Learn more clinical pearls from the Point of Care Medicine Substack!
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07.03.2026 22:00
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Learn more clinical pearls from the Point of Care Medicine Substack!
open.substack.com/pub/rokeefe...
Anemia is a marker of time; its presence suggests a bleed has been occurring long enough for intravascular volume to re-equilibrate.
Source: CPS - December 20, 2025 Academy Session with Rabih: GI bleed - Anemia or Thrombocytopenia?
Daily Pearl:
In an acute GI bleed, a normal hemoglobin can be more ominous than anemia, as it may reflect a massive, hyperacute hemorrhage with no time for hemodilution.
Learn more clinical pearls from the Point of Care Medicine Substack!
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Non-blanching, palpable purpura is a cardinal physical exam finding for small vessel vasculitis, representing inflammation and extravasation of blood from damaged dermal vessels.
Source: CPS - December 18, 2025 VMR with Rabih & Gillian - malaise and myalgias to lower limbs
Autoimmune hemolytic anemia can cause significant LDH and mild transaminase elevation due to red blood cell breakdown, potentially being misattributed to primary liver injury or hepatitis. An undetectable haptoglobin is a key differentiator.
The development of arterial or venous thrombosis (including digital necrosis) in a patient with SLE should immediately raise suspicion for a co-existing secondary Antiphospholipid Syndrome (APS), which mandates anticoagulation.
It could also present with an insidious onset, displaying constitutional symptoms and findings of serositis and cytopenias.
The classic renal and dermatologic involvement is less common, as is the malar rash.
Daily Pearl(s):
Late-Onset Lupus
Late-onset lupus (diagnosed after age 50) is not uncommon. While it typically affects younger women, there’s a more balanced gender distribution compared to lupus diagnosed earlier in life.
Learn more clinical pearls from the Point of Care Medicine Substack!
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CNS infection (meningitis or encephalitis) is a rare but life-threatening complication that can occur via hematogenous spread during bacteremia or direct extension from a sinus or ear infection.
Source: CPS - December 17, 2025 VMR with Sharmin & Mark - nausea and vomiting
Presentations of a Pasteurella infection range from skin and soft tissue infection to severe pneumonia, septic arthritis, and endocarditis.
For example, you should consider Pasteurella multocida bacteremia in a septic patient with close animal contact, particularly with a pet dog or cat, even in the absence of a reported bite or scratch.
Daily Pearl(s):
Pasteurella Bacteremia
Influenza infection can severely impair host defenses, predisposing patients to severe bacterial superinfections with both common (S. aureus, S. pneumo) and uncommon pathogens.
Learn more clinical pearls from the Point of Care Medicine Substack!
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Source 1: CPS - December 13, 2025 IMG VMR with Elmhurst IM Residency - papilledema and worsening headache.
Source 2: Palliative Fast Facts www.mypcnow.org/fast-fact/n...
The definitive diagnosis relies on identifying malignant cells on cytology. The sensitivity of a single LP is low (50-60%), and serial LPs (up to three) are often required to increase the diagnostic yield.
Communicating hydrocephalus, which is caused by malignant cells obstructing CSF outflow at the arachnoid granulations, is a common issue and can lead to symptoms of increased intracranial pressure, such as headache and papilledema.
Clinical presentations are highly variable given symptoms depend on what level of the neuroaxis is affected. Common signs and symptoms can include headaches, altered mental status, cranial neuropathies (such as facial droops or diplopia), radiculopathy, gait instability.
The most common solid tumors that cause this are lung cancer, breast cancer, melanoma. Lymphoma and leukemia are also frequent causes.
Daily Pearl(s):
Leptomeningeal carcinomatosis is the diffuse infiltration of the leptomeninges, including the arachnoid and pia mater, by malignant cells.
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Source: CPS - December 11, 2025 VMR with Rabih & Sarah B - sudden onset left sided neurological deficits
Daily Pearl:
Septic emboli are a strong contraindication to thrombolysis (tPA) for ischemic stroke due to the high risk of hemorrhagic transformation from underlying vasculitis or a pre-existing mycotic aneurysm.
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A low-pitched, diastolic “rumbling” murmur (mitral stenosis) or a holosystolic murmur (mitral regurgitation) may be heard.
A loud S1 and an opening snap can also be present in mitral stenosis.
Source: CPS - December 9, 2025 VMR with Ravi & Kirtan - SOB for 3 days and LE edema for 3 months
Daily Pearl(s):
Rheumatic Mitral Stenosis
The pathognomonic finding for rheumatic mitral stenosis is the “hockey stick” appearance of the anterior mitral leaflet during diastole, caused by fusion at the leaflet tips while the base remains mobile.
Learn more clinical pearls from the Point of Care Medicine Substack!
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Source: CPS - December 5, 2025 VMR with Rabih & Academy - 1: Diffuse Abdominal Pain 2: Hypogastric Abdominal Pain
A normal or non-tender abdominal exam is not reassuring in an elderly or immunocompromised patient, especially in the presence of systemic derangements like profound metabolic acidosis, which is a major red flag for an intra-abdominal catastrophe.