Recent ucladom_clinicalinsights items

EKG Changes from Life-threatening Hyperkalemia

Mon, 20 Jul 2026 00:00:00 +0000

EKG Changes from Life-threatening Hyperkalemia

When "Normal Enough" is Not Normal: Detecting Mild Neurocognitive Disorder Through Integrated Primary Care and Neuropsychology

Mon, 20 Jul 2026 00:00:00 +0000

When "Normal Enough" is Not Normal: Detecting Mild Neurocognitive Disorder Through Integrated Primary Care and Neuropsychology

When the Immune System Turns on the Joints: Reflections on Checkpoint Inhibitor–Associated Arthritis

Mon, 20 Jul 2026 00:00:00 +0000

Immune checkpoint inhibitors have transformed the treatment of advanced malignancies, but their capacity to amplify immune activity extends beyond tumor cells, producing a spectrum of immune-related adverse events that increasingly bring patients to rheumatology clinics. Inflammatory arthritis is among the most common rheumatologic manifestations, occurring in roughly 4–6% of patients, and may present as seronegative symmetric polyarthritis, oligoarthritis, or polymyalgia rheumatica–like disease. This essay reflects on a clinical encounter with an older woman receiving checkpoint inhibitor therapy for metastatic melanoma who developed functionally limiting inflammatory arthritis at the very moment her cancer treatment appeared to be working. Her experience illuminates the central paradox of immunotherapy: the mechanism that enables tumor destruction can simultaneously turn against the patient’s own tissues. Through this encounter, the essay explores the clinical features, pathophysiology,...

Amlodipine Induced Chyloperitoneum

Mon, 20 Jul 2026 00:00:00 +0000

Amlodipine Induced Chyloperitoneum

Primary Myelofibrosis Presenting with New Staghorn Calculus

Mon, 20 Jul 2026 00:00:00 +0000

Primary Myelofibrosis Presenting with New Staghorn Calculus

A Persistent Wound

Mon, 20 Jul 2026 00:00:00 +0000

A 58-year-old female with a complex medical history, including type 2 diabetes mellitus (T2DM), hypertension, hyperlipidemia, peripheral artery disease (PAD), coronary artery disease (CAD) status post coronary artery bypass graft (CABG) four months prior, and never tobacco smoker presented with a painful, non-healing ulcer on the left lower extremity over a month. This case highlights the diagnostic challenge of mixed-etiology ulcers, as they often have clinically overlapping features. They can also be difficult to treat. Ultimately, a multi-disciplinary plan encompassing treatments for both arterial and venous ulcers was instituted for this patient to promote optimal wound healing.

Concurrent New-Onset Hyperparathyroidism and Hyperthyroidism

Mon, 20 Jul 2026 00:00:00 +0000

This case describes a 36-year-old woman who presents with a palpable left-sided thyroid nodule and laboratory evidence of dual endocrine dysfunction: subclinical hyperthyroidism and primary hyperparathyroidism). While thyroid autoantibodies were negative, imaging revealed a 2.85 cm complex nodule in the left inferior thyroid lobe.

Diagnostic challenges arose when a sestamibi scan and parathyroid CT failed to identify a distinct parathyroid adenoma, showing only a hyperfunctioning focus corresponding to the known thyroid nodule. The suspicion of an intrathyroidal parathyroid adenoma (IPA) was confirmed via fine-needle aspiration (FNA) with PTH washout, which returned a significantly elevated level of 549 pg/mL.

The patient underwent a left thyroid lobectomy. Histopathology confirmed a 1.0 cm parathyroid adenoma embedded within the thyroid tissue. Postoperatively, intraoperative PTH levels dropped by over 95%, and at the three-month follow-up, both TSH and calcium...

