Thanks to Dr. Hahr for a great morning report on an unfortunate case of anaplastic thyroid carcinoma, a rare disease with very poor prognosis.

Learning points from today’s case:

• Symptoms: When evaluating neck masses, make sure to screen for symptoms of compression: Dysphonia, Dysphagia, Dyspnea.
• Physical exam: Thyroid nodules in the setting of vocal cord paralysis (LR 18), cervical lymphadenopathy (LR 8), or fixation to nearby structures (LR 8) are highly suspicious for carcinoma. 
• Diagnostics: FNA is an acceptable initial approach to obtain head and neck mass tissue due to availability and  lower morbidity. Studies have shown sensitivity >90% for malignancy using this approach (PMID: 11568593, 24350168).   However, LN excisional biopsy is still preferred for LN architecture when feasible and suspicious for lymphoma, and core biopsy may have higher diagnostic yield (PMID: 22127851).
  
• 20-30% of patients with anaplastic thyroid carcinoma have coexisting differentiated thyroid carcinoma.

Thank you to Dr. Delani Gunawardena for an excellent case of an atypical presentation of Crohn’s disease!

Learning Points:

-Crohn’s disease may present atypically, and extraintestinal manifestations commonly include involvement of the mouth (stomatitis), eyes (uveitis, episcleritis), skin (erythema nodosum, pyoderma gangrenosum), and joints (seronegative spondyloarthropathy).

-Most extraintestinal manifestations of IBD will respond to treatment of underlying bowel disease.

–Click here for an excellent review article describing the extraintestinal manifestations of IBD.

Thank you Dr. Betty Lai for a great case of gout presenting as acute monoarthritis

Learning points:

–Acute inflammatory monoarthritis should be regarded as infectious until proved otherwise
–Septic arthritis is an orthopedic emergency
–Most common causes of infectious arthritis in a healthy adult is Staphylococcus aureus, Strepotococcal species, and Neisseria gonorrhoeae
–The typical attack of acute gouty arthritis includes the following clinical features severe pain, redness, warmth, swelling, and disability, with maximal severity of the attack usually reached within 12-24 hours.
–Synovial fluid: <2,000 WBC/mm3 = noninflammatory;  ≥2,000 WBC/mm3 is considered inflammatory
–Click here for an Algorithmic Approach to the patient with monoarticular pain
–Click below for a great review article on Gout