HoPingKong-isms

(Modigliani's Paul Guillaume Novo Pillota. In Paris' Musee d'Orangerie)

1. "....if you are anemic with your chronic renal failure, are you drinking the Tour de France drink?..." Okay...this one isn't too tough. He is referring to erythropoietin, a glycoprotein hormone produced by interstitial fibroblasts in the renal cortex, responsible for stimulating red blood cell production. Patients with chronic renal failure commonly have anemia secondary to low levels of this hormone. It is also a common performance enhancing drug which some famous athletes on the Tour de France were caught with recently.

2. "....is is hard to diagnose rheumatoid arthritis? No, they are usually deviant...". I liked this one. He is referring to ulnar deviation of the metacarpal bones in RA. Other common findings in the rheumatoid hand include swelling of the small joints - namely the MCPs and the PIPs, swan neck and boutonniere deformities in the fingers, median nerve entrapment, and trigger fingers (from nodules forming on tendon sheaths).

3. "...do you do math? Adding and subtracting? C'mon...this is a crisis!..." This was mentioned in the context of an elderly person on longstanding prednisone for a hemolytic anemia. "Adding"? "Crisis"? In a person on steroids? Yes, this is an Addisonian Crisis (adrenal crisis). Patients may present with clinical evidence of volume depletion, nausea, vomiting, shock, abdominal pain, and hyperkalemia with or without hyponatremia and hypoglycemia.

4. "...is it dangerous to take antibiotics? Is this a difficult hospital...?" Hmmm...'antibiotics'? 'Difficult'? Yep, this has got to be Clostridium difficile infection. A good review by local talent can be found here.

5. "...you look unflappable....is it frosty in here?...." I really liked this one. We were discussing a case of an elderly gentleman who presented with 1 week of malaise. He is referring to some signs of renal failure, including asterixis (unflappable - may also be seen in hepatic encephalopathy or hypercarbia), and the uremic frost. We don't really see uremic frost all that much - it's from severe uremia such that there are nitrogenous deposits on the skin Here's a case from NEJM with picture below.