Metastatic Colorectal Cancer in the Setting of Uncontrolled Hypercholesterolemia

Mon, 20 Jul 2026 00:00:00 +0000

Metastatic Colorectal Cancer in the Setting of Uncontrolled Hypercholesterolemia

Gastric Antral Vascular Ectasia (GAVE) and Systemic Sclerosis

Mon, 20 Jul 2026 00:00:00 +0000

Gastric Antral Vascular Ectasia (GAVE) and Systemic Sclerosis

Anomalous origin of the right coronary artery with an inter-arterial course

Mon, 20 Jul 2026 00:00:00 +0000

Anomalous origin of the right coronary artery with an inter-arterial course

Anticoagulant-Associated Chest Wall Hematoma After Resistance Training in an Elderly Patient

Mon, 20 Jul 2026 00:00:00 +0000

Anticoagulant-Associated Chest Wall Hematoma After Resistance Training in an Elderly Patient

Delayed Insulin Hypersensitivity Reaction

Mon, 20 Jul 2026 00:00:00 +0000

Delayed Insulin Hypersensitivity Reaction

The Therapeutic Effect of Tamales

Mon, 20 Jul 2026 00:00:00 +0000

The Therapeutic Effect of Tamales

One Umeboshi at a Time: Language, Culture, and Care

Mon, 20 Jul 2026 00:00:00 +0000

Language and culture are foundational to patient-centered care, and their importance is often magnified in the care of older adults with limited English proficiency (LEP). This narrative essay describes the clinical encounter of a 92-year-old Japanese-speaking patient whose medical needs, autonomy, and dignity became fully visible only through language-concordant care. By engaging the patient in her native language and drawing upon culturally familiar practices, a shared understanding was established that led to improved medication adherence and clinical stability. The case highlights how aging-related cognitive changes can diminish proficiency in non-native languages and how cultural norms may further limit self-advocacy in healthcare settings. Framed within the broader literature on health disparities affecting older adults with LEP, this reflection underscores the role of linguistic and cultural concordance in reducing barriers to care, enhancing trust, and improving outcomes....

The Importance of a Chest X-ray in Evaluating Rapid Unintentional Weight Loss

Mon, 20 Jul 2026 00:00:00 +0000

The Importance of a Chest X-ray in Evaluating Rapid Unintentional Weight Loss

Tenosynovial Giant Cell Tumor: An Interesting Case of a Finger Tumor

Mon, 20 Jul 2026 00:00:00 +0000

Tenosynovial Giant Cell Tumor: An Interesting Case of a Finger Tumor

Trampling Down Death: Hope at the End of Life

Mon, 20 Jul 2026 00:00:00 +0000

Trampling Down Death: Hope at the End of Life

Atrial Myxoma-Diagnosis and Management

Mon, 20 Jul 2026 00:00:00 +0000

Atrial Myxoma-Diagnosis and Management

Pseudotumor as a Complication of a Metal on Metal Hip Implant Leading to Deep Venous Thrombosis

Mon, 20 Jul 2026 00:00:00 +0000

Pseudotumor as a Complication of a Metal on Metal Hip Implant Leading to Deep Venous Thrombosis

Worse with Age: A Case of Adult Chickenpox with Severe Rash

Mon, 20 Jul 2026 00:00:00 +0000

Worse with Age: A Case of Adult Chickenpox with Severe Rash

Tracheal adenoid cystic carcinoma

Mon, 20 Jul 2026 00:00:00 +0000

Tracheal adenoid cystic carcinoma

Barriers to Providing PRP Injections to Patients with Knee Osteoarthritis in the United States

Mon, 20 Jul 2026 00:00:00 +0000

Barriers to Providing PRP Injections to Patients with Knee Osteoarthritis in the United States

Severe Tophaceous Gout

Mon, 20 Jul 2026 00:00:00 +0000

25yo non-verbal Asian male born with cerebral palsy with spastic quadriparesis, restrictive lung disease s/p chronic tracheostomy, GJ tube dependence was found on labs over several years to have leukocytosis (WBC 10-18), mild microcytic anemia (Hgb 10-12.8), and thrombocytosis (platelets 400-1000). Per his parents, patient appears to be comfortable and at his baseline mental state, denying fevers, cough, bleeding, urinary changes, diarrhea or signs of pain. Initial exam without lymphadenopathy, changes in cardiopulmonary status, abdominal changes, and without decubitus ulcers. Differential diagnosis at the time was indolent infections (ie atypical/fungal pneumonia, osteomyelitis), lymphoproliferative disorders, hematologic/bone marrow disorders, and autoimmune conditions. Additional labs showed elevated Erythrocyte Sedimentation Rate (ESR) >130, C-Reactive Protein (CRP) 7.3, IgA 473, IgG 3154. Iron levels were low. Peripheral blood smear with leukocytosis with few reactive...

