A 52 y.o. male from Haiti presents with a sore throat. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4f7b4ede-5c47-477e-aeb0-ba424de20de7/brain+cal+haiti.JPG The Naunheim Files - A 52 y.o. male from Haiti presents with a sore throat. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/3/11/a-52-yo-woman-with-a-hx-of-anxiety-had-been-rubbing-her-eye-because-it-was-itching monthly 0.5 2024-03-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9d8a9a7a-8b1a-4edf-b3cb-430d538faeb0/corneal+perf.JPG The Naunheim Files - A 52 y.o. woman with a hx of anxiety had been rubbing her eye because it was itching - Make it stand out What is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9579a19b-78e9-4ad5-b96d-16447663cb08/cornealstromafff.jpg The Naunheim Files - A 52 y.o. woman with a hx of anxiety had been rubbing her eye because it was itching - Make it stand out Keratitis is inflammation of the cornea. The stroma is the thickest layer of the cornea; seen here in blue. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4a6831ae-b711-40d2-8690-414084157751/acantheye.JPG The Naunheim Files - A 52 y.o. woman with a hx of anxiety had been rubbing her eye because it was itching - Make it stand out acanthamoeba can cause a paracentral ring in the stroma and may lead to blindness. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ac73bf89-e88f-4858-a8b7-8c37b6f6e2c5/pukff.jpg The Naunheim Files - A 52 y.o. woman with a hx of anxiety had been rubbing her eye because it was itching - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b18aeabf-6d9b-44b8-90fb-68fd359d5fe1/hot+springs.JPG The Naunheim Files - A 52 y.o. woman with a hx of anxiety had been rubbing her eye because it was itching - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/3/4/a-45-yo-female-was-picking-her-nose-with-a-bobby-pin-when-it-opened-and-she-was-unable-to-remove-it monthly 0.5 2024-03-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cc131c23-71db-4d10-b064-ae6858759945/xrat+oibbpinffJPG.jpg The Naunheim Files - A 45 y.o. female was picking her nose with a bobby pin when it "opened" and she was unable to remove it. - Make it stand out A CT was done shown below https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6e696b77-c80c-4bc6-9af2-e306fd0f1ee7/bobbypinf.JPG The Naunheim Files - A 45 y.o. female was picking her nose with a bobby pin when it "opened" and she was unable to remove it. - Make it stand out it iis wedged against the nasal bone. How would you remove it? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3229e53d-a9ab-4c15-ab66-fa3f826090ad/entforeign+bodies+imageJPG.JPG The Naunheim Files - A 45 y.o. female was picking her nose with a bobby pin when it "opened" and she was unable to remove it. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/95a949af-f748-47bb-aa87-1813a03cd778/nose+bugsnoseJPG.JPG The Naunheim Files - A 45 y.o. female was picking her nose with a bobby pin when it "opened" and she was unable to remove it. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/58cb5622-cb40-4df5-9689-d8230c2ad2cc/in++noseJPG.JPG The Naunheim Files - A 45 y.o. female was picking her nose with a bobby pin when it "opened" and she was unable to remove it. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6d69d1a3-ba56-4d49-a9ec-21d463470794/blakesleyffJPG.JPG The Naunheim Files - A 45 y.o. female was picking her nose with a bobby pin when it "opened" and she was unable to remove it. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/2/26/a-61-yo-male-sp-renal-transplant-in-2023-presents-with-fever-lactate-of-5-elevated-lfts-wbc-of-15-and-platelets-of-27000 monthly 0.5 2024-02-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/96436986-e558-465a-b8a3-dd24aa2fde3e/lone+star+tick.JPG The Naunheim Files - A 61 y.o. male sp renal transplant in 2023 presents with fever, lactate of 5, elevated LFTs, WBC of 1.5 and platelets of 27,000. - Make it stand out Could this be the source of his problem? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4384937e-7736-435a-8a41-7c64edde950c/e+in+cells.JPG The Naunheim Files - A 61 y.o. male sp renal transplant in 2023 presents with fever, lactate of 5, elevated LFTs, WBC of 1.5 and platelets of 27,000. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0ad41e6d-5cd9-4603-9d67-e751cec3408c/ticklonestarJPG.JPG The Naunheim Files - A 61 y.o. male sp renal transplant in 2023 presents with fever, lactate of 5, elevated LFTs, WBC of 1.5 and platelets of 27,000. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d420adc6-a409-4476-86fd-13a61d1eba7d/tick+relative+size.JPG The Naunheim Files - A 61 y.o. male sp renal transplant in 2023 presents with fever, lactate of 5, elevated LFTs, WBC of 1.5 and platelets of 27,000. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/098d6d79-06c7-4d03-bd36-36200e939945/ticks+engorged.JPG The Naunheim Files - A 61 y.o. male sp renal transplant in 2023 presents with fever, lactate of 5, elevated LFTs, WBC of 1.5 and platelets of 27,000. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/2/19/a-74-yo-male-with-nonischemic-cardiomyopathy-a-fib-and-renal-failure-present-s-after-crt-d-therapy-with-nausea-and-epigastric-pain monthly 0.5 2024-02-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cb65dc38-561b-4736-81f5-516363534bee/tamponadecxr.JPG The Naunheim Files - A 74 y.o male with nonischemic cardiomyopathy, a fib and renal failure present s after CRT D therapy with nausea and epigastric pain - Make it stand out this is the patient’s cxr https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/169130e1-acc3-41df-b133-fb8c576c5cfc/pericardial+tamp.JPG The Naunheim Files - A 74 y.o male with nonischemic cardiomyopathy, a fib and renal failure present s after CRT D therapy with nausea and epigastric pain - Make it stand out what do you notice on the noncon CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/356e50ae-64d3-46f5-870e-994ecf7f8b67/crtp.JPG The Naunheim Files - A 74 y.o male with nonischemic cardiomyopathy, a fib and renal failure present s after CRT D therapy with nausea and epigastric pain - Make it stand out wither a pacemaker alone or a pacer/defibrillator can be placed. CRT—D describes the defibrillator https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/db95f3c5-bdef-4ea8-b0f7-a031ed2afd7b/pacerperfno+tamp.JPG The Naunheim Files - A 74 y.o male with nonischemic cardiomyopathy, a fib and renal failure present s after CRT D therapy with nausea and epigastric pain - Make it stand out sometimes the pacer wire perforates without tamponade https://everydayebm.org/naunheim-files/2024/2/12/an-80-yo-male-with-ht-cad-and-ischemic-cardiomyopathy-comes-in-with-a-week-of-postitionaheadaches monthly 0.5 2024-02-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/db2190fa-a5aa-493d-a8d6-69187804fd1e/EPPS.JPG The Naunheim Files - An 80 y.o. male with HT, CAD and ischemic cardiomyopathy comes in with a week of postitionaheadaches. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b3cae145-d104-4f29-9d76-1d88013a0e54/tegmental+defectfff.jpg The Naunheim Files - An 80 y.o. male with HT, CAD and ischemic cardiomyopathy comes in with a week of postitionaheadaches. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ec2e75c0-f4f4-4c1a-8e6b-75140b8a45a6/third+windowf.jpg The Naunheim Files - An 80 y.o. male with HT, CAD and ischemic cardiomyopathy comes in with a week of postitionaheadaches. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/2/5/a-42-yo-male-with-a-hx-of-tonsillar-ca-sp-resection-and-recurrent-esophageal-strictures-presents-with-knee-and-ankle-pain-a-rash-is-noted-on-the-legs monthly 0.5 2024-02-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/aceff490-d0ed-4814-a617-5622270d15a5/scurvy.JPG The Naunheim Files - A 42 y.o. male with a hx of tonsillar ca sp resection and recurrent esophageal strictures presents with knee and ankle pain; a rash is noted on the legs. - Make it stand out Hint: he has a normal platelet count https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5a99c9b3-3a62-4864-8f37-1b210d80ff9c/wager.JPG The Naunheim Files - A 42 y.o. male with a hx of tonsillar ca sp resection and recurrent esophageal strictures presents with knee and ankle pain; a rash is noted on the legs. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f82fc7b6-120c-4fbc-af37-e371ef8e2f8c/vit+def.JPG The Naunheim Files - A 42 y.o. male with a hx of tonsillar ca sp resection and recurrent esophageal strictures presents with knee and ankle pain; a rash is noted on the legs. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b728b38a-3f0e-45ea-a593-43d554e9e9a3/scrurvyteethfff.jpg The Naunheim Files - A 42 y.o. male with a hx of tonsillar ca sp resection and recurrent esophageal strictures presents with knee and ankle pain; a rash is noted on the legs. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/1/29/a-38-yo-construction-worker-with-a-hx-of-graves-disease-presents-with-central-vision-loss-in-the-r-eye monthly 0.5 2024-01-31 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0b9a1f37-f928-4ad3-b152-88249b8c81d1/ocular+syphilis.JPG The Naunheim Files - A 38 y.o construction worker with a hx of Graves disease presents with central vision loss in the R eye. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/46381f6f-8d1a-4503-837a-0f1c261993bb/fundusanatJPG.JPG The Naunheim Files - A 38 y.o construction worker with a hx of Graves disease presents with central vision loss in the R eye. - Make it stand out For review, this is a normal retina. The macula appears red if there is central retinal artery occlusion because the rest of the retina is ischemic and whitish. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/adbf6d8b-d740-43b7-b1be-f81e7fb73581/early+pap.JPG The Naunheim Files - A 38 y.o construction worker with a hx of Graves disease presents with central vision loss in the R eye. - Make it stand out early papillema shows blurring on the nasal side of the disc https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6777949d-b829-4e34-aa9c-4f3b2ab11647/post+globe+flatteningfff.JPG The Naunheim Files - A 38 y.o construction worker with a hx of Graves disease presents with central vision loss in the R eye. - Make it stand out papilledema on MRI https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9de4c64b-da00-4231-9651-767c2aa13b18/us+pap.JPG The Naunheim Files - A 38 y.o construction worker with a hx of Graves disease presents with central vision loss in the R eye. - Make it stand out papilledema on US is most convincing with both the elevated optic nerve and widened optic nerve sheath. https://everydayebm.org/naunheim-files/2024/1/19/a-20-yo-woman-with-a-hx-of-reynauds-asthma-and-iga-deficiency-presents-with-fever-and-shortness-of-breath monthly 0.5 2024-01-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5f39c230-9204-4142-aa7f-9296a8c0d5fd/cxr+secondJPG.JPG The Naunheim Files - A 20 y.o. woman with a hx of Reynaud's, asthma and IgA deficiency presents with fever and shortness of breath - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9701860c-3844-412a-8c7d-20da2161be97/reynaudsfffJPG.jpg The Naunheim Files - A 20 y.o. woman with a hx of Reynaud's, asthma and IgA deficiency presents with fever and shortness of breath - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/569b552d-714c-4fa5-8be1-59c4529d2023/mechanics+hands.JPG The Naunheim Files - A 20 y.o. woman with a hx of Reynaud's, asthma and IgA deficiency presents with fever and shortness of breath - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/1/15/a-46-yo-male-presents-with-hip-pain-after-a-fall-from-standing-plain-films-are-normal monthly 0.5 2024-01-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f8434fc2-67e6-4fed-9ae4-8e57fcd398a1/gluteal+tear.JPG The Naunheim Files - A 46 y.o. male presents with hip pain after a fall from standing. Plain films are normal - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6ef9bb62-2f5a-455f-8721-7b6403e9a198/gluteus+mediuspic.JPG The Naunheim Files - A 46 y.o. male presents with hip pain after a fall from standing. Plain films are normal - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b18f6b1e-b8fe-4c88-8e7c-d856feb80d34/itband.JPG The Naunheim Files - A 46 y.o. male presents with hip pain after a fall from standing. Plain films are normal - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2024/1/8/a-29-yo-woman-presents-with-painful-labial-ulcers monthly 0.5 2024-01-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/2d66f58c-1f0f-4ea0-a461-38c9ef74cc47/labial.JPG The Naunheim Files - A 29 y.o. woman presents with painful labial ulcers - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4e5fc1b9-c4ce-4599-82bd-50bd10a8f8e9/silk+road.JPG The Naunheim Files - A 29 y.o. woman presents with painful labial ulcers - Make it stand out The Silk road was a system of ancient trade routes established during the Han Dynasty in 130 BCE; transporting silk, porcelain, gold and spices from Asia to Europe. In 1453 the Ottoman empire closed the routes and refused to trade with the West. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/10a62009-9b15-4fd9-adbc-ae015968652b/behcetsbowel.JPG The Naunheim Files - A 29 y.o. woman presents with painful labial ulcers - Make it stand out A patient with perforated bowel from Behcet’s disease. ASCA(anti-saccharomyces cerevisiae antibodies) are seen in 45% of patients with bowel involvement in Behcet’s https://everydayebm.org/naunheim-files/2024/1/1/a-47-yo-woman-with-a-hx-of-dm-ht-and-cervical-cancer-sp-chemo-and-rt-presents-with-diplopia monthly 0.5 2024-01-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a024ac56-b2c8-43aa-b74c-304c014a2f75/tempfff.JPG The Naunheim Files - A 47 y.o. woman with a hx of dm, ht, and cervical cancer sp chemo and RT presents with diplopia - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1edcd581-e26d-4c19-918f-1a89517ed883/cermapfff.JPG The Naunheim Files - A 47 y.o. woman with a hx of dm, ht, and cervical cancer sp chemo and RT presents with diplopia - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ad8b5633-21c1-4f56-aa0a-50805ef96d28/cervicalriskpicffjpg.jpg The Naunheim Files - A 47 y.o. woman with a hx of dm, ht, and cervical cancer sp chemo and RT presents with diplopia - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/12/26/a-61-yo-male-presents-with-ruq-pain-he-is-sp-cholecystectomy-102022 monthly 0.5 2024-03-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/152d3af7-64d3-4a74-a5ad-4f7e34d0b258/dropinchestff.jpg The Naunheim Files - A 61 y.o. male presents with RUQ pain, he is sp cholecystectomy 10/2022. - Make it stand out something extends into the chest https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b625a36f-b0dd-4848-8a26-0f78549c354a/mass+behind+liverff.jpg The Naunheim Files - A 61 y.o. male presents with RUQ pain, he is sp cholecystectomy 10/2022. - Make it stand out and it starts behind the liver. What could it be? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/68edd8c6-c641-4737-ae4e-52357c82b93a/dropped+into+subq.JPG The Naunheim Files - A 61 y.o. male presents with RUQ pain, he is sp cholecystectomy 10/2022. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9fe4e046-9b21-4969-afcd-126db350662e/sphincterof+oddifff.jpg The Naunheim Files - A 61 y.o. male presents with RUQ pain, he is sp cholecystectomy 10/2022. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/12/18/a-44-yo-male-fell-down-a-flight-of-stairs-he-landed-on-the-l-knee-stood-up-and-fell-on-to-the-r-knee monthly 0.5 2023-12-22 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ec974914-cdcd-4ae9-9919-f9c74ea212ce/kneeL+lovan.JPG The Naunheim Files - A 44 y.o. male fell down a flight of stairs. He landed on the L knee, stood up and fell on to the R knee. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/18034091-e2d9-4345-8b61-720d4c0f4db8/R+knee+lovanJPG.JPG The Naunheim Files - A 44 y.o. male fell down a flight of stairs. He landed on the L knee, stood up and fell on to the R knee. - Make it stand out you can compare it to the R knee https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/28f05bd4-783e-4df7-8947-863d10a3e94a/quad+tendonJPG.JPG The Naunheim Files - A 44 y.o. male fell down a flight of stairs. He landed on the L knee, stood up and fell on to the R knee. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9a10b78e-71de-41b2-8b05-1edb72b3cd8a/usten.JPG The Naunheim Files - A 44 y.o. male fell down a flight of stairs. He landed on the L knee, stood up and fell on to the R knee. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6a61c564-b0ca-46b8-9df5-c7366af3b56b/tibial+plateau+soccer.JPG The Naunheim Files - A 44 y.o. male fell down a flight of stairs. He landed on the L knee, stood up and fell on to the R knee. - Make it stand out a 16 y.o. soccer player with a tibial plateau fracture. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/656aaf1f-713d-499b-b930-26167b9b032b/arcuate+final.JPG The Naunheim Files - A 44 y.o. male fell down a flight of stairs. He landed on the L knee, stood up and fell on to the R knee. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/12/11/a-48-yo-male-comes-in-with-shortness-of-breath monthly 0.5 2023-12-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e8425843-a733-4b61-a90c-9b6e8af341ed/neck+mass+1.JPG The Naunheim Files - A 48 y.o. male comes in with shortness of breath - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/77b78262-e0f8-4e8d-82a0-16b5dfe8493f/neckcxrfff.JPG The Naunheim Files - A 48 y.o. male comes in with shortness of breath - Make it stand out hint: where is the trachea ; how should the patient be managed. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8b69ef3b-5d00-4673-a802-b8395636dabb/types+of+thyroid+ca.JPG The Naunheim Files - A 48 y.o. male comes in with shortness of breath - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/dc89d680-1954-49a6-a1dd-237819342c03/goiter+belt.JPG The Naunheim Files - A 48 y.o. male comes in with shortness of breath - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/12/4/a-48-yo-male-presents-with-inability-to-walk monthly 0.5 2023-12-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/87ce4073-2537-4033-836b-cfbcddf79d7d/gummadeal.JPG The Naunheim Files - A 48 y.o. male presents with inability to walk - Make it stand out what do you notice on the MRI? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e7850ca6-c570-424f-87b0-97c8fdf63028/gummabetterfff.jpg The Naunheim Files - A 48 y.o. male presents with inability to walk - Make it stand out Hint: you also note a lesion on the leg.. What is the cause? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8878adfb-0f28-48ec-929e-8a924706ae69/syph+charJPG.JPG The Naunheim Files - A 48 y.o. male presents with inability to walk - Make it stand out the stages of syphilis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a2c6c987-fdec-4b69-8c76-74906071786a/hut.JPG The Naunheim Files - A 48 y.o. male presents with inability to walk - Make it stand out Hutchinson’s triad of deafness, dental malformations and keratitis can occur in congenital syphilis https://everydayebm.org/naunheim-files/2023/11/27/a-54-yo-woman-with-a-history-of-lymphoma-comes-in-with-shortness-of-breath monthly 0.5 2023-11-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/99ff442c-85ec-4bd7-8d64-09e7c9897d18/rv+arrow+final.JPG The Naunheim Files - A 54 y.o. woman with a history of lymphoma comes in with shortness of breath. - Make it stand out The RV free wall appears thickened. What does this mean? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c90ce3ef-d3cf-4876-a7bd-48bf5b206fd6/autoimmunedis.JPG The Naunheim Files - A 54 y.o. woman with a history of lymphoma comes in with shortness of breath. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c6199dbc-90f9-44e4-9933-347ce13c7c17/cardiac+tumorse.JPG The Naunheim Files - A 54 y.o. woman with a history of lymphoma comes in with shortness of breath. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/11/6/a-67-yo-woman-presented-to-the-ed-after-a-fall-with-a-painful-shoulder monthly 0.5 2023-11-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/be66fe10-1c9e-4f4b-9f14-817c877508cb/shoulder.JPG The Naunheim Files - A 67 y.o. woman presented to the ED after a fall with a painful shoulder - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4e1133ac-032e-42b1-9bea-4b0ef2974bf9/photo+luxatio+erectaJPG.JPG The Naunheim Files - A 67 y.o. woman presented to the ED after a fall with a painful shoulder - Make it stand out luxatio erecta https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c78c8e4f-c7a8-439a-b994-1232a31df411/types+of+shoulder+dis.JPG The Naunheim Files - A 67 y.o. woman presented to the ED after a fall with a painful shoulder - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6f3a6a77-dede-4380-a0ab-47552ef4b929/bluescrub.JPG The Naunheim Files - A 67 y.o. woman presented to the ED after a fall with a painful shoulder - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/db9b4be0-d947-49c5-be35-a24946a99c7c/shoulder+two+step.JPG The Naunheim Files - A 67 y.o. woman presented to the ED after a fall with a painful shoulder - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/10/30/a-45-yo-woman-with-lupus-comes-to-the-ed-with-r-flank-pain monthly 0.5 2023-11-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b67ec25a-8183-4142-87bb-202b44f7aa6c/heart+perc.JPG The Naunheim Files - A 45 y.o. woman with lupus comes to the ED with R flank pain - Make it stand out The RV is not enlarged. What is the next step? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/be8b3f3a-48b4-4ea2-ae00-9b9ab9f4cdac/PERC+RULE.JPG The Naunheim Files - A 45 y.o. woman with lupus comes to the ED with R flank pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/227e1dd9-461d-45b5-b844-2494e9aa9d92/hypercoagulableff.JPG The Naunheim Files - A 45 y.o. woman with lupus comes to the ED with R flank pain - Make it stand out Many conditions result in a hypercoagulable state. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/08a95e2b-f400-4cf6-a697-fca6c5a409e8/PERC+RLL+INFARCT.JPG The Naunheim Files - A 45 y.o. woman with lupus comes to the ED with R flank pain - Make it stand out A RLL infarct explaining her pleuritic pain https://everydayebm.org/naunheim-files/2023/10/23/a-66-yo-woman-with-seronegative-rheumatoid-arthritis-presents-with-chest-pain monthly 0.5 2023-10-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/274a2b76-9ccf-4a33-98d0-b5e9e23aeaae/dl+coronalred+arrowJPG.jpg The Naunheim Files - A 66 y.o. woman with seronegative rheumatoid arthritis presents with chest pain. - Make it stand out Hint: it is a vessel that normally belongs on the right https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f444d3a4-5488-40c2-bbac-e8f2d968bc1f/dlbetter.JPG The Naunheim Files - A 66 y.o. woman with seronegative rheumatoid arthritis presents with chest pain. - Make it stand out where is the esophagus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/18debb42-b983-4bf0-b6b8-7a28e5e1c92c/dysphagia+lusoriae.JPG The Naunheim Files - A 66 y.o. woman with seronegative rheumatoid arthritis presents with chest pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a2114263-a245-4e72-99c5-dbec5c931a81/dlswallow.JPG The Naunheim Files - A 66 y.o. woman with seronegative rheumatoid arthritis presents with chest pain. - Make it stand out obstruction can be seen on UGI caused by an aberrant subclavian https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/408f2cc9-c5fc-4906-b8c0-b9a7d7a0c5ee/dysphagia.JPG The Naunheim Files - A 66 y.o. woman with seronegative rheumatoid arthritis presents with chest pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/10/16/a-73-yo-woman-with-a-hx-of-stroke-comes-in-with-altered-mental-status monthly 0.5 2023-10-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ac34c14e-582c-4961-a2d8-b727ffe3ddec/air+3.JPG The Naunheim Files - A 73 y.o. woman with a hx of stroke, comes in with altered mental status - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b35d297c-6c7c-47da-bfa4-3df99c5aee6a/air.JPG The Naunheim Files - A 73 y.o. woman with a hx of stroke, comes in with altered mental status - Make it stand out hint: there is air where it does not belong https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/beea3b7c-8fbc-4f00-9881-11fc63ece61c/airemarrowdJPG.JPG The Naunheim Files - A 73 y.o. woman with a hx of stroke, comes in with altered mental status - Make it stand out air appears similar to the air in the trachea https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8b87fbb8-bed5-4026-ad42-6e5c76c1fdc2/airem+on+echoJPG.JPG The Naunheim Files - A 73 y.o. woman with a hx of stroke, comes in with altered mental status - Make it stand out air embolus can be seen on echo https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/62e03903-7e18-44e3-ae72-dfdbd6d9a701/air+embolus+after+hydrogen+peroxide.JPG The Naunheim Files - A 73 y.o. woman with a hx of stroke, comes in with altered mental status - Make it stand out air embolus after hydrogen peroxide ingestion https://everydayebm.org/naunheim-files/2023/10/9/an-81-yo-male-presents-with-fatigue-what-do-you-notice-on-exam monthly 0.5 2023-10-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c46d8b6d-a686-4e3e-84b0-29d3cecc00cc/jaundiceJPG.JPG The Naunheim Files - An 81 y.o. male presents with fatigue. what do you notice on exam? - Make it stand out hint: he has a history of bladder cancer and was treated with BCG; then grew M bovis out of the urine. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f5e83d63-7fc2-49a4-b07e-366ceeaebae5/bovine.JPG The Naunheim Files - An 81 y.o. male presents with fatigue. what do you notice on exam? - Make it stand out Mycobacterium bovis infects cattle and can be transmitted in unpasteurized milk. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e0c9c468-cb1c-4a65-b59b-7965c4c186aa/bcg+spine.JPG The Naunheim Files - An 81 y.o. male presents with fatigue. what do you notice on exam? - Make it stand out BCG can cause systemic dissemination similar to M. tuberculosis with spinal infections https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e8612bc9-69dc-4d66-8fc5-3c624872c54a/bcgkidpic.JPG The Naunheim Files - An 81 y.o. male presents with fatigue. what do you notice on exam? - Make it stand out Treatment is required even if tuberculosis is confined to the GU system, since granulomas caused by BCG can cause calcification and renal destruction. https://everydayebm.org/naunheim-files/2023/10/2/a-67-yo-physician-comes-to-the-ed-for-diplopia-she-had-been-seen-at-an-urgent-care-and-had-a-ct-of-the-head monthly 0.5 2023-10-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/954d9f41-5963-40fa-867e-5184911398f8/menin.JPG The Naunheim Files - A 67 y.o. physician comes to the ED for diplopia. She had been seen at an urgent care and had a CT of the head - Make it stand out there appears to be edema around a mass https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e6fd753c-b318-4b4f-bc3f-a9c076144704/menin2.JPG The Naunheim Files - A 67 y.o. physician comes to the ED for diplopia. She had been seen at an urgent care and had a CT of the head - Make it stand out the mass is larger as you approach the chiasm. What is it? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ec76f8c3-157b-4d4c-ba86-ed65d0586db7/planum+meningioma.JPG The Naunheim Files - A 67 y.o. physician comes to the ED for diplopia. She had been seen at an urgent care and had a CT of the head - Make it stand out the planum meningioma is said to resemble a primrose with calcification appearing as petals. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cc87e6ce-e3e4-4283-b7e2-27bc466865c2/phinfff.JPG The Naunheim Files - A 67 y.o. physician comes to the ED for diplopia. She had been seen at an urgent care and had a CT of the head - Make it stand out Gage had a personality changes and could no longer follow through with a plan . He worked in California during the gold rush. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/03cb496e-729d-4858-925e-1a47d0c65839/kluverfff.JPG The Naunheim Files - A 67 y.o. physician comes to the ED for diplopia. She had been seen at an urgent care and had a CT of the head - Make it stand out while Kluver Bucy syndrome is most often associated with temporal lobe injury causing hypersexuality; in the original experiments monkeys also lost their fear responses as in this monkey looking at a cobra. https://everydayebm.org/naunheim-files/2023/9/25/a-64-yo-farmer-was-bending-over-in-the-hay-barn-when-a-bale-of-hay-weighing-150-lbs-landed-on-his-back monthly 0.5 2023-09-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7ff3517f-aba3-4fa2-9c85-24541d9c307e/spinal+stenosisnervstimJPG.JPG The Naunheim Files - A 64 y.o. farmer was bending over in the hay barn when a bale of hay weighing 150 lbs landed on his back. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a1f1be7f-dffe-4b4c-94c8-3fed0958b85e/spinediag.JPG The Naunheim Files - A 64 y.o. farmer was bending over in the hay barn when a bale of hay weighing 150 lbs landed on his back. - Make it stand out spinal cord tracts https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ee0602be-f89f-4eb9-aab5-4313a3920214/hoffm.JPG The Naunheim Files - A 64 y.o. farmer was bending over in the hay barn when a bale of hay weighing 150 lbs landed on his back. - Make it stand out Hoffmann’s sign is suggestive of corticospinal tract dysfunction localized to the cervical cord. If you flick the tip of the middle finger, the thumb and index finger move togerher. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/511586bb-0022-4f7d-9569-a4996da5c1ee/herdiscant+spinal+art.JPG The Naunheim Files - A 64 y.o. farmer was bending over in the hay barn when a bale of hay weighing 150 lbs landed on his back. - Make it stand out an acutely herniated disc can cause spasm or occlude the artery of Adamkiewicz causing paralysis https://everydayebm.org/naunheim-files/2023/9/18/a-76-yo-woman-comes-in-two-weeks-after-peritoneal-dialysis-catheter-placement-she-has-no-abdominal-pain monthly 0.5 2023-09-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3885afc6-378a-4d0f-9878-f7f766000504/chylous+ascites.JPG The Naunheim Files - A 76 y.o woman comes in two weeks after peritoneal dialysis catheter placement. She has no abdominal pain - Make it stand out what happened? what needs to be done https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8094d5ea-8e14-4b47-8167-f28b4b21eb93/lymph+finalJPG.JPG The Naunheim Files - A 76 y.o woman comes in two weeks after peritoneal dialysis catheter placement. She has no abdominal pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d5422eee-2c7f-4a7d-8426-c4c30922cde8/pulmonary+cause+of+chylothoraxJPG.JPG The Naunheim Files - A 76 y.o woman comes in two weeks after peritoneal dialysis catheter placement. She has no abdominal pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/9/11/a-28-yo-male-comes-to-the-ed-with-severe-foot-pain-after-dropping-a-heavy-weight-on-his-foot monthly 0.5 2023-09-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0af7b14e-f2ac-480e-b3be-3e4f9292c48b/lfst.JPG The Naunheim Files - A 28 y.o. male comes to the ED with severe foot pain after dropping a heavy weight on his foot - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6c64add4-31f9-4628-aa7a-e81485e891ea/lisfranc+yellow+footJPG.JPG The Naunheim Files - A 28 y.o. male comes to the ED with severe foot pain after dropping a heavy weight on his foot - Make it stand out If the Lisfranc ligament is torn it often requires surgical repair. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8f8adeec-ceb9-41c5-8ba1-fdc3696e88e4/severelisfranJPG.JPG The Naunheim Files - A 28 y.o. male comes to the ED with severe foot pain after dropping a heavy weight on his foot - Make it stand out This midfoot injury is a bit more obvious https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a90f027f-4829-496b-a156-59791d236d9d/apcfff.JPG The Naunheim Files - A 28 y.o. male comes to the ED with severe foot pain after dropping a heavy weight on his foot - Make it stand out fracture of the anterior process of the calcaneus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/de05d7d1-f761-45bd-9dd1-7d6229f27940/apcfootJPG.JPG The Naunheim Files - A 28 y.o. male comes to the ED with severe foot pain after dropping a heavy weight on his foot - Make it stand out the injury to the anterior process of the calcaneus can mimic an ankle sprain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/172b3406-50ac-44ff-9fb2-711e23c7a09b/lptJPG.JPG The Naunheim Files - A 28 y.o. male comes to the ED with severe foot pain after dropping a heavy weight on his foot - Make it stand out the snowboarder’s fracture. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/36693947-e785-4bbd-99f1-835239dc8dfa/lfscrews.JPG The Naunheim Files - A 28 y.o. male comes to the ED with severe foot pain after dropping a heavy weight on his foot - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/9/4/a-22-yo-comes-in-with-a-rash-it-began-3-weeks-ago-as-papules-and-now-has-become-necrotic-erz2r monthly 0.5 2023-09-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/10a1d3b5-10e4-4195-8e05-215c3bd2a8f5/necJPG.JPG The Naunheim Files - A 22 y.o. comes in with a rash; it began 3 weeks ago as papules and now has become necrotic. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e6b77aa8-8790-4dd7-83c5-e0aec1dcdbd1/leucocytopath.JPG The Naunheim Files - A 22 y.o. comes in with a rash; it began 3 weeks ago as papules and now has become necrotic. - Make it stand out biopsy is diagnostic for leukocytoclastic vasculitis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/171e7081-fbe6-4fc9-b7e3-e0d2bb6d84fe/henoch.JPG The Naunheim Files - A 22 y.o. comes in with a rash; it began 3 weeks ago as papules and now has become necrotic. - Make it stand out Henoch Scholein purpura is IgA related thought to be post viral, occurs in children ages 2-5 and may affect the bowel or kidneys. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/571eff71-6afb-410f-972a-f87cbcb1eee9/frostbite.JPG The Naunheim Files - A 22 y.o. comes in with a rash; it began 3 weeks ago as papules and now has become necrotic. - Make it stand out In frostbite, cold causes vasoconstriction and tissue ischemia. “Winter is coming” (the Starks) https://everydayebm.org/naunheim-files/2023/8/28/a-35-yo-male-truck-driver-had-a-seizure-in-his-vehicle-he-co-l-shoulder-pain monthly 0.5 2023-08-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5be408d3-38af-46b4-89b6-dee0641fe09c/sz+post+shoulderJPG.JPG The Naunheim Files - A 35 y.o. male truck driver had a seizure in his vehicle. He co L shoulder pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/572c4ead-f72f-4f14-b6d7-c1e773f3f055/postshoulder.JPG The Naunheim Files - A 35 y.o. male truck driver had a seizure in his vehicle. He co L shoulder pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1d0da6a8-3daf-4e9a-a0b5-d2e3b56b3e95/cpm.JPG The Naunheim Files - A 35 y.o. male truck driver had a seizure in his vehicle. He co L shoulder pain. - Make it stand out central pontine myelinolysis from alcoholism https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f8f19317-bcd9-4208-8d8e-f7a55262be30/ddavpcl.JPG The Naunheim Files - A 35 y.o. male truck driver had a seizure in his vehicle. He co L shoulder pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a59bdbc1-817c-4c75-8f8c-a5f0388ff968/causes+of+siadh1.jpg The Naunheim Files - A 35 y.o. male truck driver had a seizure in his vehicle. He co L shoulder pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/8/21/a-33-yo-woman-with-diabetes-sp-failed-kidney-pancreas-transplant-in-2022-and-presents-with monthly 0.5 2023-08-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/db294f32-aa86-461a-b716-8282a6e63103/epf.JPG The Naunheim Files - A 33 y.o. woman with diabetes, sp kidney pancreas transplant in 2022 who presents with abdominal and flank pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/51197847-2ab6-457f-9d73-1e5c93e74450/eparrow.jpg The Naunheim Files - A 33 y.o. woman with diabetes, sp kidney pancreas transplant in 2022 who presents with abdominal and flank pain - Make it stand out gas in the collecting system https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e9307788-33c3-4edc-90c4-02ae55240a31/epretroJPG.JPG The Naunheim Files - A 33 y.o. woman with diabetes, sp kidney pancreas transplant in 2022 who presents with abdominal and flank pain - Make it stand out emphysematous pyelo with gas extending to the retroperitoneum https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cc515171-e99f-49a9-a958-443c2a6f44e8/bearpaw+fJPG.JPG The Naunheim Files - A 33 y.o. woman with diabetes, sp kidney pancreas transplant in 2022 who presents with abdominal and flank pain - Make it stand out The bearpaw sign with xanthogranulomatous pyelonephritis in the setting of a staghorn calculus. https://everydayebm.org/naunheim-files/2023/8/3/a-30-yo-woman-with-schizophrenia-comes-in-with-a-rash-on-her-buttocks monthly 0.5 2023-08-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/27120822-cd50-4dc9-b067-03511ecf9261/monkey+vs+syp.JPG The Naunheim Files - A 43 y.o woman with schizophrenia comes in with a rash on her buttocks - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9244510f-f319-4c55-982c-d4f148f11425/warts.jpeg The Naunheim Files - A 43 y.o woman with schizophrenia comes in with a rash on her buttocks - Make it stand out venereal warts can look similar to condyloma lata https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/74182931-8c6c-496d-bbf5-718ca10340ac/syp.jpeg The Naunheim Files - A 43 y.o woman with schizophrenia comes in with a rash on her buttocks - Make it stand out stages of yphilis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/405d7a60-5a2f-4964-87db-bc5e400f0eb8/Image+8-9-23+at+4.05+PM.jpeg The Naunheim Files - A 43 y.o woman with schizophrenia comes in with a rash on her buttocks - Make it stand out The rise and fall of mpox from the world health organization https://everydayebm.org/naunheim-files/2023/7/31/a-62-yo-male-with-a-hx-of-previous-resection-of-a-benign-brain-tumor-comes-to-the-ed-with-headache-and-fever monthly 0.5 2023-08-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d7806549-b9a6-461e-a9d3-8e1570e98f84/barrfffJPG.JPG The Naunheim Files - A 62 y.o. male with a hx of previous resection of a benign brain tumor comes to the ED with headache and fever. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/61b97ffb-214a-435c-8459-0c3f3fbc9d67/derlipidfluid+levelfffPG.jpg The Naunheim Files - A 62 y.o. male with a hx of previous resection of a benign brain tumor comes to the ED with headache and fever. - Make it stand out the lipid/csf interface from a ruptured dermoic https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1ab93ded-f132-4376-a399-b6eb3820e6c1/dermoid+unruptured.JPG The Naunheim Files - A 62 y.o. male with a hx of previous resection of a benign brain tumor comes to the ED with headache and fever. - Make it stand out An unruptured dermoid presents as a fatty lesion in the brain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8dc849f5-1e3e-48af-827d-8272be5d2a57/dermoidantfon.JPG The Naunheim Files - A 62 y.o. male with a hx of previous resection of a benign brain tumor comes to the ED with headache and fever. - Make it stand out Dermoids can be found where the skin fails to fuse normally as at the anterior fontanelle. https://everydayebm.org/naunheim-files/2023/7/24/a-53-yo-with-a-hx-of-alcoholism-gout-and-seizures-presents-with-a-rash monthly 0.5 2023-07-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c58e0790-5742-4382-9ae0-40c204cfe008/rash.JPG The Naunheim Files - A 53 y.o. with a hx of alcoholism, gout, and seizures presents with a rash. - Make it stand out Hint: he also has marked proteinuria https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6654dd08-3d2a-48dd-8210-503deb1b4f55/hen.JPG The Naunheim Files - A 53 y.o. with a hx of alcoholism, gout, and seizures presents with a rash. - Make it stand out Henoch Schonlein purpura in children tends to start in dependent areas. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f120dd1b-1214-497a-a412-d13c51165e4d/glomeruli.JPG The Naunheim Files - A 53 y.o. with a hx of alcoholism, gout, and seizures presents with a rash. - Make it stand out IgA deposition ion kidney biopsy https://everydayebm.org/naunheim-files/2023/7/17/a-44-yo-woman-comes-in-with-an-ischemic-l-arm monthly 0.5 2023-07-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/873783b6-0589-4975-92a8-c0ebcf9f574a/arm+ischemia.JPG The Naunheim Files - A 44 y.o. woman comes in with an ischemic L arm - Make it stand out yes, she does have a splenic infarct https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4a9ae3a6-0ff5-4ada-b319-50b9ee3d33e6/arm+ischemia2fff.jpg The Naunheim Files - A 44 y.o. woman comes in with an ischemic L arm - Make it stand out the brachial clot https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/435b4ea8-4b09-42dc-8f9e-06b1933749a2/meth+mouthfff.jpg The Naunheim Files - A 44 y.o. woman comes in with an ischemic L arm - Make it stand out meth mouth https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d6538ca4-04f3-4bf5-ae77-1ad38f274359/iscarmfasJPG.JPG The Naunheim Files - A 44 y.o. woman comes in with an ischemic L arm - Make it stand out forearm fasciotomy https://everydayebm.org/naunheim-files/2023/7/10/a-43-yo-truck-driver-is-referred-to-the-ed-for-a-posterior-shoulder-dislocation-and-possible-seizure monthly 0.5 2023-07-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6f6884a9-af74-4c5c-908d-cb8e555fb9a8/malightfff.JPG The Naunheim Files - A 43 y.o. truck driver is referred to the ED for a posterior shoulder dislocation and possible seizure. - Make it stand out compare it to the normal CT of a young person below https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8d291707-318d-443d-82eb-a10bc8f8b7bc/head+ct+nlfffJPG.JPG The Naunheim Files - A 43 y.o. truck driver is referred to the ED for a posterior shoulder dislocation and possible seizure. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8cf401d1-d571-4f6c-9f22-83816b3d92b2/cerebral+edemaf.JPG The Naunheim Files - A 43 y.o. truck driver is referred to the ED for a posterior shoulder dislocation and possible seizure. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/633becc2-a286-41df-8c92-5043789a4be4/csf+spaces..JPG The Naunheim Files - A 43 y.o. truck driver is referred to the ED for a posterior shoulder dislocation and possible seizure. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/eccf9960-ae5f-4bb6-a5cf-8403f8d80459/branch+retinal+art+occlusionsJPG.JPG The Naunheim Files - A 43 y.o. truck driver is referred to the ED for a posterior shoulder dislocation and possible seizure. - Make it stand out branch retinal artery defects in young patients without atherosclerosis are characteristic of Susac”s syndrome. https://everydayebm.org/naunheim-files/2023/7/3/a-77-yo-woman-with-a-hx-of-stage-iii-squamous-cell-cancer-of-the-lung-complains-of-r-knee-pain-after-a-fallee-pain-after-a-fall monthly 0.5 2023-07-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/00992742-8f80-4e05-9f72-d384673e5239/lipohem1.JPG The Naunheim Files - A 77 y.o. woman with a hx of stage III squamous cell cancer of the lung complains of R knee pain after a fall. - Make it stand out What do you notice on her CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b14cbde1-0632-4f77-b9f6-c774c62a1438/lipoplan+film.JPG The Naunheim Files - A 77 y.o. woman with a hx of stage III squamous cell cancer of the lung complains of R knee pain after a fall. - Make it stand out how about now? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1a9d397c-a52c-4d3c-9cea-7285fa35b5a4/lipohemarrowon+plain.JPG The Naunheim Files - A 77 y.o. woman with a hx of stage III squamous cell cancer of the lung complains of R knee pain after a fall. - Make it stand out the lipohemarthrosis with layering in the suprapatellar bursa https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5b407fe3-de1c-4329-86b2-0bac02621772/parfait+sign+on+us.JPG The Naunheim Files - A 77 y.o. woman with a hx of stage III squamous cell cancer of the lung complains of R knee pain after a fall. - Make it stand out The parfait sign on US: the asterix is a layer of serum between the fat and RBCs https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/2cc1ab1d-f47a-4620-8083-7a6ff2ea7189/patellar+ext+mechJPG.JPG The Naunheim Files - A 77 y.o. woman with a hx of stage III squamous cell cancer of the lung complains of R knee pain after a fall. - Make it stand out the high riding patella and inability to extend at the knee are hallmarks of the quadraceps tendon rupture https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c6f46b0b-47fa-4ea6-8041-2bc8721cd380/tibplatfx.JPG The Naunheim Files - A 77 y.o. woman with a hx of stage III squamous cell cancer of the lung complains of R knee pain after a fall. - Make it stand out the fracture in our patient was much easier to see on CT https://everydayebm.org/naunheim-files/2023/6/26/a-26-yo-woman-is-shot-in-the-r-buttock-she-complains-she-cannot-move-her-legs monthly 0.5 2023-06-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0fd2843b-3802-4d21-92a0-30bb2a25d372/gsw1.JPG The Naunheim Files - A 26 y.o. woman is shot in the R buttock. She complains she cannot move her legs. - Make it stand out Hint; the image below points to the problem; and yes she is 23 wks pregnant https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/bd267b4e-0d5e-42ef-a50e-578a584e96b5/gswarrow.JPG The Naunheim Files - A 26 y.o. woman is shot in the R buttock. She complains she cannot move her legs. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8f4dc20f-df85-47f5-b836-645f236b9e64/gsw2.JPG The Naunheim Files - A 26 y.o. woman is shot in the R buttock. She complains she cannot move her legs. - Make it stand out final position of the bullet after traversing L5. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9f00caa5-be57-44c0-ab4e-47dee9304dc9/fsw+fetus.JPG The Naunheim Files - A 26 y.o. woman is shot in the R buttock. She complains she cannot move her legs. - Make it stand out A fetus who survived an intrauterine gsw with lung, diaphragmatic and bowel injuries after an emergency C section https://everydayebm.org/naunheim-files/2023/6/16/a-63-yo-male-with-a-hx-of-a-fall-comes-to-the-ed-with-pain-in-the-distal-long-finger-of-the-r-hand monthly 0.5 2023-06-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/133baf6e-2f7d-459d-b56a-0a5dbefd1132/handffJPG.JPG The Naunheim Files - A 63 y.o. male with a hx of a fall comes to the ED with pain in the distal long finger of the R hand. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/24c2c077-fb0d-4f31-a4e3-c47791c21b8f/isfing2JPG.JPG The Naunheim Files - A 63 y.o. male with a hx of a fall comes to the ED with pain in the distal long finger of the R hand. - Make it stand out the patient returned with an ischemic finger https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9591f734-0cec-44aa-bbec-3904edfa9bf6/calcitbc.JPG The Naunheim Files - A 63 y.o. male with a hx of a fall comes to the ED with pain in the distal long finger of the R hand. - Make it stand out calcified lymph nodes from tuberculosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a8f57a19-1196-490d-925d-2d3b59d0b173/tumoral+calcinoisis.JPG The Naunheim Files - A 63 y.o. male with a hx of a fall comes to the ED with pain in the distal long finger of the R hand. - Make it stand out calcification can occur in tumors because of a high calcium phosphorus product https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d8c9ecf4-2432-4c78-9b7d-77ca49c099ab/calciphy.JPG The Naunheim Files - A 63 y.o. male with a hx of a fall comes to the ED with pain in the distal long finger of the R hand. - Make it stand out calciphylaxis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/95111cbc-5658-4c56-8c08-a76c45f255e7/afterial+calci.JPG The Naunheim Files - A 63 y.o. male with a hx of a fall comes to the ED with pain in the distal long finger of the R hand. - Make it stand out arterial calcification in a child due to a lack of inhibition of hydroxyapatite formation. this is a genetic cause of calcification https://everydayebm.org/naunheim-files/2023/6/15/a-50-yo-male-with-a-hx-of-esrd-on-dialysis-ht-copd-hep-c-presents-with-a-rash monthly 0.5 2023-06-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ce603922-0958-4882-ac48-d83392eb233f/sworfffJPG.jpg The Naunheim Files - A 50 y.o. male with a hx of ESRD on dialysis, ht, copd, and hep C presents with a rash - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1a8162ce-ea67-482f-8536-334ea427c961/monkeyfff.JPG The Naunheim Files - A 50 y.o. male with a hx of ESRD on dialysis, ht, copd, and hep C presents with a rash - Make it stand out monkey pox is also presents with fever and a rash. A biopsy would show mixed lymphocytes and neutrophils. A PCR would be positive. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5657d26a-05fa-40e0-b714-56795ed99575/pg.JPG The Naunheim Files - A 50 y.o. male with a hx of ESRD on dialysis, ht, copd, and hep C presents with a rash - Make it stand out pyoderma gangrenosum presents with necrotic lesions https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/97596726-f4a8-4f97-ab52-68bb6a548460/em.JPG The Naunheim Files - A 50 y.o. male with a hx of ESRD on dialysis, ht, copd, and hep C presents with a rash - Make it stand out erythema nodosum presents with a lymphocytic infiltrate on biopsy Mycoplasma and herpes often cause it. https://everydayebm.org/naunheim-files/2023/6/5/a-73-yo-male-presents-with-several-weeks-of-diplopia-and-l-eye-ptosis monthly 0.5 2023-06-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f704e21a-55a3-4619-b5f1-77d8863d30c3/diplopia1fff4.JPG The Naunheim Files - A 73 y.o. male presents with several weeks of diplopia and L eye ptosis. - Make it stand out he is unable to look down and in with the L eye https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/bf56cd1a-4fd1-43c0-9cf4-1bd47195bb0b/dip3.JPG The Naunheim Files - A 73 y.o. male presents with several weeks of diplopia and L eye ptosis. - Make it stand out he is unable to look to the R with the L eye https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d2147f08-20c6-4019-83a4-7758fde7ba03/dep6.JPG The Naunheim Files - A 73 y.o. male presents with several weeks of diplopia and L eye ptosis. - Make it stand out he is unable to look to the L with the L eye https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/05efe82e-7335-4aa4-97ac-92052cab32da/cavsindiaJPG.JPG The Naunheim Files - A 73 y.o. male presents with several weeks of diplopia and L eye ptosis. - Make it stand out Cavernous Sinus Anatomy. Cavernous Sinus Anatomy is designed by Dr. Kuybu and Diana for Stat Pearls on 8/2/2018 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7c1743b6-bdb8-499a-b49b-aaf0a5935b73/cav+sinus+graphJPG.JPG The Naunheim Files - A 73 y.o. male presents with several weeks of diplopia and L eye ptosis. - Make it stand out Causes of carotid cavernous syndrome https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7641a6a9-ed32-4bb6-992e-786592ef5fd5/caroticavpict.JPG The Naunheim Files - A 73 y.o. male presents with several weeks of diplopia and L eye ptosis. - Make it stand out A carotid cavernous fistula with the bottom image showing an enlarged draining ophthalmic vein. https://everydayebm.org/naunheim-files/2023/5/29/a-66-yo-woman-was-hit-in-the-back-of-the-leg-by-a-heavy-hedgeawhtrimmer-which-fell-from-nine-feet monthly 0.5 2023-05-31 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/01b86abc-6c41-41a5-9b71-807add0bebb9/kager.JPG The Naunheim Files - A 66 y.o. woman was hit in the back of the leg by a heavy hedge trimmer which fell from nine feet - Make it stand out Hint: it has something to do with a triangle. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ca973efc-849d-468f-a4d1-d722e56ca79e/K+xray.JPG The Naunheim Files - A 66 y.o. woman was hit in the back of the leg by a heavy hedge trimmer which fell from nine feet - Make it stand out Kager’s triangle https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f1462292-1b1a-40d0-b886-69dc635ebfed/kdiagram.JPG The Naunheim Files - A 66 y.o. woman was hit in the back of the leg by a heavy hedge trimmer which fell from nine feet - Make it stand out the anatomy of Kager’s triangle. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c992f9dc-a5be-4a15-8fc3-6c45bc8fac7c/achillesPG.JPG The Naunheim Files - A 66 y.o. woman was hit in the back of the leg by a heavy hedge trimmer which fell from nine feet - Make it stand out Achilles was the strongest warrior in the Greek army during the Trojan War. He had one vulnerability; his heel. His mother’s hand had covered his heel when she dipped him in the River Styx to make him invulnerable. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f9f900bf-d7fa-481c-ae22-3e7edcfdeaa0/kos+trigonus.JPG The Naunheim Files - A 66 y.o. woman was hit in the back of the leg by a heavy hedge trimmer which fell from nine feet - Make it stand out the os trigonum is NOT a fracture. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0370e383-4e0c-4dc2-a128-9a31414345ce/achiweber.JPG The Naunheim Files - A 66 y.o. woman was hit in the back of the leg by a heavy hedge trimmer which fell from nine feet - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/5/22/a-79-yo-woman-with-a-hx-of-r-sided-weakness-fell-forward-on-to-her-face monthly 0.5 2023-05-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/92bed2d9-7a58-4d9b-a044-a2f380b022f0/cervical1ff.jpg The Naunheim Files - A 79 y.o. woman with a hx of R sided weakness fell forward on to her face. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b2fb15b4-e4eb-4023-bc7e-828082751f65/cervical+MRI+t2ffar.jpg The Naunheim Files - A 79 y.o. woman with a hx of R sided weakness fell forward on to her face. - Make it stand out within the spinal cord there is white signal on this T2 weighted images; above the arrow the cord is normal. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6562a648-5050-473a-b9e9-c237f497923f/cspinelaminar.JPG The Naunheim Files - A 79 y.o. woman with a hx of R sided weakness fell forward on to her face. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/51de3d7e-55a2-434e-9448-e9354dd6c09c/cspinedegfffJPG.jpg The Naunheim Files - A 79 y.o. woman with a hx of R sided weakness fell forward on to her face. - Make it stand out changes of cervical spondylosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5fd70553-f7fc-41dd-9c97-7066d67a3b33/methue.JPG The Naunheim Files - A 79 y.o. woman with a hx of R sided weakness fell forward on to her face. - Make it stand out As our population ages it is important to consider cervical spondylosis in our patients with falls. This is Anthony Hopkins as Methusaleh, who was reportedly 969 years old. https://everydayebm.org/naunheim-files/2023/5/15/an-80-yo-woman-with-a-fib-presented-with-acute-back-pain-radiating-down-the-l-leg monthly 0.5 2023-05-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e421bda7-8bc4-4446-aa9d-b62a92745a12/sciatica+firste.JPG The Naunheim Files - An 80 y.o. woman with a fib, presented with acute back pain radiating down the L leg - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/091152cc-ec1a-4912-9b34-5d31f215170a/sciatica.JPG The Naunheim Files - An 80 y.o. woman with a fib, presented with acute back pain radiating down the L leg - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/752597f8-ffeb-4862-be61-374de39ef03c/degmental+ateial+.JPG The Naunheim Files - An 80 y.o. woman with a fib, presented with acute back pain radiating down the L leg - Make it stand out A 9mm pseudoaneursym of the common hepatic artery cased by segmental arterial mediolysis. This is a risk factor for retroperitoneal bleeding. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c3784d27-2b2f-40b0-900e-5de328dc7cc9/sciatic+nerve+branches.JPG The Naunheim Files - An 80 y.o. woman with a fib, presented with acute back pain radiating down the L leg - Make it stand out the sciatic nerve is the longest nerve in the body and its sensory branches supply all but the medial leg. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/afe61f64-5e47-43ca-b9dd-13e76e03afd9/sciatpyriformis.JPG The Naunheim Files - An 80 y.o. woman with a fib, presented with acute back pain radiating down the L leg - Make it stand out the sciatic nerve can run through the piriformis muscle causing leg pain in 12-17% of the population https://everydayebm.org/naunheim-files/2023/5/8/a-70-yo-male-presents-with-altered-mental-status monthly 0.5 2023-05-11 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ab0e28e7-c12e-493f-8452-ae082bf2c1b2/post+f1fff.jpg The Naunheim Files - A 70 y.o. male presents with altered mental status - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/bc0a7e5b-caac-4e12-bd70-7670968f881a/postfossa2ff.jpg The Naunheim Files - A 70 y.o. male presents with altered mental status - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e0ee75be-27eb-4168-bb42-eb4e62efcf16/caavsht.JPG The Naunheim Files - A 70 y.o. male presents with altered mental status - Make it stand out while hypertensive bleeds and cerebral amyloid angiopathy can both involve the cerebellum; CAA can also be found in the periphery. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c3bca2ca-cd32-4230-8dc7-8fcb65426022/caapicJPG.JPG The Naunheim Files - A 70 y.o. male presents with altered mental status - Make it stand out Congo red staining and birefringence in polarized light showing cerebral amyloid beta in cerebral vessels https://everydayebm.org/naunheim-files/2023/5/3/a-43-yo-cook-presents-with-severe-wrist-pain monthly 0.5 2023-05-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/508638ad-87c2-4ebb-bc52-ad8d2aef4fb8/dq.JPG The Naunheim Files - A 43 y.o. cook presents with severe wrist pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a6d9ac4d-155a-4d35-939a-e1516b60adaa/dequarrow.jpg The Naunheim Files - A 43 y.o. cook presents with severe wrist pain - Make it stand out A tender nodule on the wrist may be a clue to the diagnosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/036cf8e5-cd41-4993-8ae2-ad383c273009/dqfink.JPG The Naunheim Files - A 43 y.o. cook presents with severe wrist pain - Make it stand out the finkelstein test https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0d17bb93-eeb0-4a93-b472-9df227ac8783/dq+on+us.JPG The Naunheim Files - A 43 y.o. cook presents with severe wrist pain - Make it stand out the diagnosis can be made on US if there is fluid around the tendons and none in the joint https://everydayebm.org/naunheim-files/2023/4/24/a-63-yo-male-presents-with-headache-weakness-and-r-eye-pain monthly 0.5 2023-04-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0a8d6777-68e0-4678-bf7c-2d104037fd2e/herpt.JPG The Naunheim Files - A 63 y.o. male presents with headache, weakness and R eye pain - Make it stand out what could be wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6772fc28-bd0b-467a-a745-b312b8dbc8b2/herpes+keratitis.JPG The Naunheim Files - A 63 y.o. male presents with headache, weakness and R eye pain - Make it stand out herpes keratitis has a classic dendritic pattern https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/596af2d9-3c31-44dd-a260-d782bde7e4c3/vcock.JPG The Naunheim Files - A 63 y.o. male presents with headache, weakness and R eye pain - Make it stand out coxsackie on a child'‘s hand https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1b8f88a6-9fc7-44e0-aba1-e5ff7dedc966/vrick.JPG The Naunheim Files - A 63 y.o. male presents with headache, weakness and R eye pain - Make it stand out rickettsial pox https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d59f9c1b-e786-4c5a-8783-b1c8e40aa5fa/vbodylice.JPG The Naunheim Files - A 63 y.o. male presents with headache, weakness and R eye pain - Make it stand out body lice can present with a vesicular rash https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/983ae70c-b47c-4c4f-9730-fc81e8498630/vpolymorphous+light.JPG The Naunheim Files - A 63 y.o. male presents with headache, weakness and R eye pain - Make it stand out polymorphous light eruption appears within 30 minutes of sun exposure. https://everydayebm.org/naunheim-files/2023/4/17/a-58-yo-with-metastatic-colon-ca-presents-with-r-leg-pain monthly 0.5 2023-04-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/acda169c-9d83-44fd-a57d-055b305f8278/cellulitisapril.JPG The Naunheim Files - A 58 y.o. with metastatic colon ca presents with R leg pain - Make it stand out A blister is noted on the dorsum of the foot. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3216b401-b7eb-4edb-b662-df2b4b215017/cell+pseuto+chartffff.jpg The Naunheim Files - A 58 y.o. with metastatic colon ca presents with R leg pain - Make it stand out fortunately most mistakes are made in just a few categories shown below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c6a720c4-3914-4d1b-9541-349169572348/stasis+dermatitis+cellu.JPG The Naunheim Files - A 58 y.o. with metastatic colon ca presents with R leg pain - Make it stand out stasis dermatitis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/2adc4a6a-bcf3-40af-b6a2-371590721d9e/cell+contactJPG.JPG The Naunheim Files - A 58 y.o. with metastatic colon ca presents with R leg pain - Make it stand out reaction to betadiene after a c section https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/932e4aa0-3844-4f9f-9d11-628fcac72b21/cellpapurt.JPG The Naunheim Files - A 58 y.o. with metastatic colon ca presents with R leg pain - Make it stand out papular urticaria https://everydayebm.org/naunheim-files/2023/4/10/a-74-yo-male-presents-with-chronic-abdominal-pain monthly 0.5 2023-04-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ddd2d0d4-6264-4aef-8b68-e8a0ccc11d90/pancyst.JPG The Naunheim Files - A 74 y.o. male presents with chronic abdominal pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6652629b-4dae-4754-981e-ea1d6b2cf346/panc+anatomJPG.JPG The Naunheim Files - A 74 y.o. male presents with chronic abdominal pain - Make it stand out anatomy of the pancreas ; the tail is toward the spleen https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a1b1d13f-ba12-48a1-9fb0-034a52f293a8/pan+asJPG.JPG The Naunheim Files - A 74 y.o. male presents with chronic abdominal pain - Make it stand out Ascaris worms can cause pancreatitis by blocking the pancreatic duct. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f4f77a45-4d9a-43d1-84b9-0117d1196ef6/pancauses.JPG The Naunheim Files - A 74 y.o. male presents with chronic abdominal pain - Make it stand out many drugs also cause pancreatitis including furosemide, simvastatin and thiazides. IgG 4 disease is a relatively new cause of autoimmune pancreatitis. Infectious causes also occur as in mumps, herpes, and HIV. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/852c7fc3-439b-4b23-9116-bbda78559d3e/panvon+hip.JPG The Naunheim Files - A 74 y.o. male presents with chronic abdominal pain - Make it stand out extra credit: what disease is genetic and associated with cysts of multiple organs including the pancreas? ans: Von Hippel Lindau https://everydayebm.org/naunheim-files/2023/4/3/a-52-yo-woman-who-is-on-chronic-steroids-for-asthma-presents-with-ha-x-one-month-she-recently-noted-polyuria-and-polydipsia monthly 0.5 2023-04-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/abfc3ab7-32c9-4965-be9f-01d32c8b4e8b/pitmarked.JPG The Naunheim Files - A 52 y.o. woman who is on chronic steroids for asthma presents with HA x one month. She recently noted polyuria and polydipsia. - Make it stand out she has a mass in the sella on MRI. What could it be? