Discovery CPC: What a Headache!

In this Discovery Clinical Pathological Conference (CPC), Drs. Nico Herrera and Jefferson Triozzi, Residents, Department of Medicine,  discuss the case of a 47-year old male patient with hypertension, diabetes mellitus, and end-stage renal disease on emergent dialysis who presented with three months of severe headaches, blurry vision, and a recent onset of fever. The patient was negative for HIV and hepatitis. However, his catheter did not show signs of infection. The patient was anemic and had elevated BUN. CT scan of the head without contrast was unremarkable. Dr. Marc Robinson, Assistant Professor, Department of Medicine, Baylor College of Medicine, serves as the faculty discussant. Dr. Robinson outlines the additional laboratory and imaging data that he would request and the clinical problem solving strategies that he would use to arrive at a differential diagnosis in this case. He highlights those items in the patient’s history, symptoms, and test results that are important, and those that can be excluded. He also explains how literature can contribute when making a differential diagnosis.

Expert comments on emergent dialysis, particularly in undocumented immigrants, are given by Dr. Rajeev Raghavan, Associate Professor, Department of Medicine, Section of Nephrology at Baylor College of Medicine. 

CME Information

CME Credit Available

You may claim CME credit after watching this activity.

Needs Statement

Faculty and trainees within the Department of Medicine who are involved in the care of patients need to be regularly updated with the recent advances and guidelines in the fields of medicine and quality improvement to increase clinical knowledge. This Grand Rounds series also aims to provide learners with the appropriate skills to implement the advances and guidelines in clinical practice to enhance the quality of patient care and outcomes.

Objectives

At the conclusion of this activity, the participant should be able to:

  • List important aspects of the history and physical exam in the workup of a patient with fever and headache.
  • Identify a differential diagnosis for a patient with fever and headache.
  • Discuss diagnostic reasoning in the use of laboratory findings for patients with fever and headache.
  • Identify diagnostic challenges unique to patients on emergent dialysis.

Target Audience

  • Physicians
  • Medical Students
  • Fellows
  • Residents
  • Nurses
  • Other Health Professionals

Accreditation/Credit Designation

Baylor College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Baylor College of Medicine designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.    

Program Director

Richard J. Hamill, M.D.
Professor
Department of Medicine
Baylor College of Medicine
Houston, Texas
Disclosure: Nothing to disclose.

Term of Approval

August 1, 2019 through August 31, 2021. Original release date: August 1, 2019.

Disclosure Policy

The Office of Continuing Medical Education (OCME) makes every effort to develop CME activities that are scientifically based, accurate, current, and objectively presented. In accordance with the Accreditation Council for Continuing Medical Education Standards for Commercial SupportSM, Baylor College of Medicine (BCM) has implemented a mechanism requiring everyone in a position to control the content of an educational activity (e.g., directors, planning committee members, contributors, peer reviewers) to disclose any relevant financial relationships with commercial interests (drug/device companies) and manage/resolve any conflicts of interest prior to the activity. Individuals must disclose to participants the existence or non-existence of financial relationships: 1) at the time of the activity or within 12 months prior; and 2) of their spouses/partners.

Baylor College of Medicine does not view the existence of interests or relationships with commercial entities as implying bias or decreasing the value of a presentation. It is up to the participants to determine whether the interests or relationships influence the presenter with regard to exposition or conclusions.

If at any time during this activity you feel that there has been commercial or promotional bias, please inform us by using the commercial bias comments box in the evaluation form. Please answer the questions about balance in the CME activity evaluation candidly.

Disclosures

The following individual(s) has/have reported financial or other relationship(s) with commercial entities whose products/services may relate to the educational content of this activity:

Presenters

  1. Richard J. Hamill, M.D.

    Richard J. Hamill, M.D.

    Professor
    Baylor College of Medicine

    Disclosure:

    Nothing to disclose.

  2. Nico Herrera, M.D. Placeholder Image

    Nico Herrera, M.D.

    Medicine Resident, PGY-2
    Baylor College of Medicine

    Disclosure:

    Nothing to disclose.

  3. Rajeev Raghavan, MD FASN

    Rajeev Raghavan, MD FASN

    Associate Professor - Program Director Nephrology Training Program
    Baylor College of Medicine

    Disclosure:

    Nothing to disclose.

  4. Marc Robinson, M.D.

    Marc Robinson, M.D.

    Assistant Professor
    Baylor College of Medicine

    Disclosure:

    Nothing to disclose.

  5. Jefferson Triozzi, M.D. Placeholder Image

    Jefferson Triozzi, M.D.

    Medicine Resident, PGY-2
    Baylor College of Medicine

    Disclosure:

    Nothing to disclose.

CME Credit Available

You may claim CME credit after watching this activity.

View the CME Information Take the Post-Test Now

Presenters:

  1. Richard J. Hamill, M.D.

    Richard J. Hamill, M.D.

    Professor Baylor College of Medicine
  2. Nico Herrera, M.D. Placeholder Image

    Nico Herrera, M.D.

    Medicine Resident, PGY-2 Baylor College of Medicine
  3. Rajeev Raghavan, MD FASN

    Rajeev Raghavan, MD FASN

    Associate Professor - Program Director Nephrology Training Program Baylor College of Medicine
  4. Marc Robinson, M.D.

    Marc Robinson, M.D.

    Assistant Professor Baylor College of Medicine
  5. Jefferson Triozzi, M.D. Placeholder Image

    Jefferson Triozzi, M.D.

    Medicine Resident, PGY-2 Baylor College of Medicine