Heliotropic Rash in a Patient with Amyopathic Dermatomyositis

Mon, 20 Jul 2026 00:00:00 +0000

Heliotropic Rash in a Patient with Amyopathic Dermatomyositis

The Lab Value Ah-Ha Moment That Changed My View

Mon, 20 Jul 2026 00:00:00 +0000

The Lab Value Ah-Ha Moment That Changed My View

Incidental Rim-Enhancing Cerebellar Cystic Lesion Of Unknown Etiology

Mon, 20 Jul 2026 00:00:00 +0000

A 89-year-old woman presented to the emergency department after referral by her retinal specialist for acute right eye vision loss of eight days duration. On further workup of giant cell arteritis patient was incidentally noted to have a rim enhancing cerebellar cystic lesion of unknown etiology.

More Than Fatigue, a Case of Narcolepsy Type 2 in a Young Healthy Male

Mon, 20 Jul 2026 00:00:00 +0000

More Than Fatigue, a Case of Narcolepsy Type 2 in a Young Healthy Male

Threshold Syncopal State: Preserved Awareness at the Edge of Circulatory Failure

Mon, 20 Jul 2026 00:00:00 +0000

Threshold Syncopal State: Preserved Awareness at the Edge of Circulatory Failure

A Liver Abscess Leading to Embolic Lung Showering

Mon, 20 Jul 2026 00:00:00 +0000

A Liver Abscess Leading to Embolic Lung Showering

Visual Diagnosis of Purple Urine Bag Syndrome in a Skilled Nursing Facility

Mon, 20 Jul 2026 00:00:00 +0000

Visual Diagnosis of Purple Urine Bag Syndrome in a Skilled Nursing Facility

The Image We Shape in the Era of GLP-1 Receptor Agonists

Mon, 20 Jul 2026 00:00:00 +0000

The Image We Shape in the Era of GLP-1 Receptor Agonists

Health Beyond Healthcare

Mon, 20 Jul 2026 00:00:00 +0000

Health Beyond Healthcare

Benign Metastasizing Leiomyoma; a rare case of diffuse pulmonary nodules

Mon, 20 Jul 2026 00:00:00 +0000

Benign Metastasizing Leiomyoma; a rare case of diffuse pulmonary nodules

Atypical Secondary Syphilis Without Palmoplantar Involvement: A Diagnostic Pitfall

Mon, 20 Jul 2026 00:00:00 +0000

Rash in Syphilis: the great mimicker

A 32-year-old Caucasian male presented to his annual preventive visit with a six-month history of a persistent, nonpruritic chest rash. He had been treated multiple times for presumed allergies and eczema with antihistamines, oral prednisone, and topical corticosteroids without improvement. The rash fluctuated in intensity without clear triggers. He also reported a painless, nonhealing lesion beneath his tongue following minor trauma.

Examination revealed a faint erythematous macular rash on the chest and upper arms, without palm or sole involvement, and a 5 mm white ulcer on the ventral tongue. Laboratory studies were unremarkable; however, sexually transmitted infection screening showed a reactive rapid plasma reagin (RPR) with positive treponemal testing (TP-PA) and a titer >1:1024. Other STI testing, including HIV, was negative.

He was treated with intramuscular penicillin G benzathine (2.4...

Acute interstitial nephritis after a single dose of brentuximab vedotin

Mon, 20 Jul 2026 00:00:00 +0000

In this article we show a unique slide image of acute interstitial nephritis with eosinophils due to a single dose of brentuximab vedotin.