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/82b8014a-8c78-4920-8ff2-605bf7670b99/pit+cav+sinus.JPG The Naunheim Files - A 52 y.o. woman who is on chronic steroids for asthma presents with HA x one month. She recently noted polyuria and polydipsia. - Make it stand out : this is a review of the anatomy; the cavernous sinuses are shown in blue. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/815b55b8-3c83-4499-bd7d-433ab67fb9f1/pitwadlow.JPG The Naunheim Files - A 52 y.o. woman who is on chronic steroids for asthma presents with HA x one month. She recently noted polyuria and polydipsia. - Make it stand out Robert Wadlow was born in Alton Illinois and grew to over 8 foeet due to growth hormone excess from a pituitary tumor. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1346d491-b388-4c3c-9ad5-d4c6ef5397a6/pit+hypothal.JPG The Naunheim Files - A 52 y.o. woman who is on chronic steroids for asthma presents with HA x one month. She recently noted polyuria and polydipsia. - Make it stand out Bleeding from a pituitary tumor into the optic chiasm is a surgical emergency. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/64538d91-3aac-4b5b-9ea0-a26a576d0f1a/hypopitff.JPG The Naunheim Files - A 52 y.o. woman who is on chronic steroids for asthma presents with HA x one month. She recently noted polyuria and polydipsia. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/3/27/a-50-yo-male-presents-with-chemosis-of-the-r-eye monthly 0.5 2023-05-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3fd48aec-8331-4e75-b5b4-17403814f92e/thyroid.JPG The Naunheim Files - A 50 y.o. male presents with chemosis of the R eye. - Make it stand out He has not responded to steroids. What does he have? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/8edc5e78-e658-46f4-8287-91b5747f636b/igfffffffffJPG.JPG The Naunheim Files - A 50 y.o. male presents with chemosis of the R eye. - Make it stand out IGF-1 in thyroid eye disease https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a6f27a28-6df6-48a8-9665-773121dfc6be/chagasfffromana.jpg The Naunheim Files - A 50 y.o. male presents with chemosis of the R eye. - Make it stand out Romana’s sign in Chagas disease causes orbital swelling https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/68ddbbcc-56e7-4720-bed4-247792197c68/spitting+cobra.JPG The Naunheim Files - A 50 y.o. male presents with chemosis of the R eye. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/3/20/a-60-yo-woman-with-a-hx-of-ht-presents-with-fever-and-fatigue monthly 0.5 2023-03-22 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c64d2b8d-c9b7-4902-8fd7-731adbddefd3/cxr1JPG.JPG The Naunheim Files - A 60 y.o. woman with a hx of hypertension presents with fever and fatigue - Make it stand out her cxr was read as normal and she was discharged home with presumed URI https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/855872c7-415c-4ad7-96c6-f04a355762e2/tbc.JPG The Naunheim Files - A 60 y.o. woman with a hx of hypertension presents with fever and fatigue - Make it stand out she returned several days later with fever and fatigue. What does she have? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d2fa776d-feff-4341-ba5c-7977fee5e5bd/tb+millet.JPG The Naunheim Files - A 60 y.o. woman with a hx of hypertension presents with fever and fatigue - Make it stand out millet seeds are approximately 2mm https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e448e310-5fe3-46e1-b476-7642a1fbccfc/tb+pottsJPG.JPG The Naunheim Files - A 60 y.o. woman with a hx of hypertension presents with fever and fatigue - Make it stand out pott’s disease is involvement of the spine with tuberculosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c546abc4-6ece-48a6-bb0c-c3605ac0206a/tb+skinJPG.JPG The Naunheim Files - A 60 y.o. woman with a hx of hypertension presents with fever and fatigue - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/3/13/a-52-yo-woman-presents-with-altered-mental-status monthly 0.5 2023-03-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c7bb7c1b-7cd4-46cc-9680-16142f557924/pneumocephmenffffe.jpg The Naunheim Files - A 52 y.o. woman presents with altered mental status - Make it stand out What do you see on the head CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f4f8c698-ed75-4663-b428-d08e438a6ba9/pneumocep+vas.JPG The Naunheim Files - A 52 y.o. woman presents with altered mental status - Make it stand out This pt had lung cancer with erosion into the airway during hiccuping he developed a fatal air embolus. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0436f6e5-ebc8-4422-a4ab-a1a775676e82/boyles+law.JPG The Naunheim Files - A 52 y.o. woman presents with altered mental status - Make it stand out Boyles law: as the pressure increases the volume decreases https://en.wikipedia.org/wiki/Boyle%27s_law#/media/File:Boyles_Law_animated.gif https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f02c1f56-0fd6-48db-839d-8aa77d035d51/pneumocep2.JPG The Naunheim Files - A 52 y.o. woman presents with altered mental status - Make it stand out Mt. Fuji sign https://everydayebm.org/naunheim-files/2023/3/6/a-25-yo-male-with-sickle-cell-disease-presents-with-3-weeks-of-ha monthly 0.5 2023-03-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6d17eca0-53f8-4516-91ad-bb2bdd3378ae/epifff.JPG The Naunheim Files - A 25 y.o. male with sickle cell disease presents with 3 weeks of HA - Make it stand out What does it show? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ebf6ec4e-affc-431e-ac26-cfa338139230/scdsmearffff.JPG The Naunheim Files - A 25 y.o. male with sickle cell disease presents with 3 weeks of HA - Make it stand out A typical smear during a sickle cell crisis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/708c5fb7-dbd7-45cf-9be4-966df99352cb/scdmoyaffffffff.JPG The Naunheim Files - A 25 y.o. male with sickle cell disease presents with 3 weeks of HA - Make it stand out “puff of smoke” shows on the arteriogram in Moyamoya disease where irregular perforating vascular networks form near occluded or stenotic vessel predispose to bleeding in sickle cell disease. Extracranial to intracranial bypass is often recommended. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c1c75883-41f4-4e49-990b-5f9f1cf2901a/scdcomplicaffff.JPG The Naunheim Files - A 25 y.o. male with sickle cell disease presents with 3 weeks of HA - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/2/27/a-48-yo-male-presents-several-hours-after-discharge-from-a-bilateral-laparoscopic-hernia-repair monthly 0.5 2023-03-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/194c135e-9d5c-4cd4-b8ff-7a8af0d48f17/ingherJPG.JPG The Naunheim Files - A 48 y.o. male presents several hours after discharge from a bilateral laparoscopic hernia repair. - Make it stand out What is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/2f7d823f-61b5-4612-ae34-127a4e463a8e/retspcefffffe.JPG The Naunheim Files - A 48 y.o. male presents several hours after discharge from a bilateral laparoscopic hernia repair. - Make it stand out The space of Retzius https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e8e40b89-eeab-4671-a655-203c73d65fea/retroperitoneal+kid.JPG The Naunheim Files - A 48 y.o. male presents several hours after discharge from a bilateral laparoscopic hernia repair. - Make it stand out The blue shows where retroperitoneal blood travels around the kidney https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/58eb8677-acae-4aca-beee-bac3e383ccc8/herniacorona.JPG The Naunheim Files - A 48 y.o. male presents several hours after discharge from a bilateral laparoscopic hernia repair. - Make it stand out The corona mortis “crown of death” has been reported to cause significant bleeding in hernia repairs. https://everydayebm.org/naunheim-files/2023/2/20/a-69-yo-woman-sustained-a-shoulder-dislocation-after-a-mechanical-fall-it-was-relocated-at-an-outside-hospital monthly 0.5 2023-02-22 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5e75c07a-8e7c-4726-89b6-c1865db419b1/shoulder.JPG The Naunheim Files - A 69 y.o. woman sustained a shoulder dislocation after a mechanical fall. It was relocated at an outside hospital - Make it stand out this is the post reduction film. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b725357e-7e61-4bf3-b6c7-d7aa4a744da0/bpbestffffdiagram.JPG The Naunheim Files - A 69 y.o. woman sustained a shoulder dislocation after a mechanical fall. It was relocated at an outside hospital - Make it stand out most injuries to the brachial plexus occur distal to the clavicle https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/2543b7ff-a4b4-42f3-a4d7-9d4b4b163ca9/bp+axillary+n.JPG The Naunheim Files - A 69 y.o. woman sustained a shoulder dislocation after a mechanical fall. It was relocated at an outside hospital - Make it stand out the axillary nerve can be the sole injury and results in inability to feel the area over the deltoid or use the deltoid muscle https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/32f6e277-704e-41fa-ac79-30250fbb93fc/brachial+plexus+scapuloffffJPG.jpg The Naunheim Files - A 69 y.o. woman sustained a shoulder dislocation after a mechanical fall. It was relocated at an outside hospital - Make it stand out measure the distance from the spine to the scapula to find a scapulothoracic dissociation. In this image more of the scapula projects over the chest on the R than the L https://everydayebm.org/naunheim-files/2023/2/13/a-59-yo-woman-presents-with-fatigue-she-has-pancytopenia-and-hemolytic-anemia monthly 0.5 2023-02-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/eedb0e26-c91b-4678-9cd1-2de4eab55d16/megaloblastic.JPG The Naunheim Files - A 59 y.o. woman presents with fatigue. She has pancytopenia and hemolytic anemia. - Make it stand out What do you see? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/dd61e422-112d-4ecd-a052-f48dcfd1abac/anemiachartff.JPG The Naunheim Files - A 59 y.o. woman presents with fatigue. She has pancytopenia and hemolytic anemia. - Make it stand out A useful way to think of anemia is to look at whether the RBCs are microcytic, normocytic or macrovytic https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/bcac3e65-63d0-4440-b060-a00feaa95863/vit+def+years.JPG The Naunheim Files - A 59 y.o. woman presents with fatigue. She has pancytopenia and hemolytic anemia. - Make it stand out If diet is the determining factor, it takes a long time to become vit B12 deficient. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/35f90268-41ef-4d46-82cc-214fce5dad57/b12+nails+fff.JPG The Naunheim Files - A 59 y.o. woman presents with fatigue. She has pancytopenia and hemolytic anemia. - Make it stand out Bluish nails are sometimes seen in dark skinned individuals with B12 deficiency. . Decreased glutathione levels results in disinhibition of tyrosinase, an enzyme of melanogenesis leading to increased melanin synthesis. https://everydayebm.org/naunheim-files/2023/2/6/a-67-yo-male-presents-with-shortness-of-breath monthly 0.5 2023-02-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c81786f7-ba3d-4890-8187-d7307063d515/mr.JPG The Naunheim Files - A 67 y.o. male presents with shortness of breath - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9129f623-e5c6-4139-936e-33ca5961f85e/MRecho.JPG The Naunheim Files - A 67 y.o. male presents with shortness of breath - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/ff2aada5-8e98-4028-b94b-07187c63c55a/unipulbulla.JPG The Naunheim Files - A 67 y.o. male presents with shortness of breath - Make it stand out Don’t be fooled by a large bulla; putting in a chest tube in this case can cause a bronchopleural fistula https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1a775f27-64ab-40aa-b44d-c0858f63930b/the+I+cxr.JPG The Naunheim Files - A 67 y.o. male presents with shortness of breath - Make it stand out You would not miss this lesion if you look at the “I” of the cxr. In this case the lateral shows the lesion since the vertebra should be more lucent as you travel down the spine. https://everydayebm.org/naunheim-files/2023/1/30/a-32-yo-male-with-a-hx-of-downs-syndrome-comes-in-with-a-rash monthly 0.5 2023-02-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/2546167d-5d24-4ed9-9bd0-f914d6bedcbc/scabfffJPG.jpg The Naunheim Files - A 32 y.o male with a hx of Down's syndrome comes in with a rash - Make it stand out what is it? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/aae6fd6b-3810-482f-84d7-9339162a4eb4/scabies+koh.JPG The Naunheim Files - A 32 y.o male with a hx of Down's syndrome comes in with a rash - Make it stand out scabies mite seen on KOH https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/2f36bf8f-715e-4070-9ea5-4c9bab790c7e/bedbugsvsscabies.JPG The Naunheim Files - A 32 y.o male with a hx of Down's syndrome comes in with a rash - Make it stand out Bedbugs vs scabies. Bedbugs are more spherical after they feed. They have banded bodies. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5edccfd1-b886-4ef1-a0ba-e15123c69c97/lice.JPG The Naunheim Files - A 32 y.o male with a hx of Down's syndrome comes in with a rash - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1071bdae-1593-4682-938a-36a6ab5ccb7b/bedbigs+vs+fleas.JPG The Naunheim Files - A 32 y.o male with a hx of Down's syndrome comes in with a rash - Make it stand out fleas have long legs which enables them to jump . The bedbug is on the L. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/4fa7d7e0-af54-4901-a0e8-f136deb00cab/flea+circus.JPG The Naunheim Files - A 32 y.o male with a hx of Down's syndrome comes in with a rash - Make it stand out Victorian flea circus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/67511109-eddd-4602-8f1d-64259f147547/ticks.JPG The Naunheim Files - A 32 y.o male with a hx of Down's syndrome comes in with a rash - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/1/20/a-68-yo-woman-was-trapped-in-the-basement-during-a-house-fire-she-was-treated-for-cyanide-poisoning-but-remained-acidotic monthly 0.5 2023-01-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f3b5704b-8972-4277-83de-52cac821af34/pneu+cn.JPG The Naunheim Files - A 68 y.o. woman was trapped in the basement during a house fire. She was treated for cyanide poisoning but remained acidotic. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/434d5236-c4e4-4b93-b0b2-9a705e069f08/rasputinJPG.JPG The Naunheim Files - A 68 y.o. woman was trapped in the basement during a house fire. She was treated for cyanide poisoning but remained acidotic. - Make it stand out cyanide will kill in minutes except for Rasputin who had a witnessed cyanide ingestion and did not die. He had to be shot in the chest and then in the head and thrown into a river. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/daa58450-5cb5-472a-a4e2-0b34dd2ebf88/cngremfffJPG.JPG The Naunheim Files - A 68 y.o. woman was trapped in the basement during a house fire. She was treated for cyanide poisoning but remained acidotic. - Make it stand out The antidotes for cyanide https://everydayebm.org/naunheim-files/2023/1/16/a-79-yo-woman-presents-with-nausea-vomiting-and-hypotension monthly 0.5 2023-01-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/61baff9f-731f-4fe8-ae41-8f830221ab7f/gbcommon.JPG The Naunheim Files - A 79 y.o. woman presents with nausea, vomiting and hypotension. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/31a3a02c-4c92-4832-b15c-ea10f69f3ce1/gb+commonductfffff.JPG The Naunheim Files - A 79 y.o. woman presents with nausea, vomiting and hypotension. - Make it stand out the stone is visible in the common duct https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/3a870b47-cd6b-49da-a980-40f0e66d5f78/gbacute+chole.JPG The Naunheim Files - A 79 y.o. woman presents with nausea, vomiting and hypotension. - Make it stand out thickening of the gallbladder wall with infiltration by neutrophils is present in acute cholecystitis-thinning and perforation of the wall are possible. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/315de36a-6d00-448a-8370-139a8b1927ec/gbacalculous.JPG The Naunheim Files - A 79 y.o. woman presents with nausea, vomiting and hypotension. - Make it stand out an enlarged gallbladder without stones is present in acalculous cholecystitis. tension on the wall causes pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d30bb787-0039-4d6e-9bf4-c84e4a0d2697/gb+typhoidmary.JPG The Naunheim Files - A 79 y.o. woman presents with nausea, vomiting and hypotension. - Make it stand out typhoid mary was a cook who had an asymptomatic chronic Salmonella gallbladder infection https://everydayebm.org/naunheim-files/2023/1/9/a-29-yo-woman-presents-with-ruq-pain-and-a-wbc-of-12 monthly 0.5 2023-01-11 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b35e5d34-9d14-42e9-9019-d421a721f924/fc29.JPG The Naunheim Files - A 29 y.o. woman presents with RUQ pain and a WBC of 12. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/63fb8b22-4be9-44de-b6d2-9c5d767602aa/FC+pelvis.JPG The Naunheim Files - A 29 y.o. woman presents with RUQ pain and a WBC of 12. - Make it stand out another example of subcapsular inflammation of the liver and an ovarian cyst with PID https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d73c4ccb-9953-407d-bd3a-9ceff24b8ce7/fcschistofff.jpg The Naunheim Files - A 29 y.o. woman presents with RUQ pain and a WBC of 12. - Make it stand out subcapsular inflammation leading to calcification in schistosomiasis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/230c5e3e-67ed-46d5-b70d-8083e3df65c8/FCextra+med.JPG The Naunheim Files - A 29 y.o. woman presents with RUQ pain and a WBC of 12. - Make it stand out extramedullary hematopoesis along the portal subcapsular liver https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/42458943-b42c-449c-80ae-97a7e5a29b80/fcpicpict.JPG The Naunheim Files - A 29 y.o. woman presents with RUQ pain and a WBC of 12. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2023/1/2/a-108-yo-woman-presents-with-an-indwelling-foley-and-hematuria monthly 0.5 2023-01-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d370b8c1-7079-4cce-ad84-dea3c497a60f/purple.JPG The Naunheim Files - A 108 y.o. woman presents with an indwelling foley and hematuria - Make it stand out What needs to be considered? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/942497e8-b05d-4849-b435-69b4b8b3cb73/purple1.JPG The Naunheim Files - A 108 y.o. woman presents with an indwelling foley and hematuria - Make it stand out beeturia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e14a52bd-3906-4ede-8c4a-102873acd503/purpleporphy.JPG The Naunheim Files - A 108 y.o. woman presents with an indwelling foley and hematuria - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/aa2fcee5-aaca-4ecb-af85-5b477de98c31/purplecnfffJPG.JPG The Naunheim Files - A 108 y.o. woman presents with an indwelling foley and hematuria - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/12/26/a-35-yo-woman-presented-with-cough-myalgias-and-hearing-loss monthly 0.5 2022-12-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d0bc164c-3ca3-4e40-9b13-25a87c161b6f/wegJPG.JPG The Naunheim Files - A 35 y.o. woman presented with cough, myalgias and hearing loss - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/afd0dc5b-44b6-4f83-83eb-ceea2e6103a0/wegsaddle.JPG The Naunheim Files - A 35 y.o. woman presented with cough, myalgias and hearing loss - Make it stand out saddle nose deformity can occur in granulomatous polyangiitis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d70e5783-bf2d-4b05-a3d5-e0d0a0c7bf8a/wegpulmrenalff.jpg The Naunheim Files - A 35 y.o. woman presented with cough, myalgias and hearing loss - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/6c6ba2e5-31bc-4103-8f9d-ab117b624e90/weggoodJPG.JPG The Naunheim Files - A 35 y.o. woman presented with cough, myalgias and hearing loss - Make it stand out A pt with Goodpasture’s presenting with a similar CXR https://everydayebm.org/naunheim-files/2022/12/19/a-27-yo-woman-injected-subutex-into-her-radial-artery-one-hour-later-she-came-to-the-ed-complaining-of-hand-pain monthly 0.5 2022-12-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/a2b6dc4e-45df-4233-bb19-d84a11740a2a/compartpre1JPG.JPG The Naunheim Files - A 27 y.o. woman injected subutex into her radial artery. One hour later she came to the ED complaining of hand pain. - Make it stand out her hand was swollen and she developed a rash on the forearm. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/cd760ca3-af55-4603-a5fb-744ac812e8dc/compart1JPG.JPG The Naunheim Files - A 27 y.o. woman injected subutex into her radial artery. One hour later she came to the ED complaining of hand pain. - Make it stand out sensation , motor function, and cap refill was intact. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/9658d5fb-de8f-42a2-bccd-a94ffe7508b8/compartment+syndromeimage.JPG The Naunheim Files - A 27 y.o. woman injected subutex into her radial artery. One hour later she came to the ED complaining of hand pain. - Make it stand out 10-11 compartments exist in the hand https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/56486c04-891d-44bf-8ed4-51ad9f666c55/compost.JPG The Naunheim Files - A 27 y.o. woman injected subutex into her radial artery. One hour later she came to the ED complaining of hand pain. - Make it stand out the thenar compartment https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/21bf7f5b-9a9d-4e2b-87a8-d51f8f512236/compcauses.JPG The Naunheim Files - A 27 y.o. woman injected subutex into her radial artery. One hour later she came to the ED complaining of hand pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/12/12/a-68-yo-males-comes-in-with-epigastric-pain-and-weakness-he-has-had-diarrhea-for-two-days monthly 0.5 2022-12-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/5551c5f1-59d1-4a77-9f91-bd62dbc94263/kfffekgddd.jpg The Naunheim Files - A 68 y.o. male comes in with epigastric pain and weakness; he has had diarrhea for two days. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1aa9c3ca-ca24-4459-9043-5be9c343cbca/K+spider.JPG The Naunheim Files - A 68 y.o. male comes in with epigastric pain and weakness; he has had diarrhea for two days. - Make it stand out consider hepatorenal syndrome in patients with spider angiomata https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b2794895-5ae5-4498-80e8-b297c0930e46/k+cirrhosis.JPG The Naunheim Files - A 68 y.o. male comes in with epigastric pain and weakness; he has had diarrhea for two days. - Make it stand out the fibrosis in cirrhosis is thought to trigger nitric oxide production causing dilation of pulmonary vessels, shunting and hypoxia. Methylene blue has been used to treat hepatopulmonary syndrome. https://everydayebm.org/naunheim-files/2022/12/5/a-67-yo-woman-presented-with-a-rash-weakness-and-difficulty-speaking-one-day-after-a-flu-shot monthly 0.5 2022-12-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1028d9d9-798f-46a6-a31a-e0003fc2e75d/dermJPG.JPG The Naunheim Files - A 67 y.o. woman presented with a rash, weakness and difficulty speaking one day after a flu shot. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b29f8513-5859-484f-bc85-da42cb90929d/derm+2.JPG The Naunheim Files - A 67 y.o. woman presented with a rash, weakness and difficulty speaking one day after a flu shot. - Make it stand out In dermatomyositis immune attack occurs in muscle areterioles causing ischemia and death of muscle fibers. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7441829c-c1fb-45f6-8288-50b3275eb154/gbfff.JPG The Naunheim Files - A 67 y.o. woman presented with a rash, weakness and difficulty speaking one day after a flu shot. - Make it stand out Guillan-Barre can be rapidly progressive and cause respiratory insufficiency https://everydayebm.org/naunheim-files/2022/11/28/a-74-yo-woman-presents-with-sob-her-nails-are-discolored monthly 0.5 2022-11-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d247d212-d933-4464-8a52-3d09f5c51f9f/half+and+halfJPG.JPG The Naunheim Files - A 74 y.o. woman presents with SOB. Her nails are discolored - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7e71a4da-237c-4fe6-b4c3-bdbea4916830/hhmelanonychia.JPG The Naunheim Files - A 74 y.o. woman presents with SOB. Her nails are discolored - Make it stand out benign melanonychia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/dba0960e-afc4-4aab-8b90-356dfa2ccbb5/hhmelanoma.JPG The Naunheim Files - A 74 y.o. woman presents with SOB. Her nails are discolored - Make it stand out IT IS IMPORTANT TO RECOGNIZE SUBUNGUAL MELANOMA AS DISTINCT FROM MELANONYCHIA. THIS IS MELANOMA https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/b114a7c9-6195-453c-833a-788f8cd0794d/hhmees.JPG The Naunheim Files - A 74 y.o. woman presents with SOB. Her nails are discolored - Make it stand out Mees lines https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/557b16e0-700f-4ccb-80a2-aec4a6a67f27/hhbeau.JPG The Naunheim Files - A 74 y.o. woman presents with SOB. Her nails are discolored - Make it stand out Interruption of nail growth occurs with chemo. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d213dc61-898c-4cff-bd29-5d6cdd210ea9/hhmeigs+with+tumor.JPG The Naunheim Files - A 74 y.o. woman presents with SOB. Her nails are discolored - Make it stand out Meig’s syndrome https://everydayebm.org/naunheim-files/2022/11/21/a-five-year-old-boy-presents-with-shoulder-pain-and-a-rash-around-his-lips-and-on-his-neck monthly 0.5 2022-11-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/7393f071-a2c5-4825-a66b-0b399e50bea2/sslip.JPG The Naunheim Files - A five year old boy presents with shoulder pain and a rash around his lips and on his neck - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/65f06258-72d0-4a20-8620-a11e014c4ebc/sss2.JPG The Naunheim Files - A five year old boy presents with shoulder pain and a rash around his lips and on his neck - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/e291d08b-8eb7-4790-a119-3ab510c25eec/sss3.JPG The Naunheim Files - A five year old boy presents with shoulder pain and a rash around his lips and on his neck - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/85213144-8ac4-4f64-accd-ef3c2245a0ef/sspicf.JPG The Naunheim Files - A five year old boy presents with shoulder pain and a rash around his lips and on his neck - Make it stand out The Nikolsky sign is present and the upper layer of skin peels away with slight pressure in scalded skin syndrome. It is also present in Stevens Johnson syndrome and pemphigus vulgasis. It is not present in bullous pemphigoid. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c0f40588-35fe-4089-ad4e-539b6e22dcd4/ssimpeti.JPG The Naunheim Files - A five year old boy presents with shoulder pain and a rash around his lips and on his neck - Make it stand out Impetigo is a localized infection https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c2bf5e41-0a3e-48f0-9258-4fccd56693fb/ssscarlet+feverton.JPG The Naunheim Files - A five year old boy presents with shoulder pain and a rash around his lips and on his neck - Make it stand out the strawberry tongue of scarlet fever https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/d2b716b9-9721-48dd-91ce-5d9e1e92321a/sskawfff.JPG The Naunheim Files - A five year old boy presents with shoulder pain and a rash around his lips and on his neck - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/11/17/a-51-yo-male-undergoes-a-ventral-hernia-repair-that-evening-he-develops-compartment-syndromes-in-both-legs-and-the-r-arm monthly 0.5 2022-11-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/52d516fb-4919-4df6-80f1-44049081bc43/fasciofirst.JPG The Naunheim Files - A 51 y.o. male undergoes a ventral hernia repair. that evening he develops compartment syndromes in both legs and the R arm. - Make it stand out necrotic muscle was found https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/c2c296a1-37fa-4e60-8192-28e94b5f7c7d/faciotfirst+RJPG.JPG The Naunheim Files - A 51 y.o. male undergoes a ventral hernia repair. that evening he develops compartment syndromes in both legs and the R arm. - Make it stand out both medial and lateral compartments were opened https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/f1630efc-0eb6-4bf3-84c1-63b2aa01577d/compartments.JPG The Naunheim Files - A 51 y.o. male undergoes a ventral hernia repair. that evening he develops compartment syndromes in both legs and the R arm. - Make it stand out compartment syndrome usually occurs after trauma like a tibiial fracture. It can also occur after revascularization procedures where newly opened vessels cause increased pressure in a compartment with infact fascia. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/08b6f80d-c452-4ba0-ac85-e484f2ba078f/mns+sero+cartoon.JPG The Naunheim Files - A 51 y.o. male undergoes a ventral hernia repair. that evening he develops compartment syndromes in both legs and the R arm. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/0b0e5cac-955d-45f9-ae25-196465e138db/nmserotonin+drugsJPG.JPG The Naunheim Files - A 51 y.o. male undergoes a ventral hernia repair. that evening he develops compartment syndromes in both legs and the R arm. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/312b45ee-9a23-4528-8312-cc55b9f09d0d/mh+sero.JPG The Naunheim Files - A 51 y.o. male undergoes a ventral hernia repair. that evening he develops compartment syndromes in both legs and the R arm. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/11/7/an-84-yo-presents-to-the-ed-with-pain-over-his-tailbone-and-down-the-l-leg monthly 0.5 2022-11-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1667832532363-W7CTGNM129JD14OVKJSG/hip.JPG The Naunheim Files - An 84 y.o. presents to the ED with pain over his tailbone and down the L leg. - Make it stand out Hint: the xray was read as mild hip OA; what could be wrong.? He was given a lidocaine patch and sent home with referral to spine https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1668013131544-WWC3KNIIV7W8SQ2NTK0L/hiparrow.JPG The Naunheim Files - An 84 y.o. presents to the ED with pain over his tailbone and down the L leg. - Make it stand out CT showed a lesion in the L ischium https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1668013269721-2G3C4BXKSQ5HE8CZQVCW/labral+tearfJPG.JPG The Naunheim Files - An 84 y.o. presents to the ED with pain over his tailbone and down the L leg. - Make it stand out A labral tear can be extremely painful https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1668013336726-ECYPK0N1AZ93FOCRN0H4/sacral+insuf.JPG The Naunheim Files - An 84 y.o. presents to the ED with pain over his tailbone and down the L leg. - Make it stand out sacral insufficiency fractures are stress fractures and can occur without trauma https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1668013400960-9TMIU8XTNSI6DHHUZI9D/sijointhydaff.JPG The Naunheim Files - An 84 y.o. presents to the ED with pain over his tailbone and down the L leg. - Make it stand out echinococcal infections can occur in the SI joint https://everydayebm.org/naunheim-files/2022/10/31/a-38-yo-male-was-found-down-in-cardiac-arrest-after-a-gsw-to-the-head-he-was-brought-to-the-ed-with-a-pulse monthly 0.5 2022-11-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1667224943886-WZ6WSYAI21YC2LDUG95B/fuji.JPG The Naunheim Files - A 38 y.o. male was found down in cardiac arrest after a gsw to the head. He was brought to the ED with a pulse - Make it stand out extensive pneumocephaly was noted with a “mount fuji” sign over the frontal lobes. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1667224990457-QD5FSO4DAWLXE7V3RWGX/fuji2JPG.JPG The Naunheim Files - A 38 y.o. male was found down in cardiac arrest after a gsw to the head. He was brought to the ED with a pulse - Make it stand out The posterior skull was fractured https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1667487676139-ISNJC32RCIHE49JCUSWQ/gsw+cavitation+from+blast+in+gel.JPG The Naunheim Files - A 38 y.o. male was found down in cardiac arrest after a gsw to the head. He was brought to the ED with a pulse - Make it stand out cavitation in ballistic gel https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1667487814004-M9HLTKDHAYKOTUTWNKBY/fujibaylor.JPG The Naunheim Files - A 38 y.o. male was found down in cardiac arrest after a gsw to the head. He was brought to the ED with a pulse - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/10/24/a-53-yo-woman-with-a-hx-of-colon-cancer-sp-chemo-and-proctocolectomy-with-ileostomy-comes-to-the-ed-with-ulcers-around-her-ostomy-site monthly 0.5 2022-10-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1666619991497-WH0648IFWJNTILAOAJQ5/pyo.JPG The Naunheim Files - A 53 y.o. woman with a hx of colon cancer sp chemo and proctocolectomy with ileostomy comes to the ED with ulcers around her ostomy site. - Make it stand out what is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1666796563795-VUP9HZ8GYP0IBP9DVH8J/pyo+cat.JPG The Naunheim Files - A 53 y.o. woman with a hx of colon cancer sp chemo and proctocolectomy with ileostomy comes to the ED with ulcers around her ostomy site. - Make it stand out Another pyoderma gangrenosum lesion showing the “cat’s paw” variant https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1666797125785-NJSWDUSGSXWGD45FR5H9/pyobromo.JPG The Naunheim Files - A 53 y.o. woman with a hx of colon cancer sp chemo and proctocolectomy with ileostomy comes to the ED with ulcers around her ostomy site. - Make it stand out History is important in making the diagnosis, substances like bromide can cause similar lesions. Bromides are found in pesticides and disinfectants. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1666797365675-Q17DMZLND2RSFKVZT0UR/pyomartPG.JPG The Naunheim Files - A 53 y.o. woman with a hx of colon cancer sp chemo and proctocolectomy with ileostomy comes to the ED with ulcers around her ostomy site. - Make it stand out Martorell ulcers are peripheral vascular disease in the skin. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1666797610651-BP8LPLYEVJ90C8D183G7/pyoanthe.JPG The Naunheim Files - A 53 y.o. woman with a hx of colon cancer sp chemo and proctocolectomy with ileostomy comes to the ED with ulcers around her ostomy site. - Make it stand out Bacterial diseases like anthrax must be ruled out. https://everydayebm.org/naunheim-files/2022/10/17/an-84-yo-male-noted-redness-and-weeping-of-the-r-leg-for-several-months monthly 0.5 2022-10-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1666013913788-IY7PF0W2L5O0BOT1YDL9/cellulitis.JPG The Naunheim Files - An 84 y.o. male noted redness and weeping of the R leg for several months. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1666197894800-2X4TE6JA0UC6EVO7T473/cellulitishor.JPG The Naunheim Files - An 84 y.o. male noted redness and weeping of the R leg for several months. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1666198010306-VT8VOH9U4E2WANBMN6R4/cellsporotrich.JPG The Naunheim Files - An 84 y.o. male noted redness and weeping of the R leg for several months. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1666198057048-JMIHA3DCUUURQ7H0586E/CELLULITIS+STASISJPG.JPG The Naunheim Files - An 84 y.o. male noted redness and weeping of the R leg for several months. - Make it stand out scaling, redness and weeping lesions can occur with stasis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1666198128853-FWCTVZUGC94NNPBC7P3N/cellulitisgout.JPG The Naunheim Files - An 84 y.o. male noted redness and weeping of the R leg for several months. - Make it stand out this patient had bumped her shin and had a gouty tophus develop https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1666198195629-8MVKALDAGZK6GJ26VVP7/CELLULITISENOD.JPG The Naunheim Files - An 84 y.o. male noted redness and weeping of the R leg for several months. - Make it stand out E nodosum is an inflammation of fat similar to paniculitis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1666198274116-DNH2U7J2G9SZK6PEOSQ5/cellulitis+nec.JPG The Naunheim Files - An 84 y.o. male noted redness and weeping of the R leg for several months. - Make it stand out necrotizing fasciitis can present with severe pain, rapid spreading and a dark center or blister https://everydayebm.org/naunheim-files/2022/10/10/a-38-yo-male-with-a-long-history-of-syncopal-episodes-often-after-he-runs-5k-a-day-comes-to-the-ed-with-chest-pain monthly 0.5 2022-10-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1665413780193-K0H52KHUXTY12KUW36LE/pulart+to+ladJPG.JPG The Naunheim Files - A 38 y.o. male with a long history of syncopal episodes; often after he runs 5K a day, comes to the ED with chest pain. - Make it stand out normal coronary anatomy is shown below https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1665413856668-TJFUFZ05XHLVSDB4U4WH/pulnormal+ctae.JPG The Naunheim Files - A 38 y.o. male with a long history of syncopal episodes; often after he runs 5K a day, comes to the ED with chest pain. - Make it stand out All the coronaries come off the aorta. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1665582671860-2EZLOEU7YXUZ65D22C1C/lad+to+pulmonary+artery..JPG The Naunheim Files - A 38 y.o. male with a long history of syncopal episodes; often after he runs 5K a day, comes to the ED with chest pain. - Make it stand out an example of an LAD to pulmonary artery fistula on cath https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1665582744716-ZBFRJV4SYYBRZ9ZQB4QL/hcmekg.JPG The Naunheim Files - A 38 y.o. male with a long history of syncopal episodes; often after he runs 5K a day, comes to the ED with chest pain. - Make it stand out hypertrophic cardiomyopathy often presents with q waves in v5,v6 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1665582829384-WZZPNTPMKBX63TV7MXV6/strawberry+tongue+.JPG The Naunheim Files - A 38 y.o. male with a long history of syncopal episodes; often after he runs 5K a day, comes to the ED with chest pain. - Make it stand out The strawberry tongue which can be seen in Kawasaki’s can also be seen in scarlet fever and MIS -C (Multisystem inflammatory syndrome) in COVID https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1665582953595-YX0UTVKE8BDJJDE6SRGQ/pul+fist+fibromusc.JPG The Naunheim Files - A 38 y.o. male with a long history of syncopal episodes; often after he runs 5K a day, comes to the ED with chest pain. - Make it stand out fibromuscular dysplasia can cause a “beads on a string” appearance in coronary arteries. This is alternating strictures and aneursymal dilation. https://everydayebm.org/naunheim-files/2022/10/3/a-31-yo-woman-comes-to-the-ed-with-ha-she-had-a-significant-head-injury-six-weeks-earlier-when-she-fell-off-an-inner-tube-being-pulled-behind-a-ski-boat monthly 0.5 2022-10-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1664806944535-0UXDOH28JUFHDAQI7X4C/haMRItrans.JPG The Naunheim Files - A 31 y.o. woman comes to the ED with HA. She had a significant head injury six weeks earlier when she fell off an inner tube being pulled behind a ski boat. - Make it stand out what does it show on the T2 weighted image? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1664987637160-Z3LT7X02HVEACS8PEYO3/hydro+tranepen.JPG The Naunheim Files - A 31 y.o. woman comes to the ED with HA. She had a significant head injury six weeks earlier when she fell off an inner tube being pulled behind a ski boat. - Make it stand out The arrows point to transependymal flow on MRI caused by increased csf pressure https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1664987881876-2KVVFIGDJNM6BVC5E9BL/hydrosurg.JPG The Naunheim Files - A 31 y.o. woman comes to the ED with HA. She had a significant head injury six weeks earlier when she fell off an inner tube being pulled behind a ski boat. - Make it stand out a suboccipital craniotomy with microscopic removal of an arachnoid cyst. https://everydayebm.org/naunheim-files/2022/9/26/a-33-yo-male-presents-with-shortness-of-breath-and-stable-vitals monthly 0.5 2022-09-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1664200928505-BXK3DMQVMD1MLYBBGKFD/hemotension.JPG The Naunheim Files - A 33 y.o. male presents with shortness of breath and stable vitals - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1664465178653-F1BX9NSXKC4AJZQ78WR7/NUT+ciliary+ganglion.JPG The Naunheim Files - A 33 y.o. male presents with shortness of breath and stable vitals - Make it stand out NUT tumor of the L medial canthus. The ciliary ganglion is the only other place in the body where the NUT gene is normally found. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1664465271363-H8G6MXBDHNH400WNRI0D/hemopseudo+an.JPG The Naunheim Files - A 33 y.o. male presents with shortness of breath and stable vitals - Make it stand out pseudoaneursym causing exsanguination after chest tube placement. https://everydayebm.org/naunheim-files/2022/9/19/a-63-yo-female-presents-with-r-flank-pain monthly 0.5 2022-09-22 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1663599369400-TF5TWKITVKSAAXKJL8I9/xaPG.JPG The Naunheim Files - A 63 y.o. female presents with R flank pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1663864019223-KCCHRZ726MQBH4ZBWC5G/xrentbJPG.JPG The Naunheim Files - A 63 y.o. female presents with R flank pain - Make it stand out renal tuberculosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1663864071394-J3KQEEDR83M41OB0E5AL/xbear.JPG The Naunheim Files - A 63 y.o. female presents with R flank pain - Make it stand out bear’s paw https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1663864106066-9AG4CGTUDXW9RZT575EN/xbear+paw.JPG The Naunheim Files - A 63 y.o. female presents with R flank pain - Make it stand out bear’s paw in xanthogranulomatous pyelonephritis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1663864164120-WMBNSKKCPVYUICW97T6K/xnepcut.JPG The Naunheim Files - A 63 y.o. female presents with R flank pain - Make it stand out nephrocutaneous fistula from xanthogranulomatous pyelonephritis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1663864281276-2EG4CVBRFQX473UWC3J2/xperinephric+hemorrhage.JPG The Naunheim Files - A 63 y.o. female presents with R flank pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/9/12/a-61-yo-woman-presents-with-osa-presents-with-l-sided-facial-pain-a-day-after-a-wisdom-tooth-was-extracted monthly 0.5 2022-09-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1662991940724-HAT2DKL3OTUCCQT3PTVG/sqairfff.JPG The Naunheim Files - A 61 y.o. woman presents with OSA presents with L sided facial pain a day after a wisdom tooth was extracted - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1663258916106-ODTT426Z7BVX88K5P32V/dentalchondro.JPG The Naunheim Files - A 61 y.o. woman presents with OSA presents with L sided facial pain a day after a wisdom tooth was extracted - Make it stand out pt seen four days ago in the ED sp minimally invasive chondrolaryngoplasty with air travelling through the incision site into the neck. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1663259046523-3ES4O2FDEOC09FTQUOO9/dental+pneu.JPG The Naunheim Files - A 61 y.o. woman presents with OSA presents with L sided facial pain a day after a wisdom tooth was extracted - Make it stand out spontaneous pneumatosis and pneumomediastinum in a patient with leukemia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1663259447173-7V8DLV0Q3LEBFVTWGRIG/dental+pulm.JPG The Naunheim Files - A 61 y.o. woman presents with OSA presents with L sided facial pain a day after a wisdom tooth was extracted - Make it stand out pt with air embolus after dental extraction. treatment is L lateral decubitus position and hyperbaric oxygen which increases the partial pressure of oxygen causing diffusion of nitrogen from inside the air bubble and reduction in size. https://everydayebm.org/naunheim-files/2022/9/5/a-43-yo-female-complains-of-parasites-coming-out-of-her-mouth-and-nose monthly 0.5 2022-09-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1662386625294-CMILCZMZIPL54EFY4332/sinusmucous.JPG The Naunheim Files - A 43 y.o. female complains of "parasites coming out of her mouth and nose" - Make it stand out this is coming from her nose and mouth https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1662386770268-8CTLTY9YQXULN5AB6Q4U/sinjanJPG.JPG The Naunheim Files - A 43 y.o. female complains of "parasites coming out of her mouth and nose" - Make it stand out What is going on? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1662745220785-6Q60NCF4PBIC3DYOGCCA/sinusanatfffffJPG.JPG The Naunheim Files - A 43 y.o. female complains of "parasites coming out of her mouth and nose" - Make it stand out evolutionarily sinuses are lined with mucous which provide an antibacterial function https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1662745307481-MGFAWVNYM5BM9KDLY7FK/sinusitis+pottsPG.JPG The Naunheim Files - A 43 y.o. female complains of "parasites coming out of her mouth and nose" - Make it stand out pt with Pott’s puffy tumor: osteromyelitis of the frontal bone after bacterial sinus infection. The treatment is surgical. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1662745451392-B6KGULBUQO3YB5UJAHZ0/sinusitis+mucor.JPG The Naunheim Files - A 43 y.o. female complains of "parasites coming out of her mouth and nose" - Make it stand out patient immunosuppressed because of liver disease who died of a Mucor infection with invasion of the cavernous sinus and bilateral optic nerves. Ischemic infarcts were seen in the frontal lobes and basal ganglia. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1662745567309-B2868EPL52T7S2F3VPEF/sindexcovidfffff.JPG The Naunheim Files - A 43 y.o. female complains of "parasites coming out of her mouth and nose" - Make it stand out pt with fungal osteomyelitis treated with dex and antibiotics for covid https://everydayebm.org/naunheim-files/2022/8/29/a-70-yo-woman-comes-in-with-copd-has-acute-sob monthly 0.5 2022-09-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1661783248367-QO2JU1EPJC3H4N7FK2XH/pneumonotfolrdPG.JPG The Naunheim Files - A 70 y.o. woman comes in with COPD has acute SOB - Make it stand out what do you notice on the xray? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1662044985804-REHEBLRQJM31Q4RMYL6X/pneumoskin+fold+vs+pneumfffPG.jpg The Naunheim Files - A 70 y.o. woman comes in with COPD has acute SOB - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1662045039200-7OH37PL9MM4ZY61MIY1F/pneumoexvacJPG.JPG The Naunheim Files - A 70 y.o. woman comes in with COPD has acute SOB - Make it stand out This is a patient with an endobronchial valve causing pneumothorax ex vacuo; seen best on the lateral. No chest tube is indicated but rather relief of the obstruction. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1662045192732-LRGIPNF9JL8WH6ERSRLV/pneumoclag1.JPG The Naunheim Files - A 70 y.o. woman comes in with COPD has acute SOB - Make it stand out The Clagett procedure can be confusing on CXR https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1662045231774-944WH0I33PFDY4XBHUC9/pneumoclag2JPG.JPG The Naunheim Files - A 70 y.o. woman comes in with COPD has acute SOB - Make it stand out A clagett is much easier to see on exam or CT.. Fortunately in humans the pleural spaces do not connect. However, the pleural spaces do connect in buffalo making them easy to kill with an arrow to one chest cavity. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1662045376115-7KE2PKQHYUNZOE3QMY4K/pneumoour+ptJPG.JPG The Naunheim Files - A 70 y.o. woman comes in with COPD has acute SOB - Make it stand out Our patient had LLL pneumonia and collapse explaining the marked volume loss on the L. https://everydayebm.org/naunheim-files/2022/8/22/a-73-yo-woman-comes-to-the-ed-with-abdominal-pain-and-leakage-around-her-g-tube-site-after-having-it-replaced-in-the-ed-2-days-earlier monthly 0.5 2022-08-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1661181005311-2A5S83PHBA7SZ7DR15YW/gtubrJPG.JPG The Naunheim Files - A 73 y.o. woman comes to the ED with abdominal pain and leakage around her G tube site after having it replaced in the ED 2 days earlier. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1661354935021-ZS2XQ6VNDB4CQ0UBKW6J/ng+tube+in+brain.JPG The Naunheim Files - A 73 y.o. woman comes to the ED with abdominal pain and leakage around her G tube site after having it replaced in the ED 2 days earlier. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1661355474309-PZOBTR8922TYW91CJB2K/ngrllJPG.JPG The Naunheim Files - A 73 y.o. woman comes to the ED with abdominal pain and leakage around her G tube site after having it replaced in the ED 2 days earlier. - Make it stand out this patient developed a delayed pneumothorax https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1661355560742-6W7QYV701QFOHU1ZZITW/nggastocolicPG.JPG The Naunheim Files - A 73 y.o. woman comes to the ED with abdominal pain and leakage around her G tube site after having it replaced in the ED 2 days earlier. - Make it stand out A colocutaneous fistula can develop if there is bowel between the stomach and skin https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1661356460987-0D6HBCOXSBY57SA9IETL/ng+pneumoper.JPG The Naunheim Files - A 73 y.o. woman comes to the ED with abdominal pain and leakage around her G tube site after having it replaced in the ED 2 days earlier. - Make it stand out For about 72 hours after a PEG placemnt pneumoperitoneum is considered normal. https://everydayebm.org/naunheim-files/2022/8/15/a-22-yo-woman-presented-with-rlq-pain-and-ascites monthly 0.5 2022-08-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1660572416614-JYI7IS912MQ1H2DF0B6W/ovarian+stim.JPG The Naunheim Files - A 22 y.o. woman presented with RLQ pain and ascites. - Make it stand out Hint: the pt is receiving LH injections as part of her infertility treatment. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1660919445768-M5WMYU1ZJLOQ5GAN0WK4/ovarianmenstrual+cycle.JPG The Naunheim Files - A 22 y.o. woman presented with RLQ pain and ascites. - Make it stand out Ovarian hyperstimultation syndrome is more likely if HCG is given or occurs naturally in the luteal phase https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1660919573167-A79JN5Z9NEE273TXP0TA/ovarian+hypleural+JPG.JPG The Naunheim Files - A 22 y.o. woman presented with RLQ pain and ascites. - Make it stand out pleural effusion in a patient with ovarian hyperstimulation https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1660919635535-PZIVK7INTL7V2DZRUMHC/ovarian+hyperstimtrip.JPG The Naunheim Files - A 22 y.o. woman presented with RLQ pain and ascites. - Make it stand out an 18 yo with spontaneous ovarian hyperstimulation syndrome. She had an abortion at 10 wks. https://everydayebm.org/naunheim-files/2022/8/8/a-60-yo-woman-is-undergoing-a-lymph-node-biopsy-for-nightsweats-and-a-positive-tspot monthly 0.5 2022-08-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1659969666366-BI427BG8D9JF6AQLLV4V/pheofffctbx.JPG The Naunheim Files - A 60 y.o. woman is undergoing a lymph node biopsy for nightsweats and a positive TSPOT - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1660318862185-EAHI2HKX60BVPZG3ZPBT/pheovhl.JPG The Naunheim Files - A 60 y.o. woman is undergoing a lymph node biopsy for nightsweats and a positive TSPOT - Make it stand out this is a patient seen in the ED recently with von Hipple Lindau and renal carcinomas https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1660318952846-WEXVH7Z5WHS18GRN9T1D/pheo+men.JPG The Naunheim Files - A 60 y.o. woman is undergoing a lymph node biopsy for nightsweats and a positive TSPOT - Make it stand out MEN syndromes can be associated with pheo or paraganglioma https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1660319040294-EKNH8NPV44QD9BUO7NVK/pheolischJPG.JPG The Naunheim Files - A 60 y.o. woman is undergoing a lymph node biopsy for nightsweats and a positive TSPOT - Make it stand out lisch spots occur in neurofibromatosis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1660319105114-1R842XUU39MGV3TM7LII/pheo+tongu+neuromasJPG.JPG The Naunheim Files - A 60 y.o. woman is undergoing a lymph node biopsy for nightsweats and a positive TSPOT - Make it stand out neurofibromas can occur first on the tongue https://everydayebm.org/naunheim-files/2022/8/1/a-32-yo-male-presents-with-inability-to-extend-at-the-r-wrist-occurring-74-and-inability-to-extend-at-the-l-wrist-716 monthly 0.5 2022-08-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1659363225209-TFCMY33UDENGCK7KYAWV/radial+nerve+palsyJPG.JPG The Naunheim Files - A 32 yo male presents with inability to extend at the R wrist occurring 7/4 and inability to extend at the L wrist 7/16 - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1659712728318-8MAEPAALUCDVHQJCKC65/tangierwristdrop.JPG The Naunheim Files - A 32 yo male presents with inability to extend at the R wrist occurring 7/4 and inability to extend at the L wrist 7/16 - Make it stand out tangier disease causes a peripheral neuropathy and presents with orange tonsils. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1659712813348-ZWY9KVEGIR47JAKWHYAY/wrist+tanffffJPG.jpg The Naunheim Files - A 32 yo male presents with inability to extend at the R wrist occurring 7/4 and inability to extend at the L wrist 7/16 - Make it stand out peripheral neuropathy caused by cassava in Nigeria https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1659713255163-SOJ27RKKW5LWEZ0MIMKZ/wrist+drop+pic+fffJPG.JPG The Naunheim Files - A 32 yo male presents with inability to extend at the R wrist occurring 7/4 and inability to extend at the L wrist 7/16 - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/7/25/a-39-yo-woman-with-a-hx-of-chronic-renal-failure-on-dialysis-peripheral-vascular-disease-presents-with-a-3-wk-hx-of-an-enlarging-mass-over-the-upper-sternum monthly 0.5 2022-07-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1658762111791-1IFC9GM7OCA99M15DYZF/calchestct.JPG The Naunheim Files - a 39 y.o woman with a hx of chronic renal failure on dialysis, peripheral vascular disease presents with a 3 wk hx of an enlarging mass over the upper sternum. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1659023534559-HP41CB1N9X1HBAMLHUAY/ossarcJPG.JPG The Naunheim Files - a 39 y.o woman with a hx of chronic renal failure on dialysis, peripheral vascular disease presents with a 3 wk hx of an enlarging mass over the upper sternum. - Make it stand out osteosarcoma can present with calcifications in soft tissue https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1659023927535-TUFA5I6WO5EOV0OUCMXM/CALCIPHYL.JPG The Naunheim Files - a 39 y.o woman with a hx of chronic renal failure on dialysis, peripheral vascular disease presents with a 3 wk hx of an enlarging mass over the upper sternum. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1659024026579-38GXGKNACW2EHPOW7NEN/calpulmf.JPG The Naunheim Files - a 39 y.o woman with a hx of chronic renal failure on dialysis, peripheral vascular disease presents with a 3 wk hx of an enlarging mass over the upper sternum. - Make it stand out metastatic pulmonary calcification from renal disease https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1659024139738-5I6H7H9YQF0GDAXUV9EH/calcitumorcaJPG.JPG The Naunheim Files - a 39 y.o woman with a hx of chronic renal failure on dialysis, peripheral vascular disease presents with a 3 wk hx of an enlarging mass over the upper sternum. - Make it stand out tumoral calcinosis https://everydayebm.org/naunheim-files/2022/7/14/a-64yo-female-comes-in-complaining-that-she-had-a-swallow-test-and-aspirates-everything monthly 0.5 2022-07-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1658154961700-I92U5U6ME7VM164ALFZO/alsJPG.JPG The Naunheim Files - A 64y.o. female comes in complaining that she had a "swallow test and aspirates everything." - Make it stand out Why is her tongue the key to solving the case? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1658414278962-3GS4E0HHOZJD16O9IUHC/alslou.JPG The Naunheim Files - A 64y.o. female comes in complaining that she had a "swallow test and aspirates everything." - Make it stand out In Lou Gehrig’s case motor weakness in the legs was the first sign of the disease https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1658414451578-ZNMZM9JSMM9RGRUK16IA/alsvxsyringobJPG.JPG The Naunheim Files - A 64y.o. female comes in complaining that she had a "swallow test and aspirates everything." - Make it stand out A syrinx of the upper cord can mimic ALS https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1658416366635-L7W0HKUWM3XWWRYNOQIT/alsbotfff.JPG The Naunheim Files - A 64y.o. female comes in complaining that she had a "swallow test and aspirates everything." - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/7/11/a-34-yo-male-was-celebrating-the-4th-of-july-with-dynamite-he-was-setting-off-quarter-sticks-and-throwing-them-unfortunately-the-last-stick-exploded-in-his-hand monthly 0.5 2022-07-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1657548324634-PIIAHCWZD0LBLXBU7NGJ/dyna.JPG The Naunheim Files - A 34 y.o. male was celebrating the 4th of July with dynamite. he was setting off quarter sticks and throwing them. Unfortunately, the last stick exploded in his hand. - Make it stand out What is the difference between fireworks and dynamite? If you do not know please watch the video below. https://www.youtube.com/watch?v=4J2rmTOzQN8 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1657731979987-FQPUCYM5NSCDW9AMP9O1/fireworkstypesJPG.JPG The Naunheim Files - A 34 y.o. male was celebrating the 4th of July with dynamite. he was setting off quarter sticks and throwing them. Unfortunately, the last stick exploded in his hand. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1657732038780-3DJJM4Y0TKRM8MUYJ6RJ/motar+firewrist.JPG The Naunheim Files - A 34 y.o. male was celebrating the 4th of July with dynamite. he was setting off quarter sticks and throwing them. Unfortunately, the last stick exploded in his hand. - Make it stand out an exploding mortar was being held in his hand causing near amputation at the wrist https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1657732128972-CUVCN29GGKBE27VWRJ51/fireworkslid.JPG The Naunheim Files - A 34 y.o. male was celebrating the 4th of July with dynamite. he was setting off quarter sticks and throwing them. Unfortunately, the last stick exploded in his hand. - Make it stand out A burn through the lid from a Roman candle https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1657732221815-XQPN5X8E8D7XS0RGVVE0/dynpins.JPG The Naunheim Files - A 34 y.o. male was celebrating the 4th of July with dynamite. he was setting off quarter sticks and throwing them. Unfortunately, the last stick exploded in his hand. - Make it stand out there was a deep laceration almost completely through the palm and the thumb was reattached https://everydayebm.org/naunheim-files/2022/7/4/two-firefighters-attempted-to-set-the-bead-on-a-flat-tire-by-using-ether-they-arrived-in-the-ed-with-facial-burns monthly 0.5 2022-07-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1656947299145-6982TP53SI3XW29BQD58/flashburnfffJPG.JPG The Naunheim Files - Two firefighters attempted to "set the bead" on a flat tire by using ether. They arrived in the ED with facial burns. - Make it stand out If you have not seen this please view the attached utube video https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1657127770412-HKHEIXGF580OTEXX93J3/burnsJPG.JPG The Naunheim Files - Two firefighters attempted to "set the bead" on a flat tire by using ether. They arrived in the ED with facial burns. - Make it stand out Full thickness burns are usually painless because nerves in the skin are destroyed https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1657128280368-S9B9HKJ5B4ZDWP2OZ9PO/burnslichfffJPG.JPG The Naunheim Files - Two firefighters attempted to "set the bead" on a flat tire by using ether. They arrived in the ED with facial burns. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1657128328921-DHO62RHWQGB8RVO8N2TT/burns+keratitis.JPG The Naunheim Files - Two firefighters attempted to "set the bead" on a flat tire by using ether. They arrived in the ED with facial burns. - Make it stand out fluorescein uptake in welder’s keratitis https://everydayebm.org/naunheim-files/2022/6/27/a-37-yo-woman-presents-with37-yo-female-sp-robotic-assisted-myomectomy-six-weeks-pta-presents-with-1-day-of-abd-pain-nausea-and-vomiting monthly 0.5 2022-06-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1656340761631-YPHE986ZAHP5QUZGYQVC/v+lock+ct.JPG The Naunheim Files - A 37 y.o. woman s/p robotic assisted myomectomy six weeks pta, presents with 1 day of abd pain, nausea and vomiting - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1656603195503-NSBHS1JBS78LY49SPAVV/vlocfinalJPG.JPG The Naunheim Files - A 37 y.o. woman s/p robotic assisted myomectomy six weeks pta, presents with 1 day of abd pain, nausea and vomiting - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1656603242702-O0K2ECDE2A6FFECR5T8Q/vloc+sbo+causesJPG.JPG The Naunheim Files - A 37 y.o. woman s/p robotic assisted myomectomy six weeks pta, presents with 1 day of abd pain, nausea and vomiting - Make it stand out Port hernias can be found to cause bowel obstruction after laparoscopic surgery https://everydayebm.org/naunheim-files/2022/6/20/a-38-yo-woman-who-sp-craniopharyngioma-resection-and-is-panhypopit-twisted-her-ankle monthly 0.5 2022-06-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1655760721562-VPLJMOPYHTYKI086K8XO/weberxfff.jpg The Naunheim Files - A 38 y.o. woman who sp craniopharyngioma resection and is panhypopit twisted her ankle. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1656027486166-AXY9YZPZ6I4LYE2TGP8T/weber+B+diag.JPG The Naunheim Files - A 38 y.o. woman who sp craniopharyngioma resection and is panhypopit twisted her ankle. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1656027634794-JLNLIX9V2BTL6ZD4GSYQ/weberbsyn.JPG The Naunheim Files - A 38 y.o. woman who sp craniopharyngioma resection and is panhypopit twisted her ankle. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/6/13/a-22-yo-woman-presents-with-a-chief-complaint-of-blue-things-seem-to-be-neon-colored-and-too-bright monthly 0.5 2022-06-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1655130466977-J6HE1UVN9LYDTFGY6EFQ/braintumor1.JPG The Naunheim Files - A 22 y.o. woman presents with a chief complaint of "blue things seem to be neon colored and too bright" - Make it stand out there appears to be a mass in the frontal lobe in the midline https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1655130507464-OCIMD0N8K8YEIH75A3YC/braintumor2JPG.JPG The Naunheim Files - A 22 y.o. woman presents with a chief complaint of "blue things seem to be neon colored and too bright" - Make it stand out and the mass extends down into the sinuses https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1655387195868-4CRO5RVJLAUFQ0NLDN27/sinoffffJPG.JPG The Naunheim Files - A 22 y.o. woman presents with a chief complaint of "blue things seem to be neon colored and too bright" - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1655387255659-G4XOVD4TPG21FW8SLLYI/sinomidlinegran.JPG The Naunheim Files - A 22 y.o. woman presents with a chief complaint of "blue things seem to be neon colored and too bright" - Make it stand out lymphoma aka “lethal midline granuloma” https://everydayebm.org/naunheim-files/2022/6/10/a-17-yo-female-came-to-the-ed-with-vertical-gaze-paralysis monthly 0.5 2022-06-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1654875938155-OYX80CCO1K6YK63MCWMN/post+comfff.jpg The Naunheim Files - A 17 y.o. female came to the ED with vertical gaze paralysis - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1654876733304-SHXV9VEA6WPFBC78E75B/og.JPG The Naunheim Files - A 17 y.o. female came to the ED with vertical gaze paralysis - Make it stand out CLICK FOR VIDEO https://everydayebm.org/naunheim-files/2022/5/30/a-40-woman-was-run-over-by-her-own-truck-52-and-returns-523-with-swelling-of-the-thigh monthly 0.5 2022-06-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1653920728785-4FHXELSHUPXR0CER8UX5/ml1JPG.JPG The Naunheim Files - A 40 woman was run over by her own truck 5/2 and returns 5/23 with swelling of the thighTh - Make it stand out hint: there is no femur fracture https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1653920759381-Q0COSZQIO6Z6KL6MU4OB/ml2.jpg The Naunheim Files - A 40 woman was run over by her own truck 5/2 and returns 5/23 with swelling of the thighTh - Make it stand out the arrows point to the pathology https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1654185532703-VLDSY9WNU9GS4KA11GZ0/mlthe+man.JPG The Naunheim Files - A 40 woman was run over by her own truck 5/2 and returns 5/23 with swelling of the thighTh - Make it stand out Dr. Morel-Lavelle never became department chair https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1654185867431-ZMT8X613HCPTI488BBW9/mlMRIJPG.JPG The Naunheim Files - A 40 woman was run over by her own truck 5/2 and returns 5/23 with swelling of the thighTh - Make it stand out MRI is the best imaging technique https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1654185954070-H1NHVL970R293V81WI9A/ml+fat+fracture.JPG The Naunheim Files - A 40 woman was run over by her own truck 5/2 and returns 5/23 with swelling of the thighTh - Make it stand out fat fracture on US. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1654186012186-I8TAA7KFW3SDST6EJPQY/mlUS+thigh.JPG The Naunheim Files - A 40 woman was run over by her own truck 5/2 and returns 5/23 with swelling of the thighTh - Make it stand out note the clear fluid collection in our patient as opposed to the fat fracture above. https://everydayebm.org/naunheim-files/2022/5/23/a-43-yo-17-wk-pregnant-woman-comes-to-the-ed-after-an-mvc-she-was-a-restrained-driver-t-boned-on-the-passengers-side-and-co-pain-in-the-chest-and-abdomen monthly 0.5 2022-05-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1653313427250-SQT0QDU6AUWELQK01HOU/molctabd.JPG The Naunheim Files - A 43 y.o. 17 wk pregnant woman comes to the ED after an MVC. She was a restrained driver T-boned on the passengers side and co pain in the chest and abdomen. - Make it stand out A CT of the chest was also done because of the nodules https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1653313503263-MG7JH1RRDVE68JJBRI5L/molCT+chest.JPG The Naunheim Files - A 43 y.o. 17 wk pregnant woman comes to the ED after an MVC. She was a restrained driver T-boned on the passengers side and co pain in the chest and abdomen. - Make it stand out more nodules were noted https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1653313539837-NXZQC8PFXPRLQLQBNMLZ/molus.JPG The Naunheim Files - A 43 y.o. 17 wk pregnant woman comes to the ED after an MVC. She was a restrained driver T-boned on the passengers side and co pain in the chest and abdomen. - Make it stand out What did the US of the uterus show? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1653579364476-S46YRJOGNK858AUTA78N/mole+p57.JPG The Naunheim Files - A 43 y.o. 17 wk pregnant woman comes to the ED after an MVC. She was a restrained driver T-boned on the passengers side and co pain in the chest and abdomen. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1653579413237-2DB4B1O76G2CRMCIO9RY/molepath.JPG The Naunheim Files - A 43 y.o. 17 wk pregnant woman comes to the ED after an MVC. She was a restrained driver T-boned on the passengers side and co pain in the chest and abdomen. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/5/16/a-65-yo-quadriparetic-male-fell-and-comes-to-the-ed-for-evaluation monthly 0.5 2022-05-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1652710385801-1H12S8L0FH2YNN5F92JB/rachitic.JPG The Naunheim Files - A 65 y.o. quadriparetic male fell and comes to the ED for evaluation - Make it stand out hint below https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1652710417770-S1LKMUOJ3QCNZ4C6ZJC8/rachiticattcxr.jpg The Naunheim Files - A 65 y.o. quadriparetic male fell and comes to the ED for evaluation - Make it stand out What are those nodules? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1652975028528-I1FDYG5R5M5IR6AQS7U1/rachitic.JPG The Naunheim Files - A 65 y.o. quadriparetic male fell and comes to the ED for evaluation - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1652975086131-WWUKIS9TX4C0L6NAYEJA/rachiticthal.JPG The Naunheim Files - A 65 y.o. quadriparetic male fell and comes to the ED for evaluation - Make it stand out In thalassemia the marrow expands causing the ribs to widen https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1652975240218-9UAZZPE66WUFCVCMZBE2/rachiticscurvy.JPG The Naunheim Files - A 65 y.o. quadriparetic male fell and comes to the ED for evaluation - Make it stand out perifollicular hemorrhages, bleeding gums and bone pain are often seen in scurvy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1652975332804-N9LZZNPXXHP2RFE73ZW5/vit+def+years.PNG The Naunheim Files - A 65 y.o. quadriparetic male fell and comes to the ED for evaluation - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/5/9/a-22-yo-who-works-at-the-ballpark-comes-in-with-a-pruritic-rash-which-has-been-present-for-three-weeks monthly 0.5 2022-05-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1652103005590-SQUDCNMGH5HUSC5QSSY6/pityf.JPG The Naunheim Files - A 22 y.o. who works at the ballpark comes in with a pruritic rash which has been present for three weeks. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1652103035175-0M7XX62CJNSLTKDW96V0/pity2.JPG The Naunheim Files - A 22 y.o. who works at the ballpark comes in with a pruritic rash which has been present for three weeks. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1652452137066-ZF8NV16QG9P46JV04VJ8/PRXMAS+TREE.JPG The Naunheim Files - A 22 y.o. who works at the ballpark comes in with a pruritic rash which has been present for three weeks. - Make it stand out the rash can follow rib lines “A Christmas tree “ rash. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1652452254891-1LELB1QC0G435QT5SI6X/prsypilis.JPG The Naunheim Files - A 22 y.o. who works at the ballpark comes in with a pruritic rash which has been present for three weeks. - Make it stand out syphilis can mimic pityriasis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1652452325064-E37DGNE4T7KESKM4C4SY/pr+lichen+pPG.JPG The Naunheim Files - A 22 y.o. who works at the ballpark comes in with a pruritic rash which has been present for three weeks. - Make it stand out lichen planus is another scaly rash https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1652452527769-JEBOV5ZKNL4CTBVCK37C/pridfff.JPG The Naunheim Files - A 22 y.o. who works at the ballpark comes in with a pruritic rash which has been present for three weeks. - Make it stand out The Id reaction occurs as hypersensitivity to fungus as in this 17 y.o. The fungus must be treated. https://everydayebm.org/naunheim-files/2022/5/2/a-44-yo-was-accepted-in-transfer-from-an-outside-ed-where-he-was-being-treated-for-cellulitis monthly 0.5 2022-05-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1651499903500-TBPJONM776GYTJ2OAU2O/nf1JPG.JPG The Naunheim Files - A 44 y.o was accepted in transfer from Christian NW health care center where he was being treated for cellulitis. - Make it stand out What is the next step? antibiotics were added: clinda and vanc and…….. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1651781276126-IX6AG6M55VWWN4RVJLGL/nf+ct.JPG The Naunheim Files - A 44 y.o was accepted in transfer from Christian NW health care center where he was being treated for cellulitis. - Make it stand out CT scan of our patient showing gas in the tissue. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1651836123237-19SV2Z626FY6T1KKOMG9/nf2.JPG The Naunheim Files - A 44 y.o was accepted in transfer from Christian NW health care center where he was being treated for cellulitis. - Make it stand out following multiple debridements over one month , the arm was finally amputated. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1651836927879-PZ1AU9IYJ8PMCONYWVHE/vibriovul.JPG The Naunheim Files - A 44 y.o was accepted in transfer from Christian NW health care center where he was being treated for cellulitis. - Make it stand out This 71 y.o. man was eating raw seafood and contracted Vibrio vulnificus https://everydayebm.org/naunheim-files/2022/4/25/a-43-yo-male-presents-with-eye-pain monthly 0.5 2022-04-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1650899984892-O6PZZ6XRN0N1TWGTQ4U4/keratoff.jpg The Naunheim Files - A 43 y.o. male presents with eye pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1651162793438-WHBZLW7ZKMR9YRMO22FA/kerateyefff.JPG The Naunheim Files - A 43 y.o. male presents with eye pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1651164214253-J0TPJKMV7VXVJWFORFB9/kerlayersffffff.JPG The Naunheim Files - A 43 y.o. male presents with eye pain - Make it stand out Layers of the cornea https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1651164394617-IIMEUFMXBU1UR8V111Q2/ketatohydropsff.JPG The Naunheim Files - A 43 y.o. male presents with eye pain - Make it stand out A white patch appears on the cornea in keratoconus with hydrops. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1651165084896-IL3EPEIV2K0VUJ9LPTIM/kerscleral+lens.JPG The Naunheim Files - A 43 y.o. male presents with eye pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/4/18/a-20-yo-male-comes-in-with-a-rash-on-his-ears-and-swelling-of-the-hands-and-feet monthly 0.5 2022-04-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1650292723912-CN96Q5TDFEPRWS24QQSY/ear.JPG The Naunheim Files - A 20 y.o. male comes in with a rash on his ears and swelling of the hands and feet. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1650472474247-KH3XL4DE1IWT5IA7CFRY/lupus+juvenile+spring+.JPG The Naunheim Files - A 20 y.o. male comes in with a rash on his ears and swelling of the hands and feet. - Make it stand out Juvenile spring eruption https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1650472580958-JQUX23FH3OCPZQ44617T/lupuslime.JPG The Naunheim Files - A 20 y.o. male comes in with a rash on his ears and swelling of the hands and feet. - Make it stand out Lime is a well known photosensitizer https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1650472655332-P2KBTIJU4ILX5BTSSGIC/lupus+pcthivJPG.JPG The Naunheim Files - A 20 y.o. male comes in with a rash on his ears and swelling of the hands and feet. - Make it stand out HIV associated with porphyria cutanea tarda https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1650472716761-1Y3UJSFCX86DE45HAVHF/lupus+pellagra+hands.JPG The Naunheim Files - A 20 y.o. male comes in with a rash on his ears and swelling of the hands and feet. - Make it stand out Pellagra (niacin deficiency ) is also associated with photosensitivity https://everydayebm.org/naunheim-files/2022/4/11/an-80-yo-male-with-a-hx-of-colonic-volvulus-presents-with-severe-abdominal-pain-while-driving-home-from-work monthly 0.5 2022-04-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1649687517565-7IJ88T7BO5368PHQWS36/volvulus1.JPG The Naunheim Files - An 80 y.o. male with a hx of colonic volvulus presents with severe abdominal pain while driving home from work. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1649951711418-DY74QWXEZ7BTH1JYNNB8/volsig.JPG The Naunheim Files - An 80 y.o. male with a hx of colonic volvulus presents with severe abdominal pain while driving home from work. - Make it stand out The coffee bean sign of sigmoid volvulus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1649951760970-AEALZM8THCL6BQRBX2LD/volcecal.JPG The Naunheim Files - An 80 y.o. male with a hx of colonic volvulus presents with severe abdominal pain while driving home from work. - Make it stand out A cecal volulus often appears in the LUQ and the cecum is> 9 cm. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1649952042355-ZUI3566JMX8AZO0A1R5H/volvulusladds.JPG The Naunheim Files - An 80 y.o. male with a hx of colonic volvulus presents with severe abdominal pain while driving home from work. - Make it stand out Ladd’s bands https://everydayebm.org/naunheim-files/2022/4/4/a-69-yo-female-with-allergies-comes-to-the-ed-with-something-in-her-eye monthly 0.5 2022-04-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1649081038745-1GMI8LINR1Q7JKVGVHS4/eyesquamJPG.JPG The Naunheim Files - A 69 y.o. female with allergies comes to the ED with "something in her eye" - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1649433007658-29FZWVBQSK1PJG40V2TY/hpv+papilloma.JPG The Naunheim Files - A 69 y.o. female with allergies comes to the ED with "something in her eye" - Make it stand out hpv papilloma of the conjunctiva https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1649434448366-5GAR3DMCP2YS8VVCXA2I/eyepterygium.JPG The Naunheim Files - A 69 y.o. female with allergies comes to the ED with "something in her eye" - Make it stand out A pterygium grows on to the cornea https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1649434517927-3SRGKRAI1QNWXICBZJL0/eyepinguec.JPG The Naunheim Files - A 69 y.o. female with allergies comes to the ED with "something in her eye" - Make it stand out pinguecula does not affect the cornea https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1649434670276-RNFCHAKC7C877S1RDOAF/eyesqssoctfffJPG.JPG The Naunheim Files - A 69 y.o. female with allergies comes to the ED with "something in her eye" - Make it stand out the arrow points to the hyperreflective epithelium characteristic of cancer invasion. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1649435001449-P8H6IM3WIUDNYKXMMB8L/eyemelan.JPG The Naunheim Files - A 69 y.o. female with allergies comes to the ED with "something in her eye" - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/3/28/a-39-yo-male-presented-with-l-arm-and-l-leg-weakness-after-a-nurse-started-his-iv monthly 0.5 2022-03-31 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1648478250267-65KI2N0SD6YK0BGC30AB/clubbingfingersJPG.JPG The Naunheim Files - A 39 y.o. male presented with L arm and L leg weakness after a nurse started his IV. - Make it stand out Why did this happen? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1648737473792-EL4QS4MVKSOPXJ7D8ZAK/clubbin+surg1JPG.JPG The Naunheim Files - A 39 y.o. male presented with L arm and L leg weakness after a nurse started his IV. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1648737579099-245CKZXDEZFDM6V2ST9R/clubbing+surgery+2.JPG The Naunheim Files - A 39 y.o. male presented with L arm and L leg weakness after a nurse started his IV. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1648737724678-XSJ294W7KCESQKQR3RP3/clubbing+surgery+3.JPG The Naunheim Files - A 39 y.o. male presented with L arm and L leg weakness after a nurse started his IV. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1648737784160-747ISGGF6UIXCKDNLH8V/clubbing+pall.JPG The Naunheim Files - A 39 y.o. male presented with L arm and L leg weakness after a nurse started his IV. - Make it stand out Pall filter https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1648737829860-O1DYN8WJCQXHRGBMU6M5/clubbing+pachyJPG.JPG The Naunheim Files - A 39 y.o. male presented with L arm and L leg weakness after a nurse started his IV. - Make it stand out pachydermoperiostosis https://everydayebm.org/naunheim-files/2022/3/22/a-48-yo-male-with-sickle-cell-anemia-was-found-unconscious-with-a-temp-of-386 monthly 0.5 2022-03-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1647957415622-W2N8GFYISZNW5DJ2XPNE/moyct2.JPG The Naunheim Files - A 48 y.o. male with sickle cell anemia was found unconscious with a temp of 38.6. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1647957455993-772OG2W54FA1W0SVQ7SL/moya+cta.JPG The Naunheim Files - A 48 y.o. male with sickle cell anemia was found unconscious with a temp of 38.6. - Make it stand out there appears to be a basal ganglia bleed; but what is going on in the lower image? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1648132903149-3BLAPUHD9DNRC9IN06RP/moya+nl+vs+not.JPG The Naunheim Files - A 48 y.o. male with sickle cell anemia was found unconscious with a temp of 38.6. - Make it stand out The abnormal arteriogram of an 11 y.o. is on the L, the normal is on the R https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1648133274050-IFYN9GFB2YPNLEHS7NQK/moyatuber.JPG The Naunheim Files - A 48 y.o. male with sickle cell anemia was found unconscious with a temp of 38.6. - Make it stand out angiofibromas are associated with tuberous sclerosis and moyamoya https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1648133381866-MFLWCRDUQMA30KUP1K17/moyaitoJPG.JPG The Naunheim Files - A 48 y.o. male with sickle cell anemia was found unconscious with a temp of 38.6. - Make it stand out areas of hypopigmentation first described by Ito are associated with a genetic form of moyamoya https://everydayebm.org/naunheim-files/2022/3/14/a-69-yo-woman-with-diabetes-and-hypertension-presents-with-rapidly-progressive-dementia-over-4-6-months monthly 0.5 2022-03-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1647267865939-TE5E3MUPFW3HCHODEVFF/cjdis.JPG The Naunheim Files - A 69 y.o. woman with diabetes and hypertension presents with rapidly progressive dementia over 4-6 months. - Make it stand out There is marked cerebral volume loss https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1647267892534-GXP3K8RQZW294FAMRD0G/cjT2flairJPG.JPG The Naunheim Files - A 69 y.o. woman with diabetes and hypertension presents with rapidly progressive dementia over 4-6 months. - Make it stand out Hint: she has no evidence of a stroke and FLAIR signal in several cortical regions https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1647464132532-VSHC4UBB2H2RBXV7AQRA/cjrein.JPG The Naunheim Files - A 69 y.o. woman with diabetes and hypertension presents with rapidly progressive dementia over 4-6 months. - Make it stand out chronic wasting disease is a prion disease found in reindeer. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1647464259084-W8EZYL09H4YIIBA07NWI/cjbrain.JPG The Naunheim Files - A 69 y.o. woman with diabetes and hypertension presents with rapidly progressive dementia over 4-6 months. - Make it stand out the disease is called a spongiform encephalopathy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1647464318498-BMKV9IPEDEVU3UP79GSC/cjprion+-+Copy.JPG The Naunheim Files - A 69 y.o. woman with diabetes and hypertension presents with rapidly progressive dementia over 4-6 months. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/3/7/a-28-yo-woman-with-a-six-month-history-of-itching-multiple-ed-visits-and-treatments-including-hydroxynzine-famotidine-and-triamcinolone-comes-in-again-with-itching monthly 0.5 2022-03-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1646666211668-23XK7JNGT9IH94NPDRWS/hod.JPG The Naunheim Files - A 28 y.o. woman with a six month history of "itching" ; multiple ED visits and treatments including hydroxyzine, famotidine and triamcinolone comes in again with itching. - Make it stand out What did he find? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1646852157423-JVZLA38GHKB3Y1TUB2QX/hod4prurigoJPG.JPG The Naunheim Files - A 28 y.o. woman with a six month history of "itching" ; multiple ED visits and treatments including hydroxyzine, famotidine and triamcinolone comes in again with itching. - Make it stand out prurigo nodularis is a result of scratching not a primary skin lesion https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1646852233388-ELWNJW7Q9PWNPPDAGE59/hod5lichen.JPG The Naunheim Files - A 28 y.o. woman with a six month history of "itching" ; multiple ED visits and treatments including hydroxyzine, famotidine and triamcinolone comes in again with itching. - Make it stand out Lichen simplex chronicus is lichenification of the skin due to constant scratching https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1646852664291-RI3SFGH83RYGN8UONPCX/hod6.JPG The Naunheim Files - A 28 y.o. woman with a six month history of "itching" ; multiple ED visits and treatments including hydroxyzine, famotidine and triamcinolone comes in again with itching. - Make it stand out Scabies also causes severe itching https://everydayebm.org/naunheim-files/2022/2/28/a-78-yo-male-with-dementia-presents-with-two-months-of-rhinorrhea-unresponsive-to-antihistamines monthly 0.5 2022-03-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1646062154398-SDF8V6BYZPH6UD9WQ2TP/csf+.JPG The Naunheim Files - A 78 y.o. male with dementia presents with two months of rhinorrhea unresponsive to antihistamines. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1646324524504-B5GNUAYOWVAN5J4N2LA8/cribricoronalfff.jpg The Naunheim Files - A 78 y.o. male with dementia presents with two months of rhinorrhea unresponsive to antihistamines. - Make it stand out the cribriform plate https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1646324587312-3TKO3MZ53DYDBCDDYYUV/csf+cribriform.JPG The Naunheim Files - A 78 y.o. male with dementia presents with two months of rhinorrhea unresponsive to antihistamines. - Make it stand out because of its proximity to the frontal and ethmoid sinuses infection can cause erosion of the cribriform plate https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1646324736617-G8D1HRKNZSIRIO4Q45NP/pneumomt+fuji.JPG The Naunheim Files - A 78 y.o. male with dementia presents with two months of rhinorrhea unresponsive to antihistamines. - Make it stand out The mt fuji sign of tension pneumocephalus https://everydayebm.org/naunheim-files/2022/2/21/a-60-yo-male-with-a-hx-of-l-inguinal-hernia-for-20-years-comes-in-the-scrotal-swelling monthly 0.5 2022-02-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1645457976750-U7409D56WDHYSP0IQRZ5/hernia.png The Naunheim Files - A 60 y.o. male with a hx of L inguinal hernia for 20 years comes in the scrotal swelling - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1645458082553-HNXBZYAXUGUEYTF04BRO/hernia2.JPG The Naunheim Files - A 60 y.o. male with a hx of L inguinal hernia for 20 years comes in the scrotal swelling - Make it stand out A CT scan was done https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1645640883009-4UVGJGIVDZ8ZE2CDWY6K/hernia+eleJPG.JPG The Naunheim Files - A 60 y.o. male with a hx of L inguinal hernia for 20 years comes in the scrotal swelling - Make it stand out In the elephant the testes are inside the body and this is felt to be due to gene mutations late in the evolution of mammals. They belong to Afrotheria as do manatees. The defect is in gene RXFP2. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1645641098621-PMBUBQKF6O14BPHMP76V/hernia+colorJPG.JPG The Naunheim Files - A 60 y.o. male with a hx of L inguinal hernia for 20 years comes in the scrotal swelling - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1645641185587-AGVESP60R3BPERUO8000/hernia+types.JPG The Naunheim Files - A 60 y.o. male with a hx of L inguinal hernia for 20 years comes in the scrotal swelling - Make it stand out femoral hernias are more common in women https://everydayebm.org/naunheim-files/2022/2/14/a-59-yo-woman-presents-with-painful-swallowing-and-a-blistering-rash monthly 0.5 2022-02-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1644852434627-A5O1D7ANVTE0VCZRJC94/eb.JPG The Naunheim Files - A 59 y.o. woman presents with painful swallowing and a blistering rash. - Make it stand out R leg https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1644852466003-82AUUDYLAHKAB05YE27Z/eb2.JPG The Naunheim Files - A 59 y.o. woman presents with painful swallowing and a blistering rash. - Make it stand out Left leg https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1645120388329-F3NQ0P6RQZOWS8ERAMAT/ebpct.JPG The Naunheim Files - A 59 y.o. woman presents with painful swallowing and a blistering rash. - Make it stand out porphyria cutanea tarda https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1645120579076-NPTKX4CJQFHC1T3CWRO0/eb+vari.JPG The Naunheim Files - A 59 y.o. woman presents with painful swallowing and a blistering rash. - Make it stand out Varicella in an immunocompetent patient can rarely be very severe as shown above. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1645120729532-36H84DJ5MEF7VB886FUJ/ebgraft.JPG The Naunheim Files - A 59 y.o. woman presents with painful swallowing and a blistering rash. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/2/7/an-87-yo-woman-presents-after-a-bout-of-svt-converted-with-adenosine-by-ems-she-now-has-abdominal-bloating monthly 0.5 2022-02-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1644247916771-DKQN9R4OTBZ5P8T4E8U2/ischemic+bowel.JPG The Naunheim Files - An 87 y.o. woman presents after a bout of SVT converted with adenosine by EMS. She now has abdominal bloating - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1644437065849-K15J6P5L19KKZY89WM9J/ischemic+bowel.JPG The Naunheim Files - An 87 y.o. woman presents after a bout of SVT converted with adenosine by EMS. She now has abdominal bloating - Make it stand out bowel wall thickening noted at the splenic flexure https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1644437217543-RAGJZ16BTYNN03GDW9JW/ischemic+supvs+inferanatJPG.JPG The Naunheim Files - An 87 y.o. woman presents after a bout of SVT converted with adenosine by EMS. She now has abdominal bloating - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1644437367231-B5XN7857DM0M45ETEJHK/bowelischevenous+vs+art.JPG The Naunheim Files - An 87 y.o. woman presents after a bout of SVT converted with adenosine by EMS. She now has abdominal bloating - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/1/31/a-2-yowith-a-history-of-medium-chain-acyl-coa-dehydrogenase-deficiency-presents-with-neck-pain-after-falling-from-the-bottom-bunk monthly 0.5 2022-02-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1643644655819-V8PVB35ZY93MIATFMGHS/epidwith+hemorrhage.JPG The Naunheim Files - A 2 y.o. with a history of Medium-chain acyl-CoA dehydrogenase deficiency presents with neck pain after falling from the bottom bunk - Make it stand out The patient refused to move his neck because of pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1643825349776-YRM0RPET1I5ERO6UFSJG/epidual+fff.JPG The Naunheim Files - A 2 y.o. with a history of Medium-chain acyl-CoA dehydrogenase deficiency presents with neck pain after falling from the bottom bunk - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1643825450918-AC8XK783PIZ2NCRPAVHQ/epidural+anatomyreal.JPG The Naunheim Files - A 2 y.o. with a history of Medium-chain acyl-CoA dehydrogenase deficiency presents with neck pain after falling from the bottom bunk - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1643825497726-2NWYRMECHDJKGBPPBCL6/epidural+hematomaMRI+STAR.JPG The Naunheim Files - A 2 y.o. with a history of Medium-chain acyl-CoA dehydrogenase deficiency presents with neck pain after falling from the bottom bunk - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1643825558233-605ZNCW39Y9FB74KDGZY/epidural+mri+of+blood.JPG The Naunheim Files - A 2 y.o. with a history of Medium-chain acyl-CoA dehydrogenase deficiency presents with neck pain after falling from the bottom bunk - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/1/24/a-41-yo-male-presents-with-fatigue-fever-body-aches-and-jaundice monthly 0.5 2022-01-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1643040437221-DLR42SV4AVDLIP550W04/malaria.JPG The Naunheim Files - A 41 y.o. male presents with fatigue, fever , body aches and jaundice - Make it stand out bilateral patchy infiltrates are seen in the lower lobes. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1643299748791-XAXTOCEP1D39RITNUCXF/malarirbc.JPG The Naunheim Files - A 41 y.o. male presents with fatigue, fever , body aches and jaundice - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1643299810422-58OD5XMN7GTJDMZPYC8R/malalifecycle.JPG The Naunheim Files - A 41 y.o. male presents with fatigue, fever , body aches and jaundice - Make it stand out The asexual stage is most relevant for human disease: beginning in the liver and then infecting RBCs https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1643299938395-PUVJX8P70D3UTM1XBLYL/malariausf.JPG The Naunheim Files - A 41 y.o. male presents with fatigue, fever , body aches and jaundice - Make it stand out Quinine tonic was manufactured in St. Louis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1643300062198-E81VBMW47O0RP60N2N3C/malaria+tonicJPG.JPG The Naunheim Files - A 41 y.o. male presents with fatigue, fever , body aches and jaundice - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/1/17/a-21-yo-male-arrives-from-a-motor-vehicle-collison-he-is-unresponsive-being-bagged-he-is-hypotensive-and-hypoxic monthly 0.5 2022-01-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1642434194819-F1KQ4Y35CNBE50OMFOJP/lungs.JPG The Naunheim Files - A 21 y.o. male arrives from a motor vehicle collision . He is unresponsive, being bagged. He is hypotensive and hypoxic. - Make it stand out What do you think happened.? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1642434272965-QXOIJ88VMRTVK2BSHPA6/lungsbrainJPG.JPG The Naunheim Files - A 21 y.o. male arrives from a motor vehicle collision . He is unresponsive, being bagged. He is hypotensive and hypoxic. - Make it stand out he has an abrasion on the L forehead; do you notice anything on his head CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1642696732858-VBAP8VL8PSMCJSZ9JC8Z/rasmussenfffJPG.jpg The Naunheim Files - A 21 y.o. male arrives from a motor vehicle collision . He is unresponsive, being bagged. He is hypotensive and hypoxic. - Make it stand out A Rasmussen’s aneusym caused by Tbc can cause massive hemoptysis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1642696872457-DOTFRL4CR8NRC9KQMXDB/tilapiafffJPG.JPG The Naunheim Files - A 21 y.o. male arrives from a motor vehicle collision . He is unresponsive, being bagged. He is hypotensive and hypoxic. - Make it stand out Fun fact; multiple cases of fisherman aspirating live fish have been reported. In the image below a fisherman died from aspirating a tilapia which lodged at the bifurcation causing anoxia. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1642697148403-NPMYB08VP3IAF0GCSUF3/greywhiteJPG.JPG The Naunheim Files - A 21 y.o. male arrives from a motor vehicle collision . He is unresponsive, being bagged. He is hypotensive and hypoxic. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2022/1/10/a-43-yo-opiod-user-comes-in-with-a-painful-heel-after-stepping-on-a-nail-on-a-railroad-track monthly 0.5 2022-01-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1641830419481-M7AXXR8MKNKBIAIXFRRO/heel.JPG The Naunheim Files - A 43 y.o. opiod user comes in with a painful heel after stepping on a nail on a railroad track. - Make it stand out the patient is incidentally COVID + https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1642087640791-92C4ZVKTU2MNQRJNUADX/blisters+cockfff.JPG The Naunheim Files - A 43 y.o. opiod user comes in with a painful heel after stepping on a nail on a railroad track. - Make it stand out cocksackie blisters on the palate https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1642087728189-U0FKRSFLH28EAG0SZ8IL/blistersnecfasfffJPG.JPG The Naunheim Files - A 43 y.o. opiod user comes in with a painful heel after stepping on a nail on a railroad track. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1642089873788-7CF2C20B684PYXFINP2T/blister+after+clinda.JPG The Naunheim Files - A 43 y.o. opiod user comes in with a painful heel after stepping on a nail on a railroad track. - Make it stand out after 4 days of clinda and debridement https://everydayebm.org/naunheim-files/2022/1/3/a-36-yo-woman-with-hgb-sc-presents-with-heavy-vaginal-bleeding-requiring-transfusion monthly 0.5 2022-01-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1641222954289-5IFOBPPB381VNZK5Y8F4/uterineavm.JPG The Naunheim Files - A 36 yo woman with Hgb SC presents with heavy vaginal bleeding requiring transfusion - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1641481957780-JHKJE2Q1OAA5MXE2SIHJ/uterineavmfff.jpg The Naunheim Files - A 36 yo woman with Hgb SC presents with heavy vaginal bleeding requiring transfusion - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1641482032263-W5FIKQEDSSHTXGKTR3JJ/UTERINE+AVM+USJPG.JPG The Naunheim Files - A 36 yo woman with Hgb SC presents with heavy vaginal bleeding requiring transfusion - Make it stand out Uterine AVM can also be diagnosed on US https://everydayebm.org/naunheim-files/2021/12/27/a-64-yo-male-presented-with-a-temporal-bone-fracture-and-subdural-requiring-craniectomy-for-increasing-pressure monthly 0.5 2021-12-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1640618427664-O1TFZTUZZK8FNVY1M2CR/treph1a.JPG The Naunheim Files - A 64 y.o. male presented with a temporal bone fracture and subdural requiring craniectomy for increasing pressure. - Make it stand out the temporal bone fracture https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1640618460720-QE0VX97ZQK9VJ30YTIJS/treph1b.JPG The Naunheim Files - A 64 y.o. male presented with a temporal bone fracture and subdural requiring craniectomy for increasing pressure. - Make it stand out The subdural requiring craniectomy for increasing pressure. The pt recovered and was discharged after surgery https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1640618524713-GH144S125GVCM5C80FXI/trephjan.JPG The Naunheim Files - A 64 y.o. male presented with a temporal bone fracture and subdural requiring craniectomy for increasing pressure. - Make it stand out He returned six months later with a shift of the midline and altered mental status. What needs to be done? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1640884262098-1E93PX0XBKGZY10Y7K1B/trephancientff.JPG The Naunheim Files - A 64 y.o. male presented with a temporal bone fracture and subdural requiring craniectomy for increasing pressure. - Make it stand out This Neolithic skull is rounded off by a growth of new bone indicating the patient survived the operation. The Inca were particularly skilled at the procedure with a survival rate of 75%. Less skilled were Civil War physicians who performed the procedure routinely on head wounds with a survival of 46%. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1640884344327-IS18G1BFREVYEJ8KGFM0/trephtool+french.JPG The Naunheim Files - A 64 y.o. male presented with a temporal bone fracture and subdural requiring craniectomy for increasing pressure. - Make it stand out French trephination tool https://everydayebm.org/naunheim-files/2021/12/20/a-24-yo-woman-with-a-hx-of-congenital-heart-disease-and-complete-heart-block-comes-in-for-dental-pain monthly 0.5 2021-12-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1640012369613-F6QAKXGQ71ITYBI5DPUJ/pacemalffffffe.JPG The Naunheim Files - A 24 y.o. woman with a hx of congenital heart disease and complete heart block comes in for dental pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1640012458254-PN589KZN0ZH03O2XXZF6/pacemalcxr.JPG The Naunheim Files - A 24 y.o. woman with a hx of congenital heart disease and complete heart block comes in for dental pain - Make it stand out Hint: the answer is on the cxr https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1640282601624-ED9BK7RKJKUDMY7408AZ/pacer+cxrarrow.JPG The Naunheim Files - A 24 y.o. woman with a hx of congenital heart disease and complete heart block comes in for dental pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1640282679931-L0DDGFQNZ7RZWVJB8KPO/pacemaker+leadless.JPG The Naunheim Files - A 24 y.o. woman with a hx of congenital heart disease and complete heart block comes in for dental pain - Make it stand out placement by catheter in the RV https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1640282755866-Q6GZNRN5O6LMP743APTT/pacermicraff.JPG The Naunheim Files - A 24 y.o. woman with a hx of congenital heart disease and complete heart block comes in for dental pain - Make it stand out The Medtronic micra is 2.59 x 6.7 mm https://everydayebm.org/naunheim-files/2021/12/13/a-52-yo-woman-presents-with-a-lesion-on-the-arm monthly 0.5 2021-12-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1639408356746-MRYSS3AJPT163VUHGD3O/nocardiaJPG.JPG The Naunheim Files - A 52 y.o. woman presents with a lesion on the arm - Make it stand out What would you do? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1639668124317-VLU5R8RY7NA1OKENRU23/nocardia+brain+f.JPG The Naunheim Files - A 52 y.o. woman presents with a lesion on the arm - Make it stand out Nocardia can go to the brain and form abcesses https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1639668319649-HW3Z1G8CJKG0LB3I9MA6/nocardactino.JPG The Naunheim Files - A 52 y.o. woman presents with a lesion on the arm - Make it stand out lumpy jaw https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1639668393329-VR3B1D4NFL87T9IJWUES/nocar+sporo.JPG The Naunheim Files - A 52 y.o. woman presents with a lesion on the arm - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1639668457036-NAT8DC166YJWVXP9FUVE/noccow.JPG The Naunheim Files - A 52 y.o. woman presents with a lesion on the arm - Make it stand out A cow with actinomycosis https://everydayebm.org/naunheim-files/2021/12/6/a-54-yo-male-presents-with monthly 0.5 2021-12-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1638806498083-82WI7KWR346L4PXLZ0RG/sclero.JPG The Naunheim Files - A 54 y.o. male presents with shortness of breath - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1638807580022-XK7F1JVLA712GRCRWB1H/sclero%2C+cxr.JPG The Naunheim Files - A 54 y.o. male presents with shortness of breath - Make it stand out His CXR appears above. What could be wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1639149572276-L2RP2IHIFS4LIZO4VJ8C/scleroderma+ankle.JPG The Naunheim Files - A 54 y.o. male presents with shortness of breath - Make it stand out maggots were removed from this ankle ulcer leaving a fairly clean wound https://everydayebm.org/naunheim-files/2021/11/29/a-49-yo-woman-comes-in-with-lower-abdominal-pain-she-recently-was-treated-for-a-uti monthly 0.5 2021-12-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1638199288956-SO2XV8DRGZ36HZYZEVP2/ooa.JPG The Naunheim Files - A 49 y.o. woman comes in with lower abdominal pain; she recently was treated for a UTI. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1638370402497-KRVDGUKQKX7529A4A0AR/00hydrisak.JPG The Naunheim Files - A 49 y.o. woman comes in with lower abdominal pain; she recently was treated for a UTI. - Make it stand out obstruction of the fimbria on the end of the tube causes scarring and fluid build up https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1638370548462-D0679V6XGV2Q5TPW2N7V/akhenatenJPG.JPG The Naunheim Files - A 49 y.o. woman comes in with lower abdominal pain; she recently was treated for a UTI. - Make it stand out Akhenaten https://everydayebm.org/naunheim-files/2021/11/22/a-68-yo-male-sp-resection-for-colon-cancer-in-the-distal-past-comes-in-with-leg-pain monthly 0.5 2021-11-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1637595463860-637S7UC87J1U36AZIEUT/varicosities.JPG The Naunheim Files - A 68 yo. male sp resection for colon cancer in the distal past comes in with leg pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1637945085537-0VBZIF0UU2NTT8HQ5HX0/venous+stasis+ulcer.JPG The Naunheim Files - A 68 yo. male sp resection for colon cancer in the distal past comes in with leg pain. - Make it stand out stasis ulcer present for many years caused by venous insufficiency https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1637945152101-1ZZ1GLKBZ6L1LSYFCJH1/varicosesupvsdeep.JPG The Naunheim Files - A 68 yo. male sp resection for colon cancer in the distal past comes in with leg pain. - Make it stand out Superficial vs deep venous system https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1637945257045-U8BAZ34VYZ3P8YQLOHFQ/venous+spider.JPG The Naunheim Files - A 68 yo. male sp resection for colon cancer in the distal past comes in with leg pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2021/11/15/a-25-yo-male-with-autism-comes-in-with-rectal-pain monthly 0.5 2021-11-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1636990377884-EI33FK1R3D42T0QVZ5H8/rectal+prolapse.jpeg The Naunheim Files - A 25 y.o. male with autism comes in with rectal pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1637160238247-C5O8EE1IS51T813NJC6P/prolapse+perianal+block.JPG The Naunheim Files - A 25 y.o. male with autism comes in with rectal pain - Make it stand out Not as complicated as it looks: basically a ring block around the anus with 20-30 cc of lidocaine https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1637160399584-J9X87ZP93T53Z1Q0KGG4/rectal+prolapse+true.JPG The Naunheim Files - A 25 y.o. male with autism comes in with rectal pain - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1637160479277-20RTWHAY70SGLRSE1XDU/hemorrhoidsff.jpg The Naunheim Files - A 25 y.o. male with autism comes in with rectal pain - Make it stand out hemorrhoids have radial folds because they are a group of dilated veins. https://everydayebm.org/naunheim-files/2021/11/8/a-64-yo-male-comes-to-the-ed-5-days-after-being-released-from-prison-with-tongue-lesions monthly 0.5 2021-11-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1636385602727-AZL5FM8QUHIF6W32TOCR/macroglossia.JPG The Naunheim Files - A 64 y.o. male comes to the ED 5 days after being released from prison with tongue lesions. - Make it stand out he has a large ulcer on the L side of the tongue and nodules anteriorly. The whole tongue is hard https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1636567280120-KSQQU84HDOHW0PPWRDY3/macroglossia+mrifff.jpg The Naunheim Files - A 64 y.o. male comes to the ED 5 days after being released from prison with tongue lesions. - Make it stand out Macroglossia on imaging. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1636567361074-JDR7GF5QMLAVGK9SJ82Y/macrogloB12.JPG The Naunheim Files - A 64 y.o. male comes to the ED 5 days after being released from prison with tongue lesions. - Make it stand out pseudomacroglossia can occur with vitamin deficiencies https://everydayebm.org/naunheim-files/2021/11/1/a-54-yo-woman-with-a-hx-of-opiod-dependence-and-schizophrenia-presents-with-a-painful-hand monthly 0.5 2021-11-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1635778951010-NA9QKT9DAV52V11QNG03/covid+handJPG.JPG The Naunheim Files - A 54 y.o. woman with a hx of opiod dependence and schizophrenia presents with a painful hand. - Make it stand out What is the problem https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1636044152850-SAEM4CG97BEH4AHSII9Z/covid+toesJPG.JPG The Naunheim Files - A 54 y.o. woman with a hx of opiod dependence and schizophrenia presents with a painful hand. - Make it stand out covid toes are common in younger people with covid https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1636044217021-HE7OZABMQR8QDPZN5FWH/covid+aortalatf.JPG The Naunheim Files - A 54 y.o. woman with a hx of opiod dependence and schizophrenia presents with a painful hand. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1636044285191-4VL35EMLLOJ9A5HUHT68/buergerJPG.JPG The Naunheim Files - A 54 y.o. woman with a hx of opiod dependence and schizophrenia presents with a painful hand. - Make it stand out Buerger’s disease is a small to medium sized artery vasculits caused by smoking https://everydayebm.org/naunheim-files/2021/10/25/a-82-yo-woman-comes-in-with-what-her-family-thought-was-a-bun-on-the-top-of-her-head monthly 0.5 2021-10-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1635172898458-V16JBGZ9PCFTWYMUVQBS/mel.JPG The Naunheim Files - A 82 y.o. woman comes in with what her family thought was a "bun" on the top of her head. - Make it stand out what could it be? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1635437820538-915NXN6HJJ9LR0IUVW93/lms+spindles.JPG The Naunheim Files - A 82 y.o. woman comes in with what her family thought was a "bun" on the top of her head. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1635437873460-MH28GDYUW7GGA0Z1HWL6/LMS+aggressive.JPG The Naunheim Files - A 82 y.o. woman comes in with what her family thought was a "bun" on the top of her head. - Make it stand out subcutanous leiomyosarcomas are often aggressive https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1635437933181-GFEYLLZSV0DTW94K33KP/lmssolitary.JPG The Naunheim Files - A 82 y.o. woman comes in with what her family thought was a "bun" on the top of her head. - Make it stand out benign solitary fibrous tumor of the pleura https://everydayebm.org/naunheim-files/2021/10/18/a-40-yo-male-woke-up-at-3-am-with-eye-pain monthly 0.5 2021-10-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1634569342399-PALSLGZ8ZZH5AVJDL8BN/eye+prop.JPG The Naunheim Files - A 40 y.o. male woke up at 3 am with eye pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1634835117770-RWSUIG41Z1GJU3JC5A66/lux+upper+lid.JPG The Naunheim Files - A 40 y.o. male woke up at 3 am with eye pain. - Make it stand out laxity of the upper lid in a patient with floppy eyelid syndrome https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1634835240467-LXT87YNL9ALVXXGL8IYR/lux+fluor.JPG The Naunheim Files - A 40 y.o. male woke up at 3 am with eye pain. - Make it stand out Our patient had a corneal lesion from drying of the cornea https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1634835322343-KSPY6NE20G8Z7NJTLY5D/lux+red.JPG The Naunheim Files - A 40 y.o. male woke up at 3 am with eye pain. - Make it stand out Our patient following his covid swab https://everydayebm.org/naunheim-files/2021/10/11/a-23-yo-transgender-female-comes-to-the-ed-with-itching-near-the-rectum monthly 0.5 2021-10-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1633964805013-WCVNXK3J8SEI8S499425/conlata.JPG The Naunheim Files - A 23 y.o. transgender female comes to the ED with itching near the anus - Make it stand out she has a pinkish papular lesion near the anus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1634229666827-XBJAOEG6BDRME85F21JD/Capture.JPG The Naunheim Files - A 23 y.o. transgender female comes to the ED with itching near the anus - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1634229708017-O499FTCN055NXJ3WMXQR/conlata+vulva.JPG The Naunheim Files - A 23 y.o. transgender female comes to the ED with itching near the anus - Make it stand out condyloma lata of the vulva https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1634229762647-4IJUQHAJTMXPHRDMFTNO/buschke+low.JPG The Naunheim Files - A 23 y.o. transgender female comes to the ED with itching near the anus - Make it stand out buschke-lowenstein low grade squamous malignancy https://everydayebm.org/naunheim-files/2021/10/4/a-23-yo-male-was-a-restrained-passenger-in-an-mvc-his-car-struck-a-pole-and-he-complains-of-abdominal-pain monthly 0.5 2021-10-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1633363059309-RO8E0E2ATFAYJ1EFZZWM/bucketffff1.JPG The Naunheim Files - A 23 y.o. male was a restrained passenger in an MVC. His car struck a pole and he complains of abdominal pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1633363105822-W3S3WQFXN15CE6FMDMAZ/bucket+handle2JPG.JPG The Naunheim Files - A 23 y.o. male was a restrained passenger in an MVC. His car struck a pole and he complains of abdominal pain. - Make it stand out Do you see any abnormality in the bowel? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1633535261232-I1MSE4DWJAW4PYRDI37A/bucket+handle+arrow+-+Copy.JPG The Naunheim Files - A 23 y.o. male was a restrained passenger in an MVC. His car struck a pole and he complains of abdominal pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1633535421388-WKTI1UIZZF76TVRHIVNA/bucket+handle+injury.JPG The Naunheim Files - A 23 y.o. male was a restrained passenger in an MVC. His car struck a pole and he complains of abdominal pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1633535487579-SAFY3S5FCJI4K1LRSD6Q/bucket+handlesigmoidJPG.JPG The Naunheim Files - A 23 y.o. male was a restrained passenger in an MVC. His car struck a pole and he complains of abdominal pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2021/9/27/a-31-yo-male-with-hiv-presents-with-swelling-of-the-l-leg-he-has-been-treated-for-syphilis-and-gonorrhea monthly 0.5 2021-09-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1632751481355-UBA8P4UFFBK8UVSDZA7S/kap.JPG The Naunheim Files - A 31 y.o. male with HIV presents with swelling of the L leg. He has been treated for syphilis and gonorrhea. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1632751505714-TNBWG22WEN1PQGFBS4AI/kapfoot.JPG The Naunheim Files - A 31 y.o. male with HIV presents with swelling of the L leg. He has been treated for syphilis and gonorrhea. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1633022535793-3MSDO5OAEVGKL02YG5R8/ksnoseJPG.JPG The Naunheim Files - A 31 y.o. male with HIV presents with swelling of the L leg. He has been treated for syphilis and gonorrhea. - Make it stand out Often presenting on the face, Kaposi’s was a visible indicator of AIDS https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1633022606644-18RIBK2N4KUWGSBI7E13/kslung.JPG The Naunheim Files - A 31 y.o. male with HIV presents with swelling of the L leg. He has been treated for syphilis and gonorrhea. - Make it stand out Kaposi’s of the lung https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1633022723118-99AXLT9X1YWUL7REH540/ksbacill.JPG The Naunheim Files - A 31 y.o. male with HIV presents with swelling of the L leg. He has been treated for syphilis and gonorrhea. - Make it stand out Bacillary angiomatosis https://everydayebm.org/naunheim-files/2021/9/20/a-27-yo-male-presented-821-with-petechiae-after-being-seen-for-pharyngitis-which-was-strep-negative monthly 0.5 2021-09-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1632148724984-379CK947MBW6WWUASDR7/itpJPG.JPG The Naunheim Files - A 27 y.o. male presented 8/21 with petechiae after being seen for pharyngitis which was strep/HIV/p24 Ag/covid negative. - Make it stand out the patient noted petechiae on multiple places on his body and complained his gums were bleeding when he brushed his teeth. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1632413902905-Q0VPLOA43SYWJ8IDUKHV/itpct+pefffff.JPG The Naunheim Files - A 27 y.o. male presented 8/21 with petechiae after being seen for pharyngitis which was strep/HIV/p24 Ag/covid negative. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1632413984849-6S9DUCTDFQLOEZQ5QAUJ/ITP+causes.JPG The Naunheim Files - A 27 y.o. male presented 8/21 with petechiae after being seen for pharyngitis which was strep/HIV/p24 Ag/covid negative. - Make it stand out ITP has been reported with lupus, hiv and many other conditions. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1632414091710-JQUCZX1Y6U8U5CPWAZEC/ITP+gi+bleed.JPG The Naunheim Files - A 27 y.o. male presented 8/21 with petechiae after being seen for pharyngitis which was strep/HIV/p24 Ag/covid negative. - Make it stand out Patient presenting with ITP after a COVID infection https://everydayebm.org/naunheim-files/2021/9/13/a-23-yo-woman-with-downs-syndrome-presented-with-headache-and-neck-pain monthly 0.5 2021-09-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1631547009673-6ODOB56J8MFZ0TBW968M/aapt+cspineJPG.JPG The Naunheim Files - A 23 y.o. woman with Down's syndrome presented with headache and neck pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1631727580136-IUJAMC5BCNBMI3MC2RJY/aac12lat+massffff.JPG The Naunheim Files - A 23 y.o. woman with Down's syndrome presented with headache and neck pain. - Make it stand out normal anatomy of C1,2 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1631727670119-GXQ69RTCDIE53KTTSS65/aaant+spacelinedraw.JPG The Naunheim Files - A 23 y.o. woman with Down's syndrome presented with headache and neck pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1631727765996-DWUZF0AO7L8ZAA83ZQ9R/aaatlasfxffffff.JPG The Naunheim Files - A 23 y.o. woman with Down's syndrome presented with headache and neck pain. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1631727837931-WEP7GWQN7HJ25ORY6D7N/aaheadtiltfff.JPG The Naunheim Files - A 23 y.o. woman with Down's syndrome presented with headache and neck pain. - Make it stand out head tilt in rheumatoid arthritis caused by erosion the C 1,2 facets and atlantoaxial subluxation https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1631727967879-1R6LW8P6U8N9SSHXZABU/aarabbit.JPG The Naunheim Files - A 23 y.o. woman with Down's syndrome presented with headache and neck pain. - Make it stand out trivia: rabbits have a condition causing head tilt, from an inner ear problem. https://everydayebm.org/naunheim-files/2021/9/6/a-60-yo-male-presents-with-swelling-over-the-l-eye monthly 0.5 2021-09-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1630959792555-J7L4R0XOA2A8F3Y3SJRX/potts2.JPG The Naunheim Files - A 60 y.o. male presents with swelling over the L eye - Make it stand out What could be wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1630960067117-8AZHW2J92OPESEY4FZGJ/potts.JPG The Naunheim Files - A 60 y.o. male presents with swelling over the L eye - Make it stand out What is wrong on the CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1631366437080-X8L2WBLXO9QBV7754I5K/potts+ct.JPG The Naunheim Files - A 60 y.o. male presents with swelling over the L eye - Make it stand out Pott’s puffy tumor on CT. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1631366608123-JJS472ZKDPURUDPYAACR/potpicf.JPG The Naunheim Files - A 60 y.o. male presents with swelling over the L eye - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2021/8/30/a-69-yo-woman-is-brought-to-the-ed-her-chief-complaint-is-the-refrigerator-was-talking-to-me-1 monthly 0.5 2021-09-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1630333805592-3BZQ1NG3LC1NF4NW2821/chickbff.jpg The Naunheim Files - A 69 y.o. woman is brought to the ED. Her chief complaint is " the refrigerator was talking to me" - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1630334411929-1KSVPOP8Q88AVCTNCWOB/hernia+chicken+bonefi.jpg The Naunheim Files - A 69 y.o. woman is brought to the ED. Her chief complaint is " the refrigerator was talking to me" - Make it stand out Chicken bone in a ventral hernia,. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1630334577371-V8XB5CYZT0L0TRLBRI17/hernia+augrectumf.JPG The Naunheim Files - A 69 y.o. woman is brought to the ED. Her chief complaint is " the refrigerator was talking to me" - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1630782597865-NWL32PT4ZBWHHQDC6OEE/beads+causing+a+bowel+obstruction.JPG The Naunheim Files - A 69 y.o. woman is brought to the ED. Her chief complaint is " the refrigerator was talking to me" - Make it stand out Magnetic beads causing a bowel obstruction https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1630782684213-VV6O97CVM2VG1YVY4SW9/foreign+mult.JPG The Naunheim Files - A 69 y.o. woman is brought to the ED. Her chief complaint is " the refrigerator was talking to me" - Make it stand out Another population other than children which swallow foreign bodies are psychiatric patients. https://everydayebm.org/naunheim-files/2021/8/23/a-59-yo-male-comes-in-with-a-painful-mass-on-the-l-flank-after-falling-from-a-roof-three-days-earlier monthly 0.5 2021-08-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1629727331860-TCT7D32BSW9NGCFABU9A/herniaff.JPG The Naunheim Files - A 59 y.o. male comes in with a painful mass on the L flank after falling from a roof three days earlier - Make it stand out A lumbar hernia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1629991017245-EOZUOT8VSVHYCZPTNBKQ/herniactfffJPG.jpg The Naunheim Files - A 59 y.o. male comes in with a painful mass on the L flank after falling from a roof three days earlier - Make it stand out CT of our patient showing bowel outside the abdominal wall https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1629991514128-HV27K1KT4JXNVN4WUKSC/lumbar+hernia+sketchff.JPG The Naunheim Files - A 59 y.o. male comes in with a painful mass on the L flank after falling from a roof three days earlier - Make it stand out Locations of lumbar hernias https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1629991568116-8PSLE1LEDVHE60GAIELM/herniasspigdia.JPG The Naunheim Files - A 59 y.o. male comes in with a painful mass on the L flank after falling from a roof three days earlier - Make it stand out The Spigelian hernia is lateral to the rectus https://everydayebm.org/naunheim-files/2021/8/16/a-29-yo-male-presents-with-dizziness-after-a-chiropractor-manipulates-his-neck monthly 0.5 2021-08-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1629124961390-LGTL887VXT86REJ911Z8/vert+dis+arrowf.jpg The Naunheim Files - A 29 y.o. male presents with dizziness after a chiropractor manipulates his neck. - Make it stand out What do you notice on the CTA of a patient with a similar problem? Hint: our patient had a homonymous hemianopsia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1629387371835-34AP9UJ871KKR9BYEJUC/Vertdis4.JPG The Naunheim Files - A 29 y.o. male presents with dizziness after a chiropractor manipulates his neck. - Make it stand out the majority of dissections occur in segment 3 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1629387445537-FZJVMJJI0V9Q4FW05QN8/vert+dissmristrokeff.jpg The Naunheim Files - A 29 y.o. male presents with dizziness after a chiropractor manipulates his neck. - Make it stand out vertebral dissections can lead to strokes as shown on this MRI of a young women with a fatal brainstem infarct after a chiropactor’s manipulation https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1629387951462-1ARDYFIQOSKU1X0XXCOQ/verthints.JPG The Naunheim Files - A 29 y.o. male presents with dizziness after a chiropractor manipulates his neck. - Make it stand out The head impluse test NORMAL IS BAD https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1629387999251-0VPJ87OK7TFBGUGZ82RG/verthintsnys.JPG The Naunheim Files - A 29 y.o. male presents with dizziness after a chiropractor manipulates his neck. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2021/8/9/an-87-yo-male-fell-forward-while-gardening-he-presented-with-epistaxis monthly 0.5 2021-08-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1628522830336-0CGRL57YX8RLXNH8KMQH/cribngf.jpg The Naunheim Files - An 87 y.o. male fell forward while gardening, he presented with epistaxis. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1628869868434-6B7W70B43SYM5KMCIT3N/cribriform+plate+anatomy.JPG The Naunheim Files - An 87 y.o. male fell forward while gardening, he presented with epistaxis. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1628869916487-SWL4Z3SCQS95JE86EBQH/cribriform+plate+skullff.jpg The Naunheim Files - An 87 y.o. male fell forward while gardening, he presented with epistaxis. - Make it stand out looking down at the skull, the cribriform plate is a series of holes. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1628870079776-KNHGYFZNS5H7UVL2TW69/cribriform+plate+mt+fujiff.jpg The Naunheim Files - An 87 y.o. male fell forward while gardening, he presented with epistaxis. - Make it stand out The Mount Fuji sign refers to the “V” shape between the frontal lobes. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1628870174712-GF8WK7F2LY3EKXB43T3R/NG+through+crib.JPG The Naunheim Files - An 87 y.o. male fell forward while gardening, he presented with epistaxis. - Make it stand out BEWARE THE CRIBRIFORM P:LATE: it may be fractured during trauma and lead to intracranial placement of an NG tube. https://everydayebm.org/naunheim-files/2021/8/2/a-49-yo-farmer-with-dm-copd-presents-with-difficulty-swallowing-x-three-weeks monthly 0.5 2021-08-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1627914921604-L9B8BXHW0VMAGAXZUQEZ/blasto.jpeg The Naunheim Files - A 49 y.o. farmer with DM, COPD, presents with difficulty swallowing x three weeks. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1627914945320-L35PF8Z4WZY6IBLUKNPT/blastoct.JPG The Naunheim Files - A 49 y.o. farmer with DM, COPD, presents with difficulty swallowing x three weeks. - Make it stand out What is the differential for this bony erosion? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1628092369612-99YF6NRA95Q6DOWWVN2U/blastomap.JPG The Naunheim Files - A 49 y.o. farmer with DM, COPD, presents with difficulty swallowing x three weeks. - Make it stand out the distribution of blastomycosis is similar to histoplasmosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1628092440165-BVKNA14INKQ8YLQDU45N/blasto+39+y.o.JPG The Naunheim Files - A 49 y.o. farmer with DM, COPD, presents with difficulty swallowing x three weeks. - Make it stand out A 39 y.o. healthy male with blasto osteromyelitis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1628092524195-ILFWTVR6HI48AHPTSBTM/blasto+skin.JPG The Naunheim Files - A 49 y.o. farmer with DM, COPD, presents with difficulty swallowing x three weeks. - Make it stand out Blasto can resemble tuberculosis on the skin https://everydayebm.org/naunheim-files/2021/7/26/a-62-yo-woman-presents-with-chest-pain-and-weakness monthly 0.5 2021-07-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1627311700358-6OORVQDWSDWGPVG32XMY/empty+sella.JPG The Naunheim Files - A 62 y.o. woman presents with chest pain and weakness - Make it stand out What do you notice on the head CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1627573411260-LDANVQUDKS8DIM0CPW4T/sellafff.JPG The Naunheim Files - A 62 y.o. woman presents with chest pain and weakness - Make it stand out empty sella with skull thickening https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1627573499016-MWFFPQX9FI8QP8Z8HXSE/sella+dural+herniation.JPG The Naunheim Files - A 62 y.o. woman presents with chest pain and weakness - Make it stand out trauma or increased ICP can cause dural herniation https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1627573778006-BUWQV9QHGL90S3IUC0EN/sella+jaw.JPG The Naunheim Files - A 62 y.o. woman presents with chest pain and weakness - Make it stand out A Russiian wrestler with acromegaly. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1627573826232-A7UF0YV00PLYWJ6Y6B7M/sella+wadlow.JPG The Naunheim Files - A 62 y.o. woman presents with chest pain and weakness - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2021/7/22/a-60-yo-male-presents-sp-radical-prostatectomyxrt-and-artificial-urinary-sphincter-placement-with-urine-that-smells-like-feces-1 monthly 0.5 2021-07-22 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1626966378397-AD6ADPPR5H4YOG8C19KJ/aus3.JPG The Naunheim Files - A 60 y.o. male presents sp radical prostatectomy/XRT and artificial urinary sphincter placement with urine that smells like feces. - Make it stand out what do you notice on plain film? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1626966431241-O3L117NSHT9KSUVZBF5F/aus4.JPG The Naunheim Files - A 60 y.o. male presents sp radical prostatectomy/XRT and artificial urinary sphincter placement with urine that smells like feces. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1626966469685-M0F2MLA3M186KNLXZH37/aus1.JPG The Naunheim Files - A 60 y.o. male presents sp radical prostatectomy/XRT and artificial urinary sphincter placement with urine that smells like feces. - Make it stand out there is inflammation near the symphysis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1626966513229-HUPIHOJCS9YN34TSXC5E/aus2.JPG The Naunheim Files - A 60 y.o. male presents sp radical prostatectomy/XRT and artificial urinary sphincter placement with urine that smells like feces. - Make it stand out and there is widening of the symphysis https://everydayebm.org/naunheim-files/2021/7/12/a-71-yo-woman-with-scleroderma-and-crest-syndrome-comes-in-with-hand-pain monthly 0.5 2021-07-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1626100867337-BEQFHS4C7TF33HITGV1J/painful+handsclero.JPG The Naunheim Files - A 71 y.o. woman with scleroderma and CREST syndrome comes in with hand pain - Make it stand out she has distal pulses and multiple nodules from her calcinosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1626100931771-GZCOSWWXH6KEX5R3LU0H/nec+fas+2.JPG The Naunheim Files - A 71 y.o. woman with scleroderma and CREST syndrome comes in with hand pain - Make it stand out the hand is swollen and the skin is tight https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1626100967300-VEZU87A5EULD7C5LCTEW/nec+fas3.JPG The Naunheim Files - A 71 y.o. woman with scleroderma and CREST syndrome comes in with hand pain - Make it stand out the palm has ecchymosis The patient is in severe pain. . what do you think is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1626359737507-IV98DQKTEQUETGKFFC5T/nec+fas+fourniers.JPG The Naunheim Files - A 71 y.o. woman with scleroderma and CREST syndrome comes in with hand pain - Make it stand out Fournier’s is usually caused by multiple organisms https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1626359821647-UETSNWSMDYA1IWB6JATD/nf+vibrio.JPG The Naunheim Files - A 71 y.o. woman with scleroderma and CREST syndrome comes in with hand pain - Make it stand out vibrio vulnificus is found in salt water https://everydayebm.org/naunheim-files/2021/7/5/a-63-yo-woman-with-biliary-cancer-and-a-duodenal-stent-presents-with-peritonitis-and-is-in-shock monthly 0.5 2021-07-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1625495140984-8FUG2SGSUI2YWTJA6TR0/bilomaff.jpg The Naunheim Files - A 63 y.o. woman with biliary cancer and a duodenal stent presents with peritonitis and is in shock. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1625838788588-PEUXN5H5VNS2IHAM9HXI/RUQ+pain+1.JPG The Naunheim Files - A 63 y.o. woman with biliary cancer and a duodenal stent presents with peritonitis and is in shock. - Make it stand out Where it says consult internist substitute “ED physician”. There are many causes of RUQ pain with biloma being one of the rarest. Causes of RUQ pain vary in different parts of the world with amebic liver abscesses occurring commonly in Mexico, India, Central and South America. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1625838999084-AC5FUI8PEVA0EXPZHQ4V/ruq+pain+strawberry.JPG The Naunheim Files - A 63 y.o. woman with biliary cancer and a duodenal stent presents with peritonitis and is in shock. - Make it stand out A strawberry gallbladder or cholesterolosis, refers to the surface appeareance of the gallbladder due to multiple small collections of triglycerides and cholesterol esters within the lamina propria https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1625839144076-R9KVW9UYELTRFBFX1WNP/RUQ+comet+tail+artifact+of+adenomyosis.JPG The Naunheim Files - A 63 y.o. woman with biliary cancer and a duodenal stent presents with peritonitis and is in shock. - Make it stand out Adenomyomatosis of the gallbladder also shows cholesterol deposits within a thickened gallbladder wall. A comet tail sign can be seen on US. https://everydayebm.org/naunheim-files/2021/6/28/a-27-yo-is-hit-in-the-l-eye-when-a-high-pressure-hose-explodes-his-vision-is-normal monthly 0.5 2021-07-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1624889175030-UVLYIJFKV8N414MT8U3R/eye+explosion+1.JPG The Naunheim Files - A 27 y.o. is hit in the L eye when a high pressure hose explodes. His vision is normal. - Make it stand out you note that the pupil is round and reactive https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1625155656658-RIO3IJQ3O3G2S7AOD4BI/eye+explosion.JPG The Naunheim Files - A 27 y.o. is hit in the L eye when a high pressure hose explodes. His vision is normal. - Make it stand out A small perforation was noted inferiorly https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1625155756437-22NJ6TI4LFTLPWCZV5ZN/lasik.JPG The Naunheim Files - A 27 y.o. is hit in the L eye when a high pressure hose explodes. His vision is normal. - Make it stand out lasik thins the corneal to improve vision quality https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1625155951801-C3HKSVK5R2FWJQM3IVGN/eye++beanbag..JPG The Naunheim Files - A 27 y.o. is hit in the L eye when a high pressure hose explodes. His vision is normal. - Make it stand out Pt with a globe rupture and canalicular injury after being shot with a beanbag gun https://everydayebm.org/naunheim-files/2021/6/18/a-36-yo-woman-presents-with-altered-mental-status-after-a-dilitation-and-extraction-of-a-fetus-dated-at-23-wks-and-6-days monthly 0.5 2021-06-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1624033554025-5N9ZX3C33Z3A61TOWNAE/jonesuterine+perf.JPG The Naunheim Files - A 36 y.o. woman presents with altered mental status after a dilitation and extraction of a fetus dated at 23 wks and 6 days. - Make it stand out clot is noted in the uterus with mild vaginal bleeding https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1624033609549-8WOCKJO90DRKF6XHTQ6Y/jonesperf.JPG The Naunheim Files - A 36 y.o. woman presents with altered mental status after a dilitation and extraction of a fetus dated at 23 wks and 6 days. - Make it stand out What do you see in the abdomen? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1624570189644-OGRZW9AKWCOZLI9P420P/dates.png The Naunheim Files - A 36 y.o. woman presents with altered mental status after a dilitation and extraction of a fetus dated at 23 wks and 6 days. - Make it stand out As the uterus enlartges the risk of abortion grows. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1624570349898-4POIOOVXK01VPCLARQX4/cost.JPG The Naunheim Files - A 36 y.o. woman presents with altered mental status after a dilitation and extraction of a fetus dated at 23 wks and 6 days. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2021/6/14/a-62-yo-woman-with-a-hx-of-ra-dm-and-ht-presents-with-syncope-while-shopping-she-co-r-shoulder-pain-1 monthly 0.5 2021-06-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1623682393267-VQ1B830UVVEWRSCTXRIG/clot+in+transitfirst.JPG The Naunheim Files - A 62 y.o. woman with a hx of RA, DM, and HT presents with syncope while shopping. She co R shoulder pain - Make it stand out Do you notice any abnormailities https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1623682440703-ZH6PWZXX0DLSS76TH34Q/clot+in+transit+1rv.JPG The Naunheim Files - A 62 y.o. woman with a hx of RA, DM, and HT presents with syncope while shopping. She co R shoulder pain - Make it stand out Because of persistent tachycardia a CT was done. What do you notice? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1623682499317-X5NFQ42NHYD893BX69TH/clot+in+transit+final.JPG The Naunheim Files - A 62 y.o. woman with a hx of RA, DM, and HT presents with syncope while shopping. She co R shoulder pain - Make it stand out Has there been a change in the CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1623944646471-I1WQ96XLLQ59AE85OD9N/clot+in+transit5.JPG The Naunheim Files - A 62 y.o. woman with a hx of RA, DM, and HT presents with syncope while shopping. She co R shoulder pain - Make it stand out Clots in transit are most often found with ultrasound https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1623944752609-LHFPLF132WQ6MJ32KTTN/clot+in+transit+chart.JPG The Naunheim Files - A 62 y.o. woman with a hx of RA, DM, and HT presents with syncope while shopping. She co R shoulder pain - Make it stand out These are some of the hematologic problems causing hypercoagulatbility https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1623944863343-D40TKNMETP67D76KISMB/clot+in+transit+russell%27s.JPG The Naunheim Files - A 62 y.o. woman with a hx of RA, DM, and HT presents with syncope while shopping. She co R shoulder pain - Make it stand out Russell’s viper is found in India https://everydayebm.org/naunheim-files/2021/6/7/a-40-yo-male-presents-with-gi-bleeding-and-a-rash monthly 0.5 2021-06-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1623073495205-KEEBSJM1Q4UMJ4EK93FZ/woodard.JPG The Naunheim Files - A 40 y.o. male presents with GI bleeding and a rash. - Make it stand out Hint: the purpura are palpable https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1623341293976-M7LFFW13VP230203W8T6/vasculitis+wegeners.JPG The Naunheim Files - A 40 y.o. male presents with GI bleeding and a rash. - Make it stand out Wegener’s involves the upper airways and may result in “saddle nose” https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1623341977616-R8H4C1WHB7WKJCYRT0LC/vasculitis+churg+strausff.jpg The Naunheim Files - A 40 y.o. male presents with GI bleeding and a rash. - Make it stand out Churg Strauss may present with necrotic nodules or hemorrhage which appears as “ground glass” on CT. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1623342086582-DHZCJ1TA7IJRP4TNPC17/vasculitis+cryof.JPG The Naunheim Files - A 40 y.o. male presents with GI bleeding and a rash. - Make it stand out cryoglobulinemia from Hep C Our patient had crypt abscesses on colonoscopy and was treated with prednisone. All other testing was negative. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1623342590367-FWIRVYTFEN8WVJ5WHXLF/vasculitisweg.JPG The Naunheim Files - A 40 y.o. male presents with GI bleeding and a rash. - Make it stand out Wegener’s https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1623342631873-0B9TLHZ9WPLL24APC5DG/vasculitis+classical+immune+complex.JPG The Naunheim Files - A 40 y.o. male presents with GI bleeding and a rash. - Make it stand out Immune complex vasculitis https://everydayebm.org/naunheim-files/2021/5/31/a-16-yo-comes-to-the-ed-with-trouble-with-his-vision monthly 0.5 2021-06-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1622475042959-TMDXHS1HTD3MHUK0RDIQ/6th+n+palsy.JPG The Naunheim Files - A 16 y.o. comes to the ED with trouble with his vision. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1622737499476-47V9ET0UQB34OSB9T6CF/6th+n+cav+sinus.ffjpg.jpg The Naunheim Files - A 16 y.o. comes to the ED with trouble with his vision. - Make it stand out infiltration of the cavernous sinus by lymphoma https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1622737593528-JKHWM30J941H52W2CD2C/sixthn+course.JPG The Naunheim Files - A 16 y.o. comes to the ED with trouble with his vision. - Make it stand out the sixth nerve travels from the pons to the lateral rectus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1622737689938-M9ASFBPN4EAWGGB3TH1M/6th+nerve+lateralview.JPG The Naunheim Files - A 16 y.o. comes to the ED with trouble with his vision. - Make it stand out The course of the 6th nerve in relation to the cavernous sinus https://everydayebm.org/naunheim-files/2021/5/24/a-41-yo-male-comes-to-the-ed-for-dehydration-and-confusion monthly 0.5 2021-05-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1621869423061-5JI0U6XUA96MPXMALGUL/death+star.JPG The Naunheim Files - A 41 y.o. male comes to the ED for "dehydration" and confusion - Make it stand out What do you notice on his CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1622128686087-LBKWBR5QGTO5TEOHCZCZ/star+csf.JPG The Naunheim Files - A 41 y.o. male comes to the ED for "dehydration" and confusion - Make it stand out The first two tubes were from one space and the second two were from the space above. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1622129032759-10FGXNS7JKWD4GZR6CNO/star+of+sah.JPG The Naunheim Files - A 41 y.o. male comes to the ED for "dehydration" and confusion - Make it stand out The star of death is formed by blood outlining the base of the brain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1622129256674-DZTO3V67TPMGWEP3V6KO/star+blood+supply.jpg The Naunheim Files - A 41 y.o. male comes to the ED for "dehydration" and confusion - Make it stand out Circle of Willis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1622129405153-1K5MML6T6LS6UE0IE7X2/pipeline.JPG The Naunheim Files - A 41 y.o. male comes to the ED for "dehydration" and confusion - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://everydayebm.org/naunheim-files/2021/5/17/a-55-yo-schizophrenic-comes-to-the-ed-with-a-rash-1 monthly 0.5 2021-05-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1621263618759-OANYC9HFAWNF9Y3WW5QC/vzv2.JPG The Naunheim Files - A 55 y.o. schizophrenic comes to the ED with a rash. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1621263748886-LR3EZDWZV8WYVTEBBSBM/vzv.JPG The Naunheim Files - A 55 y.o. schizophrenic comes to the ED with a rash. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1621527722906-SM7KN3X6M9BJBRFY4F7E/vzv+chlor.JPG The Naunheim Files - A 55 y.o. schizophrenic comes to the ED with a rash. - Make it stand out In 2019 a Hong Kong reporter was exposed to dioxin in tear gas and devloped chloracne https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1621527837894-T69WUMM9SH6KT41NQO3Q/vzv+sweets.JPG The Naunheim Files - A 55 y.o. schizophrenic comes to the ED with a rash. - Make it stand out Often the lesions in Sweets syndrome are raised . https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1621528295394-8TVTCT3DKBGSQQ3RXQRO/vzvsimplex.JPG The Naunheim Files - A 55 y.o. schizophrenic comes to the ED with a rash. - Make it stand out A patient with a cold sore developed erythema multiforme on the palms from herpes simplex. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1621528372260-SOWADGLS4UBMMAM1A14S/vzv+guinea+pigff.jpg The Naunheim Files - A 55 y.o. schizophrenic comes to the ED with a rash. - Make it stand out fun fact: guinea pigs are not from Guinea and are not related to pigs. They are from South America https://everydayebm.org/naunheim-files/2021/5/10/a-47-yo-male-comes-having-been-recently-released-from-jail-with-headache monthly 0.5 2021-05-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1620661715397-DUIPV1W1T9RH8YQ3QYXX/saviano.JPG The Naunheim Files - A 47 y.o. male comes having been recently released from jail with headache. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1620927642181-ZYPOQDZUEZ200A5E17Z4/third+ventricle.JPG The Naunheim Files - A 47 y.o. male comes having been recently released from jail with headache. - Make it stand out the third ventricle connects the lateral ventricles. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1620927705746-3WGRXI2M7CFPMSIEWP1N/ventricular+system%2C+diagram.JPG The Naunheim Files - A 47 y.o. male comes having been recently released from jail with headache. - Make it stand out our pt had a colloid cyst obstructing the foramen of monro https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1620927792182-UQ5MXH8LR6AQ3UVD8013/foramenchrron+hydrof.jpg The Naunheim Files - A 47 y.o. male comes having been recently released from jail with headache. - Make it stand out hydrocephalus that occurs more slowly results in thinning of the cortex of the brain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1620928776364-KN65Y86W0AUEJVP5JZMU/savianofffff.jpg The Naunheim Files - A 47 y.o. male comes having been recently released from jail with headache. - Make it stand out Actually the mass is here, at the arrow, the third and fourth ventricles are not dilated. https://everydayebm.org/naunheim-files/2021/5/8/a-2-yo-girl-presents-with-a-rash-and-fever monthly 0.5 2021-05-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1620513775563-F1AEJPC075QFLFGVFM97/rime1.JPG The Naunheim Files - A 2 y.o. girl presents with a rash and fever. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1620513946262-J94GK76BASFVPUOU4E9X/RIME+chart.JPG The Naunheim Files - A 2 y.o. girl presents with a rash and fever. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1620514078502-7WJFHEKICN9DRVGU95MJ/4.JPG The Naunheim Files - A 2 y.o. girl presents with a rash and fever. Mucositis is associated with RIME https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1620514376887-GX79NYNWCM6A26ROT482/emcauses.JPG The Naunheim Files - A 2 y.o. girl presents with a rash and fever. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1620514399097-CKG4HYU5KWRSN2W472JO/empicture.JPG The Naunheim Files - A 2 y.o. girl presents with a rash and fever. The classic target lesion of erythema multiforme https://everydayebm.org/naunheim-files/2021/4/26/a-39-yo-female-comes-in-with-daily-headaches-and-unequal-pupils monthly 0.5 2021-04-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1619448391539-FDW7PRYKLGRZEJ7ZQRZM/adiesfirstf.jpg The Naunheim Files - A 39 y.o. female comes in with daily headaches and unequal pupils What is the differential? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1619712553417-LGG5N0HAZU0X01C74SSW/adies+accomodation.JPG The Naunheim Files - A 39 y.o. female comes in with daily headaches and unequal pupils https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1619712645590-V21SI6PSSE54ITM511E8/adief.jpg The Naunheim Files - A 39 y.o. female comes in with daily headaches and unequal pupils https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1619712815092-WYIYL3RD7YXZCK98XTVP/david+bowie.png The Naunheim Files - A 39 y.o. female comes in with daily headaches and unequal pupils David Bowie had anisocoria because he was punched in the eye at age 16 and damaged his ciliary muscle The pupil is so dilated a red reflex from retinal vessels could sometimes be seen. https://everydayebm.org/naunheim-files/2021/4/19/a-16-yo-female-came-to-the-ed-with-pain-in-the-l-shoulder-and-a-diffuse-rash monthly 0.5 2021-04-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1618840735240-C9F205G53K9MR9ZBEPSL/br1.JPG The Naunheim Files - A 16 y.o. female came to the ED with pain in the L shoulder and a diffuse rash. this was an image of the patients back with an area of edema https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1618840790624-RP0O6VLNTLB4R3ZF9R2L/br2.JPG The Naunheim Files - A 16 y.o. female came to the ED with pain in the L shoulder and a diffuse rash. A lesion developed on her back. what do you think caused this? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1619111244424-7TDCFQTAQGJX5UDVHLPL/BR+spider.JPG The Naunheim Files - A 16 y.o. female came to the ED with pain in the L shoulder and a diffuse rash. note the violin shape on the body of the spider. The spiders can be this large but are often smaller. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1619111335537-CZHYB7OUSBWDKNWUCHHZ/br+range.JPG The Naunheim Files - A 16 y.o. female came to the ED with pain in the L shoulder and a diffuse rash. Brown recluse spiders are found routinely in Missouri https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1619111435677-IGN6V63VAOAMCKC2M33F/brblackwid.JPG The Naunheim Files - A 16 y.o. female came to the ED with pain in the L shoulder and a diffuse rash. The black widow has an hour glass shape on the ventral surface and eats her mate; hence the name. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1619111516472-UJWGT0KY3VZUQ0D5BADV/br+wolfff.jpg The Naunheim Files - A 16 y.o. female came to the ED with pain in the L shoulder and a diffuse rash. the wolf spider https://everydayebm.org/naunheim-files/2021/4/12/dcoj1o2pcj6xiokcqe8434amkc3pqm monthly 0.5 2021-04-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1618245240645-U4JSVU5BFYXVHJSJBHN1/haglunds.JPG The Naunheim Files - A 60 y.o. woman presented with pain in her heel She is afebrile. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1618498008469-8G0MKW1ZEIWZ81FI1BQ0/haglundsxray.JPG The Naunheim Files - A 60 y.o. woman presented with pain in her heel Haglund’s exostosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1618498066948-HJYI6RCDMKOE2J4ZMT5X/haglund%2Ckager.JPG The Naunheim Files - A 60 y.o. woman presented with pain in her heel Kagers triangle is not visible if there is Achilles tendonitis, bursitis of the retrocalcaneal bursa or Achilles rupture https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1618498157431-6YK58AHMIVKZGTBICSP9/haglunds+US.JPG The Naunheim Files - A 60 y.o. woman presented with pain in her heel https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1618498211244-PI3BL4QC4AURPTKQ0N28/haglunds%2C1670f.jpg The Naunheim Files - A 60 y.o. woman presented with pain in her heel Men’s shoes https://everydayebm.org/naunheim-files/2021/4/5/a91-yo-with-a-hx-of-partial-anomalous-pulmonary-venous-return-presents-with-shortness-of-breath monthly 0.5 2021-04-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1617638505070-8TACZRXTM9ZX1VZ3SIUE/partial+anomolous.JPG The Naunheim Files - A 91 y.o. with a hx of partial anomalous pulmonary venous return presents with shortness of breath. what do the arrows represent? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1617887544749-V529YOUYZ0R28LKPHOB7/partial+anomolous2.JPG The Naunheim Files - A 91 y.o. with a hx of partial anomalous pulmonary venous return presents with shortness of breath. The Scimitar is shown here https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1617888204466-ASXDCMB6SGPDB7P2OGE2/partial+anomalous+pvr+svc.JPG The Naunheim Files - A 91 y.o. with a hx of partial anomalous pulmonary venous return presents with shortness of breath. Pulmonary veins draining into the SVC https://everydayebm.org/naunheim-files/2021/3/29/a-67-yo-woman-with-a-hx-of-endometrial-cancer-presents-with-leg-swelling monthly 0.5 2021-04-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1617025303549-RY8E1K2VGJKJAQ0B38KB/retrop.JPG The Naunheim Files - A 67 y.o. Albanian woman with a hx of endometrial cancer presents with leg swelling. What do you notice on CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1617292292737-RUZH5LFO8HZQF8Z8SHMJ/retropff.jpg The Naunheim Files - A 67 y.o. Albanian woman with a hx of endometrial cancer presents with leg swelling. the arrow demonstrates retroperitoneal fibrosis encasing the vessels https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1617292354556-MB3Q6LP6YYT67NUD0Q35/balkansff.jpg The Naunheim Files - A 67 y.o. Albanian woman with a hx of endometrial cancer presents with leg swelling. https://everydayebm.org/naunheim-files/2021/3/22/a-34-yo-woman-comes-in-with-r-arm-numbness monthly 0.5 2021-03-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1616424925904-7ZEWTTF45694Q0QNP6HA/takayasu.JPG The Naunheim Files - A 34 y.o. woman comes in with R arm numbness on CTA she has a markedly small aorta; what disease is this? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1616685777177-2O4D117LXOWA91SMB1GG/vas+tak+eye.JPG The Naunheim Files - A 34 y.o. woman comes in with R arm numbness neovascularization associated with takayasu’s https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1616685880558-J1IKTH0URWYF1CAUG2A8/vas+cryo.JPG The Naunheim Files - A 34 y.o. woman comes in with R arm numbness cryoglobulinemia a small vessel vasculitis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1616686088833-2RFJPUNEAL7OZRGY7HV0/taka2.JPG The Naunheim Files - A 34 y.o. woman comes in with R arm numbness narrowing of the R subclavian and absent common carotid on the L in Takayasu’s https://everydayebm.org/naunheim-files/2021/3/13/a-47-yo-woman-is-sp-hysterectomy-for-fibroids-and-presents-with-a-llq-mass monthly 0.5 2021-03-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1615642972593-3MEIASUQ36K43OTY5NZO/leiomyosarcf.jpg The Naunheim Files - A 47 y.o. woman is sp hysterectomy for fibroids and presents with a LLQ mass https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1616172008917-KTK1C3I6SQUJ90HBONAM/leio+gross.JPG The Naunheim Files - A 47 y.o. woman is sp hysterectomy for fibroids and presents with a LLQ mass A large leiomyoma was found to have microscopic foci of sarcoma https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1616172144945-EPEMZTOBGCNO7P8BZYMA/leiomri.JPG The Naunheim Files - A 47 y.o. woman is sp hysterectomy for fibroids and presents with a LLQ mass This patient had morcellation of a leiomyomatous uterus and presented 28 months later with metastatic sarcoma https://everydayebm.org/naunheim-files/2021/3/8/a-17yo-with-sudden-onset-of-sore-throat monthly 0.5 2021-03-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1615220029683-D1GWIM24R5YP68LV82FA/pmed1.JPG The Naunheim Files - A 17y.o. with sudden onset of sore throat Hint: Dr. Grass will know https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1615404057537-XQ13CCFD71UFP11ZO06E/pmed2.jpg The Naunheim Files - A 17y.o. with sudden onset of sore throat Air visible at the arrows https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1615404340432-L24GN6Q6AAEMJVHM4UZN/pmed3.JPG The Naunheim Files - A 17y.o. with sudden onset of sore throat Air is much easier to see on the CT , especially in the neck https://everydayebm.org/naunheim-files/2021/3/1/a-90-yo-woman-is-transferred-from-an-osh-with-a-felon-involving-the-dip-joint monthly 0.5 2021-03-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1614617043787-U01331CFO78IK8KO4HMC/goutx.JPG The Naunheim Files - A 90 y.o. woman is transferred from an OSH with a "felon involving the DIP joint" https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1614617294962-AZTWHHERKTS51PDKZ1A8/gout6f.JPG The Naunheim Files - A 90 y.o. woman is transferred from an OSH with a "felon involving the DIP joint" hint: the distal DIP joint appears involved What is wrong? What should you do? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1614875642387-RCOOPTKFOS2G1VBLTPLX/gout+henry+the.JPG The Naunheim Files - A 90 y.o. woman is transferred from an OSH with a "felon involving the DIP joint" Podagra is gout of the great toe and was well known in the Middle Ages. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1614875757105-S6CXC6S09DPF0BHDSHQP/goutunder+over.JPG The Naunheim Files - A 90 y.o. woman is transferred from an OSH with a "felon involving the DIP joint" https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1614875815160-JHN7Z85P1ZDDIGML0GZK/gout+vs+pseudof.JPG The Naunheim Files - A 90 y.o. woman is transferred from an OSH with a "felon involving the DIP joint" gout crystals are needle like and pseudogout are rhomboid https://everydayebm.org/naunheim-files/2021/2/22/a-51-yo-woman-with-lupus-comes-in-with-abdominal-pain-and-night-sweats monthly 0.5 2021-02-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1614010395764-BZA3HL38WCVN21HLJ6YD/pseudo1.PNG The Naunheim Files - A 51 y.o. woman with lupus comes in with abdominal pain and night sweats. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1614271377115-QMWSRWGCFR1L14Y10G7L/pseudo2.PNG The Naunheim Files - A 51 y.o. woman with lupus comes in with abdominal pain and night sweats. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1614271581678-X2OAKXZSGVQARWPVDR6F/mycotic+aneu+LAD+17+y.o.+with+neurofibromatosis.PNG The Naunheim Files - A 51 y.o. woman with lupus comes in with abdominal pain and night sweats. mycotic aneursym of the LAD in a patient with neurofibromatosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1614271773268-7D84GSGLNV43JEQ8L8TO/mycotic+a+18y.owith+endocarditis.PNG The Naunheim Files - A 51 y.o. woman with lupus comes in with abdominal pain and night sweats. mycotic aneursyms often occur in the brain as in this 18 y.o. with endocarditis. https://everydayebm.org/naunheim-files/2021/2/15/a-29-yo-woman-presents-with-a-rash monthly 0.5 2021-02-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1613427916215-Y30VDW4BLQCF5WEQ1TW6/scabiesf.png The Naunheim Files - A 29 y.o. woman presents with a rash. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1613663956588-R35GQUE6A4UPF4U0WNO0/scabies+burrow.PNG The Naunheim Files - A 29 y.o. woman presents with a rash. The burrows of scabies mites https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1613664074127-026OFI9Z9HCYZOZ0N6P4/scabies+life+cycle.PNG The Naunheim Files - A 29 y.o. woman presents with a rash. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1613664161545-GMY3XTUV3WA6RSQD94L2/scabies%2C+the+mite.PNG The Naunheim Files - A 29 y.o. woman presents with a rash. Under 40x power the mite would appear about 1/4 this size https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1613664486274-6YREMKMFQGKVWMYQEPO2/scabies+dog.PNG The Naunheim Files - A 29 y.o. woman presents with a rash. mite infestation in a dog https://everydayebm.org/naunheim-files/2021/2/8/a-55-yo-male-with-untreated-hiv-presents-with-a-skin-rash monthly 0.5 2021-02-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1612805468366-AIEM87KHCTLV6XDHGQUZ/decon2.PNG The Naunheim Files - A 55 y.o. male with untreated HIV presents with a skin rash https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1612881988370-PQUG84U5XPP5C42592XH/deconsebf.png The Naunheim Files - A 55 y.o. male with untreated HIV presents with a skin rash https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1612882361556-RPHODMO16VGF8AVRUMUX/decon7crypto.PNG The Naunheim Files - A 55 y.o. male with untreated HIV presents with a skin rash cryptococcal skin infection https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1612882974538-S8J77HWF8ZYS8JGWHJ0K/deconmolluscum.PNG The Naunheim Files - A 55 y.o. male with untreated HIV presents with a skin rash molluscum https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1612883046742-EEY5C7EPZNK5KO9A7MTA/deconcinbuschke+low.PNG The Naunheim Files - A 55 y.o. male with untreated HIV presents with a skin rash Buschke-Lowenstein giant anal codyloma with malignant tranformation. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1612883200491-K56ZAPZXCWYIXOB26IBK/decon3.PNG The Naunheim Files - A 55 y.o. male with untreated HIV presents with a skin rash https://everydayebm.org/naunheim-files/2021/2/1/a-47-yo-with-newly-discovered-hiv-presents-with-severe-truncal-ataxia-and-is-unable-to-walk monthly 0.5 2021-02-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1612197062940-338IRCETD45GIWLKWH9K/pmlf.png The Naunheim Files - A 47 y.o. with newly discovered HIV presents with severe truncal ataxia and is unable to walk. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1612458120822-4W64TQ6WYCZG1ZPLIQYW/hiv+cerebellar+tests.PNG The Naunheim Files - A 47 y.o. with newly discovered HIV presents with severe truncal ataxia and is unable to walk. The standard cerebellar tests https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1612458559227-DYRUG1OSHBBRYCL3A4GB/cerebellar+atrophy.PNG The Naunheim Files - A 47 y.o. with newly discovered HIV presents with severe truncal ataxia and is unable to walk. much more common than JC virus is cerebellar atrophy due to alcohol use https://everydayebm.org/naunheim-files/2021/1/25/a-46-yo-woman-presents-5-days-after-an-assault-in-which-she-sustained-rib-fractures-of-the-9th-and-10th-rib-on-the-l monthly 0.5 2021-01-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1611591052661-SA7MA5VN55T9DHU7XDED/splenicartpseudoa.PNG The Naunheim Files - A 46 y.o. woman presents 5 days after an assault in which she sustained rib fractures of the 9th and 10th rib on the left https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1611860112888-4P8XMAK7I7HWYJDKZ5OF/splenicartpseudoafff.png The Naunheim Files - A 46 y.o. woman presents 5 days after an assault in which she sustained rib fractures of the 9th and 10th rib on the left splenic artery pseudoaneursyms five days after injury https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1611860223632-09FLIE4LTLBP01DBD5EN/spleen+normal+post+mvc.PNG The Naunheim Files - A 46 y.o. woman presents 5 days after an assault in which she sustained rib fractures of the 9th and 10th rib on the left A 49 y.o. with normal spleen post MVC and C2 fracture https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1611860275149-U3FSMBXG4NPKF207H7H0/splenic+three+days+later.PNG The Naunheim Files - A 46 y.o. woman presents 5 days after an assault in which she sustained rib fractures of the 9th and 10th rib on the left this is the same 49 y.o. pt three days later showing a splenic rupture https://everydayebm.org/naunheim-files/2021/1/18/a-30-yo-woman-presents-with-dka-and-r-flank-pain monthly 0.5 2021-01-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1610985226782-LIFSZTSQG34GUT6IX02D/polysplenia.PNG The Naunheim Files - A 30 y.o. woman presents with DKA and R flank pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1611247960808-QRHVS6X1DYEXCIGE1MS3/polyspleniacxrfff.png The Naunheim Files - A 30 y.o. woman presents with DKA and R flank pain Our pt had a R paratracheal mass which is a dilated azygous vein from vena caval interruption https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1611248201123-NQ2SR6HT6M6LZ1YTPDO1/polysplenia%2C+interrupted+ivcf.PNG The Naunheim Files - A 30 y.o. woman presents with DKA and R flank pain 1 is the dilated azygous seen on cxr; a central line in this pt would cross the midline https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1611248330001-NC6C40GM2WVZKVSF59K5/polysplenia+howell+jolly.PNG The Naunheim Files - A 30 y.o. woman presents with DKA and R flank pain look for Howell-Jolly bodies if you are concerned about functional asplenia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1611248404837-4I1HC1TT0BIYAK3NES8X/polysplenia+on+ct+male.PNG The Naunheim Files - A 30 y.o. woman presents with DKA and R flank pain the stomach is always on the side of the spleens as in this 70 y.o. man https://everydayebm.org/naunheim-files/2021/1/11/a-52-yo-male-presents-with-back-pain-so-severe-he-has-to-crawl-on-the-floor-and-cannot-walk monthly 0.5 2021-01-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1610381360360-8L5C5W6OILB9TP7SY1NK/sif.png The Naunheim Files - A 52 y.o. male presents with back pain so severe he has to crawl on the floor and cannot walk. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1610728069184-C3Z2WCP7WV2XJIC5MZ2T/si+as+sijointfff.png The Naunheim Files - A 52 y.o. male presents with back pain so severe he has to crawl on the floor and cannot walk. Sacroiliitis in ankylosing spondylitis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1610728148070-R1D4T4D12A2JU3WPRKNH/si%2Csacral+insufficien.PNG The Naunheim Files - A 52 y.o. male presents with back pain so severe he has to crawl on the floor and cannot walk. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1610728274432-8NIYDE35LIVZ9F1IF6FK/SI+AS+cspinf.png The Naunheim Files - A 52 y.o. male presents with back pain so severe he has to crawl on the floor and cannot walk. A patient from last week with ankylosing spondylitis and an odontoid fracture https://everydayebm.org/naunheim-files/2021/1/4/a-61-yo-alcoholic-comes-in-with-decreased-vision-in-the-r-eye-after-falling-on-her-face-two-weeks-previously monthly 0.5 2021-01-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1609775781541-1EL0P96VCNIM13SO2KR8/traumatic+optic+n+inj.PNG The Naunheim Files - A 61 y.o. alcoholic comes in with decreased vision in the R eye after falling on her face two weeks previously. There is an abnormality of the optic nerve. What does this indicate? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1609775843305-3ZPUHRHNIFF3ZCJSSXBE/optic+nerve+normal.PNG The Naunheim Files - A 61 y.o. alcoholic comes in with decreased vision in the R eye after falling on her face two weeks previously. A normal optic nerve for reference https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1610037770532-K0TFJ37T7TPZ8TAXS2L2/optic+neuropathy%2C+trauma.PNG The Naunheim Files - A 61 y.o. alcoholic comes in with decreased vision in the R eye after falling on her face two weeks previously. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1610038240382-BK0J4LZXXXDJ3NOUC4SF/optic+disc+edema%2Ccrv+occlu.PNG The Naunheim Files - A 61 y.o. alcoholic comes in with decreased vision in the R eye after falling on her face two weeks previously. optic disc edema can result from central retiinal vein occlusion without hemorrhages. https://everydayebm.org/naunheim-files/2020/12/28/a-44-yo-woman-with-mixed-connective-tissue-disease-and-renal-failure-on-dialysis-presents-with-a-rash monthly 0.5 2021-01-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1609169556556-0OVFZOYYSAW1P08JMEQR/sjs+breast.PNG The Naunheim Files - A 44 y.o. woman with mixed connective tissue disease and renal failure on dialysis presents with a rash https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1609169611855-QH9TI76BP1FB27DTPQ7V/sjs+lips.PNG The Naunheim Files - A 44 y.o. woman with mixed connective tissue disease and renal failure on dialysis presents with a rash there are no lesions in the mouth. What is your differential? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1609521352075-Y90T1DI6YLHZIOGVB8NV/pemphigus+f.png The Naunheim Files - A 44 y.o. woman with mixed connective tissue disease and renal failure on dialysis presents with a rash A pt seen in the ED with pemphigus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1609521436887-X5MI83FLJ70S06BCBLYH/sjs+man.PNG The Naunheim Files - A 44 y.o. woman with mixed connective tissue disease and renal failure on dialysis presents with a rash https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1609521494622-TQ4A7EEPHGXO962SM9ZA/sjs+blistering.PNG The Naunheim Files - A 44 y.o. woman with mixed connective tissue disease and renal failure on dialysis presents with a rash https://everydayebm.org/naunheim-files/2020/12/21/a-40-yo-male-presents-with-loss-of-vision-in-the-l-outer-lower-quadrant-of-the-l-eye monthly 0.5 2020-12-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1608559804096-RC35YZCONB80EXWW4872/syphilis+eye.PNG The Naunheim Files - A 40 y.o. male presents with loss of vision in the L outer lower quadrant of the L eye What is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1608840156246-8TZ0H22WUFHD98L2LF54/syph+spiro.PNG The Naunheim Files - A 40 y.o. male presents with loss of vision in the L outer lower quadrant of the L eye The spirochetes can be seen on dark field microscopy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1608840236718-1LY6TE1RP874CIY26MUK/syphilisfeet.PNG The Naunheim Files - A 40 y.o. male presents with loss of vision in the L outer lower quadrant of the L eye the soles of his feet showed a classic secondary syphilis rash https://everydayebm.org/naunheim-files/2020/12/14/gasngnmpcc75p4tfdfy5pjjy5cwhvj monthly 0.5 2020-12-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1607962621761-44C785T5NS6Q86ZX34AE/krause+1.PNG The Naunheim Files he has air in both psoas muscles and in the renal collecting system https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1607962664331-7ETIGXF18ND9K3H0VRA9/krausespaif.png The Naunheim Files And air in the spinal canal; What is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1608222481601-S6W97YE73LMOABASB8PX/pyelotbc.PNG The Naunheim Files tuberculosis is a common cause of pyelitis/pyelonephritis world wide. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1608222652781-FXK6QO97Q4IWC7KDAUWF/pyelousfff.png The Naunheim Files https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1608222701328-P1LPT9DJFRIDH6TRVZWX/pyelochrf.png The Naunheim Files Chronic pylonephritis results in a small scarred kidney https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1608223104752-9C0ETU8K5GZXYBC5XW8D/pyeloxanff.png The Naunheim Files in xanthogranulomatous pyelonephritis the differentiation of the calyces is lost https://everydayebm.org/naunheim-files/2020/12/7/a-34-yo-woman-and-daily-meth-user-comes-in-with-a-rash-and-eye-pain monthly 0.5 2020-12-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1607356188335-3S25CCXB46Q9YVZXRGSO/mccowineyef.png The Naunheim Files - A 34 y.o. woman who is a daily meth user comes in with a rash and eye pain and WBCs in the anterior chamber https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1607356289019-TNEJMDE41TWK19CNNHNN/mccowinff.png The Naunheim Files - A 34 y.o. woman who is a daily meth user comes in with a rash and eye pain and a large corneal ulcer https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1607356319407-TPDIGZNM6KV5EVSTT36N/image-asset.png The Naunheim Files - A 34 y.o. woman who is a daily meth user comes in with a rash and eye pain but she also has a papular skin rash all over her body. What could be wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1607620949804-4QTOICDXVXIPPYFRZVWX/mccowinvita.PNG The Naunheim Files - A 34 y.o. woman who is a daily meth user comes in with a rash and eye pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1607621019252-3OQ9MP0FW2NTPFCIUTQS/vit+a+defworld.PNG The Naunheim Files - A 34 y.o. woman who is a daily meth user comes in with a rash and eye pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1607621091326-9L0WT40NX8DFLU28QCHE/vit+a+toad+skinf.png The Naunheim Files - A 34 y.o. woman who is a daily meth user comes in with a rash and eye pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1607622305361-BEUSQPLQE7IL1NHRPT8T/vit+def+years.PNG The Naunheim Files - A 34 y.o. woman who is a daily meth user comes in with a rash and eye pain It takes some time to become vit A deficient https://everydayebm.org/naunheim-files/2020/11/30/a-74-yo-male-is-brought-to-the-ed-after-a-seizure monthly 0.5 2020-12-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606751763334-C7H4KYLH9GV3F3RPTKT1/huger+page.PNG The Naunheim Files - A 74 y.o. male is brought to the ED after a seizure What do you suppose happened? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606751805763-N8VFBTXR8MS6O84LCAG0/huger.PNG The Naunheim Files - A 74 y.o. male is brought to the ED after a seizure Hint: the CT was normal; the passenger also seized https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1607013073467-H3AJBEF036LYIQ62GWKI/CO2+catf.png The Naunheim Files - A 74 y.o. male is brought to the ED after a seizure https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1607013113669-7RECHX9KQ5Q3164Z2MSE/co2+piesf.png The Naunheim Files - A 74 y.o. male is brought to the ED after a seizure https://everydayebm.org/naunheim-files/2020/11/23/an-18-yo-presents-with-arm-pain monthly 0.5 2020-11-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606145867135-BMQKG5ZTIIX7T24CNE0W/thoracic+outletf.png The Naunheim Files - An 18 y.o. presents with arm pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606494016551-1OP0E4O9RXZGZVO8KFL4/toa+anatomy.PNG The Naunheim Files - An 18 y.o. presents with arm pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606494065086-W2VJI74WTOOBK2O9QXF6/tos+post+sug.PNG The Naunheim Files - An 18 y.o. presents with arm pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606494161533-W8ZCXHGDTOLYJO9SVHWQ/tos+us.PNG The Naunheim Files - An 18 y.o. presents with arm pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606494178812-FLNB0Q72ZIQD1645QB3E/tos+us+1.PNG The Naunheim Files - An 18 y.o. presents with arm pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606494199850-2GPWMG0SA119JPVX97PP/tos+US+2.PNG The Naunheim Files - An 18 y.o. presents with arm pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606494220174-TG61048VENTLBO6366VL/tos+us3.PNG The Naunheim Files - An 18 y.o. presents with arm pain https://everydayebm.org/naunheim-files/2020/11/16/a-44-yo-iraqi-woman-comes-to-the-ed-with-r-flank-pain-she-is-sp-a-hysterectomy-and-l-oophorectomy monthly 0.5 2020-11-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1605541895000-7J9AG2HGCZEYBPMOMH3D/endom.PNG The Naunheim Files - A 44 y.o. Iraqi woman comes to the ED with R flank pain. She is sp a hysterectomy and L oophorectomy. Hint: there appears to be a problem in the pelvis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1605802336318-WAUG3JJFMNR3ZL4L15PO/endomet+lapf.png The Naunheim Files - A 44 y.o. Iraqi woman comes to the ED with R flank pain. She is sp a hysterectomy and L oophorectomy. The best way to make the diagnosis of endometriosis is by laparoscopy. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1605802424546-INTI3MTKEHGO84BT6KDS/endometrioma%2Cpneumo.PNG The Naunheim Files - A 44 y.o. Iraqi woman comes to the ED with R flank pain. She is sp a hysterectomy and L oophorectomy. pneumothorax within 72 hrs of menstruation should prompt a consideration of endometriosis. https://everydayebm.org/naunheim-files/2020/11/9/a-78-yo-male-on-hemodialysis-with-a-hx-of-cirrhosis-and-monthly-paracentesis-presents-with-abdominal-pain monthly 0.5 2020-11-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1604935246261-JYC5UD6JYA8H06F4YKOH/galanf.png The Naunheim Files - A 78 y.o. male on hemodialysis with a hx of cirrhosis and monthly paracentesis presents with abdominal pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1604935265219-VML9IANMVG3QJKMP2648/galann2.PNG The Naunheim Files - A 78 y.o. male on hemodialysis with a hx of cirrhosis and monthly paracentesis presents with abdominal pain the pt is hypotensive; what needs to be done? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1605285556637-FM6JKQ95UDPLQD2KX7C1/parcentesis+sites.PNG The Naunheim Files - A 78 y.o. male on hemodialysis with a hx of cirrhosis and monthly paracentesis presents with abdominal pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1605285586354-GZMVGN22D4U1ASYQWN3K/paracentesis+vessels.PNG The Naunheim Files - A 78 y.o. male on hemodialysis with a hx of cirrhosis and monthly paracentesis presents with abdominal pain inferior epigastric vessels https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1605285649338-KT2PTA4SLNC9FN3YQ5KB/para+z.PNG The Naunheim Files - A 78 y.o. male on hemodialysis with a hx of cirrhosis and monthly paracentesis presents with abdominal pain the skin is pulled down as the lidocaine is injected and when it is released the abdominal wall helps retain ascitic fluid https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1605285776396-NO2QIEKNAXIK6KTXKGGZ/para+tipsf.png The Naunheim Files - A 78 y.o. male on hemodialysis with a hx of cirrhosis and monthly paracentesis presents with abdominal pain A TIPS bypasses the cirrhotic liver https://everydayebm.org/naunheim-files/2020/11/2/a-42-yo-male-iv-fentanyl-and-cocaine-user-comes-to-the-ed-with-a-wound-on-the-l-arm monthly 0.5 2020-11-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1604332248480-XKV3H6RIBHY3GK95QD1M/cocaine+and+koolaid.png The Naunheim Files - A 42 y.o. male IV fentanyl and cocaine user comes to the ED with a wound on the L arm why does he mix cocaine with Kool-aid? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1604593507943-PYVJJASWWABXBUOZWMVK/koolaidf.png The Naunheim Files - A 42 y.o. male IV fentanyl and cocaine user comes to the ED with a wound on the L arm https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1604593561259-VUOWB8Q9BG29K19TUYT1/fungal+endophf.png The Naunheim Files - A 42 y.o. male IV fentanyl and cocaine user comes to the ED with a wound on the L arm fungal endophthalmitis with Candida https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1604593734681-TWIVAZBCBAQWANOADPGG/complications+of+IV+drug+use.PNG The Naunheim Files - A 42 y.o. male IV fentanyl and cocaine user comes to the ED with a wound on the L arm Endocarditis is found in 8.5% of IV drug users with fever. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1604593871842-8IW4IZA4CRE2GSX5I38D/koolaid+lung.PNG The Naunheim Files - A 42 y.o. male IV fentanyl and cocaine user comes to the ED with a wound on the L arm A patient from Monday found at the side of the road unresponsive with a fentanyl OD. Differential here includes aspiration, pneumonia or noncardiogenic pulmonary edema. https://everydayebm.org/naunheim-files/2020/10/26/a-57-yo-woman-comes-in-with-neck-pain-and-fever monthly 0.5 2020-10-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1603717141257-MB4VTSMKAQN4REXGN3PZ/mediastinitis2.PNG The Naunheim Files - A 57 y.o. woman comes in with neck pain and fever. you notice some air in the soft tissues https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1603717183730-UP0JAYD2P5M7IFWPMUYQ/mediastinitis1.PNG The Naunheim Files - A 57 y.o. woman comes in with neck pain and fever. and you can follow the air all the way to the mediastinum and heart. What happened here? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1603986946861-8F6UYNKAEYIC1ORM2T8B/vibrio+vul.PNG The Naunheim Files - A 57 y.o. woman comes in with neck pain and fever. this pt went on to an arm amputation. he had been eating raw seafood and developed a vibrio vulnificus infection. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1603987102437-ANAJH2AUEM8UCDP0T9T3/vibrio+hotspots.PNG The Naunheim Files - A 57 y.o. woman comes in with neck pain and fever. where to find vibrio vulnificus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1603987163346-KZ034TQE41QMV2P35VBP/gas+grangrene.PNG The Naunheim Files - A 57 y.o. woman comes in with neck pain and fever. gas gangrene https://everydayebm.org/naunheim-files/2020/10/19/a-30-yo-woman-comes-in-with-r-flank-pain monthly 0.5 2020-10-22 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1603117683146-IGIO0AAX966IUBJNX6FC/angiomyolipoma.PNG The Naunheim Files - A 30 y.o. woman comes in with R flank pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1603379971350-06U5O014W2VSZRK3OO20/angiotuberousf.png The Naunheim Files - A 30 y.o. woman comes in with R flank pain. Often adenoma sebaceum , nodules across the midface are the first finding https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1603380049648-GUS9NYBECTW48O1DCX8N/angiolamf.png The Naunheim Files - A 30 y.o. woman comes in with R flank pain. cystic lung disease in LAM https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1603380197805-Z5321TIITZKO9QNL7IUT/angioskinf.PNG The Naunheim Files - A 30 y.o. woman comes in with R flank pain. Shagreen patches shown on the right are raised lesions described as “orange peel” in character. https://everydayebm.org/naunheim-files/2020/10/12/a-32-yo-male-is-in-the-icu-he-is-intubated-on-pressors-and-profoundly-hypoxic monthly 0.5 2020-10-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1602511326375-ZN0W5EQX7L42Q1SVGGW2/tache+noirf.PNG The Naunheim Files - A 32 y.o. male is in the ICU. He is intubated, on pressors, and profoundly hypoxic What condition causes it? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1602776597671-2GTU2HKSW8FIMDM26BYG/tache+noire2.PNG The Naunheim Files - A 32 y.o. male is in the ICU. He is intubated, on pressors, and profoundly hypoxic tache noire in a patient with sepsis and multiorgan system failure https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1602776658685-T4OXOIQGWVMYHZNZZTWT/tache+noire2next.PNG The Naunheim Files - A 32 y.o. male is in the ICU. He is intubated, on pressors, and profoundly hypoxic the same patient on the next day treated with lubricants and eye patching https://everydayebm.org/naunheim-files/2020/10/5/a-34-yo-comes-in-with-knee-pain monthly 0.5 2020-10-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1601907417629-18205MLB3ONULUHB10F9/calcinosis+cutisf.PNG The Naunheim Files - A 34 y.o. comes in with knee pain Hint : she cannot open her mouth. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1602176523950-9L53GNVFTCMCSVAC6ISQ/scleroderma+mouth.PNG The Naunheim Files - A 34 y.o. comes in with knee pain tightening of the skin in scleroderma can result in difficulty opening the mouth https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1602176679143-QHC843346Z1I482Q1EWK/scleroderma%2Cdactyly.PNG The Naunheim Files - A 34 y.o. comes in with knee pain sclerodactyly https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1602176830744-83TCN1WOAVD6UUJ66KTU/calciphylaxis.PNG The Naunheim Files - A 34 y.o. comes in with knee pain calciphylaxis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1602177158696-1XSZLIPHIJ0K208AC5X1/sclerodermadermatomyositis.PNG The Naunheim Files - A 34 y.o. comes in with knee pain calcinosis can occur in other autoimmune diseases as well https://everydayebm.org/naunheim-files/2020/9/28/a-29-yo-woman-presents-with-ha-fever-and-fatigue monthly 0.5 2020-10-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1601303705396-MPZFSOKJ61Q7B9M5MWUV/all.PNG The Naunheim Files - A 29 y.o. woman presents with HA , fever and fatigue What do you notice on her peripheral smear? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1601568792982-92RXBEYUZV5IAZ6CP4T0/leukemia%2C+cells+f.PNG The Naunheim Files - A 29 y.o. woman presents with HA , fever and fatigue myeloblasts have more cytoplasm and may have auer rods. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1601568933994-4O7VFKNK3GZMJU9XFT7N/leukemia+promyelo.PNG The Naunheim Files - A 29 y.o. woman presents with HA , fever and fatigue promyelocytes have large granules https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1601569004263-TTNOHPY64HMYUASWXRBA/leukemia%2C+blood+cell+diff.PNG The Naunheim Files - A 29 y.o. woman presents with HA , fever and fatigue A review of blood cell differentiation https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1601569075473-OJTTC81R6EQAYU451ZGE/leukemia+auerf.png The Naunheim Files - A 29 y.o. woman presents with HA , fever and fatigue auer rods are found in myelogenous leukemia https://everydayebm.org/naunheim-files/2020/9/21/a-40-yo-male-was-cleaning-an-industrial-tank-of-hydrogen-peroxide-he-became-thirsty-and-took-a-swallow-out-of-a-bottle-he-assumed-had-water monthly 0.5 2020-09-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1600697270552-3GS43MYO72BT6NOTM8FJ/hydrogen+perox2.PNG The Naunheim Files - A 40 y.o. male was cleaning an industrial tank of hydrogen peroxide. He became thirsty and took a swallow out of a bottle he assumed had water. What happened? What should you do? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1600962551282-0PM9HIPB4MBZBCRKTRK7/hydrogen+per4.PNG The Naunheim Files - A 40 y.o. male was cleaning an industrial tank of hydrogen peroxide. He became thirsty and took a swallow out of a bottle he assumed had water. three days later the gas was gone and the pt was discharged https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1600962666446-RF3P91JWHL5J10LQ279Z/hydrogen+peroxidejeff.PNG The Naunheim Files - A 40 y.o. male was cleaning an industrial tank of hydrogen peroxide. He became thirsty and took a swallow out of a bottle he assumed had water. when dish soap and food coloring are added the result can be dramatic https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1600962753471-Q5784OIHGNA32SRMV40B/hydroemphygastritis..PNG The Naunheim Files - A 40 y.o. male was cleaning an industrial tank of hydrogen peroxide. He became thirsty and took a swallow out of a bottle he assumed had water. emphysematous gastritis on CT https://everydayebm.org/naunheim-files/2020/9/14/a-59-yo-woman-was-hit-in-the-head-with-a-pipe-at-work-five-days-later-she-was-found-on-the-floor-at-her-home monthly 0.5 2020-09-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1600094426233-YW13INN7YRK5P7OIEFBD/kernohans.PNG The Naunheim Files - A 59 y.o. woman was hit in the head with a pipe at work; five days later she was found on the floor at her home why is she weak on the R side if the subdural is on the right? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1600357292319-ND2Z93U6VHUKT9I8ORLU/kernorhan%27s+notchf.PNG The Naunheim Files - A 59 y.o. woman was hit in the head with a pipe at work; five days later she was found on the floor at her home weakness on the same side as the lesion https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1600357378318-JSGX36WALKOFGQMI6V4P/kernohanpath+uncal.PNG The Naunheim Files - A 59 y.o. woman was hit in the head with a pipe at work; five days later she was found on the floor at her home herniation of the medial temporal lobe causing compression of the brainstem https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1600357440504-H911FQLNFC73A9T94229/kernoforamen+magnum.PNG The Naunheim Files - A 59 y.o. woman was hit in the head with a pipe at work; five days later she was found on the floor at her home cerebullum heriating through the foramen magnum represented by the white line https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1600357589505-4769MEUT5UZF7EZX7VUL/kernotypes+of+herniation.PNG The Naunheim Files - A 59 y.o. woman was hit in the head with a pipe at work; five days later she was found on the floor at her home types of herniatiion https://everydayebm.org/naunheim-files/2020/9/7/a-63-yo-male-presents-with-painful-urination monthly 0.5 2020-09-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1599489739351-Z9KV7H8SQ8DVELOUJA3A/fungus2.PNG The Naunheim Files - A 63 y.o. male presents with painful urination The pt is altered due to fentanyl and cannot give more history https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1599489858792-9CNJBH9MPUNWEHN9FS6K/emphysematous+pyelof.jpg The Naunheim Files - A 63 y.o. male presents with painful urination You notice his kidney is abnormal on the L https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1599750621864-PTJUAE2QZCM9DMFP9T46/fungus+ball+bl+pic.PNG The Naunheim Files - A 63 y.o. male presents with painful urination a fungus ball in the bladder on cystoscopy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1599750682611-ECSJLJCJRSOYNP3OTVLW/fungus+balls+in+bl.PNG The Naunheim Files - A 63 y.o. male presents with painful urination US is very useful for detecting mycetomas https://everydayebm.org/naunheim-files/2020/8/31/a-60-yo-male-presents-with-painful-ankles-and-a-rash monthly 0.5 2020-09-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1598885175833-X52UCULGVVIKTVQJB1ZA/palpable+p.PNG The Naunheim Files - A 60 y.o. male presents with painful ankles and a rash hint: he also had pericarditis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1599146006363-RZAXCKDNWOBJR4VMS37R/leukocauses.PNG The Naunheim Files - A 60 y.o. male presents with painful ankles and a rash in all cases of small vessel vasculitis some sort of antibody production occurs . Hep C causes this by producing cryoglobulins. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1599146096525-TYYUJ3UXXYJ38IW3B6K8/leukohen.PNG The Naunheim Files - A 60 y.o. male presents with painful ankles and a rash Henoch Schonlein https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1599146163850-49RWB8VL67PODMMDZOS3/leukowegf.jpg The Naunheim Files - A 60 y.o. male presents with painful ankles and a rash saddle nose from Wegener’s https://everydayebm.org/naunheim-files/2020/8/24/a-33-yo-woman-with-renal-failure-comes-in-with-l-hip-pain monthly 0.5 2020-08-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1598279946891-Q5D889TDKSG3MTOOGBOB/irving+1.PNG The Naunheim Files - A 38 y.o. woman with renal failure comes in with L hip pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1598279978867-VHM0197622F0ZKE99LPH/irving2.PNG The Naunheim Files - A 38 y.o. woman with renal failure comes in with L hip pain. what do you notice on her CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1598543945365-WA3WVTQN795VUPEA11W8/irving3.PNG The Naunheim Files - A 38 y.o. woman with renal failure comes in with L hip pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1598544235866-ZLJBB5SOZ2LHUQBT8YE9/eosinophilic+gran.PNG The Naunheim Files - A 38 y.o. woman with renal failure comes in with L hip pain. eosinophilic granuloma causing a lytic lesion in the skull https://everydayebm.org/naunheim-files/2020/8/17/a-62-yo-woman-sp-lumbar-laminectomy-comes-in-for-back-pain-and-headache monthly 0.5 2020-08-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1597673048380-YADE4LA70WW0E1MSFWT1/glenda+lopezmri.PNG The Naunheim Files - A 62 y.o. woman sp lumbar laminectomy comes in for back pain and headache hint: this is a T2 weighted image https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1597937562452-RRWZ3WPSQUDAJZTXPG4A/meningocelef.PNG The Naunheim Files - A 62 y.o. woman sp lumbar laminectomy comes in for back pain and headache a true meningocele or myelomeningocele(containing spinal cord) is covered with dura. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1597937683132-6YP1X8HDKO4D7MLXHG7K/pseudomeningocele1.PNG The Naunheim Files - A 62 y.o. woman sp lumbar laminectomy comes in for back pain and headache this pseudomeningocele extended into the scalp on the L https://everydayebm.org/naunheim-files/2020/8/10/a-23-yo-woman-comes-to-the-ed-with-ruq-pain monthly 0.5 2020-08-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1597067908625-9TD0CQQIZLB5P0NBHQ33/lybyer.PNG The Naunheim Files - A 23 y.o. woman comes to the ED with RUQ pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1597330700017-FDXX7GAQVAO8V6YAU8IE/endocarditis%2C+mitral+valve+image.PNG The Naunheim Files - A 23 y.o. woman comes to the ED with RUQ pain mitral valve endocarditis post resection https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1597330895727-1ZQQV7ANSU2FR9SY36OH/endo+janeway.PNG The Naunheim Files - A 23 y.o. woman comes to the ED with RUQ pain janeway lesions are often flat areas on the palms. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1597331081268-YS7GJ33K88GNTGWSXW7V/endocar+osler.PNG The Naunheim Files - A 23 y.o. woman comes to the ED with RUQ pain oslers nodes are more nodular than Janeway lesions but they can be confused. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1597331334216-DWU0YRNB6HK0IT53H6I1/endocarditis%2C+culture+neg.PNG The Naunheim Files - A 23 y.o. woman comes to the ED with RUQ pain https://everydayebm.org/naunheim-files/2020/8/3/a-30-yo-woman-was-a-passenger-in-an-suv-that-was-rear-ended-airbags-deployed-and-she-had-amnesia-for-three-hours-her-head-ct-is-shown-below-at-the-time-of-the-accident monthly 0.5 2020-08-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1596465365368-95UVOXLG5WNIJG16JQSN/raffel+ct.PNG The Naunheim Files - A 30 y.o. woman was a passenger in an SUV that was rear ended. Airbags deployed and she had amnesia for three hours. Her head ct is shown below at the time of the accident. Hint: the CT is normal. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1596729575683-SNUV9TKQKD3RDQ5A2BN6/cerebral+saltffff.png The Naunheim Files - A 30 y.o. woman was a passenger in an SUV that was rear ended. Airbags deployed and she had amnesia for three hours. Her head ct is shown below at the time of the accident. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1596729858696-713U27E3G6D8BJT6RPVQ/cerebral+salt+wasting.PNG The Naunheim Files - A 30 y.o. woman was a passenger in an SUV that was rear ended. Airbags deployed and she had amnesia for three hours. Her head ct is shown below at the time of the accident. remember the bnp may help make the diagnosis https://everydayebm.org/naunheim-files/2020/7/27/a-53-yo-woman-presents-with-skin-lesions monthly 0.5 2020-07-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1595862265347-Q6WL33JLFWC1E9WAN1ER/gumma+face.PNG The Naunheim Files - A 53 y.o. woman presents with skin lesions https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1595862296319-RWHQTCY8LVRUQ34OAGM7/gumma+buttock.PNG The Naunheim Files - A 53 y.o. woman presents with skin lesions these are perianal lesions. Hint: HIV is negative https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1596121454919-3QR6YNIGFM07Y38U38CY/gumma+yawsfff.png The Naunheim Files - A 53 y.o. woman presents with skin lesions Yaws is a tropical disease also caused by a spirochete but much less common than syphilis—only 1,000 cases in the US each year. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1596121554025-JRAE00PF4VNHYSIDFTEX/gumma+stagesfff.png The Naunheim Files - A 53 y.o. woman presents with skin lesions https://everydayebm.org/naunheim-files/2020/7/20/a-57-yo-male-comes-to-triage-with-a-chief-complaint-of-decreased-vision-in-the-r-eye monthly 0.5 2020-07-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1595256388204-WJIBXESY569IFVLE4RPG/endophthal2ff.png The Naunheim Files - A 57 y.o. male comes to triage with a chief complaint of decreased vision in the R eye hint: the pt has had a gradual decrease in vision for six months. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1595518773606-KOWB3YLY7KZUN212IGZS/cavernous+sinus.PNG The Naunheim Files - A 57 y.o. male comes to triage with a chief complaint of decreased vision in the R eye cranial nerve abnormalities are often seen with caverous sinus thrombosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1595518892279-2RLRE216VCUI7ZA0UMEQ/cav+sinus710.PNG The Naunheim Files - A 57 y.o. male comes to triage with a chief complaint of decreased vision in the R eye Our patient has not had improvement after antibiotics for preseptal cellulitis https://everydayebm.org/naunheim-files/2020/7/13/a-57-yo-with-l-hemiparesis-complains-of-scrotal-swelling-you-notice-three-masses-in-the-scrotal-sac monthly 0.5 2020-07-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1594653190151-3O1TMBIJ5MCL6H1GHS36/spermatocele1.PNG The Naunheim Files - A 57 y.o. with L hemiparesis complains of scrotal swelling; you notice three masses in the scrotal sac the L testicle is on the R of the image what is the other mass? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1594914100325-2IDVE1GBU5QXG169B8VG/spermaoreilly.PNG The Naunheim Files - A 57 y.o. with L hemiparesis complains of scrotal swelling; you notice three masses in the scrotal sac spermatoceles arise from the epididymis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1594914220465-D62D64K7L9N30KO8HDR5/sperma-hematocele.PNG The Naunheim Files - A 57 y.o. with L hemiparesis complains of scrotal swelling; you notice three masses in the scrotal sac hematocele after inguinal surgery https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1594914287769-6E5NC19M3UY9W2KS82PU/varicofff.png The Naunheim Files - A 57 y.o. with L hemiparesis complains of scrotal swelling; you notice three masses in the scrotal sac varicoceles are described as appearing like a “bag of worms” https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1594914367231-XDWWSHOB9K0E7CFGCIJY/sperm-hernia.PNG The Naunheim Files - A 57 y.o. with L hemiparesis complains of scrotal swelling; you notice three masses in the scrotal sac https://everydayebm.org/naunheim-files/2020/7/6/a-2-day-old-comes-in-with-a-cephalohematoma monthly 0.5 2020-07-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1594047105884-LAUZPOQRF7GYFKDK5OJL/hemophilia+ct.PNG The Naunheim Files - A 2 day old comes in with a cephalohematoma. A forceps delivery had been performed. What do you see on the CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1594396202099-8AZRLYYSQWSHYYRND653/alexei+nikolaevichff.png The Naunheim Files - A 2 day old comes in with a cephalohematoma. A forceps delivery had been performed. Heir to the Russian throne who had hemophilia and was treated by Rasputin https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1594396302336-TGHEJH9R6X0QMD6X75RA/hemophiliachart.PNG The Naunheim Files - A 2 day old comes in with a cephalohematoma. A forceps delivery had been performed. helpful tests for diagnosing bleeding disorders. https://everydayebm.org/naunheim-files/2020/6/30/a-98-yo-woman-with-copd-and-ht-comes-to-the-ed-with-abdominal-pain-she-is-pain-free-by-the-time-she-is-seen monthly 0.5 2020-07-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1593532383790-9P6HLNU94IZQLM9H0V0W/eugenia+young+pan.PNG The Naunheim Files - A 98 y.o. woman with COPD, and HT comes to the ED with abdominal pain; she is pain free by the time she is seen what do you see on the CT of her abdomen? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1593532442859-NWQ5289ZJFPKRP9Q1JAI/renal+sinus+cyst.PNG The Naunheim Files - A 98 y.o. woman with COPD, and HT comes to the ED with abdominal pain; she is pain free by the time she is seen and what else? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1593792883868-HLZMPHQQE2066UEPCF8T/eugenia+young+panff.png The Naunheim Files - A 98 y.o. woman with COPD, and HT comes to the ED with abdominal pain; she is pain free by the time she is seen the pancreatic mass https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1593792969859-21MYZ59EE7DQBESEP402/pneumatofff.PNG The Naunheim Files - A 98 y.o. woman with COPD, and HT comes to the ED with abdominal pain; she is pain free by the time she is seen pneumatosis can be a sign of bowel ischemia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1593793407473-B2XIH1EB4WY2K03H09KQ/elderly.PNG The Naunheim Files - A 98 y.o. woman with COPD, and HT comes to the ED with abdominal pain; she is pain free by the time she is seen suggested algorithm for those over 90 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1593793737213-B5GHCWRWIMZCBDPSGYGO/old+man%2Cpapyrus.PNG The Naunheim Files - A 98 y.o. woman with COPD, and HT comes to the ED with abdominal pain; she is pain free by the time she is seen heiroglyphics for the problems of aging. https://everydayebm.org/naunheim-files/2020/6/23/a-31-yo-male-had-a-previous-gsw-to-the-r-chest-and-notes-a-mass-on-the-chest-wall monthly 0.5 2020-06-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1592961031164-S5VJCJ9U5GCSL752QQKJ/empyema+necessitans.PNG The Naunheim Files - A 31 y.o. male had a previous gsw to the R chest and notes a mass on the chest wall. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1593105343634-XC2F385UAR1NKZFL396L/empyema+nec+1fff.png The Naunheim Files - A 31 y.o. male had a previous gsw to the R chest and notes a mass on the chest wall. empyema necessitans in tuberculosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1593106305548-04H470861EXADF0NWDO2/actinomycosissulf+fff.PNG The Naunheim Files - A 31 y.o. male had a previous gsw to the R chest and notes a mass on the chest wall. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1593106350566-E3ENBR6D8Z1ILZBX7PJB/actinomyosulf+gran.PNG The Naunheim Files - A 31 y.o. male had a previous gsw to the R chest and notes a mass on the chest wall. sulfur granules seen with PMNs under a microscope. https://everydayebm.org/naunheim-files/2020/6/15/a-54-yo-woman-comes-in-with-chest-pain-after-her-dalmation-jumped-up-on-her-chest monthly 0.5 2020-06-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1592235046132-E1YJEDE3JA5CEDSCSU42/breast+bleed.PNG The Naunheim Files - A 54 y.o. woman comes in with chest pain after her dalmatian jumped up on her chest. What is causing her pain? ( She has subglandular breast implants.) https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1592495916060-9ESTK6L0K3EAE1C4IZT5/breast+implant+contracturef.png The Naunheim Files - A 54 y.o. woman comes in with chest pain after her dalmatian jumped up on her chest. capsular contraction https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1592496035824-AGMCDD2RMJYIDVNGZX5J/clydesdale+and+dalmatianff.png The Naunheim Files - A 54 y.o. woman comes in with chest pain after her dalmatian jumped up on her chest. A dalmatian is often seen with the Budweiser Clydesdales as in this SuperBowl ad https://everydayebm.org/naunheim-files/2020/6/8/a-24-yo-male-with-hiv-comes-in-with-bright-red-blood-per-rectum-and-a-swollen-painful-knee monthly 0.5 2020-06-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1591625514220-T3U6BOYBDP6VUPL87BPR/chlamydial+proctitisff.png The Naunheim Files - A 24 y.o. male with HIV comes in with bright red blood per rectum and a swollen painful knee. hint: there is marked thickening of the rectal wall and lymphadenopathy of the inferior mesenteric chain. Arthrocentesis revealed a WBC of 48,926. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1591973890828-SA937S87EC3WCC1ZTIG8/reiters++other+symptoms.PNG The Naunheim Files - A 24 y.o. male with HIV comes in with bright red blood per rectum and a swollen painful knee. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1591973925168-JW6O0Y0SVSH8579AGUG4/reiters+skin.PNG The Naunheim Files - A 24 y.o. male with HIV comes in with bright red blood per rectum and a swollen painful knee. A psoriasis like rash can be a manifestation of reactive arthritis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1591973993834-BIMIDC0KJGXHWR3H3S49/reiters+kagers+triangle.PNG The Naunheim Files - A 24 y.o. male with HIV comes in with bright red blood per rectum and a swollen painful knee. in reactive achilles enthesitis Kager’s triangle is often obliterated because of inflammation https://everydayebm.org/naunheim-files/2020/6/1/a-23-yo-male-is-the-driver-of-a-car-that-crashed-into-a-curb-at-70-mph-he-complains-of-neck-pain monthly 0.5 2020-06-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1591019870229-5VI2PH21O8W8C3WBZT39/occipital+condyle+fxfff.png The Naunheim Files - A 23 y.o. male is the driver of a car that crashed into a curb at 70 mph, he complains of neck pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1591285426621-4ZN9E9FU08P5W1R0QID0/tectorial+membrane+rupture.PNG The Naunheim Files - A 23 y.o. male is the driver of a car that crashed into a curb at 70 mph, he complains of neck pain alar ligaments connect the dens to the occipital condyle https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1591285541680-SRWQ6G248J3XT8AFSAUT/tectorial+membrane+rupture1f.png The Naunheim Files - A 23 y.o. male is the driver of a car that crashed into a curb at 70 mph, he complains of neck pain In our patient there was a cervical epidural hematoma caused by the tectorial membrane tear https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1591285813691-5IHUPHCVSRJB2L3SBX3K/atlantooccipital+dissx.PNG The Naunheim Files - A 23 y.o. male is the driver of a car that crashed into a curb at 70 mph, he complains of neck pain craniocervical dissociation https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1591285894643-7U6AB18DY4K4PL4K9DMH/atlantoocciptial+disso.PNG The Naunheim Files - A 23 y.o. male is the driver of a car that crashed into a curb at 70 mph, he complains of neck pain how the diagnosis of craniocervical dissociation is made. https://everydayebm.org/naunheim-files/2020/5/25/a-23-yo-woman-presents-with-r-sided-abdominal-pain monthly 0.5 2020-06-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1590417749128-O4NPI7B6ONN0BRFRISRZ/fitzliverfff.png The Naunheim Files - A 23 y.o. woman presents with R sided abdominal pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1590418152313-0IFHGE7KQHJ14CZ4D4MQ/fitz2+final.PNG The Naunheim Files - A 23 y.o. woman presents with R sided abdominal pain And do you notice anything in the pelvis? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1590680639870-2FSJPO8YSNUTOFJY2BBY/FitzC.PNG The Naunheim Files - A 23 y.o. woman presents with R sided abdominal pain these adhesions are best diagnosed on laparoscopy but as in our case hepatic inflammation can sometimes be seen https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1590680930599-179239NXLCP79IR9C90M/fitzgraph.PNG The Naunheim Files - A 23 y.o. woman presents with R sided abdominal pain It is hard to guess based on symptoms whether an STI is present https://everydayebm.org/naunheim-files/2020/5/18/a-16-yo-presents-with-a-rash-and-hypotension monthly 0.5 2020-05-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1589813527504-7Z1EASPTCEM37J51RUVO/lox+28+first.PNG The Naunheim Files - A 16 y.o. presents with a rash and hypotension this lesion was seen on her back https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1589813605984-TZHNYLW17I3A0NLEN47K/lox29.PNG The Naunheim Files - A 16 y.o. presents with a rash and hypotension the rash spread over the upper back https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1590074350414-ED632VTG5OMK9LU3TE6S/lox+5.PNG The Naunheim Files - A 16 y.o. presents with a rash and hypotension Desquamation in our patient https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1590074425735-4BREIBIXUWDDP30K7N2I/brown+recluse+six+eye+in+three+pairs..JPG The Naunheim Files - A 16 y.o. presents with a rash and hypotension 6 eyes and a violin shape on the thorax mark the brown recluse. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1590074703469-64GHOPRLLDJLIZ07X380/brs+st+vitus+dance.PNG The Naunheim Files - A 16 y.o. presents with a rash and hypotension People who were bitten by a wolf spider (Lycosa tarantula, no relation to tarntula spiders) engaged in frantic dancing. The tarntella dance supposedly was a cure for tarantism. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1590074782256-XEI8YKN123SQRW11M0Z0/brstarantulaf.png The Naunheim Files - A 16 y.o. presents with a rash and hypotension https://everydayebm.org/naunheim-files/2020/5/11/a-71-yo-male-with-warkany-syndrome-and-developmental-delay-comes-to-the-ed-from-a-nursing-home-because-his-eye-is-turning-white monthly 0.5 2020-05-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1589211393023-4Z4W9K77VR1EBMYTGV9B/hypopion1.PNG The Naunheim Files - A 71 y.o. male with Warkany syndrome and developmental delay comes to the ED from a nursing home because "his eye is turning white" he has apparently had a “dense cataract” for many years; this change seems to be painless What could be wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1589476779361-J4RA7LW7UYB7N07EKSQQ/hypopion1.PNG The Naunheim Files - A 71 y.o. male with Warkany syndrome and developmental delay comes to the ED from a nursing home because "his eye is turning white" https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1589476824944-BFF36ITB0JBHPQ85E49D/hypopyon.PNG The Naunheim Files - A 71 y.o. male with Warkany syndrome and developmental delay comes to the ED from a nursing home because "his eye is turning white" https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1589476921746-90DI7V5HRZI54YBFXFH8/hypopion+toxicara.PNG The Naunheim Files - A 71 y.o. male with Warkany syndrome and developmental delay comes to the ED from a nursing home because "his eye is turning white" toxicara canis causing a hypopyon https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1589476979064-C0LVB1R6KL93T7GV1HCQ/hyporetinoblastoma.PNG The Naunheim Files - A 71 y.o. male with Warkany syndrome and developmental delay comes to the ED from a nursing home because "his eye is turning white" retinoblastoma causing clouding of the anterior chamber https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1589477059017-1OJFC662RZVBRSHLL1QJ/hypopyondesmeto.PNG The Naunheim Files - A 71 y.o. male with Warkany syndrome and developmental delay comes to the ED from a nursing home because "his eye is turning white" complication of a hypopyon; a descemetocele, thinning of the cornea leaving only decemets membrane. https://everydayebm.org/naunheim-files/2020/5/4/a-45-yo-male-comes-in-with-abdominal-pain-he-volunteers-that-he-was-told-his-stomach-is-stuck-to-his-liver monthly 0.5 2020-05-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1588601339610-XAH5MBAJ3RVURQT1OT3G/hf1.PNG The Naunheim Files - A 45 y.o. male comes in with abdominal pain; he volunteers that he was told " his stomach is stuck to his liver" there is something in the epigastric area as well; see the image below https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1588601471396-9C2JYT2R7ZNJ5W5G4QPU/hf+blow+upf.png The Naunheim Files - A 45 y.o. male comes in with abdominal pain; he volunteers that he was told " his stomach is stuck to his liver" What would cause the esophagus shown in yellow to be going through the stomach outlined in red? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1588866441582-DT1XRYGR1F0GH1008Y4N/nissen.PNG The Naunheim Files - A 45 y.o. male comes in with abdominal pain; he volunteers that he was told " his stomach is stuck to his liver" The Nissen fundoplication https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1588866610849-C5OITIGDS0L59YC5OCZA/nissen+ugi2.PNG The Naunheim Files - A 45 y.o. male comes in with abdominal pain; he volunteers that he was told " his stomach is stuck to his liver" In both these cases the wrap herniated causing obstruction which can lead to ischemia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1588866710512-DJ6Z2FO7A3LW4GX2SUUG/nissen+ugi+no+sx.PNG The Naunheim Files - A 45 y.o. male comes in with abdominal pain; he volunteers that he was told " his stomach is stuck to his liver" In these cases there is no obstruction and the herniated wrap is asymptomatic https://everydayebm.org/naunheim-files/2020/4/27/a-34-yo-woman-comes-to-the-ed-with-abdominal-pain-she-was-found-on-the-floor-in-her-basement monthly 0.5 2020-04-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1587999255008-FTC3JLQ9IVHK325XJO9J/syphiaor.PNG The Naunheim Files - A 34 y.o. woman comes to the ED with abdominal pain she was found on the floor in her basement. A non con scan of the abdomen shows a large L perirenal hematoma https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1587999391308-BDAZNAZCWF7QHC7YP8LS/syphaortitis.PNG The Naunheim Files - A 34 y.o. woman comes to the ED with abdominal pain she was found on the floor in her basement. Hint : the pt has a vascular abnormality https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1588267103165-9ETI6QC6FVQ6KZF28T9L/syph+aor+path.PNG The Naunheim Files - A 34 y.o. woman comes to the ED with abdominal pain she was found on the floor in her basement. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1588267180331-F90AMNF0PW9YE6DSHXXO/syph+aortitis+without+aneursym.PNG The Naunheim Files - A 34 y.o. woman comes to the ED with abdominal pain she was found on the floor in her basement. syphilitic aortitis can occur without an aneursym as in the case above. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1588267280576-W01HJY4U78TI43TSU6XT/syphilis+stages.PNG The Naunheim Files - A 34 y.o. woman comes to the ED with abdominal pain she was found on the floor in her basement. https://everydayebm.org/naunheim-files/2020/4/20/a-15-yo-woman-comes-in-with-shortness-of-breath monthly 0.5 2020-04-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1587394695331-F26YIKRWFBS6AVR3PDK9/covid.PNG The Naunheim Files - A 15 y.o. woman comes in with shortness of breath https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1587653206559-MZ46P26QM4PYNENB7ZTX/covid+ct+f.png The Naunheim Files - A 15 y.o. woman comes in with shortness of breath A collection of covid + patient CTs from China https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1587653290865-NAD1JWQ5OTO047BEI5LE/covid+ct+various+appearances.PNG The Naunheim Files - A 15 y.o. woman comes in with shortness of breath https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1587653698347-4WGEFVEZI36TUSQ3CHGM/covid+survival+f.PNG The Naunheim Files - A 15 y.o. woman comes in with shortness of breath 30 day survival in the UK https://everydayebm.org/naunheim-files/2020/4/13/a-51-yo-woman-presents-with-l-flank-pain-and-pelvic-pain monthly 0.5 2020-04-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1586788328564-3K0CJ06YW14VG8UAG9IA/pelvic+congestionarr.png The Naunheim Files - A 51 y.o. woman presents with L flank pain and pelvic pain. hint the arrow is pointed at dilated veins https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1586788401690-IEDY1JCN1ZL8CKNVGIRE/nutcracker+final.PNG The Naunheim Files - A 51 y.o. woman presents with L flank pain and pelvic pain. Could there be a cause of dilated veins higher in the abdomen? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1587055779548-2NP4R6VZA9GIDUPTYF7H/nutcracker+anatomy.PNG The Naunheim Files - A 51 y.o. woman presents with L flank pain and pelvic pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1587055842946-3SFZID6PLZCAY6S156YS/nutcracker+pancreas.PNG The Naunheim Files - A 51 y.o. woman presents with L flank pain and pelvic pain. the pancreas can push down on the superior mesenteric artery causing nutcracker syndrome in cases of cancer https://everydayebm.org/naunheim-files/2020/4/6/a-73-yo-male-presents-with-abdominal-pain monthly 0.5 2020-04-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1586187932027-W1D8XRIQCIBJRRDA31LG/hot+quadrate+4.PNG The Naunheim Files - A 73 y.o. male presents with abdominal pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1586187955926-F6EKNTQ4BI4R4NPC4YQ4/hot+quadrate2.PNG The Naunheim Files - A 73 y.o. male presents with abdominal pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1586449363339-CGFXW6PIX344R7L59M9M/hot+quadrate.PNG The Naunheim Files - A 73 y.o. male presents with abdominal pain another view of our patient with increased contrast in the quadrate lobe https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1586449424751-VO1TORL9LSO07MZJLDMJ/liver+lobes.PNG The Naunheim Files - A 73 y.o. male presents with abdominal pain the lobes of the liver are visualized here anteriorly and posteriorly. Segment I is the caudates. It is posterior and superior. Segment IV posteriorly shows the quadrate lobe which is inferior and medial on the L lobe of the liver. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1586449604786-LN8MLEFIYN553QDIFJ61/liver+hot+caudatef.png The Naunheim Files - A 73 y.o. male presents with abdominal pain contrast in the caudate lobe with Budd Chiari syndrome https://everydayebm.org/naunheim-files/2020/3/30/a-19-yo-with-a-hx-of-asthma-not-on-steroids-but-a-previous-intubation-comes-to-the-ed-with-shortness-of-breath monthly 0.5 2020-04-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1585579962545-CHR48SP9MDBXHCT75OI8/granulation+tissue.PNG The Naunheim Files - A 19 y.o. with a hx of asthma ( not on steroids but a previous intubation) comes to the ED with shortness of breath what do you see? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1585840726164-KHDCSNA2KB9OY2PRXB72/endoaryt.PNG The Naunheim Files - A 19 y.o. with a hx of asthma ( not on steroids but a previous intubation) comes to the ED with shortness of breath this view is upside down from the view during intubation with the ant portion of the neck on the bottom https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1585840867834-TQT9Q3YNCOYLPOXB1A77/endo+post+gloV.PNG The Naunheim Files - A 19 y.o. with a hx of asthma ( not on steroids but a previous intubation) comes to the ED with shortness of breath the glottis is the small area right under the cords https://everydayebm.org/naunheim-files/2020/3/23/a-32-y-male-presents-with-a-feeling-that-his-throat-is-closing monthly 0.5 2020-03-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1584975766111-OSTTU2URT1LEC7EZK9K3/epi.PNG The Naunheim Files - A 32 y. male presents with a feeling that his throat is closing. what do you see? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1585237809847-E1CSCNV388KDRDV4WZEE/epi+cyst.PNG The Naunheim Files - A 32 y. male presents with a feeling that his throat is closing. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1585237926009-6SLQWWG77G9Q3ERXOBML/epi-the+worst.PNG The Naunheim Files - A 32 y. male presents with a feeling that his throat is closing. picture is C is epiglottitis after antibiotics and recovery. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1585238051860-PWBKOJAJYJRBR2YD43KG/high+rising+epiglottisf.png The Naunheim Files - A 32 y. male presents with a feeling that his throat is closing. Since the epiglottis is at the base of the tongue, a normal variant of a high rising epiglottis can occasionally be seen in the mouth https://everydayebm.org/naunheim-files/2020/3/16/an-84-yo-presents-from-a-nursing-home-with-fever-and-r-arm-pain monthly 0.5 2020-03-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1584373090479-5AIS8QNN311060S8757L/nf1.PNG The Naunheim Files - An 84 y.o. presents from a nursing home with fever and R arm pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1584373126035-SGQGLCWE9DOA0IC92CVO/nf2.PNG The Naunheim Files - An 84 y.o. presents from a nursing home with fever and R arm pain This rash appeared over one day https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1584629953592-0UN8WUUUWEAJMPNG33BP/nfctf.png The Naunheim Files - An 84 y.o. presents from a nursing home with fever and R arm pain fluid and edema along fascial planes https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1584630346988-MPPADL74A620XZZ7TU8D/nftissue+death.PNG The Naunheim Files - An 84 y.o. presents from a nursing home with fever and R arm pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1584631006501-QZC6Q8YBTQFXEBW60AMA/nf+earlyf.png The Naunheim Files - An 84 y.o. presents from a nursing home with fever and R arm pain https://everydayebm.org/naunheim-files/2020/3/9/a-46-yo-woman-complained-of-nausea-and-vomiting-she-was-treated-symptomatically-and-had-a-wbc-of-46-and-hgb-of-108 monthly 0.5 2020-03-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1583765017761-IKVO09EM87QTMV7LB1BS/anc0f.png The Naunheim Files - A 46 y.o. woman complained of nausea and vomiting, she was treated symptomatically and had a WBC of 4.6 and Hgb of 10.8 hint : the patient has only lymphocytes in the peripheral smear not neutrophils https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1584037756586-6YLKYU32RUC522G3ITX0/neutropenia+tbc+in+hiv.PNG The Naunheim Files - A 46 y.o. woman complained of nausea and vomiting, she was treated symptomatically and had a WBC of 4.6 and Hgb of 10.8 lower lobe tbc in hiv https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1584038618574-L20W9D6F2ZVPZJSA84E7/neutropenia+causes.PNG The Naunheim Files - A 46 y.o. woman complained of nausea and vomiting, she was treated symptomatically and had a WBC of 4.6 and Hgb of 10.8 https://everydayebm.org/naunheim-files/2020/3/2/a-57-yo-presents-with-sob-and-hemoptysis monthly 0.5 2020-03-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1583162788193-HO5X4LSNR622VH5QU0CB/hattie.PNG The Naunheim Files - A 57 y.o. presents with sob and hemoptysis What do you think is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1583426053330-YO87U5SFS4365US0BPCS/small+vessel+vasculitis.PNG The Naunheim Files - A 57 y.o. presents with sob and hemoptysis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1583426179052-V4EZL547X1422VSH68I3/henoch+scholeinf.png The Naunheim Files - A 57 y.o. presents with sob and hemoptysis Henoch Schonlein small vessel vasculitis is caused by IgA https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1583426247673-55XYQ2N7L23QDXKOXDL2/bluenosefff.PNG The Naunheim Files - A 57 y.o. presents with sob and hemoptysis Pt with lymphoma causing small vessel vasculitis https://everydayebm.org/naunheim-files/2020/2/24/a-51-yo-diabetic-comes-in-with-sudden-onset-of-severe-pain-in-the-l-eye monthly 0.5 2020-02-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1582563184205-DPKS4F0NCDQV9OJBFOBA/scleritis.JPG The Naunheim Files - A 51 y.o. diabetic comes in with sudden onset of severe pain in the L eye What could be wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1582744689831-IURO06496YKV9EHGA81U/layers+of+the+eye.PNG The Naunheim Files - A 51 y.o. diabetic comes in with sudden onset of severe pain in the L eye the sclera is the outer fibrous layer of the eye https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1582744761639-YO3YI0EAM6WM4QWY3HQ8/scleritis+loaloa.PNG The Naunheim Files - A 51 y.o. diabetic comes in with sudden onset of severe pain in the L eye loa loa, a parasite being removed from the sclera https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1582744830727-PWKPTY3VYRG5YTLZCRPF/scleritis+nec.PNG The Naunheim Files - A 51 y.o. diabetic comes in with sudden onset of severe pain in the L eye necrotizing scleritis from rheumatoid arthritis. https://everydayebm.org/naunheim-files/2020/2/17/a-25-yo-male-with-a-hx-of-asthma-presents-with-hemoptysis monthly 0.5 2020-02-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1581953271053-JBEG1AZCPE7D6R2TZXXI/fibmed.PNG The Naunheim Files - A 25 y.o. male with a hx of asthma presents with hemoptysis hint: there is narrowing of the L mainstem bronchus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1581953311933-D4NGB2E9NV1OYF0AVU45/fibmed2.PNG The Naunheim Files - A 25 y.o. male with a hx of asthma presents with hemoptysis There is calcium in the L hilar nodes https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1582226287449-AOOYCG5XI0FZIF01Z8ER/iggplasma+cell.PNG The Naunheim Files - A 25 y.o. male with a hx of asthma presents with hemoptysis plasma cells with typical “clockface” pattern of chromatin are derivatives of lymphocytes https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1582227665476-7UFKDA5DT6TQSNXCM8WH/igg4+prostate.PNG The Naunheim Files - A 25 y.o. male with a hx of asthma presents with hemoptysis IgG4 fibrosis in the prostate causing prostatitis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1582227819026-NGVSERJHIHT81F9CZIAN/igG+hemoptysis.PNG The Naunheim Files - A 25 y.o. male with a hx of asthma presents with hemoptysis https://everydayebm.org/naunheim-files/2020/2/9/a-20-yo-woman-presents-with-a-persistently-high-hcg-after-a-miscarriage monthly 0.5 2020-02-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1581295455499-S7Z6ZNE12NI7NIMSN9D6/chorio.PNG The Naunheim Files - A 20 y.o. woman presents with a persistently high HCG after a miscarriage Why does she have a nodule in the R mid lung? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1581696379385-OL4AWBX3S7QTIGSAIBLV/gtd.PNG The Naunheim Files - A 20 y.o. woman presents with a persistently high HCG after a miscarriage The molar pregnancy is the most common form of GTD https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1581696500067-W7IWE23I8XQ2INJSZ701/gtd%2Cmole.PNG The Naunheim Files - A 20 y.o. woman presents with a persistently high HCG after a miscarriage vesicular lesions noted in a molar pregnancy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1581696591379-63OQE2841TCHH2RFOL3T/gtd+ctf.png The Naunheim Files - A 20 y.o. woman presents with a persistently high HCG after a miscarriage appearance of molar pregnancy on ct. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1581696927574-3UOR1AG8E5OCWY5NNTJQ/gtd+us.PNG The Naunheim Files - A 20 y.o. woman presents with a persistently high HCG after a miscarriage molar pregnancy on us https://everydayebm.org/naunheim-files/2020/2/3/a-51-yo-woman-presents-with-fever-and-l-biceps-pain monthly 0.5 2020-02-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1580744564508-AFAVOZX4WVAXS44Z4Z7U/ax+abscess.PNG The Naunheim Files - A 51 y.o. woman presents with fever and L biceps pain Hint follow the course of the intercostal brachial nerve https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1580744616468-6TKEJHTBESVBC0H2WJWU/intercostal+brachial+n.PNG The Naunheim Files - A 51 y.o. woman presents with fever and L biceps pain Thanks to Drs. Levine and Lew https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1581007164416-HQ02K4MPBGO3BKGNR2FM/ax+abscessf.png The Naunheim Files - A 51 y.o. woman presents with fever and L biceps pain the abscess ion the chest wall https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1581007301101-NJOCZDYLY6S74Q4OX2PP/icbncadaver.PNG The Naunheim Files - A 51 y.o. woman presents with fever and L biceps pain The course of the nerve is extremely variable https://everydayebm.org/naunheim-files/2020/1/27/a-61-yo-male-presents-with-pain-in-his-face monthly 0.5 2020-01-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1580146081631-OP9NYL7VW4T1SVTG0ANY/ramsey+hunt+2f.jpg The Naunheim Files - An 83 y.o. male presents with pain in his face https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1580400185586-IKYSS5BN3JV3R38GDDH9/ramsay+hunt1f.jpg The Naunheim Files - An 83 y.o. male presents with pain in his face Our pt also had involvement of the tongue. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1580400277263-JJZ2YO1WTFF1J7CTF8GZ/ram3.JPG The Naunheim Files - An 83 y.o. male presents with pain in his face another example of Ramsay Hunt https://everydayebm.org/naunheim-files/2020/1/20/a-61-yo-homeless-man-complains-of-fever-and-cough monthly 0.5 2020-01-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1579537170901-0LOJJ1EO7RFX8H581UQE/empyema.JPG The Naunheim Files - A 61 y.o. homeless man complains of fever and cough What does it show? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1579791702714-NO4YIYWYL1S2BJQJI2H8/em+thoracoplasty.JPG The Naunheim Files - A 61 y.o. homeless man complains of fever and cough thoracoplasty for tuberculous empyema https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1579791903379-0ATANIX96DJGFLMH5ZIF/empyema+clagett.JPG The Naunheim Files - A 61 y.o. homeless man complains of fever and cough In a Clagett procedure, a rib is removed creating a hole to allow pleural drainage, the rest of the lung does not collapse because it is adherent to the chest wall. The wound can be closed with a muscle flap shown here from the serratus anterior. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1579792412236-A3N5LSEY5PRZXBI9E36N/empleural+fluid.JPG The Naunheim Files - A 61 y.o. homeless man complains of fever and cough What to measure in a pleural effusion https://everydayebm.org/naunheim-files/2020/1/13/a-59yo-male-presents-after-a-fall-with-pain-in-the-hand monthly 0.5 2020-01-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1578930777580-1T90CFVQNASM6MPSEUIM/sweets.JPG The Naunheim Files - A 59y.o. male presents after a fall with pain in the hand https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1579192791522-S05MQDU56RHLVYWG4UEL/sweets2.JPG The Naunheim Files - A 59y.o. male presents after a fall with pain in the hand chest lesions in our patient https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1579192867362-HX75S5CNWJH1ZI3OPSZE/Sweets%2Ccausesf.jpg The Naunheim Files - A 59y.o. male presents after a fall with pain in the hand causes of Sweet’s syndrome are varied. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1579192987399-KXVXBVWR1V1IX8LASRED/sweets+%282%29.JPG The Naunheim Files - A 59y.o. male presents after a fall with pain in the hand another pt seen in the ED with Sweet’s syndrome and treated erroneously for weeks as infection https://everydayebm.org/naunheim-files/2020/1/6/a-40-yo-woman-with-a-hx-of-brain-tumor-resection-presents-with-fever-and-altered-mental-status monthly 0.5 2020-01-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1578326549176-CD0QBT47NGA15YLSS32A/elevated+protein.JPG The Naunheim Files - A 40 y.o. woman with a hx of brain tumor resection presents with fever and altered mental status. What causes elevated CSF protein? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1578674855263-372UWYVFFXTSFR7AVHT0/elevprot2.JPG The Naunheim Files - A 40 y.o. woman with a hx of brain tumor resection presents with fever and altered mental status. our patients brain tumor 7 yrs ago https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1578674925301-HZ0RCI87DZO7T0E0H55P/csf+xanthochromic.JPG The Naunheim Files - A 40 y.o. woman with a hx of brain tumor resection presents with fever and altered mental status. xanthochromia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1578674990239-QOMKS0GWN916NJ3SEM60/elv+pro+causesf.jpg The Naunheim Files - A 40 y.o. woman with a hx of brain tumor resection presents with fever and altered mental status. brain tumors and shunt malfunctions are also causes of elevated protein https://everydayebm.org/naunheim-files/2019/12/30/a-63-yo-woman-comes-in-with-a-swelling-in-her-neck monthly 0.5 2020-01-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1577718324032-VMEQQ6OPP2P2AOV6W05K/salivary+stctmolly.jpg The Naunheim Files - A 63 y.o. woman comes in with a swelling in her neck hint: there is a fluid collection on the right https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1577718670998-8A5HV58ZXB0HTLYX4G32/salivctf.jpg The Naunheim Files - A 63 y.o. woman comes in with a swelling in her neck https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1577982175176-DZPZYP1PKG4PXLS2W3M8/saliv+glandsf.jpg The Naunheim Files - A 63 y.o. woman comes in with a swelling in her neck https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1577982228673-7CQIW4BS33A4I5KBJX8F/salivaryperson.JPG The Naunheim Files - A 63 y.o. woman comes in with a swelling in her neck small stone is visible at the gland sphincter https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1577982301832-SXNSPJ6UZSSAYSWFZF9W/salivary+stone.JPG The Naunheim Files - A 63 y.o. woman comes in with a swelling in her neck Our patients stone https://everydayebm.org/naunheim-files/2019/12/21/a-30-yo-male-presents-with-leg-pain monthly 0.5 2019-12-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1576935192402-4FD5JR3WCBDSODP2D0ZG/calciphylaxis.JPG The Naunheim Files - A 30 y.o. male presents with leg pain what is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1577379518206-6Q43J9O5L4JAPPN4YANI/calcified+capillaries.JPG The Naunheim Files - A 30 y.o. male presents with leg pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1577379577229-RGRGRNAEK9XGY5GNR7SZ/calci.JPG The Naunheim Files - A 30 y.o. male presents with leg pain ulcers often lead to sepsis in calciphylaxis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1577379676164-S3JYIF8IE13A44MF527F/calcification+in+lung.JPG The Naunheim Files - A 30 y.o. male presents with leg pain https://everydayebm.org/naunheim-files/2019/12/16/a-20-yo-males-presents-with-cervical-adenopathy-he-was-referred-for-a-biopsy monthly 0.5 2019-12-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1576772321976-171MMG7S76ERZDI75JVD/cats+ct.JPG The Naunheim Files - A 20 y.o. male presents with cervical adenopathy. He was referred for a biopsy. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1576772087703-4JVXUT558IE1P0NOU7FV/cat.JPG The Naunheim Files - A 20 y.o. male presents with cervical adenopathy. He was referred for a biopsy. cat saliva can transmit Bartonella https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1576772154942-426AM1Z5KT7NOHLXQFWQ/cat+parinauds+oculoglan.JPG The Naunheim Files - A 20 y.o. male presents with cervical adenopathy. He was referred for a biopsy. cat scratch disease was originally described in the eye: Parinaud’s oculoglandular syndrome https://everydayebm.org/naunheim-files/2019/12/9/a-24-yo-asian-woman-presents-with-a-rash-on-her-palms-and-soles monthly 0.5 2019-12-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1575906843229-T3NBB9UAWFPOXD0TT64V/erythema+multi.JPG The Naunheim Files - A 24 y.o. Asian woman presents with a rash on her palms and soles https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1576253980295-70175NDXL9X93V9EUN47/erythm.JPG The Naunheim Files - A 24 y.o. Asian woman presents with a rash on her palms and soles target lesions of erythema multiforme https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1576254123062-1KT1LOD2QX6X24IF518E/erythemam+causesf.jpg The Naunheim Files - A 24 y.o. Asian woman presents with a rash on her palms and soles causes of erythema multiforme https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1576254195510-YOVGVD843SEAWRB66O7D/syphilispalms.JPG The Naunheim Files - A 24 y.o. Asian woman presents with a rash on her palms and soles syphilis presenting with a palmar rash https://everydayebm.org/naunheim-files/2019/12/2/a-29-yo-woman-presents-with-a-positive-pregnancy-test-and-lower-abd-pain monthly 0.5 2019-12-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1575302083001-K947RJNZ0F2FY7EY5TXB/donesia.JPG The Naunheim Files - A 29 y.o. woman presents with a positive pregnancy test and lower abd pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1575562302443-711X0R4LDNHPSQ1JOI11/ectopic+tubal+ring+signf.jpg The Naunheim Files - A 29 y.o. woman presents with a positive pregnancy test and lower abd pain. beware the tubal ring sign, the pregnancy is still ectopic, you must find the uterus. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1575562394369-4T2JI7X4MZJ8UF577KWC/ectopic+liver.JPG The Naunheim Files - A 29 y.o. woman presents with a positive pregnancy test and lower abd pain. ectopic pregnancy can be anywhere; this one is between the liver and stomach https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1575562509618-8GBB4DX1FR09AY8W4FYH/ectopic+risk+factors.JPG The Naunheim Files - A 29 y.o. woman presents with a positive pregnancy test and lower abd pain. https://everydayebm.org/naunheim-files/2019/11/25/a-41-yo-woman-from-china-presents-with-a-platelet-count-of-17000-and-a-large-lesion-in-her-liver monthly 0.5 2019-11-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1574695839850-39E1VNGRDTEPKJNKQB88/thrombocytop.JPG The Naunheim Files - A 41 y.o. woman from China presents with a platelet count of 17,000 and a large lesion in her liver https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1575123288440-6VEPNZRVJDO83BTM5I7M/KMerritt.JPG The Naunheim Files - A 41 y.o. woman from China presents with a platelet count of 17,000 and a large lesion in her liver this baby was treated with sirolimus and steroids. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1575123749350-1APC0QATMSVUTGIW8BS3/KM2.JPG The Naunheim Files - A 41 y.o. woman from China presents with a platelet count of 17,000 and a large lesion in her liver Karabach Merritt can be associated with angiosarcoma https://everydayebm.org/naunheim-files/2019/11/18/a-20-yo-presents-is-unconscious-after-an-mvc-he-was-intubated-in-the-field monthly 0.5 2019-11-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1574093770572-GX1UFBERURTKLL26N9Z5/hornersf.jpg The Naunheim Files - A 20 y.o. presents is unconscious after a gsw to the face; he was intubated in theED for ongoing bleeding https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1574355851335-OHY7Y3PQCV6VXRGKPAVN/horners+sympathetics.JPG The Naunheim Files - A 20 y.o. presents is unconscious after a gsw to the face; he was intubated in theED for ongoing bleeding https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1574355928693-ZS0ZXQJJSMIVFJ5XFWQS/sympathectomy.jpg The Naunheim Files - A 20 y.o. presents is unconscious after a gsw to the face; he was intubated in theED for ongoing bleeding An ED patient with a sympathectomy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1574356017996-RDQEIL8YPHVYGC1O6QL9/horners+ct.JPG The Naunheim Files - A 20 y.o. presents is unconscious after a gsw to the face; he was intubated in theED for ongoing bleeding our pts ct showing facial fractures https://everydayebm.org/naunheim-files/2019/11/11/a-47-yo-male-became-short-of-breath-after-cleaning-the-corals-in-his-fish-tank monthly 0.5 2019-11-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1573488685252-HZ90GEC8ON2N3A9RJJZ0/jeckstadt+3.JPG The Naunheim Files - A 47 y.o. male became short of breath after cleaning the corals in his fish tank. fathers xray https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1573488881643-0KF0UV7Z9QJLZ3ORZZUS/jeckstadt2.JPG The Naunheim Files - A 47 y.o. male became short of breath after cleaning the corals in his fish tank. sons xray 24 hrs after admission What could have happened? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1573839490107-IA9DMX6KDMPVVE8JXUN7/palytoxin.JPG The Naunheim Files - A 47 y.o. male became short of breath after cleaning the corals in his fish tank. coral containing palytoxin https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1573839629355-2FI5I0NLZ9KJFZ67O8RH/marine+toxins%2C+octo.JPG The Naunheim Files - A 47 y.o. male became short of breath after cleaning the corals in his fish tank. the blue ringed octopus contains tetrodotoxin; https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1573839717061-XIDAGO70RYP44NZUAPK4/marine+toxins+puffer.JPG The Naunheim Files - A 47 y.o. male became short of breath after cleaning the corals in his fish tank. the puffer fish also contains tetrodotoxin in its organs. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1573839802106-BAXFSM7EAC4FSIL34DHQ/marine+toxins+jelly.JPG The Naunheim Files - A 47 y.o. male became short of breath after cleaning the corals in his fish tank. The box jellies of Australia contain a potent toxin; another cnidarian https://everydayebm.org/naunheim-files/2019/11/7/a-38-yo-male-comes-in-with-severe-hip-pain-he-had-been-unconscious-after-a-fentanyl-od- monthly 0.5 2019-11-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1573146125817-RZ2IXRW39XOEOBRALWHH/glutealct.JPG The Naunheim Files - A 38 y.o. male comes in with severe hip pain. He had been unconscious after a fentanyl OD. Do you notice anything on the CT? Hint: it is in the muscle on the right. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1573146219976-7OKU5A4F0P86ZDD8QZZE/gluteus+MRI.JPG The Naunheim Files - A 38 y.o. male comes in with severe hip pain. He had been unconscious after a fentanyl OD. Swelling in the right gluteal muscles on MRI https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1573146321881-I2KIE75ARGH8LU7137HP/gluteal+anatomyf.jpg The Naunheim Files - A 38 y.o. male comes in with severe hip pain. He had been unconscious after a fentanyl OD. In our patient only the gluteus medius and gluteus minimus were involved. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1573146469823-7M10A59WS7UPZYNS817X/gluteal+actual+surg.JPG The Naunheim Files - A 38 y.o. male comes in with severe hip pain. He had been unconscious after a fentanyl OD. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1573146828400-92K82IP0927HPO44YCVO/king+crush.JPG The Naunheim Files - A 38 y.o. male comes in with severe hip pain. He had been unconscious after a fentanyl OD. Remember crush injuries also can cause a compartment syndrome. https://everydayebm.org/naunheim-files/2019/10/28/a-51-yo-woman-presents-with-altered-mental-status-occurring-over-months monthly 0.5 2019-10-31 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1572273574932-T2DSFF3946B4AZNQMJXQ/kwan.JPG The Naunheim Files - A 51 y.o. woman presents with altered mental status occurring over months What could cause this extensive calcification? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1572535247238-D60RNSI47A5132P91KOC/brain+tumors.JPG The Naunheim Files - A 51 y.o. woman presents with altered mental status occurring over months https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1572535319554-GD2995BIYKDD760D3CXK/brain+cal+sturge+weber..JPG The Naunheim Files - A 51 y.o. woman presents with altered mental status occurring over months sturge weber can also lead to calcifications but is usually found in children because of the Port wine stain on the skin. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1572535442663-FHGH3ABW5HDJZLTF7669/brain+tumor%2C+oligo.JPG The Naunheim Files - A 51 y.o. woman presents with altered mental status occurring over months another ct of an oligodendroglioma https://everydayebm.org/naunheim-files/2019/10/21/a-52-yo-male-sp-esophagectomy-and-gastric-pull-up-for-esophageal-ca-10-years-pta-presents-with-chest-pain-sents-for monthly 0.5 2019-10-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1571670091252-T8K9P0QRDXJEBGJPR8CW/pneumo+1.jpeg The Naunheim Files - A 52 y.o. male sp esophagectomy and gastric pull up for esophageal ca 10 years pta presents with chest pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1571670172312-K7Z19TLC4B9JHNT3N044/pneumo+2.jpeg The Naunheim Files - A 52 y.o. male sp esophagectomy and gastric pull up for esophageal ca 10 years pta presents with chest pain. What do you notice on the images? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1572012091532-YNMD7SKFGAKDBQ0A9BTY/pneumo+2arrow.jpg The Naunheim Files - A 52 y.o. male sp esophagectomy and gastric pull up for esophageal ca 10 years pta presents with chest pain. air fluid level in the pericardium https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1572013493705-JFWLV5J8ITV4OL6O26SF/cath%2C+femavfist.JPG The Naunheim Files - A 52 y.o. male sp esophagectomy and gastric pull up for esophageal ca 10 years pta presents with chest pain. A more common complication of cath is AV fistula https://everydayebm.org/naunheim-files/2019/10/14/a-49-yo-male-presents-with-several-months-of-hoarseness monthly 0.5 2019-10-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1571066943255-TSNH47B4EJHBCB23GHRA/vocal+cord+lesionfff.jpg The Naunheim Files - A 49 y.o. male presents with several months of hoarseness What is the differential for vocal cord infiltration? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1571325415639-L5R68CSUFZMUBADEKA50/vocal+cord+arytenoid.JPG The Naunheim Files - A 49 y.o. male presents with several months of hoarseness anatomy of the arytenoids and cords https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1571325638441-OFF26PJZWUBX7D8X5VDW/vocal+cord+%2Ccricoaryfarrow.jpg The Naunheim Files - A 49 y.o. male presents with several months of hoarseness the cricoarytenoid joint is the axis around which the cords pivot https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1571326427012-S0PNUVJRYCEFP0KL6XU2/vocal+cord+post+edema+in+RA.JPG The Naunheim Files - A 49 y.o. male presents with several months of hoarseness Edema of the intraarytenoid space may occur as in this case in RA. https://everydayebm.org/naunheim-files/2019/10/7/a-62-yo-woman-presents-with-chest-pain-after-a-roll-over-mvc monthly 0.5 2019-10-11 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1570458995221-THYZHQAAGRG0C2H3NVJZ/airbag+inj+hayes.JPG The Naunheim Files - A 62 y.o. woman presents with chest pain after a roll over MVC https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1570807400432-6JF1O00G6VEQ5W3FZ6SY/seat+belt+2.JPG The Naunheim Files - A 62 y.o. woman presents with chest pain after a roll over MVC https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1570807459950-DSY6EC80BB0802Z8DWI4/seat+belt+3.JPG The Naunheim Files - A 62 y.o. woman presents with chest pain after a roll over MVC https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1570807639571-PFV0HIXTTT099S2O7MXL/seat+belt+1.JPG The Naunheim Files - A 62 y.o. woman presents with chest pain after a roll over MVC A classic seat belt injury https://everydayebm.org/naunheim-files/2019/9/30/a-35-yo-asian-male-presents-with-gradual-alteration-of-mental-status-and-inability-to-speak-over-8-weeksak-over monthly 0.5 2019-10-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1569855118174-ZC5BSJRP106Z0NG8FZPK/limbic+encepmahasong.JPG The Naunheim Files - A 35 y.o. Asian male presents with gradual alteration of mental status and inability to speak over 8 weeks Hint: the location of the thalami are shown below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1569855179483-R6CKJGZVQDGB4LZK7GMB/limbic+encephalitis2.JPG The Naunheim Files - A 35 y.o. Asian male presents with gradual alteration of mental status and inability to speak over 8 weeks The patient has increased signal in both thalami; What could be the cause? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1570117782379-POSANCBQM986KKPGF6SU/enceph+imageffff.jpg The Naunheim Files - A 35 y.o. Asian male presents with gradual alteration of mental status and inability to speak over 8 weeks A 13 y.o. with uptake in the left temporal area from limbic encephalitis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1570117879706-E0UPYI08S463GEPQO4RF/encephdifferential.JPG The Naunheim Files - A 35 y.o. Asian male presents with gradual alteration of mental status and inability to speak over 8 weeks DIFFERENTIAL FOR ENCEPHALITIS. https://everydayebm.org/naunheim-files/2019/9/23/a-73-yo-woman-comes-in-after-a-fall-and-has-severe-knee-pain monthly 0.5 2019-09-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1569249415847-5VKOY9N0GR6YG4857U4F/bakers+cyst+3.JPG The Naunheim Files - A 73 y.o. woman comes in after a fall and has severe knee pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1569515474418-V4IHSX6Z6ID3EG3K0L2H/bakers+cystplickebaumf.jpg The Naunheim Files - A 73 y.o. woman comes in after a fall and has severe knee pain. Baker’s cyst and prepatellar hematoma https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1569515989246-AHWGCWAQ61KGHD2QPXHH/bakers+cystfffff.JPG The Naunheim Files - A 73 y.o. woman comes in after a fall and has severe knee pain. bakers cyst showing the valve where it is leaking from the joint. https://everydayebm.org/naunheim-files/2019/9/16/a-67-yo-male-comes-in-with-shortness-of-breath monthly 0.5 2019-09-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1568626643219-D0VY8HPX4DOQ3TK3WN49/goiter.JPG The Naunheim Files - A 67 y.o. male comes in with shortness of breath https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1568912139241-FT0I9ZYLC82BT08FB982/goiterbeltf.JPG The Naunheim Files - A 67 y.o. male comes in with shortness of breath https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1568912622419-C1N6N8V0B0BN4YI1G7BP/goiterctf.JPG The Naunheim Files - A 67 y.o. male comes in with shortness of breath goiter on ct https://everydayebm.org/naunheim-files/2019/9/9/a-75-yo-woman-presents-with-hoarseness-and-coughing-up-blood monthly 0.5 2019-09-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1568039472545-2AGG6BT5QT0ZMMXERWMY/vocal+cordf.jpg The Naunheim Files - A 75 y.o. woman presents with hoarseness and coughing up blood. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1568039509793-Z6553ZD4FN57G19X96GB/vocal+cord2f.jpg The Naunheim Files - A 75 y.o. woman presents with hoarseness and coughing up blood. But the lesion surrounds the carotid without compressing it and also extends into the mediastinum. What is it? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1568383725170-98HJVE571VPJ1VX0QGL8/hem1.JPG The Naunheim Files - A 75 y.o. woman presents with hoarseness and coughing up blood. hemangioma in a child https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1568383812711-ML6Q8JAONMXSKIVZG75S/hemangiocherry.JPG The Naunheim Files - A 75 y.o. woman presents with hoarseness and coughing up blood. common cherry hemangiomas https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1568383873182-7WETRM1KF1DWKV130GFQ/hemangiomas%2C+corduroy.JPG The Naunheim Files - A 75 y.o. woman presents with hoarseness and coughing up blood. the “corduroy sign” of spinal hemangiomas https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1568383931122-3ZOU6BXR4Q1AUCIGAXE3/hempolkaf.jpg The Naunheim Files - A 75 y.o. woman presents with hoarseness and coughing up blood. cross section of the spinal hemangioma “the polka dot sign” https://everydayebm.org/naunheim-files/2019/9/2/a-67-yo-female-presents-with-shortness-of-breath monthly 0.5 2019-09-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1567438922044-BBVQMADEASDRN2OIBRQQ/warthins.JPG The Naunheim Files - A 67 y.o. female presents with shortness of breath hint: the patient has has a mass for 15 years and it is slowly enlarging https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1567696732247-P41E7ZK8SC6S83J1Y0VX/neck+mass+war.JPG The Naunheim Files - A 67 y.o. female presents with shortness of breath cystic appearance of a Warthin’s tumor https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1567696798495-H7QI59NFLNPSPPYL1VRV/neck+mass+cys+hygf.jpg The Naunheim Files - A 67 y.o. female presents with shortness of breath cystic hygroma in an adult; it is more common in children https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1567697104710-7RCBXF2UPOMFUR04WM0F/branchial+cl+diagramf.jpg The Naunheim Files - A 67 y.o. female presents with shortness of breath branchial cleft cysts https://everydayebm.org/naunheim-files/2019/8/26/a-73-yo-woman-presents-with-abdominal-pain monthly 0.5 2019-08-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1566836705898-TEAMYX2NFUHPJBVO8M97/coral+reef2f.jpg The Naunheim Files - A 73 y.o. woman presents with abdominal pain A hint is in the picture below https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1566836752056-30ELXZHGLDPQG237JKBV/coral+reef+4f.jpg The Naunheim Files - A 73 y.o. woman presents with abdominal pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1567175719089-4NK41RPJFX4SK55YSUPI/coral+reef+aorta.JPG The Naunheim Files - A 73 y.o. woman presents with abdominal pain https://everydayebm.org/naunheim-files/2019/8/19/a-61-yo-sp-treatment-for-epidural-abscess-on-vancomycin-for-one-month-presents-with-a-rash monthly 0.5 2019-08-22 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1566228073103-J4K06DA5B1A3OMYBVFNH/hickey.JPG The Naunheim Files - A 61 y.o. sp treatment for epidural abscess with vancomycin for one month, presents with a rash. Absolute eosinophil count was 3.5 (high), alt 78 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1566228136639-PP4CQI8J6MCWM81ZVKPG/hickey+3.JPG The Naunheim Files - A 61 y.o. sp treatment for epidural abscess with vancomycin for one month, presents with a rash. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1566486319863-NILJDERKTUYDBV3OQI6E/dress+causes.JPG The Naunheim Files - A 61 y.o. sp treatment for epidural abscess with vancomycin for one month, presents with a rash. The cause for our patient was vancomycin https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1566486516602-OTSKM58EQOL0ODSP19EU/sjs.JPG The Naunheim Files - A 61 y.o. sp treatment for epidural abscess with vancomycin for one month, presents with a rash. necrotic epidermis seen in stevens-johnson syndrome https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1566486594934-E7HXO52AJ17DFD4PQ4EA/hickey2.JPG The Naunheim Files - A 61 y.o. sp treatment for epidural abscess with vancomycin for one month, presents with a rash. our patient did have mouth lesions which usually is found in SJS https://everydayebm.org/naunheim-files/2019/8/15/a-40-yo-presents-with-a-fever-and-a-lesion-on-her-arm monthly 0.5 2019-08-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1565883190221-MR2HMKUB4GL6AVY0P9Y1/brachial+art.JPG The Naunheim Files - A 40 y.o. presents with a fever and a lesion on her arm. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1565883241489-TOJOYNAMSU75WKSEEQ5R/pseudoaneursym+fem+art.ffff.jpg The Naunheim Files - A 40 y.o. presents with a fever and a lesion on her arm. femoral artery pseudoaneursym https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1565883314688-KY3NO3I1LY6GAPV7OB4Q/pseudoaneursym+sub+cxr.JPG The Naunheim Files - A 40 y.o. presents with a fever and a lesion on her arm. Pseudosneursym of the R subclavian https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1565883377220-3YEQEYTPC7G7HUIUJC23/pseudoaneursubclavian.JPG The Naunheim Files - A 40 y.o. presents with a fever and a lesion on her arm. pseudoaneursym of the R subclavian https://everydayebm.org/naunheim-files/2019/8/5/a-22-yo-returns-from-africa-with-a-fever-of-103-and-a-rash-she-has-a-history-of-autoimmune-hepatitis monthly 0.5 2019-08-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1565010514337-CQR3VTQSSNFJBZAJ1UL7/africa+fever.JPG The Naunheim Files - A 22 y.o. returns from Africa with a fever of 103 and a rash. She has a history of autoimmune hepatitis. A diffuse rash is seen https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1565205391242-7D872UAYF1SUHJYUBGN7/fever+and+africa1.JPG The Naunheim Files - A 22 y.o. returns from Africa with a fever of 103 and a rash. She has a history of autoimmune hepatitis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1565205422833-TWPRUNF0NVDK1Q78JERZ/fever+and+africa+2.JPG The Naunheim Files - A 22 y.o. returns from Africa with a fever of 103 and a rash. She has a history of autoimmune hepatitis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1565205484276-KPN8XXZZ8FJ9WFFMVW67/chick.JPG The Naunheim Files - A 22 y.o. returns from Africa with a fever of 103 and a rash. She has a history of autoimmune hepatitis. Chikungunya https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1565205563551-GMCSZDHL7Z3418Z4H2O1/fever+and+africa+imgty.JPG The Naunheim Files - A 22 y.o. returns from Africa with a fever of 103 and a rash. She has a history of autoimmune hepatitis. typhoid rose spots https://everydayebm.org/naunheim-files/2019/7/29/a-56-yo-male-presents-with-paraplegia monthly 0.5 2019-08-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1564413382289-72YDTNQPR31MJ3DPSA3H/spinal+lipomatosis.JPG The Naunheim Files - A 56 y.o. male presents with paraplegia what is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1564673643454-21ZPNPSTJRCIUYLO4KAC/lipomatosis+grade+II.JPG The Naunheim Files - A 56 y.o. male presents with paraplegia https://everydayebm.org/naunheim-files/2019/7/22/a-48-yo-male-loses-control-of-his-bicycle-and-skids-off-a-slick-road-into-a-ditch-he-has-an-obvious-partial-avulsion-of-the-r-ear monthly 0.5 2019-07-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1563807287000-CV93IB98D1SNKGAPSQ9B/boyer.JPG The Naunheim Files - a 48 y.o. male loses control of his bicycle and skids off a slick road into a ditch. He has an obvious partial avulsion of the R ear. do you agree with the radiologists read? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1564067176619-40Q3PCRY5RGDN9NVQEP0/boyerf.jpg The Naunheim Files - a 48 y.o. male loses control of his bicycle and skids off a slick road into a ditch. He has an obvious partial avulsion of the R ear. The pt actually had a subdural along the falx https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1564067283644-5PUQ5N8V10XUMUBOZLFR/boyer2.JPG The Naunheim Files - a 48 y.o. male loses control of his bicycle and skids off a slick road into a ditch. He has an obvious partial avulsion of the R ear. On T2 MRI the injury appears white over tthe posterior cervical spines https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1564067395984-CSY2HX0CW7HNM9JIJMUF/cspneg.JPG The Naunheim Files - a 48 y.o. male loses control of his bicycle and skids off a slick road into a ditch. He has an obvious partial avulsion of the R ear. an 84 y.o. fell out of his wheelchair and had neck pain with a negative CT of the C spine https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1564067458249-FFRGASLFIKA95GJ5RCAH/cspinmri.JPG The Naunheim Files - a 48 y.o. male loses control of his bicycle and skids off a slick road into a ditch. He has an obvious partial avulsion of the R ear. He returned with persistent pain and an odontoid fracture was seen on MRI requiring treatment. https://everydayebm.org/naunheim-files/2019/7/15/a-58-yo-presents-with-an-expanding-abdominal-wall-hematoma-six-days-after-having-an-abscess-aspirated monthly 0.5 2019-07-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1563205637336-M99GXH74AV78AKKZ4A2C/pseudohematoma.JPG The Naunheim Files - A 58 y.o. presents with an expanding abdominal wall hematoma six days after having an "abscess" aspirated needle aspiration of an “abscess” after appendectomy; only blood returns https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1563205889863-VWVWWSLBZEM5DRO2QK4X/pseudoarrow.JPG The Naunheim Files - A 58 y.o. presents with an expanding abdominal wall hematoma six days after having an "abscess" aspirated she returns six days later with an expanding hematoma; What happened? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1563462127990-FYGVY5HT67JFUO0CB0MC/aneursym.JPG The Naunheim Files - A 58 y.o. presents with an expanding abdominal wall hematoma six days after having an "abscess" aspirated https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1563462292420-1DT63RDG8OKRRE0EI7JO/pseudoheart.JPG The Naunheim Files - A 58 y.o. presents with an expanding abdominal wall hematoma six days after having an "abscess" aspirated https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1563463125897-FROIE1HGT9XU7BV92E3R/usmlef.JPG The Naunheim Files - A 58 y.o. presents with an expanding abdominal wall hematoma six days after having an "abscess" aspirated a. septal rupture b. left ventricular free wall rupture c. right ventricular free wall rupture d. mitral regurgitation e. left ventricular aneursym https://everydayebm.org/naunheim-files/2019/7/8/a-30-yo-male-with-no-medical-history-presents-for-memory-loss-he-reports-his-short-term-memory-has-been-gone-for-two-weeks monthly 0.5 2019-07-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1562600631322-XHH8DJCBBU6LMGTEN5C3/encepf.jpg The Naunheim Files - A 30 y.o. male with no medical history presents for memory loss. He reports his short term memory has been gone for two weeks. Increased T2 signal is seen in subcortical areas of the frontal lobes on MRI https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1562944431666-HOPZ0KA1LRBYG3ZZVG9D/encep+rocky+mt+spotted+fever.JPG The Naunheim Files - A 30 y.o. male with no medical history presents for memory loss. He reports his short term memory has been gone for two weeks. Rocky Mountain spotted fever https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1562944505450-CYGQYKRPJ7KIDU2KN831/enceppowassan.JPG The Naunheim Files - A 30 y.o. male with no medical history presents for memory loss. He reports his short term memory has been gone for two weeks. Powassan encephalitis is also tick borne and not the cause of our patients disease.. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1562944789597-LZRTTETA4NLJE6ZHRTPJ/encephwest+nile.JPG The Naunheim Files - A 30 y.o. male with no medical history presents for memory loss. He reports his short term memory has been gone for two weeks. Remember West Nile as a possible cause of encephalitis https://everydayebm.org/naunheim-files/2019/7/1/a-39-yo-woman-persents-with-peritonitis-she-has-a-history-of-a-peritoneal-inclusion-cyst-which-has-been-drained-by-ir monthly 0.5 2019-07-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1561995260098-G26GZSTBFFA1DN7QZU4S/peritoneal+inclusion+cyst.JPG The Naunheim Files - A 39 y.o. woman persents with peritonitis, she has a history of a peritoneal inclusion cyst which has been drained by IR. cyst seen on US 3/19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1561995304062-SIFWAG8D5X2XP9A1H8X5/peritoneal+TOA.JPG The Naunheim Files - A 39 y.o. woman persents with peritonitis, she has a history of a peritoneal inclusion cyst which has been drained by IR. CT prior to cyst drainage. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1562259249923-9HURAT184UO174HNGPVX/peritoneal+inclusion+cysts.JPG The Naunheim Files - A 39 y.o. woman persents with peritonitis, she has a history of a peritoneal inclusion cyst which has been drained by IR. peritoneal inclusion cysts caused by adhesions to the ovary. https://everydayebm.org/naunheim-files/2019/6/24/a-51-yo-presents-for-a-swelling-in-the-buttock monthly 0.5 2019-06-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1561398016174-WQEV9BCOSYT83S99TCJ5/avm.JPG The Naunheim Files - A 51 y.o. presents for a swelling in the buttock What is it? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1561762868348-YAJ08OOTJFEVJGPRCSFD/uterine+avm.JPG The Naunheim Files - A 51 y.o. presents for a swelling in the buttock Uterine AVM presenting with vaginal bleeding and diagnosed with US. While US is the first modality for diagnosis, MRA is often used as well. https://everydayebm.org/naunheim-files/2019/6/17/a-60-yo-male-with-altered-mental-staus-is-found-wandering-you-notice-something-in-his-chest monthly 0.5 2019-06-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1560781167654-67GXSQLC26RUGBYER2K9/loop+event+monitor.JPG The Naunheim Files - A 60 y.o male with altered mental staus is found wandering; you notice something in his chest. what happened to him? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1561128755101-PAAZ5ZY2Z0HDXL94CU2L/loop+recorder%2Chop.JPG The Naunheim Files - A 60 y.o male with altered mental staus is found wandering; you notice something in his chest. placement of a loop event monitor https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1561129042095-Y8Y40W4F4QYRPMSNKTUD/2.JPG The Naunheim Files - A 60 y.o male with altered mental staus is found wandering; you notice something in his chest. https://everydayebm.org/naunheim-files/2019/6/10/a-23-yo-female-involved-in-a-head-on-mvc-is-awake-and-alert-she-is-taken-to-the-or-and-post-op-does-not-wake-up monthly 0.5 2019-06-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1560179146068-CFB894M7VUCDU5I3BMYL/fat+emboli2.JPG The Naunheim Files - A 23 y.o. female involved in a head on MVC, is awake and alert. She is taken to the OR and post op does not wake up. patchy ground glass infiltrates are seen HInt: she had a leg fracture https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1560527671316-3H9IAROQC94AORUEHADA/fat+embolus3.JPG The Naunheim Files - A 23 y.o. female involved in a head on MVC, is awake and alert. She is taken to the OR and post op does not wake up. our patient had fat emboli from a femur fracture https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1560527779540-L743TGU9ECIYTHUV330Q/fat+emboli3brain.jpg The Naunheim Files - A 23 y.o. female involved in a head on MVC, is awake and alert. She is taken to the OR and post op does not wake up. mini infarct in the brain on her T2 weighted images. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1560527928755-55RHUQX5CMDNKXQPKNZW/fat+emboli+with+O+redfff.JPG The Naunheim Files - A 23 y.o. female involved in a head on MVC, is awake and alert. She is taken to the OR and post op does not wake up. fat globues with Oil red O stain in macrophages on bronchoalveolar lavage. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1560528025158-P16BQMY6XY8F8OV6LRTA/fat+embolism+petechiae.JPG The Naunheim Files - A 23 y.o. female involved in a head on MVC, is awake and alert. She is taken to the OR and post op does not wake up. petechiae in fat embolism https://everydayebm.org/naunheim-files/2019/6/3/a-49-yo-woman-presents-with-diarrhea-and-abdominal-pain monthly 0.5 2019-06-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1559571016524-JIT8TZVOT8XJKBM5AT9T/tera.JPG The Naunheim Files - A 49 y.o. woman presents with diarrhea and abdominal pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1559838363383-WVA2IO5A15RBSQJ7L9ZQ/teratomapath.jpg The Naunheim Files - A 49 y.o. woman presents with diarrhea and abdominal pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1559838430369-1R9SGY4MKZHH5VQ5ZILP/teratoma+brain.JPG The Naunheim Files - A 49 y.o. woman presents with diarrhea and abdominal pain. A nine y.o. with headache has a teratoma with teeth in the brain https://everydayebm.org/naunheim-files/2019/5/27/a-61-yo-woman-is-depressed-because-her-cat-died-she-is-drinking-alcohol-and-is-sent-to-the-psych-pod monthly 0.5 2019-05-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1558969276013-J9FOTC75PIQ6O4I5HVM9/torsades.JPG The Naunheim Files - A 61 y.o. woman is depressed because her cat died; she is drinking alcohol and is sent to the Psych pod. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1558969370855-8QI7FGU71WV5OPJSEBVI/torsadesf.JPG The Naunheim Files - A 61 y.o. woman is depressed because her cat died; she is drinking alcohol and is sent to the Psych pod. A toxicologist happened to be in the psych pod and suggested amiodarone not be used. Why? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1559231257514-99BX3CDVKY5MGXQ0880J/amio.JPG The Naunheim Files - A 61 y.o. woman is depressed because her cat died; she is drinking alcohol and is sent to the Psych pod. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1559231302681-WRCOK8NV79MKX5XXQ8ZC/amio2.JPG The Naunheim Files - A 61 y.o. woman is depressed because her cat died; she is drinking alcohol and is sent to the Psych pod. ANd EXCEPT in patients at risk for hypomagnesemia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1559231362804-B2ROTLH9A7T8IICS3Y1E/amio.3JPG.JPG The Naunheim Files - A 61 y.o. woman is depressed because her cat died; she is drinking alcohol and is sent to the Psych pod. AND EXCEPT when the patient is in “slow v tach” because it might be a reperfusion arrhythmia, hyperkalemia or sodium channel blocker OD. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1559231475662-C2KVGZ6V6GSUR2NJU4NI/v+tach.JPG The Naunheim Files - A 61 y.o. woman is depressed because her cat died; she is drinking alcohol and is sent to the Psych pod. This is a case of v tach with av dissociation and fusion beats. courtesy of Amal Mattu https://everydayebm.org/naunheim-files/2019/5/20/a-44-yo-woman-presents-with-r-chest-pain monthly 0.5 2019-05-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1558362383747-TUK7LTNBBJFTFUFVVO5V/histofinal.JPG The Naunheim Files - A 44 y.o. woman presents with R chest pain because of a persistent infiltrate on cxr a PE protocol CT was done. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1558362777793-27SIZLAYP80UK3NO8J82/histo3final.JPG The Naunheim Files - A 44 y.o. woman presents with R chest pain what do you notice on the PE protocol ct? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1558625317611-1G2FNGFENC1P0SEDORPT/histo3f.jpg The Naunheim Files - A 44 y.o. woman presents with R chest pain The mass extends beyond the pulmonary artery https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1558625393379-DS35DXME5JLRB1A1KY6R/fibro.JPG The Naunheim Files - A 44 y.o. woman presents with R chest pain fibrosing mediastinitis with bronchial narrowing https://everydayebm.org/naunheim-files/2019/5/13/a-40-yo-male-complains-of-wrist-pain-after-a-fall monthly 0.5 2019-05-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1557763691878-H4WH4UPGE33ZGZ1J7LGI/signet+ring+of+the+scaphoidf.JPG The Naunheim Files - A 40 y.o. male complains of wrist pain after a fall. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1558016240473-G172AQDX84DO5OBUEXOD/signet+ring+game+of+thrones.JPG The Naunheim Files - A 40 y.o. male complains of wrist pain after a fall. The signet ring of the House of Targaryen, the three headed dragon. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1558016329979-I1LIPYASEGJ0JZHHG9HD/signet+ring+of+scaphoid.JPG The Naunheim Files - A 40 y.o. male complains of wrist pain after a fall. The scaphoid is rotated causing the “ring” sign https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1558016503717-37F2NIRHNG3YJ9R0BV6O/signet+ring+%2Cbronchiectasis.JPG The Naunheim Files - A 40 y.o. male complains of wrist pain after a fall. signet ring in brochiectasis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1558016582032-57IWBZTAAP6A2GRZK2HI/signet+ring+signpapnec.JPG The Naunheim Files - A 40 y.o. male complains of wrist pain after a fall. signet ring sign of papillary necrosis where the sloughed papilla is surrounded by contrast in the calices. https://everydayebm.org/naunheim-files/2019/5/6/a-19-yo-woman-falls-forward-on-to-her-chin-she-has-a-1-cm-lower-lip-laceration-and-severe-l-ear-pain monthly 0.5 2019-05-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1557152594614-4NEU1MTKMK85X8TU4CE4/1brent.JPG The Naunheim Files - A 19 y.o. woman falls forward on to her chin; she has a 1 cm lower lip laceration and severe L ear pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1557152609572-5Y5KPCWEHF3PALCSA30O/2Brent.JPG The Naunheim Files - A 19 y.o. woman falls forward on to her chin; she has a 1 cm lower lip laceration and severe L ear pain Hint the ear pain is her major complaint https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1557330469847-ZE55KH4Z19GZXMPQI06L/brent.JPG The Naunheim Files - A 19 y.o. woman falls forward on to her chin; she has a 1 cm lower lip laceration and severe L ear pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1557330517741-0B0YWQ0LLAH1LHQ912L0/brent2.JPG The Naunheim Files - A 19 y.o. woman falls forward on to her chin; she has a 1 cm lower lip laceration and severe L ear pain condylar fracture on the L https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1557331042328-PH545KTYEHHU4T5CCAKX/intermaxillary+fixation.JPG The Naunheim Files - A 19 y.o. woman falls forward on to her chin; she has a 1 cm lower lip laceration and severe L ear pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1557331193999-KXICBWO7RBS3KSD0BSTK/condylar+fr+kursh+wire.JPG The Naunheim Files - A 19 y.o. woman falls forward on to her chin; she has a 1 cm lower lip laceration and severe L ear pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1557331223006-M1E2Y4VH8HO2V7JSWVRH/condylarkirschboy.JPG The Naunheim Files - A 19 y.o. woman falls forward on to her chin; she has a 1 cm lower lip laceration and severe L ear pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1557331416421-U7GHECRR75KMVVG5TGJR/condylar+anat.JPG The Naunheim Files - A 19 y.o. woman falls forward on to her chin; she has a 1 cm lower lip laceration and severe L ear pain anatomy of the jaw https://everydayebm.org/naunheim-files/2019/4/29/a-20-yo-woman-presents-with-a-cardiac-arrest-rosc-is-obtained monthly 0.5 2019-05-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1556547155921-5JL6SDWXDUXQ9K6588JL/ekg1.JPG The Naunheim Files - A 20 y.o. woman presents with a cardiac arrest; ROSC is obtained. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1556813373675-9VUPA3K8PJY9C27MCQCH/ekg2.JPG The Naunheim Files - A 20 y.o. woman presents with a cardiac arrest; ROSC is obtained. Ischemic changes have resolved https://everydayebm.org/naunheim-files/2019/4/22/a-25-yo-male-with-cushings-syndrome-presents-with-abdominal-distention monthly 0.5 2019-04-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1555943512062-GC08JVDW8UB3KYH014Q1/intussuseption.JPG The Naunheim Files - A 25 y.o. male with cushing's syndrome presents with abdominal distention. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1556292092143-PWMQ6QQCH643YOC64QO8/intussuseptionf.jpg The Naunheim Files - A 25 y.o. male with cushing's syndrome presents with abdominal distention. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1556292152234-312KKRMYJ46HT0COA8YX/intussus.JPG The Naunheim Files - A 25 y.o. male with cushing's syndrome presents with abdominal distention. intussusception in a pt with cancer https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1556292492066-BM6UQHK89MQA7I20MWVB/intus%2C+tumor.JPG The Naunheim Files - A 25 y.o. male with cushing's syndrome presents with abdominal distention. lead point for the intussusception shown above, small bowel tumor https://everydayebm.org/naunheim-files/2019/4/15/a-48-yo-complains-of-inability-to-urinate-and-lower-abdominal-pain monthly 0.5 2019-04-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1555339609374-9VXG2ZTHNKCB2SBZJDUO/stercoral+colitis+f.JPG The Naunheim Files - A 48 y.o. complains of inability to urinate and lower abdominal pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1555600788142-WBQMXFPK9UNVEQ7SB3QS/stercoral+perf.JPG The Naunheim Files - A 48 y.o. complains of inability to urinate and lower abdominal pain stercoral colitis causing perforation with free abd fluid, and discontinuity of the sigmoid in an opiod user https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1555600890692-ZKYYGSWTAHYSBAOKI572/toxic+megacolon.JPG The Naunheim Files - A 48 y.o. complains of inability to urinate and lower abdominal pain toxic megacolon occurs in 1% of patients with c diff as in this patient. https://everydayebm.org/naunheim-files/2019/4/8/a-33-yo-male-presents-with-leg-swellingand-oh-by-the-way-a-rash-on-the-penis monthly 0.5 2019-04-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1554735503890-3U54TDMD3E1NUTTAEJ9Y/image-asset.jpeg The Naunheim Files - A 33 y.o. male presents with leg swelling(and Oh, by the way, a rash on the penis) https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1555004253818-APQ2XQKT03GF1LZ54B8I/membranous.JPG The Naunheim Files - A 33 y.o. male presents with leg swelling(and Oh, by the way, a rash on the penis) pathologic findings of membranous glomerulonephropathy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1555004372346-EC610G8BG8DIK046GP7K/endothelins+produce+fibrosis.JPG The Naunheim Files - A 33 y.o. male presents with leg swelling(and Oh, by the way, a rash on the penis) https://everydayebm.org/naunheim-files/2019/4/1/a-39-yo-woman-with-lupus-presents-with-swollen-breasts-and-no-other-swelling monthly 0.5 2019-04-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1554129746804-81N3L0ZCK89Z1K2XNFX2/svc.JPG The Naunheim Files - A 39 y.o. woman with lupus presents with swollen breasts and no other swelling https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1554479090060-DF53K05IBB103EQ9LOGB/svc+collaterals.JPG The Naunheim Files - A 39 y.o. woman with lupus presents with swollen breasts and no other swelling collaterals on the chest wall with svc thrombosis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1554479199857-3G9PP5UVVFATD9QXBB2H/fibrosing+med+svc.JPG The Naunheim Files - A 39 y.o. woman with lupus presents with swollen breasts and no other swelling fibrosing mediastinitis causing svc obstruction https://everydayebm.org/naunheim-files/2019/3/25/a-62-yo-male-from-st-louis-presents-with-fever-hypoxic-respiratory-failure-and-tender-inguinal-nodes monthly 0.5 2019-03-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1553533170566-AOLJKR225HNK5B3FYNOX/tu.JPG The Naunheim Files - A 62 y.o. male from St. Louis presents with fever, hypoxic respiratory failure and tender inguinal nodes. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1553533205541-HB67M8MJATDIQAAJMEAJ/tu2f.jpg The Naunheim Files - A 62 y.o. male from St. Louis presents with fever, hypoxic respiratory failure and tender inguinal nodes. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1553784921014-LWI5NXP1S1KJ9IQ1IS31/tular2.JPG The Naunheim Files - A 62 y.o. male from St. Louis presents with fever, hypoxic respiratory failure and tender inguinal nodes. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1553785062316-OXU84O6P53HLJZZ9KJJH/tular.JPG The Naunheim Files - A 62 y.o. male from St. Louis presents with fever, hypoxic respiratory failure and tender inguinal nodes. Cases in the US in 2016 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1553785260976-W8HKFEOHSUO9DKAW9P86/tular5.JPG The Naunheim Files - A 62 y.o. male from St. Louis presents with fever, hypoxic respiratory failure and tender inguinal nodes. Ulceroglandular tularemia https://everydayebm.org/naunheim-files/2019/3/18/a-69-yo-presents-with-shortness-of-breath monthly 0.5 2019-03-22 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1552948796302-WDK6HF8VX81QU4XYS3QA/leio.JPG The Naunheim Files - A 69 y.o. presents with shortness of breath https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1553266312190-9EF5LOPRT7KDJLGIBN59/adenoma+sebaceum.JPG The Naunheim Files - A 69 y.o. presents with shortness of breath skin manifestations of tuberous sclerosis include adenoma sebaceum https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1553266414253-Y8QAG9QXCRY9VZE0G7OJ/birt+hogg.JPG The Naunheim Files - A 69 y.o. presents with shortness of breath more skin manifestations of cystic lung disease https://everydayebm.org/naunheim-files/2019/3/11/a-bust-in-the-musee-dhomme-in-paris-depicts-a-disease-what-is-it monthly 0.5 2019-03-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1552293021734-QPB4PGCX8PHT6D4KD2E8/Screen+Shot+2019-03-11+at+3.21.46+AM.png The Naunheim Files - A bust in the Musee l'Homme in Paris depicts a disease. What is it? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1552847021886-T2P2ZECOOLXKJ0BHIYYU/sy1.JPG The Naunheim Files - A bust in the Musee l'Homme in Paris depicts a disease. What is it? Electron micrograph of spirochetes; similar spirochetes cause leptospirosis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1552847811353-I5P9S1PPBIXVI2WTK3NL/syaws.JPG The Naunheim Files - A bust in the Musee l'Homme in Paris depicts a disease. What is it? There are several non-venereal types of treponema pallidum including yaws shown above. https://everydayebm.org/naunheim-files/2019/3/4/a-67-yo-male-arrests-in-front-of-ems-and-his-ekg-is-shown-below monthly 0.5 2019-03-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1551716225522-O871L675THQQYMW88RPQ/lane+first+ekg.JPG The Naunheim Files - A 67 y.o. male arrests in front of EMS and his EKG is shown below https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1551827514611-SX98SM4WECP0WOR7F329/ekg2.JPG The Naunheim Files - A 67 y.o. male arrests in front of EMS and his EKG is shown below https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1551827644712-IP9UZI3ZD9NOKLID9T5J/blood+supply.JPG The Naunheim Files - A 67 y.o. male arrests in front of EMS and his EKG is shown below https://everydayebm.org/naunheim-files/2019/2/25/a-22-yo-woman-presents-with-vomiting-and-weight-loss monthly 0.5 2019-02-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1551108812827-MUKIOK5JAX0DF6GRDNI5/super%2Ces.png The Naunheim Files - A 22 y.o. woman presents with vomiting and weight loss the arrows point at the problem https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1551369827991-MG52OT7QM9G9MFUFW6T7/sma+1.JPG The Naunheim Files - A 22 y.o. woman presents with vomiting and weight loss an angle of 20 degrees between the sma and aorta is considered likely to cause sma syndrome https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1551369983235-4Z3FL1AOGV1MJP19IYVP/smaduojej.JPG The Naunheim Files - A 22 y.o. woman presents with vomiting and weight loss surgical correction of sma syndrome with a duodenojejunostomy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1551370431367-ZXO76877FRTNLGQMHQCN/sma%2Cct.JPG The Naunheim Files - A 22 y.o. woman presents with vomiting and weight loss sma syndrome can be diagnosed on Ct as well. the large white arrow is the dilated duodenum, the small black area is the compressed distal duodenum and the two small black arrows show the closeness of the sma and aorta. with the duodenum compressed between. https://everydayebm.org/naunheim-files/2019/2/18/a-36-yo-woman-presents-with-shortness-of-breath-what-is-the-most-likely-cause monthly 0.5 2019-02-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1550506354934-2OBVR57T98N1UQENC8R9/cxr+cannonball.JPG The Naunheim Files - A 36 y.o. woman presents with shortness of breath. What is the most likely cause? what causes cannonball lesions of the lung? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1550769206153-5EENYXU2TDUSMVV7GW8S/cannonball+renal.JPG The Naunheim Files - A 36 y.o. woman presents with shortness of breath. What is the most likely cause? renal cell ca https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1550769257146-7PQCFQMPYHXL9DX3LTQG/cannonball+tbc.JPG The Naunheim Files - A 36 y.o. woman presents with shortness of breath. What is the most likely cause? pulmonary tbc in a diabetic pt https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1550769522432-EZNNPAFY153VN1RUKO1H/cannonball+ra.JPG The Naunheim Files - A 36 y.o. woman presents with shortness of breath. What is the most likely cause? rheumatoid nodules are composed of B lymphocytes and often occur after methotrexate is started. https://everydayebm.org/naunheim-files/2019/2/11/a-27-yo-with-a-hx-of-sinusitis-for-two-months-presents-with-a-seizure monthly 0.5 2019-02-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1549899668493-5A6VQ05LIA72MNK8QVCH/IGG4sinusitis.JPG The Naunheim Files - A 27 y.o. with a hx of sinusitis for two months presents with a seizure https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1549899689824-J6BR30PGODHK24CKJF1O/igg4+vasogenic.JPG The Naunheim Files - A 27 y.o. with a hx of sinusitis for two months presents with a seizure and what is going on the in the L frontal lobe? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1550244199013-WYUZDBTD9X36BY547SM7/IgG4+prostate.JPG The Naunheim Files - A 27 y.o. with a hx of sinusitis for two months presents with a seizure IgG4 in the prostate with a dense lymphocytic infiltrate https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1550244316664-GL78ILGGNB9VR1WR0HEL/IgG4+parotid.JPG The Naunheim Files - A 27 y.o. with a hx of sinusitis for two months presents with a seizure IgG4 related disease in the parotid on the R, Mikulicz disease https://everydayebm.org/naunheim-files/2019/2/4/a-41-yo-woman-fell-while-playing-in-the-snow-and-injured-her-ankle monthly 0.5 2019-02-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1549296186995-T5HY3QFFYEEEFP4AFDGE/fib+fx+2.jpg The Naunheim Files - A 41 y.o. woman fell while playing in the snow and injured her ankle https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1549558260844-UJLLJBMX9N1EVT7UG7HZ/fibular+fx+lat.JPG The Naunheim Files - A 41 y.o. woman fell while playing in the snow and injured her ankle spiral fibular fx seen on lateral view https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1549558333931-0PVRJNDT3YC5MYIPQ2PM/fib+fx+stress.JPG The Naunheim Files - A 41 y.o. woman fell while playing in the snow and injured her ankle widening of the ankle mortice on stress view https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1549558426592-V1LA4J3NI48N8OC8RKXW/galeazzif.JPG The Naunheim Files - A 41 y.o. woman fell while playing in the snow and injured her ankle https://everydayebm.org/naunheim-files/2019/1/24/a-24-yo-with-spina-bifida-presents-with-shortness-of-breath monthly 0.5 2019-01-31 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1548351959209-HPO4A2RM7OXIOI8EDU53/may+thurner+clot+in+ivc.JPG The Naunheim Files - A 24 y.o. with spina bifida presents with shortness of breath do you see a possible reason for her shortness of breath? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1548955715981-9SC1OGT7NKBV81DNE4JR/may+thurner+syndrome.JPG The Naunheim Files - A 24 y.o. with spina bifida presents with shortness of breath R iliac artery compressing the L iliac vein https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1548955831063-LHJHLXLCDHXPZMMIKJY8/phelgmasia+cerulia.JPG The Naunheim Files - A 24 y.o. with spina bifida presents with shortness of breath phlegmasia cerulea dolens https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1548956082022-NSO3P6QP7603OTGJI0Z6/phlegmasia+alba.JPG The Naunheim Files - A 24 y.o. with spina bifida presents with shortness of breath https://everydayebm.org/naunheim-files/2019/1/21/a-56-yo-male-presents-with-painful-l-arm-swelling-and-a-rash monthly 0.5 2019-01-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1548085332057-VQV0T6T5FZ6UC7DN79QZ/kaposis+arm.JPG The Naunheim Files - A 56 y.o. male presents with painful arm swelling and a rash What is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1548348995055-00XG933OWK5BA9J24UKP/kaposi%27s+lung.JPG The Naunheim Files - A 56 y.o. male presents with painful arm swelling and a rash Involvement of the lung caused LLL collapse https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1548349060818-JKR8VBW1C9MJJ8B9MTOC/kaposis+nose.JPG The Naunheim Files - A 56 y.o. male presents with painful arm swelling and a rash Kaposi’s can be nodular or flat as appears on this image https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1548349524498-3GS5WQWP8M1WG0LYA2Z9/kaposis+africa.JPG The Naunheim Files - A 56 y.o. male presents with painful arm swelling and a rash Untreated Kaposi’s becomes nodular https://everydayebm.org/naunheim-files/2019/1/14/a-79-yo-woman-presents-with-ruq-pain monthly 0.5 2019-01-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1547481082124-207FM4CPYFTOHNOX3P6O/polycystic+liver.JPG The Naunheim Files - A 79 y.o. woman presents with RUQ pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1547891575842-5WR7W5021GUELF159VGZ/hydatid+cysts.JPG The Naunheim Files - A 79 y.o. woman presents with RUQ pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1547891651340-NHJX25OEPCVLHQV7ETLK/hydatid+uterus.JPG The Naunheim Files - A 79 y.o. woman presents with RUQ pain hydatid cysts can occur in many organs including uterus and bone. https://everydayebm.org/naunheim-files/2019/1/7/a-57-yo-woman-presents-with-jaundice-and-hct-of-16-her-peripheral-smear-is-shown-below monthly 0.5 2019-01-11 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1546876515398-MAVE3AFC15EUQQPYD9F4/spur+cell.JPG The Naunheim Files - A 57 y.o. woman presents with jaundice and a Hct of 16. Her peripheral smear is shown below. What is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1547221206308-HTQJFKF82E4C82C2ZIYS/echino.JPG The Naunheim Files - A 57 y.o. woman presents with jaundice and a Hct of 16. Her peripheral smear is shown below. echinocytes https://everydayebm.org/naunheim-files/2018/12/31/a-29-yo-male-comes-in-with-l-flank-pain monthly 0.5 2019-01-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1546269173120-ZOPWUFWPOW2ASN087H0X/divert2.JPG The Naunheim Files - A 29 y.o. male comes in with L flank pain CT was correctly read by the junior in EM1. Great work Scott! https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1546533052650-2WGSI0SNWIM50V89303R/divert2ar.jpg The Naunheim Files - A 29 y.o. male comes in with L flank pain our patient with a L sided diverticulum https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1546533143017-VNMZPVELTUF08NU57DA6/divertcolonoscopy.JPG The Naunheim Files - A 29 y.o. male comes in with L flank pain diverticulae on colonoscopy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1546533256954-JNWNB74010YE9J2WSI5W/divert3ar.jpg The Naunheim Files - A 29 y.o. male comes in with L flank pain an 86 y.o with sigmoid diverticulae causing a stricture https://everydayebm.org/naunheim-files/2018/12/24/a-57-yol-woman-with-pancreatic-cancer-has-an-ivc-filter-placed-for-iliac-dvt monthly 0.5 2018-12-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1545663965751-FVD0D2OF77OUH9SIJ21V/ivc+dup1.JPG The Naunheim Files - A 77 y.o. woman with pancreatic cancer has an IVC filter placed for iliac DVT. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1545926778601-7SCZLAWKWTOJZH2WNWPN/ivc+dup+arrow.jpg The Naunheim Files - A 77 y.o. woman with pancreatic cancer has an IVC filter placed for iliac DVT. Arrow showing the IVC on the L https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1545926843485-ITQ0ZDP0VMHAYB6IJRHH/double+archf.JPG The Naunheim Files - A 77 y.o. woman with pancreatic cancer has an IVC filter placed for iliac DVT. double aortic arch on cxr https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1545926883125-N8SSS05OY0IFRB6RHON8/double+arch+dia.JPG The Naunheim Files - A 77 y.o. woman with pancreatic cancer has an IVC filter placed for iliac DVT. double aortic arch https://everydayebm.org/naunheim-files/2018/12/17/a-54-yo-with-metastatic-squamous-cell-ca-of-the-tongue-presents-with-rlq-pain monthly 0.5 2018-12-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1545062577793-WJQ92EROX7LQA87SGQGF/typlitis+3.JPG The Naunheim Files - A 54 y.o. with metastatic squamous cell ca of the tongue presents with RLQ pain. What is in the RLQ? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1545324743761-LCBD25TQTHATHKZ2F6RP/typhilitis2.JPG The Naunheim Files - A 54 y.o. with metastatic squamous cell ca of the tongue presents with RLQ pain. Cecal wall thickening seen more easily with contrast in typhlitis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1545325176628-65MKMOY8NBEYRORIT6TZ/right+lower+quad+ovarian+vein.JPG The Naunheim Files - A 54 y.o. with metastatic squamous cell ca of the tongue presents with RLQ pain. Thrombosed R ovarian vein, shown non enhancing with arrows and open arrow showing fat stranding; another cause of RLQ pain. https://everydayebm.org/naunheim-files/2018/12/10/a-47-yo-pt-with-bipolar-disorder-presents-with-r-eye-drainage monthly 0.5 2018-12-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1544456949992-U7IP3R2NUIZ93XFEGHW4/eye+implant.JPG The Naunheim Files - A 47 y.o. pt with bipolar disorder presents with R eye drainage What is wrong with her eye? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1544802393156-T5WKN41UZX3XJH6Y4WNI/eye+implantdia.JPG The Naunheim Files - A 47 y.o. pt with bipolar disorder presents with R eye drainage https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1544802461531-VDW2ESDYHWNGAIE4IK94/eye+implant+ha.JPG The Naunheim Files - A 47 y.o. pt with bipolar disorder presents with R eye drainage ocular implant made from coral https://everydayebm.org/naunheim-files/2018/12/3/a-38-yo-diabetic-presents-with-abdominal-pain monthly 0.5 2018-12-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1543851664632-3VM6B0FFYX01JV8866TT/nec+pan2.JPG The Naunheim Files - A 38 y.o. diabetic presents with abdominal pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1544120990106-HYDDK6JJN52MY971BHPO/panpath.JPG The Naunheim Files - A 38 y.o. diabetic presents with abdominal pain inflamed pancreas above the duodenum https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1544121065345-9ED2B9NB7QWTSBN7IKND/panransons.JPG The Naunheim Files - A 38 y.o. diabetic presents with abdominal pain https://everydayebm.org/naunheim-files/2018/11/26/a-47-yo-woman-presents-with-acute-abdominal-pain monthly 0.5 2018-11-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1543247376455-1JBJ0XO9NAMQ5X8B3IN2/koehler.JPG The Naunheim Files - A 47 y.o. woman presents with acute abdominal pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1543507923814-NZ04UOEYMBK9JVO16QAH/image-asset.jpeg The Naunheim Files - A 47 y.o. woman presents with acute abdominal pain A cecal volvulus often points to the LUQ https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1543508002461-4RHQI84JXETQWXM4573E/sig+coffee+bean.JPG The Naunheim Files - A 47 y.o. woman presents with acute abdominal pain sigmoid volvulus can be similar with a dilated loop of sigmoid extending to the mid abdomen. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1543508256445-2KY5XZPT2DSMG1MN29UJ/sig+path.JPG The Naunheim Files - A 47 y.o. woman presents with acute abdominal pain The “coffee bean” of sigmoid volvulus https://everydayebm.org/naunheim-files/2018/11/19/a-30-yo-woman-was-in-an-mvc-she-co-abd-pain monthly 0.5 2018-11-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1542643685270-N0KB86JDSVX0EBLH3ZXC/uterine+rupture.JPG The Naunheim Files - A 17 y.o. woman in a high speed MVC presents with abdominal pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1542987162846-5VTKE4FUYE7XNY294I5W/us+uterine+rupture.jpg The Naunheim Files - A 17 y.o. woman in a high speed MVC presents with abdominal pain US with arrow pointing to the placenta, which is outside the uterus. https://everydayebm.org/naunheim-files/2018/11/12/a-49-yo-male-is-bitten-by-a-japanese-pit-viper monthly 0.5 2018-11-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1542039315436-324RC65BS21DOQ5AUPXR/marfisi.jpg The Naunheim Files - A 49 y.o. male is bitten on the thumb by a Japanese pit viper https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1542297069434-UCH24I632CMIXQQLR7YF/image-asset.jpeg The Naunheim Files - A 49 y.o. male is bitten on the thumb by a Japanese pit viper Protobothrops elegans, a Japanese pit viper. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1542297216819-KWC8JI9CNFI7ECXDO5S3/snake.JPG The Naunheim Files - A 49 y.o. male is bitten on the thumb by a Japanese pit viper Echis carinatus, also in the viper familym causes 50% of the snakebite deaths in India. https://everydayebm.org/naunheim-files/2018/11/5/a-40-yo-male-who-had-a-claviculectomy-for-thoracic-outlet-presents-with-drainage-from-the-wound monthly 0.5 2018-11-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1541427605379-BYQLNFOEC33S3JEI9H6K/lymph.jpg The Naunheim Files - A 40 y.o. male who had a claviculectomy for thoracic outlet presents with drainage from the wound. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1541694630985-U6YB95KDOLVA601SDMCF/lymphatic+ducts.JPG The Naunheim Files - A 40 y.o. male who had a claviculectomy for thoracic outlet presents with drainage from the wound. R sided lymphatic drainage https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1541694788104-KC1VQBCDEH04P9H4LEY3/chyle+pink.JPG The Naunheim Files - A 40 y.o. male who had a claviculectomy for thoracic outlet presents with drainage from the wound. A chylous effusion can also look like a pink milkshake as it did in a second pt seen this week in the ED https://everydayebm.org/naunheim-files/2018/10/29/a-52-yo-presents-with-fever-he-is-developmentally-delayed-and-cannot-give-a-history monthly 0.5 2018-11-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1540826291131-CY8FYRADE0JY5P3AFIHT/pneumobilia.JPG The Naunheim Files - A 52 y.o. presents with fever; he is developmentally delayed and cannot give a history. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1541088749497-OI2UUNPQF5HMLXB7AXZQ/pneumobilia%2Cgallstone+pan.JPG The Naunheim Files - A 52 y.o. presents with fever; he is developmentally delayed and cannot give a history. gallstone pancreatitis causes a biliary enteric fistula https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1541088836145-5Q9YVY0YAHTLIHI4IBDI/portal+venous+gas.JPG The Naunheim Files - A 52 y.o. presents with fever; he is developmentally delayed and cannot give a history. portal venous gas is more peripheral https://everydayebm.org/naunheim-files/2018/10/22/a-48-yo-male-is-shot-in-the-posterior-calf-with-a-water-cannon-he-co-worsening-leg-pain monthly 0.5 2018-10-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1540220588040-XYUL0Y2R202BE7QA1O9J/watercannon4.JPG The Naunheim Files - A 48 y.o. male is shot in the posterior calf with a water cannon. He was seen and discharged on bactrim and now returns with worsening pain one day later. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1540220611727-GEON7GDVPX10F9MREG2X/water+cannon+1.JPG The Naunheim Files - A 48 y.o. male is shot in the posterior calf with a water cannon. He was seen and discharged on bactrim and now returns with worsening pain one day later. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1540476820520-4YY0I57B67JDUAUXPOXK/watercannon+5.JPG The Naunheim Files - A 48 y.o. male is shot in the posterior calf with a water cannon. He was seen and discharged on bactrim and now returns with worsening pain one day later. Swelling of the L calf one day after injury. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1540476921498-JBVDYFZN5WC2XXC0KMDK/high+pressure+paintgun.JPG The Naunheim Files - A 48 y.o. male is shot in the posterior calf with a water cannon. He was seen and discharged on bactrim and now returns with worsening pain one day later. More serious injury occurs with paint guns. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1540476993895-T2S7J0QWCM7Q8Q7UH5DB/high+pressure+water.JPG The Naunheim Files - A 48 y.o. male is shot in the posterior calf with a water cannon. He was seen and discharged on bactrim and now returns with worsening pain one day later. Injection of the R tonsillar pillar. https://everydayebm.org/naunheim-files/2018/10/15/a-37yo-male-comes-in-with-altered-mental-status monthly 0.5 2018-10-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1539615226410-UUVRGL02PWOQFUNWESJJ/holoprocecephaly.JPG The Naunheim Files - A 37y.o. male comes in with altered mental status https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1539876340493-XLBLYY7OT80EX4WW2H5I/holoprosencephaly.JPG The Naunheim Files - A 37y.o. male comes in with altered mental status https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1539876379262-0SDF9QM2G3FG148UITKD/holoprosencephaly1.JPG The Naunheim Files - A 37y.o. male comes in with altered mental status https://everydayebm.org/naunheim-files/2018/10/8/a-43-yo-woman-with-previous-back-pain-comes-in-with-r-leg-pain monthly 0.5 2018-10-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1539012342602-2004NLQZTD04P9JYJW6T/synovial+cyst.JPG The Naunheim Files - A 43 y.o. woman with previous back pain comes in with R leg pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1539354155273-VMZRKB5FXH2QPLSGP94V/synovial+cyst+pic.JPG The Naunheim Files - A 43 y.o. woman with previous back pain comes in with R leg pain. synovial cyst https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1539354467202-7YZUQF735FE9YYUPQ19H/bakers+cyst.JPG The Naunheim Files - A 43 y.o. woman with previous back pain comes in with R leg pain. Baker’s cyst behind the knee https://everydayebm.org/naunheim-files/2018/10/1/a-36-yo-woman-complained-of-a-painful-nodule-on-the-l-chest-2-weeks-after-an-mvc monthly 0.5 2018-10-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1538407684367-110LMUEITBVPBJDJLGK2/image-asset.jpeg The Naunheim Files - A 36 y.o. woman complained of a painful nodule on the L chest 2 weeks after an MVC https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1538667713735-ZUU9IOMFVUC1TZY48BVO/sternoclav+joint+infection.JPG The Naunheim Files - A 36 y.o. woman complained of a painful nodule on the L chest 2 weeks after an MVC inflammation around the L sternoclavicular joint with distal clavicle osteo. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1538667822280-NRI41WVR9B9X35IHSRBJ/sternoclav+joint+inf2.JPG The Naunheim Files - A 36 y.o. woman complained of a painful nodule on the L chest 2 weeks after an MVC https://everydayebm.org/naunheim-files/2018/9/24/a-28-yo-with-a-sore-throat-was-sent-from-an-outside-hospital-for-peritonsillar-abscess monthly 0.5 2018-09-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1537797734578-OSSKN02VBFTSLPOJ56MH/tonsils%2C+mono.JPG The Naunheim Files - A 28 y.o. with a sore throat was sent from an outside hospital for peritonsillar abscess https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1538062492700-WNUA012HN7UYHV3N55B7/monobilat.JPG The Naunheim Files - A 28 y.o. with a sore throat was sent from an outside hospital for peritonsillar abscess bilateral spontaneous tonsillar rupture in mono https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1538062596729-9F79Z6ZX77D2CGV9NS6L/pta.JPG The Naunheim Files - A 28 y.o. with a sore throat was sent from an outside hospital for peritonsillar abscess typical PTA https://everydayebm.org/naunheim-files/2018/9/17/a-71yo-woman-with-multiple-sclerosis-presents-3-wks-after-a-feral-cat-bit-her-on-the-heel-with-a-rash-on-her-leg monthly 0.5 2018-09-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1537197525484-4XAH6BCUHJQSUWF8RRCA/cat+bite.jpg The Naunheim Files - A 71y.o. woman with multiple sclerosis presents 3 wks after a feral cat bit her on the heel with a rash on her leg. Contrary to popular belief, cat bites often cause severe injuries. Leave it to a cat to ruin even Christmas. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1537198148259-M4YEVJVF6M825WFSA5U9/CatbiteinjuryPS4.jpg The Naunheim Files - A 71y.o. woman with multiple sclerosis presents 3 wks after a feral cat bit her on the heel with a rash on her leg. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1537459843097-RAAPY8DDFYMZSUWJCKJ7/cat+scratch.JPG The Naunheim Files - A 71y.o. woman with multiple sclerosis presents 3 wks after a feral cat bit her on the heel with a rash on her leg. biopsy of cat scratch showed necrotic areas with star shaped abscessed and granulomas https://everydayebm.org/naunheim-files/2018/9/10/a-29-yo-with-high-risk-sexual-behavior-comes-in-with-two-rashes monthly 0.5 2018-09-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1536590713112-GSZEF6BD98K7LFK05ALW/petechiae.JPG The Naunheim Files - A 29 y.o. with high risk sexual behavior comes in with two rashes https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1536590783351-LH7D5LO9G5P0R8IK11U0/herpes.JPG The Naunheim Files - A 29 y.o. with high risk sexual behavior comes in with two rashes could these rashes by related? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1536926089093-4DVUY5I5ZDZN9BX6RZAE/Capture.JPG The Naunheim Files - A 29 y.o. with high risk sexual behavior comes in with two rashes small vessel vasculitis with neutrophils lining vessels https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1536926564235-NRLD3H8N894VVNLPQ7XA/lcvhenock.JPG The Naunheim Files - A 29 y.o. with high risk sexual behavior comes in with two rashes henoch schonlein vasculitis ofter occurs on lower extremities https://everydayebm.org/naunheim-files/2018/9/6/a-45-yo-transexual-female-with-hiv-and-cd4-count-of-5-presents-with-a-rash monthly 0.5 2018-09-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1536253162802-HYE6602P8SJOMZZVZVHQ/photorash+%281%29.jpg The Naunheim Files - A 45 y.o. transexual female with HIV and CD4 count of <5 presents with a rash What is the differential diagnosis? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1536253254388-ET8V9537NVGD4LS0G6LU/pellegra.JPG The Naunheim Files - A 45 y.o. transexual female with HIV and CD4 count of <5 presents with a rash pellegra in an alcoholic https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1536253389323-ASCUEVPTIOL5M5RRDUNX/vit.JPG The Naunheim Files - A 45 y.o. transexual female with HIV and CD4 count of <5 presents with a rash https://everydayebm.org/naunheim-files/2018/8/27/a-28-yo-woman-comes-in-with-luq-pain monthly 0.5 2018-08-31 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1535383809996-XSFM1QQ2UG7HWGB7PQGL/polysplenia.JPG The Naunheim Files - A 28 y.o. woman comes in with LUQ pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1535727434263-LPLKVLMY1HP69XWKD233/heterotaxy+fetal+us.JPG The Naunheim Files - A 28 y.o. woman comes in with LUQ pain This is an US of a 35 wk fetus showing the azygous to the R of the aorta in heterotaxy polysplenia syndrome; this baby had malrotation as well https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1535727627870-V6SGWCUSPZJXFTEOVHP4/heterotaxy+with+liver+on+the+L.JPG The Naunheim Files - A 28 y.o. woman comes in with LUQ pain https://everydayebm.org/naunheim-files/2018/8/20/a-24-yo-social-worker-with-a-hx-of-crohns-since-2010-comes-in-with-rlq-pain monthly 0.5 2018-08-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1534779061145-TUQ5Y6QDZK0Z2UPPOZDJ/capsule+endos2.JPG The Naunheim Files - A 24 y.o. social worker with a hx of crohn's since 2010 comes in with RLQ pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1535038021260-DZU7KKLBOIQBG6ULODA8/capsule+endos.JPG The Naunheim Files - A 24 y.o. social worker with a hx of crohn's since 2010 comes in with RLQ pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1535038101882-UZOVSQ3SRGX800YRCH81/capsule+endosc+crohns.JPG The Naunheim Files - A 24 y.o. social worker with a hx of crohn's since 2010 comes in with RLQ pain 1-4% of crohn's patients retain the endoscopy capsule https://everydayebm.org/naunheim-files/2018/8/13/a-27-yo-woman-presents-with-ha-and-difficulty-letting-go-of-objects-when-she-grips-them monthly 0.5 2018-08-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1534172832977-30P21LWQ7A1W8GC3K72N/csf+leakfff.jpg The Naunheim Files - A 27 y.o. woman presents with HA and difficulty letting go of objects when she grips them. What is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1534516292274-XGPIL2JO02XK5L4SXVUN/csf+leak+cranial+n.JPG The Naunheim Files - A 27 y.o. woman presents with HA and difficulty letting go of objects when she grips them. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1534516350441-QS3XF82WODRWHELPOMTG/image-asset.jpeg The Naunheim Files - A 27 y.o. woman presents with HA and difficulty letting go of objects when she grips them. fluorescein injected in the lumbar area can show where the dural leak is after septoplasty https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1534516473517-9QQ3XDB3DU8TZSUZ6940/csf+leak+ana.JPG The Naunheim Files - A 27 y.o. woman presents with HA and difficulty letting go of objects when she grips them. https://everydayebm.org/naunheim-files/2018/8/6/a-54-yo-woman-with-seronegative-arthritis-presents-with-eye-pain monthly 0.5 2018-08-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1533568339925-K7DIJ01TG8TYMU9RE8JZ/lacrimal+sw.JPG The Naunheim Files - A 54 y.o. woman with seronegative arthritis presents with eye pain. Hint: she has no cell or flare, no iritis, no uveitis and no retinal abnormalities https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1533909354552-ACY4ZJQMQLCPIHXDDVBD/lacrimal+gland+pic.JPG The Naunheim Files - A 54 y.o. woman with seronegative arthritis presents with eye pain. anatomy of the lacrimal system https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1533909529163-KP04ZY168FQ4SCC1TRT7/lacrimal+gland+involvement+in+wegeners.JPG The Naunheim Files - A 54 y.o. woman with seronegative arthritis presents with eye pain. lacrimal gland involvement in Wegener's https://everydayebm.org/naunheim-files/2018/7/30/a-31-yo-woman-presents-with-abdominal-pain-and-a-positive-rpr-at-116 monthly 0.5 2018-08-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1532963471199-MNIVAHQR2EKX3Q4F9GVF/teratomag.jpg The Naunheim Files - A 31 y.o. woman presents with abdominal pain and a positive RPR at 1:16 Arrow points to the uterus. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1532963510171-CYR8SVU5SWKDU70HKW5Z/teratoma2.JPG The Naunheim Files - A 31 y.o. woman presents with abdominal pain and a positive RPR at 1:16 View from lower in the pelvis showing the bladder. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1533227053243-B2PDFR1KREPWXXJEXDG2/teratoma%2Cdot+and+dash.JPG The Naunheim Files - A 31 y.o. woman presents with abdominal pain and a positive RPR at 1:16 Dot and dash sign of a teratoma. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1533227219135-RB6G317AQSXGERXZPHM2/syphilis%2C+darkfield.JPG The Naunheim Files - A 31 y.o. woman presents with abdominal pain and a positive RPR at 1:16 Dark field microscopy of syphilis https://everydayebm.org/naunheim-files/2018/7/23/a-44-yo-male-presents-with-a-sore-throat monthly 0.5 2018-07-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1532356981059-F0L9A7HCGZX20NONNS2W/thyroglossal.JPG The Naunheim Files - A 44 y.o. male presents with a sore throat hint: it's near the epiglottis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1532621925304-SY3NTJIE6R859LMCS875/thyroglossal+duct.JPG The Naunheim Files - A 44 y.o. male presents with a sore throat cysts can occur anywhere along the thyroglossal duct tract https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1532622033051-ZUE2433T3AXE6LN34KEP/image-asset.jpeg The Naunheim Files - A 44 y.o. male presents with a sore throat more common location of a thyroglossal duct cyst https://everydayebm.org/naunheim-files/2018/7/16/a-73-yo-woman-with-a-hx-of-breast-ca-and-osteoporosis-presents-with-jaw-pain monthly 0.5 2018-07-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1531753092277-7PXR6IS7KZAY9FLS1PP2/phosjaw.JPG The Naunheim Files - A 73 y.o. woman with a hx of breast ca and osteoporosis presents with jaw pain. hint: she has had two teeth removed but her jaw won't heal. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1532013167665-Y9K0V71CQ4HXFCO52WU1/phossy+jaw+pic.JPG The Naunheim Files - A 73 y.o. woman with a hx of breast ca and osteoporosis presents with jaw pain. non healing fistula from dead bone. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1532013283404-HYK22AUNF5LIJWYVX274/phossy+jaw.JPG The Naunheim Files - A 73 y.o. woman with a hx of breast ca and osteoporosis presents with jaw pain. Match factory worker with phossy jaw https://everydayebm.org/naunheim-files/2018/7/9/a-59-yo-woman-comes-in-the-l-chest-pain monthly 0.5 2018-07-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1531149530732-D8OD3O6524QB8532N2NS/gastric+band+2.JPG The Naunheim Files - A 59 y.o. woman comes in the L chest pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1531493600792-UD4UQ9J75C6PMTWI61JB/roux+en+Y.png The Naunheim Files - A 59 y.o. woman comes in the L chest pain the arrow points to the bypassed duodenum of the Roux-en-Y https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1531493925664-3M2ES5LZDRZCWZOAT252/duodenal+switch.png The Naunheim Files - A 59 y.o. woman comes in the L chest pain this procedure leads to weight loss with the possibility of malnutrition especially thiamine deficiency. https://everydayebm.org/naunheim-files/2018/7/2/a-70-yo-woman-presents-with-chest-pain-and-a-positive-troponin monthly 0.5 2018-07-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1530543271934-GHOPP2L0QKMFDZQLI9UG/paraesoph.JPG The Naunheim Files - A 70 y.o. woman presents with chest pain and a positive troponin. What is the cause of her pain? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1530805627343-GMWK3460YD0D5S1OUGCS/paraesophekg.JPG The Naunheim Files - A 70 y.o. woman presents with chest pain and a positive troponin. EKG of our patient unchanged from 2014 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1530805732084-9PF3UC6EYXZTEHH7WCU5/paraesophageal+hernia2ct.JPG The Naunheim Files - A 70 y.o. woman presents with chest pain and a positive troponin. a paraesophageal hernia on CT https://everydayebm.org/naunheim-files/2018/6/25/a-30-yo-woman-presents-to-the-the-psychiatric-area-of-the-ed-with-refusal-to-eat-in-her-evaluation-for-altered-mental-status-she-gets-a-head-ct monthly 0.5 2018-06-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1529961279727-8XZP1UMCLZ3U1WU4YUG1/proteus1.jpg The Naunheim Files - A 30 y.o. woman presents to the the psychiatric area of the ED with refusal to eat. In her evaluation for altered mental status she gets a head ct. What do you notice? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1530192951894-IE1SQRIIP0CYAWPB39U2/proteus3.JPG The Naunheim Files - A 30 y.o. woman presents to the the psychiatric area of the ED with refusal to eat. In her evaluation for altered mental status she gets a head ct. aymmetric growth of the legs https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1530193146324-FXREISTFA4ED5V4NFGKB/proteus2.JPG The Naunheim Files - A 30 y.o. woman presents to the the psychiatric area of the ED with refusal to eat. In her evaluation for altered mental status she gets a head ct. ear enlargement from Proteus syndrome https://everydayebm.org/naunheim-files/2018/6/19/a-57-yo-male-presents-with-abdominal-distention monthly 0.5 2018-06-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1529441612746-FTKW9WW3Q7GNXFT98TLF/pneumatosis3.jpg The Naunheim Files - A 57 y.o. male presents with abdominal distention hint the wall of the bowel is abnormal https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1529711465073-HUH42DW323UPDGQWF9CP/Screen+Shot+2018-06-22+at+11.41.59+AM.png The Naunheim Files - A 57 y.o. male presents with abdominal distention in pneumatosis the ruptured cysts can cause free intraperitoneal air and yet the bowel wall is intact as shown above. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1529711636352-IBCLKYU56VGPGF2YCACO/image-asset.png The Naunheim Files - A 57 y.o. male presents with abdominal distention submucosal cysts https://everydayebm.org/naunheim-files/2018/6/11/a-31-yo-male-presents-with-abd-pain monthly 0.5 2018-06-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1528726135726-3EJ4J82S56UUA13FA8SL/Screen+Shot+2018-06-11+at+8.56.12+AM.png The Naunheim Files - A 31 y.o male presents with abd pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1528990976508-4FE1JM3TF39EG0ROZYUO/intussuception.JPG The Naunheim Files - A 31 y.o male presents with abd pain intussuscepted bowel https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1528991039302-SK1CWE74ARVF7XXJDPB6/intussjejunumf.JPG The Naunheim Files - A 31 y.o male presents with abd pain Intussusception caused by a J tube https://everydayebm.org/naunheim-files/2018/6/4/a-31-yo-graduate-student-comes-in-with-abdominal-bloating-the-ct-results-are-shown monthly 0.5 2018-06-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1528124854289-IPQALKJ9DRMT041AL419/peritonitis.JPG The Naunheim Files - A 31 y.o. graduate student comes in with abdominal bloating. The CT results are shown https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1528386632449-TB89EAFYESHTPG4KGGDF/peritoneal+nodular+thickening+fromaden.JPG The Naunheim Files - A 31 y.o. graduate student comes in with abdominal bloating. The CT results are shown peritoneal thickening from adenocarcinoma https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1528386794667-9HGEXBXKEPPBLHHBI737/peritoneal+pseudomyxoma+peritoneri.JPG The Naunheim Files - A 31 y.o. graduate student comes in with abdominal bloating. The CT results are shown peritoneal pseudomyxoma https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1528386857134-ABFILCCRB8A26I4PBZ8E/peritonitis+tuberculous.JPG The Naunheim Files - A 31 y.o. graduate student comes in with abdominal bloating. The CT results are shown difficult to see red bacilli in the peritoneal biopsy https://everydayebm.org/naunheim-files/2018/5/28/a-66-yo-woman-presents-with-nasal-congestion monthly 0.5 2018-05-31 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1527518232552-JE7L6IMI998N1VDCU5Z8/nasal+congestion.JPG The Naunheim Files - A 66 y.o. woman presents with nasal congestion What is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1527784320718-S7WPLTWP5LEYQ7LTSV0W/midlineenceph.JPG The Naunheim Files - A 66 y.o. woman presents with nasal congestion encephalocele https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1527784477649-AIRK2CYKUDJWI3PG8S93/midline+rhinoscleroma.JPG The Naunheim Files - A 66 y.o. woman presents with nasal congestion Rhinoscleroma https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1527784620837-WYUC9MB0ZQG0VHRXMG0D/midline+leper.JPG The Naunheim Files - A 66 y.o. woman presents with nasal congestion leprosy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1527800958315-BUX93TIJG99VYSSFNPG1/lethal+miline+gran.JPG The Naunheim Files - A 66 y.o. woman presents with nasal congestion lethal midline granuloma https://everydayebm.org/naunheim-files/2018/5/21/a-42-yo-woman-co-one-month-of-intermittent-shoulder-pain-ems-called-in-for-an-acute-mi-and-transmitted-the-first-image monthly 0.5 2018-05-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1526914443131-K71U1C0F6LFYFEXCWB89/aliekg1.JPG The Naunheim Files - A 42 y.o. woman co one month of intermittent shoulder pain; EMS called in for an acute MI and transmitted the first image. The EKG in the ED appears below https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1526914478896-T4PVC464AB8055KMKIIB/aliekg2.JPG The Naunheim Files - A 42 y.o. woman co one month of intermittent shoulder pain; EMS called in for an acute MI and transmitted the first image. What could account for the difference in the two EKGs? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1527257959021-ZWA9TEB2BKL1ET4L2MHT/cad+multiple+lumens.f.jpg The Naunheim Files - A 42 y.o. woman co one month of intermittent shoulder pain; EMS called in for an acute MI and transmitted the first image. notice the lucency in the circumflex characteristic of a dissection https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1527258130268-P5FMAHQ16KMV1FHHLC9F/cad+optical+picf.jpg The Naunheim Files - A 42 y.o. woman co one month of intermittent shoulder pain; EMS called in for an acute MI and transmitted the first image. dissection may also appear as narrowing on cath; which can be shown as a dissection on optical coherence tomography. https://everydayebm.org/naunheim-files/2018/5/14/a-45-yo-male-presents-with-proptosis-of-the-r-eye-his-ct-and-mri-are-shown-below monthly 0.5 2018-05-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1526312924033-1QD8EJI0AU1V4FIJ0ROU/muco4.jpg The Naunheim Files - A 45 y.o. male presents with proptosis of the R eye his CT and MRI are shown below https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1526312960845-OI91U4R3DQOJ6Y1TJ5OS/muco3.JPG The Naunheim Files - A 45 y.o. male presents with proptosis of the R eye his CT and MRI are shown below https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1526312986702-OPTBIXR20SY0VIZOJMGH/muco1.JPG The Naunheim Files - A 45 y.o. male presents with proptosis of the R eye his CT and MRI are shown below hint he had a previous craniotomy for trauma in 1996. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1526658619848-UHYXO7R5WMSQUPHPV9IB/muco18.JPG The Naunheim Files - A 45 y.o. male presents with proptosis of the R eye his CT and MRI are shown below proptosis with a R frontal sinus mucocele https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1526658827314-24ONQ5GGRDCKUL8SGGXC/mucocele%2Cfront.JPG The Naunheim Files - A 45 y.o. male presents with proptosis of the R eye his CT and MRI are shown below open approach for mucocele removal https://everydayebm.org/naunheim-files/2018/5/7/a-31-yo-comes-from-prison-with-vision-loss-he-was-hit-in-the-l-eye-playing-softball monthly 0.5 2018-05-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1525704410998-YYE8G2JUP1O5QS4IZ2KA/berlins+edema.JPG The Naunheim Files - A 31 y.o. comes from prison with vision loss; he was hit in the L eye playing softball. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1525906447709-Q2X4K9SBJ590EZH43QXH/eye+lens.JPG The Naunheim Files - A 31 y.o. comes from prison with vision loss; he was hit in the L eye playing softball. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1525906557574-SXX0JSC7ZN6L7LLQ19KP/eye+us.JPG The Naunheim Files - A 31 y.o. comes from prison with vision loss; he was hit in the L eye playing softball. https://everydayebm.org/naunheim-files/2018/4/27/a-49-yo-woman-with-breast-cancer-and-autoimmune-hepatitis-with-cirrhosis-and-hepatocellular-carcinoma-presents-with-abd-pain monthly 0.5 2018-05-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1524841427969-S025WN59EKFB7WMGZY73/splenic+infarct.JPG The Naunheim Files - A 49 y.o. woman with breast cancer and autoimmune hepatitis with cirrhosis and hepatocellular carcinoma presents with abd pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1525363906835-54SE0LM3OLGK356O9G2G/splenic+inf+path.JPG The Naunheim Files - A 49 y.o. woman with breast cancer and autoimmune hepatitis with cirrhosis and hepatocellular carcinoma presents with abd pain. gross pathology of a splenic infarct. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1525364048754-6P5ZW7FZ35AUDW995L2E/bezacizumab.JPG The Naunheim Files - A 49 y.o. woman with breast cancer and autoimmune hepatitis with cirrhosis and hepatocellular carcinoma presents with abd pain. splenic and liver infarcts in a patient with bevacizumab. https://everydayebm.org/naunheim-files/2018/4/23/an-88-yo-presents-with-reddened-itchy-skin-what-is-the-problem monthly 0.5 2018-04-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1524495898863-QAM981QW3VI99FG875O8/sezary.JPG The Naunheim Files - An 88 y.o. presents with reddened itchy skin. What is the problem? hint the peripheral smear has unusual cells pictured below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1524496026029-HJOD7TFSW2XL4J2AI3BS/sezary1.JPG The Naunheim Files - An 88 y.o. presents with reddened itchy skin. What is the problem? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1524758615090-B7SKOJDP0ON01V6XLDZY/mycosis+fun.JPG The Naunheim Files - An 88 y.o. presents with reddened itchy skin. What is the problem? mycosis fungoides with typical plaques https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1524758802051-8MAKRU0JW4Z6VCSU1199/mf+lymphoskinbx.JPG The Naunheim Files - An 88 y.o. presents with reddened itchy skin. What is the problem? https://everydayebm.org/naunheim-files/2018/4/16/a-28-yo-male-has-lesions-in-the-liver-what-could-cause-this monthly 0.5 2018-04-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1523888676866-4NAYH15W2YBDVBWBQ2F3/sarcoid1.JPG The Naunheim Files - A 28 y.o. male has lesions in the liver; what could cause this? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1523888774860-HGEMW8UX1MN1WKWU8RE9/sarcoid2.JPG The Naunheim Files - A 28 y.o. male has lesions in the liver; what could cause this? hilar adenopathy https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1524149982189-C5PXWLK6SUX4B8AQQ96P/sarcoid4.JPG The Naunheim Files - A 28 y.o. male has lesions in the liver; what could cause this? involvement of sacral roots on MRI https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1524150220589-EL2RBTF5V3A41QR1MWSD/sarcoidenod.JPG The Naunheim Files - A 28 y.o. male has lesions in the liver; what could cause this? e nodosum https://everydayebm.org/naunheim-files/2018/4/9/a-24-yo-presents-to-the-ed-with-a-three-week-hx-of-a-neck-mass-and-sore-throat monthly 0.5 2018-04-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1523287102929-S5RTN3YDVGDSTBEVGDG7/branchial+cleft+abs.JPG The Naunheim Files - A 24 y.o. presents to the ED with a three week hx of a neck mass and sore throat. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1523632095761-04I4T8KEQMEEC254FNH8/common+branchial2018-04-12+at+7.54.33+M.png The Naunheim Files - A 24 y.o. presents to the ED with a three week hx of a neck mass and sore throat. common sites for branchial cleft cysts https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1523632163974-D1XWG5AFEGKB0NZHQO85/branchial+2018-04-12+at+8.06.30+AM.png The Naunheim Files - A 24 y.o. presents to the ED with a three week hx of a neck mass and sore throat. Other branchial cleft sites https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1523632334048-43KAAIV7H0NGIAKL2SPH/branchial+cleft.JPG The Naunheim Files - A 24 y.o. presents to the ED with a three week hx of a neck mass and sore throat. MRI of our patients neck https://everydayebm.org/naunheim-files/2018/4/2/a-23-yo-presents-to-the-ed-with-carpopedal-spasms-you-notice-something-unusual-on-exam-of-his-skin monthly 0.5 2018-04-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1522682401207-3V8WSM1E8Z3UU575FEW0/melanosis.JPG The Naunheim Files - A 23 y.o, presents to the ED with carpopedal spasms, you notice something unusual on exam of his skin. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1522943464292-GWK2DB8J3NF9QF5AVJU3/meltemp2.JPG The Naunheim Files - A 23 y.o, presents to the ED with carpopedal spasms, you notice something unusual on exam of his skin. melanosis in the R temporal lobe in our patient prior to surgery https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1522943696587-M38URH09CA9D9SSDGSXQ/carpo.JPG The Naunheim Files - A 23 y.o, presents to the ED with carpopedal spasms, you notice something unusual on exam of his skin. carpopedal spasm https://everydayebm.org/naunheim-files/2018/3/26/a-41-yo-male-presents-with-anemia-and-shortness-of-breath-his-peripheral-smear-appears-below monthly 0.5 2018-03-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1522075533594-EFOIKRK2U8ZIN04SIG21/hus+f.JPG The Naunheim Files - A 41 y.o. male presents with anemia and shortness of breath. His peripheral smear appears below. What is the differential? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1522423691969-T88C7FLW92PMDI9OX0CJ/rbc.JPG The Naunheim Files - A 41 y.o. male presents with anemia and shortness of breath. His peripheral smear appears below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1522423789009-C98VQAGTGCWLYJ5YDJQI/hemolysis.JPG The Naunheim Files - A 41 y.o. male presents with anemia and shortness of breath. His peripheral smear appears below. causes of hemolysis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1522424130852-JRNXFLCXQCXX67TFIR4N/thrombocy.JPG The Naunheim Files - A 41 y.o. male presents with anemia and shortness of breath. His peripheral smear appears below. https://everydayebm.org/naunheim-files/2018/3/19/a-31-yo-male-comes-in-with-bilateral-heel-pain-his-xray-is-shown-below monthly 0.5 2018-03-22 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1521472108723-AY7NJBGVZ021JTJPS5JD/kagers.JPG The Naunheim Files - A 31 y.o. male comes in with bilateral heel pain. His xray is shown below what do you notice when compared to the normal image below https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1521472221284-ZRD8PVJB0ZETHGGMK6AE/kagers+normal.JPG The Naunheim Files - A 31 y.o. male comes in with bilateral heel pain. His xray is shown below https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1521733311738-QQXVW3WIFJWYYVKWBYFL/kagers+fat+pad.JPG The Naunheim Files - A 31 y.o. male comes in with bilateral heel pain. His xray is shown below https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1521733786487-ECMAQSO5WYQ66PAYYAJ6/calcaneus+haglands..JPG The Naunheim Files - A 31 y.o. male comes in with bilateral heel pain. His xray is shown below https://everydayebm.org/naunheim-files/2018/3/12/a-64-yo-male-comes-to-the-ed-with-abdominal-pain-and-hypotension monthly 0.5 2018-03-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1520862847038-9QEO7CYJ6NPZQNY9O9RW/GB1.JPG The Naunheim Files - A 64 y.o. male comes to the ED with abdominal pain and hypotension. you notice some gallstones ....and https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1520862874933-P45H3UYVUSFHQ7KDRZ9F/GB+rup.JPG The Naunheim Files - A 64 y.o. male comes to the ED with abdominal pain and hypotension. and a discontinuity at the end of the gall bladder. What happened? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1521143863755-SGJF52OY0QG56X8ZWIWL/gbopen+chole.JPG The Naunheim Files - A 64 y.o. male comes to the ED with abdominal pain and hypotension. perforated gallbladder at surgery( initially done laparascopically and converted to open https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1521144014463-ZH8NVRT54H4SYT3684VC/gallbladderperff.JPG The Naunheim Files - A 64 y.o. male comes to the ED with abdominal pain and hypotension. look for gall bladder perforation on US https://everydayebm.org/naunheim-files/2018/3/5/a-30-yo-woman-g8p1-comes-to-the-ed-with-vaginal-bleeding-you-notice-two-things-in-the-uterus monthly 0.5 2018-03-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1520263819590-43TF6W5YZV0TDV95IM3M/higgins2.JPG The Naunheim Files - A 30 y woman, G8P1 comes to the ED with vaginal bleeding. You notice two things in the uterus. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1520263898171-Z6CGNGAJE9EBPUR9KMR6/higgins6.JPG The Naunheim Files - A 30 y woman, G8P1 comes to the ED with vaginal bleeding. You notice two things in the uterus. and you also notice this mass; what is it? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1520438453138-JL7UUETIS8FGC3RCWDYO/molar+twin.JPG The Naunheim Files - A 30 y woman, G8P1 comes to the ED with vaginal bleeding. You notice two things in the uterus. molar twin pregnancy at 19 wks. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1520438952315-BPQXLOMRYW08AJPWJRH9/molar+preg+path.JPG The Naunheim Files - A 30 y woman, G8P1 comes to the ED with vaginal bleeding. You notice two things in the uterus. The ""bunch of grapes" appearance of a molar pregnancy https://everydayebm.org/naunheim-files/2018/2/26/a-22-yo-woman-fell-from-her-horse-she-has-pain-over-the-l-shoulder-and-is-sent-from-an-urgent-care monthly 0.5 2018-03-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1519660704541-B1K8UPK6WGC2YA99XTFO/pseudoshoulderdis.JPG The Naunheim Files - A 22 y.o. woman fell from her horse; she has pain over the L shoulder and is sent from an urgent care what do you want to do? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1520004180169-48KE1UCLD7EM35CTZ9JJ/pseudosubluxaxillary.JPG The Naunheim Files - A 22 y.o. woman fell from her horse; she has pain over the L shoulder and is sent from an urgent care humeral head in the glenoid on axillary view; not dislocated. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1520004431546-RLFVHD7WKC6GU7IF4PVG/sdlipohemarthrosisf.JPG The Naunheim Files - A 22 y.o. woman fell from her horse; she has pain over the L shoulder and is sent from an urgent care https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1520006137643-ZHX1N8B89FLI2G0FZQIZ/types+of+shoulder+dislocations.JPG The Naunheim Files - A 22 y.o. woman fell from her horse; she has pain over the L shoulder and is sent from an urgent care from Magid https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1520006237319-VKVBOQQFVH7P7XQ2DAQF/sorini1.JPG The Naunheim Files - A 22 y.o. woman fell from her horse; she has pain over the L shoulder and is sent from an urgent care Us showing fluid in the joint https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1520006374996-UK7G0PKALE1AWJ56NDLD/shoulderdis.JPG The Naunheim Files - A 22 y.o. woman fell from her horse; she has pain over the L shoulder and is sent from an urgent care https://everydayebm.org/naunheim-files/2018/2/19/a-61-yo-female-has-had-a-copd-exacerbation-x-several-weeks monthly 0.5 2018-02-22 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1519056631440-YGROKLUXP86ZA6IWX6OJ/saddle.JPG The Naunheim Files - A 61 y.o. female has had a COPD exacerbation x several weeks What do you notice on her chest CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1519318218366-G2T3ZHG2TH7TGJ1G85IQ/saddlef.jpg The Naunheim Files - A 61 y.o. female has had a COPD exacerbation x several weeks https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1519318316461-BT4TAJQUVDV03AZJ5IEL/stroke+%2Cblood+flow.JPG The Naunheim Files - A 61 y.o. female has had a COPD exacerbation x several weeks https://everydayebm.org/naunheim-files/2018/2/12/a-44-yo-male-presents-to-an-outside-ed-with-penile-pain-and-forceful-urination-that-sprays-per-ems monthly 0.5 2018-02-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1518451646343-NE668F3A5EQ96VWIZXTS/urethradil.JPG The Naunheim Files - A 44 y.o. male presents to an outside ED with penile pain and forceful urination that "sprays" per EMS. The urethra is very dilated suggesting a stricture https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1518452084832-OGSNE7LQO4XQNF8ZOMKX/urethra%2C+rupture+with+nec.JPG The Naunheim Files - A 44 y.o. male presents to an outside ED with penile pain and forceful urination that "sprays" per EMS. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1518709324977-EERXKCBNA85Y1TMC8P4A/nec+fas.JPG The Naunheim Files - A 44 y.o. male presents to an outside ED with penile pain and forceful urination that "sprays" per EMS. Gas in the soft tissues from necrotizing fasciitis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1518710165764-ZRYQ6R78M2C37XL1TCF9/fascists.JPG The Naunheim Files - A 44 y.o. male presents to an outside ED with penile pain and forceful urination that "sprays" per EMS. The fasces appears on the left. https://everydayebm.org/naunheim-files/2018/2/5/a-30-yo-male-presents-with-sob-his-friend-says-he-turned-blue-why-is-his-trachea-so-severely-narrowed monthly 0.5 2018-02-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1517846676398-Z8RWFVHTHU21PS45S3QT/goiter%2Ctrachea+f.jpg The Naunheim Files - A 30 y.o. male presents with SOB, his friend says he "turned blue". Why is his trachea so severely narrowed? arrow points to the trachea; the answer is on the image below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1517846763504-5XFC0KG7YGXSWHNVM7RX/goiter2f.jpg The Naunheim Files - A 30 y.o. male presents with SOB, his friend says he "turned blue". Why is his trachea so severely narrowed? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1518194441907-T8TYOJAW6IYUO5IK5F8R/goiters+him.JPG The Naunheim Files - A 30 y.o. male presents with SOB, his friend says he "turned blue". Why is his trachea so severely narrowed? goiters in the Himalayas https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1518194622961-S9QP9TP4T9NY69731HSE/goiter+belt.JPG The Naunheim Files - A 30 y.o. male presents with SOB, his friend says he "turned blue". Why is his trachea so severely narrowed? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1518194878406-I7WGS29NXFW6A0BA2PKP/goiter%2C+cretinism+in+the+congo..JPG The Naunheim Files - A 30 y.o. male presents with SOB, his friend says he "turned blue". Why is his trachea so severely narrowed? cretinism(severe iodine deficiency in three children in the Congo https://everydayebm.org/naunheim-files/2018/1/29/a-59-yo-male-being-treated-for-melanoma-comes-in-with-shortness-of-breath-his-ct-is-shown-below monthly 0.5 2018-02-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1517242836878-DUDTEJXFU30EB48J5R85/nivolumab.JPG The Naunheim Files - A 59 y.o. male being treated for melanoma comes in with shortness of breath. His CT is shown below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1517503965044-TK7BC00IKZFPX3JMI8QB/atoll.JPG The Naunheim Files - A 59 y.o. male being treated for melanoma comes in with shortness of breath. His CT is shown below. The atoll is a coral reef around a sunken istand https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1517504068981-DQ2ET8N5EPP6AIGX9B1Q/niv+improv+with+steriods.JPG The Naunheim Files - A 59 y.o. male being treated for melanoma comes in with shortness of breath. His CT is shown below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1517504120670-16SDE72YMT77JJCEMRK6/niv+org+pneumf.jpg The Naunheim Files - A 59 y.o. male being treated for melanoma comes in with shortness of breath. His CT is shown below. https://everydayebm.org/naunheim-files/2018/1/22/a-37-yo-male-fell-off-his-segway-one-week-pta-a-ct-of-the-abdomen-is-shown-below monthly 0.5 2018-01-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1516634485274-DLMGS1CO6E8IC83K5DFM/delrupspl.JPG The Naunheim Files - A 37 y.o. male fell off his segway one week pta. a ct of the abdomen is shown below. Hint: It is normal https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1516634540797-K3KN9G19UGQPAXURATE3/delayed+rup.JPG The Naunheim Files - A 37 y.o. male fell off his segway one week pta. a ct of the abdomen is shown below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1516901138887-31USKK8CGA618NJTANR6/splenic+pseudo.JPG The Naunheim Files - A 37 y.o. male fell off his segway one week pta. a ct of the abdomen is shown below. splenic pseudocyst https://everydayebm.org/naunheim-files/2018/1/15/a-61-yo-woman-on-steroids-for-copd-comes-in-with-back-pain-she-is-sent-in-to-rule-out-cauda-equina monthly 0.5 2018-01-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1516033976164-VACNSX2NRQ5I59P8XCLU/sacral+insu.JPG The Naunheim Files - A 61 y.o. woman on steroids for COPD comes in with back pain; she is sent in to rule out cauda equina. hint: it has something to do with the edema near the arrow https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1516034039645-BO91ZDEZ7TZ7U4GTJQQG/sacral+insuarr.jpg The Naunheim Files - A 61 y.o. woman on steroids for COPD comes in with back pain; she is sent in to rule out cauda equina. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1516296494064-3TMSELAJRLYRKQ25EWIW/sacral+insuf.JPG The Naunheim Files - A 61 y.o. woman on steroids for COPD comes in with back pain; she is sent in to rule out cauda equina. The fractures can form an H across the body of the sacrum https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1516296747545-NHYKHUGOPEV8DK0FMT9S/sif.jpg The Naunheim Files - A 61 y.o. woman on steroids for COPD comes in with back pain; she is sent in to rule out cauda equina. https://everydayebm.org/naunheim-files/2018/1/8/an-85-yo-male-walks-in-the-the-ed-with-a-complaint-of-neck-pain-he-is-sp-a-cervical-epidural-injection-three-weeks-earlier monthly 0.5 2018-01-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1515422716520-U2KWM8WNIQLC3KYQSYRK/atlantoax.JPG The Naunheim Files - An 85 y.o. male walks into the the ED with a complaint of neck pain, he is s/p a cervical epidural injection three weeks earlier. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1515773604103-CSDDO1X6TFL48PRPBJNS/atlantoaxialprev.JPG The Naunheim Files - An 85 y.o. male walks into the the ED with a complaint of neck pain, he is s/p a cervical epidural injection three weeks earlier. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1515773719267-WFK974SSC872W20B21UB/atlantoax+fixed.JPG The Naunheim Files - An 85 y.o. male walks into the the ED with a complaint of neck pain, he is s/p a cervical epidural injection three weeks earlier. https://everydayebm.org/naunheim-files/2018/1/1/a-55-yo-woman-who-has-had-sinus-surgery-comes-in-for-epistaxis-when-you-scope-her-you-see-what-is-pictured-below monthly 0.5 2018-01-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1514821466150-3DOMG90PPGMYT8XOLYT0/vomero.JPG The Naunheim Files - A 55 y.o. woman who has had sinus surgery comes in for epistaxis. When you scope her you see what is pictured below. what is it? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1514998687128-F1YB5697L8USJ97785X1/vomero2.JPG The Naunheim Files - A 55 y.o. woman who has had sinus surgery comes in for epistaxis. When you scope her you see what is pictured below. close up of the Vomeronasal organ on the septum https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1514998862197-ER5VOBML3DQ9HWYKJTGK/VNO+snake.JPG The Naunheim Files - A 55 y.o. woman who has had sinus surgery comes in for epistaxis. When you scope her you see what is pictured below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1514998973879-4GOAS6OHHORBL02MO2G6/vnocat.JPG The Naunheim Files - A 55 y.o. woman who has had sinus surgery comes in for epistaxis. When you scope her you see what is pictured below. tiger catching a scent https://everydayebm.org/naunheim-files/2017/12/26/a-25-yo-woman-is-brought-to-the-ed-after-a-high-speed-mvc-she-has-a-gcs-of-11-and-appears-to-be-intoxicated monthly 0.5 2017-12-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1514306545691-EORI9SAXBNW9EKQ0Z9HM/occ+con.JPG The Naunheim Files - A 25 y.o. woman is brought to the ED after a high speed MVC, she has a GCS of 11 and appears to be intoxicated hint it's near C1,C2 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1514475762885-PPPWODI6APZKO0IXB23J/occ+conarr.jpg The Naunheim Files - A 25 y.o. woman is brought to the ED after a high speed MVC, she has a GCS of 11 and appears to be intoxicated https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1514475810591-1RL717BUO3LQUZ2CJ0OL/occ+con3.JPG The Naunheim Files - A 25 y.o. woman is brought to the ED after a high speed MVC, she has a GCS of 11 and appears to be intoxicated https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1514475914530-5O58BUZ0EGSWH2108YWA/occ+con2.JPG The Naunheim Files - A 25 y.o. woman is brought to the ED after a high speed MVC, she has a GCS of 11 and appears to be intoxicated A more obvious occipital condyle fracture. https://everydayebm.org/naunheim-files/2017/12/18/a-35-yo-male-presents-with-decreased-vision-in-the-r-eye-and-pain monthly 0.5 2017-12-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1513614799307-71KC0LREUXHB5FQ0VYVQ/meth+eyef.jpg The Naunheim Files - A 35 y.o. male presents with decreased vision in the R eye and pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1513876357121-PVOKIO2VRFUZU84W6K76/descem.JPG The Naunheim Files - A 35 y.o. male presents with decreased vision in the R eye and pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1513876410357-P97XKV3OLY9H8FT7ZCVA/desc2.JPG The Naunheim Files - A 35 y.o. male presents with decreased vision in the R eye and pain. a more subtle descemetocele https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1513876482500-JMTJ514OJK2W2SULI0HV/corneal+txp.JPG The Naunheim Files - A 35 y.o. male presents with decreased vision in the R eye and pain. the eye exam after a corneal transplant. https://everydayebm.org/naunheim-files/2017/12/11/a-62-yo-male-complains-of-persistent-pain-in-the-wrist-after-a-fall monthly 0.5 2017-12-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1513010383996-Z1W6MX4DN9TMNCBACQTQ/scapholunate.JPG The Naunheim Files - A 62 y.o. male complains of persistent pain in the wrist after a fall. What do you notice on imaging? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1513274885812-0L9NGSBGD2A260OBAOET/scapholundiagram.JPG The Naunheim Files - A 62 y.o. male complains of persistent pain in the wrist after a fall. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1513275133143-LGPCITHM5SR1CZII9X1K/scapholunate+dislocation2.JPG The Naunheim Files - A 62 y.o. male complains of persistent pain in the wrist after a fall. https://everydayebm.org/naunheim-files/2017/12/4/a-20-yo-male-with-c6-fracture-and-tetraplegia-presents-with-severe-ha monthly 0.5 2017-12-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1512402222311-XNCBXSMGNS11NJT1VS5L/presf.jpg The Naunheim Files - A 20 y.o. male with C6 fracture and tetraplegia presents with severe HA. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1512749195757-PLWGDD2U4TZO7BW47PFR/preschart.JPG The Naunheim Files - A 20 y.o. male with C6 fracture and tetraplegia presents with severe HA. https://everydayebm.org/naunheim-files/2017/11/27/a-59-yo-male-presents-with-fever-nausea-and-groin-pain monthly 0.5 2017-11-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1511800243984-82IK8MCL2MWV8BZXGT56/prostate+abscess2.JPG The Naunheim Files - A 59 y.o. male presents with fever, nausea and groin pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1512060959001-7ZJXCN1XIVA27LWPOAGL/prostate+abscess+3.JPG The Naunheim Files - A 59 y.o. male presents with fever, nausea and groin pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1512061039748-OSSSACDLIYRVN03UMDJX/prostate+abscessf.JPG The Naunheim Files - A 59 y.o. male presents with fever, nausea and groin pain prostate abscess in a 19 yo healthy male https://everydayebm.org/naunheim-files/2017/11/20/a-57-yo-male-comes-in-with-a-complaint-of-i-think-i-have-poison-ivy monthly 0.5 2017-11-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1511189325946-QQEO6CHVD8GR2O06WL4J/novpempnigoid.JPG The Naunheim Files - A 57 y.o. male comes in with a complaint of " I think I have poison ivy" https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1511540428197-8DNMF4TISO9D0KYNA7XU/PCT.JPG The Naunheim Files - A 57 y.o. male comes in with a complaint of " I think I have poison ivy" porphyria cutanea tarda in an alcoholic https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1511540637826-9VK9SS419BVF1785E5R8/epidermolysis.JPG The Naunheim Files - A 57 y.o. male comes in with a complaint of " I think I have poison ivy" epidermolysis bullosa https://everydayebm.org/naunheim-files/2017/11/13/a-49-yo-male-presents-with-a-pruritic-rash-on-the-top-of-his-head-and-his-penis monthly 0.5 2017-11-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1510587370792-YZ86ATLDVAUME2RN7ND9/novlichenpl.JPG The Naunheim Files - A 49 y.o. male presents with a pruritic rash on the top of his head and his penis. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1510845685305-NUDK5F2CX13T1WNLGO6I/wickhams+striae.JPG The Naunheim Files - A 49 y.o. male presents with a pruritic rash on the top of his head and his penis. Wickham's striae, white lacy lines on the oral mucosa. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1510845811795-KLZ22TSURHT5NN14LQNW/lichen+sclerosisf.JPG The Naunheim Files - A 49 y.o. male presents with a pruritic rash on the top of his head and his penis. lichen sclerosus https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1510845976757-056E0WP7Q508TXLTQD66/lichen+planus+path.JPG The Naunheim Files - A 49 y.o. male presents with a pruritic rash on the top of his head and his penis. https://everydayebm.org/naunheim-files/2017/11/6/a-28-yo-presents-with-shortness-of-breath-what-should-you-do monthly 0.5 2017-11-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1509982112296-KIV0U5A7JOE826QZ8C51/cxr1.JPG The Naunheim Files - A 28 y.o. presents with shortness of breath. What should you do? this is his cxr https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1510255830952-8TEVLCSP8O00KHP7NNOK/pneumo+4.JPG The Naunheim Files - A 28 y.o. presents with shortness of breath. What should you do? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1510255918790-PXWLH103W52HL4PNX89H/pneumo3%2C+larry+stevens.JPG The Naunheim Files - A 28 y.o. presents with shortness of breath. What should you do? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1510256065852-BM1FZVJ5PYL21SMWPPH8/pneumo2.JPG The Naunheim Files - A 28 y.o. presents with shortness of breath. What should you do? lung markings seen on the emphysematous side https://everydayebm.org/naunheim-files/2017/10/30/a-57yo-presents-with-a-cold-pulseless-r-leg-a-ct-is-done-to-ro-aortic-dissection-there-is-no-dissection-but-the-finding-below-is-seen-what-does-it-mean monthly 0.5 2017-11-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1509376820827-JELI8O4CI2588TU60KYR/half+moon+signf.jpg The Naunheim Files - A 57y.o. presents with a cold pulseless R leg, a CT is done to ro aortic dissection. There is no dissection but the finding below is seen. What does it mean? dye is refluxing into the liver and there is a "half-moon" sign in the vena cava. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1509642197002-Z9KO927X2E49SKKTKK51/half+moon+pacer.JPG The Naunheim Files - A 57y.o. presents with a cold pulseless R leg, a CT is done to ro aortic dissection. There is no dissection but the finding below is seen. What does it mean? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1509642230316-NH6YHBDXQCSKU2BJZR4Q/half+moon+pacer+tangle..JPG The Naunheim Files - A 57y.o. presents with a cold pulseless R leg, a CT is done to ro aortic dissection. There is no dissection but the finding below is seen. What does it mean? https://everydayebm.org/naunheim-files/2017/10/23/a-29yo-woman-presents-with-abdominal-pain-what-do-you-notice-on-the-ct monthly 0.5 2017-10-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1508770302512-UT9DMNE96GNRPF6CNQIN/silicone.JPG The Naunheim Files - A 29y.o. woman presents with abdominal pain. What do you notice on the CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1509031021188-MOXBXDCWMCUQARZMF2G6/silicone+embolus2.JPG The Naunheim Files - A 29y.o. woman presents with abdominal pain. What do you notice on the CT? Transbronchial biopsy of a pt with silicone embolus with intra-alveolar hemorrhage and vaculolated glabular deposits of silicone in the interstitial capillaries. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1509031155250-DISQ3PQFYP0UHC2AC94A/silicone+lung.JPG The Naunheim Files - A 29y.o. woman presents with abdominal pain. What do you notice on the CT? https://everydayebm.org/naunheim-files/2017/10/16/a-22-yo-woman-presents-to-the-ed-with-low-back-pain-after-a-fall-in-the-bathtub-her-cxr-and-bone-scan-are-shown monthly 0.5 2017-10-19 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1508169343846-AP5ERTN5NCPY2YTEAUQW/rickets3.JPG The Naunheim Files - A 22 y.o. woman presents to the ED with low back pain after a fall in the bathtub. Her cxr and bone scan are shown. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1508169389679-HSE0ZHLGLW4UC1SEBF5H/rickets2.JPG The Naunheim Files - A 22 y.o. woman presents to the ED with low back pain after a fall in the bathtub. Her cxr and bone scan are shown. bone scan https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1508430097111-NPTPPDN4S23ALN1SFPAX/rickets+bow.JPG The Naunheim Files - A 22 y.o. woman presents to the ED with low back pain after a fall in the bathtub. Her cxr and bone scan are shown. Bowed legs https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1508430210496-UQPWOMIZX55OGEFGCEMG/rachitic.JPG The Naunheim Files - A 22 y.o. woman presents to the ED with low back pain after a fall in the bathtub. Her cxr and bone scan are shown. swollen costchondral junctions; the rachitic rosary https://everydayebm.org/naunheim-files/2017/10/9/a-71-yo-woman-presents-with-nausea-and-vomiting-do-you-see-a-reason monthly 0.5 2017-10-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1507545652275-H1T87Z7I83Z3FGJBZX7W/hyche.JPG The Naunheim Files - A 71 y.o. woman presents with nausea and vomiting. Do you see a reason? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1507817677343-3AP72URM4T3FKG8XRWM3/fibroids2.JPG The Naunheim Files - A 71 y.o. woman presents with nausea and vomiting. Do you see a reason? uterine sarcoma https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1507818057843-T05CKMNDOEP4LM3B38JG/fibroids1.JPG The Naunheim Files - A 71 y.o. woman presents with nausea and vomiting. Do you see a reason? https://everydayebm.org/naunheim-files/2017/10/2/a-21-yo-male-presents-with-a-sore-throat-and-a-rash-on-his-palms-what-does-he-have monthly 0.5 2017-10-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1506959870198-9A809JTAEMFZ4LXEWK06/rash.JPG The Naunheim Files - A 21 y.o. male presents with a sore throat and a rash on his palms. What does he have? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1507130904608-64MBLOZH1O1OLIFYVSIO/hand+foot+mouth.JPG The Naunheim Files - A 21 y.o. male presents with a sore throat and a rash on his palms. What does he have? A child with hand/foot/mouth disease https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1507131023024-ZFJQ5S2NBZJAXLS4FTF7/janeway600.JPG The Naunheim Files - A 21 y.o. male presents with a sore throat and a rash on his palms. What does he have? Janeway lesions in an IV drug user with endocarditis of the aortic valve. https://everydayebm.org/naunheim-files/2017/9/25/a-40-yo-male-with-a-history-of-aortic-dissection-repair-comes-to-the-ed-with-altered-mental-status monthly 0.5 2017-09-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1506352070756-5T2ESJ5RAJT9VU0USFV4/spinal+epicxr.JPG The Naunheim Files - A 40 y.o. male with a history of aortic dissection repair and paraplegia comes to the ED with altered mental status. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1506352361603-CX1JJ8NHBXRP6XSQ044Y/epidural+abscessf.jpg The Naunheim Files - A 40 y.o. male with a history of aortic dissection repair and paraplegia comes to the ED with altered mental status. And confirmed on CT. What is the problem? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1506613274064-EH7F1AFWOO034XLEZWXY/epidural+abscess+meyerf.jpg The Naunheim Files - A 40 y.o. male with a history of aortic dissection repair and paraplegia comes to the ED with altered mental status. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1506613537422-0HX19K2RMHLDH2AIT0A4/epidural+abscess%2Cmisseyf.jpg The Naunheim Files - A 40 y.o. male with a history of aortic dissection repair and paraplegia comes to the ED with altered mental status. https://everydayebm.org/naunheim-files/2017/9/18/a-51-yo-woman-comes-in-with-shortness-of-breath monthly 0.5 2017-09-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1505747416131-4B6LT5NMN96S4AIN9A06/lam.JPG The Naunheim Files - A 51 y.o. woman comes in with shortness of breath https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1505747452662-X4G8ZQGULGAXOR7UAAS3/image-asset.jpeg The Naunheim Files - A 51 y.o. woman comes in with shortness of breath https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1506006927666-485EI9O51QBVYWDSE0B9/tuberous+sclerosis+brain+1.JPG The Naunheim Files - A 51 y.o. woman comes in with shortness of breath tubers in the brain on MRI https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1506007022155-D4II9F5ZVRZBBRBKQY0Q/tuberous+sclerosis+kid.JPG The Naunheim Files - A 51 y.o. woman comes in with shortness of breath Angiomyolipomas of the kidneys https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1506007419654-H6N1GGAEJIXNTJYQLNYJ/tuberous+sclerosis+adeseb.JPG The Naunheim Files - A 51 y.o. woman comes in with shortness of breath adenoma sebaceum https://everydayebm.org/naunheim-files/2017/9/11/a-78-yo-female-with-a-hx-of-recurrent-arrhythmias-sp-mitral-valve-repair-presents-with-diffuse-abdominal-pain monthly 0.5 2017-09-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1505142842639-WW790W3XZ9YKGCYV5OMS/urine3.JPG The Naunheim Files - A 78 y.o. female with a hx of recurrent arrhythmias sp mitral valve repair presents with diffuse abdominal pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1505142885158-NX8ZUR9M3WQ6OEFIJ8NK/urine+delayed+film.JPG The Naunheim Files - A 78 y.o. female with a hx of recurrent arrhythmias sp mitral valve repair presents with diffuse abdominal pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1505485553111-ET12Z7PWUOKH313GY0EU/calyceal+rupturecauses.JPG The Naunheim Files - A 78 y.o. female with a hx of recurrent arrhythmias sp mitral valve repair presents with diffuse abdominal pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1505485798330-AFRPSBGFWLUB9PE3AB3E/calyceal+rupture%2C+tachy.JPG The Naunheim Files - A 78 y.o. female with a hx of recurrent arrhythmias sp mitral valve repair presents with diffuse abdominal pain. https://everydayebm.org/naunheim-files/2017/9/4/a-71-yo-female-sp-bilateral-lung-transplant-in-2007-presents-with-fever-pancytopenia-and-altered-mental-status-her-cxr-is-shown-below monthly 0.5 2017-09-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1504804574111-7I7HM91UCSLC1P5L6GH2/erlichio.JPG The Naunheim Files - A 71 y.o. female sp bilateral lung transplant in 2007 presents with fever, pancytopenia and altered mental status. Her CXR is shown below. What is the differential? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1504804031094-H6AVZ9QNIS5I11T59MPY/ehrlichia+map.JPG The Naunheim Files - A 71 y.o. female sp bilateral lung transplant in 2007 presents with fever, pancytopenia and altered mental status. Her CXR is shown below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1504804177762-TDPF3ZI2IAKDZK1G5VNU/ehrlichia%2C+morula.JPG The Naunheim Files - A 71 y.o. female sp bilateral lung transplant in 2007 presents with fever, pancytopenia and altered mental status. Her CXR is shown below. https://everydayebm.org/naunheim-files/2017/8/28/a-38yo-woman-arrested-after-an-opiate-overdose-immediate-cpr-was-done-by-her-boyfriend-and-she-was-revived monthly 0.5 2017-08-31 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1503931331758-5O30VST6DSR84M9FECBK/opiodarrowpneumomediastinum+and+L+pleural+effusion+jpg.jpg The Naunheim Files - A 38y.o. woman arrested after an opiate overdose. Immediate cpr was done by her boyfriend and she was revived. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1503931483992-2NNC9B7EKZAMK5WVW2ZI/opiod+1stagnant+contrast+in+lesser+sac+jpg.jpg The Naunheim Files - A 38y.o. woman arrested after an opiate overdose. Immediate cpr was done by her boyfriend and she was revived. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1504196249288-W9A8026UGFWZVC5H6N85/lesser+sac.JPG The Naunheim Files - A 38y.o. woman arrested after an opiate overdose. Immediate cpr was done by her boyfriend and she was revived. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1504196283699-9G01Z2DNYV7QIRKECHXR/lessersac+2.JPG The Naunheim Files - A 38y.o. woman arrested after an opiate overdose. Immediate cpr was done by her boyfriend and she was revived. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1504196361680-MU7ZH0KPITVE3TWM0OLE/opiod+final+free+air+and+stomach+draining+into+lesser+sac+jpg.jpg The Naunheim Files - A 38y.o. woman arrested after an opiate overdose. Immediate cpr was done by her boyfriend and she was revived. free air https://everydayebm.org/naunheim-files/2017/8/21/a-30-yo-woman-with-hiv-and-lupus-was-treated-for-a-rash-on-the-day-pta-she-now-presents-with-fevers-myalgias-and-worsening-rash monthly 0.5 2017-08-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1503326734990-YSZ1WSOSTIXIQRF4USOY/jar.jpg The Naunheim Files - A 30 y.o. woman with HIV and lupus was treated for a rash on the day pta. She now presents with fevers, myalgias and worsening rash. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1503326768307-O9HC5CEPTI3VMSH1AWQ5/jar2.jpg The Naunheim Files - A 30 y.o. woman with HIV and lupus was treated for a rash on the day pta. She now presents with fevers, myalgias and worsening rash. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1503450889920-NPWLGJ0Z4LLK4MLIDPYF/Screen+Shot+2017-08-22+at+8.02.51+PM.png The Naunheim Files - A 30 y.o. woman with HIV and lupus was treated for a rash on the day pta. She now presents with fevers, myalgias and worsening rash. secondary syphilis of the tongue https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1503450974769-HMMV2NL337MVAMTOVLEK/chancre-oral-1-200.jpg The Naunheim Files - A 30 y.o. woman with HIV and lupus was treated for a rash on the day pta. She now presents with fevers, myalgias and worsening rash. primary syphilis of the tongue https://everydayebm.org/naunheim-files/2017/8/14/a-30-yo-woman-comes-to-the-ed-with-hoarseness-she-is-scoped-and-you-find-what-is-pictured monthly 0.5 2017-08-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1502721777679-N7ERQAY06I5LHQNSRTY6/image-asset.jpeg The Naunheim Files - A 30 y.o. woman comes to the ED with hoarseness . She is scoped and you find what is pictured. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1502721811974-7RXIRAP8D7U4ZO5JRTUM/image-asset.jpeg The Naunheim Files - A 30 y.o. woman comes to the ED with hoarseness . She is scoped and you find what is pictured. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1502986259246-DPVL31M33MNIH19XKTY6/image-asset.jpeg The Naunheim Files - A 30 y.o. woman comes to the ED with hoarseness . She is scoped and you find what is pictured. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1502986404283-R9VB09ICGLA717EAF6JJ/image-asset.jpeg The Naunheim Files - A 30 y.o. woman comes to the ED with hoarseness . She is scoped and you find what is pictured. https://everydayebm.org/naunheim-files/2017/8/7/a-28-yo-male-arrives-in-the-ed-with-a-rash-and-a-finding-under-his-tongue-what-problem-does-this-represent monthly 0.5 2017-08-11 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1502116164374-N6Z5SZCR2RPJGAMURMFD/image-asset.jpeg The Naunheim Files - A 28 y.o. male arrives in the ED with a rash and a finding under his tongue. What problem does this represent? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1502116201828-EUPLWRS7UJURXG2EVUL7/image-asset.jpeg The Naunheim Files - A 28 y.o. male arrives in the ED with a rash and a finding under his tongue. What problem does this represent? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1502459187911-AGL2UDQWF3B5JDG7AKGZ/image-asset.jpeg The Naunheim Files - A 28 y.o. male arrives in the ED with a rash and a finding under his tongue. What problem does this represent? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1502459362701-HW30C65NETUQAYOVT68W/image-asset.jpeg The Naunheim Files - A 28 y.o. male arrives in the ED with a rash and a finding under his tongue. What problem does this represent? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1502459422937-K6NCVBM7M1SK5NMXL0VB/image-asset.jpeg The Naunheim Files - A 28 y.o. male arrives in the ED with a rash and a finding under his tongue. What problem does this represent? black widow with hour glass marking https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1502459541595-FE7FI5J4PKZ7WZ60X3PO/image-asset.jpeg The Naunheim Files - A 28 y.o. male arrives in the ED with a rash and a finding under his tongue. What problem does this represent? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1502459645874-8Y6B9OO34M648P5ZYDA0/image-asset.jpeg The Naunheim Files - A 28 y.o. male arrives in the ED with a rash and a finding under his tongue. What problem does this represent? https://everydayebm.org/naunheim-files/2017/7/31/a-32-yo-male-was-smoking-methamphetamines-and-complains-of-shortness-of-breath monthly 0.5 2024-02-15 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1501514698065-ZTT9VM5765MBJYFU8EY6/image-asset.jpeg The Naunheim Files - A 32 y.o. male was smoking meth and complains of shortness of breath. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1501777157513-VYHMBWYTMLW9VFV5L01F/image-asset.jpeg The Naunheim Files - A 32 y.o. male was smoking meth and complains of shortness of breath. Cutaneous larva migrans (hookworm) of the lung: Loeffler's syndrome. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1501777221014-GOCTPN43TPOD4XG7QEL6/image-asset.jpeg The Naunheim Files - A 32 y.o. male was smoking meth and complains of shortness of breath. Peripheral rash associated with hookworms. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1501777320903-LA3WH69C1BEX9DLPHXH6/image-asset.jpeg The Naunheim Files - A 32 y.o. male was smoking meth and complains of shortness of breath. Differential diagnosis of eosinophilic pneumonia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1501777394544-UDUF2HDXYY95BMXPTG54/image-asset.jpeg The Naunheim Files - A 32 y.o. male was smoking meth and complains of shortness of breath. https://everydayebm.org/naunheim-files/2017/7/24/a-65-yo-male-with-a-history-of-juvenile-idiopathic-arthritis-presents-with-a-three-month-hx-of-recurrent-pericardial-effusions monthly 0.5 2017-07-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1500908521114-VY9X2V2NM8WUYJ2ZDGJ5/ec+bone.JPG The Naunheim Files - A 65 yo male with a history of juvenile idiopathic arthritis presents with a three month hx of recurrent pericardial effusions. Pet scan showing uptake in the distal femurs. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1500908571866-OJ7ULLIRK43FCM52MA2J/image-asset.jpeg The Naunheim Files - A 65 yo male with a history of juvenile idiopathic arthritis presents with a three month hx of recurrent pericardial effusions. and infiltration of the retroperitoneum with bilateral hydronephrosis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1500908636555-U3PXEEXADKFP370A9HVH/image-asset.jpeg The Naunheim Files - A 65 yo male with a history of juvenile idiopathic arthritis presents with a three month hx of recurrent pericardial effusions. and something infiltrating his pituitary on MRI; what disease does he have? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1501168921759-XRKGNYLONGLGQSUVETMA/image-asset.jpeg The Naunheim Files - A 65 yo male with a history of juvenile idiopathic arthritis presents with a three month hx of recurrent pericardial effusions. our patient had been treated for chf for many weeks based on this cxr https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1501169016980-L8NIBM2WVPTN5I4O8GNM/image-asset.jpeg The Naunheim Files - A 65 yo male with a history of juvenile idiopathic arthritis presents with a three month hx of recurrent pericardial effusions. Diseases causing pituitary infiltration https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1501169171330-MQWKV6SID9WU5PGEEI5J/ecbiopsy.JPG The Naunheim Files - A 65 yo male with a history of juvenile idiopathic arthritis presents with a three month hx of recurrent pericardial effusions. foamy macrophages and fibrosis seen on biopsy https://everydayebm.org/naunheim-files/2017/7/17/a-58-yo-woman-who-works-as-a-park-superintendent-in-sullivan-mo-comes-in-with-somnolence-fevers-and-a-rash-she-reports-several-tick-bites monthly 0.5 2017-07-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1500302336433-IJXBESYIKIL30MMSTBKW/image-asset.png The Naunheim Files - A 58 y.o. woman who works as a park superintendent in Sullivan, MO, comes in with somnolence, fevers and a rash. She reports several tick bites. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1500565358008-H3KOHGJOX5FN5YO8VRI9/image-asset.png The Naunheim Files - A 58 y.o. woman who works as a park superintendent in Sullivan, MO, comes in with somnolence, fevers and a rash. She reports several tick bites. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1500565424570-ZT1W4WMBALMNXSJ8ZN32/image-asset.png The Naunheim Files - A 58 y.o. woman who works as a park superintendent in Sullivan, MO, comes in with somnolence, fevers and a rash. She reports several tick bites. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1500565570563-2HGZDP9WTQH00VAUL0F1/rmsf+rash..JPG The Naunheim Files - A 58 y.o. woman who works as a park superintendent in Sullivan, MO, comes in with somnolence, fevers and a rash. She reports several tick bites. rocky mountain spotted fever rash. https://everydayebm.org/naunheim-files/2017/7/10/a-45-yo-construction-worker-states-he-has-an-infection-in-his-hand-his-hand-is-pictured monthly 0.5 2017-07-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1499697192812-9O0EX8YCMV35473JMIT0/image-asset.jpeg The Naunheim Files - A 45 y.o. construction worker states he has an infection in his hand. His hand is pictured. What is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1500044996355-W74PA2R2NOSFTD3ICBCE/sweets+path.PNG The Naunheim Files - A 45 y.o. construction worker states he has an infection in his hand. His hand is pictured. skin biopsy of a pt with sweets showing neutrophils https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1500045165676-VYWB38WNRJCKPJ2X04AB/sweets+pyo.PNG The Naunheim Files - A 45 y.o. construction worker states he has an infection in his hand. His hand is pictured. pyoderma gangranosum in the setting of crohns https://everydayebm.org/naunheim-files/2017/7/3/a-33-yo-with-a-history-of-depression-is-found-on-the-basement-floor-wearing-a-swim-suit-and-in-a-pool-of-urine-pictured-are-her-urine-and-vomitus monthly 0.5 2017-07-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1499095511366-UTBWTWQFGTD88QN6K098/image-asset.jpeg The Naunheim Files - A 33 y.o. with a history of depression is found on the basement floor wearing a swim suit and in a pool of urine. Pictured are her urine and vomitus. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1499095547966-PCSV2CEO2UZW3WVLH6SD/image-asset.jpeg The Naunheim Files - A 33 y.o. with a history of depression is found on the basement floor wearing a swim suit and in a pool of urine. Pictured are her urine and vomitus. She is somnolent; what could she have taken? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1499358610157-JJBWP8JZII8BCNW5EJVN/image-asset.jpeg The Naunheim Files - A 33 y.o. with a history of depression is found on the basement floor wearing a swim suit and in a pool of urine. Pictured are her urine and vomitus. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1499696597278-PL3KXPDGO7VEBBPQ9S8V/image-asset.jpeg The Naunheim Files - A 33 y.o. with a history of depression is found on the basement floor wearing a swim suit and in a pool of urine. Pictured are her urine and vomitus. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1499696744759-I298KW15Y1WBCUU308BY/image-asset.jpeg The Naunheim Files - A 33 y.o. with a history of depression is found on the basement floor wearing a swim suit and in a pool of urine. Pictured are her urine and vomitus. https://everydayebm.org/naunheim-files/2017/6/26/a-44-yo-woman-presents-with-memory-loss-headaches-and-twitching-of-her-arms monthly 0.5 2017-06-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1498495486285-HZ04S241EE90F7EAD2NB/image-asset.jpeg The Naunheim Files - A 44 y.o. woman presents with memory loss, headaches and "twitching" of her arms. What does her MRI show? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1498753412323-PGMK6H8BQ1KQRR08BLXE/image-asset.jpeg The Naunheim Files - A 44 y.o. woman presents with memory loss, headaches and "twitching" of her arms. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1498753440899-7YYUNBYSCL36F4ZQSW82/image-asset.jpeg The Naunheim Files - A 44 y.o. woman presents with memory loss, headaches and "twitching" of her arms. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1498753589597-DAKILDFSX4OSVI892RSR/image-asset.jpeg The Naunheim Files - A 44 y.o. woman presents with memory loss, headaches and "twitching" of her arms. https://everydayebm.org/naunheim-files/2017/6/19/a-70-yo-man-presents-with-a-one-day-history-of-bilateral-parotid-swelling monthly 0.5 2017-06-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1497898734529-T4Q7XB3N909KDRDULJHJ/image-asset.jpeg The Naunheim Files - A 70 y.o. man presents with a one day history of bilateral parotid swelling https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1498271623023-K45WML9Z65NCRWQPX2YD/image-asset.jpeg The Naunheim Files - A 70 y.o. man presents with a one day history of bilateral parotid swelling https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1498271720053-AU7TSWAL1D8FWFA5T59J/image-asset.png The Naunheim Files - A 70 y.o. man presents with a one day history of bilateral parotid swelling sarcoid is also a cause of bilateral parotid swelling https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1498271818610-9CINQL3U84GZX5S8XPEO/image-asset.png The Naunheim Files - A 70 y.o. man presents with a one day history of bilateral parotid swelling air in parotids https://everydayebm.org/naunheim-files/2017/6/12/a-21-yo-avid-outdoorsman-complains-of-r-pleuritic-chest-pain monthly 0.5 2017-06-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1497273689939-KL71VRBYFTSCYRJEZQWG/image-asset.jpeg The Naunheim Files - A 21 y.o. avid outdoorsman complains of R pleuritic chest pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1497273829921-BT2424KFFJTHKDBK7SJY/image-asset.jpeg The Naunheim Files - A 21 y.o. avid outdoorsman complains of R pleuritic chest pain What is wrong with this patient? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1497676006168-YKKK4K8QRFC5TCRCHPX9/image-asset.png The Naunheim Files - A 21 y.o. avid outdoorsman complains of R pleuritic chest pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1497676284562-9R0L00NSAAD7DFK5CRPY/image-asset.png The Naunheim Files - A 21 y.o. avid outdoorsman complains of R pleuritic chest pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1497676347514-U92W9W2V24PVLV5IZXZ4/image-asset.png The Naunheim Files - A 21 y.o. avid outdoorsman complains of R pleuritic chest pain https://everydayebm.org/naunheim-files/2017/6/5/a-79-yo-woman-is-a-restrained-passenger-in-a-high-speed-mvc-loc-her-only-complaint-is-that-she-is-confused monthly 0.5 2017-06-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1496678104489-XRATLZIWJKOR6U136JTN/image-asset.jpeg The Naunheim Files - A 79 y.o. woman is a restrained passenger in a high speed MVC. + LOC . her only complaint is that she is confused. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1497019256280-RV3LEKQI8UOFFAWD55Q4/image-asset.jpeg The Naunheim Files - A 79 y.o. woman is a restrained passenger in a high speed MVC. + LOC . her only complaint is that she is confused. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1497019466808-QENU5WKCFNJ25BL5YJSQ/image-asset.jpeg The Naunheim Files - A 79 y.o. woman is a restrained passenger in a high speed MVC. + LOC . her only complaint is that she is confused. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1497019565532-YD6QBBDN8HDRNUMTQ6K8/image-asset.jpeg The Naunheim Files - A 79 y.o. woman is a restrained passenger in a high speed MVC. + LOC . her only complaint is that she is confused. https://everydayebm.org/naunheim-files/2017/5/30/a-51-yo-male-was-working-on-his-car-in-the-rain-and-was-found-unconscious-with-the-rash-below monthly 0.5 2017-06-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1496153809175-FT261PJ3EQJS81G4LWQE/image-asset.jpeg The Naunheim Files - A 51 yo male was working on his car in the rain and was found unconscious with the rash below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1496153875718-CR6FAG8KFUAGV7QF2FSG/image-asset.jpeg The Naunheim Files - A 51 yo male was working on his car in the rain and was found unconscious with the rash below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1496416474233-2VN3QRYHWZPNPUZPPLHN/image-asset.jpeg The Naunheim Files - A 51 yo male was working on his car in the rain and was found unconscious with the rash below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1496416545969-N8J9L5SZZRUOCXEXLZLR/image-asset.jpeg The Naunheim Files - A 51 yo male was working on his car in the rain and was found unconscious with the rash below. https://everydayebm.org/naunheim-files/2017/5/18/a-52-yo-pedestrian-was-struck-by-a-car-she-was-unresponsive-at-the-scene-and-brought-to-the-ed-her-imaging-appears-below monthly 0.5 2017-05-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1495204741810-H8ZDOTFCS77Q562D33BJ/image-asset.jpeg The Naunheim Files - A 52 y.o. pedestrian was struck by a car. She was unresponsive at the scene and brought to the ED. Her imaging appears below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1495205234552-5F494ZMD8UDXO00EXJ47/image-asset.jpeg The Naunheim Files - A 52 y.o. pedestrian was struck by a car. She was unresponsive at the scene and brought to the ED. Her imaging appears below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1495205601163-O8ECVNDN7AQIZOMCCVFK/image-asset.jpeg The Naunheim Files - A 52 y.o. pedestrian was struck by a car. She was unresponsive at the scene and brought to the ED. Her imaging appears below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1495205688002-D169H9KVD97Y8LTWJTUC/image-asset.jpeg The Naunheim Files - A 52 y.o. pedestrian was struck by a car. She was unresponsive at the scene and brought to the ED. Her imaging appears below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1495206496846-UBAWNJHZ9E3WQEGC5K1E/image-asset.jpeg The Naunheim Files - A 52 y.o. pedestrian was struck by a car. She was unresponsive at the scene and brought to the ED. Her imaging appears below. https://everydayebm.org/naunheim-files/2017/5/15/a-55-yo-diabetic-presents-with-a-chief-complaint-of-i-am-going-blind-in-my-r-eye monthly 0.5 2017-05-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1494860815975-Q2ZK05JXTD1SAL42AI7U/image-asset.jpeg The Naunheim Files - A 55 y.o. diabetic presents with a chief complaint of ," I am going blind in my R eye" https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1495123317166-7CATFZDKP8ZGC9469HVF/image-asset.jpeg The Naunheim Files - A 55 y.o. diabetic presents with a chief complaint of ," I am going blind in my R eye" https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1495123380291-SBHHYHVFEXFERGV8T303/image-asset.jpeg The Naunheim Files - A 55 y.o. diabetic presents with a chief complaint of ," I am going blind in my R eye" https://everydayebm.org/naunheim-files/2017/5/8/a-27-yo-female-presents-with-rlq-pain-the-us-appears-below monthly 0.5 2017-05-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1494251785668-H0GTCYLJDF4UDPYIG6CB/image-asset.jpeg The Naunheim Files - A 27 y.o. female presents with RLQ pain. The US appears below. What is the differential https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1494598513288-G8QAAIHVF6MGCOG92ZYQ/image-asset.jpeg The Naunheim Files - A 27 y.o. female presents with RLQ pain. The US appears below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1494598575693-4UWQHTQ770D4U0UQMB9E/image-asset.jpeg The Naunheim Files - A 27 y.o. female presents with RLQ pain. The US appears below. https://everydayebm.org/naunheim-files/2017/5/1/a-64-yo-diabetic-presents-with-l-flank-pain-and-elevated-blood-sugar-his-ct-is-below monthly 0.5 2017-05-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1493652234884-DZO5V0NW4FRW40QS90QT/image-asset.jpeg The Naunheim Files - A 64 y.o. diabetic presents with L flank pain and elevated blood sugar. His CT is below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1493914891970-88N151PT3OLH9URA96VM/image-asset.jpeg The Naunheim Files - A 64 y.o. diabetic presents with L flank pain and elevated blood sugar. His CT is below. https://everydayebm.org/naunheim-files/2017/4/24/a-61-yo-hispanic-male-presents-with-a-headache monthly 0.5 2017-04-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1493041253183-GPDFYLJ6S9U4O3QK1P7S/image-asset.jpeg The Naunheim Files - A 61 y.o. Hispanic male presents with a headache. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1493304570634-Z5K4KCKZG4QHTBG3682O/image-asset.jpeg The Naunheim Files - A 61 y.o. Hispanic male presents with a headache. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1493304772737-8FYPK2BD7N66K5YCQAX9/image-asset.jpeg The Naunheim Files - A 61 y.o. Hispanic male presents with a headache. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1493304825640-4JXH4S1Y0OR0XNNFKMPO/image-asset.jpeg The Naunheim Files - A 61 y.o. Hispanic male presents with a headache. https://everydayebm.org/naunheim-files/2017/4/17/a-42-yo-woman-who-had-a-roux-en-y-gastric-bypass-in-2004-presents-with-a-rash-on-her-hands monthly 0.5 2017-04-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1492440599862-WBOQ6RM5RPNGZZCZARSX/image-asset.jpeg The Naunheim Files - A 42 y.o. woman who had a Roux-en-Y gastric bypass in 2004 presents with a rash on her hands. What is the cause of the rash? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1492703936451-LKVWM9UAWIE93YG0RPJA/image-asset.jpeg The Naunheim Files - A 42 y.o. woman who had a Roux-en-Y gastric bypass in 2004 presents with a rash on her hands. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1492704773933-RA6O7VAHT0724UWCHJ0Q/image-asset.jpeg The Naunheim Files - A 42 y.o. woman who had a Roux-en-Y gastric bypass in 2004 presents with a rash on her hands. https://everydayebm.org/naunheim-files/2017/4/10/a-50-yo-man-presents-with-sinus-congestion-and-deafness-in-the-r-ear monthly 0.5 2017-04-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1491836295947-5G4YVZCHF4KAUI2H0OJ7/image-asset.jpeg The Naunheim Files - A 50 y.o. man presents with sinus congestion and deafness in the R ear https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1492183427804-1SC655CP9YZPY0Q0IVEC/palate+tumor.JPG The Naunheim Files - A 50 y.o. man presents with sinus congestion and deafness in the R ear https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1492183755639-NRFTCBGVD808P6HWL35A/nicotine+stomatitis.JPG The Naunheim Files - A 50 y.o. man presents with sinus congestion and deafness in the R ear https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1492183983628-0H2ZYHI31QAXOHWKA06U/image-asset.jpeg The Naunheim Files - A 50 y.o. man presents with sinus congestion and deafness in the R ear necrotizing sialometaplasia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1492184108883-EIFTMOOMU4Y8MXV94AP3/image-asset.jpeg The Naunheim Files - A 50 y.o. man presents with sinus congestion and deafness in the R ear https://everydayebm.org/naunheim-files/2017/4/3/a-51-yo-man-comes-in-after-being-treated-for-bronchitis-with-the-urine-shown-below monthly 0.5 2017-04-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1491234866360-R8VVVTNAHPUJ6PHP9OWE/dark+urineapril.jpg The Naunheim Files - A 51 y.o. man comes in after being treated for bronchitis with the urine shown below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1491494314331-Y5SKQHJU8E9K0MRAZL4I/image-asset.jpeg The Naunheim Files - A 51 y.o. man comes in after being treated for bronchitis with the urine shown below. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1491494410003-B0ZR5PUCAXF2AOZ6ZL2S/image-asset.jpeg The Naunheim Files - A 51 y.o. man comes in after being treated for bronchitis with the urine shown below. https://everydayebm.org/naunheim-files/2017/3/27/a-66-yo-farmer-presents-with-an-abnormal-cxr-and-no-symptoms monthly 0.5 2017-03-31 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1490626331944-TWPQJDX8QOPFHBN7VW24/image-asset.jpeg The Naunheim Files - A 66 y.o. farmer presents with an abnormal cxr and no symptoms. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1490970774260-6B155L8IV5EP9W5Q9XWM/image-asset.jpeg The Naunheim Files - A 66 y.o. farmer presents with an abnormal cxr and no symptoms. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1490970876576-SK9EBXMG06GWOEYDXI68/image-asset.jpeg The Naunheim Files - A 66 y.o. farmer presents with an abnormal cxr and no symptoms. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1490972092856-A1X5RGZTXAUO7CQ03UUM/image-asset.jpeg The Naunheim Files - A 66 y.o. farmer presents with an abnormal cxr and no symptoms. https://everydayebm.org/naunheim-files/2017/3/20/a-35-yo-male-has-just-started-a-job-at-a-sushi-restaurant-and-comes-in-with-a-rash-on-his-hands monthly 0.5 2017-03-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1490020439311-W4RG416JZ0JTZTVRK4V6/image-asset.jpeg The Naunheim Files - A 35 y.o. male has just started a job at a sushi restaurant and comes in with a rash on his hands. What could cause this? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1490282238338-9HZAA3MEUUP486HPCOA2/image-asset.jpeg The Naunheim Files - A 35 y.o. male has just started a job at a sushi restaurant and comes in with a rash on his hands. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1490282346028-8J0OG3RN4PIEHS3HRV9N/image-asset.jpeg The Naunheim Files - A 35 y.o. male has just started a job at a sushi restaurant and comes in with a rash on his hands. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1490282472109-ZOLWDQVOCWAPJ6G96ICY/image-asset.jpeg The Naunheim Files - A 35 y.o. male has just started a job at a sushi restaurant and comes in with a rash on his hands. https://everydayebm.org/naunheim-files/2017/3/13/a-64-yo-woman-presents-with-pain-in-the-l-heel monthly 0.5 2017-03-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1489417044089-V69KOR4KEPEDLRASM89R/image-asset.jpeg The Naunheim Files - A 64 y.o. woman presents with pain in the L heel. What is the differential https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1489762300777-A574DYNUBZ3O093GF5QO/image-asset.jpeg The Naunheim Files - A 64 y.o. woman presents with pain in the L heel. https://everydayebm.org/naunheim-files/2017/3/6/a-45-yo-presents-with-a-rash-on-his-back monthly 0.5 2017-03-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1488816806291-BJ9BXM9J2CWEGHX37VJ9/image-asset.jpeg The Naunheim Files - A 45 y.o. presents with a rash on his back What is this? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1489159576230-TOTYN6DNFSNXGS0I39HT/image-asset.jpeg The Naunheim Files - A 45 y.o. presents with a rash on his back https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1489159669546-T5WELHGF6WKY484CY40U/image-asset.jpeg The Naunheim Files - A 45 y.o. presents with a rash on his back https://everydayebm.org/naunheim-files/2017/2/27/a-600-lb-women-presents-with-pain-in-the-r-leg monthly 0.5 2017-03-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1488214779207-RBE1R4D35GZATS2W19RY/image-asset.jpeg The Naunheim Files - A 600 lb women presents with pain in the R leg. the arrow represents her hip. What is this condition? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1488479595438-LHF11PVIK2R92BWLLG3I/image-asset.jpeg The Naunheim Files - A 600 lb women presents with pain in the R leg. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1488479722744-MNYVVV6DANO0ANYV8QIN/image-asset.jpeg The Naunheim Files - A 600 lb women presents with pain in the R leg. compression for lymphedema https://everydayebm.org/naunheim-files/2017/2/20/a-pt-is-transferred-to-toxicology-from-an-outside-hospital-after-a-k2-ingestion monthly 0.5 2017-02-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1487603242815-I5XUGE0Q1JN0K24GSC92/image-asset.jpeg The Naunheim Files - A pt is transferred to toxicology from an outside hospital after a K2 ingestion What do you notice on theCT image? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1487867593597-WOZPORZ0I3ULESN0A14Z/pneumomediastinum.JPG The Naunheim Files - A pt is transferred to toxicology from an outside hospital after a K2 ingestion https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1487867770124-1HZYVZC7IC2YLHOR3GGD/image-asset.jpeg The Naunheim Files - A pt is transferred to toxicology from an outside hospital after a K2 ingestion https://everydayebm.org/naunheim-files/2017/2/13/a-14-yo-was-accidentally-kicked-in-the-suprapubic-area-while-playing-basketball monthly 0.5 2017-02-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1487003525361-5PL0RM8HYI3WK5CFM97K/image-asset.jpeg The Naunheim Files - A 14 yo was accidentally kicked in the suprapubic area while playing basketball. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1487265512697-IF6QM93VKTQOCOTF0A1A/image-asset.jpeg The Naunheim Files - A 14 yo was accidentally kicked in the suprapubic area while playing basketball. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1487265588587-ZK5ZBC6ZJ064GFE0A03V/horseshoe+kidney.JPG The Naunheim Files - A 14 yo was accidentally kicked in the suprapubic area while playing basketball. horseshoe kidney https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1487265639059-2MRJQ2L47QTSR8LLTTCF/image-asset.jpeg The Naunheim Files - A 14 yo was accidentally kicked in the suprapubic area while playing basketball. pancake kidney https://everydayebm.org/naunheim-files/2017/2/6/a-90-yo-is-send-in-from-the-veterans-home-with-altered-mental-status-he-is-unable-to-give-a-history-but-you-notice-a-wound-on-his-head monthly 0.5 2017-02-10 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1486395164908-2840VVE2Z8ZZSRZ19JYE/image-asset.jpeg The Naunheim Files - A 90 y.o. is sent in from the veterans home with altered mental status. He is unable to give a history but you notice a wound on his head. What is wrong? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1486741579775-MFF3X94470SBCAEPU2O4/image-asset.jpeg The Naunheim Files - A 90 y.o. is sent in from the veterans home with altered mental status. He is unable to give a history but you notice a wound on his head. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1486741628366-ATHUZGYNSQRG9A1SGN74/image-asset.jpeg The Naunheim Files - A 90 y.o. is sent in from the veterans home with altered mental status. He is unable to give a history but you notice a wound on his head. https://everydayebm.org/naunheim-files/2017/1/30/a-63-yo-male-with-hiv-presents-with-diplopia-and-the-images-shown monthly 0.5 2017-02-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1485792813765-G9QQNXQYMH5KTIPJVD7L/image-asset.jpeg The Naunheim Files - A 63 yo male with HIV presents with diplopia and the images shown https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1485792875498-UUE4RHM4M87FDDWRTR5R/image-asset.jpeg The Naunheim Files - A 63 yo male with HIV presents with diplopia and the images shown https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1486138719048-HMT9X7OH2WBYWKYHKXFG/image-asset.jpeg The Naunheim Files - A 63 yo male with HIV presents with diplopia and the images shown https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1486138840522-O0BS3POZN9U55N0X5UUE/image-asset.jpeg The Naunheim Files - A 63 yo male with HIV presents with diplopia and the images shown https://everydayebm.org/naunheim-files/2017/1/23/a-35-yo-presents-with-hemoptysis monthly 0.5 2017-01-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1485186642918-UMNRCZCZ6C9H4S6HXNHS/image-asset.jpeg The Naunheim Files - A 35 y.o. presents with hemoptysis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1485456286435-V9LGSHPHAN75GHWTQXS7/image-asset.jpeg The Naunheim Files - A 35 y.o. presents with hemoptysis https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1485456438039-FQVWPEUHAYDZMDD01RFN/image-asset.jpeg The Naunheim Files - A 35 y.o. presents with hemoptysis https://everydayebm.org/naunheim-files/2017/1/16/a-43-yo-k2-user-comes-in-after-a-fall-the-fast-of-the-bladder-is-shown monthly 0.5 2017-01-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1484579313953-ZOC2Y50B3IWIMGDDRKK2/image-asset.jpeg The Naunheim Files - A 43 y.o. K2 user comes in after a fall. The fast of the bladder is shown. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1484925601848-0JHTTN84MKW709PLD6FX/image-asset.jpeg The Naunheim Files - A 43 y.o. K2 user comes in after a fall. The fast of the bladder is shown. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1484925664223-SSM3KDKBIMJY933O0OVB/image-asset.jpeg The Naunheim Files - A 43 y.o. K2 user comes in after a fall. The fast of the bladder is shown. https://everydayebm.org/naunheim-files/2017/1/9/a-52-yo-presents-with-abd-pain-and-the-ct-shown-what-does-this-represent monthly 0.5 2017-01-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1483975744466-6AFW8UYPZTWU1C87HZVX/image-asset.jpeg The Naunheim Files - A 52 y.o. presents with abd pain and the CT shown. What does this represent? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1483975806920-S7RZFCVVKS81Z4MAMYE3/image-asset.jpeg The Naunheim Files - A 52 y.o. presents with abd pain and the CT shown. What does this represent? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1484320814172-B69Y1KPTZL3O87QO4AMP/image-asset.jpeg The Naunheim Files - A 52 y.o. presents with abd pain and the CT shown. What does this represent? https://everydayebm.org/naunheim-files/2017/1/2/a-77-yo-woman-presents-with-this-ct-after-a-fall monthly 0.5 2017-01-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1483373982872-8RH64LVMU4508ICVP7RG/image-asset.jpeg The Naunheim Files - A 77 y.o. woman presents with this CT after a fall https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1483635046729-2LB8GJCKHUTFKLORSWRI/image-asset.jpeg The Naunheim Files - A 77 y.o. woman presents with this CT after a fall https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1483635334920-YAVEIVUHJS1Q4IKCK5SG/image-asset.jpeg The Naunheim Files - A 77 y.o. woman presents with this CT after a fall https://everydayebm.org/naunheim-files/2016/12/26/a-48-yo-male-fell-and-is-transferred-with-blood-layering-in-both-globes monthly 0.5 2016-12-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1482769917486-GOOSU5TWRGQWXI0GYOSF/image-asset.jpeg The Naunheim Files - A 48 yo male fell and is transferred with "blood layering in both globes" https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1483035104403-1K79VS0PG9YT4VP3Z6JD/image-asset.jpeg The Naunheim Files - A 48 yo male fell and is transferred with "blood layering in both globes" https://everydayebm.org/naunheim-files/2016/12/19/a-1 monthly 0.5 2016-12-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1482167879596-AD4TWM8YG7ZGCY02YGQX/image-asset.jpeg The Naunheim Files - A 21 yo woman who is nursing presented with a painful breast. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1482509134334-9IQL0Q3PKY1NO2LRJG35/image-asset.jpeg The Naunheim Files - A 21 yo woman who is nursing presented with a painful breast. https://everydayebm.org/naunheim-files/2016/12/12/a-72-yo-with-a-known-aaa-presents-with-severe-abd-and-back-pain monthly 0.5 2016-12-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1481564103183-UUNXQR7SF6EEAXL4DY8R/image-asset.jpeg The Naunheim Files - A 72 y.o. with a known AAA presents with severe abd and back pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1481564139640-ZAPLOQPW4Q9RP6VXFX5S/image-asset.jpeg The Naunheim Files - A 72 y.o. with a known AAA presents with severe abd and back pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1481903813714-F1CYJ71WAN75TCV2U4TW/image-asset.jpeg The Naunheim Files - A 72 y.o. with a known AAA presents with severe abd and back pain https://everydayebm.org/naunheim-files/2016/12/5/a-58-yo-man-received-imaging-and-promptly-coded-and-died monthly 0.5 2016-12-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1480954453571-KM7ESRU6QIGRQBWCCKP2/image-asset.png The Naunheim Files - A 58 yo man received imaging and promptly coded and died. 0at did he die of? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1481251091852-E6J65D4YIZTU0R7CAUJP/image-asset.png The Naunheim Files - A 58 yo man received imaging and promptly coded and died. https://everydayebm.org/naunheim-files/2016/11/28/a-37-yo-presents-with-vomiting monthly 0.5 2016-12-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1480352225506-DSFZHXGWS8W15E10PCH4/image-asset.jpeg The Naunheim Files - A 37 y.o. presents with vomiting https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1480694015414-LXK3MFY3AA5ZD3E73ZG3/image-asset.jpeg The Naunheim Files - A 37 y.o. presents with vomiting https://everydayebm.org/naunheim-files/2016/11/21/a-38-yo-presents-with-acute-respiratory-failure monthly 0.5 2016-11-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1479744461070-V6YGSQD357ATJIEW5EV1/image-asset.jpeg The Naunheim Files - A 38 yo presents with acute respiratory failure https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1480085746346-VXY2YYBHYQLT9ZM70P4I/image-asset.jpeg The Naunheim Files - A 38 yo presents with acute respiratory failure https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1480085859036-AHA5BUYZ3FX4H6FG2JSZ/image-asset.jpeg The Naunheim Files - A 38 yo presents with acute respiratory failure https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1480085947483-RL2TIIBK224ERRJXK2E0/image-asset.jpeg The Naunheim Files - A 38 yo presents with acute respiratory failure https://everydayebm.org/naunheim-files/2016/11/14/i-was-eating-chicken-at-a-barbeque-and-something-stuck-in-my-throat monthly 0.5 2016-11-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1479139599738-ZN4LG87PWGK1YHJX3XCW/image-asset.jpeg The Naunheim Files - I was eating chicken at a barbeque and something stuck in my throat https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1479401820768-WG9LBDWA3RTVZLC9ROZH/image-asset.jpeg The Naunheim Files - I was eating chicken at a barbeque and something stuck in my throat https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1479402004670-VXC0G4SWOI0P3WG2ZQIA/image-asset.jpeg The Naunheim Files - I was eating chicken at a barbeque and something stuck in my throat https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1479402040541-AIOX20ZHKYFWNZ5SV8AR/image-asset.jpeg The Naunheim Files - I was eating chicken at a barbeque and something stuck in my throat perforated intestine from a grill brush wire. https://everydayebm.org/naunheim-files/2016/11/7/a-47-yo-biochemist-is-found-in-his-lab-confused-and-urinating-on-the-floor monthly 0.5 2016-11-11 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1478533300074-Q01HAFR9BT9D8WRAZOGV/image-asset.jpeg The Naunheim Files - A 47 y.o. biochemist is found in his lab confused and urinating on the floor. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1478876118719-E0ZA1I6GA1X0XIMD5JMG/image-asset.jpeg The Naunheim Files - A 47 y.o. biochemist is found in his lab confused and urinating on the floor. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1478876217902-YWSCFGOXK385BNWHBT5C/image-asset.jpeg The Naunheim Files - A 47 y.o. biochemist is found in his lab confused and urinating on the floor. https://everydayebm.org/naunheim-files/2016/10/31/a-30-yo-woman-with-no-past-medical-history-was-burning-leaves-and-became-sob monthly 0.5 2016-11-04 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1477925709304-8PZYO6RY8MEL3U8GL63B/image-asset.jpeg The Naunheim Files - A 30 yo woman with no past medical history was burning leaves and became sob. What happened? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1478271874858-0ITW8YU7TP6UPAJI06RW/image-asset.png The Naunheim Files - A 30 yo woman with no past medical history was burning leaves and became sob. poisonous sumac with white berries and a red stem https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1478271961658-EDJF5F24ZYWS4LPV0KII/image-asset.jpeg The Naunheim Files - A 30 yo woman with no past medical history was burning leaves and became sob. non poisonous sumac https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1478272177036-Y98Y0SVQ36ZLA3L4P5GA/image-asset.jpeg The Naunheim Files - A 30 yo woman with no past medical history was burning leaves and became sob. https://everydayebm.org/naunheim-files/2016/10/24/a-25-year-old-with-a-sore-throat monthly 0.5 2016-10-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1477322992442-QNZ0DU94B8WD6EGBK6LR/image-asset.png The Naunheim Files - A 25 year old with a sore throat What do you see on the xray? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1477586801407-YU4XT82WZMG9WVPCBIPM/image-asset.png The Naunheim Files - A 25 year old with a sore throat https://everydayebm.org/naunheim-files/2016/10/17/my-knee-hurts monthly 0.5 2016-10-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1476715821676-495KD1EGT8HOO9B5WXT3/image-asset.png The Naunheim Files - My knee hurts A 45 y.o. female presents with knee pain https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1477061952528-MHHL4UZ91Q7JSX0HY0WM/image-asset.png The Naunheim Files - My knee hurts Legg calve perthes on the R https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1477062045474-NW0BPSWHIAFE2PJSLZOR/image-asset.png The Naunheim Files - My knee hurts https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1477062093417-5V1DQGFJOTLR0NX26UQM/image-asset.png The Naunheim Files - My knee hurts https://everydayebm.org/naunheim-files/2016/10/10/a-rash-at-midnight-in-missouri monthly 0.5 2016-10-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1476112907078-KLFHRD09SGS53RPMPST4/image-asset.png The Naunheim Files - Midnight in Missouri https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1476463255564-PZWH45N91WCRLI39HYA5/image-asset.png The Naunheim Files - Midnight in Missouri https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1476463379117-NXBRXA250F6Q4TVIO213/image-asset.png The Naunheim Files - Midnight in Missouri https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1476463439478-52F7RW5B58P8O9O0U9NK/image-asset.png The Naunheim Files - Midnight in Missouri https://everydayebm.org/naunheim-files/2016/10/3/a-17-yo-with-galactorrhea monthly 0.5 2016-10-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1475509056325-VOWFTE1XT9ZD0HLNWUA4/image-asset.jpeg The Naunheim Files - A 17 y.o with galactorrhea What causes galactorrhea in a young male? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1475849099435-UMUE2ZZZSHS8HMFB8IV0/image-asset.png The Naunheim Files - A 17 y.o with galactorrhea infant exposed to tea tree oil https://everydayebm.org/naunheim-files/2016/9/26/an-11-year-old-boy-with-a-headache monthly 0.5 2016-09-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1474904663817-0DXTZIAW8ER5BND0730C/image-asset.png The Naunheim Files - An 11 year old boy with a headache What is the finding on this CT? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1475247391162-TPTLN9H4C97H5FU75C1L/image-asset.png The Naunheim Files - An 11 year old boy with a headache https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1475247582927-G6IPRZ6OLY3JUTDFNG8L/image-asset.png The Naunheim Files - An 11 year old boy with a headache Pilocytic astrocytomas are cystic tumors of young people strongly associated with neurofibromatosis type 1.. They can affect the optic nerves and posterior fossa. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1475247831452-UH6OJ1HDJQA8GB5N0HA5/image-asset.png The Naunheim Files - An 11 year old boy with a headache mucopolysaccharidosis https://everydayebm.org/naunheim-files/2016/9/19/i-have-a-problem-with-my-foot monthly 0.5 2016-09-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1474299442618-OZ3C7QBJCCTAOBP0YKOU/image-asset.jpeg The Naunheim Files - I have a problem with my foot. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1474643803764-6TAZGNT2LENK411YF63V/image-asset.png The Naunheim Files - I have a problem with my foot. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1474643930572-OJOTM4R0NB7TMKWNLGLI/image-asset.png The Naunheim Files - I have a problem with my foot. https://everydayebm.org/naunheim-files/2016/9/12/is-this-an-airway-emergency-how-would-you-handle-it monthly 0.5 2016-09-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1473706844988-6ZFD5Z6D2FNL4VAV6BRF/image-asset.jpeg The Naunheim Files - Is this an airway emergency? How would you handle it? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1473706900209-BGQGC8FH50CKJ6MRVFBW/image-asset.jpeg The Naunheim Files - Is this an airway emergency? How would you handle it? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1474035078444-MV1QFL8CZ6DN4S48QFLL/image-asset.png The Naunheim Files - Is this an airway emergency? How would you handle it? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1474036107005-UOYAZQLZBC7QCSA5EEUR/image-asset.jpeg The Naunheim Files - Is this an airway emergency? How would you handle it? https://everydayebm.org/naunheim-files/2016/9/5/an-eye-problem monthly 0.5 2016-09-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1473115189766-NYZJAHVK9NKZP93SV9XH/image-asset.jpeg The Naunheim Files - An eye problem https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1473430490528-FB5H7D3UBLE0VET5KH6B/image-asset.png The Naunheim Files - An eye problem https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1473430532657-UQQIWPU4V37H7TA8ZTU4/image-asset.png The Naunheim Files - An eye problem bella donna (deadly nightshade) flower https://everydayebm.org/naunheim-files/2016/8/29/a-29-yo-woman-from-guatemala-presents-with-dysphagia-and-weight-loss monthly 0.5 2016-09-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1472477735641-AYKL14GX7N9OH57C405Y/image-asset.jpeg The Naunheim Files - A 29 y.o. woman from Guatemala presents with dysphagia and weight loss. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1472832671848-Z24R4JNCU6SURGDBMD11/image-asset.png The Naunheim Files - A 29 y.o. woman from Guatemala presents with dysphagia and weight loss. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1472832754837-1Y32KRB6XXRCA3CLRMY6/image-asset.png The Naunheim Files - A 29 y.o. woman from Guatemala presents with dysphagia and weight loss. Romana's sign https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1472832849253-LWQBZY6WKUE0SA8VBBQP/image-asset.png The Naunheim Files - A 29 y.o. woman from Guatemala presents with dysphagia and weight loss. trypanosome with Giesma stain https://everydayebm.org/naunheim-files/2016/8/22/a-skin-lesion-from-nigeria monthly 0.5 2016-08-26 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1471876266141-9VUY9RWNJTV9M2QIZ68I/igbo+T+cell.jpg The Naunheim Files - A skin lesion from Nigeria A 51 year old woman from Nigeria presents with a skin lesion. What is it? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1472219562477-5LC8BG1H9G1RAXGDKXUM/image-asset.png The Naunheim Files - A skin lesion from Nigeria https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1472219669081-DSUY93OODMILTBCYV1NA/image-asset.png The Naunheim Files - A skin lesion from Nigeria https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1472219856726-5RERXVASNXLCF23Z9I6C/image-asset.png The Naunheim Files - A skin lesion from Nigeria leprosy with neuropathic ulcers https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1472220044940-5QHS0CPC6IDG6RTEY45X/image-asset.png The Naunheim Files - A skin lesion from Nigeria Clinical Course: Our patient presented not only with skin lesions but large bulkly L cervical adenopathy. The disease is incurable, although it can be dormant for a time. In the end stages it invades solid organs. Sezary syndrome occurs when the malignant cells are visible in the blood and the cells are filled with mucopolysaccharides.   References Hwang ST, Janik JE, Jaffe ES, Wilson WH. “Mycosis fungoides and Sezary syndrome” Lancet 2008 371(9616): 945-57. Alibert JLM (1806) descritions des maladies de la peau observes a l’Hopital Saint-Louis, et exposition des meilleures methods suivies pour leur traitement ( in France) Paris: Barrois l’aine p 286. Spitalnik, S, Arinsburg, S, Jhang J. Sept. 2014 Clinical Pathology Board Review . Elsevier Health Sciences. P 310. “It is important to be able to recognize buttock cells and to know that they represent cleaved centrocytic cells of follicular lymphoma”. https://everydayebm.org/naunheim-files/2016/8/15/too-many-tubes monthly 0.5 2016-08-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1471270952100-0D2IUBCSMIG51JZ1T22J/image-asset.png The Naunheim Files - Too many tubes https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1471270985388-YI8QZCIXT3JDOD7XEZ6U/image-asset.png The Naunheim Files - Too many tubes https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1471530778872-2HSXNLK2YRXCFZFLDMMY/image-asset.png The Naunheim Files - Too many tubes https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1471530865833-0Q23I53G60GA1A7OLLOR/image-asset.png The Naunheim Files - Too many tubes https://everydayebm.org/naunheim-files/2016/8/12/rnq551b3thig19dnq1pugr2h9bcsmk monthly 0.5 2016-08-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1471011155071-IR02RCHVV6TVD2UQ4BIF/image-asset.png The Naunheim Files https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1471011228635-9F3AGNJ333SM59OEUOR4/image-asset.png The Naunheim Files https://everydayebm.org/naunheim-files/2016/8/8/waiting-for-sobriety monthly 0.5 2016-08-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1470668590760-NAUMEA5GLYUPP3O85QMM/image-asset.png The Naunheim Files - Waiting for sobriety https://everydayebm.org/naunheim-files/2016/8/1/how-would-you-drain-this-abscess monthly 0.5 2016-08-05 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1470089875618-ZCFMMWVFCTQKDMC3ITS4/image-asset.jpeg The Naunheim Files - How would you drain this abscess? A 73 y.o. male came in from his doctor's office saying he needs his abscess drained. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1470406532977-E37ICY9YNM160E9928OM/image-asset.png The Naunheim Files - How would you drain this abscess? https://everydayebm.org/naunheim-files/2016/7/25/a-swollen-tongue monthly 0.5 2016-07-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1469456142683-6OKBOYQVZPDTOUZACURP/image-asset.jpeg The Naunheim Files - A swollen tongue The patient complained of a swollen tongue. What are the possible causes? Hint: it's not an ace inhibitor, an arb, an allergy or hereditary angioedema. This patient had acquired angioedema caused by lymphoma. 0.5 % of people with B cell lymphoproliferative disorders have acquired C1esterase inhibitor deficiency. Lymphoma, monoglonal gammopathyof uncertain significance (MGUS) , and cryoglobulinemia all have been reported to be associated with C1esterase inhibitor deficiency.       https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1469806042226-YQ5S6EQZ7S58GGMZX6GK/image-asset.png The Naunheim Files - A swollen tongue C1 esterase inhibitor blocks the activation of C1. When it is absent there is inappropriate activation of C1 and activation of C2 which results in kinin-like activity that increases vascular permeability. Edema can occur in the upper airway, GI tract (resulting in abdominal pain) or subcutaneous areas (often in the genitals). There is no urticarial with C1 esterase inhibitor deficiency because it is not IgE mediated.   Hereditary angioedema usually results from a deficiency of C1 esterase inhibitor (type I) or decreased biologic function ofC1 esterase inhibitor (type II). Acquired angioedema is complement mediated and is characterized by low levels of C4, C2 and C1 INH during and between attacks. C1q levels , however , are low only inacquired angioedema. There isa normal level of C1 in hereditary angioedema compared to a low level of C1 in acquired disease. In ACE inhibitor angioedema an excess of bradykinin occurs because of failure to break it down. Fresh frozen plasmacontains the enzyme ACE and is thought to degrade bradykinin by replacing the enzyme inhibited by the ACE inhibitor. Newer agents like ecalantide ( which is approved for hereditary angioedema) have been tried for ACE inhibitor angioedema with mixed results. It is designed to inhibit the production of bradykinin but does not increase its degradation. The cost of a single dose is $9,000. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1469806112688-1DRTFJ1X7K8FJ35KSHM2/image-asset.png The Naunheim Files - A swollen tongue https://everydayebm.org/naunheim-files/2016/7/19/a-19-yo-male-is-driving-down-the-highway-when-he-is-cut-off-by-a-semi-and-swerves-into-the-median-his-car-becomes-airborne-and-rolls-five-times-he-comes-to-the-ed-complaining-of-neck-pain monthly 0.5 2016-07-21 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1468937018922-FUG3IK5ELNCDODLPK7ZK/image-asset.png The Naunheim Files - A 19 y.o. male is driving down the highway when he is cut off by a semi and swerves into the median. His car becomes airborne and rolls five times. He comes to the ED complaining of neck pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1469118879434-NEHGF4GW31IB4M5NXZ6H/image-asset.png The Naunheim Files - A 19 y.o. male is driving down the highway when he is cut off by a semi and swerves into the median. His car becomes airborne and rolls five times. He comes to the ED complaining of neck pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1469118919818-H3QYLKDDRWU2FFT2W0HS/image-asset.png The Naunheim Files - A 19 y.o. male is driving down the highway when he is cut off by a semi and swerves into the median. His car becomes airborne and rolls five times. He comes to the ED complaining of neck pain. https://everydayebm.org/naunheim-files/2016/7/11/a-teenager-was-involved-in-a-significant-accident-on-the-4th-of-july monthly 0.5 2016-07-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1468248905227-JUTNIGQM5MH3FCHFZ7QY/image-asset.png The Naunheim Files - A teenager was involved in a significant accident on the 4th of July. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1468249002648-DEZCUAQQWQ2D0HLWG59X/anvil2.PNG The Naunheim Files - A teenager was involved in a significant accident on the 4th of July. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1468591022419-KJQ69GEAW4LW974WTUWD/image-asset.png The Naunheim Files - A teenager was involved in a significant accident on the 4th of July. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1468591077657-JBXLZ0EH99DL2NMMM0DP/image-asset.png The Naunheim Files - A teenager was involved in a significant accident on the 4th of July. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1468591113821-8QLDWVB78RL84RU98A9O/image-asset.png The Naunheim Files - A teenager was involved in a significant accident on the 4th of July. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1468591513917-C0W8BUVE1HXBAUJH7N9D/image-asset.png The Naunheim Files - A teenager was involved in a significant accident on the 4th of July. https://everydayebm.org/naunheim-files/2016/7/5/a-63-yo-woman-presents-with-a-mass-that-moves-around-in-her-r-breast monthly 0.5 2016-07-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1467722280166-XR8ANA34FI5ZI044FYME/breast+implant.PNG The Naunheim Files - A 63 y.o. woman presents with a mass that moves around in her R breast. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1467722444684-C1G8FS7NLF7S7H5W3ZZM/image-asset.png The Naunheim Files - A 63 y.o. woman presents with a mass that moves around in her R breast. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1467990665915-6EQ06E65VXPIY0UOUMFR/image-asset.png The Naunheim Files - A 63 y.o. woman presents with a mass that moves around in her R breast. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1467990860882-7VX0MYS1UAIJMPBYDBH9/image-asset.png The Naunheim Files - A 63 y.o. woman presents with a mass that moves around in her R breast. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1467991592655-XY5HI6UWWY7Y8GEL05N2/image-asset.png The Naunheim Files - A 63 y.o. woman presents with a mass that moves around in her R breast. https://everydayebm.org/naunheim-files/2016/6/28/a-52-yo-baseball-fan-returned-from-the-dominican-republic-with-flu-like-symptoms-and-abdominal-pain monthly 0.5 2016-07-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1467127190378-2LLDRXQ3V8K63QNSDIEV/image-asset.png The Naunheim Files - A 52 y.o. baseball fan returned from the Dominican Republic with flu-like symptoms and abdominal pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1467385181003-ZXEJT6VOORFZ8736YR4V/image-asset.png The Naunheim Files - A 52 y.o. baseball fan returned from the Dominican Republic with flu-like symptoms and abdominal pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1467385265963-6UJII91YT9V25FS6YF3O/image-asset.png The Naunheim Files - A 52 y.o. baseball fan returned from the Dominican Republic with flu-like symptoms and abdominal pain. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1467385301939-6G1TKSJXM8M51JC3IREK/image-asset.png The Naunheim Files - A 52 y.o. baseball fan returned from the Dominican Republic with flu-like symptoms and abdominal pain. bowel wall abscess from E. histolyticqa https://everydayebm.org/naunheim-files/2016/6/19/an-very-elderly-lady-with-a-knot-on-her-head monthly 0.5 2016-06-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1466387049129-DPZQA54JLO12YS9PD7SK/image-asset.jpeg The Naunheim Files - A VERY elderly lady with a "knot on her head"... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1466730474617-LIC86U4AYGE0B36V5DL3/cutan1.PNG The Naunheim Files - A VERY elderly lady with a "knot on her head"... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1466730474530-8LVGTPDNX5LDWWQ29CXD/cutan2.PNG The Naunheim Files - A VERY elderly lady with a "knot on her head"... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1466730474783-1E9CL5R02GH01N0FABVE/cutan3.PNG The Naunheim Files - A VERY elderly lady with a "knot on her head"... https://everydayebm.org/naunheim-files/2016/6/12/a-60-something-year-old-male-with-aphasia-and-confusion monthly 0.5 2016-06-17 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1465783923340-NC48FJU3YAU4R0Q96B2T/image-asset.jpeg The Naunheim Files - A 60-something year old male with aphasia and confusion... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1466182659167-S6K8MEPK2SSKGJC801PK/image-asset.png The Naunheim Files - A 60-something year old male with aphasia and confusion... Image source: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2012000500010 https://everydayebm.org/naunheim-files/2016/5/30/a-69-yo-woman-comes-to-the-ed-with-syncope-and-an-abnormal-cxr monthly 0.5 2016-06-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1464740204222-FFOZ4V54IZ8796T1AKHK/image-asset.jpeg The Naunheim Files - A 69 y.o. woman with syncope... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1465400865534-2FSRHNMDNE3V5AY2QU95/image-asset.jpeg The Naunheim Files - A 69 y.o. woman with syncope... https://everydayebm.org/naunheim-files/2016/5/23/p25irwsiyplisufrluwsa69o70hb2y monthly 0.5 2016-05-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1464052397047-K77EK7DCIDQTTM3JDY1T/image-asset.jpeg The Naunheim Files - A middle aged female with left cheek swelling... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1464209018845-YL4HY8MWHLS0KP21521M/image-asset.jpeg The Naunheim Files - A middle aged female with left cheek swelling... Image source: Reference 1 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1464209105061-A7SM70XY0EVTIOPFAE38/image-asset.jpeg The Naunheim Files - A middle aged female with left cheek swelling... https://everydayebm.org/naunheim-files/2016/5/16/what-is-wrong-on-the-ct-scan monthly 0.5 2016-05-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1463454439591-33CIZ05HVY6M2732LZVG/image-asset.png The Naunheim Files - What is wrong on the CT scan? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1463758294237-IZFIHU5SPNC9UKEE2PWG/image-asset.jpeg The Naunheim Files - What is wrong on the CT scan? ISandhu, R., Min, Z., & Bhanot, N. (2014). A gigantic anogenital lesion: Buschke-Lowenstein tumor. Case reports in dermatological medicine, 2014.mage source: https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1463758345610-SRKM0MFAAEVUSCSNRNM4/image-asset.jpeg The Naunheim Files - What is wrong on the CT scan? Buschke-Lowenstein tumor of the penis https://everydayebm.org/naunheim-files/2016/5/9/does-he-have-tuberculosis monthly 0.5 2016-05-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1462833114978-6Y7KFDIJZHSW58TEFN7M/image-asset.jpeg The Naunheim Files - Does he have tuberculosis? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1463145823837-82C77OHXRMJL2V4I0AGW/image-asset.png The Naunheim Files - Does he have tuberculosis? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1463145855780-VST0SHTB2DUDZ5RLIF55/image-asset.jpeg The Naunheim Files - Does he have tuberculosis? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1463145904268-8FY73VULXQIA7SM7EBFA/image-asset.jpeg The Naunheim Files - Does he have tuberculosis? The Leprosarium at Carville, Louisiana https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1463146016867-D9TXRY5IL3SAGJOT78HU/image-asset.png The Naunheim Files - Does he have tuberculosis? Tuberculoid granuloma https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1463146045150-ZCNVKC3XMCMXOMSHREVR/image-asset.png The Naunheim Files - Does he have tuberculosis? Uveitis https://everydayebm.org/naunheim-files/2016/4/29/an-abnormal-cxr monthly 0.5 2016-05-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1461941999433-20B7QAPVONSY96RTO0S4/hemothorax+diaphragmatic.png The Naunheim Files - An abnormal CXR https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1462566751175-3NBQIKJGA4E3CAC5IITQ/image-asset.png The Naunheim Files - An abnormal CXR https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1462566808389-BM3LYSEUQNGI6YQ1XCOX/image-asset.png The Naunheim Files - An abnormal CXR https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1462566927484-OTGG0MKKVJQ7S1IZUC4L/image-asset.png The Naunheim Files - An abnormal CXR https://everydayebm.org/naunheim-files/2016/4/24/an-elderly-female-with-double-vision monthly 0.5 2016-04-29 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1461553725697-QXTUWZ9VRAT66P2A1DG5/image-asset.jpeg The Naunheim Files - An elderly female with double vision.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1461939754120-QPB528HT8R7OIT6YW8CT/image-asset.jpeg The Naunheim Files - An elderly female with double vision.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1461939935032-R7JNCCU0106I56ANHNYL/image-asset.jpeg The Naunheim Files - An elderly female with double vision.... Source: Reference [2] https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1461939975157-OX04Q0VYXV31M9SGZ61F/image-asset.jpeg The Naunheim Files - An elderly female with double vision.... Figure 1: Tract of the 6th cranial nerve. Source: Reference [3] https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1461940052797-UQG2NYWO2P5POZ7ZMMLX/image-asset.jpeg The Naunheim Files - An elderly female with double vision.... Figure 2: Anatomy of the cavernous sinus. Image source: http://healthfavo.com/cavernous-sinus-anatomy.html/cavernous-sinus-anatomy-2 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1461940157971-D8SAPEV59207U4MVYN1C/image-asset.jpeg The Naunheim Files - An elderly female with double vision.... Figure 3: Classification of Carotid-Cavernous Fistulas. Image source: Reference [5]. https://everydayebm.org/naunheim-files/2016/3/27/a-middle-aged-male-with-abdominal-discomfort-and-distension monthly 0.5 2016-04-01 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1459119656612-UFSJLGW7NGOPZ835EBWB/image-asset.jpeg The Naunheim Files - A middle aged male with abdominal distension... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1459119700658-MV84EEK7Z3LE0ZZOKLMN/image-asset.jpeg The Naunheim Files - A middle aged male with abdominal distension... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1459119719985-1YIASL15BPNG9IMI0O60/image-asset.jpeg The Naunheim Files - A middle aged male with abdominal distension... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1459119744603-V9V3BZAAEGLMACF7YMUD/image-asset.jpeg The Naunheim Files - A middle aged male with abdominal distension... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1459119763994-RN2AH1HBHVZURNRTZ060/image-asset.jpeg The Naunheim Files - A middle aged male with abdominal distension... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1459477097621-P2BSNZD5JY3J4KUGU6DE/image-asset.jpeg The Naunheim Files - A middle aged male with abdominal distension... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1459477312240-RGXTHQOUN5SPLWQHTXER/image-asset.jpeg The Naunheim Files - A middle aged male with abdominal distension... Source: Reference [1] https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1459477433574-HQYZ0SLI3QYB5S3JHC52/image-asset.jpeg The Naunheim Files - A middle aged male with abdominal distension... Image source: http://images.slideplayer.com/13/3883134/slides/slide_6.jpg https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1459477609311-ZE2B63BE3IHLVP2YW0DL/image-asset.jpeg The Naunheim Files - A middle aged male with abdominal distension... Image source: Reference [3] https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1459477592638-BX2P1BGIVCINKWMX8GP0/image-asset.jpeg The Naunheim Files - A middle aged male with abdominal distension... Table source: Reference [3] https://everydayebm.org/naunheim-files/2016/3/20/floaters monthly 0.5 2016-03-23 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1458525921968-OJW6DKS7A4P5121A7M4R/image-asset.jpeg The Naunheim Files - A middle aged female with floaters in her left eye... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1458526474389-72IB55E0RZNG9WQ5QR5W/image-asset.jpeg The Naunheim Files - A middle aged female with floaters in her left eye... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1458775696550-0T5STR0OU3KVDI3TSQS2/image-asset.png The Naunheim Files - A middle aged female with floaters in her left eye... Image source: http://www.mrcophth.com/pathology/choroidalmelanoma/melanoma.html https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1458775757658-8B8SUG2BQSAW37KFVE1F/image-asset.jpeg The Naunheim Files - A middle aged female with floaters in her left eye... Image source: http://www.oculist.net/downaton502/prof/ebook/duanes/pages/v6/v6c070.html https://everydayebm.org/naunheim-files/2016/3/13/3983yqlyqxndj2fcstbjguysaepbfi monthly 0.5 2016-03-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1457878560075-XEF6L8HZHH6IJC6KAAQE/image-asset.jpeg The Naunheim Files - A middle - aged male with knee pain... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1457878578552-93YDI5NO07KOLGOCN96L/image-asset.jpeg The Naunheim Files - A middle - aged male with knee pain... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1458157145766-ZVWJGQ884USE6QCLSE7Y/image-asset.jpeg The Naunheim Files - A middle - aged male with knee pain... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1458156780424-529BHIQI02VKTEXPSHTS/knee_bursa.jpg The Naunheim Files - A middle - aged male with knee pain... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1458156828579-YD24DVWL91HBX5QX4HDQ/image-asset.jpeg The Naunheim Files - A middle - aged male with knee pain... Image source: Reference [2] https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1458156873975-3U4QZO2CUIY6W3XGCCUY/image-asset.jpeg The Naunheim Files - A middle - aged male with knee pain... Image source: Reference [2] https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1458156900375-AH5DWMVG8SFYBR9RIAAF/image-asset.jpeg The Naunheim Files - A middle - aged male with knee pain... Image source: Reference [2] https://everydayebm.org/naunheim-files/2016/3/6/a-twist-and-a-pop monthly 0.5 2016-03-13 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1457276684181-M4JOGS6P3RXEOAASKOO0/image-asset.jpeg The Naunheim Files - A Twist and a Pop.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1457276721315-I18C8A5CTBBHJ3KX02PI/image-asset.jpeg The Naunheim Files - A Twist and a Pop.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1457276906775-2E6I3AT3PQL2P5E0O8XC/image-asset.jpeg The Naunheim Files - A Twist and a Pop.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1457276759471-4BX3XJXKB4LCL3UT6AB1/image-asset.jpeg The Naunheim Files - A Twist and a Pop.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1457841433201-V3FO9JJL68TFRT7F7A6Q/image-asset.jpeg The Naunheim Files - A Twist and a Pop.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1457841469821-1EPQP3HBUWQWPJU9GKIY/image-asset.jpeg The Naunheim Files - A Twist and a Pop.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1457841728663-3GUTRD2SS80KFY8VW8GZ/image-asset.png The Naunheim Files - A Twist and a Pop.... Dahlov Ipcar's children's book "The Cat at Night" focuses on what you can't see rather than what you can. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1457842173787-ZV6OIRJL01LD4K3WSGLJ/image-asset.jpeg The Naunheim Files - A Twist and a Pop.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1457842229884-LFKWFRTDM1VSQH3WPPGB/image-asset.jpeg The Naunheim Files - A Twist and a Pop.... https://everydayebm.org/naunheim-files/2016/2/27/hmmmm-whats-that-on-the-cxr monthly 0.5 2016-03-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1456625678586-LN9LCUOTWYZOQ5IUV1G9/image-asset.jpeg The Naunheim Files - Hmmmm.... what's that on the CXR? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1456625701020-XV6SYEEA7EEQE2MYXV02/image-asset.jpeg The Naunheim Files - Hmmmm.... what's that on the CXR? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1456944872880-Z3AZ8RPK0V5U0A0GETH0/image-asset.jpeg The Naunheim Files - Hmmmm.... what's that on the CXR? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1456943971555-WU86HMEMHBTUHCOMO625/image-asset.png The Naunheim Files - Hmmmm.... what's that on the CXR? Image from Reference [3] https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1456944028514-ZNE5UGDP8U6OM9X2603X/image-asset.jpeg The Naunheim Files - Hmmmm.... what's that on the CXR? Source: Reference [4] https://everydayebm.org/naunheim-files/2016/2/21/back-from-a-vacation-with-beautiful-memories-and-an-itchy-rash monthly 0.5 2016-02-28 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1456071915595-Z0J649EKYANJHN7UK0DG/image-asset.jpeg The Naunheim Files - Back from a vacation with beautiful memories and an itchy rash... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1456354157405-OR64T05NA5HERJFDS06I/image-asset.jpeg The Naunheim Files - Back from a vacation with beautiful memories and an itchy rash... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1456354268115-VDXRI5NZTA2T4PCP8WSX/image-asset.jpeg The Naunheim Files - Back from a vacation with beautiful memories and an itchy rash... Image source: Reference [2] https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1456354379767-6RPSCW11ZZXDOTJ6N8LR/image-asset.jpeg The Naunheim Files - Back from a vacation with beautiful memories and an itchy rash... Image source: Reference [1] https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1456354642715-8B1M7RXG4TF6AN7LJSW5/image-asset.jpeg The Naunheim Files - Back from a vacation with beautiful memories and an itchy rash... Source of phylogeny image: Reference [2] https://everydayebm.org/naunheim-files/2016/2/14/an-elderly-patient-on-peritoneal-dialysis-with-abdominal-pain monthly 0.5 2016-02-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1455461620664-2YUMRNLH148OTSBD3M3T/image-asset.jpeg The Naunheim Files - An elderly patient on peritoneal dialysis with abdominal pain... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1455461698905-A1QCNAWKNKZ8AM6ZCXBO/image-asset.jpeg The Naunheim Files - An elderly patient on peritoneal dialysis with abdominal pain... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1455765326029-MS4BFABSUS4YD4OYNV7P/image-asset.png The Naunheim Files - An elderly patient on peritoneal dialysis with abdominal pain... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1455765642903-7HF0HGCOBSVTU2C5Z3MD/image-asset.jpeg The Naunheim Files - An elderly patient on peritoneal dialysis with abdominal pain... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1455765797337-UV7GZ52RQPGD1Q8KJ3AS/image-asset.jpeg The Naunheim Files - An elderly patient on peritoneal dialysis with abdominal pain... Source: Reference 2 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1455765876703-AGW2S9Y00WCIU1FLGIGS/image-asset.jpeg The Naunheim Files - An elderly patient on peritoneal dialysis with abdominal pain... https://everydayebm.org/naunheim-files/2016/2/7/a-easy-dispo-in-triage monthly 0.5 2016-02-11 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1454871881750-553MJELG7HJSDHBTSQ1D/image-asset.jpeg The Naunheim Files - A easy dispo in triage.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1455155931426-4IJ0Y5YMM6Y0P1QCSPOS/image-asset.jpeg The Naunheim Files - A easy dispo in triage.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1455156008128-9TD879MW2VFX80XM4O4Z/image-asset.jpeg The Naunheim Files - A easy dispo in triage.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1455156077740-CF3H35DWWHZ1A4IX7WCC/image-asset.jpeg The Naunheim Files - A easy dispo in triage.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1455156129327-NRRW2FQG4NKOMCPK2PMB/image-asset.jpeg The Naunheim Files - A easy dispo in triage.... Sequential mechanism of Maissoneuve Fracture & Radiologic Correlates https://everydayebm.org/naunheim-files/2016/1/31/a-young-man-with-an-itchy-rash monthly 0.5 2016-02-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1454272049445-LCNBDR9D6QNW88XRL6D8/rash.jpg The Naunheim Files - A young man with an itchy rash.... https://everydayebm.org/naunheim-files/2016/1/24/a-man-from-mexico-brought-in-by-ems-following-an-mvc monthly 0.5 2016-01-27 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1453676855790-LS4E1EEW98T2LJ96N3ZD/image-asset.jpeg The Naunheim Files - A man from Mexico brought in by EMS following an MVC.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1453926093181-70K6Z1OUBTH646H2UD2B/image-asset.jpeg The Naunheim Files - A man from Mexico brought in by EMS following an MVC.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1453926120976-V7LZFUX4DX5G5NL442DG/image-asset.jpeg The Naunheim Files - A man from Mexico brought in by EMS following an MVC.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1453926178449-YXSH1FLW9PUHFJ8XLA6D/image-asset.jpeg The Naunheim Files - A man from Mexico brought in by EMS following an MVC.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1453926217189-UN298FRK0S13Q6R5LGOT/image-asset.jpeg The Naunheim Files - A man from Mexico brought in by EMS following an MVC.... https://everydayebm.org/naunheim-files/2016/1/16/a-4-yo-boy-with-fever-abdominal-pain-and-vomiting monthly 0.5 2016-01-20 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1452999692872-U9MK2AFWJN7YWMXMG7QX/image-asset.jpeg The Naunheim Files - A 4 yo boy with fever, abdominal pain and vomiting.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1452999719526-RMHD9926YGGO4KRF7XHA/image-asset.jpeg The Naunheim Files - A 4 yo boy with fever, abdominal pain and vomiting.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1453329728240-RJ2ALW0JY5Y2BNB61WAO/image-asset.jpeg The Naunheim Files - A 4 yo boy with fever, abdominal pain and vomiting.... https://everydayebm.org/naunheim-files/2016/1/10/a-young-woman-with-sore-throat-and-a-new-rash- monthly 0.5 2016-01-14 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1452449414590-ONQNGTL9OW64TI0SLOKY/image-asset.jpeg The Naunheim Files - A young woman with sore throat and a new rash ... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1452705996875-GN7OX3JI637HM92W5CNX/image-asset.jpeg The Naunheim Files - A young woman with sore throat and a new rash ... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1452705302561-SUMNEKAVQUUJ9HZNUZ1L/image-asset.jpeg The Naunheim Files - A young woman with sore throat and a new rash ... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1452705833268-4B94CO7UMD8BN2GICKVB/image-asset.jpeg The Naunheim Files - A young woman with sore throat and a new rash ... https://everydayebm.org/naunheim-files/2016/1/3/a-young-man-with-chest-pain-on-swallowing monthly 0.5 2016-01-06 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1451849234985-823SEK18S7LHA6BQ30RF/image-asset.jpeg The Naunheim Files - A young man with chest pain on swallowing... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1451848960688-PTGHKR0T2EAYERYK4XS0/image-asset.jpeg The Naunheim Files - A young man with chest pain on swallowing... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1452102227935-TRH9HSAVHV66QVOAAGG9/image-asset.jpeg The Naunheim Files - A young man with chest pain on swallowing... https://everydayebm.org/naunheim-files/2015/12/27/a-middle-aged-male-with-eye-discomfort monthly 0.5 2015-12-30 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1451253026744-TK9DGF9NW3ENX8GD8CJI/image-asset.jpeg The Naunheim Files - A sheet metal worker with blurry vision ... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1451476175312-NKYQF9JZWQP253DUOK72/image-asset.jpeg The Naunheim Files - A sheet metal worker with blurry vision ... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1451476486014-U73CWESDD5HSHODGXMVP/image-asset.jpeg The Naunheim Files - A sheet metal worker with blurry vision ... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1451476680772-KS441VOBM8VKD5JU2DNX/image-asset.jpeg The Naunheim Files - A sheet metal worker with blurry vision ... https://everydayebm.org/naunheim-files/2015/12/20/an-elderly-male-with-syncope- monthly 0.5 2015-12-24 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1450658735509-K1D85K8LQZGG9C7YQEB5/image-asset.jpeg The Naunheim Files - An elderly male presents following a syncopal event ... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1450880048706-3UUQBQMT315MAMEHCFSR/image-asset.jpeg The Naunheim Files - An elderly male presents following a syncopal event ... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1450880191042-RZAQ8BU8J4IXFNGX6HMJ/image-asset.jpeg The Naunheim Files - An elderly male presents following a syncopal event ... Source: Hooper, C., Lee, Y. G., & Maskell, N. (2010). Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax, 65(Suppl 2), ii4-ii17. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1450880263398-YPM27PSZM9SH1OYY9KYP/image-asset.jpeg The Naunheim Files - An elderly male presents following a syncopal event ... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1450880320290-XDHUSY7KAORATESX6XYT/image-asset.jpeg The Naunheim Files - An elderly male presents following a syncopal event ... https://everydayebm.org/naunheim-files/2015/12/12/a-young-male-with-neck-pain-and-discomfort-when-swallowing monthly 0.5 2015-12-16 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1449941742927-855A7WOXUPKEOVSV2KHD/image-asset.png The Naunheim Files - A young male with neck pain and discomfort when swallowing... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1450109687491-WFQOQHD6KY4UWMN6OX8H/image-asset.jpeg The Naunheim Files - A young male with neck pain and discomfort when swallowing... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1450289322960-7RT2Z6UEKNAIMSMJLQ8L/image-asset.png The Naunheim Files - A young male with neck pain and discomfort when swallowing... Image source: wikipedia https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1450289531574-RXZI2ZI07JRPYJ41RTLO/image-asset.jpeg The Naunheim Files - A young male with neck pain and discomfort when swallowing... https://everydayebm.org/naunheim-files/2015/12/6/a-middle-aged-male-with-chest-pain-and-nipple-discharge monthly 0.5 2015-12-09 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1449452198066-ZABMQ6YAETSSNLBJ692G/image-asset.jpeg The Naunheim Files - A middle aged male with chest pain ... and nipple discharge. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1449674694134-YU9MYMBRFQLACN5CG1BX/image-asset.jpeg The Naunheim Files - A middle aged male with chest pain ... and nipple discharge. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1449674711414-327D1A8QQJI2IUUCORQ4/image-asset.jpeg The Naunheim Files - A middle aged male with chest pain ... and nipple discharge. https://everydayebm.org/naunheim-files/2015/11/27/a-middle-aged-woman-with-shortness-of-breath-after-shoulder-surgery monthly 0.5 2015-12-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1448683742823-KS8U5C6E8QD9JBFOIHWL/image-asset.jpeg The Naunheim Files - A middle aged woman with shortness of breath after shoulder surgery... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1448683893309-OIMJNC0LS5AAK9HRY4GH/image-asset.jpeg The Naunheim Files - A middle aged woman with shortness of breath after shoulder surgery... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1449088862604-7IYCPOCTQY97GZYC2NWO/image-asset.jpeg The Naunheim Files - A middle aged woman with shortness of breath after shoulder surgery... https://everydayebm.org/naunheim-files/2015/11/21/a-young-woman-with-fever-generalized-weakness-and-a-new-rash monthly 0.5 2015-11-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1448134434074-3R6I36JVD6XQ5LCLEBKU/image-asset.jpeg The Naunheim Files - A young woman with fever, generalized weakness and a new rash.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1448134557048-24L0UZHGGO3KES2P6FD9/image-asset.jpeg The Naunheim Files - A young woman with fever, generalized weakness and a new rash.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1448455010619-XGYR22JYQYH6P346PUVB/image-asset.jpeg The Naunheim Files - A young woman with fever, generalized weakness and a new rash.... Protein C deficiency is the final common pathway of the multiple etiologies of Purpura Fulminans, including congenital, infectious, autoimmune, and drug-induced causes . https://everydayebm.org/naunheim-files/2015/11/14/an-elderly-man-in-dark-stools-and-intraoral-lesions monthly 0.5 2015-11-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1447536872115-FRNYZZKX6YAUO76DIAPR/image-asset.jpeg The Naunheim Files - An elderly man with intraoral lesions and generalized weakness.... https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1447812520424-MCZSDYA8Y3N51NRDFQ15/image-asset.jpeg The Naunheim Files - An elderly man with intraoral lesions and generalized weakness.... https://everydayebm.org/naunheim-files/tag/Hematology monthly 0.5 https://everydayebm.org/naunheim-files/tag/Naunheim+Files monthly 0.5 https://everydayebm.org/sound-waves daily 0.75 2017-12-07 https://everydayebm.org/sound-waves/2017/12/6/detecting-elevated-icp-with-optic-sheath-nerve-diameter monthly 0.5 2017-12-12 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1512854480730-LVL8FSGK727FJJZNPHIV/ONSD+NL+36mm.png Sound Waves - Detecting Elevated ICP with Optic Sheath Nerve Diameter Normal OSND of 3.6 mm. Image courtesy of Dr. Deborah Shipley Kane https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1512854557677-JJBD6AAVTVHZNSQXYFFG/ONSD+abnormal+55mm+papilledema.png Sound Waves - Detecting Elevated ICP with Optic Sheath Nerve Diameter Large OSND of 5.6 mm, suggesting elevated ICP. Image courtesy of Dr. Deborah Shipley Kane https://everydayebm.org/sound-waves/2017/6/1/ultrasound-case-series-2-pain-down-there monthly 0.5 2017-06-14 https://everydayebm.org/sound-waves/2017/1/26/ultrasound-case-series-1-not-pregnant-but monthly 0.5 2017-02-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1485490858973-XLWHAK078X7TNDU1EJMK/image-asset.png Sound Waves - Ultrasound Case Series #1: Not Pregnant, but... https://everydayebm.org/resus-pieces daily 0.75 2021-05-07 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1515441847345-HATF5SGVJ3M0YO87M53D/Resus+Pieces+3.JPG Resus Pieces https://everydayebm.org/resus-pieces/2018/6/15/life-saver-edition-tranexamic-acid monthly 0.5 2018-06-18 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1529044819914-PPLSK0B3TB8G7XYJ2FO8/TXA.png Resus Pieces - Life Saver Edition: Tranexamic Acid TXA molecule, ball and stick representation https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1529048222421-68CB3T0T6IB6WPLFRHTL/fibrinolysis.png Resus Pieces - Life Saver Edition: Tranexamic Acid TXA stops the conversion of plasminogen to plasmin https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1529048454099-RM3EXCS4XPR43UZ7FN73/Combat+Medic.jpg Resus Pieces - Life Saver Edition: Tranexamic Acid https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1529049466034-9O0XY2HPEHSHL0H7YA9Q/Forceps_delivery._Wellcome_L0005447.jpg Resus Pieces - Life Saver Edition: Tranexamic Acid https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1529049969874-SDFZQH83ROHBEMF06FDC/ChrisCreel.png Resus Pieces - Life Saver Edition: Tranexamic Acid https://everydayebm.org/resus-pieces/2018/5/1/flolan-in-the-ed monthly 0.5 2018-05-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1525288575155-9G0NQFIFZ0V9FOXE6POZ/Screen+Shot+2018-05-02+at+1.49.34+PM.png Resus Pieces - Epoprostenol in the ED--Go with the Flolan? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1525191206749-SCV2YOLBRBFB8WZAC7M2/Screen+Shot+2018-05-01+at+11.07.24+AM.png Resus Pieces - Epoprostenol in the ED--Go with the Flolan? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1525191242554-TEPROKUZGJDWH88DF7ZD/Screen+Shot+2018-05-01+at+11.07.48+AM.png Resus Pieces - Epoprostenol in the ED--Go with the Flolan? https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1525194541882-6PYCIOUCW7K9RRCS2TUR/HeyGang.png Resus Pieces - Epoprostenol in the ED--Go with the Flolan? https://everydayebm.org/resus-pieces/2018/1/2/the-uri-from-hell monthly 0.5 2018-01-08 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1515432225354-XN5CMAZ3SQV3PV4MXWSG/Resus+Pieces+3.JPG Resus Pieces - The URI from Hell https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1515039013489-D4NJ97PT8KYAY6YU8I6R/ezgif.com-crop.gif Resus Pieces - The URI from Hell https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1514937381176-JNSWCSG2NBHTKLMWPWK3/MyocarditisEtiologies.jpg Resus Pieces - The URI from Hell https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1514939001856-7GYBQFC1PSYX070ZQNLB/AlSaysHi.jpg Resus Pieces - The URI from Hell -Dr Al Lulla https://everydayebm.org/post-it-pearls daily 0.75 2020-11-22 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1595298308096-7B5ZJAYVZIKL5DX901GZ/main%2Bpicture%2Bfor%2Bblog.jpg Post it Pearls https://everydayebm.org/post-it-pearls/2020/11/22/fall-ultrasound-pearls monthly 0.5 2020-11-25 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606149263221-EDBED0JPKOW4WCD1WTIY/Screen+Shot+2020-11-23+at+10.33.24+AM.png Post it Pearls - Fall Ultrasound Pearls https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606149749727-RHSB9WFGOHZK86R3M9MC/Screen+Shot+2020-11-23+at+10.42.14+AM.png Post it Pearls - Fall Ultrasound Pearls https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606151848875-OEO95WIE07ZDXTGGXA2F/Screen+Shot+2020-11-23+at+11.00.56+AM.png Post it Pearls - Fall Ultrasound Pearls Building evidence for fluid tolerance and intolerance. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606290461112-0J2S9QOHY5GQLQBLV0I3/Screen+Shot+2020-11-25+at+1.45.51+AM.png Post it Pearls - Fall Ultrasound Pearls extrapolating information from our ultrasound to apply it to the Frank Starling curve. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606290868012-P9HDASIHZ4NE1ZM6U3R3/mitral+inflow.jpg Post it Pearls - Fall Ultrasound Pearls https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606290868012-IGVFOF4MWHC8YH1J3RKY/E+wave%3AA+wave.jpg Post it Pearls - Fall Ultrasound Pearls https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606290868595-V96BCDDU34XU72UB6OXN/tissue+doppler.jpg Post it Pearls - Fall Ultrasound Pearls https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606290868643-4Q81ISD6J6MJYL57B8J0/prime+.jpg Post it Pearls - Fall Ultrasound Pearls https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606152449905-RD4M7D8YICGCU0IIDXLJ/Screen+Shot+2020-11-23+at+11.25.50+AM.png Post it Pearls - Fall Ultrasound Pearls https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1606291527922-HCXMBUARTD779KW0O9XH/Screen+Shot+2020-11-25+at+2.05.19+AM.png Post it Pearls - Fall Ultrasound Pearls https://everydayebm.org/post-it-pearls/2020/9/2/julyaugust-pearl-2-d10-vs-d50-for-hypoglycemia monthly 0.5 2020-09-02 https://everydayebm.org/post-it-pearls/2020/9/2/cwlq2kojmdop2b9mo1qgngud09ejnh monthly 0.5 2020-09-02 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1599078154905-APB5OYRUZBNZ6ZGO2O74/Screen+Shot+2020-09-02+at+3.21.12+PM.png Post it Pearls - July/August Pearl #3: Fleck Sign https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1599078732403-ZO9HA39JVVUCTTEA6VM9/Lisfranc+Mechanism.jpg Post it Pearls - July/August Pearl #3: Fleck Sign https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1599078732511-B2E97K8QJRL19YEX2JPN/Lisfranc+mechanism+2.png Post it Pearls - July/August Pearl #3: Fleck Sign https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1599079330310-P4E4TEF140IZ9YM3N9BE/Screen+Shot+2020-09-02+at+3.33.20+PM.png Post it Pearls - July/August Pearl #3: Fleck Sign Normal: note the alignment of the metatarsals and the cuneiform. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1599079424105-AUHU4OVHCCEWQAMWNMLV/Screen+Shot+2020-09-02+at+3.33.34+PM.png Post it Pearls - July/August Pearl #3: Fleck Sign Abnormal Left pane: circle shows widening >2mm between 1st and 2nd metatarsal concerning for unstable Lisfranc ligament injury (circle). Middle pane: fracture of second metatarsal (arrow) and cuboid fracture (circle). Right pane: no fractures, but rather a complete dislocation of the entire midfoot (box). https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1599079619405-DTPMF0VLJP4HSYXSZHTV/Screen+Shot+2020-09-02+at+3.33.40+PM.png Post it Pearls - July/August Pearl #3: Fleck Sign Subtle injury: weight bearing views (with adequate analgesia) can be obtained for high suspicion injuries with negative initial injuries. The picture on the right (arrowhead) shows widening of the 1st and 2nd metatarsal spaces with weight bearing images. Compare to the left without weight bearing showing what was read as normal (arrow). Of note: CT and MRI might be indicated with negative injuries. - Tos et al. is a small retrospective analysis showing 12% of negative or equivocal weight bearing X-ray films had a positive CT scan. https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1599080170382-OPL3IILO02TFMV70VFBY/Screen+Shot+2020-09-02+at+3.56.01+PM.png Post it Pearls - July/August Pearl #3: Fleck Sign Recent Case: Mechanism: high speed MVC of restrained driver. Note the metatarsal fractures, widening of the 1st and 2nd metatarsal, and fleck sign (arrows). Disposition: orthopedics took this patient to the OR (post op on right). https://everydayebm.org/post-it-pearls/2020/8/3/june-pearl-3-vasopressin-for-upper-gi-bleed monthly 0.5 2020-08-03 https://images.squarespace-cdn.com/content/v1/5636d26fe4b06c8363f3872a/1596468561167-M2XELNBI1F3HWPHAQSP5/image-asset.jpeg Post it Pearls - June Pearl #3: Vasopressin for upper GI bleed. Source: adapted from Wagener et al. 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