Pub Date : 2022-01-01DOI: 10.25270/con.2022.01.00001
N. Lam, Patricia Campbell
A 21-year-old woman with no significant medical history presented to our clinic with “something hanging” from her uvula. She had noticed it a few months prior to presentation when she felt a tickling sensation at the back of her throat. At presentation, she said it now felt like it grew, because it was causing her to gag at times when swallowing. She denied any pain, difficulty swallowing, difficulty breathing, snoring, bleeding, or any changes in her voice. She is concerned because she believes her uvula is now connected to her tongue and is worried it may be cancerous. On physical examination, her vital signs were stable with 100% oxygen saturation on room air. Results of a head, eyes, ears, nose, and throat examination were normal except for the uvula abnormality. An oropharynx examination revealed a thin strand of tissue connecting the tip of her uvula to the base of her tongue (Figure). No cervical lymphadenopathy was noted, and the rest of her examination was unremarkable. Based on the patient’s history and physical examination, which one of the following is the most likely diagnosis?
{"title":"A Concerning Uvula Abnormality","authors":"N. Lam, Patricia Campbell","doi":"10.25270/con.2022.01.00001","DOIUrl":"https://doi.org/10.25270/con.2022.01.00001","url":null,"abstract":"A 21-year-old woman with no significant medical history presented to our clinic with “something hanging” from her uvula. She had noticed it a few months prior to presentation when she felt a tickling sensation at the back of her throat. At presentation, she said it now felt like it grew, because it was causing her to gag at times when swallowing. She denied any pain, difficulty swallowing, difficulty breathing, snoring, bleeding, or any changes in her voice. She is concerned because she believes her uvula is now connected to her tongue and is worried it may be cancerous. On physical examination, her vital signs were stable with 100% oxygen saturation on room air. Results of a head, eyes, ears, nose, and throat examination were normal except for the uvula abnormality. An oropharynx examination revealed a thin strand of tissue connecting the tip of her uvula to the base of her tongue (Figure). No cervical lymphadenopathy was noted, and the rest of her examination was unremarkable. Based on the patient’s history and physical examination, which one of the following is the most likely diagnosis?","PeriodicalId":35575,"journal":{"name":"Consultant","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69417100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.25270/con.2022.08.000008
S. Hersh, Joshua Hersh, P. Gerard, Sana Ali
{"title":"Sudden Hearing Loss Linked to Metastatic Adenocarcinoma of the Temporal Bone","authors":"S. Hersh, Joshua Hersh, P. Gerard, Sana Ali","doi":"10.25270/con.2022.08.000008","DOIUrl":"https://doi.org/10.25270/con.2022.08.000008","url":null,"abstract":"","PeriodicalId":35575,"journal":{"name":"Consultant","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69418759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.25270/con.2022.02.00008
Sierra Crowe, E. C. Schmidgal
A 20-year-old woman with a Fitzpatrick score of 2 presented via telehealth with “divots” on her forehead and scalp. She reported that 2 months prior to presentation she had received multiple steroid injections into her forehead and posterior skull by a neurologist for treatment of migraines. She had soon thereafter developed fat atrophy in 3 areas: 2 on her forehead and 1 on her occipital scalp. Although they were not painful or otherwise symptomatic, she was unhappy with the cosmetic appearance. She had no other skin or systemic symptoms. She visited the office the following day, and on examination, 2 atrophic plaques were noted on her bilateral forehead around the mid-pupillary lines, with a larger atrophic plaque on the occipital scalp (Figures 1 and 2). Given the location and timing of the lesions, they were consistent with skin atrophy induced by her prior steroid injections. Therefore, a biopsy was not performed.
{"title":"Intradermal Injection of Normal Saline for Treatment of Fat Atrophy Following Corticosteroid Injection","authors":"Sierra Crowe, E. C. Schmidgal","doi":"10.25270/con.2022.02.00008","DOIUrl":"https://doi.org/10.25270/con.2022.02.00008","url":null,"abstract":"A 20-year-old woman with a Fitzpatrick score of 2 presented via telehealth with “divots” on her forehead and scalp. She reported that 2 months prior to presentation she had received multiple steroid injections into her forehead and posterior skull by a neurologist for treatment of migraines. She had soon thereafter developed fat atrophy in 3 areas: 2 on her forehead and 1 on her occipital scalp. Although they were not painful or otherwise symptomatic, she was unhappy with the cosmetic appearance. She had no other skin or systemic symptoms. She visited the office the following day, and on examination, 2 atrophic plaques were noted on her bilateral forehead around the mid-pupillary lines, with a larger atrophic plaque on the occipital scalp (Figures 1 and 2). Given the location and timing of the lesions, they were consistent with skin atrophy induced by her prior steroid injections. Therefore, a biopsy was not performed.","PeriodicalId":35575,"journal":{"name":"Consultant","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69417523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.25270/con.2022.07.000016
G. Thota, Mehak Bassi, Niraj Nagaraj Ballam
Acute kidney injury (AKI) is defined as a rapid reduction in kidney function (within 48 hours) as measured by an increase in serum creatinine level, decrease in urine output, or need for renal replacement therapy, or all of the above. Herein, we present a rare case of AKI induced by oral valacyclovir. Nephrotoxicity due to valacyclovir is caused by intratubular precipitation of acyclovir crystals. A 39-year-old woman presents with acute onset of nonspecific reports of low back pain, nausea, and vomiting. After determining there was an AKI, the patient was treated with intravenous fluids and was monitored for improvement. The cause was deduced to be oral valacyclovir, which was being used to treat herpes labialis, and ultimately caused crystal-induced nephrotoxicity. Due to the rapid speed of renal excretion, acyclovir can surpass the solubility, and hence crystals can accumulate in the distal and collecting ducts. This can cause the symp-tomatology such as in this patient. In this case presentation and discussion, we re-view the presenting symptoms, diagnostic testing, differentials, and pathophysiology regarding crystal-induced AKI, specifically from valacyclovir.
