Category Archives: Daily Report

Inpatient Daily Report, weekdays 9:00am – 10:00am

NEW Collaborative Care Round

Howdy, residents! We are rolling out our new Collaborative Care Round (CCR)! See roll out date and schedule below:

 

Teams Location Rounding Time Roll out Date
C & D 4D127 Team D: 10:00am

Team C: 10:15am

March 7th,2017
A & B 4D107 Team B: 10:00am

Team A: 10:15am

March 13th, 2017
E & F 5C106 Team F: 10:30am

 

Team E: 10:45am

March 20th, 2017
G & H 5D107 Team H: 10:30am

 

Team G: 10:45 am

March 27th, 2017

 

 

Block 8 Ambulatory Week: Academic Half Day

All Intern Didactics have been rescheduled to Wednesday on Ambulatory week to pilot Academic Half DaySBP is still on Friday.

 

Fri 
Location: Clinic A
7:30-8:00am: SBP (Dr. Soleymani)

Wed
Location: 6D103
7:30-8:00am: COPD (Dr. Gold)
8:00-8:30am: URI (Dr. Rotblatt)
8:30-8:45am: Break
8:45-9:15am: Asthma (Dr. Suthar/Dr. Barot)
9:15-9:45am: Wellness 101 (Dr. Nafisi/Chiefs)
9:45-10:00am: Break
10:00-12:00pm: Profession of Medicine (POM) – Geriatrics (Drs. Kim/Schickedanz)

Disseminated Histoplasmosis

histo-microscopy

Thank you Dr. Brendan Cerk for an excellent presentation on neurocysticercosis presenting with new onset seizure

Teaching Points

  • Histoplasmosis is a common endemic mycosis, usually asymptomatic but occasionally results in severe illness
  • Hematogenous dissemination occurs during the acute infection before cellular immunity develops
  • Diagnosis: serum and urine antigen
  • Treatment: itraconazole for 12 months, if CNS then liposomal amphotericin B for 4-6 weeks then itrazonazole for an additional 12 months

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Neurocysticercosis

Thank you Dr. Rajat Suri for an excellent presentation on neurocysticercosis presenting with new onset seizure

Teaching Points

  • Initial treatment for seizure: IV lorazepam 0.1mg/kg –> IV fosphenytoin –> sedation/intubation
  • Neurocysticercosis  is caused by Taenia Solium
  • Spreads hematogenously to the brain, liver, muscle
  • Diagnosis: presentation+imaging.  serum testing not reliable
  • Treatment: dexamethasone, albendazole, anti-epileptic

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Acute Esophageal Variceal Bleed

esophageal_varices_by_ink95-d9f81u1

Thank you Dr. Kirollos Zaki for an excellent presentation on UGIB from esophageal varices

Teaching Points

  • Management of GI bleed
    • fluids, goal hg>7, plt >50, INR<1.5.
    • protonix drip if UGIB, add octreotide drip if concern for variceal bleed
  • Endoscopy
    • variceal ligation: using banding, goal is within 12 hours
    • sclerotherapy: usueally epi is used, similar results as ligation but high rebleeding risk
  • TIPS
    • Indications: active hemorrhage despite endoscopic treatment or recurrent bleed

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Pulmonary Squamous Cell Carcinoma

1

Thank you Dr. Annie Belzowski for an excellent presentation of pulmonary squamous cell carcinoma complicated by pulmonary abscess

Teaching Points

  • Common causes of pulmonary abscess:
    • Bacterial: Anaerobic bacteria, Pseudomonas aeruginosa, Mycobacteria
    • Fungal: Aspergillus, Coccidioides, Histoplasma, Blastomyces, Cryptococcus
    • Non-infectious: malignancy, embolism, vasculitis, scarcoidosis
  • Clindamycin preferred agent, time course dependent on follow up imaging
  • Common forms of lung cancer: adenocarcinoma (40%), small cell (15%), squamous cell (30%)

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Thyrotoxicosis

hyperthyroidism

Definitionthyrotoxic crisis or thyroid storm refers to the life-threatening exacerbation of thyrotoxicosis accompanied by fever, delirium, seizures, coma, vomiting, diarrhea, jaundice

Typical Presentation:  Tachycardia, tremor, goiter, warm skin, lid retraction, exophthalmos, pretibial myxedema, Irritability, Heat intolerance and sweating, Palpitations, Diarrhea, Polyuria

Causes:   Grave’s disease, toxic multinodular goiter, toxic adenoma, subacute thyroiditis, TSH secreting pituitary adenoma, thyroid hormone resistance syndrome

Treatment:  Methimazole, Propylthyouracil, Radioiodine, Thyroidectomy

Power Pointmorning-report-10-3-16-thyrotoxicosis

Further Readingatypical-manifestations-of-graves-disease

Multiple Myeloma

download

Thank you Dr. Michael Ayoub for an excellent presentation on Multiple Myeloma

Teaching Points:

  • Multiple myeloma is a proliferation of a plasma cell population
  • Dx with bone marrow biopsy or plasmacytoma AND evidence of end-organ damage
  • End organ damage: hyeprcalcemia, renal insufficiency, anemia, bone lesions (CRAB)
  • Hypervisosity syndrome
    • Occurs in 2-6% of multiple myeloma
    • IgM more frequently involved than IgG or IgA
    • Treatment is plasmapheresis

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Gastrointestinal Stromal Tumor

2-2-3-peptic

Thank you Dr. Kristina Lee for an excellent presentation on GIST

Teaching Points

  • Important considerations in GI bleed: sx of volume depletion (dizzyness, syncope), hemodynamic instability or vitals differing from baseline, coagulopathy or other comorbid conditions
  • Management of GI bleed
    • fluids, goal hg>7, plt >50, INR<1.5.
    • protonix drip if UGIB, add octreotide drip if concern for variceal bleed
  • GIST sx: vague, nonspecific abdominal pain or discomfort, malaise, fatigue
  • GIST dx: CT abdomen, PET, biopsy with path showing expression of the CD117 antigen
  • GIST tx: surgery, tyrosine kinase inhibitors (imatinib)

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