Grand Rounds: The Great Mimics

In a quiet seminar room at Boston General Hospital, Professor Mike reviews tricky diagnostic cases with senior residents Rebecca and John.

Grand Rounds: The Great Mimics

True or false?

The first patient presented with classic severe chest pain.

• True
• False

Initial ECG changes were absent despite high troponin levels.

• True
• False

The second case involved an aortic dissection with normal arm pressures.

• True
• False

John guessed correctly that the third patient was Professor Mike himself.

• True
• False

Professor Mike's third case turned out to be mild hypercalcemia.

• True
• False

Listen again and complete the sentences

• Mike: Good afternoon, team. Let's look at some tricky cases from the emergency department this week. Rebecca, you're up first. We had an elderly patient who arrived with vague complaints of indigestion and mild fatigue. What's your ____ here?
• Rebecca: Well, Professor Mike, given the age and the ____ , it's classic for gastritis or perhaps cholecystitis. But knowing your clinical puzzles, it's probably a silent heart attack masquerading as gastrointestinal distress.
• John: That's a classic trap. While it sounds like a textbook ____ , the normal bilateral pressure might lead doctors to dismiss it and fall straight into anchoring bias.
• Mike: Exactly. Diagnostic momentum almost caused the team to miss the intimal flap visible on the urgent CT angiogram. Now comes the real test for both of you. Last Tuesday, a fit man in his fifties presented with profound ____ ... oh wait, he wasn't elderly, he was my age. He had terrible dizziness, cold sweats, and sudden falls, yet all standard neurological exams were completely normal. What did I have?
• Rebecca: Wait... you're talking about yourself, Professor? Were you having an ____ or severe hypercalcemia from that conference coffee?

Sources: photo by Yan Krukau on Pexels