{"title":"A Case of Oral Valacyclovir–Induced Acute Kidney Injury","authors":"G. Thota, Mehak Bassi, Niraj Nagaraj Ballam","doi":"10.25270/con.2022.07.000016","DOIUrl":"https://doi.org/10.25270/con.2022.07.000016","url":null,"abstract":"Acute kidney injury (AKI) is defined as a rapid reduction in kidney function (within 48 hours) as measured by an increase in serum creatinine level, decrease in urine output, or need for renal replacement therapy, or all of the above. Herein, we present a rare case of AKI induced by oral valacyclovir. Nephrotoxicity due to valacyclovir is caused by intratubular precipitation of acyclovir crystals. A 39-year-old woman presents with acute onset of nonspecific reports of low back pain, nausea, and vomiting. After determining there was an AKI, the patient was treated with intravenous fluids and was monitored for improvement. The cause was deduced to be oral valacyclovir, which was being used to treat herpes labialis, and ultimately caused crystal-induced nephrotoxicity. Due to the rapid speed of renal excretion, acyclovir can surpass the solubility, and hence crystals can accumulate in the distal and collecting ducts. This can cause the symp-tomatology such as in this patient. In this case presentation and discussion, we re-view the presenting symptoms, diagnostic testing, differentials, and pathophysiology regarding crystal-induced AKI, specifically from valacyclovir.","PeriodicalId":35575,"journal":{"name":"Consultant","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69418273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.25270/con.2022.08.000001
Ryan C. Higgins, Madhavi Singh
{"title":"Acute Adrenal Crisis From Mental Stress in a Patient With Hypopituitarism","authors":"Ryan C. Higgins, Madhavi Singh","doi":"10.25270/con.2022.08.000001","DOIUrl":"https://doi.org/10.25270/con.2022.08.000001","url":null,"abstract":"","PeriodicalId":35575,"journal":{"name":"Consultant","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69418652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.25270/con.2022.08.000004
James J. Matera
{"title":"Systemic Lupus Erythematosus in a 24-Year-Old","authors":"James J. Matera","doi":"10.25270/con.2022.08.000004","DOIUrl":"https://doi.org/10.25270/con.2022.08.000004","url":null,"abstract":"","PeriodicalId":35575,"journal":{"name":"Consultant","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69418841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.25270/con.2022.10.000003
M. Grover, Sethu Sandeep Koneru
{"title":"Weakness in the Upper Extremity After a Fall","authors":"M. Grover, Sethu Sandeep Koneru","doi":"10.25270/con.2022.10.000003","DOIUrl":"https://doi.org/10.25270/con.2022.10.000003","url":null,"abstract":"","PeriodicalId":35575,"journal":{"name":"Consultant","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69420142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.25270/con.2022.10.000004
Jesse D. Bracamonte, Michael Underhill, Denise Schweda
{"title":"Oral Congenital Melanocytic Nevi: A Rare Finding","authors":"Jesse D. Bracamonte, Michael Underhill, Denise Schweda","doi":"10.25270/con.2022.10.000004","DOIUrl":"https://doi.org/10.25270/con.2022.10.000004","url":null,"abstract":"","PeriodicalId":35575,"journal":{"name":"Consultant","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69420282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.25270/con.2022.11.000002
Daniel A Reich, Carols A. Arango
{"title":"Allergic Asthma Therapy and Management","authors":"Daniel A Reich, Carols A. Arango","doi":"10.25270/con.2022.11.000002","DOIUrl":"https://doi.org/10.25270/con.2022.11.000002","url":null,"abstract":"","PeriodicalId":35575,"journal":{"name":"Consultant","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69420784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.25270/con.2022.11.000008
G. Thota, M. Shah, S. Chandna, Marnie E. Rosenthal
{"title":"Neurosyphilis in the Time of COVID-19: Avoiding Anchoring Heuristics","authors":"G. Thota, M. Shah, S. Chandna, Marnie E. Rosenthal","doi":"10.25270/con.2022.11.000008","DOIUrl":"https://doi.org/10.25270/con.2022.11.000008","url":null,"abstract":"","PeriodicalId":35575,"journal":{"name":"Consultant","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69422052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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