Professors edge out students

Melissa H. Fries, MD, and David Scott Miller, MD, share a laugh Tuesday during the Gerald and Barbara Holzman Stump the Professors session. The professors were only stumped on one of the four cases presented this year.

Melissa H. Fries, MD, and David Scott Miller, MD, share a laugh Tuesday during the Gerald and Barbara Holzman Stump the Professors session. The professors were only stumped on one of the four cases presented this year.

After last year’s battle between students and professors ended in a tie, both sides of the 2013 Gerald and Barbara Holzman Stump the Professors session were looking to gain ground early in the competition on Tuesday, May 7, at the Annual Clinical Meeting.

The professors were Haywood Brown, MD, Duke Medicine, Durham, NC; Melissa H. Fries, MD, MedStar Washington Hospital Center, Washington DC; David Scott Miller, MD, University of Texas Southwestern Medical Center, Dallas; and Russell R. Snyder, MD, University of Texas Medial Branch at Galveston.

“This is probably some kind of privacy violation, but one of the things we factored in in picking this panel is that we secretly researched their training records, and all four of them achieved the lowest scores all four years of their residency,” quipped moderator Christopher M. Zahn, MD, ACM general chair, of Bethesda, MD. “That ought to help out the Junior Fellows.”

The Junior Fellows started strong with a presentation by Jonathan Kort, MD, District IX, Stanford University, Palo Alto, CA. Through “An Interesting Case of the Blues,” he presented the case of a 28-year-old woman at 29 weeks’ gestation with blue discoloration of her fingertips and toes.

Jonathan Kort, MD

Jonathan Kort, MD

Emily J. Goulet, MD

Emily J. Goulet, MD

Erica Hofland, MD

Erica Hofland, MD

Priya Prasad, MD

Priya Prasad, MD

After hearing of other symptoms and the patient’s medical history, Dr. Brown asked Dr. Kort about her echocardiogram results. “At this point we thought an echo wouldn’t help because of her physical exam findings,” Dr. Kort responded.

“How’s that possible that an echo can’t help somebody who’s cyanotic, passes out when they cross the room, who’s pregnant, who comes from Mexico, who could have an underlying cardiac legion that was undiagnosed?” Brown said, generating applause from the audience.

“The cardiologist was out of town,” Dr. Kort quickly replied.

“You’re from Stanford?” Dr. Fries quipped.

Despite the jabs, Dr. Kort’s presentation in fact stumped the professors as they failed to guess the correct diagnosis of methemoglobinemia.

From then on, however, the professors took control, guessing the correct diagnosis or a variation of the diagnosis that still earned them a win.

The cases included “Never Let the Skin Stand Between You and the Diagnosis” by Emily J. Goulet, MD, District XI, University of Texas Southwestern at Austin. A 35-year-old Hispanic female presented to the ER with severe constant epigastric pain that radiated to the back and was exacerbated by movement. The final diagnosis was an epithelioid trophoblastic tumor with choriocarcinoma.

Erica Hofland, MD, District VI, University of Iowa, Iowa City, presented “The Three-Year Itch,” a case of a 25-year-old nulliparous woman who was referred for a three-year history of dyspareunia and recurrent posterior fourchette fissuring. She also experienced intermittent vulvar burning and pruritus, which wasn’t relieved with local topical steroids. Final diagnosis: hemorchromatosis.

Priya Prasad, MD, District II, Bronx-Lebanon Hospital Center, Bronx, NY, concluded with “Did Surgery Go Wrong?” A 27-year-old woman had a repeat cesarean delivery performed under combined spinal-epidural anesthesia without complications. A day later, she couldn’t move her left leg. The final diagnosis was extramedullary hematopoiesis producing spinal cord compression.

“So we got three, and they got one?” Dr. Brown asked the moderator.

“Yes,” Dr. Zahn said.

Dr. Miller laughed slowly. It was an easy win for the professors.