A Case of Outpatient Hysterectomy in the Setting of Gitelman Syndrome.

Gitelman syndrome is a rare autosomal recessive disorder involving a defect in the sodium-chloride cotransporter, which is expressed in the apical membrane of the distal convoluted tubule. Electrolyte abnormalities commonly occur in patients with Gitelman syndrome as a result, including hypokalaemia, hypomagnesemia, and metabolic alkalosis. As a result, the disorder may present with various clinical manifestations, including fatigue, weakness, muscle tetany, facial paresthesias, and a predisposition to the development of various ventricular arrhythmias. As a result, the perioperative management of patients with this disorder presents unique challenges with regard to fluid and electrolyte management and the prevention and management of potential arrhythmias. In addition, the pharmacology of various anesthetics may present additional complexity with regard to perioperative management in this particular patient population. The following case presentation of a 42-year-old female with Gitelman syndrome undergoing elective outpatient hysterectomy for suspected endometriosis serves to illustrate the challenges that arise with regard to perioperative management in this particular patient population and demonstrates how they may be addressed.

Review of Cognitive Biases in ACGME Milestones Training Assessments in Post-graduate Medical Education Programs.

The course of study for young physicians for post-graduate training is an exciting and life-changing opportunity, one that is filled with the relentless optimism of intellectual discovery and personal growth and development. The American Council for Graduate Medical Education (ACGME) is a non-profit private council that evaluates and accredits internship, residency, and fellowship programs. The role of the ACGME is to oversee curriculums, training environments, and specialty evaluation standards to ensure satisfactory competency leading to board eligibility and certification in the respected field of study. The ACGME has the monumental task of guiding educational standards that are designed to both protect the public welfare and further educational programs. Many educational standards are objective, such as quantitative performance on examinations, involvement in research, and involvement in systems development and quality improvement. However, key clinical performance measures are based on prior training and experience. Over the last several years, studies examining rates of abuse and discrimination during post-graduate medical training in both the United States and Canadian studies, which have reported alarmingly high rates of 50%. With the increasing utility and availability of social media, such issues have become more transparent to the public. A plethora of studies has been conducted, examining physician biases towards patients, practice changes, insurance company regulations, and evolving healthcare systems. However, a significant amount of evaluation is merited when examining individual institutional cultures and the educational environments that harbor them. We wish to examine the role of ever-evolving specialty-specific ACGME-instituted educational milestones in Internal Medicine and Opthalmology in the context of potential cognitive biases and their implementation within post-graduate training programs.

Pseudohyperkalemia: Look before you treat.

Pseudohyperkalemia is defined as a reported rise in serum potassium concentration along with a normal effective plasma potassium concentration. We present a case report of a 57-year-old gentleman with a history of chronic lymphocytic leukemia, who presented with an elevation in serum potassium along with a normal plasma potassium concentration. Through an exploration of the literature, we demonstrate that pseudohyperkalemia is an important phenomenon to watch for as it may sometimes lead to unnecessary and potentially dangerous treatment.