The Role of Family Medicine Physicians in Prenatal and Obstetric Care in Resource-Rich Settings

Mon, 20 Jul 2026 00:00:00 +0000

The Role of Family Medicine Physicians in Prenatal and Obstetric Care in Resource-Rich Settings

Aortic Paradox: Type A Dissection in a Mildly Dilated Aorta

Mon, 20 Jul 2026 00:00:00 +0000

Aortic Paradox: Type A Dissection in a Mildly Dilated Aorta

Overcoming Trichotillomania

Mon, 20 Jul 2026 00:00:00 +0000

Case report

A 31-year-old female patient came to our clinic with a complaint of a bald spot on her head for more than a year. She denied any history of trauma to that area of her head. The patient mentioned that she had been under a lot of stress over the past year due to conflicts with her husband. Initially, she felt embarrassed to see a doctor and tried to cover the bald spot, which significantly decreased her self-confidence. However, she eventually decided to seek treatment.

She denied any family history of hair loss. The patient did not smoke or consume alcohol and had no other medical history. There was a family history of hypertension in her father.

On examination, a bald spot was noted at the top center of her head, with broken hair of varying lengths. The rest of the examination was normal. After further questioning, the patient admitted that when she gets stressed, she pulls her hair, which gives her a sense of relief. She was referred to...

Development and Implementation of Direct Observation Tools for Serious Illness Conversations in Internal Medicine Residency: A Mixed-Methods Study

Mon, 20 Jul 2026 00:00:00 +0000

Development and Implementation of Direct Observation Tools for Serious Illness Conversations in Internal Medicine Residency: A Mixed-Methods Study

Acromegaly Presenting as Hypogonadism

Mon, 20 Jul 2026 00:00:00 +0000

Acromegaly is a rare endocrine disorder caused by excess growth hormone (GH), most commonly from a pituitary adenoma. Diagnosis is frequently delayed due to insidious onset and subtle clinical manifestations. We report a 37-year-old male who presented with fatigue and weight gain, initially prompting evaluation for hypogonadism. Laboratory testing revealed low testosterone and mild hyperprolactinemia, leading to a broader pituitary evaluation. Insulin-like growth factor-1 (IGF-1) was elevated on repeated testing, and GH failed to suppress during oral glucose tolerance testing, confirming acromegaly. Pituitary MRI demonstrated a 9 mm sellar lesion. The patient underwent transnasal transsphenoidal surgery with gross total resection. Pathology confirmed a GH-secreting adenoma. Postoperative GH levels were consistent with biochemical remission. This case highlights the importance of considering acromegaly in patients with nonspecific symptoms and minimal physical findings.

Ring-Enhancing Brain Lesions Secondary to PTLD Manifesting as Primary CNS Lymphoma

Mon, 20 Jul 2026 00:00:00 +0000

In this article we present two images of ring-enhancing brain lesions secondary to PTLD manifesting as primary CNS lymphoma.

Colonoscopy - A Tale of Two Options

Mon, 20 Jul 2026 00:00:00 +0000

No abstract

Acute Chest Pain following Trigger Point Injections

Mon, 20 Jul 2026 00:00:00 +0000

Acute Chest Pain following Trigger Point Injections

Giant Prolactinoma complicated by Cerebrospinal Fluid Leak

Mon, 20 Jul 2026 00:00:00 +0000

Giant Prolactinoma complicated by Cerebrospinal Fluid Leak

Plastic Bronchitis - A Case Presentation and Review

Mon, 20 Jul 2026 00:00:00 +0000

Plastic Bronchitis - A Case Presentation and Review

Chronic Neurocysticercosis in a Patient Presenting with Chest Pain

Mon, 20 Jul 2026 00:00:00 +0000

A 64-year-old woman presented to the emergency department (ED) with chest, left arm and jaw pain in the setting of severely elevated blood pressure. Patient subsequently noted chronic headaches as well and during workup for chronic headache was found to have chronic neurocysticeercosis.

Foreign Body Appendicitis (Nailed the Diagnosis)

Mon, 20 Jul 2026 00:00:00 +0000

Foreign Body Appendicitis (Nailed the Diagnosis)

A Diagnostic Deficiency

Mon, 20 Jul 2026 00:00:00 +0000

This format of article does not have an abstract.

Announcing UCLA Department of Medicine Clinical Insights, a companion to Proceedings of the UCLA Department of Medicine

Mon, 17 Nov 2025 00:00:00 +0000

Announcing UCLA Department of Medicine Clinical Insights, a companion to Proceedings of the UCLA Department of Medicine