Archive of Didactics

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

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)

Teaching Points

• Definition of Fever of Unknown Origin (FUO):
  • Fever for >3 weeks
  • Documented T>38.3
  • At least 1 week of inpatient investigation or 3 clinic visits
• FUO Differential: infection (24.5%), malignancy (14.5%), inflammatory (23.5%), micellaneous  (7.5%)
• FUO labs: CBC, ESR/CRP, LFTs, Blood cultures, UA, CXR, PPD/quant gold, HIV, hepatitis serologies, ANA, RF