Ryan O'Keefe

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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.

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Neoplastic Meningitis | Palliative Care Network of Wisconsin Background     Neoplastic meningitis (NM) – also known as leptomeningeal metastases, [...]

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.

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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.

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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.

The clinical presentation can be dramatic, with the sudden onset of severe, diffuse abdominal pain, often described as the worst of their life.

Patients typically lie still to avoid any peritoneal movement.

The etiology of perforation is broad and includes peptic ulcer disease, diverticulitis, appendicitis, malignancy, or direct trauma.

Daily Pearl(s):

Peritonitis and Perforations

Secondary bacterial peritonitis results from the spilling of gastrointestinal contents into the normally sterile peritoneal cavity.

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Source: CPS - December 1, 2025 Neurology VMR with Dr. Helen Shi - Left hand weakness and numbness

Daily Pearl:

A significant discrepancy between a large vessel occlusion (ICA) and relatively mild, subcortical symptoms should raise suspicion for either a chronic, slowly progressive stenosis (like Moyamoya) or excellent acute collateral circulation.

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Source: CPS - December 1, 2025 Neurology VMR with Dr. Helen Shi - Left hand weakness and numbness

The RoPE (Risk of Paradoxical Embolism) score is a useful clinical tool to help quantify the probability that a PFO is the cause of a cryptogenic stroke, which can guide decisions regarding percutaneous closure.